COVID-19 Renews Interest in the Psychiatric Symbolism of Windows

In 1980, during my first year as a psychiatry resident, I spent a quiet Christmas Eve on call watching “One Flew Over the Cuckoo’s Nest” in the day room with about a dozen patients. We all laughed and cried at the same scenes. At that moment, I could not discern any difference between myself and the patients. In Maya Angelou’s poem “Human Family,” she writes, “In minor ways we differ [but] in major ways we’re the same.” Collectively, she concludes, “We are more alike, my friends, than we are unalike.”

Mental Wanderlust

I have been reminded of this certitude countless times in my career, most recently while revisiting the classic 1966 film “Le Roi de Coeur” (“The King of Hearts”), a quirky anti-war fable set in France at the end of World War I. The film’s theme and message—who’s crazy and who’s sane— resemble the motif in Cuckoo’s Nest, only the inmates from the asylum have literally escaped and are in command of the town. The colorful patients have a glorious time running the shops before returning to the asylum (Asile D’aliénés), where the last line in the movie is spoken by one of the patients who approaches an open window and exclaims, “The most beautiful journeys are taken through the window.”

Peering through windows often gives rise to mental wanderlust—a natural tendency for the mind to wander—from the mundane to fantasy. Random trips into random topics are common and are a form of stress relief. Invariably, windows become fixtures that lead to daydreaming, and although daydreamers have been derided by society, daydreaming is considered a normal and healthy mechanism to overcome old, rusty ways of understanding the world and training the mind to expand even further through introspection and imagination. It is not unusual for a daydream, or series of daydreams, to precede an episode of creative writing or invention.(1) Sometimes the most important revelations and decisions come from looking into a window.

Classical Wanderlust

For psychiatric patients confined to mental hospitals, windows provide a way to look at the world outside and imagine the opportunities it offers. The patient Auguste Forestier (1887-1958) was famous for classical wanderlust—the urge to travel widely. His longing for faraway places resulted in repeated escapades around the globe. When he was eventually placed in an asylum and could no longer venture outside, Forestier invented imaginary means of travel and depicted them in his paintings and sculptures, which even Pablo Picasso admired. His wanderlust was unbroken by his detention in a psychiatric facility, prompting his psychiatrist to comment: “Forestier’s work will always bear traces of the ideal of the traveler.”(2)

The classical form of wanderlust, as originally described by 19th-century psychiatrists, was considered an obsessive-compulsive disorder, or, alternatively, an impulse control disorder similar to kleptomania and pyromania. Those who were severely affected, so-called dromomaniacs, were believed to be suffering a traveling disease.(3) In the 1890s, Europe was besieged by a small epidemic of mad travelers notorious for their extraordinary expeditions undertaken in dissociative fugue states. All were males and inevitably were incarcerated for vagrancy or assigned to a mental asylum, like Forestier.

Today, dromomania occasionally is mentioned as a consequence of homelessness, Alzheimer disease, or Munchausen syndrome.(4) However, wanderlust has been declassified as a pathological condition and has even become something desirable and attractive, reported to provide positive emotional experiences and mental health benefits. Studies have shown that higher levels of wanderlust are associated with greater odds of experiencing intense awe and joy during leisure travel, as well as small yet noticeable effects on self-reported life satisfaction.(5) Animal models of wanderlust, such as monkeys switching from exploiting a known resource to exploring various options, have demonstrated neuronal changes in the posterior cingulate cortex, an area associated with reward processing.(6)

COVID-19

The question remains, however, what happens to the human mind when travel is prevented or restricted, as with the COVID-19 pandemic? Certainly, we know that the prevalence of anxiety and depression will increase.(7) But is there an antidote for the pandemic other than vaccinations and travel bans? Can beautiful journeys actually be taken through windows, and might gazing through them counteract, in part, the mental health consequences of a lockdown? Here, I rely on my clinical experience to provide some answers, and I start at the beginning of my career.

A window figured prominently in my first clinical encounter with a psychiatric patient. In my third year of medical school, I was assigned to a state-run mental institution for my psychiatry clerkship. I approached the locked psychiatric ward with trepidation and skeleton key in hand. The key was provided to open the locked door to the inpatient unit. “The only way you can flunk this rotation,” my attending said, “is to lose the key.”

A tiny woman peering through the window of the door was awaiting my arrival. I inserted the key, and as I turned it, the woman backed away and disappeared into her room. Slowly opening the door, I entered the ward and turned around to relock it. Suddenly, the woman sprang from the doorway of her room and fixed her gaze on me. “Hey, Mr. DJ,” she shouted, “are you the postman?” The absurdity of her comment unmasked a profoundly disturbed and psychotic woman, and yet her behavior and question clearly indicated a longing for contact with the outside world.

Symbolism of Windows

Windows have many symbolic meanings in psychiatry. Peering through them may reveal opportunity, desire, and yearning. Windows also symbolize liberation. Recall that in the final scene of Cuckoo’s Nest, Chief Bromden finally has the courage to break free from the hospital. He escapes through a window after smashing it the way McMurphy had told him to—by grabbing a huge bathroom sink and plucking it from its base. As the other patients look on in shock, the Chief leaps through the window and into the open field. He has regained his freedom.

Although windows provide welcome light from the outside, they also may pose a threat by virtue of what the light might show, e.g., character flaws or other pathology prime for psychoanalysis. Psychotherapy is an ambivalent, uncomfortable experience for many patients. Their reluctance to open a window (“open up”) in therapy is one reason many sessions often are required before any improvement is seen.

Windows are a compelling metaphor to capture psychiatrists’ efforts to create access to the inner world of their patients. The phrase “windows to the unconscious” was coined by Sigmund Freud to label techniques for diagnosing hidden problems, such as dream interpretation. Tinted windows may shield patients from real or perceived threats in the environment. They must become translucent in order for psychoanalysis to proceed successfully.

Windows represent a visual bridge between the interior and the exterior, filtering elements that may frighten some yet entice others.

Windows often separate observers from participants. For example, individuals who tend to be isolated and disconnected from society commonly enjoy a rich inner life, but they are not fully engaged with their peers or with social activities. Windows represent a visual bridge between the interior and the exterior, filtering elements that may frighten some yet entice others. The frightened stay behind while the adventurous cross the bridge and seek new experiences. It’s no wonder that today’s wanderers speak of self-discovery and wanting to lose themselves to accomplish internal change. Without internal change, they argue, there is no fulfillment or meaning in life.

Although many individuals stare out of windows, in certain instances they are feared. Some people only feel safe when inside their homes; they dread going out, especially in crowded or public spaces. The plane of glass shields them physically; however, they are exposed psychologically and are vulnerable to the chaos of the external environment. For those individuals, windows represent something to avoid—except when the temptation to stare or gawk overrides their fear, as in Alfred Hitchcock’s “Rear Window.” The voyeur L.B. Jeffries (“Jeff,” played by Jimmy Stewart) would rather look at the lives of others through a window, aided by a telephoto lens on his camera, than live inside his own skin.

Cultural Contribution

Painters, poets, and musicians have added depth to the symbolism of windows in psychiatry. Joni Mitchell has described her life “from both sides . . . from up and down . . . from win and lose.” The Dutch baroque artist Johannes Vermeer painted his famous “Girl Interrupted at Her Music” from the perspective of light streaming through a window. Vermeer was considered a master of the use of light; his painting inspired author Susanna Kaysen’s memoirs, Girl, Interrupted—“interrupted at the music of being seventeen . . .” Singer-songwriter Aimee Mann’s musical adaptation of the account, “Queens of the Summer Hotel,” uses a line borrowed from an Anne Sexton poem written to her psychiatrist during her stay at a psychiatric hospital. All of these works incorporate psychological dimensions of storytelling and confession, illuminated through a window of artistic expression.

Conclusion

Windows are gateways to the human mind, and looking through them is a time-honored exercise in reflection and introspection. Although people appear to be looking outward, they are really looking within to find answers or explore new possibilities and terrain. Sometimes, when I stare out the window and daydream, I see myself in the window’s reflection, at first blurred, then gradually coming into focus. It’s a reminder that the line between sane and insane, between normal and crazy, is not always clear. I feel humbled. I’m transported back to the psychiatry day room watching Cuckoo’s Nest on the television. I’m in the company of patients who are psychiatrically ill yet acting normal. They are my family on Christmas Eve. They are more like me than unalike.

References

1. Strickland BR, ed. Gale Encyclopedia of Psychology. 2nd ed. Farmington Hills, MI: Gale Group; 2001:67-68. Available at www.al-edu.com/wp-content/uploads/2014/05/Gale-Encyclopedia-of-Psychology-2nd-ed.-2001.pdf .

2. Faupin S. Auguste Forestier’s unbroken wanderlust. Epidemiol Psychiatr Sci. 2017;26:228-230. DOI:10.1017/S2045796016000901.

3. Hackling I. Mad Travelers: Reflections on the Reality of Transient Mental Illness. Charlottesville, VA: University Press of Virginia; 1998.

4. Chapman JS. Peregrinating problem patients—Munchausen’s syndrome. JAMA. 1957;165:927-933. DOI:10.1001/jama.1957.02980260013003.

5. Chen-Chen C, Zou SS, Petrick JF. Would you be more satisfied with your life if you travel more frequently? Tourism Analysis. 2021;26(1):57-63(7). DOI: 10.3727/108354220X16072200013427.

6. Pearson JM, Hayden BY, Raghavachari S, Platt ML. Neurons in posterior cingulate cortex signal exploratory decisions in a dynamic multioption choice task. Current Biology. 2009;19:1532-1537. DOI: 10.1016/j.cub.2009.07.048.

7. Ettman CK, Abdalla SM, Cohen GH, et al. Prevalence of depression symptoms in US adults before and after the COVID-19 pandemic. JAMA Network Open. 2020;3(9):e2019686. DOI:10.1001/jamanetworkopen.2020.19686.