J Med Humanit (2011) 32:257–267

DOI 10.1007/s10912-011-9148-2

The Other Self: Psychopathology and Literature

Javier Saavedra Macías & Rafael Velez Núñez

Published online: 9 August 2011

# Springer Science+Business Media, LLC 2011

Abstract The figure of the “double” or the other self is an important topic in the history of
literature. Many centuries before Jean Paul Richter coined the term, “doppelgänger,” at the
beginning of the Romantic Movement in the year 1796, it is possible to find the figure of
the double in myths and legends. The issue of the double emphaszses the contradictory
character of the human being and invokes a sinister dimension of the psychological world,
what has been called in German as “umheimlich.” However, does multiciplicity always
involve pathology? Related to this figure in literary history, a new perspective from clinical
psychology called “dialogical self” defines the self as a multi-voice reality. Along the same
line, postmodernist psychology considers the self a discursive construction. From these
perspectives, the “self” is situated a long way away from the classical essential conception
of the self. In this paper, we review briefly some important landmarks of the figure of the
double in the literature, and we compare the coincidences of the “double” experiencies
described in literature with the experiences of our patients. Finally, we discuss how this
literary tradition can help us to understand new psychological perspectives.

Keywords Psychopathology . Literature . Double . Self . Identity

Der Mensch ist nie allein: das Selbstbewußtsein macht, daß immer zwei Ich in der
Stube sind.
Man is never alone: self- consciousness means that there are always two of you in the
room.
Jean Paul
What view of identity has been privileged in western culture and academic psychology?
According to Bruner (1990), the “self” has traditionally been viewed as a substance or
essence whose existence was prior to or independent of our social practices and the way in

J. S. Macías (*)
Department of Experimental Psychology, University of Seville, Seville, Spain
e-mail: fjsaavedra@us.es

R. V. Núñez
Department English Studies, University of Cádiz, Cádiz, Spain
258 J Med Humanit (2011) 32:257–267

which we describe ourselves. Thus, identity has been understood as an internal dimension
that belongs to subjects and to individuals rather than an interactive feature. Identity has
also been described as a stable and reliable trait through which we can recognise people. It
can be depicted as what is similar and what remains stable in the long run: that is, the
essence of a person. In psychology we can measure these traits using standardised
instruments. Identity makes us recognisable and predictable in society, and we are allowed
to participate in society. From a sociological perspective, Bauman (1998) argues that to
achieve its project, based on the enlightenment ideal of progress, industrial society needed
human beings with a coherent identity, one that was unitary, stable over time and able to
suppress desire. The literary genre that best reflects this essential identity is the
“bildungsroman” in which the hero develops his identity from childhood or adolescence
into adulthood, the typical progressive story of the self-made man.
However, if we explore mythological literature and ancient art, we see that for thousands
of years the nature of human beings has been considered, at least, as dual. For example, in
the epic of Gilgamesh, probably the first mythological story, the semi-god king of Uruk,
Gilgamesh, faces his double, Enkidu, who is sent to him by the goddess Aruru. Enkidu is
half-man, half-wild animal. At the end, Gilgamesh discovers the mortal dimension of
Enkidu and must cope with his death. Many systems of age-old beliefs are based on a
dualist conception of nature. For the Taoist tradition, based on the philosophy of Lao Tse,
the Chinese philosopher from the 4th century B.C, all human beings are born with the
opposing principles of the “yin” and “yang.” In Mesoamerica, we find a dualist view of the
world in many pre-Columbian cultures. Some primitive beliefs about the soul may also be
classified as dualist. For example, the Egyptian “ka” is a vital principle that could live
outside the body–a synonym of the soul, represented by the Egyptians as a shadow. This
motif, the shadow, holds a privileged place in double literature. Moreover, the importance of
the dual or multiple nature of the human being is demonstrated by the large number of
names or terms for referring to it in different cultures: for instance, sosia in Greece and
Spain, alter ego in Rome, coimimeadh in Scotland and fetch or wraith in England.
The motif of the double has been and still is highly important in the history of literature.
Different forms of experimenting with duality or multiplicity have played central roles in
essential works from Plutarch through Shakespeare to the romantic and gothic literature
with which we shall deal. But what makes the experience of duality or multiplicity in the
history of literature and its presence in innumerable religious or mythological traditions so
important? The reason for this extraordinary presence is rooted in two dimensions of the
human condition, which appear as central axes in double literature.
The first dimension is psychological. An essential form of duality in all human beings is
tied to the acquisition of consciousness. Looking at oneself, thinking about oneself implies
becoming objective, seeing oneself as different. The discovery of a not–I either internal or
external–in other words, social–is vital for the birth of the experience of identity. Together
with consciousness is born language, the ability to talk to oneself. Language is the most
effective instrument for becoming objective. It is no surprise that the process of
individualization and the appearance of language in human evolutionary development
come together. For this reason, some philosophers have defined the “self” as a split and, at
the same time, a synthesis of opposites in whose dialectics “one of the terms remains its
opposite” (Kierkegaard 1983).
The second dimension is moral. This source of duality is directly related to the motives
and drives that push us in different, sometimes opposing, directions. The human being is
continuously compelled to choose between different actions and their consequences. These
actions may respond to different motives and objectives in the same person and at the same
J Med Humanit (2011) 32:257–267 259

time. This human experience is directly related to the question of the origin of evil and the
freedom of the human being to avoid it. In line with Herdman (1990), this dimension of the
human condition is the one that provides the most richness and authenticity to the double in
the history of literature. For this author, the paradigmatical model of this conflict in western
culture is reflected in the oration of Jesus Christ in the garden of Gethsemane: “Father, if
thou art willing, remove this cup from me; nevertheless not my will, but thine, be done.”
Apart from these two basic experiences of duality, we analyze the reason for the double
from two perspectives. First, we reflect on the similarities between the experiences of the
characters in books covering the subject “of the double” with the experiences of people
suffering from severe mental disorders. This is not to pathologize the experience of the
characters in literary works but to comprehend the experience of people with severe mental
disorders within the two universal dimensions of duality described above. This latter idea is
a very important one, the reason why the study of literature may be very useful for all those
who work in the area of mental health. Second, we explore the historical and cultural
factors that influence how we understand the identity and the moral conflicts reflected in
these works. For example, how scientific or pseudoscientific theories, such as mesmerism,
inspired and were even embodied in some literary protagonists.
In the following section, we explore different ways of representing otherness or
multiplicity in literature, in particular romantic and gothic literature through the experiences
of several major characters. In the third section, we look at the experiences of duality or
multiplicity of people with severe mental disorders–particularly schizophrenia–and compare
them with the literary tradition. Finally, in the discussion we emphasize the existential value
of experiences which, from a clinical perspective, we call “psychotic symptoms” and reflect
briefly on the latest conceptions of identity in psychology1.

The figure of the double in literature

It is not our intention in this section to perform an exhaustive exploration of the figure of
the double in literature. We are concerned solely with describing certain features of
characters’ experiences in this type of literature that may help us approach psychopath-
ological symptoms from a different perspective. We first explore representations of alterity
in literature up until the romantic double as the extreme experience of otherness.
Independent characters who work as alter-egos are found in literary stories such as Sancho
Panza and Don Quixote in the novel by Miguel de Cervantes Saavedra in which different
archetypal perspectives of the world are represented. Some authors have used the term
“quasi-doubles” for extreme forms of this type of representation (Frank 1976). The quasi-
doubles are always completely independent; in other words, they have a separate reality in
the plot, but they reflect inner images, mirroring each other, laying bare a profound conflict
1
The authors declare that the extracts from interviews with people with severe mental disorders that are
discussed in this article were obtained after reporting on the method and objectives of the research to the
institution where patients live and obtaining their consent (FAISEM. Andalusian Public Foundation for the
Social Integration of Persons with Severe Mental Disorder). The institution was continuously informed about
the development of the ongoing investigation. The interviewees agreed to participate freely. None of the
patients who showed doubts about their participation was interviewed. Those who agreed to participate were
given a document signed by the main researcher to ensure that data could only be used for scientific reasons
and that the identity of interviewees would be confidential. To avoid any possibility of recognition, all
personal information—age, sex, diagnosis or date of the interview—has been removed. Similarly, any
information within the extracts that could identify patients, such as proper names, has been deleted or
modified.
260 J Med Humanit (2011) 32:257–267

at the same time as mutual dependence. Dostoyevsky’s The Brothers Karamazov and The
Idiot also contain some examples of these doubles. In recent years, we have discovered very
similar examples of this type of doubling in two contemporary works: Life and Fate by
Vasily Grossman and The Kindly Ones by Jonathan Little in which a meeting between a
Nazi officer and a communist official during World War II work as archetypal mirrors of
one another.
A second way in which we find some kind of alterity in literature is the use of secret
twins to create dramatic or comic situations. This type of intrigue is almost a literary sub-
genre because of the large number of works. There are many examples from the plays of
Plutarch to the optimistic novel of Antony Hope, The Prisoner of Zenda. One of the most
famous is William Shakespeare’s Comedy of Errors.
We also find circumstantial doubles who appear for no apparent reason or because of
supernatural causes. Plutarch’s play, Amphitryon, is the best example. In this play, the god
Zeus takes the form of Amphitryon, a Theban general, to have sex with his wife, Alcmene,
while he is fighting in a battle. This play has been reinterpreted by many writers including
Moliere and Kleist.
The type of double on which we focus is the Romantic double, which involves an
internalization of the double. Romanticism transformed the double into a sinister,
psychological and moral issue–umheimlech in German. The German term that describes
this type of double is doppelgänger, coined by Jean Paul in a novel called Siebenkäs in
1796, as the concept of people who see themselves (Paul 1960). The cornerstone of the
doppelgänger motif is the paradox of encountering oneself like another. Put another way, it
is the most radical expression of otherness: ‘I’ as ‘other.’ While the representation of the
double in literature is both diverse and complex, making it nearly impossible to classify in a
systematic way, there are two expressions, two ways of experiencing the double in romantic
and gothic literature which we will dsecribe.
The first is the psychological double who steals the identity of the protagonist and pursues
him. The double continuously threatens the social position of the protagonist, making life
impossible. Romantic literature transforms the external double into an inner double, an
independent consciousness that torments the victim. This inner double may appear in many
different ways and may be experienced as an outer being who threatens to invade the
protagonist’s identity. In fact, the external materialization of the double as another character in the
plot, together with the moral conflict and the theological reflection of evil, have been considered
the cornerstone of the romantic double. These characteristics faded with the growth of the
influence of positivist psychological science during the 19th century where the experience of the
double was described, from a clinical perspective, as a psychopathology (Herdman 1990; Miller
1985). We find the best illustrations of this kind of double in the novel, The Devil’s Elixir, first
published in 1815, which deals with the adventures of Brother Medardus, an 18th-century
Capuchin monk. Brother Medardus is chosen to take a message to Rome. On his journey, he is
involved in a game of double impersonation. Complex and rich, Hoffman’s novel contributed
greatly to the development of the double, exemplified by the following passage:

I no longer walked alone! On the contrary, it seemed to me as if some person ran all
the way very near me, keeping time with my steps, and I heard a stammering voice,
which pronounced the words—Ever, ever am I with thee! Brother, brother Medardus!
Go whither thou wilt, east, north or south, I am ever with thee! […] I became
convinced that this horrible double, by whom I was haunted, had his existence only in
my own disturbed imagination. However, I could by no means get rid of the frightful
images. ((Hoffman 1824), 96)
J Med Humanit (2011) 32:257–267 261

The passage illustrates the process of internalization of the double in which the
protagonist recognizes that the double is a product of his imagination. The horror
transmitted by the character comes from his experience of the loss of identity, from an alien
influx that reflects hidden aspects of his own self. This process makes one a stranger to
oneself, an object, a thing possessed by an unknown self.
One of the best stories for observing the connection between the figure of the double and
the consciousness that we describe above is Poe’s “William Wilson,” a short story with
Gothic overtones written in the first person in which the protagonist is pursued and
tormented by a double from his childhood until his death. The double, exactly like the
protagonist, even has the same name, obstructing and preventing all of the bad actions of
the protagonist. At the end of the story, the protagonist kills his double, discovering that he
has killed his conscience and, in so doing, has killed himself. In this extract, after stabbing
his double, the protagonist discovers that the double’s voice is his own:
[…] It was my antagonist—it was Wilson, who then stood before me in the agonies of
his dissolution […] It was Wilson; but he spoke no longer in a whisper; and I could
have fancied that I myself was speaking while he said –“You have conquered, and I
yield. Yet henceforward art thou also dead—dead to the world and its hopes. In me
didst thou exist—and, in my death, see by this image, which is thine own, how utterly
thou hast murdered thyself. ((Poe 1988), 178)
As Miller (1985) writes, the originality of the double in “William Wilson” lies in its role
as the “admonitory conscience.” In other words, the double is freed from bearing the
protagonist’s evil not only because it is conscious of his evil acts but also because it
assumes the moral essence still remaining in the protagonist. This story highlights the
relation of the double with the existence of the conscience, of the reflexivity that
characterizes the human being. Once the double dies, once the conscience has been
eliminated, the human being is no longer a human being and dies. Thus, the experience of
duality is seen as inseparable from the human condition. This episode, in which the
protagonist kills his double to discover that he no longer exists, is characteristic of the
literature of doubles.
Another example is the short story, “The Horla,” published in 1887 by Maupassant. For
some critics such as Herdman (1990), Maupassant’s story represents a decline in the figure
of the romantic double as it reduced its sinister ambiguity, reflecting the influence of
positivist psychological scientific thinking and the disappearance of moral conflict from the
plot. “The Horla” is written in the form of a journal: the narrator, an upper-class, unmarried,
bourgeois man expresses his painful thoughts and feelings of anguish because he is being
possessed by a powerful and invisible extraneous presence:
August 14. I am lost! Someone is in possession of my mind and controlling it!
Someone orders all my acts, all my movements, all my thoughts. I am no longer
master of myself, nothing except an enslaved and terrified spectator of the things
which I do. (Maupassant et al. (1986), 333)
In this passage is an example of the ultimate extreme of the loss of liberty, the end
product of the pursuit of the double: total possession. The hero, pursued by his double, runs
the risk of ending up as a robot, becoming an automaton of himself. The figure of the
automaton and the experience of possession are very frequent themes in literature and in the
experiences of people who suffer from severe mental disorders.
The double is also found in literature as a split personality or dark half of a protagonist
acting as a physical manifestation of a dissociated part of the self. This type of double
262 J Med Humanit (2011) 32:257–267

breaks away from the protagonist’s self, possibly satisfying the latter’s desires initially, but
then becoming uncontrollable and eventually destroying the hero’s life. A good illustration
of this type of double is Stevenson’s Dr. Jekyll and Mr. Hyde (1886). Another version of this
kind of double is Wilde’s The Picture of Dorian Grey in which the picture becomes a
progressive representation of the dark and evil soul of Dorian Grey (1891). In this work, the
protagonist dies after destroying the portrait much as the protagonist dies on killing his
double in “William Wilson.”
The following passage from Dr. Jekyll and Mr. Hyde illustrates how Dr. Jekyll wants to
free the good part of his consciousness, or put another way, resolve the problem of the
duality. This way, each part of the self would be housed in separate identities. His attempt to
overcome the human condition has terrible consequences:
[…] I saw that, of the two natures that contended in the field of my consciousness,
even if I could rightly be said to be either, it was only because I was radically both
[…] If each, I told myself, could be housed in separate identities, life would be
relieved of all that was unbearable […] no longer exposed to disgrace and penitence
by the hands of this extraneous evil. ((Stevenson 1886), 109)
Whatever the appearance of the double in literature—robbed reflection, shadow, spectral
brother, imaginary replica terrorizing a protagonist–the figure gains meaning when it is
contextualized in the dimensions of the human condition. The figure of the double places
the human being in front of the mirror, is a metaphor of the reflective nature of human
existence. The literature of the double self, particularly in the romantic tradition,
emphasizes the close relationship between the figure of the double, consciousness and
death. Put another way, the moment that we acquire consciousness, the capacity to observe
ourselves, the experience of alterity, the double, appears.
The experience of the double, therefore like consciousness itself, is part of the human
condition. In fact, the price that we have to pay for having consciousness is seeing
oneselves “dead”: being conscious of our own mortality. Thus, the figure of the double
anticipates, announces or brings with it death.
The double in literature reflects the manifestation of evil, as in “The Devil’s Elixir” by
Hoffman or in the classic Scottish gothic novel, Private Memoirs and Confessions of a
Justified Sinner by James Hogg, or it is the hand accusing the protagonist of depravity in
Poe’s “William Wilson.” The appearance of other doubles is due to the intervention of
characters. In line with Herdman (1990), concern over the existence of free will is the
central axis of the romantic double. The figure of the double shows how impossible it is for
the protagonists to escape from their destiny, from the inheritance of family evil as in “The
Devil’s Elixir.” Or the inability to resist the power of evil that takes over the identity of
protagonists until it creates automatons, as happens in “The Sandman” also by Hoffman
(1982). It is no surprise then that Hoffman and other German writers were influenced by the
pseudoscientific doctrines of “animal magnetism” of G.H Schubert and Mesmer’s
“magnetic union of souls.”
If we are inhabited by different pulsions, if we cannot escape from our own selves, how
can we act and live in a society with a split identity in accordance with the regulations? The
main characters in the works mentioned above struggle towards integration in society by
repressing or trying to control their other selves. The social norms described by romantic
authors as frivolous, bourgeois and tedious are the ones from which both characters and
authors are trying to escape. In the following section, we describe the experiences of people
with psychosis from a phenomenological perspective to see if they bear many
commonalities of double characters.
J Med Humanit (2011) 32:257–267 263

Psychopathology and literature: People with severe mental disorders as romantic

heroes

When we live or work with a person diagnosed with a severe mental disorder, such as
schizophrenia, we observe how they fight to present a coherent image of themselves. They
have difficulty achieving a recognisable and reliable self that allows them to participate in
society, and the basic categories of human existence have broken down. According to Laing
(1960), from an existential perspective, such people are afraid of being swallowed up by the
external world and may think that others can penetrate their minds or read their thoughts.
They also feel a void and wish to make contact with the world, but at the same time they are
afraid of being fragmented by strong feelings. Finally, they fear being turned into
automatons, feeling petrified, or having the power to transform other people into
automatons. The “self” of these people is constantly under threat. These selves have been
described as cacophonous, empty or monological (Lysaker and Lysaker 2002). In any case,
some patients are virtually incapable of integrating different social positions into their
identity, and their discourse is completely incoherent (Saavedra et al. (2009).
From a biomedical and psychobiological perspective, the morphology and content of
these experiences can be understood as epiphenomena of neurobiological maladjustment or
cognitive deficits. However, if we delve further into the lives of such people we become
aware of the same existential value as in the experiences of the literary heroes. The
following are examples from narrative interviews with people diagnosed with severe mental
disorders. To avoid any possibility of recognition, all personal information such as age, sex,
diagnosis or date of the interview has been removed.
Interview 1
Interviewer: Did you live there with your mother? How many brothers do you have?
User: I have four, thanks to god. But my mother had more and because of the posh
man I do not have any more brothers. The posh man is revolting!
U: And is the posh man a person?
I: He is a person. The day he dies, I’ll be cured.
U: And where is he? Can you see him?
I: Yes, I see him in my imagination. Do you know what an unreal number is? An
unreal number is fractioned, a fraction of the reality, the unreality is a fraction of the
reality, it is to think that… do you know?
I: So, the posh man is in your head?
U: Absolutely, he threatens and coerces me! The posh man killed my mother, he has
taken my life, he threatens and coerces me, he has made me a schizophrenic, he has
destroyed my family, and the posh man is an illness.
In this excerpt, there are several similarities with the last two literary texts. First, the
patient tells us about a presence that has tormented him throughout his life. This character,
the posh man, has even killed the patient’s mother and is described as an illness. The patient
is completely dominated by this character and recognises that this character is a product of
his imagination although he talks about him like an external person during the interview.
Many delusional complexes try to explain the existence of the evil, sometimes it consists
of the patient’s real or imagined bad actions as in the following extract.
Interview 2

User: From the age of 16 to the age of 18. Two things happened to me, the two things
which happened to me, were both bad things. Once a kind of black spirit came in
264 J Med Humanit (2011) 32:257–267

through my mouth.
Interviewer: A kind of what?
U: Black spirit! A kind of black spirit!
I: Ah! A black spirit.
U: A black spirit came into me and I committed an offence of indecent exposure. I
was caught by the Civil Guard Police because I did not want to do anything.… I did
not want to do anything…. This case of indecent exposure happened because I was
possessed. Afterwards I went to sleep in.… And both cases were similar… as if I
were possessed.
In this interview, the patient makes a black spirit responsible for his offences of indecent
exposure. Here the black spirit works like a double and the patient exonerates himself from
blame for the crime. However, he has paid a high price. Finally, this patient was immersed
in a really complex delusion in order to explain all the evil in the world; he even identified
himself as Satan. As in the literature, doubles provide a medium for explaining the evil that
cannot be accepted morally by the protagonist.
An evident issue in common between double motifs in literature and the experience of
madness, including hallucinations and delusions, is how to achieve a stable and socially
recognisable identity based on fragmented events and chaotic relationships and perceptions.
Like protagonists of doubles in literature, people with severe mental disorders can find it
hard to recognise themselves as social agents; they may discover new disrupting and
threatening identities or have problems recognising significant people in their lives. In this
second excerpt, the same patient is very worried because people call him “Satan”; in other
words, they confuse his identity.
Interview 2, continued:
U: Even children called me Satan. I said, call me George! My name is George! They
wanted to put Satan in hell; they wanted to put me together with Satan because I was
looking for him to warn him what was going to happen in Seville. I wanted to warn
him to avoid the war.
As illustrated in this extract with a patient who has undergone a divorce 2 years earlier
and is now living in a care home, he expresses doubts about whether he actually is a father.
While he says he knows that his wife has some children, he neither knows them nor is he
sure of his paternity.
Interview 3
U: I don’t know who my sons are. A boy who is in the world and I don’t know him.
I’ve been looking for them for a long time.
I: Do you want to see them?
U: Of course, two children who said that they are my children visited me last night.
They pounded my head all night
I: And did they pound…?
U: Yes pounding my head, the voices, they did it. They will make me kill myself.
I: And do you hear them?
U: I hear them as if they were angels and they were stamping on the head of their
father.

The ambiguous social position of the patient as father and husband and the inability to
elaborate a coherent story is reflected in the voices of his children’s doubles: “two children
who said that they are my children.” The voices torment him and even incite him towards
J Med Humanit (2011) 32:257–267 265

suicide. Amongst people with severe mental disorder that we have interviewed,
consciousness of death is a central topic. For example, some patients believe that the
world is about to be destroyed. One of us (JS) knew a patient who believed that he was
dead, he saw himself as a dead man.
The position in the world of the literary protagonists is very similar to those of the
patients in these extracts. So much so that in some cases, it would be difficult to
differentiate between extracts from patients’ experiences and the literary characterizations
of doubles. Moreover, the above referenced patients do not identify the protagonists of their
delusions as doubles, much like the literary heroes do at the end of their stories when they
recognize them as such, as in Maupassant’s short tale “Le Horla.” However, from a
discursive perspective not only the protagonists of some delusions but also the doubles in
literature can be interpreted as fragments of the patients’ or literary heroes’ identity that
cannot be integrated in a coherent narration of themselves. Thus, the figure of the double in
literature can help interpret some experiences related to madness from a new and productive
point of view.
Both the literary characters and the patients are pursued by beings, and while they are
neither recognized nor accepted, at a discursive level they may be identified as particularly
conflictive positionings of the self, especially illustrated in interviews two and the second
part of 3. These positionings of the self that are nearly always related to actions considered
evil or with ambiguous emotions may be externalized in the form of auditory hallucinations
or form part of a persecutory delusive complex (Saavedra et al. in press). Both patients and
literary heroes are concerned about their social integration. Patients and literary heroes
anxiously fear an imminent dissolution of their self or predict their own deaths. Finally,
both patients and literary heroes are anxiously aware of the multiplicity of their self, of the
multiple dimensions of their identity which they are unable to integrate.

Discussion

Romantic and gothic literature relate the experience of duality or multiplicity mainly as a
sinister event that foreshadowing death or the dissolution of the self. Later, with the
influence of scientific psychology at the end of the 19th and beginning of the 20th
centuries, it became identified with pathology and by the second half of the 20th century,
social sciences and psychology began to understand identity as multiple.
Undoubtedly, mid-century postmodern philosophers such as Foucault, Baudrillard,
Lyotard and Deleuze have severely criticized the modern concept of “identity,” initiating the
decline of the essential self (Lyotard 1984) and the concept of the essential self has
gradually eroded. In the wake of this decline, the social sciences have come to consider the
experience of multiplicity as universal. In other words, all human beings construct their
identity, their own self, with traces of experiences, meanings, desires and activities, often in
conflict and dependent on the socio-cultural contexts in which they develop. This way, the
negative nature of multiplicity has steadily lost intensity and has even acquired positive
values, particularly in a world where flexibility and complexity of social networks are the
rule (Gergen 2001, 2009).
The eruption of the metaphor of the narrator, understanding the human being as a
narrator, or as a living being who is continuously telling and being told stories to make
sense of his or her life experiences within a specific community, means questioning two of
the mainstays of the psychological tradition: the existence of elements of an essential
internal reality and the existence of a completely individualized and autonomous human
266 J Med Humanit (2011) 32:257–267

being. Bruner (1990) coined the term of “distributed self,” a self distributed among different
sociocultural scenarios in which it acts. Memory or intelligence from a cultural perspective
has also been considered distributed or interpersonal. In an even more radical manner,
Gergen (1985) moved away from the first formulations of psychology which saw the self as
a stable structure. He conceives the narrative self imbued with the social properties of
discourse and emphasizes the sociocultural nature of identity. Identity becomes a specific
discourse which is the product of social exchange. Identity is a social construction. From
what has been called the “Dialogical Self Theory,” Hermans (2001) conceives the “self” as
a set of multiple, dynamic and relatively autonomous positionings in the landscape of the
mind. From this point of view, the self can be transferred to different positions, even if they
are opposing. When characters get underway in a story, they acquire their own lives with
their own narrative requirements.
Other authors have also reached conclusions that complement the above-mentioned. In
two classic works, Watkins (1986) from psychology and Caughey (1984) from
anthropology focused on this question. Watkins shows that the practical repercussions of
the mental processes in which interiorized imaginary characters participate are exactly the
same as in those in which real characters participate. In the same vein, Caughey found in
his ethnographic research, Imaginary Social World, that imaginary relationships are very
usual in the western world.
Some of these approaches to identity are inspired by the contributions of the Russian
literary critic Bakhtín (1987). According to Bakhtín, thoughts, ideas and memory–the inner
world–embody multiple voices in dialog, be they real or imagined. Each person lives in a
wide range of scenarios (worlds); in each scenario he or she builds a character who
becomes an independent author telling his or her own narrative. This way, it is assumed that
each self is made up of a great multiplicity of authors in continuous dialog, constructing a
highly complex self. In summary, according to this perspective, self-construction is a socio-
genetic process involving voices imbued with past meanings and intentions from the social
contexts in which we live. In fact, the self of some schizophrenic patients and literary
heroes can be defined as an amalgam of disconnected voices that prevent the patient from
having a coherent and integrated identity. The powerlessness of people with schizophrenia
and protagonists of doubles in literature to integrate these voices discloses the social and
multiple nature of self.
Literature should become a resource for learning and reflection for all mental
health professionals as it brings us all closer to the subjective experience of
“madness,” beyond diagnostic categories, emphasizing the struggle of protagonists to
construct a communicable self on the fringe of the human condition. The experiences
of the literary heroes we have reviewed, like those of people with severe mental
disorders, gain meaning and existential value when they are conceived as an extreme
case of the struggle of human beings to achieve a balance between their selves in
conflict and build a coherent and shareable identity with the sociocultural values of
the community in which they live.

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