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[Expositions 8.1 (2014) 29–37]  Expositions (online) ISSN: 1747–5376 

Madness Defamiliarized: The Value of Poetic Description of Mental Illness 
 
NATHAN GOWER 
Campbellsville University 

 
 

In his memoir Darkness Visible, William Styron argues that a cultural overuse and dampening of 
words like “depression” or “melancholy” can—prevent people who do not suffer from mood 
disorders from fully understanding the madness these words should truly connote. As someone 
who has dealt with severe clinical depression first hand, Styron is unapologetic in his claim that 
our language is grossly deficient in providing a true context for mental illness: 

 
[Depression is a] noun with a bland tonality and lacks any magisterial presence, 
used indifferently to describe an economic decline or a rut in the ground, a true 
wimp of a word for such a major illness. […] Nonetheless, for over seventy-five 
years the word has slithered innocuously through the language like a slug, leaving 
little trace of its intrinsic malevolence and preventing, by its very insipidity, a 
general awareness of the horrible intensity of the disease when out of control. (37) 

 
A similar claim might be made about any number of words used to describe variants of mood or 
schizotypal disorders. Consider the word “madness” itself, which is used as a sort of slippery 
catch-all to describe mental illness in academic and popular discussions alike. A very simplistic 
question, then, is Why don’t we have more sufficient words at our disposal? The problem with 
answering this question lies primarily in the fact that our words to describe madness have, 
indeed, changed over time; yet we are still left with the same deficiencies. It seems likely, then, 
that the problem is not with individual words themselves, but with what Virginia Woolf calls the 
“poverty of language” in describing illness: “English, which can express the thoughts of Hamlet 
and the tragedy of Lear, has no words for the shiver and the headache. It has all grown one way. 
The merest schoolgirl, when she falls in love, has Shakespeare or Keats to speak her mind for 
her; but let the sufferer try to describe a pain in his head to a doctor and the language at once 
runs dry” (7). 

Importantly, in preventing an accurate portrayal of mental illness, this poverty of language 
serves to promote a sort of cultural pseudo-familiarity with madness that leaves most of us—to 
manipulate a well-worn proverb—with just enough knowledge of mental illness to be dangerous. 
This seems particularly true considering Daniel Nettle’s well-argued claim that many of the traits 
of the “madman” are characteristics that are present, though attenuated, in “normal” people, that 
madness is in fact a gradation at the extremes of normal human experience. He even claims that 
“the symptoms of madness are related to the proper functioning of the human mind. They differ 
from health in that they are terribly exaggerated” (9). It seems reasonable, then, that most people 



Madness Defamiliarized  30 
 

who are free from the extremes of mental illness might overestimate their ability to understand 
madness or sympathize with those who are suffering in its grip. 

If this is indeed the case, and if language is a primary barrier in conveying the experience of 
the mentally ill, where do those of us who do not suffer from madness turn to better understand 
it? Paradoxically, I would argue that rather than looking away from language, we might confront 
its challenges head on to exploit what it does well: clarify through metaphor and other poetic 
devices. For this, we might turn to an important concept in the art of fiction writing that was first 
introduced during Modernism. 

 
Defamiliarization in Context 
 
In his 1917 essay “Art as Device,” Russian writer and critic Viktor Shklovsky coined the term 
“defamiliarization” to help define a literary device that was widely used, but not discussed in 
scholarship. Defamiliarization (or “estrangement,” as it is sometimes translated) is the literary 
device of using poetic language to make familiar concepts strange. I will argue that overlaying 
this literary device on the concepts of madness will prove to be useful; but first one needs a 
better understanding of why defamiliarizing concepts is desirable in its own context: creative 
writing. 

Shklovsky argues that the idea that “Art is thinking in images,” first propounded by Potebnya, 
is misguided because the paradigm “has failed to notice that there exist two types of imagery: 
imagery as a practical way of thinking, that is, as a means of uniting objects in groups, and 
secondly, imagery as a way of intensifying the impressions of the senses” (3). The former type is 
the imagery of prose (used very strictly by Shklovsky to mean practical writing without any 
poetic leanings) while the latter is the imagery of poetry (used broadly to include fiction and 
other creative forms). This distinction is crucial to Shklovsky’s argument because he is working 
toward a dismissal of Veselovsky’s idea that “The merit of a style consists precisely in this: that 
it delivers the greatest number of ideas in the fewest number of words” (qtd. in Shklovsky 4). 
While Shklovsky readily accepts that economy of language by the writer equals an economy of 
effort by the reader, and therefore it should govern the practical domain of language, he makes 
clear that “we have to consider the question of energy expenditure and economy in poetry, not by 
analogy with prose, but on its own terms” (4); and it is in this assertion where defamiliarization 
becomes crucial. 

Since poetic imagery, as explained by Shklovsky, is to intensify the impressions of the senses, 
sometimes there is reason to be purposefully uneconomical; that is to say, there is value in 
allowing the language of poetry and creative prose to levy a mental and emotional tax on readers, 
to create a sort of hard-work reading experience: “By estranging [defamiliarizing] objects and 
complicating form, the device of art makes perception long and laborious” (6); and unlike the 
reading of “practical” prose, this laboriousness is what gives poetic heft and value to the reading 
of creative works: “And so, in order to return sensation to our limbs, in order to make us feel 
objects, to make a stone feel stony, man has been given the tool of art” (6). 



31  Gower 
 

Examining the concepts of defamiliarization through example is perhaps the best way to see its 
value, and we will do just that in a later discussion of defamiliarizing the language of madness. 
For now, examining Shklovsky’s own analysis of defamiliarization in Tolstoy’s writing will 
suffice to illustrate its importance in the poetic purposes of creative work:  

 
The devices by which Tolstoy estranges [defamiliarizes] his material may  be 
boiled down to the following: he does not call a thing by its name, that is, he 
describes it as if it were perceived for the first time. […] In addition, he foregoes 
the conventional names of the various parts of a thing, replacing them instead 
with the names of corresponding parts in other things. Let me demonstrate this 
with an example. In “Shame” Tolstoy estranges the idea of flogging by describing 
people who, as punishment for violating the law, had been stripped, thrown down 
on the floor, and beaten with switches. […][This] is typical of the way Tolstoy 
reaches our conscience. The usual method of flogging is estranged by a 
description that changes its form without changing its essence. (6) 

 
And it is here, in changing a concept’s form but not its essence, where we might find incredible 
value in the use of defamiliarization in our discussion of mental illness. The intent of describing 
madness in poetic, even bizarre language is not to undermine its severity or trivialize the very 
unpoetic pain of the sufferer; rather, poetic language can help us see madness where we have 
overlooked it before; and this goal finds a direct link with Shklovsky’s assertion that “After 
being perceived several times, objects acquire the status of ‘recognition.’ An object appears 
before us. We know it’s there but we do not see it, and for that reason, we can say nothing about 
it. The removal of this object from the sphere of automatized perception is accomplished in art” 
(6). For the remainder of this paper, the “object” in question is our understanding of madness. 

 
Criteria for Defamiliarizing Madness 

 
Importantly, if there is value in using poetic language to defamiliarize our collective framework 
for the many offshoots of madness, we must establish some criteria for which creative works can 
be relied upon to help further this purpose. The first criterion builds from a claim argued in the 
introduction of this paper: if one accepts the position that those who do not suffer at the extremes 
of mental illness will likely lack proper perspective (and language) to describe it, one must 
conclude that those who have first-hand experience of madness are the prime candidates to 
defamiliarize the language which governs it.  

However, it is important to recognize that first-hand knowledge is only half of the equation. 
An equally important criterion in establishing authorities for defamiliarizing the language 
revolves around a mastery of poetic language itself. One cannot reasonably equate personal 
experience of madness with an ability to poetically articulate what that experience is like.  



Madness Defamiliarized  32 
 

Incidentally, there is an ever-growing consensus in medical and psychological scholarship that 
there exists a correlation between creativity and madness, and this link exists whether one is 
discussing affective or schizotypal disorders. In discussing mood disorders, Jamison writes, 
“Recent research strongly suggests that, compared with the general population, writers and artists 
show a vastly disproportionate rate of manic-depressive or depressive illness” (5). Similarly, 
arguing a link with schizotypal disorders, Nettle writes, “The evidence for a link between 
schizotypal traits and creative thinking is quite strong” (135). The research by Jamison and 
Nettle, which is extremely helpful but much too involved for the purposes of this paper, indicate 
that finding people who have (1) first-hand experience with mental illness, and (2) the creative 
capacity to articulate that experience poetically, might not prove difficult. Importantly, though, 
just as mental illness does not presuppose creativity, a creative disposition does not presuppose 
mental illness. One must seek both of these criteria independently when searching to find poetic 
language that is helpful to defamiliarize madness. 

Once these criteria have been established, we might turn our attention to the pragmatic work 
of digging through the literature itself to see what we can learn. The remainder of the paper will 
suggest three ways poetic language can work to defamiliarize madness. 

 
Defamiliarization through Imagery 
 
Perhaps the most direct application to consider is the use of poetic imagery—the kind of imagery 
that Shklovsky says should “intensify the impressions of the senses”—in narrative passages 
describing madness. A wonderful example of such a passage can be found in the fiction of 
Breece D’J Pancake’s most celebrated short story, “Trilobites.” Certainly no stranger to 
madness, Pancake was described anecdotally as a “lonely and melancholy man” (McPherson 9). 
While he was never formally diagnosed, literary accounts of his life strongly suggest he suffered 
somewhere on the broad spectrum of affective disorders, and there is some speculation that his 
suicide at the age of 26 was partially the result of a psychotic break (McPherson 17–18).  

Consider the imagistic portrayal of madness in this very brief passage from “Trilobites,” just 
after the depressed protagonist Colly is asked what killed his father:  
 

“Little shell fragment. Been in him since the war. Got in his blood . . .” I snap my 
fingers. I want to talk, but the picture won’t become words. I see myself scattered, 
every cell miles from the others. I pull them back and kneel in the dark grass. I 
roll the body face-up, and look in the eyes a long time before I shut them.” (34; 
emphasis added) 

 
What Pancake creates here is a series of images, almost cinematic in presentation, that conveys a 
depth of depressed experience. We see (and hear) the snap of the fingers, the mouth trying to 
form words that cannot escape. We see Colly being ripped apart at a cellular level (however it is 
that we subjectively experience that image), and then him collapsing to the darkness below his 



33  Gower 
 

feet. Importantly, Pancake never gives us slippery abstractions like “depression” or “confusion” 
to deal with; but instead, he allows the poetry of his language to defamiliarize these abstractions. 
In this way, even the reader who has never experienced the polar ends of depression can, at least 
for the moment, feel what it is to live in that dark place. 

The use of metaphor can also wield the power of poetic imagery to help defamiliarize 
madness. For an example of this, we might look at a passage from Marya Hornbacher’s memoir 
Madness: A Bipolar Life. As the title suggests, Hornbacher has been clinically diagnosed with 
manic-depressive disorder. In the following passage, she illustrates a scene of madness she once 
shared with a short-term companion she ironically calls “Crazy Sean”: 
 

How long have we been gone? It doesn’t even occur to us. We scream to be heard 
over the wind. Colorado. We are paranoid, afraid of the crowded bar. We are 
afraid in the grocery store, trying desperately to find booze. We are coming in and 
out. We are a radio station. We are a short wave. We are the news. The 
fluorescent lights are threatening and burn my eyes. We recoil, run out of the 
store, lock ourselves in a motel room, all orange shag carpet, one of those horrible 
seventies globe lamps dangling from a chain. The chain concerns us. We discuss 
which of us should hang ourselves first. (120) 

 
Hornbacher’s language is strange, indeed, and the metaphors she uses are a sort of puzzle the 
reader is forced to work through. Unlike the example from Pancake, Hornbacher does choose to 
use some abstractions, explicitly stating that they were “paranoid” and “afraid”; and these words 
might provide a sense of familiarity for the reader, a sort of way in to the discussion. If 
Hornbacher had left the description dangling on these abstractions, though, she would have been 
expressly inviting the unaffected reader to rely completely on his or her own limited 
understanding of these words based on a worldview outside of madness. Instead, she 
defamiliarizes what these words mean to two people swept away in a flurry of mania. 

Poetic imagery, then, is one way to consider the defamiliarization of madness through creative 
writing; but what can one learn by looking past the images and into the form and style of the 
writing itself? 

 
Defamiliarization through Form and Style 

 
Building on Shklovsky’s original assertion that there is a clear distinction between the language 
of creative writing and that of practical prose, I have employed “poetic language” very broadly 
across creative genres. While this is appropriate, one should not dismiss the value of poetic form 
and the way it might be used to defamiliarize madness in ways that creative prose might not. 
Consider Emily Dickinson’s poem “Pain – Has an Element of Blank”: 

 
Pain – has an Element of Blank – 



Madness Defamiliarized  34 
 

It cannot recollect 
When it begun – or if there were 
A time when it was not – 

   
It has not Future – but itself – 
Its Infinite Realms contain 
Its Past – enlightened to perceive 
New periods – of Pain. 

 
It is well documented that Dickinson suffered frequently from both physical and mental illness, 
so one cannot be certain here of the specific nature of the “pain” Dickinson had in mind. 
Nonetheless, this poem can be very instructive if we apply it to pain associated with mental 
illness. Its imagery is very effective, but we will leave that aside for now to focus on the form.  

Consider, first, all those dashes, the prevalence of which is always a good indication one is 
experiencing a Dickinson poem. Many publications of the poem omit the dashes, as early 
publishers of Dickinson adjusted her unusual punctuation and idiosyncratic capitalization to meet 
the conventions of the day; but I argue that the dashes are a crucial element here, and to omit 
them is to undermine one of the more helpful aspects of the poem. The dashes force readers to 
slow down, to challenge the assumptions they may already have about the very familiar word 
“pain.” 

Notice, too, how the dashes set off “pain” on either end of the poem, which serves to reinforce 
the idea that pain is an altogether set-apart experience, one that has an “element of blank,” one 
that cannot recognize itself unless it is in the very moment when the pain occurs. Aside from the 
dashes, there is value in beginning and concluding the poem with the word “pain,” as it invites 
the reader to end where he or she began, commenting on the cyclical nature of pain, echoing the 
idea that pain “cannot recollect / When it began – or if there was / A time when it was not” (2–4). 

In the same way that poetic form can serve as an important tool in defamiliarization, stylistic 
choices in creative prose can achieve a similar result. For an example, we can return back 
Hornbacher’s memoir, Madness: A Bipolar Life: 

 
I run. Time stops. Thoughts stop. The never-ending pounding of my blood, the 
energy that surges through me all the time these days, it never runs out, I feel as if 
I will explode with it, I run. Up and down the long hall, compulsively touching 
the cold metal door on each end, must touch it or it doesn’t count, one mile, five 
miles, ten miles, chanting thinner, thinner, thinner, I am killing myself with the 
running, the starving, but I am alive. (36–7) 

 
As with the previous Hornbacher passage, the language here is strange, almost threatening; but 
behind the language is a style and structure that is instructive on its own terms. The first three 
sentences are only two words, producing a jarring staccato rhythm that lets the reader in on a 



35  Gower 
 

secret: this world is different than yours. Then, without warning, Hornbacher unleashes a series 
of run-on sentences, which creates a breathless reading experience. On several occasions, one 
might even feel a bit anxious in the pacing of Hornbacher’s writing; and one should not dismiss 
this feeling as a coincidence. To say nothing of the subject matter—which jumps from one 
loosely connected idea to the next—the style and structure of the passage gives the reader a way 
to approach a manic experience in a way that is unavailable in practical prose. 

We have seen, then, that poetic imagery coupled with intentional form and style can serve as 
an important method of defamiliarizing madness. Still, there may be an even more direct 
approach: to explicitly contrast our limited concepts of mental illness to the real world of 
madness. 

 
Defamiliarization through Poetic Rhetoric 
 
Sometimes the best method of breaking preconceived notions about any subject is to tackle them 
head on, treating them as rhetorical counter-claims to a more appropriate thesis. To be sure, 
poetic language and rhetoric are not mutually exclusive; in fact, a poignant passage from 
Styron’s memoir Darkness Visible demonstrates how the two can be combined to help 
defamiliarize madness. In response to the popular belief that unaffected people can readily 
sympathize with those who suffer from clinical depression, Styron writes: 
 

What I had begun to discover is that, mysteriously and in ways that are totally 
remote from normal experience, the gray drizzle of horror induced by depression 
takes on the quality of physical pain. But it is not an immediately identifiable 
pain, like that of a broken limb. It may be more accurate to say that despair, 
owing to some evil trick played upon the sick brain by the inhabiting psyche, 
comes to resemble the diabolical discomfort of being imprisoned in a fiercely 
overheated room. And because no breeze stirs this caldron […] it is entirely 
natural that the victim begins to think ceaselessly of oblivion. (50) 

 
From the first sentence, Styron fights against the misinformed notion that severe depression is 
somehow knowable through normal experience, and he is building on an idea he introduced 
earlier in the memoir that depression is “so mysteriously painful and elusive in the way it 
becomes known to the self—to the mediating intellect—as to verge close to being beyond 
description” (7). The best way to attempt a description, Styron seems to be saying, is to counter 
what most people think depression is. The passage suggests that depression is not merely 
sadness, but it closer to physical pain; yet experience of physical pain is not quite enough to 
sympathize either because depression is “not an immediately identifiable pain, like that of a 
broken limb” (50) but something outside of the realm of normal existence. Once his counter 
claim has been made, he sets in to defamiliarizing the sensation of depression by placing the 



Madness Defamiliarized  36 
 

reader in a stifling hot room with no circulation, which is no doubt something most everyone can 
relate to, but had probably not considered in terms of depression. 

Later in the memoir, Styron employs the same pattern of rhetorical defamiliarization in 
addressing the misconception that mental illness, like familiar types of sadness or pain within the 
normal human experience, should simply be absorbed on the short term, as things will return to 
equilibrium soon enough: 

 
There is a region in the experience of pain where the certainty of alleviation often 
permits superhuman endurance. We learn to live with pain in varying degrees 
daily, or over longer periods of time, and we are more often than not mercifully 
free of it. […] In depression this faith in deliverance, in ultimate restoration, is 
absent. The pain is unrelenting, and what makes the condition intolerable is the 
foreknowledge that no remedy will come—not in a day, an hour, a month, or a 
minute. […] It is hopelessness even more than pain that crushes the soul. So the 
decision-making of daily life involves not, as in normal affairs, shifting from one 
annoying situation to another less annoying […] but moving from pain to pain. 
One does not abandon, even briefly, one’s bed of nails, but is attached to it 
wherever one goes. (61–2) 

 
Here again, in language that is accessible but beautiful, Styron presents his counter claim: one 
cannot simply “wait out” this type of madness like forms of minor illnesses because when one is 
at the center of the depression, one genuinely feels the end will simply not come. This, Styron 
argues, is one reason we see so many suicides as a result of mood disorders. 

 
Conclusion: The Limits of Defamiliarization 
 
Mental illness, in all its forms both known and unknown today, is much too complicated to 
reduce to a simple formula for understanding; and studying the defamiliarization of madness 
through poetic language certainly does not intend to attempt such a reduction. Still, it is 
important to recognize the wealth of first-hand knowledge of madness that is accessible in our 
most celebrated creative writing, only a miniscule fraction of which has been discussed in this 
paper. While individual words may fail in our attempts to peel back the complexities of mad 
experience, creative writing can serve as a reminder that our language is more than the sum of its 
parts. 
 

 

 

 



37  Gower 
 

 

 

Works Cited 

Hornbacher, Marya. 2008. Madness: A Bipolar Life. Boston: Mariner Books. Print.  
 
Dickinson, Emily. 1960. Complete Poems. Ed. Thomas H. Johnson. Boston: Little, Brown. 

Print.  
 
Jamison, Kay Redfield. 1994. Touched with Fire: Manic-Depressive Illness and the Artistic 

Temperament. New York: Simon & Schuster. Print. 
 
McPherson, James Alan. 2002. “Forward.” The Stories of Breece D’J Pancake. New York: 

Back Bay Books. 3–19. Print. 
 
Nettle, Daniel. 2001. Strong Imagination: Madness, Creativity and Human Nature. Oxford: 

Oxford University Press. Print. 
 
Pancake, Breece D’J. 2002. “Trilobites.” The Stories of Breece D’J Pancake. New York: 

Backbay Books: 21–37. Print. 
 
Shklovsky, Viktor. 1998. Theory of Prose. Trans. Benjamin Sher. Normal, IL: Dalkey 

Archive Press. Print 
 
Styron, William. 1992. Darkness Visible: A Memoir of Madness. New York: Vintage Books. 

Print 
 
Woolf, Virginia. 2012. On Being Ill. Ashfield: Paris Press, Print. 


