Man Of La Mancha performed by the English National Opera

Dramatherapist at the theatre. The mad man Don Quixote is living in a fantasy land. How can dramatherapy work with people with psychosis? #dramatherapy #psychosis #schizophrenia #impossibledream

I saw this English National Opera performance, at the London Coliseum, on the 11th May. It stared Kelsey Grammer in the lead role of Cervantes / Don Quixote and Danielle de Niese in the role of Alsonza/Dulcinea. The imposing multi tiered set and 35 piece orchestra vividly brought this classic tale alive.

Spoilers *This blog contains spoilers about Man of La Mancha. If you are not familiar with the plot in the 1965 musical, or the 1972 film or the 17th-century source novel Don Quixote, then you will find out some of the plot twists if you continue reading* As usual with my dramatherapist at the theatre blog, I will be unpicking some of the main themes and looking at some related dramatherapy or psychotherapy theories.

The Plot

Cervantes lives in a fantasy land; he believes he is a medieval soldier named Don Quixote on a quest to be knighted, he starts a fight with a windmill he mistakes for a four armed giant, he believes a shaving basin is the magical”golden helmet of Mambrino”, he mistakes a prostitute named Aldonza  for his pure lover Dulcinea. Throughout it all he is pursued by his niece Antonia and her fiance Dr. Sanson Carrasco who are highly embarrassed by his behaviour and want to put a stop to his madness before he makes a fool of their family.

And yet, throughout the farce of the delusions, there is something very appealing and truthful about Don Quixote’s quest. He is motivated to be the “Destroyer of evil”, he sees the good in those he meets, he embodies values of chivalry and justice “I am brave and courteous, bold and generous”

Is fantasy dangerous?

Many people believe it is dangerous to live in fantasy. In an early parents evening one of my teachers told my parents that I had “a wee butterfly mind” as I was often daydreaming. This is perhaps a little cute in a child with an edge of frustration from a teacher with targets to meet, it is a sign of bad behaviour in teenagers who should have grown out of it. When someone hears voices many people want to tell them it is not real, to medicate them until the voices stop, or in TV and film adaptations we see them being strapped to a trolley and wheeled away to a room with no stimulation that could set off their madness. When someone has dementia, do you allow them to live in their past memories or do you correct them with the reality of the present?

In Man of La Mancha, Cervantes family and friends explore whether excess of imagination harm anyone:

Aldonza :You’re more of a fool than he is
playing tricks on a man who is mad. Leave me!

Priest:  One might say Jesus was mad… or St. Francis.

Sansón Carrasco: A man who chooses to be mad can also choose to be sane.

Man Of La Mancha playtext

Because we are a society we frame visions, halucinations and living in a fantasy as signs of psychosis and mental illness, and we literally talk about mad people “loosing their mind”, the idea of using drama for fantasy is met with suspicion by some. But actually, sometimes drama can allow us to get very close to difficult subjects without feeling overwhelmed.

We have considered the most common criticism of drama – that it is dangerous, that it is not real and that it can confuse people, and redefined it within a different reality, that of dramatic truth that is safe because of the distancing that is established through symbol and metaphor, as well as the setting of limits and boundaries.’

Jennings, S. (1990). Dramatherapy with Families, Groups and Individuals. London: Jessiea Kingsley. Page 24

Real and not real

Although Cervantes spends most of the play in role as Don Quixote, he has moments where he seems to be very aware that the fantasy is not real and reflects on some of the real experiences under this character:

Cervantes : My friend, I have lived almost fifty years, and I have seen life as it is. Pain, misery, hunger… cruelty beyond belief. I have heard the singing from taverns and the moans from pitiful bundles of filth on the streets. I have been a soldier and a slave. I have seen my comrades fall in battle, or die more slowly under the lash in Africa. I have held them in my arms at the final moment. These were men who saw life as it is, yet they died despairing. No glory, no gallant last words. Only their eyes filled with confusion, whimpering the question: Why? I do not think they asked why they were dying, but why they had ever lived. When the world itself seems lunatic, who knows where madness lies? Too much sanity may be madness. To seek treasure where there is only trash. Too much sanity may be madness. But, maddest of all, is to see life as it is . . . and not as it should be.

Man Of La Mancha script

When someone has experienced any kind of trauma, abuse or grief, fantasy and dramatherapy can offer a vehicle to explore the reality in a way which takes in the important themes rather than focusing in on the specific painful details.

‘Though the performance itself does not alter ones external reality, an integrated post performance period can lead one to make positive life changes’

Emunah, R. (1994). Acting for real: drama therapy process, technique, and performance. New York: Routledge Ltd. Page 298

Imagined hope in a cruel reality

But not everyone is able to experience the hope of the Don Quixote quest. After being wooed as the sweet Dulcinea, Aldonza has a cruel wake up call that her real life is still full of trauma, abuse and a lack of love.

Aldonza: Crime. You know the worst crime of all? Being born. For that you get punished your whole life!

[Sings] I was spawned in a ditch
By a mother who left me there,
Naked and cold and too hungry to cry;
I never blamed her.
I’m sure she left hoping
That I’d have the good sense to die! …

You have shown me the sky,
But what good is the sky
To a creature who’ll never
Do better than crawl?

Of all the cruel bastards
Who’ve badgered and battered me,
You are the cruelest of all!
Can’t you see what your gentle
Insanities do to me?
Rob me of anger and give me despair!
Blows and abuse
I can take and give back again,
Tenderness I cannot bear!
So please torture me now
With your “Sweet Dulcineas” no more!
I am no one! I’m nothing!
I’m only Aldonza the whore!

A key to understanding Aldonza’s struggle is that Aldonza has no safe base from which to imagine a different world. Maslow’s Hierachy of Needs suggests that there must be a foundation of the lower needs like food and safety before the person can focus on some of the higher needs like love and self-esteem. For this reason I know many therapists will not work with clients whose lives are not stable enough to integrate the changes achieved in therapy.

But life is rarely linear, sometimes it is not until the person has built trust in someone else that they can begin to reflect on their life and decide to meet some of their basic needs.

For example, Dramatherapists have done some fantastic work with clients in prison helping to look at reform and healing early traumas even though the prison cell they return to is not necessarily the ideal safe space. Dramatherapists have also worked with clients who self harm or are suicidal because sometimes the client needs that therapeutic relationship as part of their journey to healing.

Any therapeutic work with clients who are vulnerable needs to be done within professional boundaries to ensure the clients safety is cared for. The work is not always easy, and sometimes, like Aldonza, the client does not yet feel able to leave an abusive situation in search of safety or to begin to practice self love and inner healing.

Face facts

Photo by Katie Bell from Pexels

In the musical, after being rebuked by Aldonza/ Dulcinea, Don Quixote must face his enemy the Knight of Mirrors, or actually his nieces fiance, Dr. Sanson Carrasco in disguise, who has come to force Cervantes to face the truth; he is not Don Quixote the knight, he is a disillusion old man. #

“Thou art no knight, but a foolish pretender. Look in the mirror of reality and behold things as they truly are. A madman dressed for a masquerade . . . See the clown.”

Man of La Mancha playtext

Surrounded by the harsh reality of this truth refelected back at him in many mirrors, Cervantes gives up and accepts that he is an old man. As the dream leaves him so does his zest for life, he becomes frail. He takes to his bed preparing to die.

On working with clients with disillusions and fantastical beliefs, Yalom says:

‘Never take away anything if you have nothing better to offer. Beware of stripping a patient who can’t bear the chill of reality.’

Yalom, I. D. (2013). Love’s executioner. London: Penguin. Page 154

Dream the impossible dream

The play finishes by reprising the anthemic song To Dream the Impossible Dream (The Quest), the song which has served Don Quixote through his Hero’s Journey. Cervantes may have played Don Quixote for one last time but the impact of the story has profoundly affected not only his life but also that of his friends including Aldonza who decided she will from now on be known as Dulcinea, accepting the positive life narrative she was offered.

To dream the impossible dream
To fight the unbeatable foe
To bear with unbearable sorrow
To run where the brave dare not go

To right the unrightable wrong
To love pure and chaste from afar
To try when your arms are too weary
To reach the unreachable star

This is my quest, to follow that star
No matter how hopeless, no matter how far
To fight for the right
Without question or pause
To be willing to march
Into hell for a heavenly cause

And I know if I’ll only be true
To this glorious quest
That my heart will lay peaceful and calm
When I’m laid to my rest

And the world will be better for this
That one man scorned and covered with scars
Still strove with his last ounce of courage
To fight the unbeatable foe
To reach the unreachable star

Song by Joe Darion / Mitchell Leigh

Dramatherapy and Psychosis

Was Cervantes mad? Maybe.

Was the fantasy land he built dangerous? In some ways yes as it led him to make some foolish decisions, but in other ways it allowed him to connect with others and express his own values. It also brought him much happiness.

Is it really safe for people who have visual or audio hallucinations to engage in fantasy? Recently, NICE ( who produce evidence-based recommendations for health and care in England ) have published guidance on how arts therapies like dramatherapy can help people with psychosis:

Consider offering arts therapies to all people with psychosis or schizophrenia, particularly for the alleviation of negative symptoms. This can be started either during the acute phase or later, including in inpatient settings.

Arts therapies should combine psychotherapeutic techniques with activity aimed at promoting creative expression, which is often unstructured and led by the service user. Aims of arts therapies should include:

-enabling people with psychosis or schizophrenia to experience themselves differently and to develop new ways of relating to others
– helping people to express themselves and to organise their experience into a satisfying aesthetic form
– helping people to accept and understand feelings that may have emerged during the creative process (including, in some cases, how they came to have these feelings) at a pace suited to the person.

NICE Guidance, (Feb 2014) Psychosis and schizophrenia in adults: prevention and management, page 25 and 26.

Dramatherapy can help many people to dream the impossible dream.


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