Diseases can be seen under close examination as a medical problem, a personal tragedy, or as a social, economic, or political issue. However, disease can be seen also as a reflection of the characteristics of a particular species.

This is a challenging subject when it comes to mental diseases. The burden caused by mental diseases makes it difficult to analyze them from a generic point of view.

However, there are historical periods when intellectuals, artists, and physicians show an interest in mental diseases from a wider cultural perspective. In Europe the interest in the artistic expression of psychiatric patients started developing in early nineteenth century. In 1801, the French psychiatrist Phillippe Pinel wrote about psychotic artists in his Medical Philosophical Treatise on Medical Disorder or Mania, and in 1887 the neurologist Jean-Martin Charcot publishes Les Demoniaques dans L’Art, both exploring the influence of mental diseases in art. But it was in the early twentieth century that artists and philosophers were profoundly attracted by the art of the insane. In 1910 the surrealist German artist Max Ernst became fascinated by the art produced by psychiatric patients, and the French philosopher and sociologist Lucien Levy-Bruhl wrote Les Fonctions Mentales dan les Societes Inferieures, connecting primitive art and the art of the insane. In 1911 the Swiss psychiatrist Eugen Bleuler introduced the term schizophrenia, which is being used since then to describe the most representative of the spectrum of mental illnesses. In 1919 the German psychiatrist Hans Prinzhorn became assistant to Karl Wilmanns at the Psychiatric Hospital of the University of Heidelberg. There, he expanded and organized the art collection of psychiatric patients, which had been started by Emil Kraepelin. This collection became the foundation of all future studies and analyses of art produced by patients with mental disorders. In 1921, the Swiss psychiatrist Walter Morgenthaler published the monography Ein Geisteskraker Als Kunsler, Madness and Art: The Life and Works of Adolf Wölfli (1), an study of the psychotic artist Adolf Wölfli. In 1922 Prinzhorn published Bildnerei der Geisteskranken, Artistry of the Mentally Ill, the most influential work among the pioneer studies of schizophrenic art (2). The psychiatrists involved in the systematic collection of works of art produced by psychiatric patients were motivated not only to use them as tools for the diagnosis or management of psychiatric patients, but by genuine interest in the artistic value of their unique pieces. Later, the artistic community became interested as well, including prominent surrealist artists, such as Max Ernst and Andre Breton. In 1948 the French artist Jean Dubuffet would coin the term Art Brut, as a form of art not conditioned by the interests and standardized social norms of other forms of art. Art Brut, later called by the more generic term Outsiders Art, was considered to represent a more genuine expression of human emotions and experiences than the art produced by professional artists. The art pieces collected by Prinzhorn (3) were classified and eventually displayed in a museum specifically dedicated to this art form, the Collection of Art Brut, in Lausanne, Switzerland. Currently, the interest for art created by outsider artists with mental disorders is widespread, and museums, galleries, collectors, and public in general have an intense fascination by pieces produced by mentally ill patients.

In examining the art pieces produced by schizophrenic patients from museums, exhibits, and published material, three themes appear frequently in their artistic expressions:  Religion, human and supernatural power, and sex. These themes frequently include representations of hallucinatory experiences. The themes repeatedly found in the art of schizophrenic patients represent experiences which are unique to the human species.

Religion, and the idea of a supernatural power controlling or reflecting our nature is exclusive of the human species. Animals do not have religions. In regard to power and the capacity to control or dominate others among the different animal species, power among humans is at a different symbolic level than in animals. Although in most animals there are ranks and stratified social structures, power in humans reflect an outreaching capacity, which is not necessarily related to the survival of the individual or the group. We could say that animals have, in general, a survival-related common sense. In contrast, humans frequently display behaviors, which would be at odds with the common sense for survival. These may include idolatries and attachment to power figures, symbols, ideologies or individuals, which are not necessarily aimed to obtain an individual benefit or the benefit of a group.

Sex in humans is only minimally intended for reproduction. Of the multiple times that humans have sex during their entire lives, only rarely sex is done with the specific intention to reproduce. Actually, sex resulting in a reproductive consequence may become a burden or an unexpected result for those who have had sex. In contrast, in animals the opposite is the most common purpose of sex. Mostly, animals have sex to produce offspring. There are, however, many examples of animal having sex without reproductive intent, particularly among mammals, such as the bonobos, canids, and others. In looking at sex as a curve of intention, we could say that humans use it mostly for non-reproductive purposes, whereas animals use mostly as a reproductive tool.

These three themes prominently found in the art of schizophrenic persons may actually reflect our human nature. The themes of religion, power, and sex can be considered as added distinctive features of the human species within a behavioral background of animal-based common sense. Thus, schizophrenic persons may represent an extreme manifestation of traits which are unique to the human species. Schizophrenia may be in fact an abnormal highlight of those unique human features to the detriment of the animal-based common sense for survival.

Recent research provides evidence that these unique behavioral hallmarks of humans have an specific genetic profile, which distinguishes the brains of the human species from other animal species. Certain genes are differentially expressed in the brains of humans compared to the brains of chimpanzees (4). The development of humans and chimpazees are not comparable within the same age groups. Thus, the experiments were done using hybrid cultured brain organoids which provide a controlled system for studying gene divergence across cell types and developmental stages. Among the divergent genes, the researchers found genes related to facial features, but also genes related to mental diseases (5). Among the differentially expressed genes, in the human brain organoids there is upregulation of the human somatostatin receptor 2 (SSTR2), a gene associated with neuropsychiatric disorders, including schizophrenia (6) and Alzheimer’s disease (7). It is particularly striking that genes such as somatostatin receptor 2, which is associated with schizophrenia is overexpressed in the human brain tissue compare to the brain tissue of chimpanzees. This led the researchers to point that being human as a species may include the potential for developing certain mental diseases which are not found in animals. This is further supported by the absence of known spontaneous examples of schizophrenia among animal species. In addition, it is difficult to evaluate laboratory developed animal models of schizophrenia, since they are not completely representative of the human disease. The current animal models of schizophrenia do not exhibit some of its defining manifestations (8,9). Although the pharmacologically induced animal models may reproduce some of the behaviors described in schizophrenia, such as anhedonia, lack of conditioning after stimuli, and repetitive stereotypical movements (10), the hallmark of schizophrenia, such as hallucinatory experiences are still uniquely human.

Taking together, examination of artistic expressions by schizophrenic patients and the recent genetic studies support the hypothesis that schizophrenia is not just a disease but an extreme manifestation of our human nature.

Acknowledgements: I thank Juana Soler de Peralta, Ph.D. for her critical review of the manuscript.

References:

1. Walter Morgenthaler W. Ein Geisteskraker als Kunsler (Madness and Art: The Life and Woks of Adolf Wölfli), Bern, 1921.
2. Prinzhorn H. Bildnerei der Geisteskranken (The Artistry of the Mentally Ill) 1922 University of Heidelberg Digital Library. Reprinted as: Prinzhorn H. (The Art of Insanity. An Analysis of Ten Schizophrenic Patients) Ed. Candice Black, Solar books, University of Chicago Press, 2011.
3. Brand-Claussen B., Jadi I., Dougas C. (1996) Beyond Reason. Art and Psychosis. Works from the Prinzhorn Collection. University of California Press, Berkeley, CA.
4. Agoglia R.M., Sun D., Birey F., Yoon S-J., Miura Y., Sabatini K., Pasca S.P., Frazer H.B. (March 17, 2021) Nature. Primate cell fusion disentangles gene regulatory divergence in neurodevelopment. Online ahead of print.
5. Kubota T. (2021). New genetic comparison technique developed at Stanford enables meticulous study of evolution of the human brain and face. Stanford News.
6. Beneyto M., Morris H.M., Rovenski K.C., Lewis D.A. (2012) Lamina- and cell-specific alterations in cortical somatostatin receptor 2 mRNA expression in schizophrenia. Neuropharmacology 62 (3): 1598-1605.
7. Adori C., Gluck L., Sarde S., Yoshitake T., Kovacs GG., Mulder J., Magloczky Z., Havas L., Bolcskei K., Mitisios N., Uhlen M., Szolcsanyi J., Kehr J., Ronnback A., Schwartz T., Rehfeld JF., Harkany T., Palkovits M., Schulz S., Hokfelt T. (2015) Critical role of somatostatin receptor 2 in the vulnerability of the central noradrenergic system; new aspects on Alzheimer’s disease. Acta Neuropathol. 129:541-563.
8. Jones CA, Watson DJG, Fone KCF (2011) Animal models of schizophrenia. British J Pharmacol. 164:1162-1194.
9. Winship IR, Dursun SM, Baker GB, Balist P.A, Kandratavicius L., Maia-de-Oliveira J.P., Hallak J., Howland J.G. (2019) An overview of animal models related to schizophrenia. The Canadian J. of Psychiatry 64(1):5-17.
10. Bhandari S. (2020). Schizophrenia exams and diagnostic tests. WebMD

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Biographical Details:

I obtained the medical degree in 1979 and PhD in 1986 from the National University of Cordoba, Argentina.

Since 1988 I worked in medical sciences research at the Unversity of Pennsylvania, Philadelphia, PA, and The Lankenau Institute of Medical Research, Wynnewood, PA.

After training in Pathology at the State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY and Cornell Medical College, New York, NY, I worked as a Pathologist at Duke University Medical Center, Durham, NC., and for about 10 years as a Dermatopathologist at the Richfield Lab., Cincinnati, OH.

I currently work as a Dermatopathologist at Inform Diagnostics Lab., in Needham, MA.

My interests include research topics in biology, medicine, evolutionary biology, art, particularly outsiders art, art history, prehistoric art, ceramics. I have been working in ceramics since childhood. Please see the page Civetceramics in Instagram for examples.

I am including a few selected publications to reflect some of those interests.

Peralta Soler A, Aoki A (1989) Estrogen influence on maturational pathway of mammary tumor virus: An immunoelectron microscopy study.  Exp. Mol. Pathol. 50: 16-25.

Peralta Soler A, Thompson KA, Smith RM, Jarett L (1989) Immunological demonstration of the accumulation of insulin, but not insulin receptors, in nuclei of insulin-treated cells. Proc. Natl. Acad. Sci. USA 86: 6640-6644.

Peralta Soler A, Knudsen KA (1991) Colocalization of N-CAM and N-Cadherin in avian skeletal myoblasts.  Develop. Biol. 148: 389-392.

Megosh L, Gilmour SK, Rosson D, Peralta Soler A, Blessing M, Sawicki JA, O’Brien TG (1995) Increased frequency of spontaneous skin tumors in transgenic mice which overexpress ornithine decarboxylase.  Cancer Res. 55: 4205-4209.

Peralta Soler A, Knudsen KA, Jaurand M-C, Johnson KR, Wheelock MJ, Klein-Szanto AJP, Salazar H (1995) The differential expression of N-cadherin and E-cadherin distinguishes pleural mesotheliomas from lung adenocarcinomas.  Hum. Pathol. 26: 1363-1369.

Peralta Soler A, Harner GD, Knudsen KA, McBrearty FX, Grujic E, Salazar H, Han AC, Keshgegian AA  (1997) The expression of P-cadherin identifies PSA-negative cells in epithelial tissues of male sexual accessory organs and in prostatic carcinomas: Implications for prostate cancer biology.  Am. J. Pathol. 151:471-478.

De Paul A, Bonaterra M, Peralta Soler A, Knudsen KA, Roth FD, Aoki A (2005) Soluble P- cadherin found in human semen. J Androl  26:44-47.

Peralta Soler A, Soler de Peralta J (2005) The confabulatory semiotics: Naming and cognition of diseases by pathologists. Med. Health Care and Phil. 8:351-355.

Peralta Soler A. (2020) Is the viral pandemic an evolutionary step towards asexual human reproduction? EdgeScience 43, Sept. (3)

Art, Genetics, Psychology