Writing Fiction In A Polyphonic Voice: The Psychiatric Creative Writing Workshop – Birgit Bundesen


By Birgit Bundesen, Chief Physician at Psychiatric Center Amager and project manager on a project on author lead writing workshops in psychiatry.


“In every soul thousands of souls are caught, in every world thousands of worlds are hidden.” (Ekelöf)


For the last two years we – a transdisciplinary research group of psychiatrists and professional fiction authors – have developed and conducted creative writing groups for people who are in psychiatric care at the Amager Psychiatric Center. Centered around the activity of creative writing, this group has the format of an art workshop. It is led by fiction authors in collaboration with a trained psychotherapist who is either a psychiatrist or a psychologist.

The participants have remarked on the value of having a group leader who is a fiction author. After her participation in 15 weekly workshops, for example, Anne, a 38 year-old who suffers from schizophrenia, reflected that:

It is important that it was a professional artist leading the group because the respect for the artistic was important. The artistic language is important: the language of fiction and poetry are more accommodating … . You can improve a text and make it more precise, but you can never write anything wrong. It was a relief to let go of the pressure to perform that has been a burden all my life. I would never have come if it had been a psychotherapy group.

Working with texts, as it takes place in the psychiatric writing groups, is primarily dialogic in Bakhtin’s sense. Emma, a participant, put it like this:

I had always attempted to explain to other people … how difficult it was to me, but no one could understand. There was always this reality that I could not bring with me into reality, which meant that there were two voices inside of me, the light and the dark. But I managed to write a text, where those two voices were able to speak to each other. It was a great pleasure to write that text. Because there was a distance in there which made it possible to say it aloud and relate to it as something that did not own me, but rather as something that I owned.

Bakhtin develops his concept of polyphony as a way of describing the novelist as possessing an exemplary ability to project discursive voices, such as in the form of fictional characters who in their stylized fictional form can emerge next to each other while voicing conflicting perspectives. These need not be subordinated, but enter into a joint dialogic process with each other as well as with the reader. This is based on an understanding of subjectivity where the I is constituted by a heterogenous mass of inner disagreements that can be condensed to quasi-autonomous I’s, what Bakhtin refers to as “voices” (Bakhtin 1984).

Bakhtin’s concepts of the dialogic and the polyphonic have been employed in psychology to create a dialogic model of the self as a collection of ‘inner voices,’ which refer to remnants of personal experiences which can condense into multiple and more or less autonomous centers of experience (Dimaggio & Stiles, 2007). The notion of the dialogic emphasizes that the self is constituted in the infant through dialogue; at first between mother and infant, and then remains as a dynamic factor in the self.

Language is shaped by our relationships to others and develops dialogically as an approach – perhaps a reaching out – to someone. Language can be aimed, more or less directly, towards really existing others, but also towards imaginary but still significant others. This can be the individual’s voice, but it can also be the voices of existing or imagined others that have become sedimented inside the individual as semi-autonomous units, which emerge within linguistic utterances as hidden voices. These voices can emerge in the structure of linguistic utterance – such as in the form of pauses, changed intonation, a surprising word choice, dialect or as jargon. It is the responsibility of the psychotherapist to create a “dialogic space” where these voices can emerge, where they can be heard, and where they can be cultivated in a shared narrative process (Leiman, 1998). Words or non-verbal signs can create a connection between the individual parts via meaningfulness, which can be established in a dialogic process such as in psychotherapy (Stiles, 2011), where the process can be regarded as a polyphonic, intrapersonal orchestration of one’s inner voices in collaboration with a listening other.

Creative writing shares with psychotherapy the conscious effort to stylize internal voices and feelings into discursive concepts; this effort makes them not only communicable but vests them with a distance that makes the concepts suitable as technologies of self-understanding.

The fiction author who leads the writing group can play with or challenge different voices in the texts by doing such things as reading aloud the texts written by the participants or by pointing out stylistic peculiarities. The stylization in fictional language provides a distance that enables a participant to experience imaginary variations of his or her own self. These emerge in the modality of the ‘what could be,’ and are not exhausted by the real. New patterns are capable of emerging that call attention to new possibilities for being in the world. One of the roles of the group leader is to listen and then to draw the participants’ attention to the formal properties of the texts. The increased awareness of language makes possible self-reflection as well as more precision in their subjective writing. It is a fundamental assumption here that form and thought are two sides of the same coin, and that stylistic mastery makes it possible to give shape to what would otherwise remain unconscious and shapeless.

After they are written, the texts are then discussed. While the discussion is based on the premise that no single interpretation is authoritative, when they are shared the texts come to life through the conversation, and tend to become woven into the group’s shared activity as a common text in the course of the writing group’s meetings. It is by experiencing the processes of writing and reading as collective events that the individual participants experience the effects of the art workshop. A turning point is reached when the group has a shared experience of art, as well as the experience of a flow of associations in which the individual texts come to be interlaced in a motley but communal texture.

Conceived as an art workshop, the writing group is conceived as a common space of possibility for the participants, as a pattern or texture that is yet unwritten and that can emerge only if the atmosphere is safe and containing for the participants. By placing his or her voice in the group, each person weaves a strand into a collective text that is in the process of being written. If the writing group can be viewed as a safe container where the voices of the participants can emerge, it is by listening to the resonant and the dissonant processes that the mental health therapist has the specific responsibility of insuring a space for the many different kinds of independent voices in the group.

Since it is a characteristic of the writing group that the artwork or text object is brought into being through a collaboration in that particular context, the workshop must be a dialogic and polyphonic space in which everyone has a voice and where all assertions are accorded the same weight.

One can never know in advance the ultimate goal of the writing group. One can introduce ideologies, technologies and common goals into groups, fashioning them into working groups. The patterns come to be structured not only around what is common, but also around what we do not agree on and what we cannot share: the lonely, the silent, the unsayable – a limit which can be the beautiful or the horrific.

Even the silent participant also participates, as a marker of one who listens, and who listens without yet speaking, as the reserve of an unspoken. And for the group, an empty chair can even assume more space than an occupied one; an unoccupied space figures less an absence than it figures a space of possibility.

The process in the group is directed towards verbalizing what already exists in the texts of each individual. While this verbalization may be marked by disagreements that may not be able to find any unambiguous harmonization in a single narrative form, the literary work and the work with formal literary strategies can still be indirectly therapeutic. We can disagree, our patterns can get tangled up in knots, touch off dissonance, creating interference with the other patterns in the group.

If the group has established itself as a yet-to-be written and principally incompletable joint text it comes to possess an ability of transmutation which can change crisis to sparks, dissolving partial patterns in order to create new ones.

Something special happens when groups are established that are able to become more than the sum of their individuals: patterns arise. Like a text, the I is also a pattern, a special organization of bodily, social and psychological impulses constituting a sketch or projection of the person. Through my speech my social relatedness is revealed, my class, my profession: this text speaks itself through me, and it reveals the worldliness, and the different worlds, of which my life-world is constituted. The Swedish poet Ekelöf writes, “A world each man is, inhabited by blind creatures in dark rebellion against the I, the king, that rules over them. In every soul thousands of souls are caught, in every world thousands of worlds are hidden.” The group exists from the outset as a pattern of individual texts, some still uncomposed – and they will come to be based not only upon conscious and unconscious structures, but also upon the meetings offered by the group. Between an inner text or identity, and an expressed or written text; between the single texts and meetings; between all the voices speaking in the texts.

Through my intonation and my choice of words I reveal my history: both consciously and unconsciously I cite those dear to me; my idols; sometimes the ones whom I fear; mixed with literary quotes, political slogans, and figures of speech. Multiple voices can reverberate, mumbling and speaking through us, heard as emerging out of the past. This choir of words, composed of both talking and silence. And composed of words that are spoken by us and by words that are spoken through us – by the language that we consist of.

In the group, the pattering of the individual emerges from the individual’s meeting with other patterns: weaving together in complex textures when we speak and interact, in and out of each other. What shows itself as words, attitudes, gestures, mimicry, gazes and patterns of movement are also part of language, and are also part of the pattern that makes up the group’s becoming woven together, as it forms a matrix or container to grow within, the inside of which provides nourishment for all its members in an exchange.

This nourishment is given back to the group in the form of an ecology of giving and taking. The group pattern forms a cycle of the inspired and the exhaled, the digested and the excreted. Held together by the meaningfulness of the spoken, by the unspoken thought, and by the desired and the feared, its vault is a reverberating membrane with interactive borders and the patterns of other worlds – lived, imagined and dreamed.

When we meet to create art we open ourselves up to the group in the pattern that we already are. Creation requires engagement. We meet to write fictional texts and to share these with each other. Every text carries the imprint of its author, and every text is addressed. It is addressed to someone; those to whom we wish to say something; those who are present in the room, or those who are not; to the real as well as the nonexistent. If the atmosphere is safe and I feel cared for, both contained by others and containing for others, I am able to open up to all the other texts that comprise or that could comprise me.

The texts are technologies of self-completion: I understand myself in the tiny mirror of the text. Fictional language creates the distance that makes visible the imagined variations of the ego, understandable to myself in play. The text shows me the pattern that I am and changes the world in that process. The group as an incompletable pattern is an actualization of the possibilities we are when we meet.

– Bakhtin, M. (1984): Problems of Dostoevsky’s Poetics. Minneapolis: University of Minnesota Press.
– Dimaggio, G. et al. (2007): Psychotherapy in Light of Internal Multiplicity. Journal of Clinical Psychology 63.2: 119–127.
– Ekelöf
– Leiman, M. (1998): Words as Intersubjective Mediators in Psychotherapeutic Discourse: The Presence of Hidden Voices in Patient Utterances. In Lähteenmäki, M., Dufva, H. Dialogues on Bakhtin: Interdisciplinary Readings. University of Jyväskylä: Centre for Applied Language Studies, pp. 106-117.
– Stiles, W. B. (2011): Coming to Terms. Psychotherapy Research, 21(4): 367–384.