Analyses and theorization about psychotic mental functioning, elaborated starting specifically from clinical experience, can benefit from some interesting aspects coming from the observation of the writing of individuals with schozophrenic syndromes. This approach is of interest in our view above all due to the specificity of the written code which, compared to orality, imposes some different ways of structuring thought and introduces significant variables at the emotional and contextual level.
The following observations are related to the activities carried out in a “creative writing workshop” we coordinated at the C.R.T. (Residential Centre for Psychiatric Therapies and Resocialization) in Cremona1.

The setting

As regards the way the workshop was conducted, we will just mention a few aspects.
The meetings, held weekly, are aimed at groups of 7-10 people, seated around a large rectangular table which makes interpersonal communication possible, while retaining the individual dimension needed in the writing activity. We sought a mediation and an integration of group aspects and individual ones; on the one hand this enabled the strengthening of the relational and emotional dynamics inherent to the group as a container of anxieties connected to a practice, namely writing, which various participants initially associated with a school context and therefore saw as an infantilizing practice tied to evaluation; on the other, it helped to make every member of the group the protagonist of his creative adventure, with the resulting positive personal narcissistic relapse.
The leader, who sits at the same table with no obvious signs of a separate role, and shares the activities, suggests a subject, which the group discuss orally before going on to drafting their texts. Writing on a “free” subject is avoided, because this possibility is perceived as an unlimited mental dimension that creates an unmanageable situation of psychic agoraphobia, making it impossible to form thoughts. A set topic on the other hand gives security, limits the avalanche of emotions, provides a container inside which one’s experiences, thoughts and the related affects can be poured. Moreover, the accepted set topic puts the group members’ minds in communication, since the topic is seen as a common reference point for thoughts and experiences.
At the end, if he agrees, each person reads his text to the group. This allows the transition from expression to communication and the development of some therapeutic group aspects such as socialization, i.e. the sharing of pain and bringing it into proportion; universality, or the reduction of the feeling of the uniqueness of one’s own problems; altruism, or mutual help and the resulting growth of self-esteem (Bloch & Crouch, 1985; Yalom, 1970). It has only happened a couple of times that a participant has asked not to read his text himself, but for the leader to do so: it was therefore not a desire not to share his thought and emotions with the group, but he preferred to entrust them to a different voice, almost as if to observe them from the outside, at a distance.

Construction of the text

Both poetry and prose texts are produced in the workshop.
Writing, particularly poetry, is conceived as a game and a “doing”, a dynamic process articulated around a text that can be manipulated and modified. The texts are created in fact through a series of contributions which, using words as objects, lead to the shifting, replacement and elimination of words, to changes in sentence structure, to breaking up of verse lines and so on.
The departure point is a prose outline of the ideas the author wants to express, without paying attention to aspects of form. In this way the contents are implicitly split from the style and structure of the text and it therefore becomes easier to overcome the barrier of the blank sheet of paper.
The leader then suggests the possibility of making some changes to the text, indicated by him with light pencil marks, hardly perceptible, on the sheets of each author. These signs do not have the appearance or the function of corrections, and are used simply as suggestions to transform the initial draft into something else, into a poem, without changing the contents but simply with slight adjustments in the form. And it is therefore suggested that some words could be eliminated, in some points one could start a new line to make the text less linear and the rhythm of the sentence more original and unpredictable, and that the position or the order of some expressions could be modified, and so on. The suggestions are then completed, corrected and personalized by the author.
In the end the text obtained is in fact still the same text, but it is also partly new, and the author is deeply impressed by the result of this game, getting a pleasant surprise with a positive narcissistic effect and an increase in self-esteem: “It really was me that did this”.

The viscosity of verbal language

We will leave out the aspects already analysed of the texts produced in this workshop (Barbieri, 2000; 2001; 2007), to concentrate on the written language used by the person with a predominantly psychotic mental functioning.
At first glance one has the impression that the poetic word and the prose word are distinguished by a different degree of viscosity.
The words of poetry appear to be units of expression on the one hand endowed with a semantic and emotive charge that is stronger than in their everyday use, and on the other hand as lexical monads tending to be isolated, or at least joined in brief segments of phrases, producing fragmentation, and at times the disintegration of the flowing syntax of prose.
The words of prose, on the other hand, are less loaded from the polysemic and emotional point of view, and seem mutually entangled in an inextricable relationship, as if they were inwardly linked in a verbal stream that no-one can escape from.
Seen in this perspective, the features highlighted would have no particular value in that each of the two verbal states could be explained largely as a reflection of the specific textual container, prose or poetry, which, though to varying degrees, impose particular structural and logical rules that affect the use of words and therefore sentence and text construction.
However, on looking more closely, the reality is different. In fact we are faced with two modes of expression, or rather two ways of structuring thought, which seem to cut across prose and poetry and to be independent of the textual genre. Moreover, each one does not necessarily belong to one author as his typical and only mode of expression: certainly, in each author one of the two forms tends to dominate, but at times both are present in the same person, in relation to different texts and to specific moods.
The written discourse at times has the rhythm of a river in full flood, it is like a fluid whose single elements are lost in the whole of which they are part; in other cases, however, it seems to be composed of a limited number of words, each of which is distinguished by being emotively loaded, so it is the individual lexical cell that ends up being the real protagonist, the fulcrum of the textual organism.
These are the aspects we will focus on, seeking explicative references and analytical keys in two domains: linguistics and psychoanalysis. But first it would be best to look more closely at some preliminary questions.

The medium, the text, the group

One cannot help spontaneously wondering why this modality of organization of thought and of the sentence seems so much more evident in the written text than in oral communication. We think it is useful to keep in mind three aspects related to the production of these texts: the medium used; the process of text elaboration; the group.
a) The medium is, as we have said, the written word which presents characteristics such as the slow time connected to its use, the permanence of the signal, and correctability. These aspects activate the mind in different ways compared to the usual ways linked to everyday orality, since they impose a different relationship with the emotions and facilitate if possible the transformation of the beta elements into alpha elements (Bion, 1963).
Slowness is connected to the hand gesture making signs on the sheet, and in this way thought can structure itself, at least in principle, in less automatic, more elaborate, less chaotic, more structured ways, helped in this by the geometricalization imposed by language signs lined up next to each other and laid out on the page in parallel lines.
The permanence of the signal may have an ambivalent emotive effect, in fact on the one hand the written text, which does not vanish immediately after being produced like the oral one, can be experienced like a mirror that reflects parts of the self that the author would prefer not to see, like a concrete reality that cannot be ignored; on the other hand, however, as a product of one’s thought, the text can be reread, observed, evaluated, criticised and restructured through various kinds of intervention (correctability). The author’s image of himself, in other words, remains and cannot be cancelled but can be modified: obviously a very important aspect.
What has been noted so far may authorize us to hypothesise that writing, even more than oral language, favors the symbolization of analogical codes of the inner world. On this point, progressive, evolutionary tendencies can be seen in the texts, connected to the elaboration of the symbol (Jones, 1918; Klein, 1930; Segal, 1957) as well as others oriented in a defensive, regressive direction (Freud, 1899). So pain, through the written word, has been in some cases exorcised and escaped from, in others at least made thinkable.
b) The process of text elaboration. While writing (Barbieri, 2003, 2004; Ferrari, 1994) has an intrinsic reparative function, this seems to be particularly strengthened by the gradual way constructing texts as described above. The text as a non definitive entity that is open and can be modified introduces the idea that also the reality underlying it, the contents and the emotions are not definitive, static, given once and for all, but can become malleable and therefore favor the reparative function of writing itself. The broken object can thus be salvaged and repaired by means of the written word.
It should not be forgotten that, through the activity of modifying the form of texts, writing helps to distance and cool down the mind’s contents to such an extent that they can be contemplated from an emotionally reassuring distance, making them easier to elaborate. It should not be forgotten that if this distance is accentuated, it can instead create rigid defensive barriers towards these same mental contents.
c) Group dynamics, too, have a significant role. It is true that being part of a group in a psychiatric facility can lead to identifying in others the aspects one sees as negative in oneself, with the result that the other person is seen as a mirror in which one’s own weaknesses, anxieties, conflicts, sense of insecurity, diversity and loneliness are reflected and amplified. But this also happens independently of the writing group, in everyday interpersonal relations in the same place. On the other hand, it can be seen that sharing the contents and the affective components of texts makes the mind enter dialogue and favors the formation of thought, thanks also to the playful non-judgemental context in which the group works.
Therefore the written code, the mode of constructing the texts and the group dynamics bring into the process of elaborating thought (and the text) some important components that encourage a more aware mentalization and communication, remove thought formation from chance, confusion, anxiety and enable mental dynamics to manifest themselves more clearly, and in a less automatic and chaotic way. The written code, the graduality of the elaboration of texts, and the group, act as good containers of the emotions and favor the redirecting of “projective transformations” in a less distorting direction, closer to the “rigid motion transformations”, which underlie shared communication (Bion, 1965).

Verbal monads and streams of words

The two stylistic results observed derive from the same psychic matrix, characterised by a split and fragmented inner world that has difficulty organizing itself cohesively.
In texts with high verbal viscosity, (to mention one literary model, we can think of the last chapter of Joyce’s Ulysses, though with some differences), the attempt to overcome splits and to give one’s mind a certain organicity seems to rely on syntax, on the relations between verbal units, while in texts where the monadic use of words prevails (the reference in this case could be to Ungaretti’s Allegria), one sees that it is the magic, allusive quality of the language unit that constitutes the fulcrum of the attempt to harmonize the mind’s contents and the emotions connected to them.
The two modes of expression reflect two types of mental functioning which in the non-psychotic dimension are integrated and automatically syntonized, while in the schizophrenic individual they tend to split. Writing centred on the shattering of verbal monads reflects the functioning of the mind based mainly on schizoparanoid dynamics, while in texts where syntactic links and the verbal flow dominate, a depressive modality is revealed.  In the psychotic’s writing one would therefore see the selective and alternating use of one of the two possible ways of organizing mental contents (respectively the split and the integration of words and concepts) which instead, as we have said, in non-psychotic thought-discourse coexist and are integrated.
One style favours the monadic word, the lexical object, semantic and emotional condensation; the other favors the syntactic connection, the link, and secondary elaboration.
It is necessary however to examine these problems in greater depth. On this point, given that, as Sapir (1957) argued, language as a structure constitutes the model of thought, we will analyse the above phenomena with a ‘double compass’, using some theorizations from the linguistics field and others from the psychodynamic domain.

Saussure

Ferdinand De Saussure (1916) underlined that the fundamental trait of the language sign is its arbitrariness, that is, the purely conventional link between the signifier and the signified, a non-natural link, not justified by any analogical relation.
Another aspect of Saussure’s theory that is of interest for our field of observation is that the signs of the language are independent from the individuals using them, they have an autonomous existence of their own. This is where we find the distance separating langue from parole, respectively the preconstituted code endowed with a series of conventional meanings that are found in dictionaries, and the appropriation of the code made by the individual speakers. Parole is the result of an individual act of will and of intelligence, while langue is passively acquired and is an unconscious, or perhaps more precisely, a pre-conscious faculty.
The two principles theorized by Saussure also lend themselves to use in relation to the verbal expression of individuals whose mental functioning is predominantly psychotic.
The language code, as we have seen, virtually exists in itself, but it actually needs a speaker in order to pass from potential to act, to really exist. The individual has a task that may seem simple in terms of habit, practice, and the automaticism due to use; however, if we think about it, it is anything but an obvious, banal operation, in fact he has to take possession of the code by vitalizing it, projecting parts of himself to give a real existence both to the code and to the parts of himself involved, and also naturally to make communication possible.
In other words, the primary, fundamental function of the verbal expression of thought envisages that individuals share an arbitrary conventional signification that is therefore independent from themselves, they use an opaque pre-existing code to make the contents of their inner world communicable. The most intimate, private, affectively loaded aspects can exist, be thought and perhaps be communicated only if they are subjected to an extraneous code, pre-formed, other than self. This is no small feat, above all for a schizophrenic person, in whom tendencies to splitting are far stronger than those towards integration, and in whom mental automaticisms are particularly erratic. The arbitrariness of the verbal sign and the independence-autonomy of the language code can be seen as a strongly destabilizing fact, as the obligation to relate with an object that is inevitable as well as extraneous, and therefore as yet another strategy alienating one from the self.
On this point, one aspect of Saussure’s thought that is often neglected should be clarified: the language sign is not determined in a relation between a name and a thing, as would seem at first sight, but it is articulated in the less mechanical and far more complex relation between a concept and a sound image: it is as if signification and communication come about in an elusive domain which cannot be pinned down, centred more on inner dynamics than on external reality.

Hjelmslev

In the theory of Hjelmslev (1953), too, there are observations relevant to our object of enquiry. The language sign has such a relational character that verbal communication is compared to chess, in which each piece receives its value from the place it occupies at each moment on the chessboard compared to the other pieces. On this point Hjelmslev introduced the idea that language is an entity articulated on two axes, the syntagmatic and the paradigmatic. The syntagmatic axis is related to the relational aspects of language: they concern combinations between lexical units (and between elements of the text). On the paradigmatic axis, on the other hand, there is the differential data, the selection, the alternative choices between various lexemes. In other words, a phrase is created by a process of selection between alternative elements (paradigmatic aspect) which are then combined (syntagmatic aspect) with other language elements, in turn selected according to certain rules and lines of meaning.
This is an ambivalent mechanism, which on the one hand sees the language sign as a fact in itself, endowed with independence, but on the other, annuls this illusory autonomy in a relational dimension.
Given that language and thought are very closely tied, one has to view one’s linguistic thought as a dynamic process that starts from the semantics of the single lexeme but that can actually exist provided that its single nuclei of meaning are passed over to create relational semantic networks. In the psychotic however it seems that the focus on the single word and on discourse as a complex system of signification can find no point of reconciliation or of fusion.
On the one hand, in fact, in the writing we observed, there is the word-monad that takes on the emotional burden of signification and can strengthen it independently of its co-textual relations. On the other hand there is the lexical network, the language flow, which tend to place the polysemic potentialities of the single word in the background to the benefit of its connections with the other verbal signs. 
The partial and problematic elaboration of thought by the psychotic can be conceived on the background of Hjelmslev’s conception of language. The fragmentation of the inner world can be (partly) verbally elaborated in two directions, both with a strongly saturating effect: the word can be used as a monad (paradigmatic aspect) strengthening its aspects of semantic and emotive self-sufficiency so that the represented reality, to which the word adheres, becomes compact and unassailable, so as not to leave any possible space to a different elaboration; or the relational dimension of the signs can be overestimated (syntagmatic aspect), relying on the connections between words in the search for cohesion and construction of meaning.
Again, Hjelmslev distinguishes between the level of expression and the level of content in a text. More specifically, a distinction can be made between the substance of expression (phonetics conceived in a physical sense and the graphic substance) and the substance of content (meanings as mental entities); the form of expression (phonological and syntactic rules, the combination between meanings) and the form of content (the structuring of the contents, and of the meanings in the text). Moreover, deeper than the level of the form and the substance of the expression and the content, there are the matter of expression and the matter of content, to be seen respectively as phonetics on the one hand and semantics on the other, being extralinguistic realities that are still unstructured, amorphous, and lacking in any organization.
It must also be remembered that between the matter, the substance and the form both of expression and of contents, there are major logical gaps and discontinuities that cannot be overcome automatically and easily in the mind’s psychotic mode of functioning. Moreover in this division into three levels, interesting links can be seen with Bion’s theory of thought, which is described in the next section.

Bion

Observing the genesis of thought from a Bionian and post-Bionian perspective, we find interesting connections with what has been observed in the linguistics field. Underlying all thought activity there are emotive experiences and sensorial impressions that have not yet been elaborated. If these emotive and sensorial nuclei are filtered by the alpha function (a component of personality that transforms emotions and sensations to make them thinkable), then they give rise to alpha elements, unconscious images that constitute the first step in thought formation. Alpha elements are not yet proper thoughts and are used in dreams, memories and in day-dreaming.
The primary emotions and sensations and aplha elements, not knowable, trigger the transformations that lead to what Ferro (1996, 1999), in the context of the patient-analyst relationship, has called “narrative derivates”, fragments of narratives uttered by the patient based on the rules of free association. In all other non-analytical contexts where oral and written texts are produced, the narrative derivate in its fragmentary essence is not expressed, is not communicated but remains in the mind at a latent, potential level as “inner narrative derivate” (Barbieri, 2005, 2007; Barbieri & Bozuffi, 2006). This is a portion of a possible story, a piece of a virtual narrative mosaic, that is waiting to be triggered and placed inside a real narrative. It is only later, therefore, that inner narrative derivates can be connected to each other and ordered so that they have semantic and logical coherence, giving rise to a text.
Thought is therefore articulated in a series of transformations that start from emotions and feelings, giving rise to alpha elements, to inner narrative derivates and finally to narratives.
It should be noticed that on the contents of the mind, the primary emotions and feelings, narratives impose the detachment needed to encourage toleration of the frustration and pain inherent to some of the facts narrated, and makes symbolization possible.
The matter of expression and the matter of content that Hjelmslev talks about are at the same level as the beta elements, the emotions and the as yet unelaborated sensations. The substance of content (and in part the substance of expression) is syntonic at the level of the alpha elements. The form of expression and the form of content are realized at the nuclear and potential level in inner narrative derivates, and are then manifested in an organized way in the text.
Bion (1965) also presents an interesting theorization of transformations. If we think of what Sassure argued about the arbitrariness and independence of the linguistic sign and what we observed on these aspects, we can picture the psychotic’s difficulties in structuring linguistic thought as difficulties found in transformations from O (the deep and unknowable truth belonging to the individual’s inner world) to Tb (the result of the transformation, therefore the verbalization, writing) passing through Ta (the transformation process). The verbal text (Tb represents the realization of the encounter between two realities of radically different and unreconcilable logical levels: O, which also in its hypothetical superficial manifestations belongs to an analogical code (Watzlawick, Beavin & Jackson, 1967), and the verbal language, by definition a digital code, whose opacity (arbitrariness of the relation between Saussure’s signifier and signified) determines the problematic nature of transformation processes Ta. And it is precisely in Ta that the difficulties in harmonizing the paradigmatic and syntagmatic aspects (Hjelmslev) of the language sign are manifested as well as those between langue and parole (Saussure).
The psychotic’s writing is therefore a testing ground which reveals the difficulties in projecting parts of the self into the verbal code to make the code actually exist and to make the same parts of the self thinkable and communicable.
It should also not be forgotten that if the process comes about on the parameters of pathological projective identification, the word is comparable to a bizarre object and it therefore seems inadequate not only for communication, but also for giving life to thought. It must however be pointed out that the authors of the texts considered are in a non-acute but chronic condition, which makes it possible to activate the alpha function, and the presence of pathological projective identification and of bizarre objects is therefore greatly limited, although it remains like a shadow that one cannot but take into account.

Narration

In the narratives produced in the CRT writing workshop in Cremona another interesting aspect is visible, connected to what was said above. The relationships between the characters and the events narrated, if considered in the thematic and logical economy of the text, often present obvious structural inconsistencies. One gets the impression that the world supporting these narratives is made up of a juxtaposition of “narrative islands” of varying sizes, each with its own internal coherence, but lacking precise, rigorous logical links with the others. To use an image from Meltzer (1986), it is as if we were faced with Lego bricks not isolated from each other nor organized in a complete building, but partially assembled in small groups that suggest the shape of the whole construction, which however has not been totally built. Meltzer connects this mental state to what Bion calls “transformation into hallucinosis”. It derives from an initial activation of the alpha function, which, however, has been interrupted and has not completed its transformation of raw emotions; these have started to be dreamed and thought, but then the process has been blocked or even inverted, and so the represented world appears fragmented into many blocks of narrative that are not successfully harmonized in a complete and satisfactory way.
In the case of the authors of these texts, who have gotten over the acute phase of their psychosis, one can think of an intermittent activation of the alpha function that has given rise to different fragments of narrative, partly coherent, which have not however become sufficiently integrated due to the discontinuity of the process of transforming emotions and feeling to render them thinkable.  While the writing and the plot of a story normally represent the crystallization of mental dynamics which find a stable systematization on the page, with a schizophrenic person there is only a partial crystallization of narrative islands which in the mind are already constructed around an unmodifiable saturated nucleus of sense that consequently cannot find a reciprocal harmony on the written page
Narrating is usually an activity of reordering, clarifying, an operation that, in the Bionian perspective, favors the passage from PS to D, or from a state of fragmentation to one of psychic integration. In the narrative texts produced in the workshop, however, D is not reached, unless in part, and the state of disgregation of PS opposes continual resistance to the unification of narrative materials into a coherent pattern (Barbieri, 2007). The text essentially appears to be studded with what, when referring to another text type, we called “beta residues” (Barbieri, 2005).

Concluding remarks

In conclusion we will add a few remarks, which naturally do not claim to be exhaustive, but which might help us to extend our understanding of some of the dynamics underlying psychotic mental functioning.
As has already been shown, the two expressive modalities found in the texts reflect two corresponding psychic dynamics, and it is this aspect we focus on.
We are helped in this sense by the conception of language of Loewald (1977), who does not share the Freudian theory of a primary process without language and a secondary process in which language makes its appearance. Language is fundamental right from the beginning of life, when the infant, whose mind works based on the parameters of the primary process, finds himself immersed in a phonetic flow in which he perceives the sounds and rhythms of words as aspects with a sensual, affective force. At a later stage, in relation to the new mental situation determined by the secondary process, the child gives priority to the semantic aspects of words. Successful adult communication depends on the optimal distance between the sensual-emotive aspects of language and the semantic ones.
The verbal expression emerging from the texts written by people with a predominantly psychotic mental functioning shows the failure to achieve this optimal distance, given that the sensual-emotive pole and the rhythmic one that characterise the language of the primary process have a far greater weight than they do in the verbal communication of the non-psychotic person. In the latter case, the semantic rules do not take second place, but coexist dynamically with the rhythmic and affective components of language. In non-psychotic communication, the rhythmic-syntactic aspects and the affective ones are integrated at the semantic level so as to vitalize it and make it emotively pregnant; in psychotic communication, in contrast, they retain a certain priority, or at least show a weight that is far greater than what is seen in the usual communication contexts.
It can be noticed that the word-monad centred on the emotive and sensual components typical of the language of the primary process, while the word absorbed in the verbal flow and taking second place to the links that constitute the discourse as a whole, focus more on the rhythmic components of the language of the primary process.
Referring to the theories of Nikolaidis (1984), we can picture the two stylistic and thought modalities that we are examining against the background of the two tendencies he identifies in the language of the schizophrenic: the first is oriented towards a narcissistic pole (which allows the author not to get lost), the second towards an object pole (which helps him to maintain contact with the world). Clutching the mainly emotive and sensual components of the word-monad, on the one hand, and on the other, the connections between lexical signs in the verbal stream, can be considered a sign of the narcissistic tendency that opposes the anxiety of getting lost. This tendency then finds strength in linking up with the semantic components of language (object pole) which are not neglected since they constitute the condition for triggering the narcissistic elements just mentioned. These are expressive modalities that, as Meltzer, Bremmer, Huxter, Widdel and Wittenberg (1975) would say, tend to exorcise the perception (or the fear) of “being open”, of lacking a sphincter function to open and close the individual towards the world.
When the “imaginary avant-texte” (Anzieu, 1994), or what is found in the author’s mind before starting to write his text, the “original visionary phase” (Anzieu, 1994), is transposed into  text, there are various ways it can be structured depending on the way it uses the narcissistic aspects and object aspects of the language sign. In the writing of a person with mainly psychotic mental functioning, greater space than usual is reserved for the narcissistic aspects.
It is always here that the orientation of the symbol in a direction which may be regressive-defensive or progressive-creative is decided; in the latter case language can assume a self-repairing function and a reparative function towards the object (Giaconia & Racalbuto, 1990).
We feel that a not unimportant role in this process is performed by the possibility of playing with words and of changing them in the phase of text elaboration. We consider this procedure as a sort of language handling (Winnicott, 1965); just as maternal handling leads to the acquisition of the corporeal schema by the infant, so this handling of words can favor the elaboration of the mind’s contents and the organization of a thought pattern.
Writing, regardless of the genre, is a tool that can get the psychotic part of the mind to dialogue with the non psychotic part, weakening or unlocking the pathological static equilibrium that has structured the patient’s mental organization. The texts presumably represent a similar condition to the “space without” (Lo Verso & Papa, 1995), in which there is no longer the old and the new is not yet there; a provisional, temporary state that, however, makes it possible to start seeking a new equilibrium.

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Notes

* Researcher at the Department of Psychology of the University of Parma, Italy. Top

1. Cremona is a city of Lombardia Region, in the North of Italy. Top