Friday, July 29, 2011

Mental Illness or Muse? Amy Winehouse and Historic Artists with Bipolar Disorder

By Mohammad Alsuwaidan, MD 

We have no doubt lost a profound musical talent in the tragic death of Amy Winehouse this week.  Her public struggle with substance abuse and bipolar disorder (commonly known as manic depression) has reignited curiosity about possible links between creativity and mental illness. In such unfortunate circumstances, it serves well to draw upon the lessons of history in making meaning out of sorrow.

A little more than 120 years ago, a misfortune befell another budding talent. A young painter entered a psychiatric hospital in Saint-Rémy-de-Provence, Southern France. Known by his neighbors in town as “fou roux" (the crazy redhead), he had been troubled with mental illness throughout his life. A few months prior, he had reached a crisis point and during his breakdown, he rushed to a brothel to see his friend - a prostitute named Rachel. He handed her a small wrapping of newspaper - telling her to “keep this object carefully” and ran off. Unwrapping it, she was shocked to find the freshly cut and still bloody lower portion of his left ear!

Vincent van Gogh holds legendary status in Art and his influence has crossed cultures and eras. To gaze onto the vivid colors and hypnotic swirls in his work is to be transported into another world - a morphed view of reality that can only be seen through his eyes. There is a tendency to romanticize van Gogh’s mental illness – which most respected psycho-biographers believe to have been bipolar disorder.

The notion that there is a fine line between creative genius and “craziness” is not new and has existed since ancient times. Most of this interest has focused on bipolar disorder; many famous figures have been speculated to have suffered from this mental illness: Beethoven, Edgar Allan Poe, Emily Dickinson, Victor Hugo, Charles Dickens, Edvard Munch, and many more. We continue to see this pattern in the modern day among celebrated actors, poets, painters, and musicians like Ms. Winehouse. Yet, despite our modern methods, illuminating the “line” or “link” between mental illness and creativity remains elusive.  Studies show that a certain level of melancholy or mixed emotions may be needed to access the creative spring. Unfortunately this negative emotion may also underlie some of the symptoms seen in bipolar disorder. 

Herein lies the eternal dilemma in the field of medicine – balancing benefits of treatments against their risks. Could some bipolar treatments dampen the creative drive? The evidence, both anecdotal and empirical, says yes.

Yet research also reveals that when individuals with bipolar disorder receive treatment, their overall productivity, focus, and organization improve. We know that the poet Robert Lowell produced the largest portion of his work after receiving lithium treatment for his bipolar disorder. And though some critics argue that his “pre-lithium” work is more striking in its poetic beauty, they admit that had it not been for the stabilizing effects of his treatment leading to many more – still beautiful – poems, we may have never known Lowell and his artistic mastery at all.

The message to mental health professionals is clear in my mind; we should attempt to treat highly-creative individuals with mood disorders with all the latest advancements including medications. BUT we should listen carefully and work with our patients to understand what effect treatment is having on their creative drive. Perhaps some individuals need some degree of discontent to “kindle the creative fire,” and we should step up to the challenge of helping them achieve a tolerable and productive balance.

At the young age of 37, after a manic episode of creating many paintings, Vincent van Gogh walked into an empty field outside his home, aimed a loaded revolver into his chest, and pulled the trigger. His famous last words, as he lay dying in his brother Theo’s arms, were "La tristesse durera toujours" (the sadness will last forever).

Perhaps had he not suffered some degree of sadness, you and I would have never heard of van Gogh. Perhaps had he lived longer, his influence would have been even greater. Perhaps the next van Gogh or Poe or Winehouse will walk into a mental health clinic next week suffocated by their sadness, yet possessed by creative inspiration. The questions are complex scientifically, ethically, and philosophically. But I believe that a balance can and should be reached (or at least approached) and that tragic endings can be re-written. 

Dr. Mohammad Alsuwaidan is a psychiatrist with expertise in Mood Disorders at the University of Toronto and a Master of Public Health candidate at Johns Hopkins University. Learn more:

KR Jamison, Touched with Fire: Manic Depressive Illness and the Artistic Temparment, Free Press Paperbacks (New York 1993). p.85
AW Flaherty, Frontotemporal and Dopaminergic Control of Idea Generation and Creative Drive. Journal of Comp. Neurology 493:147-153 (2005).
Santosa C.M. et al. Enhanced creativity in bipolar disorder patients: A controlled study. J. Affect. Disord. (2006), doi:10.1016/j.jad.2006.10.013
Flaherty, A. (2011). Brain illness and creativity: mechanisms and treatment risks. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 56(3), 132.

Thursday, July 21, 2011

Can My Child Have Bipolar Disorder? Pediatric Bipolar Disorder: Fact or Fiction

By Molly McVoy, M.D.   

Can children really have bipolar disorder?  Or, is it a parenting issue?  Is this mental illness overly-diagnosed?

Many of these questions have been raised in the media with increased frequency over the last several months.  What's most concerning is, that instead of focusing on diagnosis and treatment for children with serious mental illness, the debate has focused on who is to blame: is it parents, psychiatrists, drug companies, schools?  The bottom line is that children are suffering, and parents are struggling to keep their children safe, healthy, and happy.  More attention should be paid to actually helping these children, not to pointing fingers of blame.
Pediatric bipolar disorder is a rare but very real illness.  The most recent statistics indicate the mental illness affects approximately 1.5% of children.  Contrary to popular reports, the most recent studies also indicate the rates of pediatric bipolar disorder are not increasing over time, and the rates do not vary between US and non-US populations.1
When pediatric bipolar disorder occurs, it can be very impairing.  Affected children have extreme mood swings – not for minutes at a time but for days.  Children can become suicidal, violent, and often feel quite out of control.  When properly diagnosed and treated, the lives of these children and their families can improve dramatically.  Treatment often involves a combination of mood stabilizing medication and intensive psychotherapy.  But when missed or misdiagnosed, these children may go on to suffer for a lifetime.

Stigma continues to be associated with a mental health diagnosis, and nowhere is that truer than in pediatric mental illness.  Perhaps, in the future, efforts will focus on how to help, not who to blame.

  1. VanMeter, AR, Moreira, AL, Youngstrom, EA. Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry. 2011, May 31.

Friday, July 8, 2011

Family Game Night Can Make You Smarter

My daughter brought two treats when she came home for college break.  A new game, Bananagrams, and a new book by Richard Restak, M.D. and puzzle master Scott Kim called The Playful Brain: the surprising science of how puzzles improve your mind

In this collaboration, Kim shares some of his favorite puzzle formats, and Dr. Restak explains the science behind the games.  Together they cover a wide variety of puzzles that have been shown to keep us alert, thinking, and youthful in mind and spirit.  fMRI data (which shows electrical activity in different parts of your brain) helps to tease out which areas of the brain are activated as people solve different types of puzzles.  

Scientists have not been able to prove a direct link between these forms of brain exercise and prevention of various forms of dementia.  But the puzzles, and games like Bananagrams, provide a focus for interpersonal interaction – playing with your family, talking with your neighbors – which does have a powerful effect on mood and our sense of well-being. 

Summer is the perfect time to bond with your kids in a board game challenge.  How do you get your family to put down their cell phones and turn off the TV to play a game?  Please share suggestions!