The Bipolar Spectrum and the Artistic Temperament PhD

8/19/2019 The Bipolar Spectrum and the Artistic Temperament PhD

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THE BIPOLAR SPECTRUM AND THE ARTISTIC TEMPERAMENT 1

Running header: THE BIPOLAR SPECTRUM AND THE ARTISTIC TEMPERAMENT

The Bipolar Spectrum and The Artistic Temperament:

The Effects of Treatment on Exceptional Artistic Talent

NIBERCA (GIGI) POLO

The New School for General Studies


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“Human salvation lies in the hands of the creatively maladjusted.”

Martin Luther King


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To God, for all the blessings, strength and perseverance.

To my husband, for his patience and support.To MariaBelén, my unborn child, who has changed my life for the best.


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Table of Contents

1. Abstract …………………………………………………………………………………….5

2. The Bipolar Spectrum and The Artistic Temperament:

The Effects of Treatment on Exceptional Artistic Talent …...…………………………….6

3. Methodology ……………………………………………………………………………...11

4. Literature Review …………………………………………………………………….......14

a. From Divinity to Pathology …...………………………………………………..14

b. Pathology or Social Construct ...………………………………………………..16

c. The Perpetuation of Stigma …...………………………………………………..18

d.

Bipolar, Creativity and Genius …...…………………………………………….21

5. Findings …...……………………………………………………………………………...30

6. Discussion of Findings .………………………………………………………………......36

7. Conclusion .…………………………………………………………………………….....49

a. Production …...………………………………………………………………….49

b. Future Studies …...……………………………………………………………...50

c.

Media Activism Plan …...………………………………………………………50

8. Appendices .………………………………………………………………………............51

1. Glossary of terms (All glossary terms are in bold throughout this paper) …………..51

2. Interviewees’ bios …...………………………………………………………….62

3. Interview protocol …...………………………………………………………….65

4. Dr. Swann interview transcript …...……………………………………………67

5.

Survey …...…………………………………………………………………….101

6. Media Activism projects …...………………………………………………….104

9. References …...……………………………………………………………………….....109


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Abstract

Bipolar Disorder is a deteriorating affective illness believed to be a source of

exceptional artistic creativity. Throughout history, artistic talent and madness have been linked

and mystified. Many studies have explored the relationship between pathology and the mad-

genius notion, with no conclusive results (Ivcevic, 2009; Gilman, 1985; Ludwig, 1989; Becker,

2000-2001; Hillard, 2002; Richards, 1993; Engel, 1977; Eysenck, 1992; Akiskal, Hantouche, and

Allilaine, 2003; Foucault, 1965). In modern times, the media have created sinister depictions of

madness that have misled public opinion and perpetuated deceitful symbols of insanity. This

paper presented the results of interviews of five bipolar artists who shared their experiences,

views and concerns regarding the illness and the stigma that surrounds it; six experts of the

medical community interviewed gave recommendations to recognize the episodes and manage

the illness. It also presented the results of a convenience survey of Dominican art students and art

professionals living in the Dominican Republic and in the Diaspora —mostly in the United

States—in order to assess the incidence in diagnosis based on seasonal episodes and cultural

tolerance, and the level of stigma among artists. The research set out to discover the effects of

treatment on exceptional artistic talent and the ways in which the illness can be managed without

affecting creative processes. Survey results showed that environmental stressors are the main

triggers of episodes of the illness, and cultural context determines the incidence of diagnoses

among artists. Most interviewees agreed that psychotropic treatments lower creativity in soft-

bipolar patients but they are needed for severe-bipolar patients to function. The results of this

research were presented in a one-hour documentary called Madly Gifted , which will be used as a

tool for media advocacy.

Keywords: artistic talent, artistic temperament, bipolar, creativity, genius, greatness,

mood disorders, psychopathology, social construct, madness


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The Bipolar Spectrum and The Artistic Temperament:

The Effects of Treatment on Exceptional Artistic Talent

"It is only too true that a lot of artists are mentally ill—it's a life which, to put it mildly,

makes one an outsider. I'm all right when I completely immerse myself in work,

but I'll always remain half crazy."

Vincent Van Gogh

The concept of madness has been seen as both a blessing and a curse. Throughout history

it has carried different meanings, and the perception of the madman has been re-examined and re-

formulated through a multitude of cultures. For the Greeks, some forms of madness were divine

intervention, a sign of a direct connection with the gods, which implied a certain special talent or

a touch of genius (Dodds, E. R., 1968; Ludwig, 1989; Becker, 2000-2001; Schlesinger, 2009;

Weisberg, 1994). This desirable disturbance—perceived as a virtue—was clearly differentiated

from clinical insanity, a state in which only the suffering was present (Ludwig, 1989).

In today’s society, insanity is considered a psychopathology; a general definition of

insanity is “a spectrum of behaviors characterized by certain abnormal mental or behavioral

patterns. Insanity may manifest as violations of social norms, including becoming a danger to

themselves and others” (Wikipedia, 2011). Both Foucault (1965) and Gilman (1985) expressed

how different and insane become synonyms.

The concept of mental disorders has been stigmatized in both private and public

conversation, alienating those who suffer from any kind of mental disorder by labeling them

outsiders. The media perpetuates this “sign of disgrace” (Byrne, 2000, p. 65) casted upon those

suffering from mental disorders when they depict the madman as a psychopath , serial killer, and a

monster — a stereotype that accentuates social difference (Levin, 2001).


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Movies like Memento, Dr. Brooks, Girl Interrupted, Secret Window, Psycho, to mention

a few, have depicted the mentally ill as monsters, portrayals that have contributed to the growth

of stigma in disproportionate levels.

However, the media are also the means by which stigma can be challenged, redefined,

and eradicated. Golden Globe Award-winning actress Glenn Close is currently in a conscious

awareness campaign to break the perpetuation of stigma in mental illness by engaging the media

in open conversation. In an interview with The Huffington Post she stated: “I have no illusions

that BringChange2Mind.org is a cure for mental illness. Yet, I am sure it will help us along the

road to understanding and constructive dialogue….every society will have to confront the issue.

The question is, will we face it with open honesty or silence? It will help deconstruct and

eliminate stigma” (Close, 2009, para. 9).

The Diagnostic and Statistical Manual (DSM) defines mental disorders as “the risk of

suffering or losing freedom”, and “a behavioral and psychological affliction, associated with

distress” (APA, DSM-IV, 1994; as cited by Lauronen, Veijola, Isohanni, Jones, Nieminen,

Isohanni, 2004, p 83). As a result of the advancement of diagnostic medicine and the expansion

of criteria of mental illnesses, many people are being diagnosed with mental disorders, especially

Bipolar Disorder, an Affective Disorder also known as Manic Depression.

According to the National Depressive and Manic-Depressive Association, Bipolar

Disorder affects 2.5 million adult Americans sometime during their lifetime; the typical age of

onset is between 18-22, and 15 to 20% of untreated people commit suicide (DBSA Boston,

former MDDA Boston, 2011). The National Institute of Mental Health found that Bipolar

Disorder affects 5.7 million adults and an estimated 1.1 million children in the United States

(Rutzen, 2010). Lifetime cost per patient goes from $12,000 for a person with a single manic

episode to $600,000 for those who suffer multiple episodes; $7.6 billion in direct healthcare costs

in the United States, annually (Nami, 2003).


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Due to the similarities between the artistic personality and symptoms of the illness,

Bipolar Disorder is also known as the disorder of the artistic temperament, which Jamison

(1993) refers to as “the artistic voyage—fierce energy, volatile moods, restlessness, feverish

temperament, imaginative powers, passion, intense emotional response….and a sense of the

visionary and the grand” (p. 2). Some authors have suggested that the propensity of this

diagnosis among artists is high (Frantom & Sherman, 1999; Simonton, 2006; Jamison,

1989/1990, Andreasen, 1987; Ludwig, 1992), although results are inconclusive and more

extensive research is needed (Rothenberg, 1990).

Since I was diagnosed with Bipolar Disorder in 2007, I have been researching this

illness and the treatments available. As an artist suffering from the disorder, I have struggled

with medications and doctors that have undermined the value of creativity in my life; the doctors

have expressed that “if losing my artistic talent is the price that I have to pay in order to be

normal, stable and functional in society, then I shouldn’t question the validity of the treatment”.

Throughout this journey I have met other bipolar artists who like me, have had similar

concerns and frustrations and have experienced huge changes in their lives as a consequence of

the illness. Since Bipolar Disorder is considered a chemical imbalance of the brain, anti-

depressants, anti-psychotics, and mood stabilizers—called psychotropic treatments—have

become the most common treatment options, often in combination with psychotherapy.

The main problem today is that some artists suffering from Bipolar Disorder have a lot

of fear that the available psychotropic treatments might lower their creativity and—because of

this fear—avoid treatment, preferring to manage the illness on their own without the supervision

of a health professional. Others don’t seek help because they are afraid of what the stigma of

being labeled mentally ill could bring to both their professional and personal lives (J. Banks,

personal communication, November 21, 2009).

A number of contemporary artists suffering from Bipolar Disorder have expressed how

episodes of mania —or hypomania—enhanced their creative thinking when they weren’t taking


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medication, whereas psychotropic treatments numbed their senses to the point of exhaustion, and

lowered their ability to create (Shenfeld, 2007, para. 9). Teresa Hsu, an artist from northern

California, says that, “Being Bipolar has enhanced my urge to make art….it has heightened my

artistic sensibility”, but she adds that, “my depressions take me to a very dark place” (Shenfeld,

2007, para. 9-10).

Today this disorder is considered to manifest on a continuum, called the Bipolar

Spectrum (Akiskal & Pinto, 1999; Angst, 2007) a term introduced in order to “alleviate the

problem of under-diagnosis and under-treatment of Bipolar Disorder”—an approach that could

face the risk of pathologizing temperament and personality traits, jeopardizing our basic human

need for individualism and uniqueness.

Creativity expert Mihaly Csikzentmihalyi writes in his book Creativity: Flow and the

Psychology of Discovery and Invention: “What’s considered ‘crazy’ in one culture isn’t in

another. We have a long list of shunning all kinds of creative people and their works and calling

them ‘crazy’ when we are not yet ready for their ideas” (Csikzentmihalyi, 1996; cited by Castle,

2006, p. 6).

Bipolar Disorder might be a by-product of creativity, or maybe Bipolar Disorder is in

the gene that carries creativity. Perhaps creativity is what makes artists—due to their sensibility

towards the world and events surrounding them—more prone to stress and thus causing Bipolar

Disorder. Or maybe everybody, at a certain point in his or her life, falls in an area of the Bipolar

Spectrum. Is it maybe that Bipolar Disorder gives those who suffer it, the potentiality to

greatness?

An extensive exploration of syntonic personalities (Claridge, 2006) and psychoticism

(Eysenck, 1992) within the character of the Bipolar Spectrum is needed in order to understand

where artistic temperament ends and the illness starts, and to differentiate between personality

traits and psychopathology. This is all in order to protect artistic talent, and hopefully, reshape

the perception of the mentally ill to reduce stigma. If artistic talent must be regarded as an


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“enduring trait of the personality….as one of the cognitive functions of the ego” (Noy, 1972, p.

243), doctors have to acknowledge that using treatments that affect the artistic talent will not

only damage a career path, it will seriously damage a person’s psyche.

Today the question remains: is mental illness a bi-product of the artistic temperament?

Or is it creativity the spark that ignites the illness? Are highly creative minds more prone to

suffer mental illness? Dietrich (2007) argues that, “mental illness does not have a link with

creativity; it has a link with a specific kind of creativity —if that” (p. 26, as cited by Bryant,

2007, p. 4).

This research paper considered the available theory on Bipolar Disorder and the Bipolar

Spectrum, its historical context, diagnosis and treatments available today, the relationship

between the Bipolar Spectrum, artistic talent, impulsivity and greatness; the anti-psychiatry

movement and the disorder as a social construct; and the stigma that surrounds it, perpetuated by

the media. This research argues that, instead of trying to eradicate the illness at the cost of

creativity, artistic patients should be placed on a personalized holistic-treatment plan that keeps

them in a hypomanic state for most time, with manageable periods of controlled sadness to reboot

energy, and continue their creative process (R. Johnson, personal communication, May 25, 2010).

The results were presented in a one-hour documentary titled Madly Gifted.

Neither the Madly Gifted documentary nor the research paper are intended to discover a

scientific truth or accurately present each and all dimensions of the Bipolar Spectrum; instead

they aim to allow the viewer to experience the world through the eyes of five bipolar artists—

their frustrations, concerns, achievements, and fears—and the recommendations of six experts of

the medical community.


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Methodology

All data was gathered using a convenience survey and personal interviews. A glossary of

terms has been added in Appendix 1.

Participants

o Five artists, who defined themselves as such, regardless of their career choices: three

diagnosed with Bipolar Disorder, one with an undetermined diagnosis between severe

Depression and Soft Bipolarity, and one with a misdiagnosis of Bipolar Disorder. Out

of the five participants, two of them currently on a treatment plan with medication and

psychotherapy, two with no medication but following psychotherapy, and one with no

treatment of any kind. (See Appendix 2a for bipolar artists’ brief biographies)

o Six health professionals—four psychiatrists and two psychologists—who treat bipolar

patients regularly in their private practice. (See Appendix 2b for health professionals’

brief biographies)

o 51 Dominican art students and professionals living in Dominican Republic, and the

Diaspora

Methods

Interviews

Five bipolar artists were interviewed, who shared their experiences, views, and concerns

regarding not only the illness but also the perception of the mentally ill in our society; these

interviews were focused on their experiences, concerns, and biographical history. Six experts of

the medical community were interviewed in order to discuss diagnosis, treatment plans, and

recommendations to patients. (See Appendix 3a for bipolar artists questionnaire protocol and

Appendix 3b for health professionals questionnaire protocol. Appendix 4 for Dr. Swann

interview transcript; other transcripts available upon request)


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Survey

I conducted a convenience survey of art students and professionals, in order to assess the

correlation between artistic temperament and the Bipolar Spectrum, the level of stigma

towards the mentally ill among this particular group, and how stigma affects their behavior and

choice to seek help; also, to find if the prevalence of a diagnosis and treatment of Bipolar

Disorder changes depending on social norms.

Questions on mood and lifestyle were adapted from the Mood Disorder Questionnaire

(MDQ) and the Eysenck Personality Questionnaire (EPQ) and formatted using the Likert Scale

for accuracy. (See Appendix 5a for Spanish survey, and 5b for English survey)

I chose to conduct a survey because of its easy creation using SurveyGizmo.com—an

online open source—and fast distribution coverage via Madly Gifted Facebook group, my

personal contacts and Twitter. Even though this was not a predictive index sample, the survey

showed the important role played by cultural context, and behavioral trends among artists that

helped me brainstorm strategies for media activism—website, iPhone app, and art exhibition—

that will be developed in the near future.

Film

Madly Gifted is a one-hour documentary that presented the findings of my research.

Through a combination of interviews, reenactments, and my artwork, I explored the complexity

of the artistic talent —which has been defined as “a special ability to use [such] ‘specific kinds of

communication’… the ability to express [himself/herself] via a specific medium of a given art”

(Noy, 1972, p. 243)—and its relation to the Bipolar Spectrum.

This documentary will also be used as a tool for social activism to (a) educate and reduce

stigma, (b) demonstrate that psychotropic treatments, e.g. anti-depressants, anti-psychotic and

mood stabilizers, have a negative impact in exceptional artistic talent, and (c) encourage more

extensive investigation to find treatments specially aimed to the artistic community that keep

artists in a hypomanic state in order to preserve cyclothymic —involved in exploration and


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creativity —and hyperthymic —involved in territoriality and leadership— temperaments

(Akiskal et al., 2003).

As part of my efforts to start a conversation among the medical community in order to

find answers to these concerns, Madly Gifted will be screened in the 164th American Psychiatry

Association Annual Meeting, to be hosted in Hawaii, on May 18th, 2011. (See Appendix 6a for

Madly Gifted promotional poster)


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Literature Review

Even though the connection between creativity and clinical insanity is a modern

concept, madness has been seen, throughout history, as both a blessing and a curse—a state from

where to achieve genius with a high price to pay: a life sentence of suffering (Foucault, 1965;

Gilman, 1985).

This literature review covers the perception of madness from a historical context—From

Divinity to Pathology, Pathology or Social Construct, and The Perpetuation of Stigma—and the

relationship between Bipolar, Creativity and Genius.

From Divinity to Pathology

In antiquity, madness was perceived as a supernatural phenomenon until it became

pathology in modern times.

For the Greeks, some forms of madness were considered divine intervention (Dodds, E.

R., 1968; Ludwig, 1989; Becker, 2000-2001; Schlesinger, 2009; Weisberg, 1994), a concept

supported by Plato’s doctrine of The Divine Madness or Enthousiasmos. According to Plato’s

(1974) Phaedrus and the Seventh and Eighth Letters, “Madness, provided it comes as a gift of

heaven, is the channel by which we receive the greatest blessings… [it] is a nobler thing than

sober sense….Madness comes from God, whereas sober sense is merely human” (p. 46-47, as

cited in Becker, 2000-2001, p. 46). These popular attributions of inspiration to higher powers are

formulated today as primary processes, pre-logical thought and dissociative thinking

(Jamison, 1993, p.103-104).

The Renaissance used the term “genio” to describe those individuals with superior

creative achievement (Becker, 2000-2001); mental illness became “alienated madness” (Foucault,

1965). The Enlightenment had a new conception of genius where imagination, judgment,

common sense and memory were the four powers needed for the new model of man; humanistic


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psychologists (e. g. May 1975; Rogers, 1954/59) argued that, “creativity is the outcome of the

well-adjusted individual fulfilling his/her potential to the upmost” (Andreasen, 1987).

The 16th century valued and recognized what the 17th century was to “misunderstand,

devalue and reduce to silence” (Foucault, 1965, p. 77). During the 19th century, Romanticism

revived the notion of divine madness; episodes of mania differentiated the extraordinary

individual—the so-called genius —from the ordinary man, the bourgeoisie and the merely

talented. The poet Byron referred to his future with apprehension: “I picture myself slowly

expiring on a bed of torture, or terminating my days like [Johnathan] Swift—a grinning idiot”

(Sanborn, 1886, p. 126, as cited by Becker, 2000-2001, p. 50).

The anti-romanticism of modernism and post-modernism treated the mad person and the

eccentric artist as an outsider, accentuating social differences (Becker 2000-2001; Schlesinger,

2009). Society found ways to justify what could not be understood and contained those who were

different from the established norm by creating institutions to remove and separate, not only the

mentally ill, but also all individuals considered unproductive (Foucault, 1965).

The discovery of the insane —through their art production—was precipitated during the

20th century by “the need to define the avant-garde movement as the antithesis of the established

order” (Gilman, 1985, p. 586). The bourgeoisie labeled the avant-garde ‘crazy’ and ‘ill’ in a

quest for supremacy upon the other (Gilman, 1985).

The blossoming of psychiatric photography in the second half of the 19th century proves

the idea that the mad exhibited differences in appearance that doctors could learn to recognize

and label by recording and documenting the physiognomy of madness (Jaynes, 1976). Wilhelm

Griesinger, a biological psychiatrist of the 19th century, declared that, “mind illness is brain

illness” (Gilman, 1985, p. 582), a moment that marked the beginning of mental illnesses being

defined as pathology, and the search for psychotropic treatments.

The concept of genius madness and divine intervention continued into the 20th century.

Cesar Lombroso (1836-1909), an Italian criminologist, was seeking the essence of genius beyond


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biographical dictionaries, letters, autobiographies and creative products, by scrutinized facial

anomalies, that he called Stigmata — a term that conveys “the awe geniuses inspire as well as the

doom that surely awaits them” (Schlesinger, 2009, p. 63). His theory of degeneracy as the

central explanation of deviancy—from sociopathic and psychopathic to creative arts—became a

cornerstone of modern psychiatry. Other psychiatrists followed this trend (e.g. Galton,

1869/1962; Morean, 1859; Stekel, 1909/1917), and linking genius with pathology became the

predominant view of the period (Schlesinger, 2009).

Pathology or Social Construct

The stigmatization of madness —a process by which the mentally ill are stereotyped and,

most of the time, wrongly depicted—reinforces the ideas of Roland. D. Laing, Thomas Szazs, and

Michel Foucault, that mental illness is not pathology but a social construction.

In 1920 the definition of outsiders was used by society to control and neutralize the

avant-garde movement. Many psychopathologies were labeled degenerate, or, as Foucault

(1965) puts it, “unproductive citizens” (p. 589). Important figures of 19th century German

psychiatry such as Emil Kraepelin, Richard Krafft-Ebbing, and Theoordore Kirchhof all agreed

that, “the Jew was inherently degenerate and, as such, was especially prone to madness”

(Gilman, 1985, p. 589). The Nazis took the equation of artist equals madman equals Jew, as a

program to eradicate the Jews, and to shut down the avant-garde movement because it threaten

the stability of the régime, by defining it as degenerate while healthy meant traditional (Gilman,

1985, p. 592).

Difference was ruled to be pathology and asylums were created to isolate these

individuals. With the beginning of the institutionalization of those considered outsiders, and the

opening of asylums and new classification of illness, segregation and stigmatization was set in

motion. Exclusions depended on culture, which defined geographical separation, material

separation, and potential separation, not visible from the outside; this was the framework for the


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perception of madness. To Foucault (1965), the mad are forced to communicate through their

same cause of madness (family, society) and those who deny them insight (medicine); it is not a

phenomenon of nature as doctors diagnosed but “a configuration of culture” (p. 78, as cited by

Gilman, 1985, p. 575).

Foucault explains how society long viewed the mentally ill as antisocial, and how our

perception today is the result of history and societal standards of behavior. In his book Madness

and Civilization; A History of Insanity in the Age of Reason, he defines this phenomenon as a

social construction used by power structures to make sense of conflicts of difference, and control

those labeled as outsiders for not complying with societal norms. He exposes the ways in which

the so called insane are isolated because they stand out from the general population and, since

society can’t find resolution to this contradiction, it prefers to “alienate consciousness hence

alienate the other” (Foucault, 1965).

In The Rhetoric of Originality: Paul Celan and the Disentanglement of Illness and

Creativity, Derek Hillard (2002) describes the relationship between genius and madness as

follows:

Both [the genius and the madman] are seemingly self[-]absorbed, act

independently, and define their reality without reference to exterior authorities.

Autonomous, they appear to speak to and address either themselves or no one. This

autonomy, however, reveals a paradox and a price to pay. The creative individual

can only posit itself by liberating itself from societal constraints, prevailing

ideologies, and frustrating aesthetics norms. Yet madness describes genius’ fate;

for the very act by which he asserts himself also makes him ill (p. 395).

During the 1960’s Laing, a Scottish psychiatrist, started the anti-psychiatry movement

that challenged the Kraepelinian theories. Laing’s argument was that psychiatric disorders were

not mentally illness but a “diagnostic designation, arbitrarily fixed by society and confirmed by


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psychiatrists” (Laing, 1960, p.7, as cited by Greene, 2007, p. 364). Thomas Szasz, an American

psychiatrist, argued that the strict definition of disease or illness does not allow for mental

disorder to be considered illness because illness affects only the body hence the concept of mental

illness is not plausible. Szasz claimed that, “psychiatry diagnoses are stigmatizing labels, phrased

to resemble medical diagnoses and applied to persons whose behavior annoys or offends others”

(Szasz, 1974, p. 267, as cited by Greene, 2007, p. 364).

Similarly, the artistic temperament seems to be defined—and re-defined—by societies

based on the context and cultural traditions of the current times, without any further investigation

of the underlying biology of this condition. Societal standards stress the need to “fix” the artist—

who has been labeled as an outsider, hence insane —and turn him/her into a normal and

productive citizen.

As Bernice Pescosolido, director of the Indiana Consortium for Mental Health Services

Research, says, “When you attach a feeling of permanence to this [mental illness], then it

justifies, in some ways, a person’s sense of ‘otherness’ or ‘less-than-humanness” (National Public

Radio, NPR, 2010).

American sociologist David Rosenhan in 1973 enlisted seven normal associates and

asked them to visit a doctor with complaints about hearing voices that said: thud, empty or

hollow, and provide their original life histories. All of them were not only given a diagnosis of

schizophrenia but also were hospitalized for at least nine days. His study concluded that mental

health professionals had no clue of the difference between sane and insane (Greene, 2007).

The Perpetuation of Stigma

Mental illness has been portrayed as the embodiment of dangerousness and violence; a

deceitful depiction that alienates those who suffer it, and perpetuates the process of stigmatization

regardless of the information available (Pescosolido, Phelan, Link & Stueve, 2000). Bipolar

Disorder is not an exception.


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The assumption that violence and madness are intertwined has over time helped form a

public register of violently insane people that prevents media images of the mentally ill from

becoming “too much like us” (Wearing, 1993, as cited by Cross, 2004). Myths, misconceptions

and misrepresentations of the mentally ill post a challenge when providing care and support

(Harper, 2005, p. 461-462). It is important to eradicate the stigma by promoting positive

representations of mental patients because it refrains mentally ill patients from seeking help and

follow their treatments because of fear of rejection (Cross, 2004, as cited by Nairn, 2007).

People form ideas of mental illness from many different sources: personal experience,

family, peer interactions, and media portrayals (Link, Struening, Neese-Todd, Asmussen &

Phelan, 2001, p. 1621). Stigma affects people in the ways in which they related to others, and

their self-esteem is seriously damaged becoming a big impediment of recovery. As a result,

hospitalized patients are less confident to the point that some avoid complete contact with their

environment, which can take them to a low-satisfaction life, unemployment and loss of income

(Link et al., 2001).

Barbara Luri, associate director of programs for the Entertainment Industries Council in

Los Angeles says: “Campaigns to change the [mass] media can work if they are constructive but

not confrontational (Levin, 2001, para. 19). George Gerbner, Ph.D., a professor of

telecommunications at Temple University, is not so hopeful that this change will happen and said

“I’ll believe in change when a headline reads: ‘Ex-Mental Patient Appointed Head of Rotary

Club” (Levin, 2001, para. 22).

Cross (2002/2004) examined the ways in which the mad have been portrayed (Gilman,

1982/1988, as cited by Nairn, 2007). Words are the most obvious discourses resources, terms

used are crazy, mad, nuts/nutter, demented, twisted, deranged, wacko and psycho (Blood et al.,

2002; Wilson et al., 2000, p. 441; as cited by Nairn, 2007, and Cross, 2002, p. 3); psycho is a

word also related to mental illness in the mass media (Wahl, 1995). Images we conventionally

associate with madness are: red-veined, staring eyes; muttered imprecations; fists shaken at


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“things” that are not there; outspoken dialogues to the different parts of oneself. These visual

depictions demarcate a symbolic but very strong boundary between “us” and “them” (Wahl,

1995).

Gilman (1985) suggested that our need to recognize madness as difference underlines a

reassuring message that the devastation of mental illness is not likely to happen to ourselves or to

the people around us. He has argued that the iconography of illness is an indicator of the way in

which society deals with and conceptualizes disease: “The portrait of the sufferer, the portrait of

the patient is… the image of the disease anthropomorphized” (p. 2, as cited by Cross, 2004, p.

199). Consistent with Gilman (1985) five studies indentify mischievement, dishevelment, show

as wild, unkempt hair and tattered clothing, being used to signify madness and loss of control

(Gaines, 1992, as cited by Nairn, 2007).

Cross’s (2004) analysis of representations of madness in television documentaries opens

up a good avenue to be explored in depth. Another underdeveloped area of study is the semiotic

analysis of images of madness across media, how they are absorbed by the culture, appropriated

and internalized by the masses. Many films use mental illness as the means to present social

alienation and political resistance, disregarding the reality of the illness; in these cases these

depictions are used as symbols of radical political and social protest. Movies like Memento, Dr.

Brooks, Girl Interrupted, Secret Window, Psycho, don’t show the truth of mental illness—as

opposed to movies like The Shine and A Beautiful Mind —but instead are molded by the culture in

service of the society (Harper, 2005, p. 479).

Fred Wiseman’s documentary Titicut Follies (1967) questions the concept of normalcy

and the depiction of the insane in a society that mistreats patients and where inmates, guards and

psychiatrists look equally mad. Shadow Voices (documentary), Manic (docu-drama), and You’re

Gonna Miss Me (personal essay) show patients’ relationships to authoritarian figures and family

life.


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Bipolar, Creativity and Genius

The link between the Bipolar Spectrum, creativity and the mad-genius (Frantom &

Sherman, 1999; Simonton, 2006; Jamison, 1989/1990, Andreasen, 1987; Ludwig, 1992) has a

long history of debate, with no conclusive results; the association between notions of mad

geniuses and artistic temperament has been long embedded in Western culture and is well

documented in eminently creative individuals (Jamison, 1993; Andreasen, 2005; Ludwig, 1995)

but it is mostly anecdotal, a problem pointed out by Rothenberg (1990); these studies, in his

opinion, are limited in size, scope and number.

Bipolar Disorder is a degenerative affective disorder (Coffman, Bornstein, Olson,

Schwarzkopf, and Nasrallah, 1990). The roots of the illness are still unknown, but a genetic

component has been implicated (Schmidt, 2005; Craddock and Jones, 1999; Rutzen, 2010). It is

considered a biological illness produced by a chemical imbalance of the brain (Crow, 1998).

Psychiatrists like Freud, Jung, and others, explored several models— Psychological,

Descriptive, Biological, Social —in an attempt to grasp the roots of the dilemma of mental illness

within a specific domain but the problem with these models is that they have a reductionist

approach, in which only one dimension of the illness is taken into account and treated (Simonton,

2003).

On the other hand, the Biopsychosocial model (Engel, 1977; Dilts 2001) combines the

different models previously mentioned, looking for a more thorough description of problems,

integrating data from different levels of organization—from the molecular level to the

community—and affirming that mental disorders have at once biological, psychological and

social dimensions, and all these dimensions must be integrated into a unified assessment and

treatment plan—a holistic approach (Double, 2004).

Because of the biological component of the illness, psychotropic medication is the

treatment most commonly used (Klein et al, 1992, as cited by Bogousslavsky, 2005; Gonzales

and Suppes, 2008; as cited by Goodwin and Jamison, 2007). These medications may impair


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cognitive functioning and noontropics are used to help regenerate cognitive functions (Goodwin

and Jamison, 2007) even though none of these stimulants is FDA (Food and Drug

Administration) approved to be used in combination with other medication for Bipolar Disorder

(Gonzales and Suppes, 2008, p. 33)

However, Bipolar Disorder is not only a biological illness, it has also a component of

the mind that is affected by its relationship to the environment and the stressors provided by such

environment that trigger the illness (Bentall, 2003). Even though a cure has not been found,

treatment plans—like psychotheraphy and medication— can help reduce the frequency and

severity of episodes, which over time can cause deterioration of cognition (Double, 2004).

Since the illness needs to manifest in at least one manic episode before a diagnosis can

be reached, no preventive treatments are available, and misdiagnosis is common. The National

Depressive and Manic-Depressive Association 2000 survey found a 70% misdiagnosis rate

(Goldberg, 2008); for Goodwin and Jamison (2007) most patients with recurrent depression have

some form of Bipolar Disorder. Due to this problematic of misdiagnosis, it is believed that the

illness manifests in a continuum, which has been called the Bipolar Spectrum (Akiskal, 1999).

Facets of the Bipolar Spectrum —hypomania and depression —but not Bipolar

Disorder itself—may confer advantages for creativity (Kretschmer, 1931; Andreasen, 1987;

Akiskal and Akiskal, 1988; Richards et al. 1988, as cited by Strong et al., 2007, p. 42). In 1920,

Emil Kraepelin introduced the notion of an enhancement of creative thinking as a result of manic

states (Weisberg, 1994).

Nancy Andreasen (1987) investigated possible relations between manic-depression and

creativity, and the positive influences of psychopathology (Facklemann, 2009). According to

Andreasen, primary-process thinking incites creative work when affective disorders are present

due to the evocation of emotion-laden associations and memories attached to concepts or

images, called endocepts, that are more prone in manic states. The conclusions of her study

supported the hypothesis that due to the ways in which information is processed and integrated,


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creativity is directly connected to affective disorders, specially to mild manic periods

(hypomania) that manifest when de-focused attention and disorganized thinking is present. In the

hypomanic state there is a “diminished control of behavioral response, inhibition and increased

flow of responses with decreased in rule governance; social, moral and legal responsibilities are

swept aside” (Crow, 1998, p. 58).

“There is no great genius without some touch of madness”

Seneca (as cited by Ludwing, 1995, p. 4)

Creativity is a bi-product of primary processes (Dilts, 2001), where primary processes

come into play as a creative response to cope with difficult situations (Skinner, 1972, as cited by

Bergquist, 2007), “a regression in service of the ego” (Earnst, 1952; as cited by Ludwig, 1989, p.

10), which could potentially make artist feel better—a behavior recognized as the “sublimation of

sexual drives” in psychoanalytic theory (Jung, 1953, as cited by Arieti, 1976; Freud, 1958, as

cited by Dilts, 2001). Between Madness and Art , Hidden Gifts: the Mysterious Case of Angus

MacPhee, and In a Dream are documentaries that explore the act of creation within the realm of

mental illness, and Outsider Art, but not specifically to Bipolar Disorder.

As Gregory J. Feist (1999) wrote, “one of the most distinguishing characteristics of

creative people is their desire and preference to be somewhat removed from regular social-

contact, to spend time alone working on their craft…to be autonomous and independent of the

influence of a group” (p. 158).

“Art is 99% perspiration 1% Transpiration”

Einstein


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Beyond the connection between creativity and the Bipolar Spectrum, there is the notion

of genius being a potential part of the illness (Ludwig, 1995). A high number of eminently

creative individuals appear to suffer from depression and related mental illnesses, particularly

Bipolar Disorder.

Many artists, including writer Ernest Hemingway, painter Jackson Pollack, poet Silvia

Plath, and film director Francis Ford Coppola, have been diagnosed with suffering from Bipolar

Disorder (Shenfeld, 2007; Richards, 1993; Kaufman, 2002; Bryant, 2007).

Many features of hypomania—outgoingness, increased energy, intensified sexuality,

increased risk-taking, persuasiveness, self-confidence, and heightened productivity—have been

linked to increased achievement and accomplishments (Jamison, 1993, p. 87; Ludwig, 1995).

Shuldberg (1990) found that creative cognition was very particular to hypomanic states.

Ludwig (1994) also studied living writers, using the DSM-III-R and the Lifetime

Creative Scale, developed by Richards and colleagues (1988, p. 393). In their findings, writers

were more likely than the general population to have episodes of mania and depression, were

more prone to suicidal attempts, panic attacks, drug abuse and eating disorders (Goodwin and

Jamison, 2007, p. 393).

Both concepts of eminence and creativity are social process because in order for them

[eminence and creativity] to happen society needs to accept them as novel, new and

extraordinary; they are measured by social and cultural standards (Csikszentmihalyi, 1996).

Authors such as Csikszentmihalyi (1996) have written about the relationship between reputation

and society, in which eminence implies reputation because it involves the judgment of people

within a domain, profession, societies, and cannot exist unless it is recognized as such.

Undiscovered genius does not exist; genius is a label defined by society (p. 28).

Jamison (1993) sees eminent artistic temperament as a condition of the Bipolar

Spectrum, where “circumstances, temperaments, intellect, imagination, happenstance, energy

and discipline facilitate the blossoming of original and sometimes revolutionary work”.


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The life of Vincent van Gogh clearly illustrates the conflict between the mad-genius

notion and social validation. In his brief career he sold only one painting but he produced—

during the years when he was in and out asylums suffering from “deliriums”—an impressive

number of masterpieces (Bogousslavsky, 2005). Even though Van Gogh was highly productive

at times, his drastic changes of mood combined with both auditory and visual hallucinations,

segregated him from society; he was alienated due to his mental condition and never achieved

either recognition or social validation in his lifetime.

“Van Gogh's finest works were produced in less than three years in a technique that

grew more and more impassioned in brushstroke, in symbolic and intense color, in surface

tension, and in the movement and vibration of form and line. Van Gogh's inimitable fusion of

form and content is powerful; dramatic, lyrically rhythmic, imaginative, and emotional, for the

artist was completely absorbed in the effort to explain either his struggle against madness or his

comprehension of the spiritual essence of man and nature”

Templeton Reid, LLC, 2008

As stated by David Schuldberg and Louis A. Sass (1999), “What merits the honorific

‘creative’ will vary according to the context of production and the perspective in which it is seen,

interpreted, and judged” (p. 512). Nowadays, Van Gogh is praised as one of the greatest minds of

the 19th century, his paintings exhibited all over the world as masterpieces of the Impressionist

Movement.

A close relation to temperament differences, addictive personalities, and impulsivity

might explain the prevalence of the illness among both creative and eminent people; Jamison’s

theory suggests that there is a correlation between certain behavioral, personality traits and

affective disorders, especially the Bipolar Spectrum. Individuals with temperaments liable to


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emotional extremes may be more likely to choose artistic careers, thereby increasing the chances

of an interaction between a biological vulnerability and psychological stress.

Many critics that oppose the idea of a link between psychopathology and artistic ability

express concern that labeling artists as mentally ill “ignores the enormous discipline, will, and

rationality that are essential to truly creative work” (Jamison, 1993, p. 97). Even though the

acquisition of expertise is important, it has been noted that eminent artists had a pronounced

precocity in their creative output hence needing less training than the regular population

(Simonton, 2006). “Our species has become dependent on creativity. Evolution has been

transformed from being almost exclusively a matter of mutations in the chemistry of genes to

being more and more a matter of changes in memes in the information that we learn and in turn

transmit to others. But we need to pick the right memes in order to survive. The culture we

create will determine our fate” (Csikszentmihalyi, 1996, p. 318).

In this respect, Ruth Richards (1988), one of the leading researchers on creativity,

discusses how biology explains sickness and health using three biological models based on

evolutionary theories where sickness and health are connected from an evolutionary standpoint:

immunity, conservatory advantage, and outmoded genetic blueprints. She found that

depression withdraws the individual from the world, increasing the quality of the creative work

but diminishing the quantity, in contrast with the overlapping productivity during mania and

hypomania. Her study of the composer Schumann confirmed that affective instability and change

in mood affect the quantity of production but not the quality of the work (Weisberg, 1994).

Others (Jamison, 2007) have stated that depressive states—not manic state—activated

creative processes and they find resolution when energy kicks in during hypomanic states

(Richards, 1981; as cited by Weisberg, 1994). We might then argue that creativity is inherent to

the being (Schmidt, Fall 2005) and that it is part of a person’s personality, whereas the intensity

of the product is directly related to the illness.


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Using an empirical-based study with 54 visual artists (28 undergraduates, 26 faculty; 34

women, 20 men), Catherine Frantom and Martin F. Sherman (1999) found connections between

Affective Disorders and creativity, by giving participants a battery of questionnaires that

measured personality characteristics of creativity and biographical profile (Sensation Seeking

Scale -SSS- Zuckerman, 1975; Zuckerman, Eysenck and Eysenck, 1978; and Kathena-Torrance

Creative Perception Inventory -SAM- Kathena and Torrance, 1976) and family history (General

Behavior Inventory -GBI- Depue, Krauss Spoont and Arbisi, 1989). These personality measures

assessed levels of creativity in combination with attitudes, values, sensibility, believes and

motivations, among others, and found a set of traits: introspective, adventurous, independent,

risk-taker, non-conformed, optimum level of arousal.

Several researchers have shown that bipolar patients, unlike normal individuals and

schizophrenics, have more combinatory thinking and patterns, characterized by humor and

playfulness (Shenton et al., 1987; Solovay et al., 1987; Russ, 200-2001; as cited by Goodwin and

Jamison, 2007, p. 397). Santosa and colleagues (Santosa, Strong, et al., 2007) found that bipolar

subjects score higher on creativity tests than normal controls and unipolar depressive subjects.

Richards and colleagues (1988) explored the idea that people with cyclothymic temperaments

are the real creatives, and not the bipolar patients; they found greater overall creativity

achievement in a combined group of bipolar and cyclothymic patients and their healthy first-

degree relatives.

Some studies suggest that Neuroticism/Cyclothymia/Dysthymia factor and the Openess

factor, across varied groups, may differentially contribute to components of creativity captured

by the Barron-Welsh Art Scale. Some authors (Kretschmer, 1931; Andreasen, 1987; Akiskal and

Akiskal, 1988; Ricards et al., 1988; Akiskal et al, 2005 a, b) have found a relationship between

cyclothymia and creativity, where cognitive (e.g. Openess) and affective (e.g. Neuroticism)

dimensions are components to creativity (Russ, 1993; Eysenck, 1995; Strong et al., 2007, p. 45)


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Neuroticism/Cyclothymia/Dysthymia provides a creative advantage by increasing

access to a range of affective experience, particularly negative affect (neuroticism) and

changeability of affect (cyclothymia). The ability to experience unusual intense (neuroticism)

and varied ( cyclothymia ) affect might propel innovation on talented individuals dissatisfied with

the current status of art, science or industry. Inducing positive affect resulted in creative problem

solving (Isen, Daubman, and Nowiscki, 1987) where in creativity the frequency of expression

super-exceeded the importance of integration of the primary-process.

Sensation seeking is a strong need for stimulation, excitement, complex sensations and

experiences; and maintenance of an optimum level of arousal (Frantom and Sherman, 1999),

clear characteristics of the DSM criteria for diagnosis.

This intense pleasure-pursuit can potentially result in high achievement, mastery and

resource acquisition, but the same tendency of addiction-like pleasurable-pursuit can result in

more harmful consequences associated with mania, and related clinical syndromes like addiction

disorders (Meyer, Rahman and Shepard, 2007, p. 801).

Hypomanic personalities have high risks of developing Bipolar Disorder and other

adjustment problems (Cassano, Akiskal, H. S., Savino, Musetti, and Perugi, 1992; Kwapil Miller,

Zinser, Chapman, L. J., Chapman, J., and Eckblad, 2000). There’s a high co-morbidity between

bipolar and addictive disorders (Brown and Kasser, 2005). By definition, addiction is a behavior

over which the person has impaired control and which is associated with harmful consequences;

they need stimuli that give pleasure, relief and excitement (West, 2001, as cited by Meyer et al.,

2007). General tendencies to develop addictions —any potentially pleasurable substances,

activities or contexts, may be one of the mediators by which a biologically determined bipolar—

or hypomania—vulnerability is expressed at the behavioral level (Brown, 2005). Hypomanic-

prone individuals are more likely to have an “addictive personality” and be “intensely engaged in

the pursuit of pleasurable activities” (Meyer et al., 2007, p. 801).


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Hypomanic personality traits have been shown to predict “manic episodes, substance

abuse, and engagement with pleasurable but potentially harmful leisure activities (Meyer et al.,

2007, p. 801), and have been measured using the Hypomanic Personality Scale (Eckblad and

Chapman, 1986). Hypomanic proneness correlates with general addictive tendencies in specific

domains; a hypomanic individual equals addictive personality features, regardless of the specific

substance or activities (Meyer et al., 2007, p. 802).


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Findings

In Touched with Fire, Jamison (1993) writes:

Another argument set forth against an association between ‘madness’ and artistic

creativity is that a bit of madness and turmoil is part and parcel of the artistic

temperament, and that artists are just more sensitive to life and the experiences

of life than are other people. This is almost certainly true, and it would be foolish

to diagnose psychopathology where none or little exists (as cited by Castle,

2006, p. 5).

Interviews

Bipolar Artists

All five bipolar artists agree that there is a relation between creativity and Bipolar

Disorder, in which the disorder maximizes creative thinking and artistic talent. Other findings, as

follows:

o Three were in favor of medication, one felt that doctors need to be more cautious

when prescribing medication but wasn’t completely against psychotropic treatment. One

felt very strongly that medication was harmful for her well-being, both physically and

mentally. Most believe that medications, although they might cause cognition

deterioration, are necessary to keep the illness under control.

o One, who was misdiagnosed as depressive, says that she developed the illness,

Bipolar Disorder, because of the anti-depressants given to her.

o One talks about the ways in which the media creates scary images of the mentally

ill, perpetuating stigma. One discusses how both the medical community and

pharmaceutical complex have pathologized every aspect of mental illness.

o One says she wants to be cured, even if it is at the cost of her creative talent.

Health Professionals


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All six experts agree that there is some connection between Bipolar Disorder and

creativity, but two of them believe that the incidence of artists being diagnosed bipolar is not

high. One discusses the idea of first-degree relatives of bipolars being the real creative’s while

the bipolar patient is paying a genetic cause by carrying the illness. Other findings, as follows:

o One out of six thinks that creative people are more productive and more creative

during manic and hypomanic phases, but not during depressive phases. One believes that

patients cannot be creative neither in manic nor depressive states but only in hypomanic

states, which is when they can be functional.

o All agree misdiagnosis is common.

o

All agree that, in the United States, psychotropic treatments are the most

common way to treat the illness and, even though other treatments could also be of use,

medication is needed in severe cases. All agree that some patients complain about

medication making them drowsy and numb, and making their lives dull. One saw

electroshock therapy as a good choice during pregnancy and people with severe illness

who don’t respond to psychotropic treatments.

o

One suggests that less severe patients could learn to manage the illness without

medication by making lifestyle changes: having enough hours of sleep, exercising,

learning copying mechanisms against stressors. One believes in four components for

treatment: medication, some kind of therapy, family support, and faith.

o All agree that Bipolar Disorder is a debilitating and dangerous disorder. Two

stress the fact that Bipolar Disorder has one of the highest rates of suicide amongst

mental disorders, and one discusses impulsivity as an important trait to Bipolar Disorder

and a determinant factor to suicide.

o All agree the illness is not a social construction but it is treated differently

depending on cultural standards of normalcy and tolerance.


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Survey

In order to clearly identify patterns of behavior, the “strongly agree/agree” responses

were added to get percentages of agreement and the “strongly disagree/disagree” responses to get

percentages of disagreement, whereas the “neutral” responses were kept as is, to be able to

compare and contrast the findings between the two groups. Results, shown below as

percentages, first present responses of Dominicans living in Dominican Republic followed by

responses of Dominicans living in the Diaspora.

In questions related to the Bipolar Assessment—taken from the Mood Disorder

Questionnaire—42.2% and 86.1% agreed in having flash of ideas (question 1) whereas 73.7%

and 72.2% disagreed on having had any trouble with the law due to impulsive behavior (question

5). In terms of questions related to artistic temperament (taken from Eysenck Personality

Questionnaire), 59.9% and 47.2% agreed on having high-energy levels for days when involved in

creative work (question 2); 83.2% and 58.4% agreed on being called “moody” and “eccentric”

many times (question 4), whereas being “the life of the party” (question 3) was 52.1% and 36.1%

agreed, closely followed by 47.7% and 47.2% neutral. Most participants recognized themselves

as artists (84.2% and 79.4%) but didn’t feel more creative when sad (question 6), 42.1% and

66.6% disagreed. Questions related to climate/seasons, 42.1% and 38.9% agreed on sunny days

making them more creative (question 7), followed by 31.6% and 38.9% neutral responses.

Seasons (question 8) have a similar result with 52.7% and 47.2% agreed with tight responses

between neutral (26.3% and 36.1%) and disagreed (21.1% and 16.7%).

In questions related to stigma, 42.1% and 47.7% agreed that mentally ill people are less

reliable than normal (question 9) with 42.1% and 45.5% disagreed. However, 63.1% and 47.4%

agreed when asked if they would sustain a relationship with a mentally ill person (question 10),

and 15.8% in both groups disagreed.

Even though 84.2% and 79.4% consider themselves artists (question 11), only 15.8% and

22.2% have been diagnosed with a mental illness (question 12), and 5.3% out of the 15.8%, and


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13.9% out of the 22.2% feel comfortable telling others they suffer from a mental illness (question

13). Out of the 15.8% and 22.2% diagnosed, 10.5% and 11.1%, respectively, are on treatment for

the illness. In the results of Dominicans living in the Diaspora there is a discrepancy of 5.5% of

diagnosed respondents, who responded “not applicable” to this last question.

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Discussion of Findings

“Stress is the result of things that happen to you.

Depression is the inability to deal with stress”

Wootton, 2005, p. 9

“Bipolar Disorder is a very common brain disease”…, says Jair Soares, MD, chair of the

Department of Psychiatry and Behavioural Sciences at the University of Texas Medical School at

Houston (UTHHealth), …“that can lead to ruined personal relations, bad job performance, and

suicide” (Rutzen, 2010). Studies reflect that over one-third of the US population will experience

psychiatric problems in their lifetime, such as hallucinations, delusions, mania, substance

dependence, anxiety, family problems and inner conflict (Dilts, 2001).

Even though both a genetic predisposition (Craddock and Jones, 1999), and an imbalance

of neurotransmitters— norepinephrine and serotonin—have been implicated (Crow, 1998;

Krishna, 2008), some believe that environmental stressors trigger the illness (Engel, 1977;

Bentall, 2003). All bipolar artists interviewed agree that a very difficult situation, or a traumatic

event, triggered the episode that caused them to be diagnosed with Bipolar Disorder. Survey

results showed that environmental stressors are the main trigger of episodes of the illness and

that cultural context determines the incidence of diagnoses among artists. Ivcevic (2009) agrees

that the cultural context must be taken into account in order to find the right diagnosis and

treatment, and urges writers and medical researchers to be more specific when describing what

they are really observing: if they are concentrating on traits and processes or observable behavior

and accomplishments.

As expected, more people are diagnosed bipolar in the Diaspora, especially in the United

States, maybe because society has become less tolerant or because diagnostic standards are more

developed. Overall most participants fit the characteristics of the artistic temperament but not


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the Bipolar Disorder assessment; in order for this assessment to be accurate, in accordance with

the DSM-IV standards of diagnosis, the Mood Disorder Questionnaire needs to be included in its

entirety.

Biological psychiatrists, like Wilhelm Griesinge, believed that mind illness was brain

illness whereas psychiatrists such as J. M. Charcot and Sigmund Freud studied the emotions as

the root of illness. In 1905 J. Rogues de Fursc wrote on the idea that art products were the

manifestation of “the illness in concrete form” (Gilman, 1985, p. 583).

The question of treatment among those diagnosed was addressed but no question on why

they answered yes or no was included. An open-ended question to know why they do not take

medication—maybe because their illness is not severe, or because they don’t want to be

stigmatized—was missing. The majority of both diagnosed and non-diagnosed responders had, in

general, similar responses.

On August 16, 2003 six “psychiatric survivors” with history of mental health treatment

began a hunger strike to challenge the American Psychiatry Association (Mind Freedom Online,

2004). The central issue seems to be the meaning of the assertion that “mental disorders affect or

are mediated by the brain” defining mental illness as a biological disorder creates a reductionist

tendency to treat people as brains that need to be circuit-cured, and psychosocial interactions tend

to be ignored. If only biological and genetic factors came to play, the implications would be that

no effort—personal and social—could improve these states, and that only psychotropic therapy

could be the answer (Double, 2004, p. 155), which has become a misconception embraced by

both pharmaceutical and insurance companies pushing for profit.

It is for this reason that health professionals have to find treatments where the right

combination and dosage of medication, nutrition, and overall lifestyle changes, give the artistic

patient quality of life and the ability to keep creating—a holistic approach. As both an artist and a

psychiatrist, John Ruskin is very aware of artists’ stressors and lifestyles; he recommends that,

“therapists can help creative patients set up healthier schedules” (Shendfeld, 2007, para. 18).


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Most of the health professionals interviewed agree that psychotropic treatments lower

creativity in soft-bipolar patients but they are needed for severe-bipolar patients to function.

Franton and Sherman (1999) ask the question: at what price art? At what cost the artist? They say

that, “to ensure that the treatment of an affective illness does not come at the expense of

creativity, the development of treatment strategies necessarily requires meaningful deliberation

so that the prevailing ethic of society and thoughts from the creative community can be

considered fully” (p. 22).

Dr. Terrence A. Ketter, a psychiatrist from Stanford University, says that, “medications,

per se, don’t cause trouble, but creativity can be hindered if you medicate people to the point that

their emotions or cognitive abilities are blunted” (as cited by Shenfeld, 2007, para. 13).

Several writers have agreed that creativity is the “production of something both new and

valuable” (Rothenberg, 1990, as cited by Castle, 2006) but this definition in itself is very

problematic since the concepts of “new” and “valuable” are delimitated by social standards—that

shift from culture to culture and from time to time—that are defined by trends. Creativity has

also been defined by self-perception, biographical profile and willingness to take chances; affect

was measured as a manifestation of depressive-like and hypomanic-like behavioral fluctuations.

Individuals with this Bipolar Disorder refuse to comply with authority, ignore

convention, have anti-social and impulsive behavior, and lose the self’s sense of unity

(Schuldberg & Sass, 1999)—traits that overlap with characteristics of the artistic temperament

(Jamison, 1993). Due to the low diagnosis rate among the group of artists that were surveyed, it

is important to stress the difference between average and exceptional artistic talent and explore

the possibility of the Bipolar Spectrum being a facilitator for exceptional artistic talent to

develop (Ludwig, 1995; Richards, 1989), so a clear distinction between exceptional artistic talent

and average creativity and talent has to be stated.


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Creativity goes from average to talent to genius; there are creative people on areas of

everyday-problem solving, and others with exceptional intelligence and talent (Andreasen,

1987). Paul Torrance (1984), the originator of the best-known standardized creativity tests,

recommends that creativity be measured by taking into account decision-making, multiple

talents, and that culturally different individuals be given tasks that evaluate “the kinds of

excellence that are valued by the particular culture or subculture” of the evaluated individuals (p.

155-156).

The bipolar temperament is a “virulent psychotic illness or mood” (Jamison, 1993).

Moody, volatile, irascible, highly temperamental; all these are characteristics of both Bipolar

Disorder and artistic personalities (Ludwig, 1995, p. 63). People with hyperthymic

temperament, and soft Bipolar Disorder, have qualities of leaders, entrepreneurs, and inventors,

and their increased energy, sharp thinking, and self-confidence are virtues that allow them to

perform such roles.

A new pathological diagnosis has been developed to make sense of this “artistic

temperament”… “Do artists create in spite of their often debilitating problems with mood?” (p.

102), Jamison asks; her theory is that there is something about the experience of prolonged

periods of melancholia—broken at times by episodes of manic intensity and expansiveness—that

lead to a different kind of insight, compassion and expression of the human condition—the debate

between mad-genius versus psychologically healthy artists (Jamison, 1993, p. 102).

Impulsivity is a big factor related to the illness but also might be what marks the

difference between being exceptional instead of average. Maybe subjects from the survey are

average-talented people but not exceptional, and that’s why they have what has been called the

hyperthymic temperament but not the illness; in order to achieve greatness one might have to

experience the episodes of the illness.

Dr. Swann believes that creative achievement is relatively uncommon among those with

the manic forms of this disorder, which is too severe and disorganizing to permit the necessary


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concentration and dedication (personal communication, June 198, 2010). It is among those with

the soft Bipolar Disorders —especially Cyclothymic Disorders—that notable artistic

achievements are found (Richards, 1993); psychosis, including severe bipolar swings, is generally

incompatible with creativity, which is something discussed by Dr. Swann (personal

communication, June 18, 2010) when he explains that bipolars can not be creative or productive

during severe episodes because the episodes are too impairing.

The evolutionary approach suggests that mood changes must have evolutionary benefits

only in mild forms of mania, and that depressed episodes allow slowing down, withdrawing from

the world, and going into a state of mental hibernation, saving resources for better times. This is

an important area to explore, a reasoning associated with the rise of evolutionary psychology,

which has become a field onto itself (McGuire; 1998). My conversations with bipolar artists

support this theory that people with Bipolar Disorder are more creative when effectively treated

than when not, but psychotropic treatments are not enough. Only early phases of mania

contribute to creativity (Schou, 1979).

Dr. Swann also discusses a different possibility: that bipolar people enhance the

creativity of their siblings not their own, they pay for the creativity of others. Maybe part of the

evolutionary advantage is not an advantage to the patient but to their siblings who tend to be more

creative than patients and controlled groups; this seems to be the price paid by patients. This

hypothesis was not confirmed in my research study since questions about family history were not

included; these questions should be added to future studies for more complete results.

Is it simply that pathological personalities are more attracted to creative fields? Or is

there something intrinsic in the creative process that predisposes the emotional illness? Is

madness the risk they run, the price to pay for creativity?

Unlike the romanticists, clinically insane patients found in art their mode of expression,

feelings and experiences impossible to externalize using words; for them, art is not a mode of

criticizing society but a way of sublimating their internal struggle and cope with the world around


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them (Gilman, 1985, p. 587). Many artists use the creative process to repair defects within the self

and its inner world of object relations. All bipolar artists interviewed feel that their art helps them

heal from traumas, voice their anguish and manage stressful events in their daily life.

“No one has ever written, painted, sculpted, modeled, built,

or invented except literally to get out of hell”

Antonin Artaud, French poet

In a study conducted by Ludwig (1995), artistic types (10%) have much higher lifetime

rates of mania than investigative types (0%). They start to succumb to mania at greater rates than

other types after the age of 25 (p.139). Overall, the artistic types (50%) seem about twice as

likely as social (27%) investigative (24%), and enterprising types (20%) to suffer from

depression during their lifetimes. They also begin to succumb to depression at a greater rate

than other types after the age of 25, and even more so after the age of 40, which could enhance

scientific creativity (p.138). This was not supported in my survey since most of them disagreed

on “being more creative when sad”, maybe because of the small sample used.

The incidence of suicide among female poets has been so prominent that some experts

call it the Sylvia Plath Effect (Kaufman and Baer, 2002, as cited by Bryant, 2007). Sylvia Plath—

who had a diagnosis of Manic-Depression and committed suicide at age 32—expressed in one of

her poems, her agitation and despair, and her desire to die:

Darling, all night

I have been flickering, off, on, off, on.

Not him, nor him

(My selves dissolving, old whore petticoats)—

To Paradise

American poet Sylvia Plath, Fever 103

( Ariel , 1966; as cited by Shenfeld, 2007, para. 1)


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Two of the health professionals interviewed stress the fact that one of the highest

percentages of suicide is among bipolar patients, maybe as a result of impulsivity as a trait of the

illness. Jamison (1995) explains how:

[M]anic Depression [Bipolar Disorder] distorts mood and thought, incites

dreadful behaviors, destroys the basis of rational thought, and too often erodes the

desire and will to live. It is an illness that is biological in its origins, yet one that

feels psychological in the experience of it, an illness that is unique in conferring

advantages and pleasures, yet one that brings in its wake almost unendurable

suffering and, not infrequently, suicide (as cited by Rutzen, 2010, para. 7).

Similarly, Nancy Andreasen supports this theory whereas Rothenberg completely

disagrees. If artistic tendencies and temperament are defined as both a gift and pathology, what

happens then, how should it be treated? Could it be cured? At what cost? What is the role-played

by syntonic personality traits? If society assumes no connection, then creativity won’t be taken

into account when finding the right treatment, but if a connection is undeniably proven, how

should it be treated?

Not all bipolar patients are creative nor are all creative bipolar, but those who are both

bipolar and creative have a special condition, where affect and impulse become important

elements in the development of the illness, and creative genius (Eysenck, 1992; Ludwig, 1995).

Artists are both psychologically ‘sicker’ (score higher on psychopathologies) and ‘healthier’

(elevated scores on self-confidence and ego-strength)” (Jamison, 1993).

For evolutionists, mental disorders are disturbances of repression, which reveals infantile

behavior or archaic forms of the personality (Foucault, 1965). But these theories are wrong in

seeing these returns as the origin and essence of pathology. Neurotic distortion can occur when

“the conscious mind inhibits the [creative] process by rigid use of symbolic functions” (Kubie,

1958; as cited by Ludwig, 1989, p. 10). All forms of creativity are “permanent operant variables

of personality” (L. Bellak, 1958, as cited by Bergquist, 2007); “The future artist learns to


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disassociate with real objects and falls in love with the world as a whole” (Greenacre, 1957; as

cited by Bergquist, 2007).

Two of the bipolar artists interviewed agree that people who suffer the illness might be

attracted to creative and artistic domains because they are trying to find ways to deal with their

way of thinking (A. Cutler, personal communication, March 7, 2010) and trying to “compensate

for feeling left out” (T. Zwerling, personal communication, March 6, 2010); one expressed how

the illness maximizes her “creative gifts” (B. Rodriguez, personal communication, May 24,

2010). If creativity promotes psychic self-help, even health, why does it heal some and not

others? (Kavaler-Adler, 1993, p. 47).

In survey questions related to the Bipolar Assessment both groups disagreed on having

trouble with the law, 73.7% and 72.2% respectively, and having flash of ideas 42.2% and 86.1%,

but 59.9% and 47.2% agreed on having high-energy levels. 83.2% of the art students and

professionals living in the Dominican Republic agreed having been called “moody” and

“eccentric”, whereas those living in the Diaspora, even though most of them agreed, the

percentage is still a lower number, 58.4%. This may be because of the culture of the Diaspora, in

contrast to the traditional culture of the Dominican Republic; “being the life of the party”

responses were close in both groups, 52.1% and 47.2%.

Lombroso’s first major work, Genius and Madness (1864), analyzed people of genius and

saw them—in an Aristotelian manner— as mad; he became famous for his concept of

degeneracy as the central explanation of deviancy (from sociopathic and psychopathic to creative

arts) and became a center pillar, a cornerstone of modern psychiatry, from where we can

delimitate 2 main concerns: (a) to find the psychopathology origin of greatness and (b) to

discover the greatness in madness.

In order for art to be recognized as such it needs society’s validation, the same society

that the mad man fights against. If Outsider Art remains as such, its value as real art does not

exist, it becomes the language of the insane and nothing more, and the mentally ill keeps his


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status as an outsider; if the art is elevated beyond a means of communication to real art, the

mentally ill status also changes, from the insane to an artist maybe a genius (Bogousslavsk,

2005; Jamison, 1993).

The existentialist philosopher Karl Jasper (1926) maintained that, “the greater

manifestation of mental illness in geniuses was the result of society’s selective granting of fame”.

For Jasper, “a general mood or inclination in Western society craves mysterious, the unusual, the

indefinable, and the blatantly diseased” (as cited by Becker, 2000-2001, p. 52). The 19th and 20

th

centuries have shown a distinct preference for those creative individuals who are diseased; the

same society that praises them also condemns them (Foucault, 1965).

Eccentricity seemed to be determined by culture and geographical context as opposed to

being intrinsic to the individual; survey responses of “being called ‘eccentric’ and ‘moody’” were

higher among those living in the Dominican Republic compared to those living in the Diaspora,

especially the Unites States, possibly because Dominican Republic is a more traditional and

conservative society. On the other hand, artists might think that to be considered as such they

need to have a little madness and accept their condition, or act out; this problem of self-

admission and projection of images in artists is discussed by George Becker (2000-2001), who

argued this issue as part of the reason why so many artists are being diagnosed with Bipolar

Disorder.

In his discussion, Becker (2000-2001) does not take into account a different possibility:

that artists might instead be making a statement to break the stigma around mental illness, to

erase the assumption that mad is something bad and that being mad means having no periods of

rational thoughts and connections with reality—which has been proven to be a misconception

(Jamison, 1993); Freud didn’t believe in the concept of normal, for him everybody had some

type of pathology (Ludwig, 1995, p. 64).

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The Bipolar Spectrum and the Artistic Temperament PhD

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