The relationship between genius & madness

[Smilemaker100]

Hi psychdocs,

I have some members of my family who are/were rather brilliant but unfortunately, are/were afflicted with mental illnesses ( bipolar depression and schizophrenia). I wanted a psychiatrist's opinion on a particular aspect of these illnesses-the relationship between madness and genius.

A few years ago, I read the biography entitled " A Beautiful Mind" (which was made into an acclaimed movie starring Russell Crowe and Jennifer Connelly not too long ago) which is the story of the Nobel prize laureate (in economics even though he was a mathematician) John Nash . It is an exceptionally well written book which discusses not only Nash's fascinating struggle with his illness but also delves into the history of mathematics. The movie actually deters from the true story quite a lot and I found the book to be more fascinating than the movie itself. It is astonishing how many mathematicians are afflicted with schizophrenia as illustrated by the author. Of interesting note, John Nash's son ( John Nash Jr) also has schizophrenia and went into the mathematics field as well. The relative I have who has schizophrenia has some language disorders, however, IQ tests which he had indicate that his mathematical ability is in the genius range. He reads about mathematics at an obsessional level and reads a lot about computer programming as well. How many psychiatrists in this forum have encountered mathematician patients who have some form of schizophrenia?

I recently purchased "Touched With Fire" written by psychiatrist Kay Redfield Jamison ( who herself has suffered from bipolar/manic depression). This book discusses the relationship between manic-depressive illness/schizoaffective disorder/ melancholy and the artistic temperament. I haven't actually started reading the book yet, however, I saw many tables with statistical data on famous poets, composers and painters in the past centuries and there does seem to be some scientific validity to this hypothesis. I have another relative who suffers from bipolar. He can never live in the same city or stick with the same job for too long...he has worked in different fields- film documentaries, painting, computer graphics and poetry writing, but he has difficulty remaining dedicated to one field. But then again, he isn't very compliant with medical treatment. I had another relative (now deceased) who was a composer/pianist/violinist and suffered from many "depressive episodes" (after he retired from his musical career) in which he was nonfunctional and became bedridden for months at a time whenever there was bad news in the family (this of course occured about 50 years ago when psychiatry wasn't very advanced). And finally, another relative (now deceased) was a pretty good painter and was resistant to the various cocktails of meds so she suffered many lapses in which she was bedridden for months except when she had ECT (electric -convulsive/shock treatment) and was hospitalized on numerous occasions. How many psychiatrists out there believe in the hypothesis that there is a clear relationship between the creative impulse and depressive disorders?

Sadly, there is still so much nonsense/prejudice in the media in regards to illnesses such as schizophrenia. Schizophrenics usually have more suicidal tendencies than homicidal tendencies . When these individuals do become homicidal (which is rare) it is usually because they are not medicated/treated and they usually turn against their own family members/caretakers rather than strangers. Sadly, as a result of a lot of government budget cuts (at least in Canada), a lot of people don't have access to mental health services and these untreated people are now roaming the streets as vagrants- now that's something to worry about.

Even with the knowledge that I have relatives who have had/still have mental illnesses, I wouldn't let it deter me from having children. I view mental illnesses not as a "curse" but as a "gift" from God which allows these individuals to view the world in unique ways that have shaped our history in the world of the arts and sciences. This is partly why I am against the genetic screening of these "illnesses" (if they ever determine the exact genes implicated in these illnesses). What will happen with future human civilizations when people are bereft of creativity? Fortunately, presently, a lot of these conditions can be treated medically. It is just a question of having the proper diagnosis and having it treated promptly.

Finally, can one be treated for "madness" and still be a productive artist/mathematician? Very often , we hear that an artist/ mathematician is more productive or has a greater imagination in their periods of "madness". How do individuals with these illnesses harness their maximal potential whether mathematically or artistically? And finally, do you think madness is more a gift or a curse?

Thanks for any opinions/feedback.

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[Gfunk6]

The link between schizophrenia and related psychotic-disorders and artistic creativities is certainly present in some individuals but this has been mostly anecdotal. There is a relative paucity of scientific literature giving hard empirical data.

That said, I find your following statement quite objectionable:

I view mental illnesses not as a "curse" but as a "gift" from God which allows these individuals to view the world in unique ways that have shaped our history in the world of the arts and sciences.

First of all, Schizophrenia only encompasses a small minority of the total spectrum of mental illness. There are disorders of mood, anxiety, eating, substance abuse/dependence, sexual/gender identity, and cognition -- merely to name a few.

Second, the DSM-IV specifies that in order for these states to be diagnosed as a "disorder" they must, by defintion, cause social and occupational dysfunction. In other words, if you are operating just fine in society and your inter-personal relationships are dandy, you are not schizophrenic.

Third, your exposure to schizophrenics is decidely slanted in favor of "geniuses." Spend a day in a locked Psychiatric ICU and you'll see how much of a curse mental disease is. These people need to be treated and given psychological and social support so that they may re-claim their lives.

With all that said, even if evidence linking hyperdopaminergic states in the brain to higher cognitive function is produced I still don't think you could define schizophrenia as "a gift from god." Do you honestly think that parents of a small percentage of autistic kids with great ability in math or music wouldn't choose to jettison those traits in order to have a normal child?

The price to pay is too high for any perceived benefits.

 

[PublicHealth]

The link between schizophrenia and related psychotic-disorders and artistic creativities is certainly present in some individuals but this has been mostly anecdotal. There is a relative paucity of scientific literature giving hard empirical data.

That said, I find your following statement quite objectionable:


First of all, Schizophrenia only encompasses a small minority of the total spectrum of mental illness. There are disorders of mood, anxiety, eating, substance abuse/dependence, sexual/gender identity, and cognition -- merely to name a few.

Second, the DSM-IV specifies that in order for these states to be diagnosed as a "disorder" they must, by defintion, cause social and occupational dysfunction. In other words, if you are operating just fine in society and your inter-personal relationships are dandy, you are not schizophrenic.

Third, your exposure to schizophrenics is decidely slanted in favor of "geniuses." Spend a day in a locked Psychiatric ICU and you'll see how much of a curse mental disease is. These people need to be treated and given psychological and social support so that they may re-claim their lives.

With all that said, even if evidence linking hyperdopaminergic states in the brain to higher cognitive function is produced I still don't think you could define schizophrenia as "a gift from god." Do you honestly think that parents of a small percentage of autistic kids with great ability in math or music wouldn't choose to jettison those traits in order to have a normal child?

The price to pay is too high for any perceived benefits.

Anyone hear of group selection? Sometimes you have to take your face out of the microscope and think about why schizophrenia and other psychiatric "disorders" are so prevalent and have been around for so long. Perhaps these conditions once conferred a selective advantage to our ancestors (at the individual or group level), but today, because of an evolutionary mismatch between biology and culture, get labeled "psychiatric disorders."

http://www.bbsonline.org/documents/a/00/00/04/60/bbs00000460-00/bbs.wilson.html

 

[PsychMD]

Here's a Princeton student web project re. "Manic-Depressive Illness and Creativity" http://www.molbio.princeton.edu/courses/mb427/2000/projects/0002/index3.html

It seems that the figures of the "mad genius"/"mad artist" are fairly common cultural "archetypes" (although not in a Jungian sense, of course!) in our civilization.

 

[Smilemaker100]

Thanks for your reply, Gfunk6,

I am not claiming to be an expert of any sort- my field is FAR from close to psychiatry which is why I wrote this post to get a professional insight.

I personally think that once mental illnesses are well managed that these individuals can contribute a lot to society.

In reply to your statement
Second, the DSM-IV specifies that in order for these states to be diagnosed as a "disorder" they must, by defintion, cause social and occupational dysfunction. In other words, if you are operating just fine in society and your inter-personal relationships are dandy, you are not schizophrenic

The relative in question was diagnosed by several psychiatrists to be schizophrenic and he had many years of social dysfunction and was unable to cope academically and had to drop both his school & work.

I am not stating that all schizophrenics are mathematical geniuses but if you look into the literature...you would discover that a lot of mathematicians
have some sort of disorder or have close relatives that have had mental illnesses.

As for your statement:

With all that said, even if evidence linking hyperdopaminergic states in the brain to higher cognitive function is produced I still don't think you could define schizophrenia as "a gift from god." Do you honestly think that parents of a small percentage of autistic kids with great ability in math or music wouldn't choose to jettison those traits in order to have a normal child?

Does that mean you believe in eugenics? As in Aldous Huxley's "Brave New World"? That is going into dangerous territory...that's a whole big ethical question.

 

[Smilemaker100]

Anyone hear of group selection? Sometimes you have to take your face out of the microscope and think about why schizophrenia and other psychiatric "disorders" are so prevalent and have been around for so long. Perhaps these conditions once conferred a selective advantage to our ancestors (at the individual or group level), but today, because of an evolutionary mismatch between biology and culture, get labeled "psychiatric disorders."

http://www.bbsonline.org/documents/a/00/00/04/60/bbs00000460-00/bbs.wilson.html

There is actually a book discussing this very issue ! I don't know if you heard of it - it is called:
"The Madness of Adam & Eve: How Schizophrenia Shaped Humanity" by David Horrobin

 

[Smilemaker100]

Here's a Princeton student web project re. "Manic-Depressive Illness and Creativity" http://www.molbio.princeton.edu/courses/mb427/2000/projects/0002/index3.html

It seems that the figures of the "mad genius"/"mad artist" are fairly common cultural "archetypes" (although not in a Jungian sense, of course!) in our civilization.

Thanks for that site- I'll look at it sometime.

"Madness, provided it comes as the gift of heaven, is the channel by which we receive the greatest blessings...the men of old who gave things their names saw no disgrace or reproach in madness; otherwise they would not have connected it with the name of the noblest of all arts, the art of discerning the future, and called it the manic art....So, according to the evidence provided by our ancestors, madness is a nobler thing than sober sense...madness comes from God whereas sober sense is merely human."
-Socrates

"We of the craft are all crazy. Some are affected by gaiety, others by melancholy, but all are more or less touched."
-Lord Byron.

"And Something's odd-within-
That person that I was-
And this One-do not feel the same-
Could it be Madness-this?"
-Emily Dickinson

 

[PublicHealth]

There is actually a book discussing this very issue ! I don't know if you heard of it - it is called:
"The Madness of Adam & Eve: How Schizophrenia Shaped Humanity" by David Horrobin

Good book. There are several others titled "Evolutionary Psychiatry" or "Darwinian Psychiatry" that address this same idea. "Why We Get Sick" by Nesse and Williams is a great introduction to how evolutionary biology informs medicine.

Unfortunately, medical education fails to take into account the importance of evolution in understanding health and disease. People in favor of this perspective often go so far as to suggest that medical schools should have departments of evolutionary biology.

Other good "evolutionarily-flavored" books include "Evolution of Infectious Disease" and "Plague Time" by Paul Ewald.

 

[PublicHealth]

Second, the DSM-IV specifies that in order for these states to be diagnosed as a "disorder" they must, by defintion, cause social and occupational dysfunction. In other words, if you are operating just fine in society and your inter-personal relationships are dandy, you are not schizophrenic.

Sure, in THIS society. Unfortunately, our brains did not evolve in THIS society and are therefore not designed to function optimally in THIS society. There is more to understanding psychiatric disorders than the DSM. Rise above the dogma. I think it was Einstein who said, "The most important thing is never to stop questioning."

 

[Smilemaker100]

Good book. There are several others titled "Evolutionary Psychiatry" or "Darwinian Psychiatry" that address this same idea. "Why We Get Sick" by Nesse and Williams is a great introduction to how evolutionary biology informs medicine.

Unfortunately, medical education fails to take into account the importance of evolution in understanding health and disease. People in favor of this perspective often go so far as to suggest that medical schools should have departments of evolutionary biology.

Other good "evolutionarily-flavored" books include "Evolution of Infectious Disease" and "Plague Time" by Paul Ewald.

Thanks, it's always interesting to hear other approaches to medicine.

 

[Smilemaker100]

Sure, in THIS society. Unfortunately, our brains did not evolve in THIS society and are therefore not designed to function optimally in THIS society. There is more to understanding psychiatric disorders than the DSM. Rise above the dogma. I think it was Einstein who said, "The most important thing is never to stop questioning."

Einstein also said, "When I examine myself and my methods of thought, I come to the conclusion that the gift of fantasy has meant more to me than my talent for absorbing positive knowledge.


I am enough of an artist to draw freely upon my imagination. Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world.
-Albert Einstein

The secret to creativity is knowing how to hide your sources.
-Albert Einstein

The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honors the servant and has forgotten the gift.
-Albert Einstein

 

[Gfunk6]

Sometimes you have to take your face out of the microscope and think about why schizophrenia and other psychiatric "disorders" are so prevalent and have been around for so long.

Right. Well, once I take my "face out of the microscope" as you so condescendingly put it, I think you should ask yourself if a psychotic patient is truly interested in your explanation as to why his prehistoric ancestors had a survival advantage with schizophrenia.

Of course I have read the theories of Crow and others trying to explain the evolutionary basis of schizophrenia. While these are certainly interesting and worthy of further study, they have very little to do with practical care and management of patients.

Furthermore, schizophrenia is undoubtedly a multi-factorial disease with environmental etiologies. It is not simply genetic evolution.

Sure, in THIS society. Unfortunately, our brains did not evolve in THIS society and are therefore not designed to function optimally in THIS society. There is more to understanding psychiatric disorders than the DSM. Rise above the dogma.

Well, unfortunately we live in THIS society. Take a trip out of your ivory tower.

Does that mean you believe in eugenics? As in Aldous Huxley's "Brave New World"? That is going into dangerous territory...that's a whole big ethical question.

I don't know how you construed that from my statement. I simply said that I think that people who have mental illnesses deserve treatment. In no way am I advocating "removing these individuals from the gene pool." Other diseases with a clear genetic basis such as cystic fibrosis and Huntington's disease are also areas where development of novel therapies is needed.

What will happen with future human civilizations when people are bereft of creativity? Fortunately, presently, a lot of these conditions can be treated medically. It is just a question of having the proper diagnosis and having it treated promptly.

Finally, can one be treated for "madness" and still be a productive artist/mathematician?

You seem to be suggesting that psychosis is a pre-requisite for creativity. Care to provide some hard scientific evidence to back that up?

To answer your second question, yes, a good number of psychotic patients can be treated and remain "sane" as long as they are compliant with their medications. Thankfully, second-generation anti-psychotics (so-called "atypicals") have come a long way in reducing the extrapyramidal side-effects of Thorazine and other older drugs. However, there is stilll a lot of work to do to reduce the side-effects.

 

[Smilemaker100]

Gfunk6 wrote: "You seem to be suggesting that psychosis is a pre-requisite for creativity. Care to provide some hard scientific evidence to back that up?"
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Nowhere did I state that psychosis is a pre-requesite for creativity but the prevalence of mental illness (namely manic depression) in the artistic community is higher (as much as twice as more) than it is in the general population. Furthermore, even those artists that don't display manic depression, quite a number of them have close relatives that were touched with the illness.

Maybe you haven't been exposed to the world of the arts- I don't know what your educational background is. But if you read numerous biographies of famous artists- it is replete with mental illnesses/mental illness in the family history- especially manic depression. One good example is that of the well known Hemingway family which has had several generations of writers & actors who were manic depressives that committed suicide. Another famous example is also that of the Barrymore family- several generations of actors with alcoholic and depressive tendencies. There a lot more families that have a history of mental illness and artists afflicted by it.

If you want scientific evidence- well why don't you read the book I suggested in my first post " Touched with Fire" which is written by a psychiatrist-Kay Redfield Jamison (who herself has a history of bipolar). This book has plenty of documentation on that subject. It isn't the only book which touches this subject- there are others ( which I still haven't gone about reading- mostly written by psychologists)

"Psychological studies of art & artists" by Panter and Virshup

" Beyond Reason:Art & Psychosis" by Chaussen and Jadi

"Manic depression and Creativity" by Hershman and Lieb

"Brotherhood of Tyrants: Manic Depression and Absolute Power" by Hershman and Lieb

"Strong Imagination, Madness, Creativity and Human Nature" by Nettle

Some scientific articles (there are more if you do a pubmed search)
1)Compr Psychiatry. 1988 May-Jun;29(3):207-17.
Bipolar affective disorder and creativity: implications and clinical management.
Andreasen NC, Glick ID

2)Psychiatry. 1989 May;52(2):125-34.
Mood disorders and patterns of creativity in British writers and artists.
Jamison KR.

3)Compr Psychiatry. 1989 May-Jun;30(3):272-3.
Compelling evidence for increased rates of affective disorder among eminent creative persons.
Richards R, Kinney DK

I think that quite a number of psychiatrists are somewhat egotistical and don't fully comprehend what it is like to have a mental illness (especially manic depression or schizophrenia) unless they are personally affected- that is, unless they themselves or one of their relatives suffers from it. You may know all your science ( etiology, pathogenesis,prognosis, and pharmacology) but some of you do not know what it is like to know someone on an intimate level who suffers from this and what they go through in their personal lives. I am not trying to discredit psychiatrists , but like any other illness, you can't sympathize 100% without having your personal life touched by someone who is afflicted by the illness.

 

[PsychMD]

Smilemaker, here's Gfunk's and most psychiatrists' perspective (admittedly, simplistic and maybe crude):

Basically, our job as physicians is to simply intervene when some sort of dysfunction or illness occurs, in order to HELP the suffering patient, regardless of whether they are a genius, an artist, a mathematician, or a cleaning lady. If they can't think or sleep, or if they're thinking about suicide... if they can't, simply put, work and love and feel at peace with themselves and the world...that's when they come to the doctor. It's up to the doctor to clarify, educate, treat...and the perspective of the doctor is not some aloof "paradigm" or "theoretical/intellectual" model, but it is the perspective of taking each patient, individually, at a time, and trying to put together something that works or helps that particular patient, regardless of the DOCTOR's general views/opinions about mental illness.

If a brilliant mathematician is losing weight/becoming dehydrated because he's not eating and not sleeping for days/weeks, until he begins to hallucinate, while working night/day on some sort of mathematical problem (admittedly even a problem, that if solved, would bring some sort of revolutionary improvement in the field of mathematics), and is found passed out, filthy and emaciated, in his apartment by his distraught parents and/or colleagues...that's when the doctor is usually called. And the doctor will not waste time trying to debate the mathematical genius of the patient, nor expound on his/her views about the relationship between madness and genius; instead, he/she will just plainly try to get that patient to sleep and eat properly, wash himself, have access to regular meals, will try to alleviate the anxiety of the parents, and, overall, restore the patient to some form of functioning. Sounds paternalistic and simplistic? You bet it does. Will the world have to wait a little longer until that mathematical problem is solved? So what! Sure, it may be fun to speculate (on our own free time) about mathematical or artistic genius and mental ilness, but all that speculation won't get the mathematician to eat and sleep regularly, and/or prevent further deterioration of this human being. If this speculation would bring us closer to be able to help restore individual patients to some form of safe/healthy level of functioning, by all means, let's continue our theoretical quest and debate. I suspect, however, that it's been a dead end so far, so that's why most psychiatrists won't really care about this subject too intensely...definitely not as much as you seem to care about it.

YOU care, of course you do...because I can just imagine what your family's had to go through, all these years, especially knowing how difficult it is to get practical competent help when a family member is being afflicted with mental illness, plus knowing all the stigma and misunderstandings that are still swirling around "madness".

If there is anything we can do to help YOU be more at peace, just ask...most psychiatrists and psychiatrists-to-be will jump right in, almost to a fault! If you think it helps to get some confirmation about links/studies about mental illness and genius/artistic talent...you got some of them. If you want more links, we can find them for you. Is there anything else you need? Just ask. It's damn hard to connect in a humane manner, person-to-person, in this superfragmented, technological age, anyway. Thank God for SDN!

 

[Smilemaker100]

Smilemaker, here's Gfunk's and most psychiatrists' perspective (admittedly, simplistic and maybe crude):

Basically, our job as physicians is to simply intervene when some sort of dysfunction or illness occurs, in order to HELP the suffering patient, regardless of whether they are a genius, an artist, a mathematician, or a cleaning lady. If they can't think or sleep, or if they're thinking about suicide... if they can't, simply put, work and love and feel at peace with themselves and the world...that's when they come to the doctor. It's up to the doctor to clarify, educate, treat...and the perspective of the doctor is not some aloof "paradigm" or "theoretical/intellectual" model, but it is the perspective of taking each patient, individually, at a time, and trying to put together something that works or helps that particular patient, regardless of the DOCTOR's general views/opinions about mental illness.

If a brilliant mathematician is losing weight/becoming dehydrated because he's not eating and not sleeping for days/weeks, until he begins to hallucinate, while working night/day on some sort of mathematical problem (admittedly even a problem, that if solved, would bring some sort of revolutionary improvement in the field of mathematics), and is found passed out, filthy and emaciated, in his apartment by his distraught parents and/or colleagues...that's when the doctor is usually called. And the doctor will not waste time trying to debate the mathematical genius of the patient, nor expound on his/her views about the relationship between madness and genius; instead, he/she will just plainly try to get that patient to sleep and eat properly, wash himself, have access to regular meals, will try to alleviate the anxiety of the parents, and, overall, restore the patient to some form of functioning. Sounds paternalistic and simplistic? You bet it does. Will the world have to wait a little longer until that mathematical problem is solved? So what! Sure, it may be fun to speculate (on our own free time) about mathematical or artistic genius and mental ilness, but all that speculation won't get the mathematician to eat and sleep regularly, and/or prevent further deterioration of this human being. If this speculation would bring us closer to be able to help restore individual patients to some form of safe/healthy level of functioning, by all means, let's continue our theoretical quest and debate. I suspect, however, that it's been a dead end so far, so that's why most psychiatrists won't really care about this subject too intensely...definitely not as much as you seem to care about it.

YOU care, of course you do...because I can just imagine what your family's had to go through, all these years, especially knowing how difficult it is to get practical competent help when a family member is being afflicted with mental illness, plus knowing all the stigma and misunderstandings that are still swirling around "madness".

If there is anything we can do to help YOU be more at peace, just ask...most psychiatrists and psychiatrists-to-be will jump right in, almost to a fault! If you think it helps to get some confirmation about links/studies about mental illness and genius/artistic talent...you got some of them. If you want more links, we can find them for you. Is there anything else you need? Just ask. It's damn hard to connect in a humane manner, person-to-person, in this superfragmented, technological age, anyway. Thank God for SDN!

Hi Psychdoc,

Well, after reading that nice lenghty response (thanks ), I must say, you sound like a great psychiatrist! The only reason why I wrote about all these hypotheses (which are not scientifically valid according to some -there is much debate on this topic) was to get a doctor's perspective since they deal with a variety of mentally ill people from different walks of life. I also work in the "head" region but in something FAR related- dentistry!!!! ( Then again, a lot of people who have phobias when they visit the dentists need psychiatric/pyschological counselling -but that's another subject in itself!)

I was not asking psychiatrists to explain or defend the hypothesis. I was wondering if psychiatrists have noted any sort of pattern-pure and simple facts without trying to make any inferences. Have you had a lot of artists that have manic depression and have you had scientists/mathematicians with some sort of schizo disorder?

There are also some psychiatrists that are interested in research as is Kay Redfield Jamison, so I thought that by posting a thread in a forum where psychiatrists are in training ( which I assume involves research to a certain extent as well as treating patients) that there would be some feedback on this topic.

BTW , what year of training are you in?

Thanks again.

 

[PsychMD]

I've finished my training and have been in practice for a while. I like coming here, on SDN, from time to time, because I (selfishly!) enjoy the enthusiasm of younger colleagues who are still in training.

To answer simply to your question...no, I have not personally noticed any specific patterns regarding a possible higher "prevalence" of artistic talent in patients with severe Bipolar disorder (classical "manic-depressive" ilness), or mathematical inclinations/aptitudes in patients with schizophrenia. This may not necessarily be because there isn't any corelation, but maybe just because I have not had a chance to notice it myself. Plus we are dealing with definitions here. I do not know actually how to define artistic talent or inclination, while OTOH a manic patient is quite easily to recognize.

I do not know much about complex mathematics, but I have had one adolescent patient with first break psychosis who was unusually preoccupied by rather abstract and esoteric mathematical questions, while at the same time being unable to concentrate on solving simple arithmetic problems, failing all classes, including calculus, being completely disorganized regarding self-care, etc. But no, I haven't noticed a pattern. Actually, empirically, I believe that the prevalence of extraordinary mathematical aptitude in the general population is much more rare than the one of schizophrenia, which is 1 % pretty much across most cultures, geographies, socioeconomic status, level of premorbid education, etc. Actually, Bipolar I also hovers around the same 1 or 1.1 %, while artistic talent...who knows?

I am familiar with Dr. Jamieson's writings, and I actually actively recommend her books to patients and families of patients who are diagnosed with Bipolar type I disorder.

In a rather similar vein, albeit regarding a different subject...there have been several neurological/psychological studies regarding right and left handedness (hemispheric dominance) and various neurological injuries/ilnesses, IQ's, learning disabilities, etc. Conclusion?...pretty much inconclusive, at least up to date. Bottom line...we don't know. Obviously, psychiatric and neuropsychiatric (especially regarding cognitive development) epidemiology and genetics have still a lot of ground to cover, and lots of questions to answer.

 

[Smilemaker100]

I've finished my training and have been in practice for a while. I like coming here, on SDN, from time to time, because I (selfishly!) enjoy the enthusiasm of younger colleagues who are still in training.

To answer simply to your question...no, I have not personally noticed any specific patterns regarding a possible higher "prevalence" of artistic talent in patients with severe Bipolar disorder (classical "manic-depressive" ilness), or mathematical inclinations/aptitudes in patients with schizophrenia. This may not necessarily be because there isn't any corelation, but maybe just because I have not had a chance to notice it myself. Plus we are dealing with definitions here. I do not know actually how to define artistic talent or inclination, while OTOH a manic patient is quite easily to recognize.

I do not know much about complex mathematics, but I have had one adolescent patient with first break psychosis who was unusually preoccupied by rather abstract and esoteric mathematical questions, while at the same time being unable to concentrate on solving simple arithmetic problems, failing all classes, including calculus, being completely disorganized regarding self-care, etc. But no, I haven't noticed a pattern. Actually, empirically, I believe that the prevalence of extraordinary mathematical aptitude in the general population is much more rare than the one of schizophrenia, which is 1 % pretty much across most cultures, geographies, socioeconomic status, level of premorbid education, etc. Actually, Bipolar I also hovers around the same 1 or 1.1 %, while artistic talent...who knows?

I am familiar with Dr. Jamieson's writings, and I actually actively recommend her books to patients and families of patients who are diagnosed with Bipolar type I disorder.

In a rather similar vein, albeit regarding a different subject...there have been several neurological/psychological studies regarding right and left handedness (hemispheric dominance) and various neurological injuries/ilnesses, IQ's, learning disabilities, etc. Conclusion?...pretty much inconclusive, at least up to date. Bottom line...we don't know. Obviously, psychiatric and neuropsychiatric (especially regarding cognitive development) epidemiology and genetics have still a lot of ground to cover, and lots of questions to answer.

Thanks again, for your lengthy reply PsychMD!

You wrote that you are familiar with Jamison's writings -does that include "Touched with Fire"?

If you don't mind my asking, what got you interested in psychiatry?

Maybe I am not expressing myself coherently- I am not asking how many of your manic depressive patients have artistic inclinations but vice versa (artists who are bipolar) nor am I asking how many schizotype patients are mathematically inclined but vice versa ( mathematicians/engineers/scientist patients who have some sort of schizo disorder).

In any case, I have read a lot of biographies of artists and there does seem to be a strong presence of mental illness in the artist themselves as well as close relatives.

One of my relatives is being treated with clozaril. What do you think about that med?

Thanks again , doc!

 

[PsychMD]

I first became interested in Psychiatry when, as a Medical Sudent, I had my first preclinical neuroscience courses. I also read several behavioral neurology texts and it seemed pretty fascinating to me at the time. My formal psych. clinical rotation solidified my decision. Currently I practice a combination of inpatient and consult-liaison psychiatry (consults on med-surg. patients with co-morbid psych. impairment), so I tend to see a fairly sick patient population.

Regarding Clozaril, there must be a reason why it is called "the golden standard" among antipsychotic meds. It has proven to be quite effective, especially in refractory cases. It has a lot of potential serious adverse reactions, but, in general, if a patient is closely monitored and tolerates it well, Clozaril can really do a great job for keeping at bay some otherwise truly debilitating symptoms. I have seen many patients with lives truly restored while being treated with Clozaril. As for all patients who require chronic tx. with neuroleptics for a chronic illness, ongoing monitoring for benefits vs. risk/adv. r. is crucial.

Regarding family members of patients with severe mental illness: in general it is accepted that there is a nine times greater risk of suffering from schizophrenia if a brother or sister is affected and a twelve times greater risk if a parent has a schizophrenic disorder. Regarding the epidemilogy of Bipolar disorder, see this article http://www.emedicine.com/ped/topic240.htm
(generally for the early onset severe type, the first degree relatives have about a 12 times greater risk than the general population). Bipolar disorder onset is, nevertheless, quite more susceptible to stress and environmental factors than Schizophrenia. Plus there is still an ongoing debate at this tyme about the very definition of Bipolar disorder and Bipolar disorder "spectrums", which make large scale epidemiological studies even more difficult to pursue and interpret. I am still not convinced re. the issue of Bipolar I disorder (per the classical Kraepelinian description) actually being a distinct/different disease among other mood disorders versus just a "more intense" variant within a "spectrum" of diseases. The epidemiological data just isn't very clear up to this point. The good news about Bipolar disorder, however, is that it tends to respond faster and better to the current tx. modalities, and lots of patients with severe Bipolar I disorder are ultimately able to maintain a good personal and social level of functioning, meaningful and stable relationships, good cognitive functioning, etc....some of which may be lost to a certain degree in many patients with Schizophrenias (especially the early onset, or the undifferentiated types). (There was a reason why Bleuler called Schizophrenia "Dementia praecox", or "early dementia").
Another interesting recent global epidemiological finding in regards to level of functioning and schizophrenia is that it seems that patients in the underdeveloped countries seem to fare better in the long run than ones in highly developed countries (in spite of better tx. available in the latter), although I'm thinking that there is some self-selection in the under-developed world for patients with the "milder" forms of illness, because the ones with the more severe forms will probably die sooner (through self neglect, violent crime, untreated co-morbid medical illnesses, etc.) than the others, and end up not being counted in the long run. (I am not sure if the most recent studies are accounting for this or not.)

We veered quite a ways off the main topic here. You guys are inspiring me to do a lot of "extra-curricular" research...I really hope that other can chime in here, with opinions and thoughts. (I really think we don't truly get too much formal interdisciplinary training during our service-focused, clinically-focused residencies in regards to psychiatric epidemiology, to psychiatry and genetics, and even to the age-old fascinating history of psychiatry.) Thank you, smilemaker, for bringing up a most intresting topic for further discussion and debate.

 

[MustafaMond]

: Seishin Shinkeigaku Zasshi. 2003;105(3):277-86. Related Articles, Links


Phenomenology of genius and psychopathology.

Doerr-Zegers O.

University of Chile, Santiago.

The relationship between genius and madness has been a subject of interest since the beginning of critical and philosophical thinking. Thus, Aristotle, in the Book XXX of the Problemata, asks himself "why are all extraordinary men in the fields of philosophy, politics, poetry and art melancholic?, adding afterwards: "...and some of them in such a way that they may suffer from pathologic manifestations whose origin is in the black bile". In the past decades the German author Tellenbach studied the personalities of several geniuses, both from fiction, such as Hamlet, and from reality, such as the writer von Kleist, concluding that they suffered from a specific form of depression that he called "Schwermut" (melancholy), which was supposedly different from the narrowly defined illness of depression. Other work done on this subject is the extensive study by the North American author Kay Jamison, who, after researching the biography and the tree of a long list of writers, composers and musicians, concluded that all of them had suffered to some degree from a bipolar disorder. This author strives to carry out a phenomenology of genius, and he finds that, together with other essential features, the geniuses always show forms of experiencing and/or of behaving which do not fall within the range that is considered normal, although they can not always be classified as pathological. His study is based on the analysis of the life and the work of three men whose genius could not be doubted: the naturalist Alexander von Humboldt, the philosopher Soeren Kierkegaard and the poet Rainer Maria Rilke. This author specially focuses on the last named, since in his later work he explicitly meditated on the suffering that has meant for him his condition of genius and what he considered the only way to overcome them: to be faithful to the work of art, whose fulfilment was imposed on him--to a certain degree from the endogenous--as an unavoidable imperative.

Publication Types:
Lectures

PMID: 12728513 [PubMed - indexed for MEDLINE]

 

[Smilemaker100]

I first became interested in Psychiatry when, as a Medical Sudent, I had my first preclinical neuroscience courses. I also read several behavioral neurology texts and it seemed pretty fascinating to me at the time. My formal psych. clinical rotation solidified my decision. Currently I practice a combination of inpatient and consult-liaison psychiatry (consults on med-surg. patients with co-morbid psych. impairment), so I tend to see a fairly sick patient population.

Regarding Clozaril, there must be a reason why it is called "the golden standard" among antipsychotic meds. It has proven to be quite effective, especially in refractory cases. It has a lot of potential serious adverse reactions, but, in general, if a patient is closely monitored and tolerates it well, Clozaril can really do a great job for keeping at bay some otherwise truly debilitating symptoms. I have seen many patients with lives truly restored while being treated with Clozaril. As for all patients who require chronic tx. with neuroleptics for a chronic illness, ongoing monitoring for benefits vs. risk/adv. r. is crucial.

Regarding family members of patients with severe mental illness: in general it is accepted that there is a nine times greater risk of suffering from schizophrenia if a brother or sister is affected and a twelve times greater risk if a parent has a schizophrenic disorder. Regarding the epidemilogy of Bipolar disorder, see this article http://www.emedicine.com/ped/topic240.htm
(generally for the early onset severe type, the first degree relatives have about a 12 times greater risk than the general population). Bipolar disorder onset is, nevertheless, quite more susceptible to stress and environmental factors than Schizophrenia. Plus there is still an ongoing debate at this tyme about the very definition of Bipolar disorder and Bipolar disorder "spectrums", which make large scale epidemiological studies even more difficult to pursue and interpret. I am still not convinced re. the issue of Bipolar I disorder (per the classical Kraepelinian description) actually being a distinct/different disease among other mood disorders versus just a "more intense" variant within a "spectrum" of diseases. The epidemiological data just isn't very clear up to this point. The good news about Bipolar disorder, however, is that it tends to respond faster and better to the current tx. modalities, and lots of patients with severe Bipolar I disorder are ultimately able to maintain a good personal and social level of functioning, meaningful and stable relationships, good cognitive functioning, etc....some of which may be lost to a certain degree in many patients with Schizophrenias (especially the early onset, or the undifferentiated types). (There was a reason why Bleuler called Schizophrenia "Dementia praecox", or "early dementia").
Another interesting recent global epidemiological finding in regards to level of functioning and schizophrenia is that it seems that patients in the underdeveloped countries seem to fare better in the long run than ones in highly developed countries (in spite of better tx. available in the latter), although I'm thinking that there is some self-selection in the under-developed world for patients with the "milder" forms of illness, because the ones with the more severe forms will probably die sooner (through self neglect, violent crime, untreated co-morbid medical illnesses, etc.) than the others, and end up not being counted in the long run. (I am not sure if the most recent studies are accounting for this or not.)

We veered quite a ways off the main topic here. You guys are inspiring me to do a lot of "extra-curricular" research...I really hope that other can chime in here, with opinions and thoughts. (I really think we don't truly get too much formal interdisciplinary training during our service-focused, clinically-focused residencies in regards to psychiatric epidemiology, to psychiatry and genetics, and even to the age-old fascinating history of psychiatry.) Thank you, smilemaker, for bringing up a most intresting topic for further discussion and debate.

Dear PsychMD,

Thanks again, for that lenghty reply.

In regards to clozaril, according to what I have read, it is true that it is considered to be some sort of "golden drug" in regards to refractory cases of schizotype illnesses. However, the risks of getting neutropenia are worrisome and the regular blood testing is bothersome for the patients. Is there any research being done presently to replace clozaril with a drug which won't cause neutropenia?

I agree with you that mental illnesses- schizophrenia, schizoaffective disorder, bipolar disorder,unipolar depression- belong to a spectrum/continuum of one illness with different manifestations. Some doctors have a hard time discerning between the conditions. According to what I have read, patients who have unipolar depression can have psychotic symptoms/delusions and patients with schizotype disorders can have depressive symptoms. It really is so confusing! And it doesn't seem to me like there is one gene linked to one disorder. It appears that we are dealing with a multifactorial problem- a combination of several genes and environmental trigerring factors. It is really fascinating.

I don't completely agree with your statement
" Another interesting recent global epidemiological finding in regards to level of functioning and schizophrenia is that it seems that patients in the underdeveloped countries seem to fare better in the long run than ones in highly developed countries"

I recall seeing a documentary which addressed this very issue. The documentary showed how mentally ill people are faring off very badly in third world countries not only because of the lack to medical treatment but mostly because of the ignorance of the populace . I still have vivid memories of the film footage of these mentally afflicted people who were tied like dogs to a tree (and treated worse than dogs)- with a noose around their neck- tied to a tree ,underfed and very often completely forgotten about by their family members. It isn't uncommon to hear people in the third world ( and even in the so called "developed" or "industrial" world) referring to mentally ill people as being possessed by the devil or demonic spirits! Actually, it wasn't so long ago, that in North America, most people had this attitude as well.

Thanks again,
Smilemaker

 

[purpledoc]

I feel I have to interject with an important point: Dr. Kay Redfield Jamison is actually a psychologist, not a psychiatrist. I am quite familiar with her work.

I have a lot more I'd like to add on this topic, but unfortunately, patients are waiting. Perhaps later.

Cheers,
Purpledoc

 

[50960]

There is alot of pseudoscience in this arena, but there is an upcoming CME convention called "Creativity and Madness" in Santa Fe, NM, and it appears to be a weekend, multiple presentation conference on the current research and theory on this topic.

s

 

[Gfunk6]

There is alot of pseudoscience in this arena

Yeppers.

I'm more inclined to do a PubMed search than to browse through the New Age section at my local Barnes and Nobles for reliable information on this topic.