Robert Lowell, Setting the River on Fire: A Study of Genius, Mania, and Character

by Kay Redfield Jamison

  The fact that the first-degree relatives of individuals who suffer from bipolar illness, and to a lesser degree those with schizophrenia, were more likely to be in creative occupations is given further strength by a recent study from Yale University. Co-twins of bipolar patients had higher scores on tests of verbal learning and verbal fluency than did control subjects. Earlier, less rigorously designed studies had found much the same thing. An investigation conducted in Iceland in 1970, for example, found that first-degree relatives of psychotic patients, as well as the patients themselves (many of whom initially were diagnosed as having schizophrenia but were later characterized by researchers as having had mood disorders, most often bipolar illness), were far more likely than the general population to be distinguished in the arts and intellectual pursuits. Nancy Andreasen, in her study of writers in the Iowa Writers’ Workshop, found that there was a significantly higher rate of bipolar disorder and depression in the relatives of the writers than in the relatives of the controls. In addition, more first-degree relatives of the writers had histories of creative accomplishment than those of the controls.

  In the late 1980s, Ruth Richards and her colleagues at Harvard University studied “everyday” creativity (which they defined as originality demonstrated in a wide range of ordinary endeavors, rather than societally recognized accomplishment in the arts or sciences) in a group of patients, their relatives, and control subjects. They found that the patients with bipolar illness, or mild variants of it, and their unaffected first-degree relatives had significantly higher creativity scores than the control subjects. In this study, the relatives of the patients with bipolar illness scored higher on creativity measures than the patients.

  These studies confirm much earlier biographical work done in the 1890s and the 1930s that showed that creativity and psychopathology threaded their way through the families of eminent composers, artists, and writers. More recently, I found the same. I studied the family histories of eminent writers, artists, and composers and found extensive histories of mania, suicide, depression, and psychosis in their pedigrees, including those of George Gordon, Lord Byron; Virginia Woolf; Eugene O’Neill; Alfred, Lord Tennyson; Robert Schumann; William and Henry James; Herman Melville; Samuel Taylor Coleridge; James Boswell; Samuel Johnson; Vincent van Gogh; Gustav Mahler; John Berryman; Anne Sexton; Tennessee Williams; August Strindberg; Théodore Géricault; and many others. Creativity and instability ran together through the bloodlines. These families had heavy burdens of mania, depression, and suicide. It is reasonable to wonder why disease genes with such dire consequences persist in our species and what evolutionary pressure might protect them.

  Many clinicians, geneticists, and evolutionary biologists have suggested that the answer may lie with the adaptive traits or states associated with the manic spectrum: greater reactivity to the environment; positive and expansive moods; increased energy and confidence; more tendency to take risks and to explore; greater ambition and curiosity; heightened aggression and increased sexual drive; more original and diverse cognitive styles; and a decreased need for sleep. Increased creativity may be part of this evolutionary advantage conferred to both the individuals who have bipolar illness and to their relatives, whose subtler manifestations of bipolar traits may benefit not only themselves and their families but society at large.

  Manic-depressive illness is not like hemophilia, color blindness, or sickle-cell disease, caused by a well-characterized mutation in a single gene and traced through families in a Mendelian dominant or recessive pattern. The genetic contributions for manic depression and schizophrenia certainly come from variations in multiple genes on diverse chromosomes. Genome-wide association studies now allow us to begin looking for these patterns by studying the entire complement of genes in tens, indeed hundreds of thousands, of individuals. Using these powerful methods, a study of nearly ninety thousand Icelandic, Dutch, and Swedish subjects, published in 2015, found that certain patterns involving multiple genes were associated with bipolar disorder and schizophrenia. The same patterns were also significantly associated with measures of creativity. The researchers concluded that “creativity, conferred, at least in part, by common genetic variants, comes with an increased risk of psychiatric disorders conferred by the same genetic variants.” The study is the first major one of its kind and has significant flaws in its design; it requires replication. But it is of scientific interest as a step toward defining biologically the link between psychopathology and creativity. To date, most scientists, for good cause, have focused more on the clinical implications of a genetic basis for mania and depression, less on its possible advantage. But it is clear that scientists will be looking more and more at the genetic underpinnings of both mental disease and creativity.

  This is not a new concept. In 1920, Bronislaw Onuf, an American neurologist whose research had led him to conclude that the temperaments of great composers were strikingly similar to those who suffered from manic-depressive illness, published a paper in the New York Medical Journal. He asked provocative questions of “eugenic interest”: “May it be beneficial to mankind to propagate the manic depressive temperament?” If so, “[c]an this be done safely, i.e., without bringing actual psychoses in the trail? Can this temperament be transmitted in combination with qualities of a superior order, fitting the individual for accomplishments of a high order?”

  Two decades later, in 1941, during an era of intense interest in eugenics not only in Germany but also in the United States, the American Journal of Psychiatry published the results of a study undertaken by the Committee on Heredity and Eugenics of the American Neurological Association. There had been “justified horror,” wrote the authors, that “mental disease appears generation after generation, causes untold social expense, and is an increasing burden of civilized society.” But, they noted, there also had been many books and papers that suggested a “relationship between mental disease and genius or, at least, high ability.” The purpose of the paper was to consider what might be the consequences of sterilizing patients with hereditary mental illnesses. Their subjects were patients and family members who, for generations, had been hospitalized at McLean Hospital in Boston.

  The authors examined the records of twenty socially important families, by which they meant families whose members included presidents of the United States, secretaries of state, chief justices, governors of Massachusetts, founders of universities and railroads, eminent poets, “medical men galore,” philosophers, and scientists. “One could not write a history of the United States without giving an important place to the individuals in these families,” they wrote.

  The “socially important” families, the researchers concluded, were saturated with manic-depressive psychosis; there would have been a high cost to sterilization:

  It does not necessarily follow that the individuals who appear in these records were great because they had mental disease, although that proposition might be maintained with considerable cogency and relevance. It may be that the situation is more aptly expressed as follows. The manic drive in its controlled form and phase is of value only if joined to ability. [If] the hypomanic temperament is joined to high ability, an independent characteristic, then the combination may well be more effective than the union of high ability with normal temperament and drive might be. The indefatigability, the pitch of enthusiasm, the geniality and warmth which one so often sees in the hypomanic state may well be a fortunate combination and socially and historically valuable….Sterilization procedures would have deprived America of some of its most notable figures.

  A study published in Germany in 1933—a few years before the Nazis undertook their systematic program of killing tens of thousands of the mentally ill, who were, Hitler maintained, “unworthy of life” and should not perpetuate themselves (doctors were ordered to starve, poison, or gas their patients)—concluded much the same as the New England researchers. The author of the German study, which had found that manic-depressive illness was greatly overrepresented in the
professional and higher occupational classes, recommended that patients with manic-depressive illness should not be sterilized, “especially if the patient does not have siblings who could transmit the positive aspects of the genetic inheritance.”

  There are consequences for any type of population selection and control—in our time more likely to be tied to preimplantation genetic diagnosis, or newly evolving genetic manipulation techniques that include, most controversially, methods to edit genes in the germ line and thus alter the DNA of all cells so that “dysfunctional” genes would no longer be passed on generation to generation. The ethical and societal implications of manipulating the inheritance of any trait are potentially monumental; altering the inheritance of a complex, treatable disease that manifests itself in variegated patterns of thinking, behavior, temperament, and energy—and one that may be linked to creativity and ambition and distributed adaptively across healthy relatives—is profound.

  There are related issues associated with the recent development of psychosis prevention programs that, laudably, attempt to identify young people at risk for psychotic illnesses in order to slow or stop progression in diseases such as schizophrenia and mania. It is important research and holds clinical potential for preventing devastating conditions. But there should be discussion of possible unintended consequences. What if the prevention of psychosis or idiosyncratic cognitive styles or extreme mood states has a dampening effect on creativity or ambition? What if clinical decisions that benefit individuals are disadvantageous to society as a whole? It is not to suggest that these interventions should not progress; they should. It just means that the societal implications of the interventions should be discussed. There has been some discussion of these issues but not enough. Not nearly enough. If we purify, Lowell asked, do the water lilies die?

  I think that your friends must not only sympathise with you but also thank you for going into terrible places of experience to bring back such poetry.

  —LETTER FROM STEPHEN SPENDER TO LOWELL, 1965

  It is not obvious that pathological mental states, especially those so aberrant as mania, should themselves aid imagination and art. It is possible that the studies reporting high rates of mania and depression in artists and writers are flawed, biased by the influence of a shared but not contributive association. Perhaps it is temperament alone, not manic thinking or moods, that artists and writers share with those who have manic-depressive illness. But, more likely, there are changes in thinking and mood that occur during mania and depression that act upon individuals who are already creative. These may catalyze art, affect its form, change its content, or determine the timing of its coming into being.

  Mania and depression each contribute, but by nearly opposite pathways. Mania is generative; it speeds the mind and fills it with words, images, and possibility. It ties together distant thoughts and blasts buried recollection into consciousness; it brings to awareness that which otherwise would pass unregistered, unfelt, unwritten. Mania infects with the certainty that newly generated ideas are important and must be shared. Mania provokes the appalling and the violent and, now and again, partakes in creating that which is beautiful. The elated mood that usually accompanies mania disinhibits, makes the taking of risks and exploration more likely and creative combination of ideas more probable. To be in the grip of mania is to experience the unimaginable, try the unthinkable, do the unforgivable. The depressed mind is entirely different; it surveys darkly. It ruminates on the raw, generally unusable work that spills out during manic fertility. The depressed mind criticizes, revises, prunes, censors, improves. It shapes chaos, or tries to.

  This is borne out by studies of the syntactical elements in speech samples taken from manic and depressed patients. Manic speech is more pressured, distractible, and colorful. Manic patients use more adjectives and action verbs and more words that reflect power and achievement; they also express themselves more vibrantly, with more color, and greater urgency. Depressed patients, on the other hand, use more qualifying adverbs; their speech is more impoverished and predictable than that of manic patients or normal individuals. Manic patients tend to talk more about things, depressed patients about themselves and other people.

  Mania and depression are first and foremost diseases of the brain; too often this is overlooked. The brain is in all ways complex; it is who we are, how we think. It determines that which makes us human: our moods, affinities, imagination; our memories and capacities. Mania originates in this brain and, when active, it transforms it. If manic depression can abet creativity, the reason must lie substantially in the mood and thinking changes that take place when individuals are manic. The fluidity and force of ideas, and the original, if often bizarre, associations that occur during mania are critical to understanding the link between mood disorders and creativity. The symptom of mania referred to as flight of ideas, so defining of mania, was described by the ancients and has long been a part of formal diagnostic criteria. It lies central to manic thought. Flight of ideas is clinically unmistakable, characterized by a torrent of near-unstoppable speech; thoughts brachiate from topic to topic, held only by a thin thread of discernible association. Ideas fly out, and as they do, they rhyme, pun, and assemble in unexampled ways. The mind is alive, electric. “Bizarre associations sprang into his mind like enchanted crickets,” said Vereen Bell about Robert Lowell. It is the perfect description.

  Virginia Woolf was another whose mind sped into genius and madness. She “talked almost without stopping for two or three days,” said her husband, “paying no attention to anyone in the room or anything said to her. For about a day she was coherent; the sentences meant something, though it was nearly all wildly insane. Then gradually it became completely incoherent, a mere jumble of dissociated words.” Virginia Woolf wrote succinctly, “Once the mind gets hot it can’t stop.”

  Emil Kraepelin observed that manic speech was a type to itself and that its characteristic pacing and sounds tied it to rhyme and free associative speech. “Apparently the only disorder in which the associations show a characteristic change is the manic excitement. In these cases for the most part the tendency to clang associations comes out very distinctly, especially rhymes, citations, and word completions, which may finally surpass all other forms.” Flight of ideas often shows itself in rhyming or repeated vowel sounds, wordplay, or grouping of words by some common element. Clang associations, words that are associated to one another by sound rather than by idea or perception, are of obvious importance to poetic composition and are particularly common during mania. It is a fecund state: “My thoughts bustle along like a Surinam toad,” said Coleridge of his overflowing mind, “with little toads sprouting out of back, side, and belly, vegetating while it crawls.” So it is with manic flight of ideas: sprouting, bustling. For most individuals, words link in a reasonably straight line. For those who are manic, or those who have a history of mania, words move about in all directions possible, in a three-dimensional “soup,” making retrieval more fluid, less predictable.

  The abnormal flow of mental associations during flight of ideas is shown in an illustration from a textbook of psychopathology. The original thought can be traced, just, through the associations it sends scattering. The mind skips ahead, darts back and sideways. The brain is engaged in knight’s move thinking.

  John Custance, a Royal Navy officer who studied modern languages, theology, and psychology at Oxford, Cambridge, and the Sorbonne, wrote about mania in his 1952 memoir Wisdom, Madness and Folly. His flight of ideas sped from the Devil’s colors to Satanic cats, from Julius Caesar to a king’s coin. Although his ideas flew, mad, from topic to topic, there was a connecting strand. His account gives a vivid sense of the racing manic mind, a squash ball ricocheting wall to wall at angles sharp and unpredictable:

  Blue was the heavenly colour; I was in Heaven, so that blue was appropriate and could be regarded as on my side. Black, on the other hand, was another of the Devil’s colours. Was he going to get me after all? What had grey to say
about it? At night all cats are grey, so perhaps grey was a feline colour. I like the cat tribe, particularly when in the manic state. They are, I know, slightly Satanic, but it is the kind of Satanism I prefer; it reminds me of a favourite delusion—that I am Satan, the Servant of All, the Scientific Snake who told the truth in the Garden of Eden….So I need not fear the Devil or his sable colour. As for the purple, well in those circumstances I could reasonably look upon it as the imperial purple, a sign that I was Emperor of colours, if of nothing else. I asked the spirit of Julius Caesar by the simple process of tossing a coin with the image and superscription of his successor, King George. Julius was good enough to give me confirmation. The coin fell heads.

  Flight of ideas during mania

  “Bizarre associations sprung into his mind like enchanted crickets.” Credit 37

  To a point, the manic flight of ideas is such a natural part of manic excitement that patients wear it lightly. This changes. The mind moves too fast, to too many places. There is no reining it in and no familiar thinking to go back to. Sanity edges into madness. “In my mental or nervous fever or madness,” wrote Vincent van Gogh, “my thoughts sailed over many seas.” The magic, the brilliance, splinters into confusion, and then into terror. Flight of ideas gives pleasure at first, but that gives way to panic. Manic excitement disinhibits as surely and more vehemently than alcohol. This may abet artistic activity, observed Kraepelin, “especially poetical activity by the facilitation of linguistic expression.” The president of the New York Psychoanalytic Society said much the same thing in 1918. The increased verbosity observed in mania, he said, gives rise to “rhyming, playing on words,” to the “grouping and successive enumeration of things….Objects just coming into their line of vision or sounds just heard or other sense-impressions of the moment are at once drawn into their talk by a quick illusion.”