Manic-Depressive Illness and Creativity

Manic-Depressive Illness
and Creativity
Does some fine madness plague great artists?
Several studies now show that creativity
and mood disorders are linked
by Kay Redfield Jamison
The Author
KAY REDFIELD JAMISON
is professor of psychiatry at
Men have called me mad,” wrote Edgar Allan Poe, “but the question is
not yet settled, whether madness is or is not the loftiest intelligence—
whether much that is glorious—whether all that is profound—does
not spring from disease of thought—from moods of mind exalted at
the expense of the general intellect.”
Many people have long shared Poe’s suspicion that genius and insanity are entwined. In-
the Johns Hopkins University
School of Medicine. She
deed, history holds countless examples of “that fine madness.” Scores of influential 18th-
wrote Touched with Fire:
and 19th-century poets, notably William Blake, Lord Byron and Alfred, Lord Tennyson,
Manic-Depressive Illness and
wrote about the extreme mood swings they endured. Modern American poets John Berry-
the Artistic Temperament and
man, Randall Jarrell, Robert Lowell, Sylvia Plath, Theodore Roethke, Delmore Schwartz
co-authored the medical text
and Anne Sexton were all hospitalized for either mania or depression during their lives.
Manic-Depressive Illness.
And many painters and composers, among them Vincent van Gogh, Georgia O’Keeffe,
Jamison is a member of the
Charles Mingus and Robert Schumann, have been similarly afflicted.
National Advisory Council
for Human Genome Re-
Judging by current diagnostic criteria, it seems that most of these artists—and many oth-
search and clinical director of
ers besides—suffered from one of the major mood disorders, namely, manic-depressive ill-
the Dana Consortium on the
ness or major depression. Both are fairly common, very treatable and yet frequently lethal
Genetic Basis of Manic-De-
diseases. Major depression induces intense melancholic spells, whereas manic-depression,
pressive Illness. She has also
written and produced a series
of public television specials
about manic-depressive ill-
Tennessee Williams
ness and the arts.
Van Gogh painted flowers while
in the asylum at Saint-Rémy.
Vincent
van Gogh
OS
T
AP/WIDE WORLD PHO
44
Mysteries of the Mind
Reprinted from the February 1995 issue
Copyright 1997 Scientific American, Inc.

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Ezra Pound
agnum
M
-BRESSON
TIER
MANN
T
Anne Sexton
AR
I/BET
UP
HENRI C
a strongly genetic disease, pitches pa-
tuitive. Most manic-depressives do not
eccentric as manic-depressive. All the
tients repeatedly from depressed to hy-
possess extraordinary imagination, and
same, recent studies indicate that a high
peractive and euphoric, or intensely ir-
most accomplished artists do not suffer
number of established artists—far more
ritable, states. In its milder form,
from recurring mood swings. To assume,
than could be expected by chance—
termed cyclothymia, manic-depression
then, that such diseases usually promote
meet the diagnostic criteria for manic-
causes pronounced but not totally de-
artistic talent wrongly reinforces simplis-
depression or major depression given in
bilitating changes in mood, behavior,
tic notions of the “mad genius.” Worse
the fourth edition of the Diagnostic and
sleep, thought patterns and energy lev-
yet, such a generalization trivializes a
Statistical Manual of Mental Disorders
els. Advanced cases are marked by dra-
very serious medical condition and, to
(DSM-IV). In fact, it seems that these
matic, cyclic shifts.
some degree, discredits individuality in
diseases can sometimes enhance or oth-
Could such disruptive diseases con-
the arts as well. It would be wrong to
erwise contribute to creativity in some
vey certain creative advantages? Many
label anyone who is unusually accom-
people.
people find that proposition counterin-
plished, energetic, intense, moody or
By virtue of their prevalence alone, it
is clear that mood disorders do not nec-
OS
essarily breed genius. Indeed, 1 percent
T
Charles Mingus
HO
of the general population suffer from
manic-depression, also called bipolar
ORLD P
disorder, and 5 percent from a major
depression, or unipolar disorder, during
AP/WIDE W
their lifetime. Depression affects twice
as many women as men and most of-
ten, but not always, strikes later in life.
Bipolar disorder afflicts equal numbers
of women and men, and more than a
third of all cases surface before age 20.
Some 60 to 80 percent of all adoles-
ARTISTS, writers and composers shown
on these pages all most likely suffered
from manic-depressive illness or major
depressive illness, according to their let-
ters and journals, medical records and ac-
counts by their families and friends. Re-
cent studies indicate that the tempera-
CHIVE
ments and cognitive styles associated with
mood disorders can in fact enhance cre-
MANN AR
T
ativity in some individuals.
BET
Mysteries of the Mind
45
Copyright 1997 Scientific American, Inc.

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The Tainted Blood of the Tennysons
Alfred, Lord Tennyson (right), who experienced
Modern medicine has confirmed that manic-de-
recurrent, debilitating depressions and
pression and creativity tend to run in certain fami-
probable hypomanic spells, often expressed fear
lies. Studies of twins provide strong evidence
that he might inherit the madness, or “taint of
for the heritability of manic-depressive illness.
blood,” in his family. His father, grandfather,
If an identical twin has manic-depressive ill-
two of his great-grandfathers as well as five
ness, the other twin typically has a 70 to 100
of his seven brothers suffered from insanity,
percent chance of also having the disease; if
melancholia, uncontrollable rage or what is
the other twin is fraternal, the chances are
today known as manic-depressive illness.
considerably lower (approximately 20 per-
His brother Edward was confined to an asy-
cent). A review of pairs of identical twins
lum for nearly 60 years before he died from
reared apart from birth—in which at least one
manic exhaustion. Lionel Tennyson, one of Al-
had been diagnosed as manic-depressive—
MANN
T
fred’s two sons, displayed a mercurial tempera-
found that in two thirds or more of the sets, the ill-
ment, as did one of his three grandsons.
ness was present in both twins.
—K. R. J.
ORBIS-BET
C
ELIZABETH
MARY
CHARLES (D'EYNCOURT)
b. 1776
b. 1777
1784–1861
Recurrent bouts
“Ferocious pessimism”;
“Inherited his father’s instability
of depression
constant quarreling
and fretfulness”; spendthrift
and gloominess
tendencies; expansive, grandiose
activities and interests
ELIZABETH FYTCHE
GEORGE CLAYTON TENNYSON
1781–1865
1778–1831
Recurrent depressive illness
Manic-depressive illness
“Easy-going” and
Vacillating moods “between frenzy and lethargy”;
Rage, unstable moods and/or insanity
“sweet tempered”
spendthrift; alcoholic; “fits”; insanity
GEORGE
CHARLES
MARY
EDWARD
SEPTIMUS
CECILIA
Died in
1808 –1879
1810 –1884
1813–1890
1815 –1866
1817–1909
infancy,
Addicted to laudanum;
“...of a wild sort
Confined in insane
“Suffered from ner-
“Mental disturbance
1806
“complete nervous break-
of countenance”;
asylum for almost 60
vous depression”; fre-
and depression”;
down”; had to be segregated
obsessed with
years; severe
quent treatments for
eccentric
from outside world; extreme
spiritualism
melancholia; death
melancholia; “the
mood swings and
from manic
most morbid
“recurrent fits of
exhaustion
of all the
psychopathic
Tennysons”
depression”
FREDERICK
ALFRED
EMILY
ARTHUR
MATILDA
HORATIO
1807–1898
1809 –1892
1811–1889
1814–1899
1816 –1913
1819–1899
Irritability; eccentric;
Recurrent depression that re-
“Suffered much
“Some mental derangement,”
“Strange personality was
violent temper and
quired treatment; trances, possibly
from depression”;
occasionally attributed to
legendary”; “rather unused
volatile; obsessed
epileptic but not thought so by
one year in
childhood accident; religious
to this planet”; per-
with spiritualism
physician; possibly transient
Crichton
obsessions; “did not entirely
ceived himself as vulner-
hypomanic episodes; “dwelling
Institution
escape the black-blooded-
able to the “weakness of the
T
in an element of gloom”
for the Insane
ness of the Tennysons”
Tennysonian temperament”
URNET
SOURCE: Adapted from Touched with Fire: Manic-Depressive Illness and the Artistic Temperament; based on biographies, autobiographical writings and letters.
LISA B
cents and adults who commit suicide
pression from normal periods of unhap-
ductivity increases. Manics frequently
have a history of bipolar or unipolar ill-
piness, the common guidelines further
become paranoid and irritable. More-
ness. Before the late 1970s, when the
require that these symptoms persist for
over, their speech is often rapid, excit-
drug lithium first became widely avail-
a minimum of two to four weeks and
able and intrusive, and their thoughts
able, one person in five with manic-de-
also that they significantly interfere with
move quickly and fluidly from one topic
pression committed suicide.
a person’s everyday functioning.
to another. They usually hold tremen-
Major depression in both unipolar
dous conviction about the correctness
and bipolar disorders manifests itself
Mood Elevation
and importance of their own ideas as
through apathy, lethargy, hopelessness,
well. This grandiosity can contribute to
sleep disturbances, slowed physical
poor judgment and impulsive behavior.
movements and thinking, impaired
During episodes of mania or hypo-
mania (mild mania), bipolar pa-
Hypomanics and manics generally
memory and concentration, and a loss
tients experience symptoms that are in
have chaotic personal and professional
of pleasure in typically enjoyable events.
many ways the opposite of those asso-
relationships. They may spend large
The diagnostic criteria also include sui-
ciated with depression. Their mood and
sums of money, drive recklessly or pur-
cidal thinking, self-blame and inappro-
self-esteem are elevated. They sleep less
sue questionable business ventures or
priate guilt. To distinguish clinical de-
and have abundant energy; their pro-
sexual liaisons. In some cases, manics
46
Mysteries of the Mind
Manic-Depressive Illness and Creativity
Copyright 1997 Scientific American, Inc.

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suffer from violent agitation and delu-
percent reported a history of hypoma-
jor depression. In collaboration with Da-
sional thoughts as well as visual and
nia or mania. Also, the relatives of these
vid H. Evans of the University of Mem-
auditory hallucinations.
writers, compared with the relatives of
phis, the Akiskals noted the same trends
the control subjects, generally performed
among living blues musicians. More re-
Rates of Mood Disorders
more creative work and more often had
cently Stuart A. Montgomery and his
a mood disorder.
wife, Deirdre B. Montgomery, of St.
For years, scientists have documented A few years later, while on sabbatical Mary’s Hospital in London examined
some kind of connection between
in England from the University of Cali-
50 modern British poets. One fourth met
mania, depression and creative output.
fornia at Los Angeles, I began a study
current diagnostic criteria for depres-
In the late 19th and early 20th centuries,
of 47 distinguished British writers and
sion or manic-depression; suicide was
researchers turned to accounts of mood
visual artists. To select the group as best
six times more frequent in this commu-
disorders written by prominent artists,
I could for creativity, I purposefully
nity than in the general population.
their physicians and friends. Although
chose painters and sculptors who were
Ruth L. Richards and her colleagues
largely anecdotal, this work strongly
Royal Academicians or Associates of
at Harvard University set up a system
suggested that renowned writers, artists
the Royal Academy. All the playwrights
for assessing the degree of original think-
and composers—and their first-degree
had won the New York Drama Critics
ing required to perform certain creative
relatives—were far more likely to expe-
Award or the Evening Standard Drama
tasks. Then, rather than screening for
rience mood disorders and to commit
(London Critics) Award, or both. Half
mood disorders among those already
suicide than was the general population.
of the poets were already represented in
deemed highly inventive, they attempt-
During the past 20 years, more system-
the Oxford Book of Twentieth Century
ed to rate creativity in a sample of man-
atic studies of artistic populations have
English Verse. I found that 38 percent
ic-depressive patients. Based on their
confirmed these findings [see illustra-
of these artists and writers had in fact
scale, they found that compared with
tion below]. Diagnostic and psycholog-
been previously treated for a mood dis-
individuals having no personal or fami-
ical analyses of living writers and artists
order; three fourths of those treated had
ly history of psychiatric disorders, man-
can give quite meaningful estimates of
required medication or hospitalization,
ic-depressive and cyclothymic patients
the rates and types of psychopathology
or both. And half of the poets—the
(as well as their unaffected relatives)
they experience.
largest fraction from any one group—
showed greater creativity.
In the 1970s Nancy C. Andreasen of
had needed such extensive care.
Biographical studies of earlier genera-
the University of Iowa completed the first
Hagop S. Akiskal of the University of
tions of artists and writers also show
of these rigorous studies, which made
California at San Diego, also affiliated
consistently high rates of suicide, depres-
use of structured interviews, matched
with the University of Tennessee at
sion and manic-depression—up to 18
control groups and strict diagnostic cri-
Memphis, and his wife, Kareen Akis-
times the rate of suicide seen in the gen-
teria. She examined 30 creative writers
kal, subsequently interviewed 20 award-
eral population, eight to 10 times that
and found an extraordinarily high oc-
winning European writers, poets, paint-
of depression and 10 to 20 times that of
currence of mood disorders and alco-
ers and sculptors. Some two thirds of
manic-depressive illness and its milder
holism among them. Eighty percent had
their subjects exhibited recurrent cyclo-
variants. Joseph J. Schildkraut and his
experienced at least one episode of ma-
thymic or hypomanic tendencies, and
co-workers at Harvard concluded that
jor depression, hypomania or mania; 43
half had at one time suffered from a ma-
approximately half of the 15 20th-cen-
EXPECTED RATE
MAJOR DEPRESSIVE ILLNESS
IN GENERAL POPULATION
MANIC-DEPRESSIVE ILLNESS
CYCLOTHYMIA
ANDREASEN’S STUDY
SUICIDE
OF WRITERS (1987)
JAMISON’S STUDY OF
ARTISTS AND WRITERS (1989)
SCHILDKRAUT AND HIRSHFELD’S
STUDY OF ARTISTS (1990)
AKISKAL AND AKISKAL’S STUDY OF
ARTISTS AND WRITERS (UNPUBLISHED)
JAMISON’S STUDY OF BRITISH POETS
BORN BETWEEN 1705 AND 1805 (1989)
MONTGOMERY AND MONTGOMERY’S
STUDY OF POETS (1993)
LUDWIG’S STUDY OF POETS (1992)
T
0
10
20
30
40
50
60
70
80
URNET
PERCENT
LISA B
INCREASED RATES OF SUICIDE, depression and manic-de-
18 times the rate of suicide seen in the general population, eight
pression among artists have been established by many separate
to 10 times the rate of depression and 10 to 20 times the rate of
studies. These investigations show that artists experience up to
manic-depression and its milder form, cyclothymia.
Manic-Depressive Illness and Creativity
Mysteries of the Mind
47
Copyright 1997 Scientific American, Inc.

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tury abstract-expressionist artists they
cognitive styles associated with hypo-
tures: the ability to function well on a
studied suffered from depressive or man-
mania (expansive thought and grandi-
few hours of sleep, the focus needed to
ic-depressive illness; the suicide rate in
ose moods) can lead to increased fluen-
work intensively, bold and restless atti-
this group was at least 13 times the cur-
cy and frequency of thoughts.
tudes, and an ability to experience a
rent U.S. national rate.
profound depth and variety of emo-
In 1992 Arnold M. Ludwig of the
Mania and Creativity
tions. The less dramatic daily aspects of
University of Kentucky published an ex-
manic-depression might also provide
tensive biographical survey of 1,005 fa-
creative advantage to some individuals.
mous 20th-century artists, writers and
Studying the speech of hypomanic
patients has revealed that they tend
The manic-depressive temperament is,
other professionals, some of whom had
to rhyme and use other sound associa-
in a biological sense, an alert, sensitive
been in treatment for a mood disorder.
tions, such as alliteration, far more of-
system that reacts strongly and swiftly.
He discovered that the artists and writ-
ten than do unaffected individuals. They
It responds to the world with a wide
ers experienced two to three times the
also use idiosyncratic words nearly three
range of emotional, perceptual, intellec-
rate of psychosis, suicide attempts, mood
times as often as do control subjects.
tual, behavioral and energy changes. In
disorders and substance abuse that com-
Moreover, in specific drills, they can list
a sense, depression is a view of the
parably successful people in business,
synonyms or form other word associa-
world through a dark glass, and mania
science and public life did. The poets in
tions much more rapidly than is consid-
is that seen through a kaleidoscope—of-
this sample had most often been manic
ered normal. It seems, then, that both the
ten brilliant but fractured.
or psychotic and hospitalized; they also
quantity and quality of thoughts build
Where depression questions, rumi-
proved to be some 18 times more likely
during hypomania. This speed increase
nates and hesitates, mania answers with
to commit suicide than is the general
may range from a very mild quickening
vigor and certainty. The constant tran-
public. In a comprehensive biographi-
to complete psychotic incoherence. It is
sitions in and out of constricted and then
cal study of 36 major British poets born
not yet clear what causes this qualita-
expansive thoughts, subdued and then
between 1705 and 1805, I found simi-
tive change in mental processing. Nev-
violent responses, grim and then ebul-
larly elevated rates of psychosis and se-
ertheless, this altered cognitive state
lient moods, withdrawn and then out-
vere psychopathology. These poets were
may well facilitate the formation of
going stances, cold and then fiery states—
30 times more likely to have had man-
unique ideas and associations.
and the rapidity and fluidity of moves
ic-depressive illness than were their con-
People with manic-depressive illness
through such contrasting experiences—
temporaries, at least 20 times more like-
and those who are creatively accom-
can be painful and confusing. Ideally,
ly to have been committed to an asylum
plished share certain noncognitive fea-
though, such chaos in those able to
and some five times more likely to have
taken their own life.
146
These corroborative studies have con-
145
141
firmed that highly creative individuals
YER,1959
142
138
experience major mood disorders more
127
137
often than do other groups in the gener-
077
108
al population. But what does this mean
057
106
TER AND A. ME
A
053
102
. SL
for their work? How does a psychiatric
051
101
OM E
illness contribute to creative achieve-
049
098
ment? First, the common features of
048
095
045
094
hypomania seem highly conducive to
ADAPTED FR
043
093
136
original thinking; the diagnostic criteria
042
092
128
for this phase of the disorder include
040
091
121
OS
T
“sharpened and unusually creative think-
039
086
119
HO
036
085 144 117
ing and increased productivity.” And
035
082 130 113
CHIVE P
accumulating evidence suggests that the
034
AR
079 129 112
143
033
078 125 111
134
Robert Schumann
031
076 097 110
133
030 120
075 096 109 148 132
032
029 064
072
084 115 074 090 107 147 131
124
021 028 027 054
060
080 081 073 089 105 140 126
004
022 017
018 023 026 052 047
058
065 071 070 088 104 139 123
003 010
011 014 012 016 020 025 038 044 050
056 061 063 068 069 087 103 135 118
007 001 008 002 005 099 009 013 006 015 019 024 037 041 046
055 059 062 066 067 083 100 122 114
1829 ’30 ’31 ’32 ’33 ’34 ’35 ’36 ’37 ’38 ’39 ’40 ’41 ’42 ’43 ’44 ’45 ’46 ’47 ’48 ’49 ’50 ’51 ’52 ’53 ’54 ’55 1856
DIED IN ASYLUM
SUICIDE
SEVERE DEPRESSION
(SELF-
ATTEMPT
THROUGHOUT 1844
STARVATION)
HYPOMANIC
HYPOMANIC
SUICIDE
THROUGHOUT 1840
THROUGHOUT 1849
ATTEMPT
ROBERT SCHUMANN’S MUSICAL WORKS, charted by
mann’s parents were clinically depressed, and two other first-de-
year and opus number (above), show a striking relation between
gree relatives committed suicide. Schumann himself attempted
his mood states and his productivity. He composed the most
suicide twice and died in an insane asylum. One of his sons
when hypomanic and the least when depressed. Both of Schu-
spent more than 30 years in a mental institution.
48
Mysteries of the Mind
Manic-Depressive Illness and Creativity
Copyright 1997 Scientific American, Inc.

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The Case of Vincent van Gogh
Many clinicians have reviewed the medi-
cal and psychiatric problems of the
painter Vincent van Gogh posthumously, diag-
nosing him with a range of disorders, including
epilepsy, schizophrenia, digitalis and absinthe
poisoning, manic-depressive psychosis, acute in-
, 1958
VY
termittent porphyria and Ménière’s disease.
Richard Jed Wyatt of the National Institute of
Mental Health and I have argued in detail that
van Gogh’s symptoms, the natural course of his
T
, GIFT OF ADELE R. LE
illness and his family psychiatric history strongly
indicate manic-depressive illness. The extent of
the artist’s purported use of absinthe and con-
vulsive behavior remains unclear; in any event,
AN MUSEUM OF AR
his psychiatric symptoms long predate any pos-
sible history of seizures. It is possible that he suf-
OPOLIT
fered from both an epileptic disorder and manic-
METR
depressive illness.
—K. R. J.
Irises, 1889
transcend it or shape it to their will can
pressive illness often worsens over time—
bilities raise a host of complicated ethi-
provide a familiarity with transitions
and no one is creative when severely de-
cal issues. It would be irresponsible to
that is probably useful in artistic endeav-
pressed, psychotic or dead. The attacks
romanticize such a painful, destructive
ors. This vantage readily accepts ambi-
of both mania and depression tend to
and all too often deadly disease. Hence,
guities and the counteracting forces in
grow more frequent and more severe.
3 to 5 percent of the Human Genome
nature.
Without regular treatment the disease
Project’s total budget (which is conser-
Extreme changes in mood exaggerate
eventually becomes less responsive to
vatively estimated at $3 billion) has
the normal tendency to have conflicting
medication. In addition, bipolar and uni-
been set aside for studies of the social,
selves; the undulating, rhythmic and
polar patients frequently abuse mood-
ethical and legal implications of genetic
transitional moods and cognitive chang-
altering substances, such as alcohol and
research. It is hoped that these investi-
es so characteristic of manic-depressive
illicit drugs, which can cause secondary
gations will examine the troubling is-
illness can blend or harness seemingly
medical and emotional burdens for
sues surrounding manic-depression and
contradictory moods, observations and
manic-depressive and depressed patients.
major depression at length. To help those
perceptions. Ultimately, these fluxes and
who have manic-depressive illness, or
yokings may reflect truth in humanity
The Goal of Treatment
who are at risk for it, must be a major
and nature more accurately than could
public health priority.
SA
a more fixed viewpoint. The “consis-
tent attitude toward life” may not, as
The real task of imaginative, com-
passionate and effective treatment,
Byron scholar Jerome J. McGann of the
therefore, is to give patients more mean-
University of Virginia points out, be as
ingful choices than they are now afford-
Further Reading
insightful as an ability to live with, and
ed. Useful intervention must control the
portray, constant change.
extremes of depression and psychosis
Tennyson: The Unquiet Heart. R. B.
The ethical and societal implications
without sacrificing crucial human emo-
Martin. Oxford University Press, 1980.
Creativity and Mental Illness: Preva-
of the association between mood disor-
tions and experiences. Given time and
lence Rates in Writers and Their
ders and creativity are important but
increasingly sophisticated research, psy-
First-Degree Relatives. Nancy C. An-
poorly understood. Some treatment stra-
chiatrists will likely gain a better under-
dreasen in American Journal of Psychia-
tegies pay insufficient heed to the bene-
standing of the complex biological ba-
try, Vol. 144, No. 10, pages 1288-1292;
fits manic-depressive illness can bestow
sis for mood disorders. Eventually, the
October 1987.
on some individuals. Certainly most
development of new drugs should make
Manic Depressive Illness. Frederick K.
Goodwin and Kay R. Jamison. Oxford
manic-depressives seek relief from the
it possible to treat manic-depressive in-
University Press, 1990.
disease, and lithium and anticonvulsant
dividuals so that those aspects of tem-
Creative Achievement and Psycho-
drugs are very effective therapies for
perament and cognition that are essen-
pathology: Comparison among Pro-
manias and depressions. Nevertheless,
tial to the creative process remain intact.
fessions. Arnold M. Ludwig in American
these drugs can dampen a person’s gen-
The development of more specific and
Journal of Psychiatry, Vol. 46, No. 3,
eral intellect and limit his or her emo-
less problematic therapies should be
pages 330–356; July 1992.
tional and perceptual range. For this
swift once scientists find the gene, or
Touched with Fire: Manic-Depressive
Illness and the Artistic Temperament.
reason, many manic-depressive patients
genes, responsible for the disease. Pre-
Kay R. Jamison. Free Press/Macmillan,
stop taking these medications.
natal tests and other diagnostic measures
1993.
Left untreated, however, manic-de-
may then become available; these possi-
Manic-Depressive Illness and Creativity
Mysteries of the Mind
49
Copyright 1997 Scientific American, Inc.

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