The mad genius: Treating artists with bipolar disorder requires creativity

CrossCurrents

Karen Shenfeld

“Darling, all night I have been flickering, off, on,” wrote American poet Sylvia Plath in the central stanza of “Fever 103.” In this poem, as well as in others published in her final collection, Ariel, Plath used violent images to evoke the landscape of an anguished mind. She composed these poems in the early winter of 1963, in a frenzied burst of productivity that came amid a period of despair. Then, on February 11, after sealing off her apartment kitchen so her two children would not be harmed, she took a bottle of sleeping pills and stuck her head in a gas oven.

The tragic details of Plath’s death are as well known to readers of literature as her famous poems. They have also strengthened the popular notion that there is a correlation between mental illness and creativity. Research has indeed shown evidence of a correlation, more specifically, that creative people have a higher rate of bipolar disorder than do members of the general population.

The list of modern artists who have been diagnosed with the disorder – which features extreme mood swings from mania to depression – includes writer Ernest Hemingway, painter Jackson Pollack, film director Francis Ford Coppola, comedian Robin Williams and humourist Art Buchwald. Biographical accounts strongly suggest that Michelangelo, Vincent van Gogh, Edvard Munch, Virginia Woolf, Edgar Allen Poe and Hans Christian Andersen could also be added to the list.

The higher prevalence of bipolar disorder among creative individuals was first empirically observed in the research of neuroscientist and psychiatrist Dr. Nancy Andreasen. Beginning in 1974, Andreasen compared the mental health of 30 writers who had been leaders of the University of Iowa’s Writers’ Workshop program with that of a control group. Andreasen followed these writers for 15 years. She found that 43 per cent had bipolar disorder, compared to only 10 per cent in the control group.

More recently, John Hopkins University psychologist Dr. Kay Redfield Jamison surveyed 47 eminent British visual artists and writers, questioning them about their mood states and treatment history. She found that 38 per cent of had sought treatment for mood disorders, a rate roughly 30 times greater than that found in the general population. In a radio broadcast with National Public Radio in 2005, Jamison, who herself has bipolar disorder, stated: “Intense experience and suffering instruct us in ways that less intense emotions can never do.”

Not all experts agree on the connection. “There is no scientific proof of the link between bipolar disorder and creativity,” says Dr. Albert Rothenberg, a psychiatrist at Harvard University. In a 2001 issue of Psychiatric Quarterly, Rothenberg argues that studies by Andreasen and Jamison show “serious flaws in sampling, methodology, presentation of results, and conclusions.” He is also critical of more recent studies conducted by scientists at Stanford University. That team assessed levels of creativity and temperamental differences in individuals with bipolar disorder or unipolar major depressive disorder, comparing them to controls.

“Our studies have shown evidence of the relationship between bipolar disorder and creativity and that the relationship may be mediated in part through temperament,” says Dr. Terence A. Ketter, a member of the Stanford team.

The team’s results have been published in four articles in 2005 and 2007 in the Journal of Affective Disorders. Rothenberg, however, questions the scientific validity of the team’s definition of creativity and of the tools used to assess creativity. “The cultural zeitgeist has swung towards the romanticization of abnormality,” he argues. “It’s important for artists with bipolar disorder to know that their illness does not facilitate their creativity.”

Teresa Hsu is an artist in northern California. Her delicate watercolours depict natural objects – beach stones, fallen leaves, flowers and fruits. “Being bipolar has enhanced my urge to make art,” she says. “It has heightened my artistic sensitivity, especially to colour. One of my manic episodes occurred during the autumn,” she relates. “I remember looking at the leaves of the trees and seeing their reds as so vibrant. I had the urge to create constantly. I was making 10 to 20 paintings a day.”

But Hsu concedes that mania can cloud one’s judgments. And she adds, “My depressions take me to a very dark place.”

The highs and lows of bipolar disorder can indeed be debilitating. Manic episodes can feature severe anxiety, rage and psychosis. Periods of depression can include suicidal ideation. In fact, 10 to 15 per cent of people with bipolar disorder die by suicide, compared to one per cent of the general population.

 

Despite the severity of the disorder, creative people may be hesitant about first seeking, and then continuing, treatment. Some complain that psychotropic medication makes them feel drugged, lethargic and restless, leading to intellectual disturbances, lack of concentration and memory problems. Hsu says, “When I was first hospitalized for depression, my biggest fear was being drugged into a haze. I had a terrible reaction to the first medication they put me on. It made me feel even worse.”

Experts agree that treating creative people poses clinical challenges. “Medications, per se, don’t cause trouble, but creativity can be hindered if you medicate people to the point that their emotions or cognitive abilities are blunted,” says Ketter.

Rothenberg agrees: “High levels of cognitive capacity are required for creative activities. A major treatment issue for creative persons with bipolar disorder is the risk of cognitive impairment.”

Widely prescribed since the 1970s, lithium carbonate remains “the standard and best drug for treating bipolar disorder,” says Rothenberg. “But for treating creative people, who need their full capacities to do their work, the best alternative may be lamotrigine, a newer anticonvulsant that has also been shown to control the shifting from mania to depression.” Other prescribed anticonvulsants include carbamazapine and valproate. “These medications may be effectively used alone or in combination with lower, and consequently less impairing, doses of lithium” says Rothenberg.

Rothenberg feels that artists, who tend to be self-reflective, can also gain special benefit from psychotherapy. He favours longer-term, insight-building psychodynamic therapy, which he believes is intrinsically appealing to creative people and provides the most lasting results. Ketter, on the other hand, supports briefer cognitive-behavioural therapies that directly address the symptoms of bipolar disorder. He also recommends dialectical behavioural therapy (DBT), originally developed to treat borderline personality disorder. “DBT can give creative people with bipolar disorder techniques to be mindful of their emotional experiences and to channel those experiences in productive ways.”

Dr. Ron Ruskin, a psychiatrist at Toronto’s Mount Sinai Hospital, cautions: “Creative people are often highly intelligent, sensitive and observant. They will be continually evaluating their healers. When treating an artist with bipolar disorder, the therapist should be able to empathize with the patient’s experience to develop a positive rapport and trust.”

As an artist, as well as a psychiatrist, Ruskin is acutely aware of his patients’ stressors and lifestyles. Artists often have to promote their own work and face continual rejection and financial strain. “Artists may be staying up all night to write or paint and not make time to eat, sleep or exercise,” Ruskin says. “Therapists can help creative patients set up healthier schedules.” If patients wish to show or discuss their art or writing or music in therapy sessions, Ruskin is willing to let them do so. “Art is a crucial way that artists express themselves, so I wouldn’t want to close the door on that opportunity,” he says. “However, if patients only want to talk about their work, a therapist may have to set limits.”

But treatment doesn’t mean limiting artists’ talents and potential. Jim Allen is an award-winning Canadian photographer who has focused his lens on such eminent Canadians as Adrienne Clarkson, Margaret Atwood, John Candy and Wayne Gretzky. In his spare time, he paints, plays jazz piano and is writing a book about his experience with bipolar disorder. No matter how he’s feeling, working on his art acts as a stabilizer. “Through therapy, I’ve recognized that I have been given the gift of creativity,” says Allen. “The best way to cope with bipolar disorder is to work to develop my gift, in conjunction with taking medication.”

 

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