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
the Johns Hopkins University
School of Medicine. She
M en 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 gloriouswhether all that is profounddoes
not spring from disease of thoughtfrom moods of mind exalted at
the expense of the general intellect.
Many people have long shared Poes suspicion that genius and insanity are entwined. In-
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.
Jamison is a member of the And many painters and composers, among them Vincent van Gogh, Georgia OKeeffe,
National Advisory Council Charles Mingus and Robert Schumann, have been similarly afflicted.
for Human Genome Re- Judging by current diagnostic criteria, it seems that most of these artistsand many oth-
search and clinical director of ers besidessuffered 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-Rmy.

Vincent
van Gogh
AP/WIDE WORLD PHOTOS

44 Mysteries of the Mind Reprinted from the February 1995 issue

Copyright 1997 Scientific American, Inc.
 Ezra Pound

HENRI CARTIER-BRESSON Magnum

UPI/BETTMANN

Anne Sexton

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 artistsfar 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-
essarily breed genius. Indeed, 1 percent
AP/WIDE WORLD PHOTOS

Charles Mingus of the general population suffer from

manic-depression, also called bipolar
disorder, and 5 percent from a major
depression, or unipolar disorder, during
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-
BETTMANN ARCHIVE

cent studies indicate that the tempera-

ments and cognitive styles associated with
mood disorders can in fact enhance cre-
ativity in some individuals.

Mysteries of the Mind 45

Copyright 1997 Scientific American, Inc.
 The Tainted Blood of the Tennysons

A lfred, Lord Tennyson (right), who experienced

recurrent, debilitating depressions and
probable hypomanic spells, often expressed fear
Modern medicine has confirmed that manic-de-
pression and creativity tend to run in certain fami-
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

CORBIS-BETTMANN
lum for nearly 60 years before he died from reared apart from birthin which at least one
manic exhaustion. Lionel Tennyson, one of Al- had been diagnosed as manic-depressive
freds 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.

ELIZABETH MARY CHARLES (D'EYNCOURT)

b. 1776 b. 1777 17841861
Recurrent bouts Ferocious pessimism; Inherited his fathers instability
of depression constant quarreling and fretfulness; spendthrift
and gloominess tendencies; expansive, grandiose
activities and interests

ELIZABETH FYTCHE GEORGE CLAYTON TENNYSON

17811865 17781831
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 18131890 1815 1866 18171909
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
18071898 18091892 18111889 18141899 18161913 18191899
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

LISA BURNETT
in an element of gloom for the Insane ness of the Tennysons Tennysonian temperament
SOURCE: Adapted from Touched with Fire: Manic-Depressive Illness and the Artistic Temperament; based on biographies, autobiographical writings and letters.

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 persons 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
movements and thinking, impaired
memory and concentration, and a loss
D uring episodes of mania or hypo-
mania (mild mania), bipolar pa-
tients experience symptoms that are in
poor judgment and impulsive behavior.
Hypomanics and manics generally
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.
 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.

F or years, scientists have documented

some kind of connection between
mania, depression and creative output.
A few years later, while on sabbatical
in England from the University of Cali-
fornia at Los Angeles, I began a study
Marys Hospital in London examined
50 modern British poets. One fourth met
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 composersand their first-degree had won the New York Drama Critics ing required to perform certain creative
relativeswere 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 poetsthe (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-depressionup 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
ANDREASENS STUDY SUICIDE
OF WRITERS (1987)

JAMISONS STUDY OF
ARTISTS AND WRITERS (1989)
SCHILDKRAUT AND HIRSHFELDS
STUDY OF ARTISTS (1990)
AKISKAL AND AKISKALS STUDY OF
ARTISTS AND WRITERS (UNPUBLISHED)
JAMISONS STUDY OF BRITISH POETS
BORN BETWEEN 1705 AND 1805 (1989)

MONTGOMERY AND MONTGOMERYS

STUDY OF POETS (1993)

LUDWIGS STUDY OF POETS (1992)

LISA BURNETT

0 10 20 30 40 50 60 70 80
PERCENT

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.
 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-
mous 20th-century artists, writers and
other professionals, some of whom had
S tudying the speech of hypomanic
patients has revealed that they tend
to rhyme and use other sound associa-
creative advantage to some individuals.
The manic-depressive temperament is,
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 kaleidoscopeof-
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

ADAPTED FROM E. SLATER AND A. MEYER,1959

These corroborative studies have con- 145
141
firmed that highly creative individuals 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
053 102
for their work? How does a psychiatric 051 101
illness contribute to creative achieve- 049 098
ment? First, the common features of 048 095
045 094
hypomania seem highly conducive to 043 093 136
original thinking; the diagnostic criteria 042 092 128
for this phase of the disorder include 040 091 121
ARCHIVE PHOTOS

039 086 119

sharpened and unusually creative think- 036 085 117
144
ing and increased productivity. And 035 082 130 113
accumulating evidence suggests that the 034 079 129 112 143
033 Robert Schumann 078 125 111 134
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 SCHUMANNS MUSICAL WORKS, charted by manns 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.
 The Case of Vincent van Gogh

M any 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

METROPOLITAN MUSEUM OF ART, GIFT OF ADELE R. LEVY, 1958

poisoning, manic-depressive psychosis, acute in-
termittent porphyria and Mnires disease.
Richard Jed Wyatt of the National Institute of
Mental Health and I have argued in detail that
van Goghs symptoms, the natural course of his
illness and his family psychiatric history strongly
indicate manic-depressive illness. The extent of
the artists purported use of absinthe and con-
vulsive behavior remains unclear; in any event,
his psychiatric symptoms long predate any pos-
sible history of seizures. It is possible that he suf-
fered from both an epileptic disorder and manic-
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 Projects 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
Byron scholar Jerome J. McGann of the
T he real task of imaginative, com-
passionate and effective treatment,
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 persons 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 330356; July 1992.
Touched with Fire: Manic-Depressive
tional and perceptual range. For this swift once scientists find the gene, or
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.