Marsh’s study spurred me to contact several kidney donors, in hopes of understanding what drove them. Harvey Mysel, who founded the Living Kidney Donor Network in 2006 after he received a kidney from his wife, said that in his experience people donate because their faith compels them to (“Do not neglect to do good and to share what you have, for such sacrifices are pleasing to God,” Hebrews 13:16). But are some donors driven to do what they do because they can’t stand the idea that another individual will suffer and possibly die for want of what they can provide? That would be the anxiety-based motivation that would qualify the act as a compulsion, one undertaken because doing otherwise allows a crushing near-panic to grip your throat and never let go.
Amy Donohue, a stand-up comic in Phoenix, was in her early forties when a woman she followed on Twitter sent out a plea: her mother was on the transplant list for a kidney; would anyone be willing to be a living donor? It was only after Amy tweeted back, Sure, why not?, that she did a little online research to see what the heck she had gotten into.
That spur-of-the-moment decision, driven by the gut and the heart rather than the head, exemplified the pattern seen in the fMRIs of kidney donors—that an acute sensitivity to other people’s distress underlies their decision. “Where does that come from?” I asked Amy. She fumbled a bit, as if trying to figure it out herself, mentioning that, yeah, her friends and family often say she’s unusually compassionate, and that after her mother threw her alcoholic father out of the house when Amy was eight she had to step up and help take care of her younger sister. She had clear memories of preparing way too many Crock-Pot dinners. And then it came pouring out. “What the fuck happened to humanity?” Amy cried. “When did we forget to help other people? People don’t even donate blood. There is such hypocrisy! When I see how many people need a kidney I am so outraged!” Although Amy’s decision to donate a kidney based on a tweet may have been driven by gut-level compassion, the drive to follow through (even at the cost of her job) was compelled by something angrier: a fed-up, I’m going to take a stand determination not to be like the selfish, self-centered millions that infuriated her. Then, more quietly, she said there was something else I should understand about her decision. “I got more out of it than she did,” Amy said, referring to the woman now living with her kidney. “I don’t have children,” she went on. That compelled her to find another way to leave a legacy, to plant one little flag in the earth saying I was here.
I don’t want to be like Mark Twain’s hammer-wielder to whom everything looks like a nail, seeing everything through the prism of anxiety. But as Amy spoke it was clear there was an undercurrent of anxiety in her drive to leave something behind, to make a difference. Most people want to do that, but it triggers deep anxiety only in some. Amy’s was not a pathological anxiety, but it was powerful enough to drive her to a magnanimous act.
Cara Yesawich, an award-winning advertising executive who lives in suburban Chicago, was fifty-four in 2010 when she donated a kidney. Although she was stone-cold fluent in the data on living donors’ survival and health—excellent—she waited until her two sons were grown, just in case. She will tell anyone who’ll listen that “living donors are the only way to reduce the waiting list and save lives.” (She was part of a complicated chain of pairs that resulted in eight patients receiving a donated kidney.)
When we began chatting, Cara was all business, reeling off the statistics (tens of thousands of people on what is likely a five-year waiting list for a kidney, with five thousand dying each year), lamenting that more dialysis centers and transplant programs do not educate their patients about living kidney donation, and giving the expected answer about why she chose to donate: “To help someone. I wanted to make a difference and I knew I could change someone’s life,” she said. “I wanted someone to be able to live, to be with their family, to get a chance at life.” But lots of people have that desire without acting on it. What is it that pushes donors over the hump that blocks everyone else? Cara, who was a volunteer in Marsh’s MRI study, remembered something her father used to ask her: Why do you have to get so involved with people, Cara? “I guess it’s true,” she said slowly, thinking aloud. “I do pick up on people’s emotions. I don’t like seeing people in pain or suffering. I guess I’m like the cliché: I do feel their pain.”
Anxious Altruists
For Cara and Amy, anxiety of the Joan Rivers variety was part of what compelled them to heights of altruism. As it happens, scientists had recently begun studying how, in people with a specific psychological makeup, anxiety underlies the drive to do good. This work grew out of studies on attachment theory, which was created by British psychiatrist John Bowlby in the mid-twentieth century to explore the roots of unhappiness, anxiety, anger, and delinquency. The idea is that children develop a sense of emotional security in the first years of life, absorbing the idea that the people who take care of them are reliable sources of safety and comfort. Or at least some children do. The unfortunate others learn that those who are supposed to protect and take care of them—for simplicity, let’s say their parents—can’t be relied on: they are sometimes there to offer comfort and sometimes not. Attachment security is the sense that one is worthy of being loved and that people will be there for you, particularly in times of stress or distress.
Bowlby was trying to explain the behavior of very young children, in particular how babies become dependent on their mothers for protection and comfort. But as attachment theory was extended, he and his acolytes found that a child’s sense of attachment reverberated into adulthood. Children who were “securely attached”—confident that someone will always be there for them—grow up to be well adjusted, comfortable with closeness and interdependence, trusting they will find solace in those they are closest to, and able to form close relationships. They tend to view problems as manageable and believe that obstacles can be overcome. But insecurely attached children never developed that sense of trust. They feel uneasy and alone rather than safe and secure and conclude that they cannot count on those closest to them. One result can be what psychologists call an anxious attachment style. A child like this typically tries desperately to become close to people, anxiously trying to gain their protection and coerce love and support. As an adult she becomes desperate for closeness and is plagued with anxiety at the thought that her partner will not be available in times of need, that he will let her down, or leave her. She typically has little confidence in her own abilities and skills to overcome problems or pain.
The relevance of attachment theory to do-gooder behavior such as kidney donation is this: people who feel insecure are, in general, less generous or altruistic, said psychologist Omri Gillath of the University of Kansas, who studies the relationship between attachment and altruism; those who feel emotionally secure are more so. “Your sense of security is like a finite mental resource,” he explained. “If you have very little, you have to focus it on yourself in order to deal with threats. But if you feel a greater sense of security, it’s as if you have some to spare. Your own emotional needs are largely taken care of, so you can turn your attention and emotional resources toward others.” That echoes what Marsh found about the correlation between well-being and the rate of kidney donation: when people’s own psychological needs are pretty much satisfied, they have emotional and mental wherewithal left over for others. If their existence is an inescapable morass of emotional discontent, they don’t.
But there is an interesting exception to this. An anxious attachment style is associated with intense personal distress at the sight or knowledge of others’ suffering. Such people may feel compelled to help others, through altruistic actions or other forms of generosity, “because they are overwhelmed with emotions over other people’s suffering,” Gillath said. “They think, ‘This can happen to me,’ ” and the anxiety that provokes can be relieved only by jumping in to do everything they can to mitigate that suffering. “When insecure people who are high on the anxiety dimension volunteer, their level of anxiet
y decreases,” he said. “They actually gain emotional security.”
Years ago, when I attended a week-long retreat in Dharamsala at which the Dalai Lama heard from neuroscientists about research on the brain’s power to change its structure and function as a result of both experiences and mental training, one Buddhist scholar put it this way: “There is helping because you really want to help, and there is helping because you feel so distressed by the sight of suffering that you act to alleviate your own suffering,” said Matthieu Ricard, a French-born monk. Some people, that is, feel compelled to help others because the distress they feel from the existence of suffering, great and small, is overpowering. When anxious people volunteer, therefore, it is often for that reason.
That jibes with what studies have found about kidney donors, whose empathy seems to derive from an acute sensitivity to the suffering of others. But such anxiety can also drive less extreme giving.
* * *
Kenn Dudek took a minimum-wage job at a nursing home just as deinstitutionalization was sweeping the country. “It was a time when the thinking about these illnesses was simply wrong, as we now know,” he told me. “I met a guy who was there because he had been diagnosed with what we’d now call bipolar illness. He told me he had played trumpet in one of the Big Bands, and all I could think of was, how the heck did he wind up here? He was a good man and an interesting man, but he had an illness that made it hard for him to function. I just felt there was a whole group of people who were treated very badly, including by the mental health profession. It was the time of thorazine and other highly sedating antipsychotics, which were given out to people with schizophrenia and bipolar like Tic-Tacs. It left them drooling and lethargic and unable to do much more than shuffle.”
It seemed like a tragic waste, with blame aplenty to go around. “Psychiatry, psychology, social work—those fields deserve some of the responsibility for why this went south for decades,” Dudek said, referring to the poor care people with mental illness received in what was supposed to be a time of scientific enlightenment. New graduates would start with the most serious mentally ill patients, and then with experience would move on to the less severe, easier cases. The reward for experience, in other words, was not working with patients who most needed help. “I couldn’t believe how badly the mentally ill were treated, starting with how mental health professionals treated them,” said Dudek.
In 1944, six former psychiatric patients and two volunteers formed “We Are Not Alone,” a group whose hope was to alleviate the social isolation that severe mental illness—schizophrenia, bipolar disorder, depression—brings. In 1948, they purchased a townhouse in Manhattan’s Hell’s Kitchen neighborhood, then a place of murderous rival gangs, and created Fountain House. It offers education, especially for young adults who have a psychotic break at college, and training programs to prepare people for jobs. Dudek became the president of Fountain House in 1992. “These are the weirdest illnesses: they become you,” Dudek told me. “Suddenly you are a schizophrenic, not a person with schizophrenia. Your personhood is subsumed in your diagnosis, your humanity is stripped away. From the beginning of my career I felt I could see the person inside the diagnosis. I could never not reach out and try to find the person instead of the illness.” The injustice he witnessed early in his career compelled him to make this his life’s work.
Something else drives him through the not-uncommon seventy-hour workweeks and midnight calls. Dudek was brought up in a tight-knit Catholic community outside Boston, his father a World War II veteran who suffered from post-traumatic stress disorder and who, despite an IQ of 160, could find employment only as a milkman and custodian. Dudek sees, in the mentally ill people at Fountain House, the shadow of his father, and of lives that could be so much more than they are. There is at least one more source of his drive. Dudek’s little brother, two years his junior, died at the age of four. “It drives me in some fashion I don’t fully understand,” Dudek said. “I believe I am living two lives. I think that’s probably one source of the compulsion to do this work.”
Compelled to Create
A strand of thought in psychology holds that the purpose of every deliberate action humans undertake is to cheat death. The actions range from having children who also have children who also have . . . , thus propagating our genes into perpetuity, to leaving a creative legacy that will outlive our mortal body. You can hear some of the latter in the reasons artists through the centuries have given for why they create. For Jeff Koons (b. 1955) “there is a responsibility that art should somehow be able to have an effect on mankind and make the world a better place,” he said in a 1986 interview. Willem de Kooning (1904–1997) cut through the verbiage and came up with the central truth: “I don’t paint to live, I live to paint.”
In most works of art, that compulsion is not apparent to the untrained eye, but in some it is as obvious as paint on canvas. In his Obsession: A History, Lennard Davis recounts the tragic tale of the neo-conceptual artist Mark Lombardi, whose signature works were drawings—diagrams, really—depicting networks of relationships. He “compulsively laid out series of circles and connecting arcing lines” depicting the flow of money around the world, Davis wrote, between and among politicians, companies and individuals, such as “Bill Clinton, the Lippo Group, and Jackson Stephens of Little Rock, Arkansas,” as one drawing is titled.I Lombardi did not wing it, however. He carefully researched every connection and transaction he could find. According to the catalogue for Mark Lombardi: Global Networks, he amassed more than fourteen thousand three-by-five index cards on which he scribbled notes about the flow of money underlying the Iran-Contra conspiracy during Ronald Reagan’s presidency, “The Tower Commission Report,” and other conspiracist hits of the 1980s. His friends described Lombardi as “consumed” and “frenetic” during his work. Lombardi would “work, without sleep, for days at a time,” said one, suggesting “a form of mania.” He clipped articles from newspapers and newsweeklies and tracked down government reports on scandals, often by badgering secondhand booksellers for copies. Lombardi committed suicide by hanging in 2000.
“There is a restlessness that characterizes some artists and other creative people,” Marcy Segal told me. She began studying creativity in 1977, at the International Center for Studies in Creativity (at Buffalo State College), and went on to a career advising corporations and other groups on how to bring out their employees’ inherent creative abilities. She has been the driving force behind World Creativity and Innovation Week, which was launched in Canada in 2001 and spread globally. Like many people in the growing field of “creativity studies,” Segal believes everyone has the capacity to be creative—or, more precisely, to be “little ‘c’ creative”: maybe not discovering the uncertainty principle or painting Guernica, but inventing a device to lock a public restroom stall when its door is broken or devising substitutes for chocolate chips when you find the cupboard bare of Toll House.
Segal’s work has focused on the temperaments that underlie creativity—she has identified four—and the specific kind of “restlessness” that, in each case, drives people to create. For people with an artisan/improviser temperament, she said, the restlessness comes from feeling, “I’ve had enough” of this way of doing things or of this imperfect device. “They start thinking about other ways,” she said. “There’s a restless energy there. It’s about feeling edgy in their current circumstances, and they put that uncomfortable feeling to use. It pushes them to create.” Or, as physicist Arthur Schawlow (1921–1999), who shared the 1981 Nobel Prize in physics for helping invent lasers, said, “The most successful scientists often are not the most talented, but the ones who are just impelled by curiosity. They’ve got to know what the answer is.” (We’ll substitute “compelled” for “impelled,” since Schawlow’s field was physics and not psychology.)
Segal’s “catalysts/idealists” experience restlessness over the state of the world. “They think, ‘Things don’t have to be this way,’ ” she said, “and th
ey’re restless as long as things don’t change.” For the third group, whose creative drive comes from an enjoyment of mastery and accomplishment, “incompetence and stupidity makes them restless,” Segal said. “They feel compelled to do something” about the sorry situation around them or their perception of themselves as not accomplishing enough. Finally, people with the creative temperament Segal calls guardians/stabilizers feel restless when things are not going smoothly. When their organization, family, or society as a whole seems to be headed for a train wreck, they feel driven to intervene before the derailment. “The output of the restlessness in all four temperaments can be creativity in any domain,” Segal said, from art to science to business.
Teresa Amabile, a professor at the Harvard Business School who has studied creativity since the 1980s, made her mark in the field with what’s called the componential theory of creativity. That model holds that creativity requires an individual to have specific skills relevant to the domain where she aims to be creative as well as what she calls “intrinsic task motivation”—what we’re calling anxiety-fueled compulsion. Amabile calls it “passion: the motivation to undertake a task or solve a problem because it is interesting, involving, personally challenging, or satisfying,” as she put it in a 2012 working paper. Substitute “compulsion” for “motivation” and you have creative drive. Not every creative person feels this strongly compelled, but you need at least some of that feeling to persevere against the forces of convention and skepticism that seek to thwart creative ideas. In 1995, for instance, physicist Joe Jacobson of the MIT Media Lab was at a beach and ran out of reading matter. That tickle of annoyance—in Segal’s words, a feeling of “I’ve had enough” and “things don’t have to be this way”—drove him to spend the rest of the afternoon brainstorming what became electronic ink, the technology behind the Sony eReader and the Amazon Kindle.
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