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Manic -D epr essive ilnessarrd tlre Artistic Temp erarnent

Kay Redfield Jamison

Copyright @ 1993by IQy Redfield Jamison

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Jamison, IQy R.Touched uith fire : manip-d.epresshse illness and the artistit

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Grateful acknowledgment is $ven to the publishers for permission to reprint excerpts fromthe following works:

"I Think Continually of Those Who Were Truly Great," from CollccteilPoems i92&I953 byStephen Spender. Copyright 1934 and renewed 1952 by Stephen Spender. Reprinted bypermission ofRandom House, Inc. Reprinted by permission ofFaber and Faber Ltd.

Excerpt from "Elegy," from FieldWorkby Seamus Heaney. Copyright @ 1976, 1979 bySeamus Heaney. Reprinted by permission of Farrar, Straus & Giroux, Inc. Reprinted bypermission of Faber and Faber Ltd.

Excerpts from "Visitors" and "Suicide" from Day by Dag by Robert I-owell. Copyright @1975, 1976, 1977 by Robert Lowell. Reprinted by permission of Farrar, Straus & Giroux,Inc. Reprinted by permission ofFaber and Faber Ltd.

Excerpt from "Elegy," copyright @ f955 by New Republic, Inc., from The Collccted Poemsof Theodnre Roethke by "Ilreodore Roethke. Used by permission of Doubleday, a division ofBantam Doubleday Dell Publishing Group, Inc. Reprinted by permission of Faber andFaber Ltd.

Excerpt from "May's Truth and May's Falsehood," in Delmore Schwartz: Sel.eaed Poems:Sumner Knowlcilge. Reprinted by permission of New Directions Publishing Corporation.Reprinted by permission of l,aurence Pollinger Limited.

Excerpt from "It's After One" by Vladimir Mayakovsky, in Edward J. Brown, Magakoosky:A Poet in Reoolution. Copyright @ 1973 by Princeton University Press. Reprinted bypermission of Princeton University Press.

Excerpt from "The First Day's Night Had Come" (poem 410): Reprinted by permission ofthe publishers and the Trustees of Amherst College kom The Poems of Emilg Dickinson,Thomas H. johnson, ed., Cambridge, Mass.: The Belknap Press of Harvard UniversityPress, Copyright @ 1951, 1955, f979, 1983 by the President and Fellows of HarvardCollege.

Excerpt from "In a Dark Time," copyright @ 1960 by Beatrice Roethke, Administratrixof the Estate of Theodore Roethke, from The Collpcted Poerns of Thcodnre Roethke byTheodore Roethke. Used by permission ofDoubleday, a division ofBantam Doubleday DellPublishing Group, Inc. Reprinted by permission of Faber and Faber Ltd.

Excerpt from "90 North" from The Conplete Poerns by nandall Jarrell. Copyrigbt @ by Mrs.Randall Jarrell. Renewal copyright @ f968 by Mrs. Randall Jarrell. Reprinted by permissionof Farrar, Straus & Giroux, Inc. Reprinted by permission of Faber and Faber Ltd.

Excerpt from "The Deceptive Present, The Phoenix Year" in: Delmore Schwartz: SelcctedPoems: Sumnvr Knou>Icdge. Copyright @ f959 by Delmore Schwartz. Reprinted by per-mission of New Directions Publishing Corporation. Reprinted by permission of LaurencePollinger Limited.

Excerpt from "Little Gidding" inFour Quartets, copyright 1943 by T. S. Eliot and renewed1971 by Esme Valerie Eliot, reprinted by permission of Harcourt Brace Jovanovich, Inc.Reprinted by permission of Faber and Faber Limited.

Excerpt from "Glen Eyre" from Spring Tidz andNeap Tidz: Seleaed Poems, 1932-1972bySorley Maclean (Edinburgh: Canongate, 1977). Reprinted by permission of CanongatePress PLC.

Excerpt fiom "384. The Marker Slants" from Tlle Dream Songs by John Berryman. Copy-right @ f969 by John Berryman. Reprinted by permission of Farrar, Straus & Giroux.Reprinted by permission of Faber and Faber Ltd.

Excerpt fiom "The Cuillin, Part VII" from From Wood to Ridge by Sorley Macl.ean.Reprinted by permission ofCarcanet Press Ltd.

ForRichard Jed Wyatt, M.D.

To those who, by the dint of glass and vapour,Discover stars, and sail in the wind's eye-

-BYRON

I think continually of those who were truly great.Who, from the womb, remembered the soul's historyThrough corridors oflight, where the hours are suns,Endless and singing, Whose lovely ambitionWas that their lips, still touched with fire,Should tell ofthe Spirit, clothed from head to foot in song.And who hoarded from the Spring branchesThe desires falling across their bodies like blossoms.

What is precious, is never to forgetThe essential delight of the blood drawn fiom ageless springsBreaking through rocks in worlds before our earth.Never to deny its pleasure in the morning simple lightNor its grave evening demand for love.Never to allow gradually the traffic to smotherWith noise and fog, the flowering of the spirit.

Near the snow, near the sun, in the highest ftelds,See how these names are ftted by the waving grassAnd by the streamers of white cloudAnd whispers of wind in the listening sky.The names of those who in their lives fought for life,Who wore at their hearts the fire's centre.Born of the sun, they travelled a short while toward the sunAnd left the vivid air signed with their honour.

-STEPHEN SPENDER

COI\TENTS

l .THAT FINB MADNESS

lntroduction

2.ENDLESS NIGHT, FIERCE FIRES

AND SHRAMMING COLD 11Manic-Depressive Illness

3.COULD IT BE MADNESS-THIS? 49

Controversy and Evidence

4.THEIR LIFE A STORM WHEREON THEY RIDE 101

Temperament and Imagination

5.THE MIND'S CANKER IN ITS SAVAGE MOOD

George Gordon, Lord Byron149

CONTENTS

6.GENEALOGIES OF THESE HICH MORTAL MISERIES ]9]

The Inheritance of Manic-Depressive Illness

7.THIS NET THROWNE UPON THE HEAVENS

Medicine and the Arts

APPENDIXESA. Diagnostic Criteria for the Major Mood Disorders 261

Writers, Artists, and Composers with Probable Cyclothymia,Major Depression, or Manic-Depressive lllness 267

NOTES 271

ACKNOWLBDGMENTS

INDEX

1.TT{AT

FII\E MADI\ESS

fntroduction

. . . his raptures were,All air, and ftre, which made his verses clear,For that fine madness still he did retain.Which rightly should possess a poet's brain.

-MTCHAEL Dnevtoxl

An Angel Descending: Dante's Dioine Comedg. Wlliam Blake, c. 1826(The Pierpont Morgan Library, New York)

TOUCIIED WITHFIRD

"We of the craft are allcrazy," remarked Lord Byron about himseHand his fellow poets. "Some are affected by gaiety, others by mel-ancholy, but all are more or less touched."z This book is aboutbeing "more or less touched"; specifically, it is about manic-depressive illness-a disease of perturbed gaieties, melancholy,and tumultuous temperaments-and its relationship to the artistictemperament and imagination. It is also a book about artists andtheir voyages, moods as their ships of passage, and the ancient,persistent belief that there exists such a thing as a "ffne madness."

The ffery aspects of thought and feeling that initially compelthe artistic voyage-fierce energy, high mood, and quick intelli-gence; a sense ofthe visionary and the grand; a restless and fever-ish temperament-commonly carry with them the capacity forvastly darker moods, grimmer energies, and, occasionally, bouts of"madness." These opposite moods and energies, often interlaced,can appear to the world as mercurial, intemperate, volatile, brood-ing, troubled, or stormy. In short, they form the common view ofthe artistic temperament, and, as we shall see, they also form thebasis of the manic-depressive temperament. Poetic or artistic ge-

TIIATFIND MADNESS

nius, when infused with these fitful and inconstant moods, can

become a powerful crucible for imagination and experience'

That impassioned moods, shattered reason, and the artistic

temperamerri ""r

be welded into a "fine madness" remains a

firrcely controversial belief. Most people find the thought that a

destrultive, often psychotic, and frequently lethal disease such as

manic-depressive illness might convey certain advantages (such as

heightened imaginative powers, intensifted emotional responses,

"niirr"r""red energy) counterintuitive. For others it is a troubling

or unlikely associati-on that conjures up simplistic notions of the

"rrrad ge.rius," bringing with it images of mindless and unaesthetic

reductionism as well as concerns about making into disease some-

thing that subsumes vital human differences in style, perception,

arrd l"mperament. Indeed, labeling as manic-depressive anyone

who is unusually creative, accomplished, energetic, intense,

moody, or eccentric both diminishes the notion of individuality

within the arts and trivializes a very serious, often deadly illness.

There are other reasons for such concerns. Excesses of psycho-

analytic speculation, along with other abuses of psychobiography,

hav. i.rviied well-deserved ridicule. Due to the extraordinary ad-

vances in genetics, neuroscience, and psychopharmacology, -muchof modern psychiatric thought and clinical practice has moved away

from the earlier influences of psychoanalysis and toward a more

biological perspective. Some fear that the marked swing from psy-

choalalysii to psychopharmacology is too much, too soon, and that

there eiists the risk of a similar entrenchment of ideas and per-

spectives. The erosion of romantic and expressive language into the

siandardization of words and phrases necessary for a scientific psy-

chiatry has tempted many to dismiss out of hand much of modern

biological psychiatry. Almost by definition, the idea of using formal

psych-iatric diagnostic criteria in the arts has been anathema, and,

i1 urry event, biological psychiatrists have displayed relatively little

interest in studying mood disorders in artists, writers, or musi-

cians. Certainly those in the arts have been less than enthusiastic

about being seen through a biological or diagnostic grid. Those in

the best position to link the two worlds-scholars of creativity-

only recently have begun to address the problem. Having previ-

o,rriy focused on the relationship between creativity and"schizophrenia" (often misdiagnosed manic-depressive illness) or

4 TOUCIIEDWTTHFIRE

difrrse notions of psychopathology, these researchers have leftlargely unexamined the specific role of mood disorders in creativework.

_ -complicating matters further, certain life-styles provide coverfor deviant and bizarre behavior. The arts have long given latitudeto extremes in behavior and mood; indeed, George Becker hasobserved that the Romantic artists used the notion of mad geniusto "provide recognition-of special status and the freedom fromconventional restraints that attended it."3:

The aura of "mania" endowed the genius with a mystical and inex-plicable quality that served to differentiate him from the typical man,the bourgeois, the philistine, and, quite importantly, the

'.mere',

man of talent; it established him as the modern heir of the ancientGreek poet and seer and, like his classical counterpart, enabled himto claim some of the powers and privileges granted to the "divinerypossessed" and "inspired. "a

Robert Burton wrote in the seventeenth century that "all poets aremad," a view shared by many since. Such a view-howeverappealing to some, and whatever its accuracy-tends to equatepsychopathology with artistic expression. A common assumption,for example, is that within artistic circles madness is somehownormal. This is well illustrated by an episode described by IanHamilton in his biography of the poet Robert Lowell; it illustratesthe reactions of Lowell's colleagues to one of his many escalationsinto mania:

Lowell had announced to all his Cincinnati acquaintances that he wasdetermined to remarry, and had persuaded them to stand with himon the side of passion. Some members of the faculty found himexcitable and talkative during this period, but since the talk wasalways brilliant and very often flattering to them, they could see noreason to think of Lowell as "ill," indeed, he was behaving just assome of them hoped a famous poet would behave. They undertook toprotect this unique fame against any dampening intrusions fromNew York. Thus, when Hardwick [Lowell's wife] became convincedthat Lowell was indeed sick----over a period of two weeks his tele-phone calls to New York became more and more confused, lengthyand abusive-she ran up against a wall of kindly meant hostility from

TIIATFIND MADNESS 5

Lowell's campus allies. Her version of Lowell was not theirs, evenwhen they were discussing the same symptoms; what to her was"mad" *ut to them another mark of Lowell's genius.s

The main purpose of this book is to make a literary, biograph-

ical, and scientific argument for a compelling association, not to say

actual overlap, between two temperaments-the artistic and the

manic-depressive-and their relationship to the rhythms and cy-

cles, or temperament, of the natural world. The emphasis will be

on understanding the relationship between moods and imagina-

tion, the nature of moods-their variety, their contrary and oppo-

sitional qualities, their fux, their extremes (causing, in some

individuals, occasional episodes of "madness"Fand the impor-

tance of moods in igniting thought, changing perceptions, creating

chaos, forcing order upon that chaos, and enabling transformation.

The book begins with a general overview of manic-depressive

illness: what it is, whom it affects, and how it shows itself. Mania,

depression, mixed manic and depressive states, and suicide are

described both from a clinical perspective and through the words

and experiences of artists, musicians, and writers who have suf-

fered from severe mood disorders. The biographical and scientific

evidence for a relationship betrveen manic-depressive illness and

artistic creativity is given in chapter 3. Recent research strongly

suggests that, compared with the general population, writers and

a.tiits show a vastly disproportionate rate of manic-depressive or

depressive illness; clearly, however, not all (not even most) writers

"rri "ttirtr suffer from major mood disorders. There remains skep-

ticism and resistance to the idea of ang such association, however-

some of it stemming understandably from the excesses of

psychobiography alluded to earlier (especially those of a highly

splcuhtive rnd ittt"tptetive nature), but much of it arising from a

lack of understanding of the nature of manic-depressive illness

itself. Many are unaware of the milder, temperamental expressions

of the disease or do not know that most people who have manic-

depressive illness are, in fact, without symptoms (that is, th-ey are

psychologically normal) most of the time. When many individu-

"lr-"""" those who are generally well versed in psychology and

medicine-think of manic-depressive illness, they tend to imagine

the back wards of insane asylums and unremitting mental illness or

6 TOUCIIDD WTTH FIRE

madness, and rightly conclude that no meaningful or sustainedcreative work can occur under such circumstances. Madness, orpsychosis, represents only one end of the manic-depressive con-tinuum, however; most people who have the illness, in fact, neverbecome insane. Likewise, work that may be inspired by, or par-tially executed in, a mild or even psychotically manic staie may besignificantly shaped or partially edited while its creator is depressedand put into final order when he or she is normar. It is thl inter-action, tension, and transition between changing mood states, aswell as the sustenance and discipline drawn from periods of health,that is critically important; and it is these same tensions and tran-sitions that ultimately give such power to the art that is born in thisway.

- The psychological and biological arguments for a rerationshipbetween "madness" and artistic creativity are presented in chapter4; the overlapping natures of the artistic and manic-depressivetemperaments, as well as similarities in patterns of thought andbehavior, are also explored. The importurr"" to the creative"p.o""r,of certain types of experiences whose existence is due to e-xtremeemotional states is discussed in some detail; however, the need fordiscipline, control, and highly reasoned thought is also stressed.The creative significance of the tension arrd ,eiorrciliation of natu-rally occurring, opposite emotional and cognitive states in artistswith manic-depressive illness or cycrothymia (its milder tempera-mental variant), and the use of art by artists to heal themselves, areexamined as well. The rhythms and cycles of manic-depressiveillness, a singularly cyclic disease, are strikingly similar toihose ofthe natural world, as well as to the death-a-nd-regeneration anddark-andlight cycles so often captured in poetry, music, and paint-ing. s_easonal cycles are particularly important, and these are dis-cussed in the context of the scientific

"rrid"n"" for seasonal patterns

in moods and psychosis, as well as illustrated by the seasonal pat-terns of artistic productivity evident in the lives of Robert schu-mann, Vincent van Gogh, and others.

Any discussion of temperament and art is best served by exam-ining one life in some depth, and none better illustrates the

TIIATFINE MADNESS 7

complexity of overlap between heredity, individual will, circum-

stance, and poetic temperament than that of George Gordon, Lord

Byron. Heir to madness, virulently melancholic, and in lifelong

fear of going insane, Byron represents the fine edge of the fine

madns55-[he often imperceptible line between poetic tempera-

ment and psychiatric illness. His terrible struggles with melan-

choly and his "savage moods,"6 yet his work's indebtedness to

them, bring up many of the medical, social, and ethical issues that

are discussed in the final chapters. Manic-depressive illness is agenetic disease, and that fact is fundamental not only to under-

standing its origins but also to the many medical and ethical issues

raised later in the book. The scientific arguments for the genetic

basis of manic-depressive illness are presented in chapter 6, put

into the context of the family psychiatric histories, or pedigrees, of

several major literary and artistic families (including those of By-

ron, Tennyson, Melville, William and Henry ]ames, Schumann,

Coleridge, van Gogh, Hemingway, and Woolf).Clearly, a close association between the artistic temperament

and manic-depressive illness has many implications-for artists,

medicine, and society. Modern psychopharmacology and genetic

research raise almost endless possibilities, both liberating and dis-

turbing, but the ethical waters remain disconcertingly uncharted.

No psychiatric illness has been more profoundly affected by the

advances in clinical and basic neuroscience research than manic-

depressive illness. The efficacy of a wide range of medications has

given clinicians unprecedented options and patients lifesaving

choices. The fact that lithium, antidepressants, and anticonvulsants

are now the standard of care for manic-depressive illness (and

psychotherapy or psychoanalysis alone, without medication, is usu-

ally considered to be malpractice) raises particularly interesting

questions about the treatment of writers and artists. Some artists

resist entirely the idea of taking medication to control their mood

swings and behaviors; interestingly, however, there is some evi-

dence that, as a group, artists and writers disproportionately seek

out psychiatric care; certainly many-including Byron, Schumann,Tennyson, van Gogh, Fitzgerald, and Lowell-repeatedly sought

help from their physicians. Other writers and artists stop taking

their medications because they miss the highs or the emotional

intensity associated with their illness, or because they feel that

TOUCIIED WITI{ FIRE

drug side effects interfere with the clarity and rapidity of theirthought or diminish their levels of enthusiarrn,

"*otion, and. en-

ergy.Although manic-depressive illness has long been assumed to

be genetic in origin, and its strong tendency to run in some familiesbut not in others has been observed for well over a thousand vears.only the recent radical advances in molecular biology ha.,re pro-vided the techniques to enable highly sophisticated-searches forthe genes involved. similarly, an almost unbelievable increase inthe rate of study of brain structure and function has resulted in alevel of biological knowledge about manic-depressive illness-thislos-! h-umanly expressed, psychologically complicated, and moodyof all diseases-that is without parallel in psychiatry. The ethicalissues arising from zuch knowledge, and from the possibility thatsuch a devastating illness can conGr individual and iocietal advan-tage, are staggering: would one want to get rid of this illness if onecould? Sterilization of patients with hereditary psychoses, mostdirectly applicable to those with manic-depressiveillrr"rr, was oncepracticed in parts of the united states, and large numbers of in-dividuals with manic-depressive illness *"r" ,yit"*atically killedin German concentration camps. Even today many provinceschina enforce mandatory sterilization and abortion poriciesthose with hereditary mental illness. what wiil be tlhe roles

ln

forof

amniocentesis, other types of prenatal diagnosis, and abortion oncethe manic-depressive genes are found? what are the implicationsfor society of future gene therapies and the possible

"arry preverr-

tion of manic-depressive illness? Does psychiatric treatment haueto result in happier but blander and less imaginative artists? whatdoes it mean for biographers and critics that manic-depressive ill-ness and its temperaments are relatively common in the writersand artists they study? These and other issues are discussed in thefinal chapter.

ultimately this book is about the temperaments and moods ofvoyagers: It is about the thin line that exists between the fate ofIcarus, who-burned by rather than touched with fire"-"felt thehot wax run, / Unfeathering him,"7 and the fates of those artistswho survive the ffight, "without selfloss through realms of chaosand'old night.' "8It is about the "Night Ferry,"is Seamus Heaneydescribed poet Robert Lowell; it is about the conjurer and setter of

TIIATFINE MADNESS 9

moods, the guide through the "ungovernable and dangerous." It isabout voyages:

You were our night ferrythudding in a big sea,

the whole craft ringingwith an armourer's musicthe course set wilfully acrossthe ungovernable and dangerous.e

EI\DLESS NIGHT,trtERCE FIRES

STTRAYIMII\G COLD

Manic-Depressive Illness

I come to ferry you hence across the tideTo endless night, fferce ffres and shramming cold.

-p4y1'61

"Come on, sir." "Easy, sir.""Dr. Brown will be here in ten minutes. sir."Instead, a metal chair unfolds into a stretcher.I lied secured there, but for my skipping mind.They keep bustling."Where you are going, Professor,you won't need your Dante."

-RoBERT LowELL2

Dante's Inferno. Gustave Dor6. c. 1860

TOUCHED WTTH FIRE

"I feel the jagged gash with which my contemporaries died,"swrote Robert Lowell about his generation of feverishly brilliant,bruised, and wrathful poets. There was, he felt,

personal anguish everywhere. We can't dodge it, and shouldn't worrythat we are uniquely marked and fretted and must somehow keepeven-tempered, amused, and in control. John B[erryman] in his madway keeps talking about something evil stalking us poets. That's a badway to talk, but there's some truth in it.a

Robert Lowell and John Berryman, along with their contemporar-ies Theodore Roethke, Delmore Schwartz, Randall jarrell, andAnne Sexton, were-among other things-"stalked" by theirmanic-depressive illness. Mercurial by temperament, they weresubject to disastrous extremes of mood and reason. All were re-peatedly hospitalized for their attacks of mania and depression;Berryman, jarrell, and Sexton eventually committed suicide.

What is the nature of this disease of mood and reason that sooften kills and yet so often is associated with the imaginative arts?

ENDLESS NIGIIT. FIERCE FIRES AND SHRAMMING COLD

What kind of illness takes those who have it on journeys wherethey, like Robert Lowell, both do and do not need their Dantes?

Manic-depressive, or bipolar, illness encompasses a widerange of mood disorders and temperaments. These vary in severityfrom cyclothymia----characterized by pronounced but not totallydebilitating changes in mood, behavior, thinking, sleep, and en-ergy levels-to extremely severe, life-threatening, and psychoticforms of the disease. Manic-depressive illness is closely related tomajor depressive, or unipolar, illness; in fact, the same criteria(described in detail in Appendix A) are used for the diagnosis ofmajor depression as for the depressive phase of manic-depressiveillness. These depressive symptoms include apathy, lethargy,hopelessness, sleep disturbance (sleeping far too much or too lit-tle), slowed physical movement, slowed thinking, impaired mem-ory and concentration, and a loss of pleasure in normallypleasurable events. Additional diagnostic criteria include suicidalthinking, self-blame, inappropriate guilt, recurrent thoughts ofdeath, a minimum duration of the depressive symptoms (two tofour weeks), and significant interference with the normal function-ing of life. Unlike individuals with unipolar depression, those suf-fering from manic-depressive illness also experience episodes ofmania or hypomania (mild mania). These episodes are character-ized by symptoms that are, in many ways, the opposite of thoseseen in depression. Thus, during hypomania and mania, mood isgenerally elevated and expansive (or, not infrequently, paranoidand irritable); activity and energy levels are greatly increased; theneed for sleep is decreased; speech is often rapid, excitable, andintrusive; and thinking is fast, moving quickly from topic to topic.Hypomanic or manic individuals usually have an inflated self-esteem, as well as a certainty of conviction about the correctnessand importance of their ideas. This grandiosity can contribute topoor judgment, which, in turn, often results in chaotic patterns ofpersonal and professional relationships. Other common features ofhypomania and mania include spending excessive amounts ofmoney, impulsive involvements in questionable endeavors, reck-less driving, extreme impatience, intense and impulsive romanticor sexual liaisons, and volatility. In its extreme forms mania ischaractertzed by violent agitation, bizarre behavior, delusionalthinking, and visual and auditory hallucinations. In its milder vari-

L4 TOUCIIED WTTHFIRE

ants the increased energy, expansiveness, risk taking, and fluencyof thought associated with hypomania can result in highly produc-tive periods. The range in severity of symptoms is reflected in thecurrent psychiatric diagnostic system. Bipolar I disorder, what onethinks of as "classic" manic-depressive illness, refers to the mostsevere form of affective illness; individuals diagnosed as bipolar Imust meet the full diagnostic criteria for both mania and majordepressive illness. (The standard diagnostic criteria for mania, hy-pomania, major depression, and cyclothymia, as well as more clin-ically descriptive criteria for cyclothymia, are given in AppendixA.) Bipolar II disorder, on the other hand, is defined as the pres-ence or history of at least one major depressive episode, as well asthe existence or history of less severe manic episodes (that is,hypomanias, which do not cause pronounced impairment in per-sonal or professional functioning, are not psychotic in nature, anddo not require hospitalization).

Cyclothymia and related manic-depressive temperaments arealso an integral and important part of the manic-depressive spec-trum, and the relationship of predisposing personalities and cy-clothymia to the subsequent development of manic-depressivepsychosis is fundamental. Cyclothymic temperament can be man-ifested in several ways-as predominantly depressive, manic, hy-pomanic, irritable, or cyclothymic. German psychiatrist ErnstKretschmer described the fuidity inherent to these manic-depressive temperaments :

Men of this kind have a soft temperament which can swing to greatextremes. The path over which it swings is a wide one, namelybetween cheerfulness and unhappiness. . . Not only is the hypo-manic disposition well known to be a peculiarly labile one, which alsohas leanings in the depressive direction, but many of these cheerfulnatures have, when we get to know them better, a permanent mel-ancholic element somewhere in the background of their be-irg. . , . The hypomanic and melancholic halves of the cycloidtemperament relieve one another, they form layers or patterns inindividual cases, arranged in the most varied combinations.s

Clearly not all individuals who have cyclothymia go on todevelop the full manic-depressive syndrome. But many do, and thetemperamental similarities between those who meet all the diag-

ENDLESSNIGIIT,FIDRCEFIRESANDSHRAMMINGCOLD 15

nostic criteria for mania or major depression (that is, are "syndro-

mal") and those who meet them only partially (that is, are"subsyndromal," or cyclothymic) are compelling. British psychia-trists Dr. Eliot Slater and Sir Martin Roth have given a generaldescription of the "constitutional cyclothymic," emphasizing thenatural remissions, vague medical complaints, and seasonal pat-terns often intrinsic to the temperament. The alternating moodstates-each lasting for days, weeks, or months at a time-arecontinuous in some individuals but subside, leaving periods ofnormality, in others. Slater and Roth also discuss the occurrence ofthe cyclothymic constitution in artists and writers:

Its existence in artists and writers has attracted some attention, es-pecially as novelists like Bj6rnson and H. Hesse have given charac-teristic descriptions of the condition. Besides those whose swings ofmood never intermit, there are others with more or less prolongedintentak of normalitg. In the hypomanic state the patient feels well,but the existence of such states accentuates his feeling of insuffi-ciency and even illness in the depressive phases. At such times hewill often seek the advice of his practitioner, complaining of suchvague symptoms as headache, insomnia, lassitude, and indigestion.. . . In typical cases such alternative cycles will last a lifetime. Incyclothymic artists, musicians, and other creative workers therhythm ofthe cycles can be read from the dates ofthe beginning andcessation of productive work.

Some cyclothymics have a seasonal rhgthm and have learned toadapt their Iives and occupations so well to it that they do not needmedical attention.o

The distinction between full-blown manic-depressive illnessand cyclothymic temperament is often an arbitrary one; indeed,almost all medical and scientific evidence argues for including cy-clothymia as an integral part of the spectrurn of manic-depressiveillness. Such milder mood and energy swings often precede overtclinical illness by years (about one-third of patients with deftnitemanic-depressive illness, for example, report bipolar mood swingsor hypomania predating the actual onset of their illness). Thesetypically begin in adolescence or early adulthood and occur mostoften in the spring or autumn, on an annual or biennial basis. Thesymptoms, whose onset is usually unrelated to events in the indi-vidual's life, generally persist for three to ten weeks and are often

16 TOUCIIDD WITH FIRE

characterized by changes in energy level as well as mental discom-fort.7 These subsyndromal mood swings, frequently debilitating,are as responsive to lithium treatment as full-blown manic-depressive illness is.8 In addition to the overlapping nature ofsymptoms in cyclothymia and manic-depressive illness, and thefact that cyclothymia responds to treatment with lithium, two fur-ther pieces of evidence support the relationship between the tem-perament and the illness. First, approximately one out of threepatients with cyclothymia eventually develops full syndromal de-pression, hypomania, or mania; this is in marked contrast to a rateof less than one in twenty in control populations.s Additionally,patients who have been diagnosed as cyclothymic have many morebipolar manic-depressive individuals in their hmily histories thanwould be expected by chance. ro Particularly convincing are thedata from studies of monozygotic (identical) twin pairs, which showthat when one twin is diagnosed as manic-depressive, the other, ifnot actually manic-depressive, very frequently is cyclothymic. rl

Manic-depressive illness is indisputably genetic; the fundamentalimportance of heritability in the etiology and understanding of thisdisease is elaborated upon in chapter 6 (within the context of lit-erary and artistic families characterized by generations of individ-uals who suffered from depressive or manic-depressive illness).While the speciftc genes responsible for manic-depressive illnesshave not yet been identiffed, promising regions on the chromo-somes have been located, It is probable that at least one of thegenes will be isolated within the next few years.

Manic-depressive illness, often seasonal, is recurrent by na-ture; left untreated, individuals with this disease can expect toexperience many, and generally worsening, episodes of depressionand mania. It is important to note, however, that most individualswho have manic-depressive illness are normal most of the time;that is, they maintain their reason and their ability to functionpersonally and professionally. Prior to the availability and wide-spread use of lithium, at least one person in ffve with manic-depressive illness committed suicide. The overwhelming majorityof all adolescents and adults who commit suicide have been deter-mined, through postmortem investigations, to have suffered fromeither bipolar manic-depressive or unipolar depressive illness.

Manic-depressive illness is relatively common; approximatelyone person in a hundred will suffer from the more severe form and

ENDLESS NIGIIT, FIERCE FIRES AND SHRAMMING COLD 17

at least that many again will experience milder variants, such as

cyclothymia. One person in twenty, or 5 percent, will experience

a major depressive illness. Men and women are equally likely to

have manic-depressive illness, in contrast to major depressive ill-

ness, which is more than twice as likely to affect women. The

average age of onset of manic-depressive illness (18 years) is con-

siderably earlier than that of unipolar depression (27 years)'

Highly effective treatments exist for both manic-depressive

and major depressive illness. Lithium has radically altered the

course and consequences of manic-depressive illness, allowing

most patients to live reasonably normal lives. In recent years anti-

convulsant medications such as carbamazepine and valproate haveprovided important alternative treatments for patients unable to

take, or unresponsive to, lithium. A wide variety of antidepressants

has proven exceptionally powerful in the treatment of major de-

pression. Psychotherapy, in conjunction with medication, is often

essential to healing as well as to the prevention of possible recur-

rences. Drug therapy, which is primary, frees most patients from

the severe disruptions of manic and depressive episodes' Psycho-therapy can help individuals come to terms with the repercussionsof past episodes, take the medications that are necessary to prevent

recurrence, and better understand and deal with the often devas-tating psychological implications and consequences of havingmanic-depressive illness.

Although we will be emphasizing the bipolar form of manic-

depressive illness in our discussion of writers and artists, manic-depressive illness, in its European and historical sense,encompasses the severe, recurrent melancholias as well. The clin-ical, genetic, and biological overlaps between recurrent depressiveand manic-depressive illness are stronger than existing differ-ences.12 Although the melancholic side of an imaginative individ-ual may be more striking, the subtler manic states are often alsothere in a fluctuating pattern. We turnthese mood disorders, given by thosethem.

to descriptions ofhave experienced

-I am groaning under the miseries of a diseased nervous Sys-tem; a System of all others the most essential to our happi-ness----or the most productive of our Misery. . . Lord, what isMan! Today, in the luxuriance of health, exulting in the enjoy-

nextwho

TOUCIIEDWTTH FIRE

ment of existence; In a few days, perhaps in a few hours,loaded with conscious painful being, counting the tardy pace ofthe lingering moments, by the repercussions of anguish, & re-fusing or denied a Comforter.-Day follows night, and nightcomes after day, only to curse him with life which gives him nopleasure.

-ROBERT BURNST3

The depressive, or melancholic, states are characterizedby amorbidity and flatness of mood along with a slowing down of vir-tually all aspects of human thought, feeling, and behavior that aremost personally meaningful. Occasionally these changes refectonly a transient shift in mood or a recognizable and limited reactionto a life situation. When energy is profoundly dissipated, the abilityto think is clearly eroded, and the capacity to actively engage in theefforts and pleasures of life is fundamentally altered, then depres-sion becomes an illness rather than a temporary or existential state.As with most kinds of illness, symptoms of depression can rangewidely in their severity. Thinking, for example, may be only mildlyslowed or it can be stuporous; mood may be only slightly downcastor it can be unrelentingly bleak and suicidal; the mind may retainits reason or it can be floridly delusional. In depression (as with themanic states)the degree, type, number, and duration of symptomslargely determine whether or not they meet diagnostic criteria fora mood, or affective, disorder.

Mood, in the more serious depressive states, is usually bleak,pessimistic, and despairing. A deep sense of futility is frequentlyaccompanied, if not preceded, by the belief that the ability toexperience pleasure is permanently gone. The physical and psy-chological worlds are experienced as shades ofgrays and blacks, ashaving lost their color and vibrancy. Irritability, quick anger, sus-piciousness, and emotional turbulence are frequent correlates ofdepressed mood; morbid and suicidal thinking are common. Themood of misery and suffering that usually accompanies depressionwas expressed by Edgar Allan Poe in a letter written when he wasin his mid-twenties:

My feelings at this moment are pitiable indeed. I am suffering undera depression ofspirits such as I have never felt before. I have strug-

ENDLESSMGHT.FIERCEFIRESANDSHRAMMINGCOLD 19

gled ln vain against the infuence of this melancholy-Iou will be-lieoe mc when I say that I am still miserable in spite of the greatimprovement in my circumstances, I say you will believe me, and forthis simple reason, that a man who is writing for ffict does not writethus. My heart is open before you-if it be worth reading, read it. Iam wretched, and know not why. Console me-for you can. But letit be quickly-or it will be too late. Write me immediately. Convinceme that it is worth one's while-that it is at all necessary to live, andyou will prove yourself indeed my friend. Persuade me to do what isright. I do not mean this-I do not mean that you should considerwhat I now write you a jest----oh pity me! for I feel that my words areincoherent-but I will recover myself. You will not fail to see that Iam suffering under a depression of spirits which will lnot fail to] ruinme should it be long continued.la

In his Memoirs French composer Hector Berlioz also wrote of theagonies attendant upon his frequent spells of depression, this most"terrible of all the evils of existence":

It is difficult to put into words what I suffered-the longing thatseemed to be tearing my heart out by the roots, the dreadful senseof being alone in an empty universe, the agonies that thrilled throughme as if the blood were running ice-cold in my veins, the disgust withliving, the impossibility of dying. Shakespeare himself never de-scribed this torture; but he counts it, in Hamleil, among the terribleof all the evils of existence.

I had stopped composing; my mind seemed to become feebler asmy feelings grew more intense. I did nothing. One power was leftme-to suffer.l5

Berlioz suffered throughout his life from these black depressions.He described in detail the two types of melancholia, or "spleen, "he had experienced: an active, painful, and tumultuous one (almostcertainly a mixed state, in which manic and depressive symptomsexist together), and another type, characterized by ennui, isola-tion, lethargy, and a dearth of feeling. "I again became prey to thatfrightful affiiction-psychological, nervous, imaginary, what youwill," he wrote, and then went on to describe one of his attacks insome detail:

The fit fell upon me with appalling force. I suffered agonies and laygroaning on the ground, stretching out abandoned arms, convul-

TOUCItrD WTTIIFIRE

sively tearing up handfuls of grass and wide-eyed innocent daisies,struggling against the crushing sense of absence, against a mortalisolation.

Yet such an attack is not to be compared with the tortures thatI have known since then in ever-increasing measure.

What can I say that will give some idea of the action of thisabominable disease? . . .

There are . two kinds of spleen; one mocking, active, pas-sionate, malignant; the other morose and wholly passive, when one'sonly wish is for silence and solitude and the oblivion of sleep. Foranyone possessed by this latter kind, nothing has meaning, the de-struction of a world would hardly move him. At such times I couldwish the earth were a shell ftlled with gunpowder, which I would puta match to for my diversion.r6

The active and malignant spleen was described by Scottishpoet Robert Burns as well: "Here I sit, altogether Novemberish, adamn'd mdlange of Fretfulness & melancholy; not enough of theone to rouse me to passion; nor of the other to repose me in torpor;my soul flouncing & fluttering round her tenement, like a wildFinch caught amid the horrors of winter newly thrust into a cage. "u

And Shakespeare, in his portrayal of the weary and melancholicHamlet, describes the bleeding out of hope, color, beauty, andbeliefi

I have of late-but wherefore I know not-lost all my mirth, forgoneall custom of exercises. And indeed it goes so heavily with my dis-position that this goodly frame the earth seems to me a sterile prom-ontory. This most excellent canopy, the air, look you, this braveo'erhanging ftrmament, this majestical roof fretted with golden fire-why, it appeareth nothing to me but a foul and pestilent congregationof vapours. r8

Eighteenth-century poet William Cowper, who was confinedto an asylum for his manic-depressive illness, spoke of the terrorsof being hunted "by spiritual hounds in the night season" as well asof the deadening side to his melancholy:

The weather is an exact emblem of my mind in its present state. Athick fog invelops every thing, and at the same time it freezes in-

ENDLDSS NIGIIT, FIDRCE FIRRSAND SHRAMMING COLD g1

tensely. You will tell me that this cold gloom will be succeeded by acheerful spring, and endeavor to encpurage me to hope for a spiritualchange resembling it. But it will be lost labour: Nature revives again,but a soul once slain, Iives no more. The hedge that has been ap-parently dead, is not so, it will burst into leaf and blossom at theappointed time; but no such time is appointed for the stake thatstands in it. It is as dead as it seems, and will prove itself no dissem-bler. re

Austrian composer Hugo Woll who died from tertiary syphilis butwhose volatility and extremes in mood predated the symptoms ofhis paresis, focused on the painful contrast between the subjectiveexperience of an arid, sterile reality and a sense of the externalworld as an unobtainable, visible, but not for him habitable placeof light, warmth, and creation:

What I suffer from this continuous idleness I am quite unable todescribe. I would like most to hang myself on the nearest branch ofthe cherry trees standing now in full bloom. This wonderful springwith its secret life and movement troubles me unspeakably. Theseeternal blue skies, lasting for weeks, this continuous sprouting andbudding in nature, these coaxing breezes impregnated with springsunlight and fragrance of flowers . . . make me frantic. Everywherethis bewildering urge for life, fruitfulness, creation-and only I, al-though like the humblest grass of the fields one of God's creatures,may not take part in this festival of resurrection, at any rate notexcept as a spectator with grief and envy.2o

He also described the gap that frequently exists between pub-lic appearance and private despair: "I appear at times merry and ingood heart, talk, too, before others quite reasonably, and it looks asif I felt, too, God knows how well within my skin; yet the soulmaintains its deathly sleep and the heart bleeds from a thousandwounds."2r

Depression affects not only mood but the nature and contentof thought as well. Thinking processes almost always slow down,and decisiveness is replaced by indecision and rumination. Theability to concentrate is usually greatly impaired and willful actionand thought become difficult if not impossible. English poet Ed-ward Thomas spoke of a "dulness and thickness of brain"22 and

88 TOUCIIED WTTH FIRE

Cowper wrote with bitter irony about the existence of only enoughsense and intellect to allow him awareness of his damaged mind:

Oh wretch! to whom life and death are alike impossible! Most mis-erable at present in this, that being thus miserable I have my sensescontinued to me only that I may look forward to the worst. It iscertain at least, that I have them for no other pu{pose, and but veryimperfectly even for this. My thoughts are like loose dry sand, whichthe closer it is grasped slips the sooner away. Mr. Johnson reads tome, but I lose every other sentence through the inevitable wander-ings of my mind, and experience, as I have these two years, the sameshattered mode ofthinking on every subject and on all occasions. IfI seem to write with more connextion, it is only because the gaps donot appear.23

Irrational fears, feelings of panic (including actual panic at-tacks), obsessions, and delusions are also present in many types ofsevere depression. Robert Schumann described his panic and ter-rors during one of his many bouts of melancholy.

I was little more than a statue, neither cold nor wann; by dint offorced work life returned gradually. But I am still so timid and fearftlthat I cannot sleep alone. . . Do you believe that I have not thecourage to travel alone . . for fear something might befall me?Violent rushes of blood, unspeakable fear, breathlessness, momen-tary unconsciousness, alternate quickly.%

Excessive preoccupation with sin and religion are not uncom-mon in depression; likewise, thoughts of suicide often accompanyfeelings of despair and apathy. David Cecil, in The Stricken Deer,wrote about one of Cowper's anguished periods of melancholicinsanity, which was followed, in turn, by the resumption of a rel-atively normal existence:

A mood of lassitude and dejection took possession of his spirits. Helost all pleasure in society, would sit for hours at his table, unable tobring himself to work at anything.

So passed December; and now January, fatal January, was here.Sure enough, the old symptoms began to reappear. His sleep wastroubled by dreams, his waking hours by accusing voices. . . . His

ENDLESSNIGIIT.FIERCDFIRESANDSHRAMMINGCOLD 83

shaken neryes could muster up no power of resistance. Every day hegrew rapidly worse. Melancholy swelled to obsession, obsession todelusion. . . . For the third time in his life Cowper was a ravingmaniac.

The disease followed its old course. Once again he tried to killhimself. Once again he shrank from all other friends . . . this time itlasted much less long than before. There was no period of gradualrecovery. One day in july he returned to his right mind; and bySeptember he was working and writing letters and dining out, tooutward appearance just the same as he had been before the attack. s

Like thought and verbal expression, activity and behavior:uealmost always slowed in the depressed phase of manic-depressiveillness. Fatigue, lassitude, and a marked inability to exercise willare part and parcel ofdepression as well. In his 1936 autobiograph-ical essay The Crack-Up, F. Scott Fitzgerald traced the ebbingsand flowings of several of his breakdowns, describing in the processthe backing offfrom friends and social ties of all sorts, endless andfearful sleeping, obsessive list making, the great e$ort required foreven the slightest of everyday transactions, and the frenetic pacethat led up to the "cracking":

I found I was good-and-tired. I could lie around and was glad to,sleeping or dozing sometimes twenty hours a day and in the intervalstrying resolutely not to think-instead I made lists . . . hundreds oflists. . . .

I realized . . . that every act of life from the morning tooth-brush to the friend at dinner had become an effort . . . hating thenight when I couldn't sleep and hating the day because it wenttoward night. I slept on the heart side now because I knew that thesooner I could tire that out, even a little, the sooner would come thatblessed hour of nightmare which, like a catharsis, would enable meto better meet the new day. , . .

All rather inhuman and undernourished, isn't it? Well, that,children, is the true sign of cracking up.26

Bleak weariness with life, very much a hallmark of his recur-rent melancholy, was also described by poet Edward Thomas:

There will never be any summer any more, and I am weary ofeverything. I stay because I am too weak to go. I crawl on because it

24 TOUCHED WITH FIRE

is easier than to stop. I put my face to the window. There is nothingout there but the blackness and the sound of rain. Neither when Ishut my eyes can I see anything. I am alone. . . There is nothingelse in my world but my dead heart and brain within me and the rainwithout.2T

Irish poet ]ames Clarence Mangan described not only theabsolute psychic and physical exhaustion of depression but also thepsychosis that, in his case, had preceded it:

My nervous and hypochondriacal [melancholic] feelings almostverged upon insanity. I seemed to myself to be shut up in a cavernwith serpents and scorpions and all hideous and monstrous things,which writhed and hissed around me, and discharged their slime andvenom over my person. .nt

A settled melancholy took possession of my being. A sort oftorpor and weariness of life succeeded to my former over-excitedsensibilities. Books no longer interested me as before; and my ownunshared thoughts were a burden and torment to me.2s

"It was," he said, "woe on woe, and'within the lowest deep a lowerdeep.' ""o It is not surprising that despair should find its way intoso many of his poems:

Tell thou the world, when my bones lie whiteningAmid the last homes of youth and eld,

That there was once one whose veins ran lightningNo eye beheld,

And tell how trampled, derided, hated,And worn by weakness, disease, and wrong,

He fled for shelter to God, who matedHis soul with song-

Tell how this Nameless, condemned for years longTo herd with demons from hell beneath,

Saw things that made him, with groans and tears, longFor even death.sl

ENDLESS NIGIIT, FIERCE FIRESAND SHRAMMING COLD 85

Gerard Manley Hopkins, English poet and Jesuit, died of afever in Dublin in 1889. At the time he was relatively young,morbidly depressed, and in fear of going mad. The depressionsfrom which he suffered were clearly becoming more chronic. In1885 he wrote that "The melancholy I have all my life been subjectto has become of late years not indeed more intense in its fits butrather more distributed, constant, and crippling . . . my state ismuch like madness."3z Later in the year he wrote, "soon I amafraid I shall be ground down to a state like this last spring's andsummer's, when my spirits were so crushed that madness seemedto be making approaches. "s In January of the year he died hestated, "All my undertakings miscarry: I am like a straining eu-nuch. I wish then for death."34 "The body cannot rest when it is inpain," said Hopkins, nor the mind be at peace as long as some-thing bitter distills in it and it aches."s5 Hopkins's poetry, like hisprose, is palpable with his anguish. His "Dark Sonnets," among thegreat poems of despair, were, he said, "written in blood. "3u Thistakes no convincing to believe:

No worst, there is none. Pitched past pitch of grief,More pangs will, schooled at forepangs, wilder wring.Comforter, where, where is your comforting?Mary, mother of us, where is your relief?My cries heave, herds-long; huddle in a main, a chief-Woe, world-sorrow; on an age-old anvil wince and sing-Then lull, then leave off. Fury had shrieked'No ling-Ering! Let me be fell: force I must be brief'.O the mind, mind has mountains; cliffs of fallFrightful, sheer, no-man-fathomed. Hold them cheapMay who ne'er hung there. Nor does long our smallDurance deal with that steep or deep. Here! creep,Wretch, under a comfort serves in a whirlwind: allLife death does end and each day dies with sleep.37

Moods are by nature compelling, contagious, and profoundlyinterpersonal, and disorders of mood alter the perceptions andbehaviors not only of those who have them but also of those whoare related or closely associated. Manic-depressive illness-markedas it is by extraordinary and confusing fuctuations in mood, per-sonality, thinking, and behavior-inevitably has powerful and of-

86 TOUCIIED WTTHFIRE

ten painful effects on relationships. The anger, withdrawal, andblackness of melancholic moods are captured graphically in thispassage from Cloud Hotoe, by Scottish novelist Lewis Grassic Gib-bon:

Sometimes a black, queer mood came on Robert, he would lockhimself up long hours in his room, hate God and Chris and himselfand all men, know his Faith a fantastic dream; and see the fleshlessgrin of the skull and the eyeless sockets at the back of life. He wouldpass by Chris on the stairs if they met, with remote, cold eyes and atwisted face, or ask in a voice that cut like a knife, Can't you leaoe mealone, nwst you alwags foll.ou?

The ftrst time it happened her heart had near stopped, she wenton with her work in a daze of amaze. But Robert came back from hismood and came seeking her, sorry and sad for the queer, black beastthat rode his mind in those haunted hours.38

Disrupted and fitful sleep,or sleeping far too much or far toolittle, are among the most pervasive and consistent symptoms ofdepression. Quentin Bell, in his biography of his aunt, VirginiaWoolf, described her sleepness nights and their aftermath: "Aftersuch nights the days brought headaches, drilling the occiput asthough it were a rotten tooth; and then came worse nights; nightsmade -terrible by the increasing weight of anxiety and depres-sion."3e Bell continued on with Woolfs own description ofluchnights from her novel TheVogage Or,rt, drawn in part from her ownexperience with manic-depressive illness: "those interminablenights which do not end at twelve, but go on into the doublefigures-thirteen, fourteen, and so on until they reach the twen-ties, and then the thirties, and then the forties . . . there is nothingto prevent nights from doing this if they choose."no Sylvia plath,who was hospitalized for severe depression and ultimately com-mitted suicide, described her awful and sleepless nights in theautobiographical novel The Bell Jar:

I hadn't washed my hair for three weeks.I hadn't slept for seven nights.My mother told me I must have slept, it was impossible not to

sleep in all that time, but if I slept, it was with my eyes wide open,for I had followed the green, luminous course of the second hand and

EIVDLESS NIGIIT, FIERCE FIRES AND SHRAMMING COLD 27

the minute hand and the hour hand of the bedside clock throughtheir circles and semicircles, every night for seven nights, withoutmissing a second, or a minute, or an hour.

The reason I hadn't washed my clothes or my hair was becauseit seemed so silly.

I saw the days ofthe year stretching ahead like a series ofbright,white boxes, and separating one box from another was sleep, like ablack shade. Only for me, the long perspective of shades that set offone box from the next had suddenly snapped up, and I could see dayafter day glanng ahead of me like a white, broad, inffnitely desolateavenue.

It seemed silly to wash one day when I would only have to washagain the next.

It made me tired just to think of it.I wanted to do everything once and for all and be through with

i t .4r

And finally, Theodore Roethke, who, like so many of his fellowpoets suffered from manic-depressive illness, described an almostunbearable pain:

I have myself an inner weight of woeThat God himself can scarcely bear.

What you survived I shall believe: the Heat,Scars, Tempests, Floods, the Motion of Man's Fate;I have myself, and bear its weight of woeThat God that God leans down His heart to hear.a2

In striking contrast to the melancholic states are the manicones, in which, wrote Hugo Wolf, the "blood becomes changedinto streams of fire."as Mania is characterized by an exalted orirritable mood, more and faster speech, rapid thought, briskerphysical and mental activity levels, quickened and more finelytuned senses, suspiciousness, a marked tendency to seek out otherpeople, and impulsiveness. In hypomania, the less severe form ofmania, these changes tend to be moderate and may or may not

38 TOUCIIED WITHEIRE-

result in serious difficulties for the individual experiencing them.As the hypomania intensiffes, however, it profoundly disrupts thelives of those who are manic, their families and acquaintances, andthe society in which they live. The range of symptoms in the manicstates, from those found in the mild hypomanias to florid psychosisin acute mania, is as wide as that found in the depressive states.

Mood in hypomania is usually ebullient, self-conffdent, andoften transcendent, but it almost always exists with an irritableunderpinning. Hypomanic mood, although elevated, is generallyboth fuctuating and volatile. Manic mood, frequently character-ized as elated and grandiose, is often as not riddled by depression,panic, and extreme irritability. The perceptual and physicalchanges that almost always accompany hypomania and mania gen-erally refect the close and subtle links that exist between elevatedmood, a sense of well-being, expansive and grandiose thought, andintensifi ed perceptual awareness.

Examples of manic grandiosity, visionary expansiveness, andunbridled euphoria are abundant in writers and artists. BenjaminHaydon-friend of )ohn Keats, and a painter who eventually killedhimself--once wrote exuberantly in his journal that "I have beenlike a man with air balloons under his armpits and ether in hissoul,"e and Theodore Roethke captured the mystical merging ofidentities and experiences so common to the manic experience:

For no reason I started to feel very good. Suddenly I knew how toenter into the life of everything around me. I knew how it felt to bea tree, a blade of grass, even a rabbit. I didn't sleep much. I justwalked around with this wonderful feeling. One day I was passing adiner and all of a sudden I knew what it felt like to be a lion. I wentinto the diner and said to the counter-man, "Bring me a steak. Don'tcook it. Just bring it." So he brought me this raw steak and I startedeating it. The other customers made like they were revolted, watch-ing me. And I began to see that maybe it rlos a little strange. So Iwent to the Dean [at the university where Roethke taught] and said,"I feel too good. Get me down off this." So they put me into thetubs.a5

William Meredith, in describing one of Robert Lowell's manymanic attacks, related the psychotic grandiosity of Lowell's think-ing and actions:

ENDLESS NIGM. FIERCE FIRES AND SHRAMMING COLD 89

No one predicts how long it will be before the drugs take hold &[I-owell] begins to be himself again. Meanwhile he writes and revisestranslations furiously and with a kind lofl crooked brilliance, andtalks about himself in connection with Achilles, Alexander, HartCrane, Hitler, and Christ, and breaks your heart.ao

Manic and hypomanic thought are flighty and leap from topicto topic; in milder manic states the pattern of association betweenideas is usually clear, but, as the mania increases in severity, think-ing becomes fragmented and often psychotic. Paranoid, religious,and grandiose delusions nre common, as are illusions and halluci-nations. Lowell, for example, wrote about one of his manic expe-riences:

Seven years ago I had an attack of pathological enthusiasm. The nightbefore I was locked up I ran about the streets of Bloomington Indianacrying out against devils and homosexuals. I believed I could stop carsand paralyze their forces by merely standing in the middle ofthe high-way with my arms outspread. . . . Bloomington stood for Joyce's heroand Christian regeneration. Indiana stood for the evil, unexorcised,aboriginal Indians. I suspected I was a reincarnation of the HolyGhost, and had become homicidally hallucinated. To have known theglory, violence and banality of such an experience is corrupting.aT

Another side of mania-its dendritic, branching-out quality-wasdescribed by john Ruskin:

I roll on like a ball, with this exception, that contrary to the usual lawsof motion I have no friction to contend with in my mind, and of crursehave some difficulty in stopping myself when there is nothing else tostop me. . . . I am almost sick and giddy with the quantity of thingsin my head-trains of thought beginning and branching to inffnity,crossing each other, and all tempting and wanting to be worked out.s

Leonard Woolf noted the deteriorating quality of Virginia Woolfsthinking and speech as her illness worsened; her speech, likeRuskin's thought, went on seemingly without stop:

She talked almost without stopping for two or three days, paying noattention to anyone in the room or anything said to her. For about aday what she said was aoherent; the sentences meant something,

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though it was nearly all wildly insane. Then gradually it becamecompletely incoherent, a mere jumble of dissociated words.ae

One of the best descriptions of the far-ranging, intoxicating,and leapfrogging nature of manic thought and conversation is givenby Saul Bellow in Hum.boldt's Glft, a novel based in part on themanic and chaotic lives of poets Delmore Schwartz and John Ber-ryman:

Now a word about Humboldt's conversation. What was the poet'sconversation actually likeP

He wore the look of a balanced thinker when he began, but hewas not the picture of sanity. I myself loved to talk and kept up withhim as long as I could. For a while it was a double concerto. butpresently I was ffddled and trumpeted off the stage. Reasoning, for-mulating, debating, making discoveries Humboldt's voice rose,choked, rose again . . . he passed from statement to recitative, fromrecitative he soared into aria, and behind him played an orchestra ofintimations, virtues, love of his art, veneration of its great men-butalso of suspicion and skulduggery. Before your eyes the man recitedand sang himself in and out of madness.

He started by talking about the place of art and culture in thefirst Stevenson administration. . . . From this Humboldt turned toRoosevelt's sex life . . . he moved easily from the tabloids to GeneralRommel and from Rommel to John Donne and T. S. Eliot. AboutEliot he seemed to know strange facts no one else had ever heard.He was fflled with gossip and hallucination as well as literary theory.Distortion was inherent, yes, in all poetry. But which came ffrst?And this rained down on me . . chorus girls, prostitution and reli-gion, old money, new money, gentlemen's clubs, Back Bay, New-port, Washington Square, Henry Adams, Henry fames, Henry Ford,Saint John of the Cross, Dante, Ezra Pound, Dostoevski, MarilynMonroe and Joe DiMaggio, Gertrude Stein and Alice, Freud andFerenczi.50

As with all signs and symptoms of manic-depressive illness,including those ofthought, perceptual and sensory changes vary indegree and kind. Mild increases in the awareness of objects thatactually exist in an individual's environment-the "hyperacusis" sofrequently a part of hypomania and mania---can progress to totaldisarray of the senses; this, in turn, can result in visual. auditorv.

ENDLESS NIGIIT. FTERCE FIRES AND SHRAMMING COLD 31

and olfactory hallucinations (sensory experiences not based onexisting physical phenomena). At the milder end of the continuumofperceptual change, Poe gave a fictional account ofmoods "ofthe

keenest appetency"r

Not long ago, about the closing in of an evening in autumn, I sat atthe large bow window ef ths p- Coffee-House in London. Forsome months I had been ill in health, but was now convalescent, and,with returning strength, found myself in one of those h"ppy moodswhich are so precisely the converse of ennui-moods of the keenestappetency, when the fflm fiom the mental vision departs . . . and theintellect, electriffed, surpasses as greatly its everyday condition, asdoes the vivid yet candid reason of Leibnitz, the mad and fimsyrhetoric of Gorgias. Merely to breathe was enjoyment; and I derivedpositive pleasure even from many of the legitimate sources of pain.sl

john Ruskin wrote of his own experiences with what he called the"conditions of spectral vision and audit" belonging to "certain statesof brain excitement":

I saw the stars rushing at each other-and thought the lamps ofLondon were gliding through the night into a World Collision. . . .Nothing was more notable to me through the illness than the generalexaltation of the neryes of sight and hearing, and their power ofmaking colour and sound harmonious as well as intense-with altern-ation of faintness and horror of course. But I learned so much aboutthe nature of Phantasy and Phantasm-it would have been totallyinconceivable to me without seeing, how the unreal and real could bemixed.52

Among the particularly dramatic and extreme clinical featuresof acute mania are its associated frenetic, seemingly aimless, andviolent actions. Bizarre, driven, paranoid, and impulsive patternsof behavior are common; irrational financial activities, includingmassive overspending and unwise investments, often occur. Theidiosyncratically meaningful, often wildly funny purchases thatmanics can make are wonderfully captured in a recent novel byJonathan Carroll:

There was no screech of tires, screams, or thunderous crash when mymind went flying over the cliff into madness, as I gather is true in

TOUCMD W]TH FIRE

many cases. Besides, we've all seen too many bad movies wherecharacters scratch their faces or make hyena sounds to indicatethey've gone nuts.

Not me. One minute I was famous, successful, self_assuredHarry Radcliffe in the trick store, looking for inspiration in a favoritespot. The next, I was quietly but very seriously mad, walking out ofthat shop with two hundred and fffty yellow pencil sharpeners. Idon't know how other people go insane, but my ,""y *"^, at leastnovel.

Melrose Avenue is not a good place to lose your mind. Thestores on the street are full oflunatic desires and are only too h*ppyto let you have them ifyou can pay. I could.

Anyone want an African gray parrot named Noodle Koofty? Inamed him in the ride back to santa Barbara. He sat silently in agiant black cage in the back of my Mercedes station wagon, sur-rounded by objects I can only cringe at when I think of them now:three colorful garden dwarves about three feet high, each holding agold hitching ring; ffve Conway Twitty albums that cost twenty dol-lars each because they were "classics"; three identical Sam the Shamand the Pharaohs albums, "classics" as well, twenty-five dollars apiece; a box of bathroom tiles with a revolting peach motif; a wall-sizeposter of a chacma baboon in the same pose as Rodin's The Thinker. . . other things too, but you get the drift.53

Mania also tends to bring with it indefatigability, a markedlydecreased need for sleep, and the aggressive pursuing of humancontact. The emotional consequences of such behaviors can bedevastating. In portions of two letters to T. S. Eliot, Robert Lowellwrote of his embarrassment following different manic episodes:

[June 196l] The whole business has been very bruising, and it isfierce facing the pain I have caused, and humiliating [to] think thatit has all happened before and that control and seltknowledge comeso slowly, if at all.s

fMarch 1964] I want to apologize for plaguing you with so manytelephone calls last November and December. When the "enthusi-asm" is coming on me it is accompanied by a feverish reaching to myftiends. After it's over I wince and wither.s

The aftermath of mania is usually depression-Lowell oncedescribed mania as "a magical orange grove in a nightmare"56-and

ENDLESS NIGIIT, FIERCE FIRES AND SHRAMMING COLD 33

indeed, as we shall see, mania and depression are frequently min-

gled together or alternate one to the other in an ongoing process of

changing vitalities, a process finding its counterpart in the natural

world, as described by Delmore Schwartz:

The river was opulence, radiance, sparkle, and shine, a rippling radi-ance dancing light's dances;

And the birds few, soared, darted, perched, perched and whistled,dipped or ascended

Like a ballet of black flutes, an erratic and scattered metamorphosisof the villages of stillness into the variety of flying:

The birds were as a transformation of trunk and branch and twig intothe elation which is the energy's celebration and consummation!

-It was dificult, then, to believe-how difficult it was and how pain-ful it was to believe in the reality of winter,

Beholding so many supple somersaults of energy and deathless featsof superexuberant vitality, all self-delighting,

Arising, waving, flying, glittering, and glistening as if in irresistible

eagerness,

Seeking with serene belief and undivided certainty, love's miracles,tender, or thrashing, or thrashing towards tenderness boldly.

It was necessary to think of pine and fir,Of holly, ivy, barberry bush and icicle, of frozen ground,

And of wooden tree. white or wet and drained,And of the blackened or stiffened arms of elm, oak and mapleTo remember. even a little. that existence was not forever

May and the beginning of summer:It was only possible to forget the presence of the present's green and

gold and white fags of flowering May's victory, summer s ascend-ancy and sovereignty,

By thinking ofhow all arise and aspire to the nature offfre, to theflamelike climbing of vine and leaf and fower,

And calling to mind how all things must suffer and die in growth andbirth.

To be reborn, again and again and again, to be transformed all overagain.57

Although much of our discussion of mania and depression hasemphasized the differences between the two clinical states, it isimportant to note that the oscillation into, out of, and within the

u TOUCHED WTNIFIRE

various forms and states of the disease is, in its own right, a hall-mark of m_anic-depressive illness. Manic and depressive symptompatterns clearly have a polar quality, but the overlapping, trans!tional, and fuctuating aspects are enormously important in de-scribing and understanding the illness as a whole. Frofessor EmilKraepelin, who more than anyone deffned and described manic-depressive illness, wrote:

The delimitation of the individual clinicar forms of the malady is inmany respects wholly artificial and arbitrary. observation not onlyreveals the occurrence ofgradual transitions between all the variousstates, but it also shows that within the shortest space of time thesame morbid case may pass through most manifold transformations.s

More recently, in the lg50s, Dr. John campbell emphasized thisfundamentally dynamic nature of manic-depressive illness by com-paring the illness with a movie:

The fluidity, change, and movement of the emotions, as thev occurin the ever-changing cyclothymic process, may be compared to thepictures of a cinema, as contrasted with a "still" photograph. Indeed,the psychiatrist, observing a manic-depressive pauent ior the ftrsttime, or as he undergoes one of the many undulations in mood, frommelancholia to euphoria or from hypomania to a depression, is re-minded of the experience of entering a movie during the middle ofthe story' No matter where one takes up the plot, the story tends toswing around again to the point where it started. The examiner mayobserve the manic-depressive patient ftrst in a manic reaction, laterin a depression, but eventually, if followed long enough, in anothermanic reaction. Like the movie, which is a continuous but constantlychanging process, the cyclothymic process is also continuous eventhough for the moment the observer is attracted by the immediatecross-section view. This conception ofchange, or constant undulationof the emotions, is much more accurate than a static appraisal.5e

The link between mania and depression had been noted forcenturies.m As early as the second century A.D., for example,Aretaeus o{cappadocia observed that "melancholia is without anydoubt the beginning and even part of the disorder called mania":6iso too, Alexander of Tralles (c. 575) wrote that individuals tended

ENDLESS NIGTTT, FIERCE FIRES AND SI{RAMMING COLD 85

to have cycles of mania and melancholia, and that "mania is nothingelse but melancholia in a more intense form."62 By the sixteenthcentury Jason Pratensis had concluded that "most physicians asso-ciate mania and melancholia (truly dreadful diseases) as one disor-

der";63 he, like most others, distinguished mania from melancholia

by "degree and manifestation" only. Alternating and interwovenpatterns of mania and depression were well described by

seventeenth-century writers, and Michel Foucault gives a vivid

summary of the work of one of them, Dr. Thomas Willis:

In the melancholic . . . the spirits were somber and dim; they casttheir shadows over the images of things and formed a kind of darktide; in the maniac, on the contrary, the spirits seethed in a perpetualferment; they were carried by an irregular movement, constantlyrepeated; a movement that eroded and consumed, and even withoutfever. sent out its heat. Between mania and melancholia, the afinityis evident: not the affinity of symptoms linked in experience, but theaffinity-more powerful and so much more evident in the landscapesof the imagination-that unites in the same ftre both smoke andflame.s

By the eighteenth and nineteenth centuries, most medical writers

thought of mania as an extreme form of melancholia. Richard Mead

wrote in \757:

Medical writers distinguish two kinds of Madness, and describe themboth as a constant disorder of the mind without any considerablefever; but with this difference, that the one is attended with auda-ciousness and fury, the other with sadness and fear: and that they callmania, this melancholy. But these generally differ in degree only.For melancholy very frequently changes, sooner or later, into ma-niacal madness; and, when the fury is abated, the sadness generallyreturns heavier than before.s

Doctors Jean Pierre Falret and Jules Baillarger, in the mid-

nineteenth century, formally posited that mania and depressioncould represent different manifestations of a single illness. Falret

noted the strong depressive quality often occurring before, during,

and after manic episodes, as well as m,elancholie anxieuse, "char'

acterized by constant pacing and inner turmoil, which incapacitates

TOUCIMD WITH FIRE

these patients so they cannot concentrate, and this state sometimesends up as manic agitation."ffi Kraepelin, in his lg2l classic text-book about manic-depressive illness, described mixed states, inwhich depressive and manic symptoms coexist; he conceptualizedthese mixed states as primarily transitional phenomerr"-th"t ir,they tended to occur when an individual was going into or out of adepressive or manic state.67 such states, as we shall see later,represent an important link between manic-depressive illness, ar-tistic temperament, creativity, and the rhythms and temperamentof the natural world. Unfortunately, they also are closely associatedwith the damaging and killing sides of manic-depresiive illness:alcoholism, drug abuse, and suicide.

"But I am constitutionally sensitive-nervous in a very un_usual degree. I became insane, with long periods of horrible san-ity," wrote Poe. "During these fits of absolute unconsciousness Idrank, God knows how much or how long. As a matter of course,my enemies referred the insanity to the drink rather than the drinkto theinsanity."* For many poe personiffes the stereotype of thealcoholic writer; it is rare to ffnd a discussion of alcohol and writerswithout reference to him, or to Fitzgerald, Hemingway, Tennes-see williams, Berryman, or Lowell. And yet all rnff"r"d from de-pressive or manic-depressive illness as well, raising complicatedquestions about whether the melancholic muse is also a

-"thirsty

muse"6e-that is, whether alcohol and other drugs "r"

ur"a bywriters and artists to alleviate painful depressions and agitatedmanic states; whether they are responsible for changes in mood;whether they are used to provoke or recapture freer, Lss inhibitedstates of mind and emotion; or whether some combination of all ofthese obtains. one Poe biographer wrote: "we know now thatwhat made Poe write was what made him drink: alcohol and liter-ature were the two safety valves of a mind that eventually tore itselfapart,"7o and W. R. Bett, writing in the lg50s, said:

Poe s indulgence . . was one of the methods by which he fought theintolerable morbidity of his manic-depressive state of mirid andsought a temporary forgeffirlness of the misfortunes and setbacks towhich he seemed predestined. Had this been his only weapon torelieve the depressions that overtook him, he would, like thousandsof others similarly affected, have lived his life unknown and goneunsung by posterity. But he had a second weapon-his pen.71

lENDLESS NIG}IT, FIERCE FIRES AND SHRAMMING COLD

Indeed, Poe himself described some of this "intolerable mor-

bidity"; he also described why on one occasion he reached out to

laudanum in a desperate, suicidal attempt to escape from his psy-

chological pain:

You saw, you felt the agony of grief with which I bade you fare-well-You remember my expressions of gloom--+f a dreadful hor-rible foreboding of ill-Indeed-indeed it seemed to me that deathapproached me even then, & that I was involved in the shadowr rhi"h went before him. . . . I remember nothing distinctly' fromthat moment until I found myself in Providence-I went to bed &

wept through a long, long, hideous night of despair-When the

day broke, I arose & endeavored to quiet my mind by a rapid walk

in the cold, keen air-but all uould not do-the demon tormentedme still. Finally I procured two ounces of laudanum' ' . ' I am so

ill*so terribly, hopelessly u-r- in body and mind, that I feel I ceN-Nor live . . . until I subdue this fearfiul agitation, which if contin-ued, will either destroy my life or, drive me hopelessly mad'72

Inordinately sensitive to his moods, Poe was also aware of their

cyclic and alternating nature. In a letter to poet |ames Russell

Lowell, whose own temperament was deeply moody, he wrote:

I can feel for the "constitutional indolence" of which you com-plain-for it is one of my own besetting sins. I am excessivelyslothful, and wonderfully industrious-by ffts. There are epochswhen any kind of mental exercise is torture, and when nothingyields me pleasure but solitary communion with the "mountains &

ih" *oodt--the "altars" of Byron. I have thus rambled and

dreamed away whole months, and awake, at last, to a sort of maniafor composition. Then I scribble all day, and read all night, so longas the disease endures.Ts

Poe was scarcely alone in sufferingfrom both manic-depressive

illness and alcohol and drug abuse. Studies are quite consistent in

finding elevated rates of alcohol and drug abuse in individuals with

manic-depressive illness;74 conversely, there is a signiffcantly

higher percentage of bipolar patients in populations of alcoholics

and drug abusers.T5 The largest and best-designed investigation to

date has been the Epidemiologic Catchment Area (ECA) study, a

TOUCIIED WITHFTRE

large survey conducted by the National Institute of Mental Healthin ffve major American population centers (New Haven. Balti-more, St. Louis, Los Angeles, and piedmont County, North Caro_lina). The study found an exceedingly high lifetime prevalencerate, 46 percent, for alcohol abuse and dependence in patients withmanic-depressive illn-ess; the ffgures foi unipolar depressed pa-tients ?ld the general

_population were 2l "r,d

13 percent respec_tively.76 A related study found that mania was strongly associatedwith alcoholism but major depression was not.zz eliho.rgh it i,perhaps more intuitive to link increased alcohol use with ihe d"-pressed phase of manic-depressive illness, evidence suggests thatincreased alcohol consumption is actually more ft"q.rerrtly associ-ated with hypomania, mania, and the m*ed or tran-sition"l ,t"t.r.Indeed, manic-depressive patients who increase their alcohol con-sumption generally do so during the manic phase.78 For RobertLowell the combination of alcohol and mania often proved an es-pecially disinhibiting one. Here he is described by the congres-sional representative who accompanied him on a c,rliural exchangeprogram to South America:

JVhen we got to Argentina, it was six double vodka martinis befbrelunch. And he made me drink with him. we went to lunch at thepresidential palace, the casa Rosada, and car [Robert Loweil]promptly insulted the general, who was in fact abo,ri to be presidentof Argentina, and started one of the many diplomatic ,urrip.rru, h"caused on that trip. There was the American cultural attachZ. whosename I cannot remember, and car was sitting at this lunch in a veryloud checked sports coat and open shirt, and all the generals werethere, very uptight and distinguished. And there was tlhis wonderfulopening scene when cal was introduced to the cultural attach6 andtalked to him for about three minutes. The guy was an absolute idiotand asked stupid questions and obviously didn t know who cal was.so cal turned on him and said, "you're the cultural attach6?" "yep,sure am." And cal said, "How can you be the cultural attach6?You're illiterate." That's how the lunch started, and it went on fiomthere. After the lunch, cal started his tour of the equestrian statues,undressing[,] and climbing the statues. He insisted on being taken toevery statue in B.A.-well, we didn't do every one, thank God. Andhe'd stop the car and ̂ start clambering up and sit next to the generalon top of the statue.Ts

ENDLESS NIGIIT. FIERCE FIRES AND SHRAMMING COLD 39

Excesses of all kinds characterize mania, and intemperatedrinking may be just one aspect of this general pattern; however,self-medication of painful or uncomfortable mood states no doubtaccounts for some of the association as well. To an extent, alcoholdoes provide relief from the irritability, restlessness, and agitationassociated with mania; not surprisingly, alcohol use often increasesdramatically during mixed states as well. Unfortunately, however,alcohol and drug abuse often worsens the overall course of manic-depressive illness, occasionally precipitates the disease in vulner-able individuals, and frequently undermines the effects oftreatment.80

Other drugs, such as cocaine and opium, are also abused byindividuals who have manic-depressive illness.sr The findingsfrom the ECA study show that the lifetime prevalence rate ofdrug abuse in bipolar patients is 4l percent; this is far higherthan in unipolar depressed patients or the general population (18and 6 percent, respectively).8z Conversely, the rates of bipolarillness among cocaine and opiate abusers are several times higherthan in the general population.s' The selection of drugs for self-medication tends to depend upon the predominant nature of thesymptoms an individual experiences; sedative drugs such as al-cohol and opiates are generally preferred by those patients whohave agitated and perturbed forms of depression, or irritable andhighly uncomfortable manias. The use of cocaine and other stim-ulants by individuals with manic-depressive illness is more com-plicated; for example, there is evidence that most patients reportusing cocaine, primarily when hypomanic or manic, in order toenhance or induce the euphoric moods associated with thesestates.8a One group of clinical investigators has reported that themajority of their bipolar and cyclothymic patients who abused co-caine stated that they were not self-medicating their depressions;rather, they were attempting to lengthen or intensiSr the eu-phoric effects of mild mania.8s

The coexistence of alcoholism, drug abuse, and manic-depressive illness is more common than not; approximately 60percent of patients with bipolar illness have a history of some kindof substance abuse or dependerrce.8u These problems, not surpris-ingly, are common in writers and artists with manic-depressiveillness as well; the consequences are often devastating. Samuel

TOUCHDD WITH FIRE

Taylor coleridge, for one, described his struggles with laudanumto a friend:

No sixty hours hatse yet passed without my having taking [taken?]Laudanum-tho' for the last week comparatively triflinj Joses. Ihave full belief, that your anxicty will not need to be ext"ended be-yond the ftrst week: and for the ffrst week I shall not, r must not bepermitted to leave your House, unless I should walk out with you.-Delicately or indelicately, this mastbe done: and both the servantand the young Man must receive absolute commands from you on noaccount to fetch any thing for me. The stimulus of conversationsuspends the terror that haunts my mind; but when I am alone, thehorrors, I have suffered from Laudanum, the degradation, theblighted Utility, almost overwhelm me--.87

One and one-half centuries later, American poet John Berrymanwrote graphically about his destructive relationship with alcohol:

social drinking until lg47 during a long & terrible love affair, my ffrstinfidelity to my wife after 5 years of marriage. My mistress drankheavily & I drank w. her. Guilt, murderous & suicidal. Hallucina-tions one day walking home, Heard voices. 7 years of psychoanalysis& group therapy in N.Y. Walked up & down drunk on a foot-wideparapet 8 stories high. Passes at women drunk, often successful. wifeleft me after 11 years of marriage bec. of drinking. Despair, heavydrinking alone, jobless, penniless, in N.y. Lost when blacked-outthe most important professional letter I have ever received. seducedstudents drunk. Made homosexual advances drunk, 4 or 5 times.Antabuse once for a few days, agony on floor after a beer. euarrel w.landlord drunk at midnight over the key to my apartment, he calledpolice, spent the night in jail, news somehow reached press & radio,forced to resign. Two months of intense self-analysis-dream-interpretation etc. Remarried. My chairman told me I had called upa student drunk at midnight & threatened to kill her. Wife left m;bec. of drinking. Gave a public lecture drunk. Drunk in Calcutta,wandered streets lost all night, unable to remember my address.Married present wife 8 yrs ago. Many barbiturates & tranquilizers off& on over last l0 yrs. Many hospitalizations. Many alibis for drink-ing, lying abt. it. Severe memory-loss, memory distortions. DT'sonce in Abbott, lasted hours. Quart of whisky a day for months inDublin working hard on a long poem. Dry 4 months 2 years ago.Wife hiding bottles, myself hiding bottles.ss

ENDLFSS NIGIIT, FIERCE FIRES AND SHRA]VIMING COLD 41

The ultimate self-destruction by alcohol, however, was personifiedby the life and death of the wildly mercurial Welsh poet DylanThomas:

Dylan was now having blackouts at frequent intervals. On more thanone occasion he had been warned by his doctor that he must go ona regime of complete abstinence from alcohol if he was to sur-vive. . . Dylan seemed exhausted, self-preoccupied, and morbidlydepressed. He went out alone, and an hour and a halflater returnedto announce, "I've had eighteen straight whiskeys, I think that's therecord." [Shortly afterwards] he died.se

In addition to drinking and using drugs to excess, individuals with

depressive and manic-depressive illness are also far more likely to

commit suicide than individuals in any other psychiatric or medical

risk group. The mortality rate for untreated manic-depressive ill-

ness is higher than it is for many types of heart disease and cancer.

Kraepelin described the grim, virtually incomprehensible level of

anguish and desperation experienced by many of his patients:

The patients, therefore, often try to starve themselves, to hang them-selves, to cut their arteries; they beg that they may be burned,buried alive, driven out into the woods and there allowed to die. . ' .One of my patients struck his neck so often on the edge of a chiselftxed on the ground that all the soft parts were cut through to thevertebrae.s

A recent review ofthirty studies found that, on the average, one-

fifth of manic-depressive patients die by suicide. From a slightly

different perspective, at least two-thirds of those people who com-

mit suicide have been found to have suffered from depressive ormanic-depressive illness.sr In an extensive clinical investigation

carried out in Sweden, suicide was almost eighty times more likely

among patients with depressive illness-unipolar or bipolar-thanin those individuals with no psychiatric disorder,e2 and, in a recentstudy of risk factors among adolescents who had died by suicide,four factors accounted for more than 80 percent of the suicides:a diagnosis of bipolar manic-depressive illness, coexisting alcoholor drug abuse, lack of prior treatment, and the availability of ftre-arms. Of these the diagnosis of manic-depressive illness contrib-

42 TOUCIIEDWTTIIFIRE

uted the most to the prediction.e3 Suicide, for many who sufferfrom untreated manic-depressive illness, is as much t'wired"

intothe disease as myocardial infarction is for those who have occludedcoronary arteries. Because suicide appears more volitional, some-how more existentially caused, and more tied to external circum-stance than it often actually is, the seriousness of manic-depressiveilln-ess as a potentially lethal medical condition is frequently over-looked. (A partial listing of artists, writers, and composers whoattempted or committed suicide is given in Appendii n.; n hi,suicide note American artist Ralph Barton predicted that tlose heleft behind would be tempted to read into his death all manner ofexplanation while constantly overlooking the crucial one, his men-tal illness:

Everyone who has known me and who hears of this will have adiferent hypothesis !o oser to explain why I did it. practically all ofthese hypotheses will be dramatic-.-and completely wrong. Any sanedoctor knows that the reasons for suicide are invariabry piycho-pathological. Difficulties in life merely precipitate the event-andthe true suicide type manufactures his o*n Jifficulties. I have hadfew real dificulties. I have had, on the contrary, an exceptionallyglamorous life-*as lives go. And I have had more than mv-share ofaffection and appreciation. The most charming, intellige.rt, arrd irrr_portant people I have known have liked me-and the list of myenemies is very flattering to me. I have always had excellent health.But, since my early childhood, I have suffered with a melancholiawhich, in the past ffve years, has begun to show deffnite symptomsof manic-depressive insanity. It has prevented my getting anlthingIike the full value out of my talents, and, for th" part thre"lr""rs, ha,rnade work a torture to do at all. It has made it impossible for me toenjoy the simple pleasures of life that seem to get other peoplethrough. I have run from wife to wife, from house tJhour",

"rri frorn

country to country, in a ridiculous effort to escape from myself. Indoing so, I am very much afraid that I have spread

" good dear of

unhappiness among the people who have loved me.s -

studies of attempted suicide in bipolar patients show thatbetween one-fourth and one-half attemptiuicide at least once.e5 rnthe largest epidemiological survey to date (more than twenty thou-sand participants), the lifetime rate for attempted suicide in indi-

t-TIIT ENDLESS NIGIIT, FIERCE FIRES AND SHRAMMING COLD 48I

III viduals with no history of mental disorder was I percent; for thoseI with major depressive illness it was 18 percent, and for those suf-

I fering from manic-depressive illness it was 24 percent.s Novelist

I Graham Greene, by his own account a manic-depressive, openly

I discussed his suicidal behavior while an undergraduate at Oxford;

I one of his friends, Lord Tranmire, told Greene's biographer: "We

I were very worried over his attempts at Russian roulette. And in theI end we made him promise he would never do it with more thanI r-o shots out of the ffve chambers,"eT Greene himself described

I his first attempt:

II I slipped a bullet into a chamber and, holdlng the revolver behlndI my back, spun the chambers round. . . . I put the muzzle of theI revolver into my right ear and pulled the trigger. There was a minuteI click, and looking down at the chamber I could see that the chargeI had moved into the ftring position. I was out by one.etII Lord Byron thought seriously about suicide as well, although

his droll wit often masked the depth of his true suffering (his se-vere, often agitated melancholias are discussed further in chapter5). In a letter to his friend and fellow poet Thomas Moore, Byronwrote, "I should, many a good day, have blown my brains out, butfor the recollection that it would have given pleasure to my mother-in-law; and, even then, if I could have been certain to haunt her-but I won't dwell upon these trifling family matters."s RobertLowell, who in one poem used Byronic wit to describe the ambi-guities and ambivalences attendant upon suicide-"A doubtful sui-cide should choose the ocean,/Who knows, he might reach theother side?"rm-wrote more tellingly in another:

Do I deserve creditfor not having tried suicide-or am I afraidthe exotic actwill make me blunder.

not knowing erroris remedied by practice,as our first home-photographs,headless, half-headed, tiltingextinguished by a fashbulb?ror

U TOUCIIDDWITHFIRE

People who commit suicide generally communicate their in-tentions to others; in a study of 134 suicides, fully two-thirds of themanic-depressive patients had communicated their suicidal ideas,most frequently through a direct and specific statement of theintent to commit suicide.ro2 Men and women did not differ signif-icantly in their frequency of suicidal communication, and the com-munications were repeated and expressed to a number of difierentpeople; rarely were these communications perceived as "manipu-lative" or "playing on the emotions of others." No one commitiedsuicide while manic; all were judged to have been depressed at thetime of death. In Darkness Visible novelist William Styron wroteabout the inescapability of his suicidal depression:

The pain is unrelenting, and what makes the condition intolerable isthe foreknowledge that no remedy will come-not in a day, an hour,a month, or a minute. If there is mild relief, one knows that it is onlytemporary; more pain will follow. It is hopelessness even more thanpain that crushes the soul. So the decision-making of daily life in-volves not, as in normal afiairs, shifting from one annoying situationto another less annoying---or from discomfort to relative comfort, orfrom boredom to activity-but moving from pain to pain. One doesnot abandon, even briefly, one's bed of nails, but is attached to itwherever one goes.ro3

And Leo Tolstoy described his weariness with life, his melan-choly, and his suicidal obsessions, all of which existed within theframework of a seemingly complete and h"ppy existence:

The thought of suicide came to me as naturally then as the thoughtof improving life had come to me before. This thought was such atemptation that I had to use cunning against myself in order not to gothrough with it too hastily. I did not want to be in a hurry onlybecause I wanted to use all my strength to untangle my thoughts. IfI could not get them untangled, I told myself, I could always goahead with it. And there I was, a fortunate man, carrying a rope frommy room, where I was alone every night as I undressed, so that Iwould not hang myself from the beam between the closets. And Iquit going hunting with a gun, so that I would not be too easilytempted to rid myself of life. I myself did not know what I wanted.I was a&aid of life, I struggled to get rid of it, and yet I hoped forsomething from it.

ENDLESSNIGIIT,FIERCEFIRESANDSHRAMMINGCOLD IT5

And this was happening to me at a time when, from all indica-

tions. I should have been considered a completely h"ppy man; this

was when I was not yet fifty years old. I had a good, loving, and

beloved wife, fine children, and a large estate that was growing and

expanding without any effort on my part. More than ever before I

was respected by friends and acquaintances, praised by strangers,

and I could claim a certain renown without really deluding myself.rq

Poet and critic A. Alvarez, in his book The Saoage God,

vividly portrayed the despair, violence and highly individudistic

motives involved in suicide. In citing Italian writer Cesare

Pavese-who once wrote that "no one ever lacks a good reason forsuicide"los and who subsequently did commit suicidrAlvarezemphasized the limits to knowing the mind of any truly suicidalperson. While it is important to avoid a sweepingly nihilistic notionof such limits, it also remains essential to recognize the ultimateinaccessibility of the many complex and idiosyncratic emotionalstates that usually accompany suicide:

It goes without saying that external misery has relatively little to dowith suicide. . . . Suicide often seems to the outsider a supremelymotiveless perversity, performed, as Montesquieu complained,"most unaccountably . . . in the very bosom of happiness," and forreasons which seem trivial or even imperceptible . . . At best theyassuage the guilt of the survivors, soothe the tidy-minded and en-courage the sociologists in their endless search for convincing cate-gories and theories. The real motives . . . belong to the internalworld, devious, contradictory, labyrinthine, and mostly out ofsight.rffi

In the same book Alvarez also described the sterile and cold worldof suicidal depression; like Hugo Wolf he drew the contrast be-tween the normal and the depressed worlds, portraying an abyssthat cannot be spanned;

A suicidal depression is a kind of spiritual winter, frozen, sterile,unmoving. The richer, softer and more delectable nature becomes,the deeper that internal winter seems, and the wider and moreintolerable the abyss which separates the inner world from the outer.Thus suicide becomes a natural reaction to an unnatural condition.

TOUCIIED WTTH FIRD

Perhaps this is why, for the depressed, Christmas is so hard to bear.In theory it is an oasis of warmth and light in an unforgiving season,like a lighted window in a storm. For those who have to stay outside,it accentuates, like spring, the disjunction between public warmthand festivity, and cold, private despair.roT

Suicidal thoughts and attempts, as well as suicide itself, areparticularly common in mixed states. In one study conducted inthe 1930s, Jameison found that mixed states were the most dan-gerous clinical phase of illness. In his study of one hundred sui-cides, half of whom had manic-depressive psychosis, he noted thatthe combination of depressive symptoms, mental alertness, andtense, apprehensive, and restless behavior was especially lethal;many other studies have found this as well.lo8 Mixed states rep-resent a critical combination of depressed feelings and thoughtscombined with an exceptionally perturbed, agitated, and unpleas-ant physical state; usually accompanied by a heightened energylevel and increased impulsivity, mixed states are far too often lethalto those who experience them. Percy Bysshe Shelley's melancholicstates were made even more unbearable by wild agitation, insom-nia, confusion, visions, obsessions, and thoughts of suicide.Themes of madness, despair, and suicide can be found in many ofhis poems:

Then would I stretch my languid frameBeneath the wild wood's gloomiest shade,And try to quench the ceaseless flameThat on my withered vitals preyed;Would close mine eyes and dream I wereOn some remote and friendless plain,And long to leave existence there,If with it I might leave the painThat with a ftnger cold and leanWrote madness on my withering mien.rG

That such a final, tragic, and awful thing as suicide can exist inthe midst of remarkable beauty is one of the vastly contradictoryand paradoxical aspects of life and art. The extraordinary and seem-ingly counterintuitive level of control in many of van Gogh's lastcanvases, completed just before his suicide, finds a comparable

ENDLESS NIGIIT, FIERCE FIRFS AND SHRAMMING COLD 47

calm and lyricism in lines by Russian poet Vladimir Mayakovsky

who, like van Gogh, committed suicide when he was in his mid-

thirties:

It's after one.You must have gone to bed.

The Milky Way runs like a silvery river through the night.I'm in no hurry

and with lightning telegramsthere's no need to wake and worry you.As they say

the incident is closedThe love boat

has smashed against conventionNow you and I are through

No need thenTo count over mutual hurts, harms, and slights.

Just see how quiet the world is!Night has laid a heavy tax of stars upon the sky.In hours like these you get up and you speakTo the ages, to history, and to the universe.rlo

Mayakovslcy's biographer Edward Brown notes "he included fourlines from this poem in his suicide note, with the change of "you"

,o ..1i9". "rrr

The clinical reality of manic-depressive illness is far more le-thal and infinitely more complex than the current psychiatric no-menclature , bipolar d,isorder, would suggest. Cycles of fluctuatingmoods and energy levels serve as a background to constantly chang-ing thoughts, behaviors, and feelings. The illness encompasses theextremes of human experience: Thinking can range from floridpsychosis, or "madness," to patterns of unusually clear, fast andcreative associations, to retardation so profound that no meaningfulmental activity can occur. Behavior can be frenzied, expansive,bizarre, and seductive, or it can be seclusive, sluggish, and dan-gerously suicidal. Moods may swing erratically between euphoriaand despair or irritability and desperation. The rapid oscillationsand combinations of such extremes result in an intricately texturedclinical picture: Manic patients, for example, are depressed andirritable as often as they are euphoric; the highs associated with

TOUCHED WITHFIRE

mania are generally only pleasant and productive during the ear-lier, milder stages. Lowell's description of the "glory, violence andbanality" of mania is compelling; so, too, is Bryon's portrayal of "anawful chaos":

This should have been a noble creature: heHath all the energy which would have madeA goodly frame of glorious elements,Had they been wisely mingled; as it is,It is an awful chaos-light and darkness-And mind and dust-and passions and pure thoughts,Mix'd, and contending without end or order,All dormant or destructiverr2

We turn from describing this "a\rful chaos" to the controver-sies and arguments surrounding the idea of a link between certaintypes of "madness" and artistic genius. In particular, we focus onthe accumulating, and surprisingly consistent, recent evidence sug-gesting that it is manic-depressive illness and its related tempera-ments that are most closely allied to creativity in the arts.

3.COULDITBE

MADI\ESS:TTIIS?

Controversy and Dvidence

[Emily Dickinson] was not an alcoholic, she was not abusive. shewas not neurotic, she did not commit suicide. Neurotic people oralcoholics who go through life make better copy, and people talkabout them, tell anecdotes about them. The quiet peoplelust dotheir work.

-JoycE cARoL oarrsr

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

-EMILY DIcKtttsoN2

Chemical Synapse: The Unbridged Junction(CourtesyofJ. E. Heuser and T. S. Reese)

50 TOUCIIED WTTH FIRE

A possible link between madness and genius is one of the oldestand most persistent of cultural notions; it is also one of the mostcontroversial. An intimate relationship between the ancient gods,madness, and the creators was described in pre-Grecian myths,most dramatically in the Dionysian struggles between violence andcreation, and madness and reason. Dionysus, son of Zeus and amortal mother, was affiicted with madness while young and epi-sodically subject to both great ecstasies and suffering. As the god ofwine, and perhaps hallucinogenic mushrooms as well,3 Dionysusinduced frenzied ecstasies, madness, and savage brutality in thosearound him. The rituals of worship set up in his honor came tosymbolize the emergence of new life and creation from chaos,brutality, and destruction. Renewed vitality, restored sanity, gifts

of prophecy, and creative inspiration often followed the violent,Dionysian blood feasts (which frequently involved the dismember-ment of both animals and humans). Significantly, much of thegreatest poetry in Greece was written for Dionysus. These ritualsof ecstatic worship, frenetic dance and violent death, were cyclic innature and tied to the seasons, representing the recurrent themes

COULD TT BE MADNESYTHIS? 51

of death and rebirth. We shall see later how these seasonal and

regenerational themes represent ties between the nature of manic-

depressive illness and creativity.By the time of Plato and Socrates, common lore held that

priests and poets communicated with the gods through inspired"madness" and sacred enthusiasms. Divine madness and inspira-

tion were thought obtainable only during particular states of mind,

such as loss of consciousness, affiiction with illness, madness, or

states of "possession." Socrates, in his speech on divine madness in

Phaedrus, said:

Madness, provided it comes as the gift of heaven, is the channel bywhich we receive the greatest blessings. . . . the men of old whogave things their names saw no disgrace or reproach in madness;otherwise they would not have connected it with the name of thenoblest of all arts, the art of discerning the future, and called it themanic art. . . . So, according to the evidence provided by our an-cestors, madness is a nobler thing than sober sense . . madnesscomes from God. whereas sober sense is merelv human.a

He then went on to discuss artistic "madness," or possession by theMuses: "If a man comes to the door of poetry untouched by themadness of the Muses, believing that technique alone will makehim a good poet, he and his sane compositions never reach per-fection, but are utterly eclipsed by the performances of the in-spired madman."s Madness, as used by Plato and Socrates,encompassed a wide range of states of thought and emotion, notjust psychosis, but the emphasis clearly was upon a profoundlyaltered state of consciousness and feeling. Later Aristotle focusedmore speciffcally on the relationship between melancholia, mad-ness, and inspiration. "Why is it," he asked, "that all men who areoutstanding in philosophy, poetry or the arts are melancholic?""The same is true of Ajax and Bellerophontes," Aristotle went on,"the former went completely insane. . . . And many other heroessuffered in the same way as these. In later times also there havebeen Empedocles, Plato, Socrates and many other well-hrownmen. The same is true of most of those who have handled poetry."6

During the Renaissance there was a renewed interest in therelationship between genius, melancholia, and madness. A stron-

5S TOUCIIED WTrII FIRE

ger distinction was made between sane melancholics of highachievement and individuals whose insanity prevented them fromusing their ability. The eighteenth century witnessed a sharpchange in attitude; balance and rational thought, rather than "in-spiration" and emotional extremes, were seen as the primary com-ponents of genius. This comparatively brief period, whichassociated moderation with genius, was almost completely reversedby the nineteenth-century Romantics, who once again emphasizednot only the melancholic side, but also the more spontaneous,inspired, and swept-by-the-muses qualities of genius. WilliamWordsworth, for example, in writing about Thomas Chatterton-the brilliant eighteenth-century poet who committed suicide at theage of seventeen--described the fate of poets:

By our own spirits are we deified:We Poets in our youth begin in gladness;But thereof come in the end despondency and madness.T

Lord Byron, the personiffcation of anguished, volatile intensitywithin the group of Romantic poets, described a turmoil of emo-tional life in words that captured the brooding frenzy of the "poetic

genius":

Yet must I think less wildly:-l haoe thoughtToo long and darkly, till my brain became,In its own eddy boiling and o'erwrought,A whirling gulf of phantasy and flame:And thus, untaught in youth my heart to tame,My springs of life were poison'd.8

In 1812, the same year that the first two cantos of Byron's

Childe Harolts Pilgrimage were published, Professor Benjamin

Rush of the University of Pennsylvania wrote the first major psy-

chiatric treatise in the United States. In it he recorded his obser-vations about the relationship between certain kinds of mania,

mental acuity, and artistic talent; like Byron and many other

nineteenth-century writers, he used metaphors of upheaval de-

rived from the natural world:

COULD ITBE MADNESYTHIS? 53

From a part ofthe brain preternaturally elevated, but not diseased,

the mind sometimes discovers not only unusual strength and acute-

ness, but certain talents it never exhibited before. . . . Talents for

eloquence, poetry, music and painting, and uncommon ingenuity in

selrJral of the mechanical arts, are often involved in this state of

madness. . . . The disease which thus evolves these new and won-

derful talents and operations of the mind may be compared to an

earthquake, which by convulsing the upper strata of our globe,

throws upon its surface precious and splendid fossils, the existence of

which was unknown to the proprietors of the soil in which they were

buried.e

Several European scholars-Dr. Jacques-Joseph Moreau in

France, and Professors Cesare Lombroso in Italy and Karl August

Mdbius in Germany-also wrote extensively about the relationship

between mental illness and genius.ro

An ironic exception to these nineteenth-century writers who

were emphasizing the mysterious, irrational, and overwhelming

forces that gave rise to genius was the essayist Charles Lamb;

conffned at one time to a private asylum for what now would almost

certainly be called manic-depressive illness, he was also the close

companion to a sister intermittently insane with manic-depressivepsychosis. lnThe Sanitg of True Genius he argued for a balance of

faculties, much as the eighteenth-century writers had done:

So far from the position holding true, that great wit (or genius, in ourmodern way of speaking), has a necessary alliance with insanity, thegreatest wits, on the contrary, will ever be found in the sanest writ-ers. It is impossible for the mind to conceive a mad Shakespeare. Thegreatness of wit, by which the poetic talent is here chiefly to beunderstood, manifests itself in the admirable balance of all faculties.Madness is the disproportionate straining or excess of any one ofthem. . . . The ground of the mistake is, that men, finding in theraptures of the higher poetry a condition of exaltation, to which theyhave no parallel in their own experience, besides the spurious re-semblance of it in dreams and fevers, impute a state of dreaminessand fever to the poet. But the true poet dreams being awake. He isnot possessed by his subject, but has dominion over it.lr

Privately, however, in a letter to Samuel Taylor Coleridge, Lambdescribed the intoxicating, exalted side to his own delusional break-

ru TOUCIIED WITHFIRE

down: "While it lasted I had many many hours of pure happi-ness. , Dream not of having tasted all the grandeur and wildnessof Fancy, till you have gone mad."r2

The late nineteenth and early twentieth centuries saw a mod-eration of earlier views, in part due to the inevitable swing awayfrom any extreme-in this case that of the Romantics-and in partto the subduing, occasionally stulti$'ing influences of academicpsychology and psychiatry. Psychologist William James and clinicalpsychiatrist and scholar Emil Kraepelin, both writing early in thetwentieth century, emphasized the positive features associatedwith certain kinds of madness and speculated about how thesefeatures might, in some instances, combine with other talents toproduce an extraordinarily creative or accomplished person. Alsoaccented, however, were the debilitating extremes of psychiatricillness (psychosis or morbid depression, for example) in contrast tothe milder manic states and the more refective, philosophical mel-ancholias. These scholars underscored the need for sustained at-tention, discipline, and balance in the truly imaginative individual.This more moderate view has characterized most twentieth-century thinking about the relationship between psychopathologyand genius. James, as we shall see in chapter 6, was himself nostranger to melancholia and disturbing mood swings, and he wroteinsightfully about the potential value of combiningaftery, unstabletemperament with intellect:

The psychopathic temperament [by which he meant "borderline in-sanity, insane temperament, loss of mental balance"], whatever bethe intellect with which it finds itself paired, often brings with itardor and excitability of character. . . . His conceptions tend to passimmediately into belief and action . . . when a superior intellect anda psychopathic temperament coalesce-as in the endless permuta-tions and combinations of human faculty, they are bound to coalesceoften enough-in the same individual, we have the best possiblecondition for the kind of effective genius that gets into the biograph-ical dictionaries. Such men do not remain mere critics and under-standers with their intellect. Their ideas possess them, they infictthem, for better or worse, upon their companions or their age.13

Kraepelin, like Benjamin Rush a century earlier, linked increasedartistic productivity more speciffcally to manic-depressive illness;

COTILD IT BE MADNESS-THIS?

The volitional excitement which accompanies the disease may undercertain circumstances set free powers which otherwise are con-strained by all kinds of inhibition. Artistic activity namely may, bythe untroubled surrender to momentary fancies or moods, and es-pecially poetical activity by the facilitation of linguistic expression,experience a certain furtherance.la

By the 1940s Dr. A. Myerson and R. D. Boyle, clinicians atBoston's Mclean Hospital, reiterated |ames's basic position but, asKraepelin and Rush had done, they focused on manic-depressiveillness. In discussing affective psychosis in socially prominent fam-ilies they concluded:

It does not necessarily follow that the individuals who appear in theserecords were great because they had mental disease, although thatproposition might be maintained with considerable cogency and rel-evance. It may be that the situation is more aptly expressed as fol-lows. The manic drive in its controlled form and phase is of valueonly if joined to ability. A feebleminded person of hypomanic tem-perament would simply be one who carried on more activity at afeebleminded level, and this is true also of mediocrity, so the bulk ofmanic-depressive temperaments are of no special value to the world,and certainly not of distinguished value. If, however, the hypomanictemperament is joined to high ability, an independent characteristic,then the combination may well be more effective than the union ofhigh ability with normal temperament and drive might be. 15

Not surprisingly, twentieth-century literary and art scholarsalso have approached the subject of the relationship between psy-chiatric illness and genius. Lionel Trilling, in his well-known essayon art and neurosis, and Rudolf and Margot Wittkower, in Bornunder saturn, acknowledge the extent to which artistic genius and"madness" have been, and continue to be, linked by society. Trill-ing notes that the conception of the artist as mentally ill "is indeedone of the characteristic notions of our culture,"r6 and the Witt-kowers caution that "the notion of the mad artist is a historicalreality and that by brushing it aside as mistaken, one denies theexist_ence of a generic and deeply signiffcant symbol."lT They alsoemphasize, as many had before them, the important distinctionbetween "positive" and "negative" melancholl (consistent with

atat

TOUCIIED W]THFIRE

their reiteration of the Platonic distinction between clinical insan-ity, which is detrimental to and at cross-purposes with true artisticachievement, and "the sacred madness of enthusiasm and. inspira-tion''). While granting that the poet may be "uniquely ,,"urJtic,,,Trilling also emphasizes the essential point (to which we returnlater) that''the one part of [the poet or artist] that is healthy, by anyconceivable definition of health, is that which gives him the powerto conceive, to plan, to work, and to bring his work to a conclu-sion."r8 In short, he stresses the indisputable roles of discipline,rationality, and sustained effort in the execution of lasting works ofart and literature.

The controversy over a link between melancholia, manic-depressive illness, and the artistic temperament continues wellinto the current era. In the remainder of this chapter we review thebiographical and scientiffc evidence supporting a link between theextremes of mood and artistic imagination, as well as the argumentsagainst it.

There are several ways to examine the relationship between mooddisorders, or aflective illness, and artistic creativity. Biographicalstudies focus on life-study investigations of prominent writers, art-ists, and composers. Research in the late nineteenth and earlytwentieth centuries, for example, provided anecdotal but sugges-tive evidence of significantly increased rates of mood disorders andsuicide in eminent writers and artists and their first-degree rela-tives.le Recently, more systematic biographical research has givenstrong support to a much higher rate of mood disorders in artisticpopulations than could be expected from chance alone. Diagnosticand psychological studies of living writers and artists, conductedduring the past twenty years, give more scientifically meaningfulestimates of the rates and types of psychopathology in groups ofartists and writers. Finally, studies of creative and related achieve-ment in affectively ill patients provide corroborating evidence froma different perspective, as do family studies of psychopathology andcreative accomplishment. We shall examine, in turn, the findingsfrom each of these types of investigations.

There are, of course, many problems in studying the relation-

COI]LD IT BE MADNDSSTHIS?

ship between mood disorders and artistic achievement. Biograph-

icai studies-while intrinsically fascinating and irreplaceable,

deeply instructive sources of information about moods, their ex-

trerires, and their roles in the lives of artists-are fraught with

difficulties. Writers and artists, however brutally honest they may

be in some of their self-assessments, are frequently blinded and

biased as well. The reliability of their letters, journals, and mem-

oirs can be limited because they are written from a single perspec-

tive or fully mindful of future biographers and posterity'

Biographers, too, write with strong slants and under the influence

of prevailing or idiosyncratic viewpoints. Historical context and

existing social customs also determine which behaviors are culled

out or emphasized for comment. As noted earlier, certain life-

styles provide cover for deviant and bizarre behavior, and the arts,

especially, have long given latitude to extremes in behavior and

mood. The assumption that within artistic circles madness, melan-

choly, and suicide are somehow normal is prevalent, making it

difficult at times to ferret out truth from expectation.Biographical or posthumous research carries with it other

problems as well.2o Any historical perspective necessarily dictates

that a listing of highly accomplished, affectively ill individuals (see

Appendix B, for example) will be only a partial one-illustrative

but by no means deffnitive. Always, in the analysis of individual

lives, problems arise. It is fairly easy to identiff any number of

major nineteenth-century British or American poets who were

manic-depressive, for example, but it is more difficult to determine

what proportion of the total pool of "great poets" they represent.(In many instances, of course, the individuals under study are

sufficiently important to be interesting in their own right, inde-

pendent of any general grouping. ) Also, more detailed information

exists for some individuals than for others (for example, those more

in the public eye, those existing in relatively recent times, or those

writing more extensively about themselves). Anthony Storr put it

well: "The more we know about anyone, the easier it becomes to

discern neurotic traits, mood disorders and other aspects of char-acter which, when emphatically present, we call neurotic. Thefamous and successful are usually less able to conceal whatevervagaries of character they may possess because biographers or

Ph.D. students will not let them rest in peace."2t

58 TOUCIIEDWTTIIFIRE

The tendency for highly accomplished individuals to be, al-most by deffnition, inordinately productive and energetic createsproblems of another sort-a bias toward the underdiagnosis of themanic side of manic-depressive illness. Biographical itudies indi-c-ate that writers, artists, and composers often describe in greatdetail their periods of melancholy or depression, but that otheraspects of mood swings, such as hypomania, and even at timesovert psychosis, are subsumed under "eccentricity," "creative in-spiration," or "artistic temperament." Thus many individuals withclear histories of profound or debilitating depressions are labeled"melancholic" rather than manic-depressive, despite their episodic(and often seasonal) histories of extremely high energy, irritability,enthusiasm, and increased productivity levels (periods often alsoaccompanied by costly lapses in financial, social, and sexual judg-ment). Paradoxically, the more chronically hypomanic the individ-ual, the more noticeable and relatively pathological the depressionwill appear. Diagnostic biases in the opposite direction also occur.Some researchers have tended to overdiagnose manic-depressiveillness because they observe patterns of behavior common to bothhypomania and normal accomplishment (for example, enthusiasm,high energy, and the ability to function with little sleep) and thenlabel as manic-depressive anyone displaying these "symptoms."

Despite the difficulties in doing diagnostic studies based onbiographical material, valid and highly useful research can be doneby using in a systematic way what is known about manic-depressiveillness: its symptomatic presentation (for example, pronouncedchanges in mood, energy, sleep, thinking, and behavior), associ-ated behavior patterns (such as alcohol and drug abuse, patholog-ical gambling, pronounced and repeated financial reversals, andchaotic interpersonal relationships), suicide (70 to g0 percent of allsuicides are associated with manic-depressive or depressive illness;therefore, if an individual has committed suicide, it is almost al-ways the case that a mood disorder was at least contributory),22 itsnatural course (an episodic, cyclic course of symptoms, with nor-mal functioning in between; usual onset of symptoms in the lateteens or early twenties, with temperamental signs often exhibitedmuch earlier; seasonal aspects to the mood and energy changes;and, if untreated, a worsening of the illness over time), and, veryimportant, a family history, especially in ffrst-degree relatives

COULD ITBE MADMSYTHIS?

(parents, siblings, or children), of depression, mania, psychosis, orsuicide. Other psychiatric and medical conditions that can havesimilar symptoms (for example, thyroid and other metabolic dis-turbances, drug-induced states, organic brain syndromes, or com-plex partial seizures and related epileptic conditions) need to beconsidered, and ruled out, as well. Making a retrospective diag-nosis is, in many ways, like putting together the pieces of an elab-orate psychological puzzle or solving a mystery by a complicatedbut careful marshaling of elements of evidence. Biographical diag-noses must ultimately, of course, be more tentative than diagnosesmade on living individuals, but they can be done, reliably andresponsibly, and with an appreciation of the complexities that gointo anyone's life, most especially the life of an artist. (Ultimatelyit should prove possible to extract DNA from hair or tissue samplesand make more definitive posthumous diagnoses.)

Several case-history studies of psychopathology in eminentwriters and artists were conducted during the late nineteenth andearly twentieth centuries-for example, those done by Drs. Fran-cis Galton, Cesare Lombroso, J. F. Nisbet, and Havelock Ellis-but it is only more recently that systematic biographical researchhas been carried out.23 Dr. Adele ]uda, who in l94g studied 113German artists, writers, architects, and composers, was one of thefirst to undertake an extensive, in-depth investigation of both art-ists and their relatives.% Her research was hampered somewhat byambiguous inclusionary criteria (that is, how the subjects werechosen) as well as inadequate diagnostic methods (a common prob-lem in psychiatric research prior to the development of standard-ized diagnostic criteria in the early 1970s), which led to aninevitable confusion between schizophrenia and manic-depressiveillness. (Although some confusion still remains, it is much less of aproblem than it used to be. Most clinicians are now aware thatpsychotic features such as flagrant paranoia, severe cognitive dis-organization, delusions, and hallucinations--once thought by somepsychiatrists to be more characteristic of schizophlsnis-a1s in factrelatively common in manic-depressive illness. The latter can usu-ally be distinguished from schizophrenia by a family history ofdepression, manic-depressive illness, or suicide, a lifetime courseof manic and depressive episodes interspersed with long periods ofnormal thinking and behavior, and generally healthier personality

59

TOUCIIED WTIIFIRE

and social functioning prior to the onset of the illness. Bizarrebehavior, once thought to be much more characteristic of schizo-phrenia, is now recognized as a frequent component of mania aswell. Many artists and writers described by some earlier biogra-_phers as schizophrenio-for example, Ruskin, Schumann, Strind_berg, Woolf, Pound, Poe, Artaud, Dadd, and van Gogh-wouldnot be classified as such today.)

Juda's study remains an important one, however, both for itsscope (more than 5,000 individuals were interviewed during thecourse of seventeen years) and its attempt to bring rigor to a highlysubjective ffeld. ]uda found that although two-thirds of the ll3artists and writers were "psychically normal," there were moresuicides and "insane and neurotic" individuals in the artistic groupthan could be expected in the general population. The highestrates of psychiatric abnormality were found in the poets (50 per-cent) and musicians (38 percent); lower rates were found in paint-ers (20 percent), sculptors (18 percent), and architects (lZ percent).The brothers, sisters, and children of those in the artistic groupwere much more likely to be cyclothymic, commit suicide, or suf-fer from manic-depressive illness than were individuals in the gen-eral population; psychosis was far more common in thegrandchildren of the artistic group as well.

In another biographical study Dr. Colin Martindale examinedthe lives of twenty-one eminent English poets (born between 1670and f809) and twenty-one eminent French poets (born between1770 and 1909).25 More than one-half (55 percent) of the Englishpoets and 40 percent ofthe French had a history ofsigniffcant psy-chopathology (for example, "nervous breakdowns," suicide, or al-coholism), and fully one in seven poets had been institutionalized inan asylum or had suffered from severe "recurring and unmistakablesymptoms" such as hallucinations or delusions. Combining the ex-pected general population rates for the two major psychoses, schizo-phrenia and manic-depressive illness, yields a combined rate ofonly 2 percent; because, as we shall see, virtually all of the psychosisin creative individuals is manic-depressive rather than schizo-phrenic in nature, an expected base rate ofl percent is probably amore appropriate comparison. Whichever ffgure is used, the ex-pected rate is far less than that shown by the poets in Martindale'ssample. Other researchers, including Dr. W. H. Trethowan, who

COTILD IT BE MADNESSTHIS?

looked at the lives of sixty composers, and Dr. Joseph SchildkrautA. ]. Hirshfeld, andJ. M. Murphy, whostudiedfifteenvisualartistsfrom the abstract expressionists of the New York School,26 havefound that approximately one-half of their subjects suffered fromdepressive or manic-depressive illness. Trethowan found that ap-proximately one-half of the composers had a "melancholic temper-ament," and that mood disorders were "easily the commonest andmost important ofpsychiatric illnesses.'€7 This represents an almosttenfold increase in affective illness over what could be expected bychance alone. That 40 percent of the artists in the Schildkraut studyactually received psychiatric treatment is signiffcant as well, as re-search indicates that only one person in three with affective illnessseeks help for it. Likewise, the suicide rate among the artists (twoout of fifteen) is at least thirteen times the general rate; it is con-siderably higher (another 13 percent) if single-vehicle car accidentsare thought of, at least in some instances, as suicide equivalents.

Dr. Arnold Ludwig's recent study of individuals, biographiesof whom had been reviewed in the NeusYorkTimes Book Reoiewover a thirty-year period (1960 to 1990), is impressive for both itsscope and careful methodolory.a Consistent with Juda's findingsin German artists and mine in British writers and artists (discussedin the following paragraphs), Ludwig found that the highest ratesof mania, psychosis, and psychiatric hospitalizations were in poets;most signiffcantly, a staggering 18 percent of the poets had com-mitted suicide. Composers also showed high rates of psychosis anddepression. Overall, when Ludwig compared individuals in thecreative arts with those in other professions (such as businessmen,scientists, and public officials), he found that the artistic groupshowed two to three times the rate of psychosis, suicide attempts,mood disorders, and substance abuse. The rate of forced psychi-atric hospitalization in the artists, writers, and composers was six toseven times that of the nonartistic group.

To study the occurrence of mood disorders and suicide in aconsecutive sample of poets born within a hundred-year period, Iexamined autobiographical, biographical, and medical records(where available) &r all major British and Irish poets born between1705 and 1805.2e'3o There was within this group, as might be ex-pected, a wide range of biographical, medical, and family historyinformation available. For some, such as Lord Byron, both the

61

TOUCHED WITH FIRE

quantity and quality of the material was excellent; for others-suchas Robert Fergusson, John Bampfylde, and william collins-theinformation, especially of a psychiatric nature, was far less com-plete. The available letters, books, and medical records were ex-amined for symptoms of depression, mania, hypomania, and mixedstates; seasonal or other patterns in moods, behavior, and produc-tivity; the nature of the course of the illness (for example, age ofonset, duration, and patterns of recurrence over time); and evi-den19 of other psychiatric or medical illnesses (for example,syphilis) that might confound the diagnostic picture. A strongemphasis was placed upon both the severity and the recurrenceof symptoms; in all cases it was the patterning of mood, cogn!tive, energy, sleep, and behavioral symptoms that formed the fo-cus of study. The family histories of the poets, although moredifficult to ascertain, were similarly analyzed. The results aresummarized in table 3-1.

It can be seen that a strikingly high rate of mood disorders,suicide, and institutionalization occurred within this group of poetsand their families. Six (William Collins, Christopher Smart,William Cowper, Robert Fergusson, John Codrington Bampfolde,and John Clare) were committed to lunatic asylums or madhouses,a rate easily twenty times that of the general population livingduring the same time period.3r Two others (Thomas Chattertonand Thomas Lovell Beddoes) committed suicide. More than one-half of the poets showed strong evidence of mood disorders. Thir-teen, or more than one out of three of the poets, seem likely tohave suffered from manic-depressive illness (Christopher Smart,William Cowper, George Darley, Robert Fergusson, ThomasChatterton, William Blake, Samuel Taylor Coleridge, George Gor-don, Lord Byron, Percy Bysshe Shelley, John Clare, Hartley Col-eridge, Thomas Lovell Beddoes, and James Clarence Mangan). Ofthese thirteen poets, the majority exhibited psychotic symptoms atone time or another, two committed suicide, and four were com-mitted to asylums. William Collins and John Codrington Bamp-fylde, who also were committed to asylums, were probably manic-depressive as well, but only the melancholic side of Collins's illnessis unequivocably documented and few details are available aboutthe nature of Bampfylde's problems. Six poets-Oliver Goldsmith,Robert Burns, Walter Savage Landor, Thomas Campbell, John

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TOUCIIED WITH FIRE

Keats, and Robert stephen Hawker-probabry had mirder forms ofmanic-depressive illness (cyclothymia or bipolar II disordlr), al-though Keats and Burns died before it became clear what theultimate severity and course of their mood disorders *o,rld hau"been. Samuel Johnson, Thomas Gray, George Crabbe, and LeighHunt suffered from recurrent depression. A comparison with ratesof manic-depressive illness in the general popul^ation (l percent),cyclothymia (l to 2 percent), and major depressive'dirord., (Spercent) shows that these British poets werl thirty times morelikely to suffer from manic-depressive illness, ten to twentv timesmore likely to be cyclothymic or to have other mirde, forms ofmanic-depressive illness, more than ftve times as likely to commitsuicide, and at least twenty times more likely to have been com-mitted to an asylum or madhouse. These rates, while markedryelevated, are consistent with findings from the other biographicalstudies that we have reviewed; they are also consistent with resultsfrom more recent studies of living writers and artists that are dis-cussed later in this chapter. The genetic nature of mood disordersi_s underscored by the family histories in many of the poets ofdepression, mania, suicide, violence, or insanity (for example, inthe families of Byron, Gray, Cowper, Chatterton, Bamp$'lde, theColeridges, and Campbell; and, suggestively, in the families ofJohnson, Crabbe, Blake, Clare, Beddoes, and Mangan). Not with-out reason did Robert Burns write: "The fates and character of therhyming tribe often employ my thoughts when I am disposed to bemelancholy. There is not, among all the martyrologies that everwere penned, so rueful a narrative as the lives of the poets."3z

Biographical studies such as the ones we have been discussingprovide one kind of evidence, persuasive in its own right, about thelink between mood disorders and artistic creativity. Modern stud-ies of living writers and artists give a different perspective; theirfindings are, however, quite consistent with those obtainedthrough the case-history, or biographical, methods. Dr. NancyAndreasen and her colleagues at the University of Iowa were thefirst to undertake scientific diagnostic inquiries into the relation-ship between creativity and psychopathology in living writers.33Their studies, using structured interviews, systematic psychiatricdiagnostic criteria, and matched control groups, represented amarked methodological improvement over prior anecdotally basedresearch, as well as over the earlier studies that failed to distinguish

COI]LD IT BE MADNESYTHIS?

adequately between types of psychopathology (especially manic-

i"pr"rri"" illness and schizophienia)._ The size of the sample of

*rit.r, was relatively small (thirty), and the writers were at varying

levels of creative achievement (all were participants in the Univer-

sity of Iowa Writers' Workshop, one of the most prestigious in the

nation; some were nationally acclaimed but others were graduate

,t,ra"tttr or teaching fellows not yet at the level of national or

international ,'"cogrrition). Andreasen notes that because she stud-

ied only writers, her resnlts cannot be generalized to other groups

of creative individuals, such as philosophers, scientists, or musi-

cians. Although this is true, and writers may be disproportionately

likely to have affective disorders, the homogeneity of her sample is

certainly valuable in its own right.The results of the Iowa research are summarized in table 3-2.

Clearly the writers demonstrated an extraordinarily high rate of

affective illness. Fully 80 percent of the study sample met formal

diagnostic criteria for a major mood disorder. In contrast, 30 per-

cen-t of the control sample (individuals whose professional work fell

outside the arts but who were matched for age, education, and sex)

TABLE 3-2.LTFETIME PREVALENCE OF MENTAL ILLNESS

IN WRITERS AND CONTROL SUBIECTS

RDC Diagnosis'

Writers(N = 30)

Vo

Controls(N=30)

Vo

Any affective disorderAny bipolar disorderBipolar IBipolar IIMajor depressionSchizophreniaAlcoholismDrug abuseSuicide

8043t330J I

030

1

1

30l00

10t70,7

,7

0

.001

.01NSNSNSNS.05NSNS

" nbC = Research Diagnostic Criteria (standnrdized diagnostic criteria for psgchinttb ill'

ness),

souacr: Adapted from N. c. Andreasen, creativity and mental illness: Prevalence rates in

writers and their ffrst-degree relatives, American Journal of Psgchiatry f44 (1987):

1288-1292. Copyright 1992, American Psychiatric Association. Reprinted by permis-

sion. " RDC:Research Diagnostic Criteria (standardized diagnostic criteria for psy-

chiatric illness).

TOUCIIED WITII FIRE

met the same criteria. The statistical difference between these tworates is highly significant, p <.001; that is, the odds of this differ-ence occurring by chance alone are less than one in a thousand.Although the lifetime prevalence of mood disorders in the controlgroup is much less than in the group of writers, it still representsa rate much greater than could be expected in the g"rr"ril popu-lation (5 to 8 percent). It is unclear whether this is due to anoverrepresentation of affective illness in the sample (for example, itcould refect the tendency, discussed later, for individuals who arebetter educated and from the upper social classes to suffer dispro-portionately from manic-depressive illness) or because the diag-nostic criteria were overinclusive for both the creative and controlgroups. of particular interest, almost one-half the creative writersmet the diagnostic criteria for full-blown manic-depressive illness,bipolar I, or its milder variant, bipolar II (major depressive illnesswith a history of hypomania). Over one-third of the writers hadexperienced at least one episode of major depressive illness, andtwo-thirds of the ill writers had received psychiatric treatment.The writers' suicide rate was also greatly in excess of the generalpopulation's. Indeed, all five of the suicides that were reportedoccurred in either the writers or their first-degree relatives; noneoccurred in the control group. None of the writers or control sub-jects met the diagnostic criteria for schizophrenia; this is scarcelysurprising, given the generally disorganizing and dementing qual-ity of the illness, but it is signiffcant in light of earlier claims thatschizophrenia and creativity were closely allied. In fact, Dr. An-dreasen, a prominent schizophrenia researcher, went into herstudy of writers in the belief that she would find a correlationbetween schizophrenia and creativity, not between mood disor-ders and creativity.

Other studies of living writers and artists have also found agreatly elevated rate of mood disorders in the artistically gifted,thus conffrming the work of Dr. Andreasen and her colleagues.University of Tennessee psychiatrist Dr. Hagop Akiskal and hiswife Kareen, for example, have recently completed extensive psy-chiatric interviews of twenty award-winning European writers, po-ets, painters, and sculptors.3a Their study, which has not yet beenpublished, found that recurrent cyclothymic or hypomanic tenden-cies occurred in nearly two-thirds of their subjects; all told, 50

IDCOTII,D IT BE MADNESS]THIS?

percent of the writers and artists had suffered from a major de-pressive episode. Preliminary data from another study by theAkiskals (done in collaboration with Dr. David Evans of MemphisState University), show similar findings in blues musicians.ss

Several years ago, while on sabbatical leave at St. George'sMedical School in London and the University of Oxford, I studieda group of forty-seven eminent British writers and artists.sG I wasinterested in looking at rates of treatment for mood disorders withinthese groups, as well as seasonal patterns of moods and productiv-ity, the nature of intensely creative episodes, the similarities be-tween such episodes and hypomania, and the perceived role ofvery intense moods in the work of the writers and artists. Thepoets, playwrights, novelists, biographers, and artists in my studywere selected on the basis of their having won at least one ofseveral major prestigious prizes or awards in their ftelds. All thepainters and sculptors, for example, were either Royal Academi-cians or Associates of the Royal Academy, honors established byKing George III in 1768 and held at any given time by a limitednumber of British painters, sculptors, engravers, and architects.Literaryprizes used as selection criteria included the Queen's GoldMedal for Poetry, and the Hawthornden, Booker, and james TaitBlack Memorial prizes. Significantly, nine of the eighteen poetsalready were represented in The Oxford. Book of Twentieth-Century EngllshVerse. Of the eight playwrights, six were winnersof the New York Drama Critics Award or the Evening Standard(London) Drama Award; several had won both, had won one ofthese awards more than once, or had also received Tony awards.Participants in the study were British, Irish, or citizens of theBritish Commonwealth. Almost all (87 percent) were men; theiraverage age was fifty-three; and approximately three-fourths wereProtestant. There were no significant religious differences betweenthe subgroups, except that the poets were disproportionately Prot-estant (94 percent) and the novelists were disproportionately Cath-olic or agnostic (50 percent).

The focus of the study was on the role of moods in the creativeprocess, not on psychopathology; this fact was made clear to allpotential subjects in order to minimize the possibility that individ-uals with mood disorders would be more likely to participate. Al-though my study required a considerable amount of time and effort

TOUCHED WITH FIRE

on the part of highly successful and busy individuals, the rate ofacceptance was surprisingly high, more than matching the stan-dards for rates of response for such types of research. AII the writ-ers and artists were asked detailed questions about any history oftreatment for depressive or manic-depressive illnesr; r""rori o,diurnal patterns, if any, in their moods and productivity; behav-ioral, cognitive, and mood correlates of their periods of most cre-ative work; and their perceptions of the role of very intense moodsin their work. speciffc psychiatric diagnostic criteria were not usedin this study, as the aim was to determine the actual rates oftreatment; this is a more stringent criterion of illness severity thanwhether or not an individual meets the diagnostic criteria for mooddisorders.sT

4 very high percentage of the writers and artists, 38 percent,had been treated for a mood disorder (see figure S-t). Of thosetreated, three-fourths had been given antidepressants or lithium orhad_been hospitalized. Poets were the most likely to have requiredmedication for their depression (33 percent) and were the onryones to have required medical intervention (hospitalization, elec-troconvulsive therapy, lithium) for mania. Fully one-half of thepoets had been treated with drugs, psychotherapy, and/or hospitalization for mood disorders. The playwrights had the highest totalrate of treatment for depression (63 percent), but a relatively largepercentage of those treated, more than half, had been treated withpsychotherapy alone. It is unclear whether this was due to a dif-ference in the severity of illness or to treatment preference.

With the exception of the poets, the artists and writers re-ported being treated for depression only, not mania or hypomania;the design of the study did not allow systematic diagnostic inquiryinto the frequency of mild manic or hypomanic episodes. Approx-imately one-third of the writers and artists reported histories ofsevere mood swings that were essentially cyclothymic in nature.One out of four reported having experienced extended elated moodstates. Novelists and poets more frequently reported the prolongedelated states; playwrights and artists, on the other hand, more of-ten reported severe mood swings. The relatively low rate oftreatment for affective illness in those individuals in the predom-inantly nonverbal ffelds (painting and sculpture) is interesting,and it may be that they are less inclined than writers to seek

o

It- 60

o

= 4 00)cc)

COI]LD ITBE MADNESS_THTS? 77

Figure 3-1.Rates of Treatmcnt for Mood Disordprs in a Sample

z 5&6

o6

" The percentages for the general popul.ation are based on Epidzmiologic catchment Areadata. Theg indicate that less than one thiril of those inilloiduals with bipolnr or unipolarillness receioe treatfitent in ang 6-month pertod.

souncr: From K. R. famison, Mood disorders and patterns of creativity in British writersand artists, Psgchiatry 52 (f989): 125-134.

psychiatric help. The total number of painters and sculptors inmy study is small, however, and it is difficult to generalize frompreliminary findings.

Virtually all the creative writers and artists (89 percent) saidthey had experienced intense, highly productive, and creative ep-isodes. This included all of the poets, novelists, and artists, and allbut one of the playwrights. Only one of the five biographers, how-ever, reported experiencing such episodes. The most frequent du-ration of these episodes was two weeks, with half of them lastingbetween one and four weeks. These "intensely creative" episodeswere characterized by pronounced increases in enthusiasm, en-ErEy, self-conffdence, speed of mental association, fuency of

€F@ 2

? o - Z * Z *f l O l l \ Z l t >= a € 9 1 € 9 0 -

"*. ?" + u

Total GeneralSample Populationa(N=47)

of British Writers and Artists

f] o"pressi re illness, pslrchotherapy only

ffi Dep.essiue illness, requiring (minimally) antidepressants

I U*r"r, requiring (minimally) hospitalization, lithium, and/or ECT

7A TOUCMDWTTHFIRE

thoughts and elevated mood, and a strong sense of well-being (seefigure 3-2), A comparison of these changes with the DSM-III cri-teria for hypomania (see chapters 2 and 4), reveals that mood,energy, and cognitive symptoms show the greatest degree of over-lap between the intensely creative and hypomanic episodes. Sev-eral of the more behavioral changes gpically associated withhypomania (hypersexuality, talkativeness, increased spending ofmoney) were reported by only a minority of subjects.

The artists and writers were also asked about changes in sleepand mood occurring just prior to these intensely creative episodes.Almost all of them reported a clearly noticeable decrease in theneed for sleep. Twenty-eight percent described waking spontane-ously at 3:00 or 4:00 a.u. and being unable to return to sleep.Mood changes were profound. One-half reported a sharp increasein mood just prior to the beginning of an intensely creative period.For example, one person described feeling "excited, anticipatory,energetic," while others said they were "elated," "euphoric," or"ecstatic"; yet another said, "I have a fever to write, and throwmyself energetically into new projects." The fact that the elevationin mood often preceded the creative periods rather than beingentirely a result of them is important in understanding the rela-tionship between moods and the creative process. We return tothis point in chapter 4. Pronounced psychological discomfort pre-ceded the creative episodes ofanother 28 percent ofthe artists andwriters. Some described themselves as "more anxious": one wrotethat he felt he was "near suicide," and yet another that he had asense of "fearfulness" and a "general mood of distress and slightparanoia." Finally, approximately one-fourth (22 percent) of thesample reported mixed mood changes and physical restlessness; forexample, one described a "mixture of elation together with somegloominess, feeling of isolation, sexual pressure, fast emotionalresponses ; several noted "restlessness"; another wrote of a "low

ebb bordering on despair often precedes good phase when workwill flow almost as though one is a medium, rather than an origi-nator," and several others observed feeling "restless and dissatis-fied." When the subjects were asked speciftcally about theimportance of very intense moods in the development and execu-tion of their work, nine out of ten stated that such moods wereeither integral and necessary (60 percent), or very important (30

COTILDITBEMADNASS{IilS? 79

Fig.re 3-2.Mood, Cognitioe, and Behaoioral Changes Reported During

Intense Creatiue Episodes

20 40 60 g0 90 Verypronounceda

-----rIIIrrIIII

"Need for sleep decreased; all the others increased.

souncn: From K. R. Jamison, Mood disorders and patterns of creativity in British writersand artists, Psgchiatry 52 (1989): I25.-I3/..

Percentage of Total SamplePeriods of Intense Creative Activitv:Changes Rated as Pronounced or

enthusiasm

enerry

self-conlidence

speed of mental association

Iluency of thoughts

mood, euphoria

ability to concentrate

emotional intensity

sense of well-being

rapid thinking

expansiveness (ideaVfeelings)

need for sleep

sensory awareness

restlessness

impulsivity

irritability

semdity

talkativeness

drinking

religious thou ghtVfeelings

spending of money

anxiety

suspiciousness

aqgumentativeness

sociability

80 TOUCIIDD WTTH FIRD

percent). Consistent with their higher rate of medical treatment formood disorders, more poets than any other group regarded thesemoods as essential to what they did and how they did it.

fn summary, the rate of treatment for affective illness (38percent)was extremely high in this sample of distinguished Britishwriters and artists. Lifetime prevalence rates for manic-depressiveand depressive illness in the general population (as determined bythe ECA study) are I and 5 percent respectively. The proportionof individuals who actually seek or receive treatment, even thoughthey meet the formal diagnostic criteria for affective illness, is farsmaller. Therefore, the ftndings of this study represent a conserv-ative estimate of the actual rate of mood disorders in the sample.Dr. Myrna Weissman and her colleagues, for example, found thatonly 20 percent of individuals with a current psychiatric disorderhad seen a mental health professional in the previous year;38 otherresearchers have concluded that only one-third of affectively illpatients actually make a mental health visit of any kind.3e Simi-larly, although lithium is the presumptive treatment of choice forapproximately I percent of the adult population, the actual utili-zation rate, as determined by Drs. R. G. McCreadie and D. P.Morrison in Scotland, is only 0.77 per one thousand.ao Dr. JavierEscobar and his associates found that lithium was used bv onlv 0.15percent of the general population.ar Both studies clearly indicate agross underutilization of lithium relative to the established preva-lence of manic-depressive illness. Antidepressants, more fre-quently prescribed, were used by 2.5 percent of the ECAcommunity sample of fffteen thousand individuals.a2 These drugtreatment ffgures are in marked contrast to those of the Britishwriters and artists I studied, 6.4 percent (16.7 percent of the poets)of whom reported the use of lithium, and 23.4 percent of whomacknowledged having used antidepressants. The contrast in rates iseven more pronounced if one considers that antidepressant use ingeneral is far more common in women than men,43 yet the sampleof writers and artists was predominantly male.

The British study revealed many overlapping mood, cogni-tive, and behavioral (especially sleep)changes between hypomaniaand intense creative states, despite the fact that questions regard-ing one state were asked independently of those regarding theother and in a manner designed to minimize possible effects of

COULD IT BE MADNESSTHIS? 8l

suggestion. Cognitive and mood changes shared far more overlapthan behavioral ones, indicating that the milder forms of hypoma-nia may represent the more productive phases of affective illness.The affective continuum that ranges from normal states throughhypomania and then mania is very important, but poorly under-stood. It remains unclear whether the overlap in cognitive andmood changes represents etiologically related syndromes or phe-nomenologically similar but causally unrelated patterns of expres-sion. It also remains unclear the extent to which writers and artistsare simply more sensitive than the general population to their ownmood states, and therefore more able-and perhaps also morewilling-to articulate and report them.

Dr. Ruth Richards and her colleagues at Harvard used a verydifferent research design to study the relationship between cre-ativity and psychopathology.a They hypothesized that a geneticvulnerability to manic-depressive illness would be accompanied bya predisposition to creativity, which, according to this hypothesis,might be more prominent among close relatives of manic-depressive patients than among the patients themselves. Such acompensatory advantage, they speculated, would be roughly anal-ogous to the resistance of malaria found among unafiected carriersof the gene for sickle-cell anemia. To test their hypothesis, Rich-ards and her associates selected seventeen manic-depressive antlsixteen cyclothymic patients, along with eleven of their normalfirst-degree relatives, using criteria that would ensure inclusions ofa spectrum of disorders. These patients and their relatives werecompared with fifteen normal control subjects, and eighteen con-trols who had a psychiatric diagnosis, but no personal or familyhistory of major affeetive disorder, cyclothymia, schizoa$ective dis-order, schizophrenia, or suicide. Unlike other studies, which lim-ited the definition of creativity only to signiffcant, sociallyrecognized accomplishment in the arts or sciences, this one at-tempted to measure the disposition toward originality manifestedin a wide range of everyday endeavors. These investigators admin-istered the Lifetime creativity scales, a previously validated in-strument that assesses the quality and quantity of creativeinvolvement in both work and leisure activities.

Richards and her colleagues found signiffcantly higher com-bined creativity scores among the manic-depressive and cyclothy-

88 TOUCIIED WITH FIRE

mic patients, and their normal first-degree relatives, than amongthe control subjects. The normal-index relatives showed sugges-tively higher creativity than did the manic-depressive patients, andthe cyclothymic patients were close to the normal relatives. Theauthors concluded:

Overall peak creativity may be enhanced, on the average, in subjectsshowing milder and, perhaps, subclinical expressions of potentialbipolar liability (i.e., the cyclothymes and normal ffrst-degree rela-tives) compared either with individuals who carry no bipolar liability(control subjects) or individuals with more severe manifestations ofbipolar liability (manic-depressives). . . . There may be a positivecompensatory advantage , . . to genes associated with greater liabil-ity for bipolar disorder. The possibility that normal relatives of manic-depressives and cyclothymes have heightened creativity rnay havebeen overlooked because of a medical-model orientation that focusedon dysfunction rather than positive characteristics of individuals.Such a compensatory advantage among the relatives of a disorderaffecting at least IVo of the population could affect a relatively largegroup of people.as

Somewhat related, though as yet still preliminary, research hasalso found an unusually high incidence of special abilities (for ex-ample, outstanding artistic, language, and mathematical abilities)in a sample of children with manic-depressive illness.a6 Two Brit-ish studies, one of architecture students and the other of chemistrystudents, found that higher academic and creative performancewas associated with greater psychological disturbance and an in-creased use of mental health facilities.aT Neither study, however,speciffed diagnosis or types of psychopathology.

Further support for a link between creativity and mood dis-orders comes from several family studies. Dr. Andreasen, in herstudy of writers from the University of Iowa Writers' Workshop,also investigated the family histories of the writers and the controlsubjects. Consistent with the higher rate of mood disorders in thewriters, her findings showed that mood disorders in first-degreerelatives (parents and siblings), summarized in table 3-3, was muchhigher for the writers than the controls. The overall rate for anytype of psychiatric disorder was also much higher in the relatives ofthe writers than in the controls. Additionally, more first-degree

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84 TOUCIIEDWTTHFIRE

relatives of writers (20 percent) showed histories of creative ac-complishment than did relatives of the controls (8 percent). Thefact that creativity and mental illness overlapped much more in therelatives of the writers than in the relatives of the controls ledAndreasen to suggest a general familial association between cre-ativity and affective disorders:

It is perhaps noteworthy that the types of creativity observed in therelatives of the writers were far broader than literary creativity. Somerelatives of creative writers were indeed also in literary ffelds, butmany were creative in other areas, such as art, music, dance, ormathematics. This suggests that whatever is transmitted within fam-ilies is a general factor that predisposes to creativity, rather than aspecific giftedness in verbal areas. Further, whenever traits are trans-mitted familially, it is of interest to determine whether the transmis-sion is due to social learning and modeling or to more purely geneticfactors. While family studies cannot disentangle this issue to thesame extent that adoption studies can, the variability in creativity inthese families does suggest the possibility of some form of genetictransmission. If social learning were the sole factor involved, onewould expect a preponderance of literary creativity in the families of' writers.4s

The familial association between mental illness and creativityhas been found in many other studies as well.ae Early, farJess-systematic investigations by C. Lombroso, F. Galton, and W.Lange-Eichbaum, for example, strongly suggested that both psy-chopathology and creative accomplishment permeated the familyhistories of eminent writers, composers, and artists. Likewise, thepedigrees of several writers and composers presented later in thebook-for example, those of Byron, Schumann, Woolf, Mary Shel-ley, Tennyson, and the Jameses-also support a pronounced pat-tern of coexisting mood disorders and creative abilities, at least incertain highly accomplished families. Juda's research findings,which were discussed earlier, are consistent with a familial associ-ation between mental illness and creativity as well. More recentlyDr. Jon Karlsson, at the Institute of Genetics in Iceland, has shownthat the first-degree relatives of psychotic patients, as well as thepatients themselves, are far more likely than the general popula-tion to be eminent across many fields of artistic and intellectual

COULD IT BE MADNESYTHIS?

endeavor.so He also found that there was a significantly increasedrisk of mental illness in distinguished Icelandic scholars and theirrelatives. Although Karlsson has posited a familial relationship be-tween schizophrenia and creativity, several researchers havepointed out that his data actually show a very strong relationshipbetween mood disorders, especially manic-depressive illness, andcreativity.sl

These studies demonstrate that creativity and mental illness,especially mood disorders, tend to aggregate in certain families andnot in others, but they do not decisively show that genetic factorsare operating; that is, they show a family association but not nec-essarily that the characteristics under discussion are heritable. Itcould be, for example, that the family and its environment areexerting the primary influence, rather than the genetic inheritanceitself. Dr. Thomas McNeil, using an adopted-offspring researchdesign, attempted to clarifu this nature-versus-nurture problem.52All of McNeil's subjects were adults who had been adopted shortlyafter birth and were part of a larger Danish psychiatric geneticsstudy. They were classified as being "high creative" (most of theindividuals in this group had achieved national prominence in thearts), "above average," or "low creative"; their rates of mentalillness were then compared with those found in their biological andadoptive parents. These results are summarized in table 3-4. Therates of mental illness were highest in the "high" creative groupand in their biological parents. The rates of psychopathology in theadoptive parents did not vary signiffcantly from one level of adop-

TABLE 3-4,RATES OF MENTAL ILLNESS IN ADOPTEES AND THEIR

BIOLOGICAL AND ADOPTIVE PARENTS

Adoptee GroupAdoptee

%

BiologicalParents

Vo

AdoptiveParents

%

High creativeAbove averageLow creative

30100

27.78 .3

12.1

5.35.05 .1

souncB: Adapted from data in T. F. McNeil, Prebirth and postbirth infuence on therelationship between creative ability and recorded mental illness, Journal of person-alita, 39 (197I): 391-406.

86 TOUCHDDWITHFIRD

tee creativity to another. Although the size of the sample wasnecessarily small, and the type of psychopathology not rigorouslyascertained, the study is both an interesting and an important one;its significance lies in the reasons given by Dr. McNeil in hissummary remarks:

Mental illness rates in the adoptees were positively and significantlyrelated to their creative ability level, substantiating the hypothesizedrelationship between creative ability and mental illness. The mentalillness rates of the biological parents were positively and signiffcantlyrelated to the creative ability of the adoptees. Mental illness ratesamong the adoptive parents and the adoptive and biological siblingswere independent of the adoptees' creative ability level. The dalawere interpreted as evidence for the influence of prebirth factorson the relationship between creative ability and mental illness. Noevidence of family-related postbirth influence was found.53

studies of social class and manic-depressive illness provide yetanother perspective on the relationship between intellectual abil-ities, personality characteristics, and manic-depressive illness. In arecent review of more than thirty studies of social class and manic-depressive illness, Dr. Frederick Goodwin and I found that, de-spite many methodological problems and incongruities*includinga time span of more than seven decades, a vast range in the size ofthe samples surveyed (from twenty to forty-seven thousand), and awide diversity of countries and cultures in which the studies wereconducted-approximately three-fourths of the research reportsshowed a positive correlation between manic-depressive ilinessand the professional or upper classes.sa Dr. Bagley, who carriedout an earlier review of the literature, concluded from his extensiveinvestigations:

The studies reviewed suggest that there is some support for the viewthat some types of "depression" and upper class economic positionare related. This finding seems to hold in several cultures, and indifferent points in time in the present century. . . . The definition ofdepression has often been unclear in many studies, but there is someevidence that the ffnding may apply to "psychotic" rather than "neu-rotic" depression, and to the classic manic depressive psychoses inparticular.s5

COI]LD IT BE MADNESSTHIS?

The same writer also compared the distribution of occupationalpositions in the adult English population at large with those amongall fifteen hundred patients who had new episodes of mood disor-ders over a three-year period in England. Using a sophisticateddiagnostic system for affective illness, he distinguished six majorcategories. Only in the category that we would term bipolar manic-depressive illness was there any significant difference in distribu-tion across occupational classes. In this group of patients, membersof the professional and managerial classes were signiffcantly over-represented. Several studies carried out during the past two de-cades have confirmed Dr. Bagley's findings. A well-designed studycarried out in Sweden, for example, found a highly significantoverrepresentation of manic-depressive patients in the upper so-cial and educational classes;s so too did a large community samplestudy of residents of New Haven, Connecticut.sT Yet other re-search, conducted in Jerusalem and drawn from Jewish first ad-missions to psychiatric hospitals, found that affective illness ingeneral was correlated with higher social class.s Although thestudy did not distinguish the bipolar from unipolar patients, almostone-half of the patients in the affectively ill sample were bipolarmanic-depressives.

Two major types of arguments have been advanced to explainthe greater incidence of manic-depressive illness in the profes-sional and upper social classes. First, some authors suggest that arelationship exists between certain personality and behavioral cor-relates of affective (primarily bipolar) illness and a rise in socialposition.5e ln fact, many features of hypomania-such as outgoing-ness, increased energy, intensifi ed sexuality, increased risk-taking,persuasiveness, self-conffdence, and heightened productivity-have been linked with increased achievement and accomplish-ments. The second hypothesis posits that manic-depressive illnessis secondary to the stresses of being in, or moving into, the uppersocial classes. This hypothesis is rather implausible because it as-sumes that, compared with lower classes, there is a special kind ofstress associated with being in the upper social classes, one capableof precipitating major psychotic episodes. Further, it ignores ge-netic factors and evidence suggesting that parental social class isoften elevated as well.

Despite the inevitable methodological problems that exist in

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TOUCHED WTTH FIRE

Figure 3-3.Mood Disord,ers in Writers and Artists

@ Malor depressive illness

@ Cyclo thymia/ Bipolar II

I Manic-depressive illness (Bipolar I)

Writerc& Artists(Akiskal &Akiskal,

unpublished)

"Treatment rate (estirnated to be one-third of the rate of illnesil.bBipoLar Il and cyclothgmia rates not ascertained."Bipolar l, bipol.ar ll, and cgclothymia rates not ascertaineil.

all the studies discussed so far-the small number of individualsstudied, types or lack of control groups, variable diagnostic andselection criteria, and flawed measurement techniques-there isan impressive consistency across the findings. Many lines of evi-dence point to a strong relationship between mood disorders andachievement, especially artistic achievement. Biographical stud-ies, as well as investigations conducted on living writers and artists,show a remarkable and consistent increase in rates of suicide, de-pression and manic-depressive illness in these highly creativegroups. Figures 3-3 and 3-4 summarize these findings in a visualway (see Appendix B as well). It can be seen that artistic groups,when compared with the expected rates for suicide and mood dis-orders in the general population,m demonstrate up to 18 times thesuicide rate, eight to ten times the rate of major depressive illness(indeed, because the ECA study found that major depression wasmore than twice as common in women, 7 percent, as in men, 2.6percent, the rates of depression in the primarily male samplesrepresented in figure 3-3 are even more striking), and ten tofiorty times the rate of manic-depressive illness and its milder

Expected Writerc Writers ArtistsRate in (Andreasen, & Artists (SchildkrautGeneral 1987) (Jamison, & Hirshfeld,

Population 1989)a,D l990)c

Poets(British,

1705-1805)(Jamison)

COI]LD IT BE MADNBSYTHIS? 89

Figure 34.Suicide Rates in Writers and Afiists

Expected Writers Artists Poets PoetcRate (Andreasen, (Schildkraut (Ludwig, (Bddsh,

in General 1987)9 & Hinhfeld, 1992) 1705-1805)Population tgg0)b (Jamison)

"Suicidp rate at tirne of studg comphtion.bTwo other artkts died indioidaallg ln singla car accidents.

variants. (Although only 6.4 percent of the writers and artists in my1989 study are represented in figure 3-3 as having bipolar I illness,this is a spuriously low estimate; all of them had received medicalintervention for mania, and epidemiological research indicates thatonly one person in three who meets the diagnostic criteria formanic-depressive illness actually seeks and receives treatment forit).61 Findings from other types of studies also point to a strongassociation between mood disorders and creativity. Manic-depressive patients, cyclothymics, and their first-degree relativesshow higher levels of creativity than normal individuals, for exam-ple, and both creativity and affective illness have been found tocoexist at higher rates than expected in the ftrst-degree relatives ofwriter and artists.

Given the historical as well as modern research support for astrong relationship between mood disorders and artistic creativ-ity-"that fine madness" described centuries ago-why does suchheated controversy continue? Putting aside for the moment foyce

TOUCHED WITH FIRE

carol oates's very legitimate concerns about the necessiw for nor-mal and quiet creative lives, as well as her more than understand-able resentment of reductionist stereotypes about neurotic andabusive writers, the major resistance to an association betweenpsychopathology, or mental illness, and creativity seems to focuson a few central points. The ffrst is that many writers, artists, andcomposers are, or were, perfectly sane; therefore, the argumentgoes, the presumption of a strong link between mental ilnlss andcreativity is, on the face of it, absurd. Harold Nicolson, in discuss-ing the health of writers, makes the extreme point rather dryly:

The theory that there exists some special connexion between literarygenius and mental derangement is one which, to my mind, has beenseriously exaggerated. It is true that a few creative writers have intheir later years become demonstrably insane; it is arso true thatalmost all creative writers have at some moments of their lives beenpanic-stricken by the conviction that their imagination was gettingthe better of their reason; but it is not in the least true that a[creative writers have been mad all the time.62

But of course no one would argue that all writers or artists, or evenmost of them, are actually mad; and, equally obviously, no onewould seriously argue that even one, much less all creative writershad been mad all the time. But the fact that there is only a partialcorrelation does not mean that there is no correlation at all. Clearlythere ar-e many artists, writers, and composers who are perfectlynormal from a psychiatric point of view. The argument heie is notthat such people do not exist, for they obviously do. Rather, theargument is that a much-higher-than-expected rate of manic-depressive illness, depression, and suicide exists in exceptionallycreative writers and artists. It is this discrepant rate that is ofinterest and that ultimately needs to be explained.

Another argument set forth against an association between"madness" and artistic creativity is that a bit of madness and tur-moil is part and parcel of the artistic temperament, and that artistsare just more sensitive to life and the experiences of life than areother people. This is almost certainly true, and it would be foolishto diagnose psychopathology where none or little exists. such anargument, however, begs the issue. It is precisely this overlap

91COIILD IT BE MADNESS-:THIS?

between the artistic and manic-depressive temperaments that weare interested in looking at. In this context Dr. William Froschmakes an important point in emphasizing that distinctions shouldbe made between analogous and homologous behaviors; that is,those behaviors that look the same in mood disorders and in thepersonalities of artists-for example, intensity of moods or the ca-pacity to experience strong feelings-may not in fact be the same.d

Nicolson, like Frosch, makes compelling arguments-al-though one might disagree with their conclusions-for restraint indiagnosing psychopathology in the artistically creative. For exam-ple, he defends Shelley from charges of insanity by arguing thatShelley was perceived as mad simply because he was different, andobjects strenuously to the fact that Shelley's schoolmates at Etondescribed him as "Mad Shelley": "The facility with which Englishschoolboys attribute insanity to anyone who is not perfectly at-tuned to their own herd behaviour has always struck me as curiousand distressing."il This is certainly a legitimate, and common,complaint that can also be leveled against biographers, psycholo-gists, and psychiatrists who equate differentness with psycho-pathology. But Nicolson then goes on to engage in anothercommon, but far more questionable, biographical practice: He at-tempts to make many of Shelley's odd behaviors seem much morenormal than in fact they probably were. "It is customary," writesNicolson in discussing Shelley's hallucinations, "for very giftedwriters to see spectres and to hear voices calling."6 This surely isopen to debate, and certainly Shelley's friends found his behav-i61-a5 did he himself-both odd and very disturbing. Nicolsonthen gives an example of one of Shelley's many rather strangeperceptual experiences: "Shelley saw a baby rise from the sea andclap its hands at him . . . it is clear from the writings of his friendsthat these sounds and visions were of not infrequent occurrence. "ffi"And yet," he goes on to say, Shelley "was certainly not mad."67Similarly Nicolson gives Cowper, who not only attempted suiciderepeatedly, but also spent a distressingly long period of time in aninsane asylum, a relatively clean bill of psychiatric health (espe-cially in light of his well-documented bouts of madness):

Twice in his life he almost succeeded in hanging himself and now wasonly saved by chance. Yet although Cowper had twice to be put in

93 TOUCIIEDWITHFIRE

conftnement, or at least under supervision, he enjoyed long inter_ludes of perfect sanity, during which he

"o*por"d much eicellent

poetry and was h"ppy in a quiet tea-party sort of way. It cannot besaid that cowper was ever a demented maniac: the worst that can besaid of him was that he was sometimes sadly confused in the head.68

Perhaps the most heated debate about what constitutes mad-ness in artists has occurred in the context of discussions of the lifeand work of william Blake. Biographers and critics have debatedendlessly about whether Blake was or was not mad, was or was nota visionary, and was or was not a mystic. some have argued that hewas indisputably insane; many others have vehementfu denied it.No one doubts that he was subject to extraordinary visions from thetime he-was,very young, or that he had wild changes in mood fromstates of highly energetic exhilaration to prolonged and severe pe-riods of despondency.-what really is at question is the meaningthat should be attached to these visions and moods. For those who"defend" Blake against charges of insanity, much of the concernseems to stem from assumptions that "mad" is somehow

'.bad,-

that madness is a ftxed condition with no periods of rational thoughtor experience, that great art cannot come from madness and, there-fore, great artists cannot have been mad. Much of the rather heateddefense also seems to come from the notion that labeling Blakemad, or even partially so, derives from an inability to compiehendhis work's subtleties and complexities. Scholar S. Foster b**.rrr,for example, dismisses the notion of Blake's madness by saying, "Itwould be cruel to print even the names of those . . . criiics whohave frankly pr^o^nounced Blake mad because they could not un-derstand him,"6e and distinguished critic Northrop Frye asserts,"A modern writer on Blake is not required to discuss his sanity, forwhich- I am grateful: I could not do so without being haunted byone of his own epigrams: 'The

Man who pretends tobe a modestenquirer into the truth of a self evident thing is a Knave.'"7oEnglish poet Algernon Charles Swinburne also attempted to de-fend Blake's sanity but, as Dr. Hubert Norman has pointed out, hegot a bit lost along the way:

It will be obvious that Blake's mental condition during the period ofhis stay at Felpham was one of marked instabilitv. Even those who

COULD ITBE MADNESYTHIS? 93

resent the ascription to him of the term "insane" admit this. "By thesounding shore," says Gilchrist, "visionary conversations were heldwith many a majestic shadow from the past-Moses and the Proph-ets, Homer, Dante, Milton." Swinburne says "that too much ofBlake's written work while at Felpham is wanting in executive qual-ity, and even in decent coherence of verbal dress, is undeniable";and adds that "everything now written in the ffdul impatient inter-vals of the day's work bears the stamp of an over-heated brain, andof nerves too intensely strung." Swinburne has, however, his ownmethod of accounting for this. It was due to the "sudden country life,the taste and savour of the sea," which "touch sharply and irritatedeliciously the more susceptible and intricate organs of mind andnature. How far such passive capacity of excitement differs frominsanity; how in effect a temperament so sensuous, so receptive, andso passionate, is further offfrom any risk of turning unsound thanhardier natures carrying heavier weigbt and tougher in the nerves,need scarcely be indicated." What does scarcely need to be indi-cated, after reading such passages as these, is that Swinburne waslittle competent to give a reasoned opinion on the matter of Blake'smental unsoundness. Only prejudice could have allowed him to drawsuch a conclusion from the evidence which he himself gives. The lastpart of the passage quoted is perilously like nonsense.Tr

Dr. Norman is not the only one to question the assumption ofBlake's sanity. Max Byrd writes:

Admirers of Blake are always expressing surprise that he should havebeen called mad by anyone-"The legends of Blake's 'madness' neverseem to cease, despite all scholarly rebuttal," complains HaroldBloom. Such puzzlement is unrealistic. The legends of Blake's mad-ness persist because he wrote poetry that describes Milton enteringhis left foot, because he claimed to speak daily and hourly with thespirit of his dead brother and with other spirits, because he wrotelong incomprehensible poems about unheard-of beings with nameslike Enitharmon and Golgonooza. In almost any Lge ofhuman historysuch a man would have seemed insane. . . . What is strihng in awayabout Blake's career is not that so many people considered himinsane but that so many people did not.72

A position perhaps somewhere in between the two absolutesof sane and insane, of manifest genius and rank incomprehensibil-

TOUCIIED WITH FIRE

ity' -rl a presumptive diagnosis of manic-depressive illness. Thiswould account not only for Blake's visionary and psychotic states,but for his forays into and out of the rather *or" pror"ically rationalworld as well. The evidence that Blake suffered from manic-depressive illness is actually quite strong, as Norman argued com-pellingly more than seventy-five years ago.

It is difficult to realise how any unprejudiced person who considersthe evidence in Blake's case can arrive at *y oth", conclusion thanthat he exhibited mental disorder. . . . Though the prevailing statewith Blake was one of exaltation and belief in his own capabilities,there were also periods of extreme depression, and the co.rditio.,may, with little doubt, be classiffed as one of maniacal-depressiveinsanity. The fluctuations in his mental condition were so -"rk"d

",to be in themselves sufficient evidence of marked nervous instabiliw.and these alternations were so pronounced as to be inconsistent withthe normal periodicity which is to be noticed in those whose sanityis not impugned. when, too, we find that in addition to these alter-nations there is evidence of diminished control-as shown in undueexcitability and impulsive violence, of hallucinations of sight andhearing, and of delusions of persecution-there is no doubt that theboundary which separates sanity from insanity has been crossed.Those who protest against this plain statement do not seem to realisethat they do Blake less than justice. They would hold him responsiblefor all his vagaries rather than allow a verdict of non

"o por. chiefly

this is so in order that the vague, mystical element in his work maybe imputed to some vague supra- or extra-natural power instead of tothe disorderly functioning of unstable nerve-tissue, or to misunder-stood organic reflexes. These nervous disorders are obscure enougheven when they are considered apart from the veiling mystery inwhich so many love to hide them; it is not, therefore, necessary toinvoke occult powers, and by so doing to render the subject nebulousand impenetrable. still less is it wise to place behind the disease ofinsanity a Mumbo-Jumbo, which has to be invoked, or a Raw_headand Bloody-bones, which has to be exorcised.T3

suggesting the diagnosis of manic-depressive illness for Blake doesnot detract from the complexity of his life; it may, however, add adifferent kind of understanding to it. Likewise, it does not renderhis work any the less extraordinary, or make him any less a greatvisionary or prophet.Ta seeing Blake as someone who suffered from

COfILD IT BE MADNDSS-TTHIS?

an occasionally problematic illness-a constitutional predispositionshared in common with many other artists, writers, and compos-ers-may not explain all or even most of who he was. But, surely,it does explain some.

What is to be made of this tendency to deny a link between psy-

chopathology and genius, to regard bizarre-and occasionally dan-gerous-behavior as somehow normal if it occurs in writers andartists? Is it simply an admirable tolerance for deviant and eccen-tric behavior if it occurs in individuals who are, by definition,already far ftom the normal temperamental and intellectual stan-dards of human society? Or does it reflect a belief that artists mayjust be fulfflling society's and their own expectations that theyought to act the part of the "tormented genius"? Do the strains andanxieties of being an artist somehow create a special type of mel-ancholy and oddness? These possibilities, while no doubt true to acertain extent, tend to disregard the possibility that individualswith temperaments liable to emotional extremes may be morelikely to choose artistic careers, thereby increasing the chances ofan interaction between a biological vulnerability and psychologicalstress. Likewise, they do not take into account the fact that theartists and writers under discussion here generally have shownemotional instability prior to the onset of their artistic careers andmanifested a severity of psychiatric symptoms, an age of onset, anda pattern of mood disturbances highly characteristic of manic-depressive illness; they also have had greatly increased rates ofdepression, manic-depressive illness, and suicide in their first-degree relatives.

Most of the controversy surrounding the "mad genius" versus"healthy artist" debate, however, arises from confusion about whatis actually meant by "madness," as well as from a fundamental lackof understanding about the nature of manic-depressive illness.TsThese two issues-<ontroversy over the meaning of "madness" andconfusion about the nature of one of the major "madnesses" (thatis, manic-depressive illnessFare inevitably and closely bound to-gether. Dr. William Ober, in his essay "Madness and Poetry: ANote On Collins, Cowper, and Smart," makes the point that:

95

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Plato distinguished clearly between prophetic insights and intuitiveinsights into the-nature of reality. He distrusted the latter as beingnonrational, but his use of the term mania does not necessarily impl|irrationality or psychosis. Even today, in English usage, mania en-compasses a wide range of attitudes and behavior, frornfolly throughuncontrollable impulses to overt psychosis; it is not a restrictiveterm.76

Any attempt to arbitrarily polarize thought, behavior, and emotioninto clear-cut "sanity" or "insanity" is destined to fail: it deffescommon sense and it is contrary to what we know about the inffnitevarieties and gradations of disease in general and psychiatric illnessin particular. "Madness," in fact, occurs only in the extreme formsof mania and depression; most people who have manic-depressiveillness never become psychotic. Those who do lose their rl"ro'-are deluded, hallucinate, or act in particularly strange and bizarreways-are irrational for limited periods of time only, and are other-wise well able to think clearly and act rationally. Manic-depressiveillness, unlike schizophrenia or Alzheimer's dir""r", is nlt a de-menting illness. It may on occasion result in episodes of acutepsychosis and fagrant irrationality, but these bouts of madness arealmost always temporary and seldom progress to chronic insanity.Yet the assumption that psychosis is an all-or-nothing sort of ph!-nomenon, and that it is stable in its instability, leads to tremendousconfusion: Van Gogh, it is said, could not have been mad, as hispaintings reflect lucidity of the highest order. Lucidity, however,is not incompatible with occasional bouts of madness, just as ex-tended periods of normal physical health are not incompatible withoccasional bouts of hypertension, diabetic crisis, hyperthyroidism,or any other kind of acute exacerbation of underlying metabolicdisease. John Ruskin, for one, has described the transitions be-tween psychological health and "morbid inflammation of thebrain":

For a physician's estimate of it, I can only refer them to my physi_cians. But there were some conditions of it which I knew better thanthey could: namely, first, the precise and sharp distinction betweenthe state of morbid inflammation of brain which gave rise to falsevisions, (whether in sleep, or trance, or waking, in broad daylight,with perfect knowledge of the real things in the room, while yet I saw

COULD ITBE MADMSS-TIIIS? 97-

others that were not there), and the not morbid, however dangerous,states of more or less excited temper, & too much quickened thought,which gradually led up to the illness, accelerating in action duringthe eight or ten days preceding the actual giving way of the brain ' . .& yet, up to the transitional moment of first hallucination entirelyhealthy, & in the full sense of the word "sane"; just as the naturalinflammation of a healing wound in flesh is sane, up to the transi-tional edge whele_ it may pass at a crisis into morbiftc, or even mor-tified substance. "

There is a great deal of evidence to suggest that, compared to"normal" individuals, artists, writers, and creative people in gen-

eral, are both psychologically "sicker"-that is, they score higher

on a wide variety of measures of psychopathology-and psycholog-

ically healthier (for example, they show quite- elevated scores on

measures of self-confidence and ego strength).78 Manic-depressiveillness is an inherited vulnerability to a disease that can manifest

itself in a wide range of fluctuating emotional states, behaviors,

thinking patterns and styles, and energy levels. Heightened pas-

sions and partial derangement of the senses tend to come and go,

as Byron so drolly described: "I can never get people to understandthat poetry is the expression of ercited passion, and that there is no

such thing as a life of passion any more than a continuous earth-quake, or an eternal fever. Besides, who would ever sharse them-

selves in such a state?"7s The temperaments associated with manic-

depressive illness are also part of the affective continuum, forming

in turn a natural bridge between a virulently psychotic illness on

the one hand and the moody, artistic temperaments on the other.

The relationship between the manic-depressive and artistic tem-peraments is discussed at length in the next chapter.

Finally, many critics who are opposed to the idea that psy-chopathology is linked to artistic ability express concern that label-ing artists as mentally ill ignores the enormous discipline, will, andrationality that are essential to truly creative work.so In speaking ofGoethe, for example, Thomas Carlyle wrote:

This man rules, and is not ruled. The stern and fiery energies of amost passionate soul lie silent in the centre of his being; a tremblingsensibility has been inured to stand, without flinching or munnur,the sharpest trials. Nothing onward, nothing inward, shall agitate or

TOUCIIED WITHFIRE

control him. The brightest and most capricious fancy, the most pierc-ing_and inquisitive intelrect, the wirdesl and deepesiimagination; thehighest thrills of joy, the bitterest pangs of sorro*, ail tfres"

"re hir,

he is not theirs.

This emphasis on the need for control calls to mind the ancientadmonition of Longinus, who argued that "sublim" i*pulr",

"r"exposed to greater dangers when they are left to themse^lves with-out the ballast and stability of knowledge; they need the curb asoften as th_e spur."82 poets, while beholden to ihe spur, have alsobeen mindful of a need_ for the curb. ]ohn Keats, in'response to apoem sent to him by Shelley, wrote:

You I am sure will forgive me for sincerely remarking that you mightcurb your magnanimity and be more of an artist, and'load eu"ry rift"of your subject with ore. The thought of such discipline must fall likecold chains upon you, who perhaps never sat with your wings furl'dfor six Months together. And is tlis not extraordina[r]y tailifor thewriter of Endymion? whose mind was like a pack of scatteredcards-s

coleridge, no stranger to the idea of scattered thoughts and un-furled wings, also underscored the absolute necessity lor order andreason'-"Poetry," he wrote, "even that of the loftiest, and seem-ingly, that of the wildest odes, [has] a logic of its own as severe asthat of science; and more difficult, because more subtle, morecomplex, and dependent on more and more fugitive causes. In thetruly great poets . . there is a reason assignable, not only forevery word, but for the position of every *ord."t.

The need for clear and logical thought is obvious but, as wediscussed earlier, clarity and logic are perfectly compatibie withthe ebbings and fowings of manic-depressive iilness

"od it, ,rro-

ciated temperaments. Indeed, whet}er out of a need to imposeorder upon a chaotic internal universe, or for other as yet unex-plained reasons, many individuals with manic-depressive illnessare inclined to be unusually obsessive and highry organized.ss And,while many ideas may be generated during mirdry manic states,much of the structuring, editing, and ftne-tuning of artistic work iscarried out during normal or mildly depressed periods. seamus

COI]LD IT BE MADNESYTHIS?

Heaney described Robert Lowell's extraordinary ability to forgethe raw material of his mind and emotions into ffnished art' Lowell,he wrote:

had in awesome abundance the poet's first gift for surrender to thoseenergies of language that heave to the fore matter that will not beotherwise summoned, or that might be otherwise suppressed. Underthe ray of his concentration, the molten stuff of the psyche ran hotand unstanched. But its final form was as much beaten as poured, thecooling ingot was assiduously hammered. A fully human and relent-less intelligence was at work upon the pleasuring quick of the cre-ative act. He was and will remain a pattern for poets in thisamphibiousness, this ability to plunge into his amphibiousness, thisability to plunge into the downward reptilian welter of the individualself and yet raise himself with whatever knowledge he gained thereout on the hard ledges of the historical present.e

The molten and amphibious nature of artistic imagination rep-resents not only a crucial element in creativity but an importantlink between the manic-depressive and artistic temperaments aswell. It is to the links between mood, temperament, and thoughtthat we turn next.

ITTIEIR LIFE

ASTORMWI{EREOI\TITEYRTDE

T elmp er ament and Imagination

Their breath is agitation, and their lifeA storm whereon they ride, to sink at last,And yet so nurs'd and bigotted to strife,That should their days, surviving perils past,Melt to calm twilight, they feel overcastWith sorrow and supineness, and so die;Even as a flame unfed, which runs to wasteWith its own fickering, or a sword laid by

Which eats into itself, and rusts ingloriously.

----cEoRGE coRDoN. r-oRo BvnoNt

Cloud Study. fohn Constable, l82l(Yale Center for British Art, Paul Mellon Collection)

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The fact that manic-depressive illness really comprises a range oftemperaments, behaviors, and patterns of thoughf (with occasionalepisodes of psychosis in some individuars) has re-d, as we have seen,to much of the controversy-and confusion-surrounding theneedle.ssly polarized "mad genius" versus "psychologically healthyartist" debate. we have also seen that therl ir

" gt"Iatly in"r"ur"d

rate of depression, manic-depressive illness, and suicidsin eminentwriters and artists. why should this be so? Is it only a coincidence?Do artists create in spite of their often-debilitating problems withmoods? or, as we will argue here, is there somethini about the ex-perience of prolonged periods of melanchoria-broken at times byepisodes of manic intensity and expansiveness-that leads to a dif-ferentkind of insight, compassion, and expression of the human con-dition? In this chapter w_e explore those aipects of manic-depressiveilln-ess that might-under some circumstances-add depih, fir",and understanding to artistic imagination.

Profound changes in mood, thinking, personality, and behav_ior can occur during all phases of manic-depressive illness. Evenduring normal states many individuals with the iilness, or who havea cyclothymic temperament, will experience striking fuctuations

TIMIR LIFE A STORM IryHEREON TIIEY RIDE 108

in the intensity of their perceptions and feelings. All these changeshave potentially important effects on personality and thought, butperhaps most relevant to the discussion of artistic creativity arethose changes that occur during the milder manic, or hypomanic,states. Even the most casual review of the diagnostic criteria forhypomania, glven in Appendix A, suggests a prima facie case for aconnection between hypomania and intellectual or artistic achieve-ment. There is perhaps some truth in the glib question that oftenarises during clinical teaching situations: Who would not want anillness that has among its symptoms elevated and expansive mood,inflated self-esteem, abundance of energy, less need for sleep,intensified sexuality, and-most germane to our argument here-"sharpened and unusually creative thinking" and "increased pro-ductivity"? The very fact that these two seemingly "soft" orsubjective symptoms have been agreed upon by a group of data-based, research psychiatrists as part of the diagnostic criteria forhypomania is remarkable in its own right. Among other things, itspeaks to the seriousness with which the association between mildmania and creativity has been taken by even some of the morerigorous clinical scientists within the ffeld of academic psychiatry.

In looking at changes associated with extreme mood states thatmight be related to artistic creativity, especially changes in emo-tion and thinking, it is perhaps helpful to first discuss the pivotalissue of "inspiration." Earlier we looked at both ancient and mod-ern speculations about the relationship between imagination, di-vine inspiration, and "madness." The notion of a special access toa power beyond what is ordinarily known to an individual or hissociety has extended across many different kinds of inspired states:the warlike, the druidic, the mystical, and the poetic. Attributionsof inspiration once made to the gods or the muses have beentransformed, during the twentieth century, into the rather moreprosaic formulations of "primary process," "pre-logical thought,"and "bisociative thinking." Arthur Koestler, who coined the latterphrase in his landmark book The Act of Creation, described theimportance of combining both rational and irrational sources in thecreative process:

We have seen that the creative act always involves a regression toearlier, more primitive levels in the mental hierarchy, while otherprocesses continue simultaneously on the rational surface-a condi-

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tion that reminds one of a shn-diver with a breathing-tube. (Need-less to say, the exercise has its dangers: skin-divers uI" f.o"" to ailvictims to the 'rapture

of the deep' and tear their breathing-tubesoff-the reculzr sens sauter of winiam Brake and so many oth-ers. .) The capacity to regress, more or less at will, to the gamesof the undergrou-nd, without losing contact with the surface, seems tobe the essence of the poetic, and olany other form or".""tiuitu. 'coaguard me from those thoughts men think / In the mind alonl, / Hethat sings a lasting song / Thinks in a marrow bone' (yeats).?

From virtually all perspectives----early Greek phirosopher totwentieth-century specialist-there is agreement that artisiic cre-ativity and inspiration involve, indeed require, a dipping into pre-rational or irrational sources while maintaining o"goi"s contactwith reality and "life at the surhce." The degreJto rJhich'individ_uals can, or desire to-,

*summon up the deptf,s" is among the more

fascinating individual differences. M"ny highly creative Jrrd """o--plished writers, composers, and artisti function essentially within

the rational world, without losing access to their psychic "under-ground." others, the subject of this book, are liiewise privy totheir unconscious streams of thought, but they must conteird withunusually tumultuous and unpredictable emotions as well. Theintegration of these deeper, truly irrational sources with more log-ical processes can be a tortuous task, but, if successful, the result-ing work often bears a unique stamp, a "touch of fire,i for what ithas been through.

Artists and writers, like other individuals, vary enormouslynot only in their capacity to experience but also to torerate ex-tremes of emotions and to live on close terms with darker forces.Yeats described this in his essay "A Remonstrance with Scotsmenfor Having soured the Dispositions of Their Ghosts and Faeries":

You have discovered the faeries to be pagan and wicked. you wouldlike to have them all up before the magistrate. In Ireland warrikemortals have gone amongst them, and helped them in their battles,and they in turn have taught men great skill with herbs, and per_mitted some few to hear their tunes. carolan srept upon a faery rath.Ever after their tunes ran in his head, and made him the greatmusician he was. ' . . You-you will make no terms with the spiritsof fire and earth and air and water. you have made the Darkness vourenemy. We-we exchange civilities with the world beyond.g

the speed of thinking may exert its infuence in different ways.Speed per se, that is, the quantity of thoughts and associationsproduced in a given period of time, may be enhanced. The in-creased quantity and speed of thoughts may exert an effect on thequalitative aspects of thought as well; that is, the sheer volume ofthought can produce unique ideas and associations. Indeed, SirWalter Scott, when discussing Byron's mind, commented: "The

wheels of a machine to play rapidly must not fit with the utmostexactness else the attrition diminishes the Impetus."n The quick-ness and ffre of Byron's mind were not lost on others who knewhim. One friend wrote: "The mind of Lord Byron was like a vol-cano, full of ftre and wealth, sometimes calm, often dazzling andplayful, but ever threatening. It ran swift as the lightning from onesubject to another, and occasionally burst forth in passionate throesof intellect, nearly allied to madness."5 Byron's mistress, TeresaGuiccioli, noted: "New and striking thoughts followed from him inrapid succession, and the flame of his genius lighted up as if wingedwith wildffre."6

Psychologist J, P. Guilford, who carried out a long series ofsystematic psychological studies into the nature of creativity, found

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that several factors were involved in creative thinking; many ofthese, as we shall see,- relate directly to the cognitive

"t"rrg", tt

"tt3kg nl-a9e during mild manias as weil. Flue-ncy of thinliing, asdefined by Guilford, is made up of several related and empir[alydefved concepts, measured by specific tasks: word fluency, theability to produce words each, foi example, containing a specificletter or combination of letters; associational fluency, tl" prodr"-tion of as many synonyms as possible for a given *ord in uli-it"damount of time; expressional fluency, the production and rapidjuxtaposition of phrases or sentences; and ideational fuencv. iheability to produce ideas to fulffll certain requirements in a limitedamount of time. In addition to fluency of thinking, Guilford devel-oped two other important concepts for the study of creativethought: spontaneous fexibility, the ability and disposition to pro-duce a great variety of ideas, with freedom to switch from categoryto category; and adaptive fexibility, the ability to come up witirunusual types of solutions to set problems. Guilford concluded thatcreative individuals were also far more likely to exhibit "divergent"rather than "convergent" thinking:

In tests of convergent thinking there is almost always one concrusionor answer that is regarded as unique, and thinking is to be channeledor controlled in the direction of that answer. . . . In divergent think-ing, on the other hand, there is much searching about or going offinvarious directions. This is most obviously seen when there is nounique conclusion. Divergent thinking . . . is characterized . . . asbeing less goal-bound. There is freedom to go offin different direc-tions. . . . Rejecting the old solution and striking out in some direc-tion is necessary, and the resourceful organism will more probablysucceed, T

The importance of divergent thinking in the creative process, al-though not without controversy, has been corroborated by thework of many other researchers, including Frank Barron in theUnited States and Liam Hudson in England.s

Early clinical researchers noted the tendency of their manicpatients to exhibit many characteristics of divergent and fuidthought. Kraepelin commented on the fact that manic thoughtshowed "heightened distractibility," a "tendency to diffusiveness,"

TIMIRLIIEA STORM WHEREON TIMY RIDE LO7

and "a spinning out the circle of ideas stimulated and jumping offto others."e Swiss psychiatrist Eugen Bleuler concurred, and fur-ther drew the parallels between manic and artistic thought:

The thinking of the manic is flighty. He jumps by by-paths from onesubject to another, and cannot adhere to anything. With this theideas run along very easily and involuntarily, even so freely that itmay be felt as unpleasant by the patient, . , .

Because of the more rapid flow of ideas, and especially becauseof the falling off of inhibitions, artistic activities are facilitated eventhough something worth while is produced only in very mild casesand when the patient is otherwise talented in this direction. Theheightened sensibilities naturally have the effect of furthering this.ro

More recently, several researchers have shown that manic patients,unlike normal individuals or schizophrenics, tend to exhibit pro-nounced combinatory thinking. Characterized by the merging of"percepts, ideas, or images in an incongruous fashion,"lr the ideasformed in this way become "loosely strung together and extrava-gantly combined and elaborated."rz Drs. Nancy Andreasen andPauline Powers of the University of Iowa compared manic patients,schizophrenics, and writers from the University of Iowa Writers'Workshop on measures of conceptual overinclusiveness (the ten-dency to combine test objects into categories in a way that tends to"blur, broaden, or shift conceptual boundaries").tt Th" authors'hypothesis that creative writers might show thinking styles similarto those seen in schizophrenics was found to be without grounds;instead, they observed that the writers showed conceptual stylesquite like those of the manic patients: "Both writers and manicstend to sort in large groups, change dimensions while in the pro-cess of sorting, arbitrarily change starting points, or use vaguedistantly related concepts as categorizing principles."ra They dif-fered primarily in the degree of control they were able to exertover their patterns of thought, with the writers able to carry out"controlled flights of fancy during the process of sorting, while themanics tend to sort many objects for bizarre or personalized rea-sons. "t5 Moreover, people who have strong emotional responses ingeneral (who also tend to score higher on measures of being at riskfor developing manic-depressive illness) tend to have more elabo-

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rate and generalizing cognitive operations.r6 More recently Dr.David shuldberg has found that several hypomanic traits contrib-ute to performance on tests measuring

".""iirrity; of particular rel-

evance here he found that creative cognition is far more similar tohypomanic flight of ideas than it is to the loose associations that arecharacteristic of schizophrenia.rT other studies have found thatrhymes, punning, and sound associations increase during mania,and many patients spontaneously start writing poetry *hJ" manic(often w.ithout any previous interest in eithei readit g or writingpoetry).18 Likewise, in studies of word-associational f"tt"rr,r, ,"-searchers have found that the number of original reiponses to aword-association task (in which an individuJir

"rk"d- to give as

many associations as possible to a particular word) increase three-fold during mania; the number of statistically common, or predict-able, responses falls by approximately one-third. re Hypomania alsohas been found to increase intellectual functioning on thr wechslerAdult Intelligence scale.2o Recent studies show that a stronglypositive, gr "up," mood facilitates ereative problem solving;2r ie-latedly, the majority of the British writers and artists in mi studvreported pronounced elevations in mood just prior to their periodsof intensive creative activity.22 Drs. Ruth Richards and bennisKinney of Harvard University found that the overwhelming ma-jority of manic-depressives in their investigation reported being ina mildly or very elevated mood when experiencing their greatestperiods of creativity. several features that were closely tied toelevated mood states in their subjects clearly overlapped thosefound in the British writers and artists; these included increasedspeed ofassociations, ease ofthinking, new ideas, and expansive-ness.23 Although the tendency has been to assume that

^creative

periods Iead to "high" or elevated moods and that noncreativeperiods lead to depressed ones, these studies suggest that thereverse may be true. It may be that elevations in mood such asthose caused by hypomania result in more creative thought; like-wise, depressed mood and thinking may well lead to periods rel-atively bereft of creative work.

In all these aspects of creative thought the elements of fuidityand flexibility of cognitive processing are pronounced. Clearly themere quickening and opening up of thought in an otherwise un-imaginative person will not result in creative achievement. If. how-

TIIEIR LIFE A STORM 1{4HEREON TITEY RIDE I@

ever, a highly imaginative person's thinking processes are hastenedand loosened by mild manic states, it is likely that a distinctivequality will be added to the creative process. The grandiosity ofspirit and vision so characteristic of mania, coupled with manicdrive and intensity, can add an expansiveness and boldness as well.Under unusual circumstances-and circumstances under which ge-nius is bred are by definition uriu5ual-this can result in a formi-dable combination of imagination, adventurousness, and a restless,quick, and vastly associative mind. No one better personifies thewide-ranging, expansive, wandering, and dendritic possibilities ofthe human mind than Samuel Taylor Coleridge.

Coleridge, whose life is further discussed in chapter 6, cameto his imaginative life with turmoil and fire in his genes and a lovefor "the Vast" in his blood. "His mind was clothed with wings,"2awrote William Hazlitt, and Coleridge himself said: "My thoughtsbustle along like a Surinam toad, with little toads sprouting out ofback, side, and belly, vegetating while it crawls. "25 Thomas Carlyledescribed the intense, grandiose, and charismatic quality to Cole-ridge's far-ranging conversational style:

I have heard Coleridge talk, with eager musical energy, two strickenhours, his face radiant and moist, and communicate no meaningwhatsoever to any individual of his hearers,----certain of whom, I forone, still kept eagerly listening in hope; the most had long beforegiven up, and formed (if the room were large enough) secondaryhumming groups of their own. He began anywhere: you put somequestion to him, made some suggestive observation: instead of an-swering this, or decidedly setting out towards answer of it, he wouldaccumulate formidable apparatus, logical swim-bladders, transcen-dental life-preservers and other precautionary and vehiculatory gear,for setting out; perhaps did at last get under way,-but was swiftlysolicited, turned aside by the glance of some radiant new game onthis hand or that, into new courses; and ever into new; and beforelong into all the Universe, where it was uncertain what game youwould eatch, or whether any.26

John Keats, in a letter to his brother, wrote about his experiencesafter meeting Coleridge for the first time:

-I walked with him a[t] his alderman-after-dinner pace for near twoMiles I suppose. In those two Miles he broached a thousand things-

110 TOUCIIED WTTH FIRB

let me see if I can give you a list-Nightingales, Poetry----on Poeticalsensation-M etaphysics-Diferent gener a and species of Dreams-Nightmare-a dream accompanied by a sense of touch-single anddouble touch-A dream related-First and second sen5siqu5ns55-. . . Monsters-the Kraken-Mermaids-southey [slc] believes inthem-southeys [sdc] belief too much diluted-A Ghost story-Goodmorning-I heard his voice as he came towards me-I heard it as hemoved away-I had heard it all the interval-if it mav be called so.27

Coleridge's wide-ranging, not to say cosmic, interests,gether by seemingly inftnite associative strands, formedsence of his imaginative style. one scholar has given an illustrativeroad map to Coleridge's mind and works:

But the road, as we shall actually travel it, leads through half thelands and all the seven seas of the globe. For we shail mlet on theway with as strange a concourse as ever haunted the slopes of par-nassus-with alligators and albatrosses and auroras and antichthones; with biscuit-worms, bubbles of ice, bassoons, and breezes;with candles, and Cain, and the Corpo Santo; Dioclesian, king ofSyria, and the dremons of the elements; earthquakes, and the Eu_phrates; frost-needles, and fog-smoke, and phosphorescent light;gooseberries, and the Gordonia lasianthus; haloes and hurricanesrlightnings and Laplanders; meteors, and the Old Man of the Moun_tain, and stars behind the moon; nightmares, and the sources of theNile; footless birds of Paradise, and the observatory at pekin; swoons,and spectres, and slimy seas; wefts, and water-snakes, and the Wan_dering Jew. Beside that compendious cross-section of chaos, night-mares are methodical. Yet of such is the kingdom of poetry. ,tnJ inthat paradox lies the warrant of our pilgrimage,s

In order for far-flung or chaotic thoughts to be transformedinto works of art, original and meaningful connections (linkings, inthe Aristotelian sense of "dissimilarity with similarity") must bemade. Here again grandiosity and a related cosmic sense oftencombine with acute observational powers to make otherwise un-imaginable emotional and intellectual leaps. The effects of suchvisionary and expansive states can be discerned not only in thework of Coleridge, but in the writings of poe, Smart, Blake,Melville, Ruskin, and many others as well. Ruskin-whose ideas

tied to-the es-

THEIR LIIE A STORM WHDREON THEY RIDE 1 1 1

and interests, like Coleridge's, spanned virtually every aspect ofhuman knowledge but whose mind also occasionally strayed overthe boundaries of the profound into utter manic madness-wrotein Mod.ern Painters about the dynamic and complex interactionthat takes place between the observer and observed during theprocess of imaginative, combining thought:

A powerfully imaginative mind seizes and combines at the sameinstant, not only two, but all the important ideas of its poem orpicture; and while it works with any one of them, it is at the sameinstant working with and modifying all in their relations to it, neverlosing sight of their bearings on each other; as the motion of a snake'sbody goes through all parts at once, and its volition acts at the sameinstant in coils that go contrary *ays.ne

This elaborate relationship between observations and the con-nections made between them is vividly portrayed by Olof Lagen-crantz in his biography of August Strindberg:

One brilliant observation followed another; Strindberg's intuitiveawareness that everything is infinitely interconnected fired its light-ning bolts into the great chaos-the starting-point of it all. Strind-berg's imagination had gained a new resilience, a new confidence inhis ability to see correspondences and parallels between diferentareas of knowledge. He connected all the kingdoms of nature, butnever in a generalizing, pantheistic way: the connections are palpa-ble, concrete. The kingffsher, he claimed, had evolved the brightlycoloured, scaleJike feathers on its neck and wings by spending manyhours sitting and staring down into the water at its prey-the fishes.The mackerel's moir6 back reflected wave motions in water, to theextent that one could copy and present them as waves on a canvas.The hoar-frost crystals on trees and blades of grass resembled cater-pillars, roses and cauliflower heads: the observation is presented asevidence for a connection between the organic and the inorganicworld. The pattern on the wings of the death's-head moth was gen-erated by the fact that the insect frequented sites of execution andgraveyards, where it laid its eggs in corpses. The forms of plantJiferecur in metals. The sunflower reflects the image of the sun with itsdisc, rays and spots. Flowers and animals mistake themselves for oneanother and exchange forms.3o

118 TOUCIIED WTTH FIRE

Strindberg (who, as we shall see, was not the only member of his

family to suffer from manic-depressive psychosis) showed an ex-

traordinary range of scientiftc interests. His biographer Michael

Meyer provides an excellent example of the grandiosity of ideas

floridly outpacing any realistic expectation of their execution:

The range of his scientiftc explorations is remarkable' "When themoment comes that people take my research seriously," he wrote on22 March to Birger Mdrner, "found a Free Laboratory for me! All Ineed: a big cottage outside Stockholm, with cheap apparatus. . . .There I would concentrate on completing the inventions which Ihave half ready: e.g., colour photography. The telescope. Air elec-tricity as motor power. Iodine from coal. Phosphorus from sulphur.Sulphuric acid from alum slate. Nickel plating without nickel (trans-mutation of metals). New ideas in iron and steel metallurgy, Etc.etc." To this list, writing six days later to Hedlund, he added: "Tomake silk from a liquid without silkworms. To transmute cottonthread into silk. To transmute linen thread into silk."3r

Making connections between opposites, crucial to the creative pro-cess, is in many respects a specialized case of making connectionsin general, of seeing resemblances between previously unassoci-ated conditions or objects. We will discuss this later in the contextof possible artistic advantages to be gained from the coexistence ofopposite emotional states such as mania and depression, the im-portance of their contrasting and fuctuating natures, and the needto come to terms with such wildly disparate perceptions, experi-ences, and aspects ofpersonality.

The neurochemical and anatomical processes responsible forthe cognitive changes occurring during both pathological andhighly creative states are poorly understood. It will remain formolecular biology, neuropsychology, and the new neuroimagingtechniques to provide us with a more sophisticated understandingof the underlying changes in thought and behavior that are en-hanced, left unaffected, or impaired by shifting patterns of mood.The neuroimaging techniques-positron emission tomography(PET), magnetic resonance imaging (especially the newly devel-oping fast MRI technologies), brain electrical activity mapping(BEAM), regional cerebral blood-flow studies (rCBF), single pho-ton emission-computed tomography (SPECT), and magnetoen-

113TIMIR LIIIE A STORM WIIDREON THEY RIDE

cephalography (MEG)-have, in the past few years, alreadyprovided unprecedented insights into many aspects of higher cere-bral functioning, including vision, memory, learning, hearing, andspeech.32 Neuropsychological studies of differences in cognitiveabilities and deficits between those individuals with and withoutdepressive or manic-depressive illness have also proven to be ofinterest.ss

Characteristics of a noncognitive nature also link the manicside of manic-depressive illness with artistic temperament andimagination. Many of these are related to the fiery side of themanic temperament, and, when coupled with an otherwise imag-inative, observant, and (ultimately) disciplined mind, they can re-sult in literary, musical, and artistic works of singular power. Thesheer force of life, the voltage, can be staggering in mania, and itoften singes if not scorches the ideas that come in its wake, leavingthem altered in lasting ways. Ruskin portrayed the role of force andfire in the action of elemental, instinctive genius:

Such is always the mode in which the highest imaginative facultyseizes its materials. It never stops at crusts or ashes, or outwardimages of any kind; it ploughs them all aside, and plunges into thevery central fiery heart; nothing else will content its spirituality;whatever semblances and various outward shows and phases its sub-ject may possess go for nothing; it gets within all fence, cuts downto the root, and drinks the very vital sap of that it deals with: oncetherein, it is at liberty to throw up what new shoots it will, so alwaysthat the true juice and sap be in them, and to prune and twist themat its pleasure, and bring them to fairer fruit than grew on the oldtree; but all this pruning and trvisting is work that it likes not, andoften does ill; its function and gift are the getting at the root, itsnature and dignity depend on its holding things always by the heart.Take its hand from off the beating of that, and it will prophesy nolonger; it looks not in the eyes, itjudges not by the voice, it describesnot by outward features; all that it afirms, judges, or describes, itaffirms. from within.s

The abandonment of normal judgment and restraint that is seen inthe uninhibited, reckless, and violent behavior so central to mania,and in some drug- and alcohol-induced states as well, compelsmovement. Combined with the sheer disruption of senses and

714 TOUCIIED WITHFIRE

intellect that also occurs during mania, such movement can be-inthose with artistic imagination and the capacity later to take morerational advantage of such experience-a form of forced voyage andexploration. The poet, wrote Rimbaud:

makes himself a seer by a long, gigantic and rational dzrangemcnt ofall the senses. All forms of love, suffering, and madness. He searcheshimself. He exhausts all poisons in himself and keeps only theirquintessences. He reaches the unknown, and when, bewil-dered, he ends by losing the intelligence of his visions, he has seenthem. Let him die as he leaps through unheard of and unnamablethings: other horrible workers will cvme; they will begin from thehorizons where the other one collapsedls

The boldness of temperament needed for original work wasstressed in a different sort of way by Keats: "That which is creativemust create itself-In Endymion, I leaped headlong into the Sea,and thereby have become better acquainted with the Soundings,the quicksands, & the rocks, than if I had stayed upon the greenshore, and piped a silly pipe, and took tea & comfortable ad-vice.-I was never afraid of failure; for I would sooner fail than notto be among the greatest."s High energy levels and boldness areclearly essential to virtually all creative endeavors; they tend to becharacteristic of manic-depressive temperaments as well.37

Learning through intense, extreme, and often painful experiences,and using what has been learned to add meaning and depth tocreative work, is probably the most widely accepted and written-about aspect of the relationship between melancholy, madness,and the artistic experience. John Berryman-poet, contemporaryof Robert Lowell and Theodore Roethke, and, like them, a manic-depressive*eventually committed suicide, as his father and aunthad done before him. Disinclined to understatement. he describedthe role of ordeal in his artistic work:

I do strongly feel that among the greatest pieces of luck for highachievement is ordeal. Certain great artists can make out without it,

II rnBIR LrrE A sroRM wrrDRDoN THEx RrDE 1lbII

ItI Titian and others, but mostly you need ordeal. My idea is this: The

I artist is extremely lucky who is presented with the worst possible

I ordeal which will not actually kill him. At that point, he's in business.I Beethoven's deafrress, Goya's deafiress, Milton's blindness, that kindI of thing. And I think that what happens in my poetic work in theI future will probably largely depend not on my sitting calmly on myJ ass as I think, "Hmm, hmm, a long poem againP Hmm," but on beingI knocked in the face, and thrown flat, and given cancer, and all kindsJ of other things short of senile dementia. At that point, I'm out, but

I rhort of that, I don't know. I hope to be nearly crucifted.s

II Roethke also wrote about adversity, focusing on the vision given by

I darkness and despair: "In a dark time, the eye begins to see," heI wrote, and then continued:

II *frat's madness but nobility of soul

I At odds with circumstance? The day's on fire!

J I know the purity ofpure despair,

I My shadow pinned against a sweating wall.That place among the rocks-is it a cave,

More than a century earlier, shelley had addressed a similar themein lulian and Maddalo, an autobiographical poem about-amongother things-madness, Byron, and himself:

The colours of his mind seemed yet unworn;For the wild language of his grief was highSuch as in measure were called poetry;And I remember one remark which thenMaddalo made. He said: "Most wretched menAre cradled into poetry by wrong,They learn in suffering what they teach in song."ro

Keats agreed. "Do you not see how necessary a world of pains andtroubles is to school an Intelligence and make it a soul? A placewhere the heart must feel and suffer in a thousand diverse ways!'arKoestler, in The Act of creafion, discussed the central imporianceto the creative act of the archetypal "Night ]ourney," during whichthe artist-hero suffers overwhelming experiences, or a spiritual

Or winding path? The edge is what I have.3e

116 TOUCHDD WTTH FIRE

crisis, that convulses the deepest foundations of his being: 'He

embarks on the Night Journey, is suddenly transferred io theTragic Plane-from which he emerges puriffed, enriched by newinsight, regenerated on a higher level of integration."a2 This is, ofcourse, a variation on the ancient theme of "the suffered is thelearned," of insight gained through trial and anguish. The dive, orjourney underground, by deffnition provides a remarkable inten-sity and range of experience for those who take it; conversely, thosewho have intense emotions, moods, and sensitivities are probablymuch more likely to take the journey.

A passionate emotional makeup is thought by many to be anintegral part of the artistic temperament. American essayist andpoet George Edward Woodberry, for example, wrote:

The sign of the poet, then, is that by passion he enters into life morethan other men. That is his gift-the power to live. . . . [Poets] havebeen singularly creatures of passion. They lived before they sang.Emotion is the condition of their existence; passion is the element oftheir being; and, moreover, the intensifting power of such a state ofpassion must also be remembered, for emotion of itself naturallyheightens all the faculties, and genius burns the brighter in its ownflames.a3

Poe, who in his nonfiction had written somewhat convincinglyabout the role of rationality in art, described in his fiction theimportance of exalted moods, madness, and passion in those whowould penetrate "into the vast ocean":

I am come of a race noted for vigor of fancy and ardor of passion. Menhave called me mad; but the question is not yet settled, whethermadness is or is not the loftiest intelligence-whether much that isglorious-whether all that is profound-does not spring from diseaseof thought-from maods of mind exalted at the expense of the gen-eral intellect. They who dream by day are cognizant of many thingswhich escape those who dream only by night, In their grey visionsthey obtain glimpses of eternity. . . . They penetrate, however rud-derless or compassless, into the vast ocean of the "light ineffable." a

Artistic expression can be the beneffciary of either visionary andecstatic or painful, frightening, and melancholic experiences. Even

THEIR LIFE A STORM WIIEREON THEY RIDE

more important, however, it can derive great strength from thestruggle to come to terms with such emotional extremes, and fromthe attempt to derive from them some redemptive value. "Themore I am spent, ill, a broken pitcher," wrote van Gogh, "by somuch more am I an artist-a creative artist this green shoot. L r r r . . . ru rJ 5 r vvu r

springing from the roots of the old felled trunk, these are suchabstract things that a kind of melancholy remains within us whenwe think that one could have created life at less cost than creatingart."45 Changes or extremes in mood and experience alone do notguarantee good art, of course. If, however, like the changes inthought discussed earlier, they are coupled with imagination anddiscipline, the possibilities for creating lasting and sustaining artmay be greatly enhanced.

Profound melancholy or the suffering of psychosis can funda-mentally change an individual's expectations and beliefs about thenature, duration, and meaning of life, the nature of man, and thefragility and resilience of the human spirit. Many writers, artists,and composers have described the impact of their long periods ofdepression, how they have struggled or dealt with them, and howthey have used them in their work. The influence of pain's domin-ion fills novels, canvases, and musical scores; there is no shortageof portrayals. Poet Anne Sexton, for one, described the importanceof using pain in her work: "I, myself, alternate between hidingbehind my own hands, protecting myself anyway possible, and thisother, this seeing ouching other. I guess I mean that creativepeople must not avoid the pain that they get dealt. . . Hurt mustbe examined like a plague."a6 Robert Lowell, who wrote aboutdepression: "I don't think it is a visitation of the angels but aweakening in the blood,"a7 also said:

Depression's no gift from the Muse. At worst, I do nothing. But oftenI've written, and wrote one whole book-For the Union Dead-about witheredness. . . . Most of the best poems, the most personal,are gathered crumbs from the lost cake. I had better moods. but thebook is lemony, soured, and dry, the drought I had touched with myown hands. That, too, may be poetry-on sufferance.a8

Lowell wrote tellingly about "seeing too much and feeling it/withone skin-layer missing."ae And Woolf, like Roethke, felt and used

LL7

TOUCIIED WITH FIRE

the double edge of emotion she experienced in her depressions:"But it is always a question whether I wish to aviid theseglooms. . . . These g weeks give one a plunge into deep waters;which is a little alarming, but full of interest. . . . There is an edgeto it which I feel is of great importance. . . . one goes down intothe well & nothing protects one from the assault of truth."5o

It seems counterintuitive that melancholy could be associated withartistic inspiration and productivity; the milder manic states andtheir fiery energies would seem, at ffrst thought, to be more ob-viously linked. The extreme pain of the deeper melancholias, andthe gentler, more refective and solitary sides of the milder ones,can be extremely important in the creative process, however. Hy-pomania and mania often generate ideas and associations, propelcontact with life and other people, induce frenzied energies andenthusiasms, and cast an ecstatic, rather cosmic hue over life.Melancholy, on the other hand, tends to force a slower pace, coolsthe ardor, and puts into perspective the thoughts, observations,and feelings generated during more enthusiastic moments. Milddepression can act as ballast; it can also serve a critical editorial rolefor work produced in more fevered states. Depression prunes andsculpts; it also ruminates and ponders and, ultimately, subdues andfocuses thought. It allows structuring, at a detailed level, of themore expansive patterns woven during hypomania.

The slightly melancholic perspective is meaningful in its ownright. The sensitivity and compassion afforded by depression are,for the most part, absent in the unbridled seH-assurance and hecticpace of hypomania. The tendency to gaze inward, to ask why andof what avail, is, on the other hand, deeply embedded in thedepressive view:

In their milder forms, one is almost inclined to say that some of theinsight manifested in the writings of people in what might be calledthe morbid state of mind, so far as depression is concerned, springsfrom the fact that they become self-searching, brood on the meaningof life-a brooding in which the healthy mind indulges only occa-sionally and even then only when thrown back on itself. United with

I

III this ability, this brooding may produce poetic, philosophic and reliI Sious insight and manifest itself in words which infuence the minds

I and the life goals of posterity.srTII Recent research has shown that observations and beliefs pro-

I duced during mildly depressed states are actually closer to "real-

I iry" than are normal mood states,s2 underscoring the pervasiveness

I of denial in everyday life and giving credence to T. S. Eliot's viewI that "Human kind cannot bear very much reality."s3 Grief andJ depression often bring with them, for good or ill, the heart of life:I the lnferno, "like Plato's cave, is the place where all men come toI know themselves ."il "ln these flashing revelations of griefs won-

I der l ftre," wrote Melville, "we see all things as they are; andJ though, when the electric element is gone, the shadows once moreI descend, and the false outlines of objects again return; yet not withI their former power to deceive."ss Depression forces a view onI reality, usually neither sought nor welcome, that looks out onto the| fleeting nature of life, its decaying core, the finality of death, and

the ffnite role played by man in the history of the universe. Notsurprisingly, Tennyson's great muses were astronomy and geology;and thoughts of death, so often the companion of melancholy, havebeen muse to countless composers, artists, and writers. Indeed, forKeats, death was "Life's high meed":

Heart! Thou and I are here sad and alone;I say, why did I laugh? 0 mortal pain!

O Darkness! Darkness! ever must I moan.To question Heaven and Hell and Heart in vain.

Why did I laugh? I know this Being's lease,My fancy to its utmost blisses spreads;

Yet could I on this very midnight cease,And the world's gaudy ensigns see in shreds;

Verse, Fame, and Beauty are intense indeed,But Death intenser-Death is Life's high meed.s

Melancholy itself often acts as a bittersweet potion and muse, add-ing a tincture of sadness and wistfulness to the creative process."Yet naught did my despair/But sweeten the strange sweetness,"57wrote English poet Edward Thomas. Although subject to paralyz-

TOUCIIED W]TH FIRE

ing and suicidal depressions, he often declared his reliance uponthe gentler side of melancholy:

And yet I still am half in love with pain,With what is imperfect, with both tears and mirth,With things that have an end, with life and earth,And this moon that leaves me dark within the door.58

Likewise, Edgar Allan Poe wrote:

And by a strange alchemy of brainHis pleasure always turn'd to pain-His naivete to wild desire-His wit to love-his wine to ffre*And so, being young and dipt in follyI fell in love with melancholy.se

And Alfred Tennyson, too, cast a partially covetous eye on melan-choly:

O Sorrow, wilt thou live with meNo casual mistress, but a wife,My bosom-friend and half of life;

As I confess it needs must be?

O Sorrow, wilt thou rule my blood,Be sometimes lovely like a bride,And put thy harsher moods aside,

If thou wilt have me wise and good.60

The use of the mild melancholic states to recall earlier and morepainful times, but at a distance, can allow a measured tapping intodeeper emotional pools, as well as a more controlled access to theback rooms of the unconscious mind. An artist certainly need notgo through all extremes of all moods and all experience, but it isundeniable that familiarity with sadness and the pain of melan-choly-as well as with the ecstatic, often violent energies of themanic states----can add a singular truth and power to artistic ex-pression. To the extent that an artist survives, describes, and thentransforms psychological pain into an experience with more uni-

131TIIEIR LIFE A STORM WIfiREON THEY RIDE

versal meaning, his or her own journey becomes one that otherscan, thus better protected, take.

Biographer Leon Edel, in a lecture given before the AmericanPsychiatric Association, carefully shied away from speculationsabout the genesis of melancholia, or "tristimania," in writers andartists; he did, however, powerfully argue for melancholia's crucialrole in the arts. "Within the harmony and beauty of most transcen-dent works," he said, "I see a particular sadness, We might say itis simply the sadness of life, but it is a sadness that somehowbecomes a generating motor, a link in the chain of power thatmakes the artist persist, even when he had lived an experience, totransform it within his medium."ut Later in the talk he expandedon his beliefi "I take it as a postulate, even an axiom, that by thetime the creating personality has acquired his adult being, a greatfund of melancholy has been accumulated. It clamors for release.We can hear it in all acuteness in Schubert and Schumann; itsounded for us in the cosmic cadences of Beethoven; it comes at usfrom almost every page of poetry."62

But, as Randall Jarrell reminds us, sometimes the darkness isonly darkness;

I see at last that all the knowledge

I wrung from the darkness-that the darkness flung me-Is worthless as ignorance: nothing comes from nothing,The darkness from the darkness. Pain comes from the darknessAnd we call it wisdom. It is pain.ff

"No one has ever written, painted, sculpted, modeled, built, orinvented except literally to get out of hell,"e wrote poet AntoninArtaud, who spend years in psychiatric wards for his recurrentbouts of insanity. His view-that art ffrst heals the artist and sub-sequently helps heal others-is an ancient one, inextricably boundto the belief that "madness" and the arts are causally linked. Inrecent times Dr. Anthony Storr has articulated this position per-suasively and eloquently in his book The Dgnamics of Creation,citing the many instances of writers and artists who have used theirwork to save not only their souls, but their minds as well.65 "A part,

133 TOUCIIED WITHFTRD

then, of what Henry James called the madness of art,,, said LeonEdel, "resides in the artist's search for some exit from the labvrinthof the imprisoned and despairing self-the verbal structure. thephilter-,^ the anodyne, that will somehow provide escape and sur-cease."ffi writers and artists themselves have been

^particularly

forceful about the relief that their work can bring. "roetry led meby the hand out of madness,"67 wrote Anne Sexton; and, althoughthis was only partially true, poetry's extraordinary role in her lilehas been well documented by biographer Diane Wood Middle-brook.68 For many artists, writing or painting or composing hasprovided an escape from their turmoils and melancholy-. Cowper,who, like Artaud and sexton was instituti onalizedfor his psychosis,wrote that a "Dejection of Spirits, which I suppose may have pre-vented many a man from becoming an Author, made me one. I findconstant employment necessary, and therefore take care to be con-stantly employ'd. Manual occupations do not engage the mindsufficiently, as I know by experience, having tried many. But Com-position, especially of verse, absorbs it wholly."6e Berlioz turned tomusic for consolation, and for control of his often-overwhelmingmood swings:

Sometimes I can scarcely endure this mental or physical pain (I can'tseparate the two), especially on ftne summer days when I'm in anopen space like the Tuileries Garden, alone. Oh then . . . I couldwell believe there is a violent "expansive force" within me. I see thatwide horizon and the sun, and I suffer so much, so much, that if I didnot take a grip of myself I should shout and roll on the ground. I havefound only one way of completely satisfuing this immense appetitefor emotion, and that is music. Without it I am certain I could not goon living.To

Berlioz's temperamental soul mate in poetry, Lord Byron, de-scribed-in appropriately volcanic terms-the mind-saving role ofpoetry: "It is the lava of the imagination whose eruption preventsan earth-quake-they say Poets never or rarely go mad. . . but aregenerally so near it-that I cannot help thinking rhyme is so faruseful in anticipating & preventing the disorder."Tt Eliot, *howrote TheWastelandwhile recovering from a nervous breakdown,remarked: "Poetry is not a turning loose of emotion, but an escape

I TTDIRLtrE A sroRM llIlrEREoNTHEv RrDE 183I

ItI from emotion, it is not the expression of personality, but an escape

I from personality. But, of course, only those who have personality

I and emotions know what it means to want to escape from these

I things."72I Creative work can act not only as a means of escape from pain,

J b"t also as a way of structuring chaotic emotions and thoughts,

I numbing pain through abstraction and the rigors of disciplined

I thought, and creating a distance from the source ofdespair. JohnI Donne and Alfred, Lord Tennyson, although writing centuries

I apart, described in very similar terms the relief provided by the

I practice and structuring of their art. Donne stressed, however

I ironically, the taming of grief through its fettering in verse:

I

| *en as the earths inward narrow crooked lanesI

I Do purge sea waters fretfule salt away,

I I thought, if I could draw my painesI Through Rimes vexation, I should them allay.

Griefe brought to numbers cannot be so fferce,For, he tames it. that fetters it in verse.73

Tennyson focused on the opiate-like relief brought about by thewriting of verse itselfi

But, for the unquiet heart and brain,A use in measured language lies;The sad mechanic exercise,

Like dull narcotics, numbing pain.

In words, like weeds, I'll wrap me o'er,Like coarsest clothes against the cold:But that large grief which these enfold

Is given in outline and no more.74

Twentieth-century poet Lowell also wrote of wrapping himself inwords for protection: "I am writing my autobiography literally to"pass the time." I almost doubt if the time would pass at all oth-erwise. However, I also hope the result will supply me with swad-dling clothes, with a sort of immense bandage of grace andambergris for my hurt nerves."75 Years later, near the end of his

TOUCIIED WITHFIRE

life, he inquired tellingly in a poem, "Is getting well ever an art, /or art a way to get well?"76

clearly the pain experienced by writers and artists is not al-ways the result of a pathological state of madness or melancholy.often it is the ordinary, as well as the universal, in life's experi-ences that combines with an unusually sensitive temperame.rf 1"y-clothymic or otherwise) to produce a heightened sense ofvulnerability, awareness, pain, and futility. Novelist GrahamGreen_e, by his own account a manic-depressive and subject toextended periods of suicidal depression, r"id th"t "writing is aform of therapy. sometimes I wonder how all those who do notwrite, compose or paint can manage to escape the madness, themelancholia, the panic fear which is inherent in the human situa-tion."" The elemental human desire to add meaning and perma-nence to lif+to avoid the fate rendered by Dante as "no morememorial / Than foam in water or smoke upon the wind"78-takeson additional depth and urgency for those who have intense moodsand brooding dispositions. The act of creating becomes, as Byrondescribed it, essential in its own right:

'Tis to create, and in creating liveA being more intense, that we endowWith form our fancy, gaining as we giveThe life we image, even as I do now.What am I? Nothing; but not so art thou,Soul of my thought! with whom I traverse earth,Invisible but gazing, as I glowMix'd with thy spirit, blending with thy birth,

And feeling still with thee in my crush'd feeling's dearth.Te

If the experience of pain-as well as its re-creation and con-veyance, its control and transformation-is such an important, notto say integral, part of the artistic experience, what effect might theamelioration or treatment of it have on the creation of literature.art, and musicP I{ as Edel says, "Out of world-sadness, out oftristimania, immortal and durable things are brought into being,"ethen what would fuel the artist who was cured of his anguishP "Theworld," wrote Nathaniel Hawthorne, "owes all its onward impulsesto men ill at ease. The happy man inevitably confines himseH

TI{EIRLMA STORM WHEREONTHEY RIDE 1-86

within ancient limits."sr Do modern psychiatric treatments andfuture gene therapies risk confining artists to "ancient limits"? Thisis a highly controversial but fundamental issue, and one to whichwe return in the ftnal chapter. We end this section by simplynoting Paul Celan's words: "Wherever one went the world wasblooming. And yet despair gave birth to poetry."8z

In addition to the changes in mood and thought that are broughtabout by mania and depression (and the experiences-both goodand bad-gleaned from the pain intrinsic to melancholia), the lessdramatic, day-to-day aspects of the manic-depressive temperamentcan provide artistic advantage as well. For individuals who livewith moods that change often and intensely, life is a tempestuousexperience. The manic-depressive, or cyclothymic, temperament,carries with it the capacity to react strongly and quickly; it is, in abiological sense, an alert and excitable system. It responds to theworld with a wide range of emotional, perceptual, intellectual,behavioral, and energy changes, and it creates around itself boththe possibilities and chaos afforded by altered experiences andfluctuating tempos. In a sense depression is a view of the worldthrough a glass darkly, and mania is a shattered pattern of viewsseen through a prism or kaleidoscope: often brilliant but generallyfractured. Where depression questions, ruminates, and is tenta-tive, mania iulswers with vigor and certainty. The constant transi-tions in and out of these constricted and then expansive thoughts,subdued and then violent responses, grim and then ebullientmoods, withdrawn from and then involving relationships, cold andthen ffery states-and the rapidity and fluidity of moves across andinto such contrasting experiences--{an be painful and confusing.Such chaos, in those able ultimately to transcend it or shape it totheir will, can, however, result in an artistically useful comfort withtransitions, an ease with ambiguities and with life on the edge, andan intuitive awareness of the coexisting and oppositional forces atwork in the world. The weaving together of these contrasting ex-periences from a core and rhythmic brokenness is one that is cru-cial to both the artistic and manic-depressive experience.

The cyclothymic lack of fixedness, a "delicate compass-needle

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so easily set-ajar,"83_resembles nothing so much as the poetic con-cepts of moblhtA and chameleon selves: "Mobilit6,,, *rlt" Byron,is "an excessive susceptibility of immediate impressions-at thesame time without losing the past; and is, though sometimes ap-parently,.rlseful to the possessor, a most painfuiand unhappy at_tribute."sa rn his poem Don Juan, Byron drew the distinctionbetween -a seeming "want of heart," or inconstancy, and an at-tribute of a highly responsive and impressionable te'mperament:

So well she acted, all and every partBy turns-with that vivacious versatility,

Which many people take for want of heart.They err-'tis merely what is called mobility,

A thing of temperament and not of art,Though seeming so, from its supposed facility;

And false-though true; for surely they're sincerest,Who are strongly acted on by what is nearest.s5

The amphibious, mercurial, many-personed, and highly respon-sive nature of both the artistic and manic-depressive temperamentsis at the core of what they are all about. Not without reason doesthe word "chameleon" permeate the descriptions of the artisticpersonality. Biographer Richard Holmes, for example, said of Cole-ridge that he had "essentially a chameleon gift, a gift for fluentadaptation and vivid response,"86 and Virginia Woolf wrote "youknow how chameleon I am _in my changes-leopard one day, allviolet spots; mouse today. "87 Keats, too, drew upon the chamele-onic metaphor, remarking: "Wtrat shocks the virtuous philosopherdelights the chameleon poet,'"88 and Shelley believed: "poets, thebest of them, are a very chameleonic race."8e Implicit to bothchameleonic and manic-depressive temperaments is the coexis-tence. within one

dualbody or mind, of multiple selves. The nature

of double orof double or dual personalities has a long history, of course, inboth literature and medicine. The depiction of a warring withinof different minds, personalities, emotions, and values reachedits height in the nineteenth century; the arbitrary and shiftingborders between the rational and irrational, the inhibited anduninhibited, were captured particularly well by Robert LouisStevenson in Dr. Jekyll and Mr. Hyde:

TIIEIR LIFE A STORM WIIDREON THEY RIDE 12,7

Man is not truly one but truly two. . . . I learned to recognize thethorough and primitive duality of man; I saw that, of the two naturesthat contended in the field of my consciousness, even if I couldrightly be said to be either, it was only because I was radicallyboth. . . . I had learned to dwell with pleasure, as a beloved day-dream, on the thought of the separation of these elements. If each,I told myself, could be housed in separate identities, life would berelieved of all that was unbearable. . . . It was the curse of mankindthat these incongruous faggots were thus bound together-that inthe agonised womb of consciousness, these polar twins should becontinuously struggling.m

Extreme changes in mood exaggerate the normal tendency to haveconflicting, or polar, selves; the undulating, rhythmic, and transi-tional moods so characteristic of manic-depressive illness and itstemperaments can also blend, or harness, seemingly contradictorymoods, observations, and perceptions. Yet, ultimately, these fluxesand yokings may more accurately refect the changes, ambiguities,and linked oppositions that truly exist both in man and the naturalworld. The "consistent attitude toward life," may not, as Professor

Jerome McGann points out, be as finally perceptive as an ability tolive with, and portray, constant change.er

Such clinical characteristics as changes in mood, thinking, en-ergy, and behavior are, as we saw earlier, usually opposite in maniaand depression. This is also true for linguistic and artistic patterns.Manic patients, for example, tend not only to speak more, andmore rapidly, but also to use more color l and powerful speech,including more action verbs and adjectives.e2 Artistic expressionalso changes across mood states.ea Manic patients tend to use vividand highly contrasting colors; depressed patients, on the otherhand, use primarily black and cold darker colors (when the depres-sion begins to clear, the palette tends to lighten accordingly). Thecontent of manic paintings tends to be more sexual, ftlled withmotion and bright portrayals of natural phenomena such as fires,waterfalls, and landscapes; in contrast, paintings done during thedepressed phase tend to show a paucity of ideas, a lack of motion,and themes of death and decay. Manic paintings, usually producedrapidly and impulsively, often have an agitated or swirling qualityto them; paintings produced by depressed patients are relativelybarren, painted slowly, and exhibit less imagination. The contrast-

I

188 TOUCIIED WITHFIRE

ing natures of the elated and depressive states provide, for thosewith artistic or literary ability, a rich variety of experiences andsensations from which to create. The explicit use of intense andopposite mood states was particularly pronounced in the Romanticpoets and composers. In his preface to the Dar:idsbiindlertriinze, apiano work illustrating the contrasting sides of his temperamentthrough abrupt alterations of mood and tempo, Robert Schumannwrote that "Joy and sorrow are inseparable all through life,"uechoing William Blake's words:

Joy & Woe are woven fine,A clothing for the Soul divine;Under every grief & PineRuns a joy with silken twine.e5

Samuel Clemens, who described his own "periodical and sudden

changes of mood . . . from deep melancholy to half-insane tem-

pests and cyclones,"e6 observed that the "secret source of humor is

not joy but sorrow,"eT reiterating years later that "there is no hu-

mor in heaven."es The simultaneous existence and shared resi-

dence of such opposite moods and feelings is well-illustrated by

Franz Schubert's assertion that whenever he sat down to write

songs of love he wrote songs of pain, and whenever he sat down to

write songs of pain he wrote songs of love' Virginia Woolf, in A

Room of One's Own, obsewed: "The beauty of the world . . ' has

two edges, one of laughter, one of anguish, cutting the heart asun-

der."se The ability to reconcile such opposite states, whether they

are of mood, thought, or vitality, is a critical part of any creative

act.lm Thomas Moore, himself a poet, described this ability in his

friend Byron:

It must be perceived by all endowed with quick powers of associationhow constantly, when any particular thought or sentiment presents

itself to their minds, its very opposite, at the same moment, springsup there also; if anything sublime occurs, its neighbour, the ridicu-

lous, is by its side; across a bright view of the present or the future,

a dark one throws its shadow; and, even in questions respectingmorals and conduct, all the reasonings and consequences that may

suggest themselves on the side of one of two opposite courses will, in

I TmIRLITEA sroRM wHEREoN TrmY RIDE 12eII

III such minds, be instantly confronted by an array just as cogent on the

I other. A mind of this structure,-and such, more or less, are all those

I i" which the reasoning is made subservient to the imaginative fac-

I ulty,-though enabled, by such rapid powers of association, to mul-

I Uply its resources without end, has need of the constant exercise of

I a controlling judgment to keep its perceptions pure and undisturbedI Uetween the contrasts it thus simultaneously calls up.rotIIIIII fhe cyclic and contrasting nature of manic-depressive illness is

I perhaps its most defining clinical feature. The recurrent and op-

I posite patterns so characteristic of the disease and its associated

I temperaments provide further possible connections between mood

I disorders and creative work. Likewise, the ebbing and flowing and

I seasonal quality to artistic "inspiration," the centrality of light, and

I the core themes of seasonal regeneration and life and death that are

I such part and parcel of artistic expression, bear inescapable resem-blance to the rhythmic changes of light and dark and the turning ofthe seasons so central to the natural world. Indeed, a strong argu-ment can be made that the periodicities of the natural world-aswell as its great beholdenness to light, its chaos, perturbances,agitations, and violence, its fluctuations, shadows, edges, and up-heavals-that all of these find their analogue in the periodicitiesand patterns intrinsic to the artistic and the manic-depressive tem-peraments. "The laws of nature he knows," wrote John Ruskinabout the imaginative artist; he knows them because "They are hisown nature."roz 15" artist, I believe, is closer to the fundamentalpulse of life because his or her daily and yearly rhythms are moresimilar to those of the natural world. The brinks, borders, andedges of nature-twilight and dawn in the course of a day, theequinoctial edges of autumn and spring during the course of ayear-may actually be experienced quite differently by those whoare artistic and/or cyclothymic by temperament. In fact there is anaccumulation of evidence to suggest that those who have manic-depressive illness or a cyclothymic temperament show an elevatedresponsiveness and sensitivity to changes in light; there is alsostrong evidence that mood disorders have a pronounced seasonalcomponent.

fi]UCIIED WITIIFIRE

Life is partition_ed by tim+years, months, days, minutes_into events that tend to recur at regular intervals, a'periodicity asevident in the behavior of protozoa and iellyfish as in the sleepinghabits and other patterns of hrr-"r, behavior. Biological function-ing is organized into periods linked to the rotations of the eartharound the sun and of the moon around the earth. Although bio-logical rhythms cycle in synchrony with these celestial ,h'ythms,they_are clearly regulated by endogenous processes. These innaterhythms probably evolved as adapiations L rhythmic fluctuationsin Earth's lighting, heat, and humidity, and perhaps Earth's elec-tromagnetic ffelds as well. such evolutionary explanations for thelngins of biological rhythms are controversial, Lut there is littledisagreement that such oscillatory processes serve to regulate lifeon the cellular, biochemical, physiological, and probabl"y psycho_logical levels as well.

Rhythmic patterns and disturbances in manic-depressive ill-ness €re clinically apparent in many ways: diurnal variations inmood, pervasive disruptions in sleep, and seasonal recurrences ofepisodes. The illness is itself an important kind of rhythm. Dailyoscillations in mood are a common feature of mood disorders andhave been noted clinically for centuries. British psychiatrists w.Mayer-Gross, E. slater, and M. Roth have described the diurnalpattern commonly observed in depressed patients:

An important and significant symptom of the endogenous depres_sion-but also of mania-is the daily fluctuaf.ion of mood and of thetotal state. Improvements of all symptoms usually oceurs towardsevening, the retardation and depressive mood particularly showing achange for the better. In the morning, however, the paiient wakesdirect from sleep into his characteristic sombre mood o, is normal fora few minuJes, before, as he says, the depression comes down ..likea cloud."rm

lhe very cyclicity of manic-depressive illness constitutes a type of4yth*. The episodic nature of the illness, together with its circa-dian disturbances, probably indicate malfunctions in a master bio-logical clock. Findings from experimental treatments, such asaltering sleep and light patterns in patients with depression andmania, point in the same direction. Drs. Thomas Wehr and Fred-

TIIEIRLIFE A STORM WIIEREON THEY RIDE

erick Goodwin of the National Institute of Mental Health note:"Because of its inherent cyclicity, the illness itself is a kind of

abnormal biological rhythm spanning weeks, months, or years.

Circadian rhythms are implicated in some of the symptoms of de-pression, such as early awakening and diurnal variation in mood'The possible importance of the circadian system in its pathogenesisis suggested by the capacity of experimental alterations in the tim-ing of sleep and wakefulness to alter clinical state."roa Biologicalrhythms range in frequency from milliseconds to months or years.Most rhythmic disturbances identified in the symptoms of manic-depressive illness occur over the course of a day-that is, they arecircadian rhythms-and are most apparent in the daily rest-activitycycle. The episodic recurrences of the illness, on the other hand,are usually infradian, oscillating over periods of months or years.Episodic mania and depression may also refect disturbances inultradian rhythms, those that oscillate more than once a day, whichare common at the cellular level and in hormone secretion, as wellas in such autonomic functions as circulation, blood pressure, res-piration, heart rate, and in the cycles of sleep.

More than two thousand years ago Hippocrates observed thatmania and melancholia were more likely to occur in the spring andautumn,lo5 and Posidonius, in the fourth century,L.o., noted thatmania tended to occur most frequently in the summer months. rffi

Toward the end of the eighteenth century, French psychiatristPhillipe Pinel described seasonal patterns in intermittent insan-ity;lo7 more recently, Kraepelin, writing about manic-depressiveillness earlier in this century, described his clinical experience withseasonal patterns of mood: "Repeatedly I saw in these cases mood-iness set in in autumn and pass over in spring:

'when the sap shoots

in the trees,' to excitement, corresponding in a certain sense to theemotional changes which come over even healthy individuals at thechanges of the seasons."rm Modern research bears out these earlyobservations. I recently reviewed the scientific literature for sea-sonal patterns in mania, depression, and suicide (see figures 4-land 4-2). The review of studies of seasonal patterns for peakmonths of occurrence for episodes of mania and depression indi-cates that there is a consistency of findings despite the method-ological problems intrinsic to such research. r@ Two broad peaksare evident in the seasonal incidence of major depressive episodes:

TOUCIIDD WITHFIRE

q)

E

v)

o 2a)

z

Figure 4-Lseasonal variations in peak occurrences of Mania and Depressfun

Mania

souRcn: Based on review of studies of peak months for the onset of episodes and./or hos-pitalizations, in F. K. Goodwin and K. R. Jamison, Manic-Deprissdoe Illnass (NewYork: Oxford University Press, lgg0).

4

oE" E J.A

o4 r

zI

0

TIMIR LIFE A STORM WHEREON THEY RIDE

Figure 4-2.

souncE: Based on review of studies of monthly peak occurrences of suicide, in F. K.Goodwin and K. R. Jamison, Manic-Depressioe lllrcss (New York: Oxford UniversityPress, 1990).

spring (March, April, May)and autumn (September, October, andNovember). The data on mania are somewhat more scarce, but thepeak incidences clearly occur in the summer months, as well as inthe early fall. Studies show signiffcant correlations of hospital ad-missions for mania with monthly total hours of sunshine and aver-age monthly day length; results are inconsistent with respect toenvironmental temperature. Seasonal patterns in suicide (see fig-we 4-2) generally parallel those for depression in that they show alarge peak in the spring (especially in May). The second suicidepeak in October may reflect an increase not only in depressiveepisodes but also in bipolar depressions following the increase in

M I I A S O N DMonth

SeasonolVarintion in Peak Occurrences of Suicifu

TOUCIIDD WITHFIRE

manic episodes during the summer months; that is, it may repre_sent suicidal postmanic depressions. consistent with the assump-tion that patterns of lighr are important in mood changes andsuicide, two studies carried out in the souther" H"-irprr"ie (eus-tralia and New South wales) found that the ,""ro"*ri,iof suicidewas consistent with the pattern seen in the Northern Hlmisphere;that is,..peaks of suicide occurred in the Australian -orrtr* orspling. rro It is important to note that both figures a-i and a-2reflect a sumrrurra of studies of peak occurrences; thus, althoughdeoressive episodes and suicideJ certainly occur i., juty, argurt,arrd september, few of the studies found ihat th" p"it ^o,,tt , to,their occurrence were during that time. Likewise, mania not in-frequently occurs in octobei and March, but these are not themonths of maximum occurrence across studies.

The light-dark, cycle is, for our purposes here, the principalseasonal variable of interest. The oveiall iength of the photop"riodhas two extremes (it is longest in the summer and shortest in thewinter), whereas the rate of change in the ratio of right to dark hastwo peaks, one in late winter-early spring, and thJ other in ratesummer-early fall (these peaks occur because of the elliptical orbitof the earth around the sun). Thus, if manic-depressive p'atients areabnormally sensitive to seasonal light changes-, one wiuld expectthat this would be reflected either by opporit" behavioral patternsat the two extremes (winter and summer) or behaviorai distu.-bances in early spring or early fall, reflecting the period of rapidlyincreasing light and rapidly decreasing light, respectively. Re-search findings show that patients with manic-depressive illn"r,do, in fact, have an increased sensitivity to light.rlfThi, increasedsensitivity is found in both the ill and well states and has also beenfound in children who have not yet shown symptoms of manic-depressive illness but who are atincreased risk iorlt because eitherone or both parents has the disease. llt This suggests that increasedsensitivity to light may be part of the genetic vulnerability to manic-depressive illness and that abnormal light sensitivity in manic-depressive patients is probably not simply a result of the illness butmay be more causally linked.

seasonal variations in mood and behavior appear to be com-mon in the general population as well as in individuals with mooddisorders. Dr. s. Kasper and his associates have found that at least

\

TIMIRLIIE A STORM WHEREONTHEYRIDE

90 percent of the general population experiences some degree of

seasonal variation in mood.rr3 Dr. M. R. Eastwood and his col-

leagues compared the infradian rhythms of mood, sleep, anxiety,

and energy over a period of fourteen months in thirty patients with

mood disorders (twenty-five of whom had manic-depressive ill-

ness) with those of thirty-four healthy control subjects matched for

age and sex. They found that the majority of patients, and many ofthe healthy subjects, had infradian rhythms in mood, energy, andsleep; about half of these were seasonal:

The principal difference between patients and control subjects is theamplitude of cycles, and hence, affective symptoms may be consid-ered a variant of normal hedonic states. . . . Affective symptomsseem to be universal, with a periodic component that differs in de-gree rather than kind; the pattern ofcycles for ill persons is deffnedby amplitude. This makes affective disorder akin to hypertension anddiabetes, wherein a physiological variatrle shades into a pathologicalvariant. r14

Eastwood's group hypothesized that, because half the rhythmswere seasonal, "some infradian mood cycles may be driven or timedby meteorologic factors." They further suggested that a "hmilial

tendency toward depression may be the factor that determines theamplitude of the cycle." In addition to the many biological vari-ables that show seasonal patterns in fluctuation,rrs recent studiesshow that certain cognitive abilities in men, such as spatial-reasoning skills, are enhanced in the spring. This is assumed to bedue to the seasonal changes in testosterone levels.rr6 In the cur-rent psychiatric literature, recognition of a syndrome characterizedby the regular appearance of depressive, manic, or hypomanicepisodes at certain seasons of the year came less than a decade ago,when Dr. Norman Rosenthal and his colleagues, who were study-ing recurrent winter depressions (which were often followed bysummer hypomanias), published the original diagnostic criteria forseasonal affective disorder.trT Because 50 to 60 percent ofpatientswho have seasonal affective disorder also have at least one first-degree relative with depressive or manic-depressive illness, it isprobably part of the general spectrum of major mood disorders thatincludes manic-depressive illness.

TOUCIIED WTTH FIRE

Clearly, everyone experiences seasons and patterns of light; just asgl"j*ly, everyone experiences seasons and patternr oiiigiri q"n,differently. Individuals who have manic-dep'r"rriu" o, urtiri" r"*-peraments may share an uncommon sensitivity to seasonal fluctu-ations in light as well as pronounced changes in mood as a result ofthose fluctuations. whether these simirarities are due to the samebiological process is unclear, although other similarities u"*""r,the cyclothymic and artistic temperamenfs-'5 well as th" gr"attyincreased rate of manic-depressive and depressive illness in irritersand artists-make it likely that similar biological mechanisms maybe operating' In any event, the inexorable ihanging

"i iG-rr, p",-

terns, the passing of seasons, is one of the great and ai"ienithr*esof both life and art. Among the many poeti particularly sensitive tothese shifts was Delmore schwartz, *ho-i. addition to the othercomplexities of his liG and mind-was a manic-depressive:

As I looked, the poplar rose in the shining airLike a slender throat.And there was an exdtation of flowers.The surf of apple tree delicately foaming.

All winter, the trees had beenSilent soldiers, a vigil of woods,Their hidden feelingsScrawled and becameScores ofblack vines.Barbed wire sharp against the ice-white sky.Who could believe thenIn the green, glittering vividness of full-leafed summer?Who will be able to believe, when winter again beginsAfter the autumn burns down again, and the day iJashen,And all returns to winter and winter's ashes.Wet, white, ice, wooden, dulled and dead, brittle or frozen.Who will believe or feel in mind and heartThe reality of the spring and of birth,

In the green warm opulence of summer, and the inexhaustible vitalitvand immortality of the earth?rl8

THEIRLFEA STORM WHEREONTHEY RIDE

The progression of seasons is among the most commonlyused metaphors in art, signifying-among many other things-the passage of time, extremes and contrasts in the natural world,the cyclicity of life, the inevitability of death, belief in rebirth,and the impermanence, as well as the stages, of human life. So,too, seasons have become metaphorical for life, and for the cre-ative process itselfi its barren winters and hoped-for springs, andits mixed and disturbing seasons, so beautifully captured by T. S.Eliot in "Little Gidding":

When the short day is brightest, with frost and fire,The brief sun fames the ice, on pond and ditches,In windless cold that is the heart's heat,Reflecting in a watery mirrorA glare that is blindness in the early afternoon.And glow more intense than blaze of branch, or brazier,Stirs the dumb spirit: no wind, but pentecostal ftreIn the dark time of the year. Between melting and freezingThe soul's sap quivers. There is no earth smellOr smell of living thing. This is the spring timeBut not in time's covenant.rre

Relatively little systematic research has looked into the rela-tionship between changes in mood, including actual episodes ofmania or depression, seasonal patterns, and changes in artisticproductivity. The work that has been done shows a tendency forartistic productivity to increase during spring and autumn, butthere is clearly a wide variability across artists and writers. Italianpsychiatrist Cesare Lombroso, working toward the end of thenineteenth century, dated the production of hundreds of poems,novels, paintings, and musical compositions.r2o Despite manymethodological problems in Lombroso's work, it is both in-trinsically interesting as well as the first to attempt a systematiclook at seasonal patterns in creativity. I have plotted Lombroso'sffndings in figure 4-3, and it can be seen that he found peaks ofproductivity in the late spring and early fall. A few years ago Istudied seasonal patterns of mood and productivity in forty-sevenof Britain's leading writers and artists (the details of the study aregiven in chapter 3). r21 Mood and productivity ratings were ob-tained for a thirty-six-month period, and these were then analyzed

TOUCIIED WTTHFIRE

Figure 4-3.Seasonal Variati,on in Literary and Artistic Output

A M I I A S O N D

Month

souRcE: Based on data in Cesare I-ombroso, Pensiero e meteore, Biblioteca scientificainternazionalc, vol. 16 (Milan: Dumonlard, rg72); L'Honnw de G6nic (paris: Alcon.l88e).

separately for those artists and writers who had been treated fordepression or manic-depressive illness and those without a his-tory of treatment for mood disorders; these results are shown inffgures 44 and 4-5, respectively. productivity in both groupsshowed a tendency to peak in the fall or late fali and in tntav. rhetwo groups differed, however, in the relationship shown betweenmoods and productivity. Those artists and writers with a historyof treatment showed inversely related curves for summer produc-tivity and moods, whereas those in the group with no history oftreatment showed mood and productivity curves that more

THEIRLIFE A STORM 1VTIEREONTIIDY RIDE

Figure 44.Mean Mood and ProductioitE Ratings (for Thirtu-six Months) in British

Writers and Artists with a History of Treatmcnt for Depression or

souRcE: From K. R. Jamison, Mood disorders and patterns of creativity in British writersand artists, P sgchiatry, 52( 1989): 125-134.

closely corresponded with one another. In the group with a his-tory of psychiatric treatment, the peaks for productivity precedeand follow the mood peak by three to four months. There areseveral possible explanations for this. Elevated mood, when as-sociated with elevated productivity, is less likely to lead to theseeking out of treatment than low productivity associated with ahigh (or any other kind of mood). The elevated mood of the treat-ment group also probably reflects more true hypomania (that is,greater distractibility, irritability, increases in seeking out ofother people, and alcohol abuse) than does just an expansive, el-evated, and creative mood; this might well lead to less produc-tivity in the acute phase. In the group with no history oftreatment, the periods of increased mood and productivity may

139

bD

x

1.0

TOUCIIED WITI{FTRE

q 2.5il

>\

o€ z.o

I . D

Figure 44.Mean Mood and Productirsity Ratings (for Thirty-six Months) in British

writers and Artists with No History of Treahrunt for Depiession or

F M A M J A S O N D

souRcE: From K' R' Jamison, Mood disorders and patterns of creativity in British writersand artists, P sgchiatry, 52( 1989): 125-134.

represent a milder form of hypomania (or simply an intensifica-tion of normal mood), with cognitive and mood changes only.These milder states may result in simultaneous peaks for moodand productivity. Within the total sample, playwrights showedthe least seasonal fuctuation in their productivity and had no dis-cernible monthly peaks. Poets, novelists, and visual artists, onthe other hand, showed pronounced seasonal patterns. The poetsand novelists reported that their greatest artistic productivity oc-curred during September, October, and November; the paintersand sculptors exhibited not only the fall peak (although Septem-ber and October only) but one in the spring (April, Ma11 and|une) as well.

1.0

M anic -D epre s sioe Illne s s

\

TIMIR LIFD A STORM WHERDON THEY RIDE t41

Every artist and writer has his or her own pattern of moodsand creative energies; some will have reasonably little variation inhow and when they produce what they do, and some will havewide seasonal or other swings in their productivity: months oryears when they produce next to nothing and then weeks or monthsduring which they are phenomenally active. English poet JohnClare, for example, wrote that "the Muse is a fickle Hussey withme she sometimes stilts me up to Madness & then leaves me as abeggar by the way side with no more life than whats mortal & thatnearly extinguished by mellancholy forbodings. "rz Here webriefly look at seasonal patterns of productivity in the work ofVincent van Gogh and Robert Schumann's lifelong productivitypatterns.

Vincent van Gogh has been diagnosed as having had virtuallyevery illness known to man, and then some. Diagnoses have in-cluded, among many others, epilepsy, schizophrenia, absinthe poi-so,ning, porphyria, and M6nidre's disease. Dr. Richard Wyatt,chief of Neuropsychiatry at the National Institute of MentalHealth, and I have argued elsewhere that there is compellingevidence for a diagnosis of manic-depressive illness.l23 The evi-dence includes the nature of van Gogh's psychiatric symptoms(extreme mood changes, including long periods of depression andextended episodes of highly active, volatile and e*cited states,altered sleep patterns, hyperreligiosity, extreme irritability, vi-sual and auditory hallucinations, violence, agitation, and aicoholabuse), the age of onset of his symptoms (htl adolescence, earlytwenties), his premorbid personality, the cyclic nature of hisattacks, which were interspersed with long periods of highly lucidfunctioning, the lack of intellectual deterioration over time. theincreasing severity of his mood swings, the seasonal exacerbationsin his symptoms, and his quite remarkable family history ofsuicide and psychiatric illness. (This is documented more exten-sively in chapter 6. His brother Theo suffered from recurrentdepressions and became psychotic at the end of his life: his sisterwilhelmina spent forty years in an insane asylum with a "chronicpsychosis," and his younger brother Cor committed suicide.)r2aAlthough the overlap between manic-depressive iilness and com-plex partial seizures (temporal lobe epilepsy) is an interesting

r42 TOUCIIED WTTH FIRE

one-and it is of no little interest that the director of the asylumat St. R6my diagnosed van Gogh as suffering from both epiiepsyand "acute mania with hallucinations of sight and hearini"r*:van Gogh's symptoms, the natural course of his illness, and hisfamily psychiatric illness are completely consistent with a diag-nosis of manic-depressive illness. Arguments against a diagnosisof M6nidre's disease or porphyria in van Gogh are presentedelsewhere and discussed more extensively in the endnotes forthis chapter. 126 Using what is known about the dating of vanGogh's artwork (which is considerable, due to van Gogh's exten-sive,documentation in his correspondence),'n' *. have illustratedin ffgure 4-6 the total number of paintings, watercolors, anddrawings done by van Gogh during different months of the year.The summer peak in productivity is consistent with what weknow about his own description of his frenzied moods and energyduring those months of the year, as well as with a perhaps nat-ural tendency to paint more in the longer, warmer, drier days ofsummer. Perhaps more interesting, however, is his pattern ofproductivity during the winter and late fall. From his letters itappears that van Gogh had relatively more "pure" depressive ep-isodes during November and February, and more "mixed" de-pressive episodes during December and January. The increasedagitation of these mixed states may well have resulted in bothmore energy, and more motivation, to paint. Van Gogh was thefirst to appreciate the episodic nature of his psychotic illness, hismoods, and his artistic productivity:

If the emotions are sometimes so strong that one works withoutknowing one works, when sometimes the strokes come with a con-tinuity and a coherence like words in a speech or a letter, then onemust remember that it has not always been so, and that in time tocome there will again be hard days, empty of inspiration.

So one must strike while the iron is hot, and put the forged barson one side.r28

The springtime peak of productivity that is shown in the worksof many writers and artists, as well as by those in both Lombroso'sstudy and my own, ffts with popular conceptions about the blos-

TIIEIR LtrD A STORM WHEREON THEY RIDE 143

Figure 44.Vincent oan Gogh. Total Number of Paintings and Drauings

bg Month, 188140

t I50o

z

J . F M A M I I A S O N D

Month

souRcE: Adapted from work summarized in K. R. Jamison and R. J. wyatt, van Gogh:Meniere's disease? Epilepsy? psychosis?, ,foz rnal of the Amzrican Medical Association,264 (199f ): 723-72,4. Copyright @ 19gl American Medical Association.

soming forth of life during springtime. But how do these ffndingsmake -sense in light of the striking peaks for severe depressiveepisodes, and suicide itself, during these same months? And whyshould_ so many artists and writers have another peak of produc-tivity during the autumn months? (This is shown in the works ofmany writers, as well as in the ftndings from both Lombroso,s andmy studies. Interestingly, there is some evidence that major math-

TOUCHED WTTH FIRE

ematical and scientiftc discoveries tend to occur during the springand fall as well. )'ee Indeed, autumn has been seen by many artistsas-their most inspiring season. John clare wrote, for example, that"the muses always pay their visits more frequent lsic] at that sea-Son,"r3o and Rosamond Harding quotes RoLert Burns as saying,"Autumn is my most propitious season, and I make more verses init than all year else"; likewise, George Crabbe declared: "Autumnis the most hvourable season of the year for poetical composi-tion."l3r One likely explanation for these equinoctial patterns inproductivity is that it is the rate of change of tight that is mostpronounced during these times, and it is also during these twoseasons of spring and autumn that there is a significant overlap inpeaks for not only depressive but manic episodes as well (this canbe seen clearly in ftgure 4-l).t"'Mixed states, where manic en-ergies and perturbance combine with melancholic mood, are morecommon during transitions into and out of mania and depression,and it may well be, as with van Gogh's fuctuations in productivityduring the winter months, that these mixed states (or their milderequivalents in those who do not have a mood disorderl-theseperiods of maximum change, contrast, and transition-are, in theirown way, highly conducive to creative work. Lucretius wrote cen-turies ago:

It is in autumn that the starlit dome of heaven throughout its breadthand the whole earth are most often rocked by thunderbolts, andagain when the flowery season of spring is waxing. In cold weatherthere is a scarcity of ffre, and in hot weather of winds, and then,too, the clouds are not so thick. So it is in weather between theseextremes that the various causes of the thunderbolt all conspire.Then the year's turning tide mingles cold and heat, which are bothneeded to forge a thunderbolt within a cold. Then there may be aclash of opposites, and the air tormented by ftre and wind maysurge in tumultuous upheaval. . . . These then are the year's cri-ses. ls

British psychiatrists Slater and Meyer undertook a fascinatinganalysis of Robert Schumann's compositional patterns and hismanic-depressive illness, not by months of the year but over thecourse of the composer's lifetime.r3a Schumann, as we shall seelater, suffered from episodic depressions and manias throughout

TIIEIR LITE A STORM WHEREON TIIEY RIDE 7JT5

most of his adult life. ,q.s he grew older, the more melancholicand taciturn side of his temperament became more prominent,no doubt a cumulative consequence of the relentless and devas-tating depressions he had been through. Figure 4-7 presentsSchumann's works by year, as well as his most clinically signifi-cant episodes of depression and mania. The quantitative relation-ship between his mood states and his creative output is quitestriking: When most depressed he produced least, and when hy-pomanic he produced at a remarkable level. The fluctuations inhis musical productivity over the years were extreme. The rela-tionship of his mood states to the quality of his productions issomewhat unclear, although both the quality and quantity of hiswork, as well as his psychological health, deteriorated in the finalyears of his life.

Not all writers, artists, or composers will show signiffcant sea-sonal or lifetime patterns of creative work; certainly not all of themwill show clear peaks of productivity in the spring and fall. Butmany do, and these ebbings and flowings provide a fascinating rinkwith the natural world on the one hand, and the ancient, persistentnotions about a "divine madness," on the other. Gaelic poet sorreyMaclean has written about life's fallow and then fertile times in"Glen Eyre," a poem from his collection Spring Tidc and NeapTid,e:

My life running to the seasthrough heather, bracken and bad grass,on its fanked eerie course,like the mean and shallow streamthat was taking its meagre way through a green patchto the sea in the Kyle,

But again and again a spring tide cameto put beauty on the river foot.to fill its destination with richness.and sea-trout and white-bellied salmon cameto taste the water of the high hillswith flood-tide in Inver Eyre. rs

No one better illustrates these tidal fluctuations in life, thedynamics of temperament, and the ffery intricacies of "that fine

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TIIEIR. LII:E A STORM WHEREON THEY RIDE tyt

madness" than the poet to whose life we turn next: George Gor-don, Lord Byron. It was he who had written the lines so importantto Robert Schumann and so finally descriptive of them both:

Look on me! there is an orderOf mortals on the earth. who do becomeOld in their youth, and die ere middle age,lVithout the violence of warlike death;Some perishing of pleasure-some of study-Some worn with toil-some of msls ti/s41ins55-Some of disease-and some insanity-And some of withered, or of broken hearts. 136

TI{E MII\D'SCAI{KER 11\ITS SAVAGE

MOOD

George Gordon, I,ord Byron

. . . the mind's canker in its savage mood,When the impatient thirst of light and airParches the heart; and the abhorred grate,Marring the sunbeams with its hideous

shade,Works through the throbbing eyeball to

to the brainWith a hot sense of heaviness and pain.

---{EORCE GORDON, LORD BYRONT

George Gordon, Lord Byron. Alain Moreau(Based on an original drawing by G. H. Harlow, l82l)

15O TOUCIIED WITH FTRE

"Lord Byron," declared the poet's tutor at Cambridge, "is a youngman of tumultuous passions,"2 thus summing up succinctly theviews of Byron's friends, enemies, and Byron himself. Fiery, fitful,and often high-spirited, with a temperament he described as "nat-urally burning,"3 Byron was by all means inflammable, his boldand expansive moods yoked to a restless, pervasive, and virulentmelancholy. Notoriously a study in contrasts, Byron, with his di-vided and mercurial temperament, resembled less a cohesive per-sonality than a field of tectonic plates clashing and grating againstone another. "There is a war," he wrote, "a chaos of the mind./When all its elements convulsed--combined-/Lie dark and jar-ring with perturbed force."a For virtually all his life, Byronengaged in such a war-a consuming civil war within his ownmind, which, then convulsing outward, at times was waged as ananything but civil war on the people and world around him. Fromthese wars came much of what made Byron who he was. "His verydefects," observed his close &iend and fellow poet Moore, "wereamong the elements of his greatness," and it was "out of the strug-gle between the good and evil principles of his nature that his

*l

ffi

THD MIND'S CANKERIN ITS SAVAGE MOOD 151

mighty genius drew its strength. "s Byron was the first to recognizethe importance of his unsettled, impetuous, and romantic temper-ament. In l8l3 he wrote to his future wife, Annabella Milbanke:"-You don't like my'restless' doctrines-I should be very sorry ifgou did-but I can't stagnate nevertheless-if I must sail let it beon the ocean no matter how stormy-anything but a dull cruise ona level lake without ever losing sight of the same insipid shores bywhich it is surrounded.-"6

The conflicting factions of his temperament, interlaced withand beholden to his constantly shifting moods, gave rise to thesense that Byron housed within himself a veritable city of selves.One of his physicians described this mutability:

Those only, who lived for some time with him, could believe that aman's temper, Proteus like, was capable of assuming so many shapes.It may literally be said, that at different hours of the day he meta-morphosed himself into four or more individuals, each possessed ofthe most opposite qualities; for, in every change, his natural impet-uosity made him fy into the furthermost extremes. In the course ofthe day he might become the most morose, and the most gay; themost melancholy, and the most frolicsome , . . the most gentle beinein existence, and the most irascible.T

Byron himself, who had written in Don luan that "I almostthink that the same skin/For one without-has two or three with-in,"8 remarked to his friend Lady Blessington, "I am so change-able, being every thing by turns and nothing long,-I

"* ,o"h ^

strange milange of good and evil, that it would be difficult todescribe me."e She clearly concurred:

I am sure, that if ten individuals undertook the task of describingByron, no two, of the ten, would agree in their verdict respectinghim, or convey any portrait that resembled the other, and yet thedescription of each might be correct, according to his or her receivedopinion; but the truth is, the chameleonlike character or manner ofByron renders it difficult to portray him.l0

Byron's chameleonlike qualities, along with the widely dispa-rate aspects of his personality, were critical to the moody, contrast-ing, and Romantic casting of his poetry: Man was "half dust, half

TOUCIIED WITH FIRE

deity, alike unfit/To sink or soar,"rl a "mix'd u.r"rrce,"l, a..conflictof elements."l3 Melancholic, although often sardonic, mixtures of'emotions-foreboding, aloneness, regret, and a dark sense of lostdestiny and ill-used passions-ar" *or"r, throughout Byron,s mostautobiographical poems, especially chltde Hirold's pilgrimage,I4ra, ayd Manfred. Perturbed and constant motion, co,rpled witha brooding awareness of life's impermanence, also mark^the t.an-sient and often bleak nature of Byron's work.

The emphasis on shifting essences, uncertainty, and ffercelycontrasting opposite states was, of course, neither new nor uniqueto Byron. He and the other Romantic poets, however, took iheideas and emotions to a particularly intense extreme. shelley'sbelief that poetry "marries exultation and horror, grief and plea-sure, eternity and change,"ra and that it "subdues to union. ,rnd",its light yoke, all irreconcilable things,"rs was in sympathy not onlywith the views of Byron but those of Keats as well.

''Negatiae

capabilitg," wrote Keats, exists "when a man is capable of being inuncertainties, Mysteries,_doubts, without any irritable reachingout after fact & reason."l6 The "poetical Character," he said:

has no self-it is every thing and nothing-It has no character-itenjoys light and shade; it lives in gusto, be it foul or fair, high or low,rich or poor, mean or elevated-It has as much delight in conceivingan Iago as an Imogen. What shocks the virtuous philosop[h]er, de-lights the camelion Poet. It does no harm from its relish of the darkside of things any more than from its taste for the bright one; becausethey both end in speculation.rT

This mobility and mutability of temperament so intrinsic tothe creative process was discussed at some length in the lastchapter. Here our focus is on the intensity, changeability, andcomplexity of Byron's temperament, its relationship to his manic-depressive illness, and Byron's quite extraordinary ability to har-ness and then transform the "storms whereon he rode."r8 Many ofByron's critics have assumed that much of what he wrote about-especially his tortured emotional states-was melodramatic, self-dramatizing, and posturing. It is the contention here that Byron infact exerted a quite remarkable degree of control over a troubled,often painful existence, and that he showed an uncommonly ex-

THE MIND'S CANKER IN ITS SAVAGE MOOD

pressive style, wit, and courage in playing out the constitutionalcards he was dealt.

"There are some natures that have a predisposition to grief, asothers have to disease," remarked Bvron:

The causes that have made me wretched would probably not havediscomposed, or, at least, more than discomposed, another. We areall differently organized; and that I feel, acutely is no more my fault(though it is my misfortune) than that another feels not, is his. Wedid not make ourselves, and if the elements of unhappiness aboundmore in the nature of one man than another, he is but the moreentitled to our pity and our forebearance.le

Byron suffered greatly from his "predisposition to grief," andoften feared that he was going mad. He wrote and talked aboutsuicide and actively engaged in a life-style likely to bring about anearly death; &om a medical point of view, his symptoms, familypsychiatric history, and the course of his illness clearly fft thepattern of manic-depressive illness.

Symptoms consistent with mania, depression, and mixed states areevident in the descriptions of Byron given by his physicians,friends, and Byron himself. His mood fluctuations were extreme,ranging from the suicidally melancholic to the irritable, volatile,violent, and expansive. Symptoms of depression included ennui,despair, lethargy, and sleeplessness. He thought of suicide anddiscussed it with others, to the extent that his friends and wife wereat times concerned that he would take his own life. To a degree hesaw his involvement with the Greek independence cause as a prob-able road to death, and it is likely that had he not died in Greecehe would have killed himself in another way. His erratic ftnancialbehavior was in a class by itself and-taken together with hisepisodic promiscuity, violent rages, impetuousness, restlessness,risk taking, poor judgment, and extreme irritability-it constitutesa classic presentation of manic behavior. Although there is no clearevidence that Byron suffered from either hallucinations or delu-sions, these are not a necessary component for the diagnosis of

153

TOUCHED WTTH FIRE

mania. Byron's irritability and rage often existed within the contextof a melancholic mood, which is consistent with the diagnosis ofmixed states (coexisting symptoms of mania and depressiin).

The clinical hallmark of manic-depressive illness is its recur-rent, episodic nature.2o Byron had this in an almost textbook man-ner, showing frequent and pronounced fluctuations in mood-energy,_sleep patterns, sexual behavior, alcohol and other druguse, and yeight (Byron also exhibited extremes in dieting, obseslsion with his weight, eccentric eating patterns, a.rd e"cessive use ofepsom salts). Although these changes in mood and behavior weredramatic and disruptive when they occurred, it is important to notethat Byron was clinically normal most of the time; this, too, ishighly characteristic of manic-depressive illness. An inordinateamount of confusion about whether someone does or does not havemanic-depressive illness stems from the popular misconceptionthat irrationality of mood and reason are stable rather than fluctu-ating features of the disease. some assume that because an indi-vidual such as Byron was sane and in impressive control of hisreason most of the time, that he could not have been "mad" or havesuffered from a major mental illness. Lucidity and normal func-tioning are, however, perfectly consistent with-indeed, charac-teristic of-the phasic nature of manic-depressive illness. This is incontrast to schizophrenia, which is usually a chronic and relativelyulrelenting illness characterized by, among other things, an in-ability to reason clearly.

The diagnosis of manic-depressive illness in Lord Byron isgiven further support by other aspects ofthe natural course ofhisillness. Byron first wrote about his melancholic moods while still aschoolboy at Harrow; this is consistent with what is well knownabout manic-depressive illness, that its ffrst symptoms tend to oc-cur in adolescence or early adulthood.2r It is not uncommon for theunderlying mobility of temperament to be apparent even earlier,and this also was the case with Byron. Manic-depressive illness isfrequently seasonal as well, with depressive episodes more com-mon in the winter months and around the time of the vernal andautumnal equinoxes, and mania more common in the summer.2z Inaddition to experiencing "september melancholias," which he de-scribed to his mistress Teresa Guiccioli, Byron appears to have hada tendency toward both winter depressions and mixed states. Au-

TIIE MIND'S CANKDRIN ITS SAVAGE MOOD

gust, for Byron, was often a time of extreme irritability, wratMul-ness, and irrationality. In manic-depressive illness such statesftequently are followed by depressive ones, and this would beconsistent with Byron's observations that Septembers "kill withtheir sadness." Mood disorders, in addition to exhibiting seasonalpatterns, frequently show pronounced diurnal rhythms as well.Byron described the most common form of this, being depressed inthe morning and showing improved mood and increased energy asthe day progressed. Yet another feature of the natural course of thedisease, and probably the most important, is that manic-depressiveand recurrent depressive illness, left untreated (or inadequatelytreated), often worsen over time; that is, the episodes of mania,depression, and mixed states tend to occur more frequently, bemore severe, or last longer.a This was true for Byron.

Finally, and especially compelling in a genetic illness, Byronhad a family history remarkable for its suicide (in itself more likelyto be associated with manic-depressive illness than with any othercondition), violence, irrationality, financial extravagance, and re-current melancholia. All these are common features of manic-depressive illness. Byron himself was the ffrst to believe in theconstitutional basis of his illness and temperament: "It is ridicu-lous," he remarked to Lady Blessington, "to say that we do notinherit our passions, as well as . . any other disorder,"% and toTeresa Guiccioli he wrote, "My melancholy is something temper-amental, inherited. "25 To his publisher lohn Murray, he stated, "Iam not sure that long life is desirable for one of my temper &constitutional depression of Spirits. "zo Lady Byron, who ultimatelysued Byron for separation on the grounds that he was insane,wrote: "The day after my marriage he said,

'You were determined

not to marry a man in whose family there was insanity.l. . .-'Youhave done very well indeed,'or some ironical expression to thateffect, followed by the information that his maternal grandfatherhad committed suicide, and a Cousin . . . had been mad, & set ffreto a house."27

Lord Byron's morbidly excitable temperament was indeed analmost inevitable inheritance, far more so than that of his title andproperties. For the latter he was obliged to the quirk of the earlydeath of more probable heirs; for the former, he was the recipientof genes passed down inexorably by generations of violent, reck-

I'D

TOUCIIED WIrIIFIRE

less, suicidal, and occasionally insane ancestors. In lgg0 one ofByron's biographers noted: "Never was poet born to so much il-lustrious, and to so much bad blood,"26 a sentiment shared byByron scholar Leslie Marchand. "The Byrons," declared March-and, "seem to have grown more irresponsible with each genera-tion, until the summit'of social irregularity is reached in thecharacter and conduct ofthe great-uncle and the father ofthe poet,if not indeed in the poet himself."2s Byron's maternal side, theGordons of Gight, displayed, he wrote, "a startling record of vio-lence rare even in the annals of scottish lairds,; presenting "aspectacle of unrestrained barbarity. ":o

-certainly, the Byrons were an ancient and notorious family inEngland-among other things, by the mid-seventeenth century, itwas being written, "Is't not enough the Byrons all excell,/As muchin loving, as in fighting well?"3r In the late seventeenth century,Margaret Fitzwilliam, wife of sir John Byron and mother of thefirst and second Lords Byron, "went out of her mind and neverrecovered her reason."32 Lady Margaret was described as a womanof "rare talent and beauty, skilled in the composition of music andpoetry,"33 and it was said that "her ravings *"r" -or" delightfulthen [sic] other women's most rationall conversations."s From itsdescription, and because the breakdown occurred following child-birth, it is possible that what she experienced was manic-depressivepsychosis. The genes, however, do not appear to have been passedon down through the branch of the family tree leading directly toGeorge Gordon Byron, the poet. The true dissipation, eccentric-ity, ffnancial chaos, and wildness of temperament appear to havebeen brought into the bloodlines at a quite speciffc point in theeighteenth century. ln 1720 William, the fourth Lord Byron, anamateur artist who had studied under the Flemish painter peterTillemans, married for a third time. It was this wife, Frances,daughter of Lord Berkeley and great-grandmother of the poet, whoseems to have been largely responsible for bringing the "taint ofblood" into the Byron line.35 She and the fourth Lord Byron hadfive children who survived into adulthood. The eldest, Isabella,who showed strong interests in art and literature, had "manymoney difficulties,"36 was "distinguished for eccentricity of *arr-ners,"37 and exhibited "peculiar conduct"3s which "r*"it"d

"o--ment even in that golden age of eccentrics. "3e The youngest child,

TIIEMIND'S CANKE,RIN ITS SAVAGE MOOD

George, showed "neither marked eccentricity nor blameless re-spectability,"ao and Richard, the next youngest, was a clergymanand amateur artist hallmarked by his "undeviating respectabil-ity."ar In striking contrast to the younger Byrons, however, wasthe eldest son and heir to the title, William, who became thefffth Lord Byron. Known as the Wicked Lord, he was renownedfor his extravagances, strange behavior, and violent temper. In1795, after a relatively minor dispute, Byron killed his cousin andwas brought to trial in the House of Lords. He was found guiltyof manslaughter but acquitted of murder and allowed to return toNewstead Abbey, the Byron family seat in Nottinghamshire. Likehis grandnephew the poet, the fifth Lord Byron was easily in-flamed. Enraged at his son, who-having inherited his father'sffnancial irresponsibility but not his willingness to marry formoney-eloped with his cousin (he, like several other Byrons,married ffrst cousins, thus hopelessly muddling the attribution ofinheritance patterns, or acquired traits), the Wicked Lord did ev-erything possible to insure that little of worth passed on to hisheirs. His singularity of purpose and peculiarity of style were de-scribed by biographer Andr6 Mauroisr

He paid his gambling debts with the oaks of the park, felling ffvethousand pounds' worth and stripping his marvelous forest nearlybare of timber. . As a ftnishing touch in the spoliation of his son,Lord Byron killed two thousand seven hundred head of deer in thepark, and granted a twenty-one years'lease ofthe Rochdale estate,where coal-seams had just been discovered, at the ridiculous rentalofsixty pounds a year.

His pleasures were those of a mischievous child. He would godown in the dark and open sluice-gates on the streams in order todamage the cotton mills; he emptied his neighbours'ponds; and onthe edge of his ovm lake he had two small stone forts constructed,with a feet of toy ships which he used sometimes to launch. Hewould spend whole days directing naval battles between tle vesselsand the forts; they ftred on each other with miniature cannon. LordByron crouched in one of the forts, while his manservant, Joe Mur-ray,lay stretched in a boat commanding the feet. Sometimes, again,his lordship would lie on the stone fags of the Abbey kitchen andamuse himself by staging races of cockroaches up and down his ownbody, fipping the insects with straws when they were sluggish.az

r57

TOUCIIED WTTII FIRE

The wicked Lord, in fact, outlived both his son and his grandson;when he died in l7g8 he passed on not only his title to i'is gr"rrd-nephew, the future poet, but his financial ihambles as well.

John ("Foulweather Jack") Byron, the fifth lord's brother andGeorge Gordon's grandfather, became a vice admiral in the BritishNavy and wrote one of the classic books about shipwreck; portionsof his adventures, in altered form, found their way years late. intoByron's great poem Don Juan. Although little hai been writtenabout any emotional difficulties Admiral Byron might have expe-rienced, a suggestive comment about a possible "bieakdown" irasbeen made by Byron genealogist violei walker. she notes thatByron declined, for "health reasons," an appointment as second incommand in North America during the war of Independence, anda few years later was the subject of a concerned letter written by afellow officer; included in the latter's report was the observation:"since I wrote to your Lordship concerning Mr. Byron, I learn thatthis unfortunate man was struck with disorder and disease thatdeprived him of his reason."as Admiral Byron, like his nephew,had married a first cousin; of particular interest here, she was thedaughter of the sister of Frances, Lady Byron, the wife of thefourth Lord Byron and the one thought responsible for insertingthe "family madness" into the Byron line. Sophia Trevanion, Ad-miral Byron's wife and therefore the poet's paternal grandmother,appears to have had a rather vivacious and mercurial temperamentherself. Dr. Johnson wrote, after meeting her, "poor Mrs. Byron isa feeler,"aa and her friends "all agreed that she had too muchsensibility, was very much up and down;"4s she was, as A. L.Rowse said about both her and her famous grandson, a "trueCelt."46

In 1756 the first son of these two cousins (Sophia Trevanionand Admiral Byron), Byron's father, was born. fohn ("Mad Jack")Byron soon made the gambling debts, ffnancial mayhem, and over-all level of dissipation of his uncle the Wicked Lord seem subduedby comparison. Charming, goodJooking, and ebullient, he servedbriefy in America with the Coldstream Guards before returning tothe social whirl of London. There he met the wife of the futureDuke of Leeds, and an heiress in her own right. After a scandalousaffair and her subsequent divorce, they married, moved to France,and had several children. The only child to survive infancy, Au-

TIIE MIND'S CANKER IN ITS SAVAGE MOOD

gusta, was the poet's half-sister and great love. (In the Byron tra-dition, Augusta married their first cousin, George Leigh, who wenton to have massive financial problems and gambling debts of hisown; two of their three sons and two of their daughters had severefinancial difficulties as well.aT [In addition, at least one of theirchildren, described as "mentally unbalanced," had to be removedfrom their home and taken care of elsewhere. ]) When his wifedied, Mad |ack, after accumulating even more debts, returned toEngland and married yet another heiress-this one Scottish-Catherine Gordon of Gight. He made rapid headway in spendingthis second fortune as well; eventually, a few years after the birthof their son, George Gordon, he moved back to France to avoid hiscreditors. He died young, dissolute, alcoholic, a victim of "hisrestless moods, his sensual appetites, his wild gaieties andglooms,"ae and a probable suicide.il

Byron's heritage from his mother's family was far more fterce,colorful, and dangerously unstable than the one from the spend-thrift, now and again rather eccentric Byrons:

The ffrst laird of Gight, Sir William Gordon, had been the son of theEarl of Huntly and Annabella Stuart, sister of King James the Sec-ond. But although the family history opened thus royally, a moretragic sequence of events could hardly be imagined, William Gordonwas drowned, Alexander Gordon murdered. John Gordon hanged forthe killing of Lord Moray in 1592, another John Gordon hanged in1634 for the assassination of Wallenstein-it seemed as if a Gordon ofGight had been strung up on every branch of their family tree.The sixth laird, a conscious evildoer, used to say: "I can tak'no rest.I know I will die upon a seaffold. There is an evil turn in my hand."5r

Several generations later, Alexander Gordon, the eleventh lairdand great-grandfather of Byron, died in a midwinter drowning thatwas almost certainly a suicide. Marchand quotes one skeptical re-sponse to a contemporary newspaper article (which had reportedthat the death was due to drowning while bathing)r "scotsmen in1760 had not become slaves to the tub so much as to induce themto bathe in ice-covered rivers in the depths of winter. "52 AlexanderGordon's son, the twelfth laird, George Gordon, also drowned; hisdeath was probably a suicide as well.s Years later his grandson the

159

TOUCITED IIITITFIRE

poet in describing the constitutional basis for his own melancholv.wrote:

You know-or you do nof know-that my maternar Grandfather (avery clever man & amiable I am told) was strongly suspected ofsuicide--{he was found drowned in the Avon at a.tit) u"d that an-other very near relative of the same branch_took poirorr_A *u,merely saved by antidotes.-For the ftrst of these .rre^nts*thure wasno apparent cause--as he was rich, respected,-& of considerableintellectual resources-hardly forty years of age-& not at all ad-dicted to any unhinging vice.-It *a, ho*"uei but a strong suspi_cion-owing to the manner of his death-& to his t"elancholytemper.s

- - Predictably, Byron's mother was left not altogether untouchedby the Gordon inheritance; described

", " *o-"n "full of the most

passionate extremes,"55 she was easily excited to rage and subjectto wildly swinging changes of mood. During his adollscence Byronoften confided in his half-sister Augusta about his mother's violentgood_s and unpredictable behavior: "My

_mother has lately be-haved to me in such an eccentri" *arrrr".,"56 he wrote while still astudent at Harrow, adding several days later, "Her temper is sovariable, and when inflamed, so furious, that I dread our meeting. . . she fies into a fft of phrenzy."'7 "Her method is so violent, socapricious," he continued, with traces of the wit that was to char-acterize so much of his writing and speech as he grew older, "thatthe patience of Job, the versatility of a membeiof the House ofCommons could not support it."58 The following year brought acontinuation of Byron's outcries about his mother's behavioi andtemperament: "she is as I have before declared certainly mad . . .her conduct is a . . compound of derangement and Folly";se shewas' he complained, his "tormentor" whose "diabolicaldiiposition. seems to increase with age, and to acquire new force withTime."m The combination of Byron's temperament with his moth-er's must have been an incendiary one, and Thomas Moore re-counts: "It is told, as a curious proof of their opinion of each other'sviolence, that, after parting one evening in a tempest . . . theywere known each to-go privately that night to the apothecaryisinquiring anxiously whether the one had been to purchase poison,

TIIE MIND'S CA.NKER IN ITS SAVAGE MOOD 161

and cautioning the vender of drugs not to attend to such an appli-cation. if made."6r

The mingling of the Byron and Gordon bloodlines was boundto raise the temperature of the already fiery gene pools. As we shallsee, Byron was the most immediate beneficiary of this coalescencebut inevitably the effects extended to Byron's descendants as well.Allegra, his illegitimate daughter with Claire Clairmont (stepsisterof Mary Shelley), died when she was only five years old and wastherefore far too young to show definitive signs of either theGordon-Byron temperament or any kind of serious mood disorder.It is suggestive, however, that Shelley quoted Byron as saying thathis daughter's temper was "violent and imperious,"62 and Shelleyhimself noted that "she has a contemplative seriousness whichmixed with her excessive vivacity . . . has a very peculiar effect ina child."63 In a letter to his sister, Byron observed that Allegra had"a devil of a spirit but that is Papa's."e Assessments of Allegra'stemperament must, due to her early death, remain highly specu-lative. Much more is known about Byron's one legitimate child,however. Ada Byron, later to become Ada, Countess of Lovelace,inherited from her mother-whom Byron early in their relation-ship had dubbed the "Princess of Parallelograms"-remarkablemathematical abilities. Described by eminent mathematician Au-gustus De Morgan as having the potential to become "an originalmathematical investigator, perhaps of first rate eminence,"6s Adaworked on Charles Babbage's calculating machine and earned forherself the designation of being the first computer programmer.(In 1980 the United States Department of Defense honored hercontributions by naming its computer programming languageADA.66)

From her father Ada inherited a mercurial temperament thatswung precipitously from the ecstatic and grandiose to the melan-cholic. She also acquired the Byron proclivities for gambling andfinancial chaos; at one point, convinced she had invented an infal-lible system for betting on horses, she suffered such severe lossesthat she was forced to pawn the Lovelace family jewels. It was hertemperament, however, by which she was most particularly herfather's daughter. Indeed, Byron, who although in exile followedher childhood as closely as he could, noted not long before he diedthat a description he had received of her disposition and tendencies

TOUCIIED WTrIIFIRE

u"ry nearly resembles that of-my own ata simirar age<xcept thatI was much more impetuous."67 Earlier, in his inirn"itable manner,h9 h1d. summed up his notion of the more diversified heaJwatersof Ada's temperament;

Her temper is said to be extremely violent._Is it so?_It is notunlikely considering her parentage. My temper is what it is-asyou_ may perhaps divine-and my Lady,s was a nice little sullennucleus of concentrated Savageness to mould my daughter upon,_tosa_y nothing of her two Grandmothers-both orwhori, to my knowl-edge were as pretty specimens of female Spirit_as yor, -igha *irhto see on a Summer's d"y.ut

Ada, like her father, was episodically charged with an,,awfulenergy & power" and a vastly conffdent "exhilaration of spirit;;6eher grandiosity, occasionally delusional in degree, rivaled ih"

"or-mic sweep of Poe and Melville. One of her biographers quotesAda, who had outlined her plans for taking on "thelylsteries of theuniverse, in a way no purely mortal lips or brains could do,,:7o

I intended to incorporate with one department of my labours a com-plete reduction to a system, of the principles & methods of discot:-ery, elucidating thesame with examples. r am already noting downa list of discoveries hitherto made, in order myself to examiie intotheir_history, origin, b progress. one first & main point, uhenerserb uhereoer I introduce the subject, will be to dzfini b to clnssifg allthat is to be legitimately included under the term d:iscooery. Herewill be a ffne field for my clear,logical b accurate, mind, to work itspowers upon; & to develop its metaphgsinal genius, which is not leastamongst its qualifications and characteristics.Tr

No wonder that Ada wrote elsewhere that "there is in my nervoussystem such utter want of all ballast & steadiness that I cannotregard my life or powers as other than precarious. "T2 The lack ofballast was refected also in her grandiose belief that she was "sim-ply the instrument for the divine purpose to act on 6 thro'. . , .Like the Prophets of old, I shall speak the ooice I am inspired with.I may be the Deborah,_the Elijah of Science."73 Doris LangleyMoore points out that Ada's swings from "transeendent elatiof' to"despair" were often only weeks, rather than months or years

TIM MIND'S CANKER IN ITS SAVAGE MOOD 163

apafi.z4 These rapid cycling mood swings were quite similar, in

many respects, to those experienced by her father. Her writing

during her melancholic moods occasionally bears an uncanny re-

semblance to his as well. In a letter to her mother she wrote:

I must refer you to Dr. Locock as to my present condition, for I amWHOLLY unable to write. . . . He will tell you how shattered &done for I at length am. Pray don't be angry with me for uhat I can'tdn. As long as lbadfeaer I could write, & had almost preternaturalpower. Now, this is all over. . . .

The least exertion, either mental or bodily, has effects now thatI never knew before . lnd repose is absolutely necessary.

. . . . Every power, mental & bodily, seems worn out.75

Ada, like her father and his father before him, died at the age ofthirty-six:

The child of love,-though born in bitterness,And nurtured in convulsion,---of thy sireThese were the elements.-and thine no less.76

Manic-depressive illness is the only medical diagnosis thatcould reasonably account for Byron's singular family history of sui-cide, tempestuous moods, violent melancholy, and erratic behav-ior-to say nothing of Byron's own symptoms and the worseningcourse of his depressions and rages. A few months before he diedByron. had a convulsive attack of some kind ("Epileptic-Para-lytic*<r Apoplectic is not yet decided by the two medical menwho attend ^"")," and this, in conjunction with Byron's violentrages, has been used as an argument that he may have sufferedfrom an epileptic or seizure disorder.T8 The attack was, however,the first in his life ("This is the ffrst attack that I have had of thiskind to the best of my belief. I never heard that any of my familywere liable to the same-though my mother was subject to hgs-terical affections")7e and almost certainly related to the ffnal illnessthat caused his death. The diagnosis ofa seizure disorder, such astemporal lobe epilepsy (or, complex partial seizures), would notaccount for Byron's pronounced family history of suicide and psy-chiatric illness, nor would it be the most explanatory diagnosis for

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TIM MIND'S CANKER IN ITS SAVAGE MOOD 165

his history of mood swings and the other symptoms so character-istic of manic-depressive illness.

The severity and pattern of Byron's moods, and their devas-tating effect upon his life, form part of the argument for a diagnosisof manic-depressive illness rather than cyclothymic tempera-ment alone. Yet Byron's temperament, coupled with his poeticgenius, made him who he was. Byron is perhaps alone amongEnglish writers in having a particular kind of temperament andpersonal style named for him. The "Byronic" has come to mean thetheatrical, Romantic, brooding, mock heroic, posturing, cynical,passionate, or sardonic. Unfortunately, these epithets suggest anexaggerated or even insincere qudity, and in doing so tend tominimize the degree of genuine suffering that Byron experienced;such a characterization also overlooks the extraordinary intellectualand emotional discipline he exerted over a kind of pain that bringsmost who experience it to their knees.

Byron's fiery and melancholic temperament at times crossedover the ffne line that separates illness from health. (This is anal-ogous to many other medical conditions-for example, diabetes,thyroid disease, and hypertension-in which the underlying pre-disposition flares up, from time to time, into acute disease. Suchexacerbations of ongoing metabolic and other states may be tem-porary and ultimately self-correcting, representing only short-termdiscomfort and possible danger, or they may be progressive and lifethreatening. But they can also be both, and manic-depressive ill-ness tends to fit this latterdescription.)In Byron's case aspects ofhis underlying temperament often worsened into periods of painfulmelancholia and disruptive, perturbed mental states; by the end ofhis life these periods of emotional distress began to outweigh pe-riods of health. His temperament also, however, made him exquis-itely responsive to virtually everything in his physical andpsychological world; it gave to him much of his great capacity forpassion and understanding, as well as for suffering.

George Gordon Byron was born in London in 1788, shortly afterhis parents' return from France, where "Mad ]ack" Byron hadtaken refuge from his creditors. Before young Byron was two, the

TOUCHED WITH FIRE

family moved to Aberdeen, where he and his mother stayed untir|-",i1h:.ia:d- his great-uncle's title and properties at the *g" of t"rr.-'Mad Jack," in the meantime, had ,eirrrrred to France ind diedbefore Byron was three. It seems clear that nyro"t1"*frr"_rrrtas a child was father to his temperament as a man. His friendMoore wrote that 'as

a chird his temper was viorent, or rathersullenly passionate";e hir was, he said, an "uncontroll"ui. ,oi.it.,,*.His schoolmasters in Aberdeen described him as "liveryj warm-hearted, and high-spirited . . passionate and r"r"n,f,rl,-Lut affec-tionate and c-ornpanionable . . . to a remarkabre degree venturousand fearless."82

Byron wrote later in his life: "I differed not at all from otherchildren, being neither tall nor short, dun nor witty . . . bufratherlively-except in my sullen moods, and then i *", always adevil'"83 Describing himself when he was about t"r, y""rr-old, hesaid: "They once (in one of my silent rages) *r"rr"h.i a knife fromme, which I had snatched from [the] table . . , and applied to myb1e-ast.'_84 By all accornts Byron alsomanifested

""rry " a"Jre and

ability fr'r deeply held friendships. Moore said: "of all the quali-ties, indeed, of his nature, affectionateness seems to have been themost ardent and deep,"Ss and his closest friend, John Cam Hob-house, wrote in his journal:

No man ever lived who had such devoted friends. His power ofattaching those about him to his person was such

", ,ro oi" I ever

knew possessed. No human being courd approach him without beingsensible of this magical influence. There was something command-ing, but not overawing in his manner. He was neither gi"u" no, g"yout of place, and he seemed always made for that company in whichhe happened to ffnd himself. There was a mildness and yet a decisionin his mode of conversing, and even in his address, *hich ur" seldomunited in the same person. ̂ He appeared exceedingly free, open, andunreserved to evervbodv.86

Most of the qualities in his temperament that made Byron who hewas-volatility, contradictoriness, and intensity of emotions; gen-erosity of impulse and money; caustic and occasionally bitter wit,usually followed by regret and softened by compassion; and astraightforwardness and honesty in dealing with emotional mat-

THE MIND'S CANKERIN ITS SAVAGD MOOD

ters-had been set in place by the time he was sixteen years old.He possessed, through his experience and understanding, a pierc-ing insight into the human condition and a broad understanding ofthe things that make human nature so especially human-love,envy, disappointment, aspiration, sex, revenge, vulnerability, andman's uneasy awareness of his own mortality.

Byron's proneness to melaneholy was evident even when hewas a schoolboy; while at Harrow, for example, he wrote to hissister of being "peevish and fretful,"87 thanking her for a letter that"acted as a cordid on my drooping spirits and for a while dispelledthe gloom."88 A year later he described his "idle disposition,""very bad spirits," and then continued, "I never was in such lowspirits in my life."8e His constitutional melancholy was joined bypainful self-consciousness about having been born lame. To Byron,taunted about it as a child in Scotland and then as a student inEngland, his deformity remained a source of bitterness and un-happiness throughout his life. Two examples of this, given by hisfriend Moore, are particularly poignanh

Seeing an unfortunate woman lying on the steps of a door, LordByron, with some expression of compassion, offered her a few shil-lings; but, instead of accepting them, she violently pushed away hishand, and, starting up with a yell of laughter, began to mimic thelameness of his gait. He did not utter a word; but "I could feel," saidMr. Bailey, "his arm trembling within mine, as we left her."s

In coming out, one night, from a hall, with Mr. Rogers, as they wereon their way to the carriage, one of the link-boys ran on before LordByron, crying, '"This way, my lord." "He seems to know you," saidMr. Rogers. "Know me!" answered Lord Byron, with some degree ofbitterness in his tone; '(every

one knows me-I am deformed."er

Byron took on and transformed his personal anguish; the followingpassage from his drama The Defonned Transformed captures thebelief that disadvantage and pain-both psychological and physi-cal-*often fuel action and drive excellence:

It is its essence ,;;'";,3.:tffi?,;;aatns'By heart and soul, and make itself the equal-

168 TOUCHED W]TH FIRE

Aye, the superior ofthe rest. There isA spur in its halt movements, to becomeAll that others cannot.e2

In october r80b Byron arrived at Trinity colrege, cambridge,where, if he "ever attended q lecture,,,*roi" orr" f,iogruph"r, ..hefound it too dull to mention.',n, H" dii, ho*"v"r,;;;;;;;;t deal,w-rite poetry, make friends, and lead an intermittentl/ dissolutelife. *I have been extravagant,"* h" wrote Augusta in Decemberof his first year, an underitated confession if ever there was one.His personal generosity, as well as his other intemperate firrurr"ialways, led him inevitably to moneyrenders and an Lver-increasingindebtedness- (by January r80g he had accrued debts ofg3,ooo, uythe end of that year he owed fr2,000; and by the time of hismarriage in 1815 he was at least 990,000 in debt).es During thefollowing years at cambridge and in London ttt"r"

"*tr"*gancesfftted into a larger pattern of frenzied activity and excesses of allkinds; this pattern, skeined with melancholy, *", purti"rriJy pro_nounced in the winter and spring. In fanuary rgdo he wrote Au-gusta that her attempts to "reanimate" his spirits would, "I amafraid, fail in their effort,"e6 and by the end of that y"*

"nJ into the

beginning of 1807, Byron was in ihe throes of "aliernate moods ofdepression, ambition, and reckless indulgenc"."nt ua t"tt"r, to t i,sister and friends throughout his cambridge and early Londonyears confirm this. In February he wrote to a close friend fromHarrow days, "I have recovered every thing but my spirits, whichare subject to depression"nt; two months later he ;"; to anotherfriend, "Nature stampt me in the Die of lndffirence. I-considermyself as destined never to be happy, althoug[ in some instancesfortunate. I am an isolated Being on the Eai=th, without a Tie toattach me to life."ee

Life never remained entirely bleak for Byron, however. In fall1807,- h"yng been told that regulations would not allow him tokeep his dog at cambridge, he acquired a tame bear-there beingno rule forbidding bears-and housed it in the turret of his colleglrooms' His pleasure in the bear, which he walked through thestreets ofcambridge, was obvious: "I have got a new frie;, thefinest in the world, a tame bear, when t brJught him here, theyasked me what I meant to do with him,

"rrJ-y reply *u, .h"

TIIE MIND'S CANKER IN ITS SAVAGE MOOD 169

should sit for a Fellou:ship. . ..' This answer delighted themnot."rm Byron and the bear, when later reunited at NewsteadAbbey, would occasionally swim together in a vault leading to thegraves of the monks who had previously inhabited the Byron an-cestral home; along with other animals, the bear was kept in thefamily chapel, a thirteenth-century converted Chapter House. By-ron had inherited his father's love for animals-in addition, asDoris Langley Moore has pointed out, to their shared capacity forincurring debt, as well as probable incest with their respectivesisterslor-and eventually developed a menagerie that, by the timehe went into exile years later, was the subject of Shelley's bemusedcomments:

Lord B's establishment consists, besides servants, of ten horses, eightenormous dogs, three monkeys, five cats, an eagle, a crow, and afalcon; and all these, exeept the horses, walk about the house, whichevery now and then resounds with their unarbitrated quarrels, as ifthey were the masters of it . . . [later] I find that my enumeration ofthe animals in this Circean Palace was defective. and that in a ma-terial point. I have just met on the grand staircase five peacocks, twoguinea hens, and an Egyptian crane.l02

By January 1808 Byron was living in London and writing to afriend that others thought of him as "the votary of Licentiousness,and the Disciple of Inftdelity";ro3 typically, however, the rest ofthe letter was filled with discussion about poetry and literary crit-ics. Just after his twentieth birthday in the same month, Byronwrote that he was "buried in an abyss of Sensuality," "given toHarlots," and in a "state of Concubinage."re His immersion indrinking, gambling, and women was not without its expected toll:

My dear Hobhouse,-The Game is almost up, for these last ffve daysI have been confined to my room, Laudanum is my sole support, andeven Pearson wears a woeful visage as he prescribes, however I amnow better and I trust my hour is not yet arrived.-I began to ap-prehend a complete Bankruptcy of Constitution, and on disclosingthe mode of my Life for these last two years (of which my residenceat Cambridge constituted the most sober part) my [Surgeon] pro-nounced another quarter would have settled my earthly accounts,and left the worms but a scant repast.-los

TOUCIIED WITH FIRE

- In July 1809, Byron left England for a two-year "Grand Tour"of Portugal, Spain, Gibraltar, Malta, Greece,

"rri tork"y. His high

spirits_and aggressive enjoyment of life continued to be mixed withperiods of melancholy. In May lgl0 he resolved to adopt a new life,"I am tolerably sick of vice which I have tried in ii"

"gr"rrbl"varieties, and mean on my return to cut all dissolute acquaintance,leave offwine and 'carnal

c.ompany'"; he meant, he said, to keepto "politics and-Decorum."16 intermittently he was "vastly h"ppyand childish,"roz having a "most social & fantastical,,rd#rrt", i'Athens, and enjoying excellent health. His inevitable melancholycaught up with him again in late 1810, however, and he wrote fromGreece with blackish humor: "I have nothing more to hope, andmay_ begin to consider the most eligible wav of walking *t of it[ife], probably I may find in England ,o-"tody irr"li'Edto ,"ueme the trouble. . . . I wish I could find ,o*" oi socrates's Hem-lock."r@ In_ May of the following year he wrote: ..At

twenty threethe best of life is over and its bitters double. . . . I am sick atheart. . . . I have outlived all my appetites and most of my vani-ties,"rro and the next month hu erplained to a friend th" ,norbidityat the heart of his seeming levity: "I am so out of spirits, & hopes,& humour, & pocket, & health, that you must bear with mv mer-riment, my only resource against a calenture. "rtr As usual tire lowspirits were preceded and followed by high ones, for Byron's en-thusiasms and excesses were part breeding ground for, and partdistraction from, his brooding seasons; ultim*atery, of course, theennui_and vivacity were inextricably bound to one another, notentirely opposite sides to the same temperamental coin.

_ When Byron returned to England in july lgll he broughtwith him the ffrst two cantos of chitde Haroldis pilgrimage, thelargely autobiographicaluz poem that was to make hiir fami,rr, aswell as a typically intriguing collection of acquisitions, includingadditions to his menagerie. He catalogued a few of these purchases:"Four ancient Athenian skulls, dug out of sarcophagi-a phial ofAttic Hemlock-four live Tortoises-a Greyhound . . . two liveGreek servants."u3 Already depressed prior to his return to En-gland, within a few months of being back, Byron experienced thedeaths of his mother, two close friends,

"r,d hir "vitlent, though

pure"lrt love from his Cambridge days, fohn Edleston. The com-bination of his naturally melancholic temperament with the losses

TIIE MIND'S Cd,NKERIN TTS SAVAGE MOOD L7L

of these deaths sent him into a deep depression; he drafted a will,adding twice for emphasis that he wished neither ceremony norburial service and desired to be buried with his "faithful dog," whowas not to be removed from their shared vault. His dark mood wasstrangely mixed, however, "for though I feel tolerably miserable,yet I am at the same time subject to a kind of hysterical merriment,or rather laughter without merriment, which I can neither accountfor nor conquer."l's H" remained depressed for several monthsand wrote to a friend about his state of mind:

I am growing nerDous (how you will laugh!)-but it is true,-really,wretchedly, ridiculously, ftne-ladically neroous.. . . I can neitherread, write, or amuse myself, or any one else. My days are listless,and my nights restless. . . . I don't know that I sha'n't end withinsanity, for I find a want of method in arranging my thoughts thatperplexes me strangely. rro

To another friend he wrote a few days later, "I am very low-spiritedonmanyaccounts. . . . Iamindeedverywretched.. . . al lp lacesare alike, I cannot live under my present feelings, I have lost myappetite, my rest, & can neither read write or act in comfort-"ru

Byron's spirits revived gradually, and in February l8l2 hedelivered his maiden speech, the ffrst of three speeches he was togive, in the House of Lords. It was ffery-"perhaps a little theat-rical,"rrs by his own account-and one that r"poit"dly "kept theHouse in a roar of laughter. "rre A few days later his brooding poemChilda Harolts Pilgrimage was published; he awoke one morning,he reported drolly, and found himself famous. Byron became, al-most overnight, the focus of London society. The Duchess of De-vonshire wrote that Childe Harold "is on every table, and himselfcourted, visited, fattered and praised whenever he appears. . . .He is really the only topic of conversation-the men jealous of him,the women of each other."r2o Lady Caroline Lamb, wife of thefuture prime minister (Lord Melbourne), dashed in her journalafter me,gting him that Byron was "mad-bad-and dangerous toknow,"rzr giving more credence to the notion that the similar areinclined toward their own. Although their temperaments were like-wise overwrought and volatile, their characters were in fact quitedifferent. Byron was ultimately a highly disciplined if yet emotional

TOUCIIED WTITI EIRE

man, and he was used to keeping his tempestuous moods underrelatively tight control; Lady caroline ramb either would not orcould not do the same, and after several turbulent months of pas-sionate attraction on both sides, and then dreadful, acrimoniouspublic scenes-including knife slashing (on her part) and verbalslashing (on his)-Byron ended the relaiionship. Fie had written toher that:

People talk as if there were no other pair of absurdities in London.-It is hard to bear all this without cause, but worse to give cause forit'- our folly has had the effect of a fault.- I conformld and couldconform, if you would lend your aid, but I can't bear to see you lookunhappy. . . . We must make an effort, this dream this defirium oftwo months must pass away."Ln

- Although there continued to be some contact and correspon-dence, the affair was, for all intents and purposes, over; she con-tinued to request time, meetings, and commitment but Byronremained resolute that the damage was long past repairing. De-spite the public embarrassment, he held himself singularly ac-countable for his own actions, as he was to do years latei followingthe far greater hurts and damages he experienced due to his wife'ibehavior. In a letter to his closest confidante, Lady Melbourne(who was also Caroline Lamb's mother-in-law and the aunt of By-ron's wife-to-be), he wrote that caroline "never did nor can de-serve a single reproach which must not fall with double justice &truth upon myself, who am much much more to blame in everyrespect, nor shall I in the least hesitate in declaring this to any ofher family. "l23

Byron's spirits continued to fuctuate over the months to fol-low. January 1813 found him "exceedingly wearied"l2a and irrita-ble, November with a "mind in fermentation,"rzs and by the endof the year he was again feeling depressed and aimless:

I am ennugd beyond my usual tense of that yawning verb, which I amalways conjugating; and I don't find that society much mends thematter. I am too lazy to shoot myself-and it would annoy Augusta. . . but it would be a good thing for George [Byron's ftrst cousin andsuocessor to his title], on the other side, and no bad one for me: butI won't be tempted. r%

178TIIE MIND'S CANKERIN ITS SAVAGE MOOD

By the end of the same month, however, he was working at break-neck speed on a new poem, The Corsair, writing more than twohundred lines a day; when published a few months later, it sold tenthousand copies on the ffrst day of publication and twenty-ffvethousand copies within one month. Yet he wrote on Februaiy 27,"I am not well; and yet I look in good health. At times, I fear,

'I am

not in my perfect mind;'-"ttd yet my heart and head have stoodmany a crash, and what should ail them now? They prey uponthemselves, and I am sick-sick-'. . . why should a cat, a rat, adog have life-and thou no life at allP' "rzz Although the quality ofhis life may have been in question to Byron, it was not strictly thecase that he had no life at all In addition to affairs with Lady oxfordand Lady Frances Webster, he had become involved in the mostemotionally binding and scandalous relationship of his life, an affairwith his half-sister Augusta:

I say'tis blood-my blood! the pure warm streamWhich ran in the veins of my fathers, and in oursWhen we were in our youth, and had one heart,And loved each other as we should not love.

She was like me in lineaments-her eyes,Her hair, her features, all, to the very toneEven of her voice, they said were like to mine;But soften'd all, and temper'd into beauty;She had the same lone thoughts and wanderingsr28

They traveled together in the summer and fall of tgl3 and thenspent part of the early winter of l8l4 together in Newstead Abbey.She became pregnant, but it remains unclear whether Byron orAugusta's husband was the father of the child (in

"rry "u"rri Byron

was godfather).In April t8l4 Byron wrote to Lady Melbourne that he had

called in a physician for himself and that he "puts so many ques_tions to me about mg mind and the state of it-that I begin io thirrkhe half suspects my senses-he asked me-how I felt ivhen any-thing-weighed upon my mind-'and I answered him by a questionwhy he should suppose that anything did?-I was laughing & sit-

174 TOUCIIED WTTHFIRE

ting quietly in my chair the whole time of his visit-& yet he thinksme horribly restless-and irritable-and talks about my havinglived, excessirselg 'out

of all compass .' "rzs The following monthByron described feeling a deep indifference to life and most sen-sations, "the same indifference which has frozen over the

'Black

Sea'of almost all my passions."rso Continuing in the same letter toMoore, he wrote, "It is that very indifierence which makes me souncertain and apparently capricious. It is not eagerness of newpursuits, but that nothing impresses me sufficiently tofix; neitherdo I feel disgusted, but simply indifferent to almost all excite-ments."r3r He was again reporting to Moore in August that he felt"quite enervated and indifferent".r3z during the same period oftime, in a rage, he threw a bottle of ink out the window. Increas-ingly convinced that his only "salvation" in life was to marry, heproposed late that summer to Annabella Milbanke, an unlikely andunfortunate choice: Prophetically, Byron was to write of his "Prin-cess of Parallelograms" that "Her proceedings are quite rectangu-lar, or rather we are two parallel lines prolonged to infinity side byside but never to meet."r33 To all intents and purposes humorless,she was also cool, cerebral, morally superior, and in almost everypossible respect opposite in temperament from her husband-to-be.She was, as biographer Doris Langley Moore has pointed out, "aconspicuously frigid type . . . perhaps no young woman ever livedwhose writings show so intense a preoccupation with her ownrectitude. "r3a Annabella had, however, shown not inconsiderable,if somewhat smug, insight into Byron's character and temperamentin her "Character of Lord Byron," written not long after she firstmet him. "The passions have been his guide from childhood," shewrote, "and have exercised a tyrannical power over his very supe-rior Intellect"; there was, however, "a chivalrous generosity in hisideas of love & friendship, and selffshness is totally absent from hischaracter, " She then went on to describe his mercurial tempera-ment and his inconsistencv of mind and mood;

When indignation takes possession of his mind-and it is easily ex-cited-his disposition becomes malevolent. He hates with the bit-terest contempt. But as soon as he has indulged those feelings, heregains the humanity which he had lost-from the immediate im-pulse of provocation-and repents deeply. So that his mind is con-

THE MIND'S CANKERIN ITS SAVAGE MOOD L75

tinually making the most sudden transitions-from good to evil, fromevil to good. A state of such perpetual tumult must be attended withthe misery of restless inconsistency. He laments his want of tran-quillity and speaks of the power of application to composing studies,as a blessing placed beyond his attainment, which he regrets.r3s

She concluded, with unintended irony, "He is inclined to open hisheart unreservedly to those whom he believes good."

In the midst of much melancholy and ambivalence, Byron-inpart "to repair the ravages of myseH & prodigal ancestry"r36-married Annabella Milbanke in fanuary 1815. Despite his resent-ments, reservations, and savage mood, Byron was able to maintainsome of his customary wit. His friend fohn Cam Hobhouse, servingas best man and well aware that Byron was at least thirty thousandpounds in debt, described the marriage ceremony: "Miss M. was asfirm as a rock and during the whole ceremony looked steadily atByron-she repeated the words audibly & well. Bfyron] hitched atfirst when he said,

'I George Gordon' and when he came to the

words, 'with

all my worldly goods I thee endow'looked at me withhalf 1smile."r37 By every account available the year of married lifeto follow was a nightmare for both parties, seared with the absoluteferocity of Byron's moods and Lady Byron's inability to deal withthem (Professor Marchand notes that "Byron's valet, Fletcher, whohad seen his master in all of his moods and had by then beenwitness to his relations with dozens of women of all kinds, re-marked with naive wisdomr 'It is very odd, but I never yet knew alady that could not manage my Lord, except my Lady."'tes; By-ron's rages and periods of morbid depression were clearly fright-ening to Lady Byron, and excessive drinking and discuisions ofother women only exacerbated the situation:

He had for many months professed his intention of giving himself upeither to women or drinking, and had asked me to tatrctior, therucourses, adding however that he should pursue them whether I gavehim leave or not. Accordingly for about three months before myconffnement he was accustomed to drink Brandy & other liquors tointoxication, which caused him to commit many outrageous acts, asbreaking & burning several valuable articles, and brought on parox-ysms of rage or frenzy*not only terrifying but dangerous to

-me in

my then situation [her pregnancy]-r3e

TOUCIIDD WTTII EIRE

Lady__Byron also reported her concerns that Byron might kill him-self:-"He used to get up almost every night, and walk"up & do*nthe long Gallery in a state of horror & agitation which ied me toapprehend he would realize his repeated threats of Suicide.,,r4o g'another occasion she noted, "He then had his loaded pistols &dagger (which are always by his bedside at night) o., ih" t"bl"through the day, and frequently intimated a dlsign of suicide.once he seized the dagger, & ran with it to his own room. the doorof which I heard him lock."rar Not only Annabeila was concernedthat Byron might take his own life. Augusta, in a letter to Anna-bella, wrote:

I have before told you of his hints of self destruction. The nightbefore last, I went as usual to his room to light his candles & seeinga Draught on the chimney piece which looked fermnnting, I said"What is this." "My Draught, to be sure-what did you think it was?Laudanum?" I replied jokingly that I was not even thinkingof Lauda-num & the truth-that I thought the Draught spoilt, which causedmy inquiry. He immediately looked very dark & black (in the oldway) & said "I have plenty of Laudanum-& shall use it." Upon mylaughing & trying to turn offthe subject he only repeated in the mostawful manner his mast solemn deterrnination on the subject.ra2

The winter of 1815 appears to have been fflled with violent ragesand dark moods, but the spring and summer brought some relief,despite unremitting financial problems. By August, however, By-ron's moods again had become wild and unpredictable, and inOctober "he became the victim again of sleepless nights and ner-vous fears."r4S His drinking and rages became even worse, hisbehavior "increasingly erratic," and by the end of the year LadyByron was convinced that he was insane. She called in a consultingphysician who could not give a "decided opinion"; neither he norLady Byron's own doctor could agree that Byron was deftnitelyinsane (he had "nothing like a settled lunacy")raa and so LadyByron was left to conclude that, if not the first part of Lady Car-oline's jottings-that is, mad-then Byron must instead be bad(the "dangerous to know" was a given). Later Byron was to write tothis point in Don Juan:

Don J6se and the Donna Inez ledFor some time an unhappy sort of life,

TIIE MIND'S CANKER IN ITS SAVAGD MOOD 177

Wishing each other, not divorced, but dead.They lived respectably as man and wife,

Their conduct was exceedingly well-bred,And gave no outward signs of inward strife,

Until at length the smother'd fire broke out,And put the business past all kind of doubt.

For Inez call'd some druggists and physicians,And tried to prove her loving lord was mad,

But as he had some lucid intermissions,She next decided he was only bad;

Yet when they ask'd her for her depositions,No sort of explanation could be had,

Save that her duty both to man and GodRequired this conduct-which seem'd very odd. ra5

In December l8l5 their daughter was born; in January of thefollowing year Byron and his wife separated. He never saw LadyByron or his daughter again. Augusta described her brother's de-meanor shortly after the separation:

He staid at home last night & was tolerably quiet, tho singing wildry& irritable. He gave me an opportunity of saying much more ofderangement, & took it very quietly. He said "Oh don't say so or talkof it because of my Will'-told me about Grandfather's end & hisMother always perceiving a resemblance between them-tarked qui-etly & rationally abt it, but seemed rather alarmed at the thought:r46

Byron's depression grew worse, deepening to the extent thathis friend Hobhouse thought it worse than at any time since he hadknown Byron. In a letter to his father-in-law, written early inFebruary, Byron discussed his own perspective on his tempera-ment and marriage:

During the last year I have had tq contend with distress without_&disease within:-upon the former I have little to say--except that Ihave endeavoured to remove it by every sacrifice in my power_&the latter I should not mention if I had not recent & piofessionalauthority for saying-that the disorder which I have to combat-without much impairing my apparent health-is such as to induce amorbid irritability of temper-which-without recurring to externalcauses-may have rendered me little less disagreeable to others than

I78 TOUCHEDWITHFIRE

I am to myself.-I am however ignorant of any particular ill treat-ment which your daughter has encountered:-she may have seen megloomy-& at times violent-but she knows the causes too well toattribute such inequalities of disposition to herself----or even to me-ifall things be fairly considered. ra7

It soon became clear that there was to be no reconciliationwith his wife, and that the thickening rumors of incest, insanity,perversion, and violence were to provide no opportunity for evena semblance of a livable existence in England. Accordingty, Byronmade plans to go abroad. Before doing so, however-and despitestaggering debts requiring the forced auction even of his books-heordered an inordinately lavish traveling coach modeled on Napo-leon's; it cost five hundred pounds and was furnished with diningand sleeping facilities as well as a library. It turned out to be, in itsown way, a bit like Byronr grand, Romantic, and liable to break-downs. Byron and his companions, including his physician (theyoungest graduate in the history of the University of Edinburghmedical school, he was himself no bastion of sanity and eventuallywent on to commit suicide), left London in April 1816. Byron leftwith bitterness and never saw England again:

I was accused of every monstrous vice by public rumor and privaterancour; my name, which had been a knightly or a noble one sincemy fathers helped to conquer the kingdom for William the Norman,was tainted. I felt that, if what was whispered, and muttered, andmurmured, was true, I was unftt for England; if false, England wasunfft for me. . I recollect, some time after, Madame de Sta€l saidto me in Switzerland, "You should not have warred with theworld-it will not do-it is too strong always for any individu-al. " . . . I perfectly acquiesce in the truth of this remark; but theworld has done me the honour to begin the war.ras

Shortly after arriving in Europe, during repairs to the car-riage-which had broken down for the third time, Byron beganwriting the third canto (his favorite, and the most personally re-vealing) of Childe Harold's Pilgrimage. When published later inthe year, it caused Byron's great friend and supporter, Sir WalterScott, to write:

TIIE MII\'D'S CANKER IN ITS SAVAGE MOOD

I have just received Childp Harold, part 3rd. Lord Byron has moreavowedly identified himself with his personage than upon formeroccasions, and in truth does not affect to separate them. It is wilderand less sweet, I think, than the first part, but contains even darkerand more powerful pourings forth of the spirit which boils withinhim. I question whether there ever lived a man who, without lookingabroad for subjects excepting as they produced an effect on himself,has contrived to render long poems turning almost entirely upon thefeelings, character, and emotions of the author, so deeply interest-ing. We gaze o\ the powerful and ruined mind which he presents us,as on a shattered castle, within whose walls, once intended for noblerguests, sorcerers and wild demons are supposed to hold their Sab-baths. There is something dreadful in reflecting that one gifted somuch above his fellow-creatures, should thus labour under somestrange mental malady that destroys his peace of mind and happi-ness, altho' it cannot quench the fire of his genius. I fear the termi-nation will be fatal in one way or other, for it seems impossible thathuman nature can support the constant working of an imagination sodark and so.^strong. Suicide or utter insanity is not unlikely to closethe scene.lae

179

A few weeks after beginning the third canto, in late May lg16,Byron met Percy Bysshe Shelley for the first time. The two poetsrented villas near one another, not far from Geneva, and spenilongdays and evenings together talking, sailing, reading, and critiquingeach-- other's poetry. Byron was "an exceedingly interesting per-son," wrote Shelley, but "mad as the winds."tio 61tr" Clairlont-Mary Godwin's stepsister, with whom Byron had begun an affairjust before leaving England, was also living with the Shelleys;when they returned to England in August she left with them,pregnant with Byron's child. The rest of 1816 passed uneventfully,at least by Byron standards. His friend Hobhouse, who visited inseptember, reported that Byron was "free from all offense. eitherto God, or man, or woman; no brandy; no very late hours. . . .Neither passion nor perverseness."rsl In the same month Byronbegan Manfred, in November he fell in love, and in December hedescribed his recent times as among the "pleasantest" and "quiet-est" of any in his life.r52 To Augusta he wrote, in high spiriti andhumor, "At present I am better-thank Heaven above-& womanbeneath."r53

TOUCHED WITH FIRE

Moderation, of course, could last only so long, and by Januaryand February r8r7 Byron was ill from the dissipations-oi an in-creasingly reckless and promiscuous lifestyle. In March he wroteMoore that he had been plagued by sleeplessness and "half-delirium" for a week. rsa

June and July found him again in goodspirits, living near venice and writing furiously (including the com-pletion of more than 125 stanzas of the fourth canto of chitd.eHarold). Hobhouse, in October, noted that Byron was "well, andmerry and happy."rs5 Byron, never one to be paralyzed by con-vention, sent for his horses so that he could gallop them along thewater. Marchand writes that "Byron's horses on the Lido becamea byword in the city. When Henry Matthews, brother of Byron'sCambridge friend, visited Venice in l8lg, he recorded: 'There

areeight horses in Venice: four are of brass, over the gate of thecathedral; and the other four are alive in Lord Byron's stable.' "rtr

January and February 1818 brought with them the early-winter dissolution that had become an almost predictable pattern,dating back to his Cambridge and London days. In May he de-scribed "a world of other harlotry,"rs7 and in June he moved intothe Palazzo Mocenigo on the Grand Canal, where he was joined-rather improbably given the circumstances-by his infant daughterAllegra and her nurse. The following month Byron began writingDon Juan, and by August, according to Shelley, he had "changedinto the liveliest and happiest looking man I ever met";tsa byDecember, however, Shelley had altered his view somewhat and,with clear disapproval, wrote that Byron "allows fathers and moth-ers to bargain with him for their daughters. He associates withwretches . . . who do not scruple to avow practices which are notonly not named, but I believe seldom even conceived in En-gland."rss Perhaps. In any event, Mary Shelley added her con-cerns to those of her husband by April of the following year (Byron,it must be admitted, had written to his publisher in February thathis involvement in the dissipations of Carnival had resulted in hisnot going to bed until7100 or 8:00 e.u. for ten days in a row): "Allgoes on as badly with the noble poet as ever I fear-he is a lost manif he does not escape soon."t@ Byron, in the meantime, was in themidst of falling in love again-this time with the Countess Guic-cioli, a nineteen-year-old girl married to a man in his late ftfties.The relationship with Teresa Guiccioli was to prove a long and

TIIE MIND'S CANKDR IN ITS SAVAGE MOOD 181

stable one, certainly as measured against the chaos of the rest ofByron's life. His moods, however, were becoming increasinglymelancholic and disturbing to him. Writing to his publisher inLondon, Byron said, "I am out of sorts----out of nerves-and nowand then-(I begin to fear)out of my senses,"l6l and in August hewrote to Hobhouse that he was writing "with ill health and worsenerves." He continued:

I am so bilious-that I nearly lose my head-and so nervous that Icry for nothing-at least today I burst into tears all alone by myselfover a cistern of Gold ftshes-which are not pathetic animals. . . . Ihave been excited-and agitated and exhausted mentally and bodilyall this summer-till I really sometimes begin to think not only "thatI shall die at top first"-but that the moment is not very remote.-Ihave had no particular cause of grief-except the usual accompani-ments of all unlawful passions.162

Byron's melancholy returned in January 1820 and January1821, as well as intermittently throughout the year. In Septemberhe wrote to Teresa describing his depression and its seasonal turns:"This season kills me with sadness every year. You know my lastyear's melancholy-and when I have that disease of the Spirit-itis better for others that I should keep away. . . . Love me. My soulis like the leaves that fall in autumn-all yellow-A cantata!"\$The next day he wrote her again: "As to my sadness-you knowthat it is in my character-particularly in certain seasons. It is trulya temperamental illness-which sometimes makes me fear the ap-proach of madness-and for this reason, and at these times, I keepaway from everyone."re

In January l82l Byron wrote in his journal:

What is the reason that I have been, all my lifetime, more or lessennug6. . . . tI] presume that it is constitutional,-as well as thewaking in low spirits, which I have invariably done for many years.Temperance and exercise, which I have practiced at times, and for along time together vigorously and violently, made little or no differ-ence. Violent passions did;-when under their immediate influ-ence-it is odd, but-I was in agitated, but not in depressedspirits. r6

TOUCHED WITIIFIRE

- The following month he noted again the tendency for his moodto- be more despondent in the morning: "I have been consideringwhat can be the reason why I always wake, at a certain hour in themorning, and always in very bad spirits-I may say, in actual de-spair and despondency, in all respects-even of that which pleasedme over night. In about an hour or two, this goes off, and I com-pose either to sleep again, or, at least, to quiet."rffi In September,as in the preceding year, he was again despairing, describing "amountain of lead upon my hear-t"'167 he also noted the worseningnature of his illness, writing that "I have found increasing upon me(without sufficient cause at times) the depression of spirits (withfew intervals) which I have some reason to believe constitutional orinherited."168In April 1822, Byron's young daughter Allegra died;he again wrote in his journal that his melancholy was becomingworse. In July Shelley drowned. Byron, who had for a long timebeen involved in various political causes, became deeply caught upin the Greek independence movement. Always an activist, and onewho believed that "a man ought to do something more for mankindthan write verses,"t6e he gave freely of his money, his eflbrts, andultimately his life. The winter before Byron sailed for Greece, anEnglish physician observed the poet's melancholy and reportedthat Byron had asked him, "Which is the best and quickest poi-son?"r7o His sudden and ungovernable rages, which had been partof his emotional makeup since childhood, and which had beenespecially pronounced during his year with Lady Byron, becamemore frequent and more furiously irrational. Moore noted that oneof the grounds for the charges of insanity brought by Lady Byronagainst her husband, in addition to fears for her own safety, was thefact that Byron had taken an old watch that he loved and had hadfor years, and in "a fit of vexation and rage . . . furiously dashedthis watch upon the hearth, and ground it to pieces among theashes with the poker."rTr 1n the spring of 1823, not long before hesailed for Greece, Ludy Blessington described a scene in whichByron had "betrayed such ungovernable rage, as to astonish allwho were present." His appearance and conduct, she wrote:

forcibly reminded me of the description of Rousseau: he declaredhimself the victim of persecution wherever he went; said that therewas a confederacy to pursue and molest him, and uttered a thousand

TIIE MIND'S CANKER IN ITS SAVAGE MOOD 183

extravagances, which proved that he was no longer master of himself.I now understood how likely his manner was, under any violentexcitement, to give rise to the idea that he was deranged in hisintellects. . . . The next day, when we met, Byron . . . asked me ifI had not thought him mad the night before: "I assure you," said he,"I often think myself not in my right senses, and this is perhaps theonly opinion I have in common with Lady Byron."L72

Byron had earlier commented to her;

As long as I can remember anything, I recollect being subject toviolent paroxysms of rage, so disproportioned to the cause, as tosurprise me when they were over, and this still continues. I cannotcoolly view anything that excites my feelings; and once the lurkingdevil in me is roused, I lose all command of myself. I do not recovera good fft of rage for days after: mind, I do not by this mean that theill-humour continues, as, on the contrary, that quickly subsides,exhausted by its own violence; but it shakes me terribly. and leavesme low and nervous after. r73

Byron sailed for Greece in July 1823, and in the followingmonth he experienced an even more violent attack of irrationalityand rage. one of his companions at the time described the onset ofthe episode: "He now vented his anger in sundry anathemata andimpreeations, until he gradually lashed himself into one of thosefurious and ungovernable torrents of rage, to which at times he wasliable; the paroxysm increased so as almost to divest him of rea-sin."vl Byron escaped into another room; the resulting scene isdescribed by Marchand:

First the abbot [host for the evening's activity] and then Dr. Brunoattempted to soothe the angry lord, but both were forcibly ejected."It appeared," Smith wrote, "that Lord Byron was seized with vio-lent spasms in the stomach and liver, and his brain was excited todangerous excess, so that he would not toterate the presence ofanyperson in his room. He refused all medicine, and stamped and toreall his clothes and bedding like a maniac Trelawny enterednext, "but soon returned, saying that it would require ten such as heto hold his lordship for a minute, adding that Lord Byron would notleave an unbroken article in the room." The Doctor asked smith toget Byron to take a pill. Pushing past a barricade, smith found Byron

"half-undressed, standing in a far corner like a hunted animal at bay.As I looked determined to advance in spite of his impreeations of'Baih!

out, out of my sightl ftends, can I have no peace, ,io ,elief f.o*this hell! Leave me, I say!' and he simply lifteilthe chair nearest tohim, and hurled it direct at my head; I escaped as best I could."r75

The remainder of 1823 and the beginning of 1824 were filledwith political and military planning focused on the Greek freedomcause. On his birthday, January ZZ, LBZ4, Byron wrote one of hislast poems:

tu TOUCIIED WITIIFIRE

On This Day I Complete My Thirty-Sixth Year

Missolonghi, Jan. 22nd, 1824'Tis time this heart should be unmoved,

Since others it hath ceased to move:Yet though I cannot

T,litfll",l; ,""",My days are in the yellow leaf;

The flowers and fruits of Love are gone;rhe worm-the canker,

:'i,::""ffil

If thou regret'st thy Youth, whg lioe?The land of honourable Death

Is here:-up to the Field, and giveAway thy Breath!

Seek out-less often sought than found-A Soldier's Grave, for thee the best;

Then look around, and choose thy Ground,And take thy RestlrTo

Byron contracted a fever and died in April 1824, almost cer-tainly a result not only of the illness but the medical treatment hereceived for it. He expressed repeatedly during the final days of hislife a fear of going mad. To both his physician and servant he said:"I know that without sleep one must either die or go mad. I wouldsooner die a thousand times,"u7

"tr6 it was only by using his fear

that he might lose his reason that his doctors were able to persuadeByron to be bled. "Do you suppose that I wish for life?" Byron

TIIE MIND'S CANKER IN ITS SAVAGE MOOD 185

asked his physician, "I have grown heartily sick of it, and shallwelcome the hour I depart fiom it."178 At another point he said,"Your efiorts to preserve my life will be vain. Die I must: I feel it.Its loss I do not lament; for to terminate my wearisome existenceI came to Greece."rTs Byron briefly recovered his mordant wit,however. A servant, told that his master was dying, said: "TheLord's will be done." "Yes," Byron replied, "not mine."r8o

Byron's body was returned to England. The scandal attachedto Byron's life was such that the Dean of Westminster Abbey re-fused him burial there (he was buried near Newstead Abbey in-stead), and the aristocracy was unwilling to participate directly inthe funeral procession. Instead they sent their carriages, a "verylong train of splendid carriages [more than forty], all of which . . .were empty."t8l Finally, as recently as 1969, nearly a century anda half after Byron's death, C. Day Lewis, England's poet laureate,put a wreath of laurel and red roses on the white marble tabletnewly laid for Byron in the Abbey floor. No doubt Byron wouldhave been gratified, as he would have been vastly amused by theabsurd delay and attendant moral outrages. It is also likely, how-ever, that he would have appreciated the two lines chosen for hisepitaph, taken fiom a, stanza in Childo Harold:

But I have lived, and have not lived in vain:My mind may lose its force, my blood its fire,And my frame perish even in conquering pain,But there is that uithin mp uhich shal| tireTor-ture and Time, and breathe uhen I expire;Something unearthly, which they deem not of,Like the remembered tone of a mute lyre,Shall on their softened spirits sink, and move

In hearts all rocky now the late remorse of love.182

Byron's work was inextricably bound to his life. Ue has be-come truly mythic, and his life's story, like a Greek tragedy or arequiem mass, is written and rewritten, within a given form andwith a certain ordering of elements: set pieces to be arranged,anecdotes to tell, fragments of poetry from which to choose andthen to recite. Upon this framework the thoughts, theories, andspeculations of each writer are woven> and into this frameworkeach writer's feelings about Byron-and the human condition-are

TOUCHED WITH FIRE

Autograph page from stanza g, canto lII, of Bgron,s Don Juan(reduced by one_third)

"Dm-/aa^-'Cq^fr ///.

f ^ "'a-<' ^ r ' ' ' , 1 .+

t7

*-4'a-/

/ ^q t.,,n4t,,y*.: * , /nr9

7*^i,4,^v%t;

cr /'*a.av- r'2-*'"4.4

,q-

t',,,

souncE: Reproduced by permission of The Pierpont Morgan Library, New york. MAS6-57.

TIIE MIND'S CANKER IN ITS SAVAGEMOOD

Reworking bg Bgron of stanza I, canto lll, from Don luanCeNro tII, sr.9

t Lifai+alryarlC{r€tAll tragedies are finished by a death,

2 All Comedies are ended by a marriage,S nerLift-a+glioAil+h€i

affiiqparr6cs@6ffint*ii6,3

eo€rary The future states of both are left to faith,

aiFbe For authors thinh description might disparage

tear5 [sic?]

l\'itl ehh0 f+eel6e+gr6rlf ailC @7

Veilr6

@a@

@5 The worlds to come of both--{c or fall beneath.6 And6S

And them both worlds would punish their miscarriage-7

So leaving €lerg$e{hc each their Priest and prayerbook ready,8 They say no more ofdeath or ofthe Lady.

souRcE: Truman Guy Stefian. Bgron's Don Juan: The Maktng of a Masterpiece. Austin:UniversityofTexas Press, 197I, p. 345.

ra7

TOUCIIED WITII EIRE

projected. Byron commands in death what he commanded in life:love, hate, respect, contempt, loyalty, and disdain_in short, con_troversy. seldom, however, does Byron elicit indifference. In hisown time, for example, Blackuood's Edinburgh Magazine pub-lished an article stating that he was "one of the most"remarkablep"l tg whom [England] has had the honour and disgrace of givingbirth." "It appears," the authors wrote, "as if this iiserable man,having exhausted every species of sensual gratiffcation-havingdrained the cup of sin even to its bitterest dregs, were resolved toshew us that he is no longer a human being, even in his frailties;but a cool unconcernedfienfl."ns Byron fared even less well at thehands of william Hazlitt, a contemporary critic and essayist, who,while admitting that Byron was "never dull, or tedious,;r& vehe_mently objected to the shadow Byron's temperament cast over hiswork, as well as his bent for making "man in his own image, womanafter his own heart."185 These criticisms were captur"J i' a par-ticularly good description of extreme Byronism:

He hangs the cloud, the fflm of his existence over all outwardthings-sits in the centre of his thoughts, and enjoys dark night,bright day, the glitter and the gloom "in cell mensstis"-\a/e see themournful pall, the cruciffx, the death's heads, the faded chaplet offlowers, the gleaming tapers, the agonized growl of geniui, thewasted form of beauty-but we are still imprisoned in a dungeon, acurtain intercepts our view, we do not breathe freely the air of natureor of our own thoughts.ls

His influence on other writers and artists, however, was profoundlydifferent. Tennyson related to William Allingham: "When I heardof his death . . . I went out to the back of the house and cut on awall with my knife,

'Lord Byron is dead,' "r87 and Goethe acknowl-

edged that "Byron alone I admit to a place by *y side."188 To ]ohnRuskin "Byron wrote, as easily as a hawk flies".l8s ";too "Byron," hesaid, "was to be my master in verse, as Turner in colour."rno "H"r"at last," he continued, "I have found a man who spoke only of whathe had seen, and known; and spoke without exaggeration, withoutmystery, without enmity, and without mercy."rer More recentlyW. H. Auden stated his belief that, "Whatever its faults, DonJuanis the most original poem in English,"re2

"t 6 Byron was the only

THE MIND'S CANKER IN ITS SAVAGE MOOD

poet singled out for a separate chapter in Bertrand Russell's His-torg of Western Philosophy. The list of writers, artists, and com-posers who were directly inspired by Byron's life and poetry isalmost without peer; it includes Hector Berlioz, Alexander Push-kin, !. M. W. Turner, Robert Schumann, Victor Hugo, Alfred-Victor de Vigny, Alfred de Musset, Giuseppe Verdi, GaetanoDonizetti, Franz Liszt, Peter Ilich Tchaikovsky, Arnold Schoen-berg, Gioacchino Rossini, Charles Baudelaire, and Virgil Thom-son.1e3 Not surprisingly, most of those infuenced by Byron werethemselves intensely emotional and inclined toward the Romantic.

Byron, for all his Romanticism, thought and wrote with re-markable clarity, maintaining an unrelenting grasp on the realitiesof both his own and human nature. His biographers have made thispoint repeatedly. Moore, who was also a close friend, notedr "Bornwith strong a$ections and ardent passions, the world had, from ffrstto last, too firm a hold on his sympathies to let imagination alto-gether usurp the place of reason,"lea and Leslie Marchand wrotethat Byron was the "most completely realistic of all the romantics"because "he accepted the romantic urge as a part of human naturewithout pretending it was more than a dream. "re5 In a related vein,but with a more interpersonal emphasis, Doris Langley Moore hasmade the point that Byron's "was a singularly reasonable mind"'re6this comes through again and again in his iournals, what is knownof his conversations, and most especially in his letters. A particu-larly impressive example is contained in a letter written by Byronto his wife several years after their separation. In it he asked thatshe review what he had written about her in his memoirs (which,unfortunately, were burned by his publisher and friends after hedied)r

I could wish you to see, read and mark any part or parts that do notappear to coincide with the truth.-The truth I have always stated-but there are two ways of looking at it-and your way may not bemine.-I have never revised the papers since theywerewritten.-youmay read them-and mark what you please. . . . You will ftnd noth-ing to flatter you-nothing to lead you to the most remote supposi-tion that we could ever have been-or be happy together.-But I donot choose to give to another generation statements which we cannotarise from the dust to prove or disprove-without letting you seefairly & fully what I look upon you to have been-and what I depict

189

TOUCHDD WTTHFIRE

you as being.-If seeing this-you can detect what is false_or an_swer what is charged-do so-Uour mark sltall not be erased.teZ

one of the many things that makes Byron so interesting is thesheer power of his life and emotions. To focus exclusively, i,

"u"nlargely, on his psychopathology----other than to use it to understandhim and his work-would be to make a mockery of his complexity,imagination, and vast energies. His personal discipline was Jxtraor-dinary; his technical discipline, although orrers^hado*ed by themore Romantic notion of effortless poetry written "as easily as thehawk flies" (and not helped by the fact that he seems io harrepublished, with little discrimination, virtually everything he everwrote) was also impressive. Byron's extensive reworking of a singlestanza from Don Juan, for example, is shown here in iis ffrst draftand an accompanying diagrammatic outline. "His reason was punc-tuated, even disturbed, by passion," wrote Alan Bold. "But what-ewer he was in person he was not, as an artist, passion's slave. Inthe po-etry Byron masks his passion and makes it into endurableart."re8 Byron himself wrote: "yet, see, he mastereth himself. andmakes/His torture tributary to his will."ree

In the end Byron brought a deeply redemptive spirit to theproblems of despair, ennui, uncertainty, and disillusionment. Inwriting about another, he more finally described himselfi

The apostle of affiiction, he who threwEnchantment over passion, and from woeWrung overwhelming eloquence, first drewThe breath which made him wretched; yet he knewHow to make madness beautiful, and castO'er erring deeds and thoughts, a heavenly hueOf words.2m

Byron's life and work were profoundly shaped by many things,not least of which were the traits passed on to him by his ancestors.He was not alone among writers and artists in having to play outthe cards of a troubled inheritance.

6.GEI\IEAI,OGIES

OFTITESEI{IGH MORTAL

MISERTES

The Inheritan ce of Manic-DepressiveIllness

The most poisonous reptile of the marsh perpetuates his kind asinevitably as the sweetest songster of the grove; so, equally withevery felicity, all miserable events do naturally beget theirlike. . . . To trail the genealogies of these high mortal miseries. . we must needs give in to this: that the gods themselves arenot for ever glad. The ineffaceable, sad birth-mark in the brow ofman, is but the stamp of sorrow in the signers.

-HERMAN IITEI,VILLN'

Tree and Cathedral Graveyard, St. Andrews, Scotland. Alain Moreau

TOUC}IBD WTTH FIRE

Manic-depressive illness is a genetic disease, running strongry, notto say pervasively, in some families while absent in most. RobertBurton, as early as the seventeenth century, wrote unequivocally,"I need not therefore make any doubt of Melanchory, but that it isan hereditary disease,"2 a view held by most medical observersIong prior and long subsequent to his time. The inexorable passingon of madness from generation to generation is an ancient lit"r*ytheme, as well as a traditional cultural and medicar berief. Alfred,Lord Tennyson, who, as we shall see, had good reason to cast abrooding eye on his family's issue, spoke of a "taint of blood"; LordByron, of like vein but in a slightly different context, felt that"Some curse hangs over me and mine." And Edgar Allan poe, ofcourse' wilh a high sense of Gothic desolation and foreboding,described these family taints and curses in The Fall of the ttouse"ifUsher:

During the whole of a dull, dark, and soundless day in the autumn ofthe year, when the clouds hung oppressively low in the heavens, Ihad been passing alone, on horseback, through a singularly dreary

GENEALOGIES OFTHESE HIGH MORTAL MISERIES 193

tract of country; and at length found myself, as the shades of theevening drew on, within view of the melancholy House of Ush-er.

Its proprietor, Roderick Usher . . . spoke of acute bodily ill-ness--of a mental disorder which oppressed him . . .

I was at once struck with an incoherence-an inconsistency . .an excessive nervous agitation. . . . His action was alternately viva-cious and sullen. His voice varied rapidly from a tremulous indeci-sion (when the animal spirits seemed utterly in abeyance) to thatspecies of energetic concision . . . which may be observed in the lostdrunkard, or the irreclaimable eater of opium, during the periods ofhis most intense excitement.

It was, he said, a constitutional and a family evil, and one forwhich he despaired to find a remedy-3

Modern medicine gives credence to these literary notions offamilial madness; the genetic basis for manic-depressive illness isespecially compelling, indeed almost incontrovertible.a Studies ofidentical and fraternal twins provide one strong source of evidencefor the hereditability of manic-depressive illness. (Identical, ormonozygotic, twins share the same genetic material whereas fra-ternal, or dizygotic, twins share only half their genes [in this, then,they are no different from other siblings]; in contrast, both types oftwins share a generally similar environment. ) If one twin hasmanic-depressive illness, the other is far more likely (70 to 100percent) to have it if the twins are identical than if they are frater-nal (approximately 20 percent).s These concordance rates (the like-lihood of a second twin being affected)for bipolar illness are muchhigher than those for unipolar depressive illness.6In an attempt todetermine the relative importance of genetic as opposed to envi-ronmental influences, a few adoption studies have been carriedout. A review of a total of twelve pairs of monozygotic twins whowere reared apart from the time of infancy-and in which at leastone of the twins had been diagnosed as having manic-depressiveillness-found that eight of the twelve pairs were concordant forthe illness. This suggests the strong infuence of genetic factors.T

In family studies of mood disorders, researchers look for fa-milial patterns in occurrence of mania, depression, and suicide.The many studies of this nature that have been done are quiteconsistent in showing that manic-depressive illness is indeed fa-

TOUCIMD WITHFTRE

milial; the rate of manic-depressive and depressive illness in first-degree relatives of patients ($"t T, parents, sibrings, and chirdrerr)is far higher than the rate found in relatives ofiontrol sr";n;.rIndividuals who have_manic-depressive illness are quite iit

"rv to

have both bipolar and unipolar reratives. There i, "iro

,o*" "ui-dence that bipolar II illness (major depressive illness with a history

of hypomania rather than mania) "breeds true"; that is, there is anincreased risk of bipolar II illness among relatives of bipolar IIpatients.e Based on an e-xtensive study of aFectivelyirr f"ii"-"t, nr.Elliot Gershon, chief of the clinicar Neurogenetics Branch of theNational Institute of Mental Health, estimates that if one parenthas manic-depressive illness and the other parent is unaffectld therisk of affective illness in the child (either depressive or manic-depressive_ illness) is 28 percent. If, ho*"u"r, Loth parents haveaffective illness and- one of them is bipolar, the risk of malor de-pression or manic-depressive illness rises dramatically, to almost75 percent ro There is a tendency for individuals witi'mood dis-orders to marry one another-<<assortative mating"-and it has tre-mendous significance not only genetically but also psychologicallyfor the children of such marriages.

A vigorous pursuit of the actual gene or genes responsible formanic-depressive illness is now underway. tn tgsz a gro,rp of in-vestigators studying an Amish community in pennsylvania reporteda link between a dominant gene they thought

"o,,f"ouJ " f."dir-position to manic-depressive illness and chromosome ll:rl atroughly the same time another team of researchers, studying anIsraeli population, reported possible linkage on the X chromo-r9T".-tn subsequent research has brought into question the validityof both the chromosome 11 and X chromosom" ffrrdi.rgr,13 but fewscientists in the field doubt that the g€nHr, far more likely, thegenes-for manic-depressive illness will be found. Interestingly,a significant number of individuals who have the gene for manic-depr-essive illness, p"Ilr"pl 20 or 30 percent, wilfnever developthe disease. This so-called "incomplete penetrance," together withthe tremendous range in the severity of the expression"of the dis-ease, raises central questions about the interactions .between ge-netic predisposition, the physical and psychological environment(including stress, alcohol and other drugs, slelp loss, changingpatterns of light, and psychological loss or trauma), and other pro-

GENEALOGIES OFTHESE HIGH MORTAL MISERIES 195

tective or potentiating genes. Pat Conroy, in his novel The Princeof Tidet, describes how the complexities of madness played them-selves out in one family:

I thought about how we had all arrived at this point in time, whatbenedictions and aggrievements each of us had carried from theisland and how each ofus had an indisputable and unchangeable rolein our family's grotesque melodrama. From earliest childhood, Sa-vannah had been chosen to bear the weight of the family's accumu-lated psychotic energy. Her luminous sensitivity left her open to theviolence and disaffection ofour household and we used her to storethe bitterness of our mordant chronicle. I could see it now: Onemember of the family, by a process of artificial but deadly selection,is nominated to be the lunatic, and all neurosis, wildness, and dis-placed suffering settles like dust in the eaves and porches of thattenderest, most vulnerable psyche. Craziness attacks the softest eyesand hamstrings the gentlest flanks. When was Savannah chosen to bethe crazy one? I thought. When was the decision made and was it byacclamation and had I, her twin, agreed to the decision? Had Iplayed a part in stringing up the bleeding angels in her room andcould I help cut those angels down?ra

We next look at several writers, composers, and artists who weredeeply affected by their "taint of blood." Apart from an individual'sown history of recurrent, severe, and fluctuating mood states, themost useful information in making a diagnosis of mood disorders isa family history of manic-depressive illness, severe depressive ill-ness, or suicide. The family histories of these creative individuals-histories of melancholia, mania, and suicide-not only providediagnostic and psychological insights into the writers, artists, andcomposers under discussion, but they bring sharply into focus theimplications that the genetic basis of manic-depressive illness hasin the understanding of the disease, its treatment, and its role insociety.

TOUCIIDD WTTIIFIRE

-

"Must I too creep to the hollou: .

ALFRED, LORD TENNYSON

I hate the dreadful hollow behind the little wood,Its lips in the ffeld above are dabbled with brood-red heath,The. ryq-rib!'d ledges drip with a silent horror of blood,And Echo there, whatever is ask'd her, answers .Death.,

For there in the ghastly pit long since a body wasfound,

His who had given me life-O father! O God! was itwell?-

Mangled, and fatten'd, and crush'd, and dintedinto the ground:

There yet lies the rock that fell with him when he fell.

What! am I raging alone as my father raged in his mood?Must / too creep to the hollow and dash myself down

and dieRather than hold by the law that I made, neverrnore

to broodOn a horror of shatter'd limbs .

-ALFnED, r,onn tnNNysoNrs

"Maud or the Madness," Tennyson wrote about the poemquoted above, "is a little Hamlet, the history of a morbid poeticsoul . . . the heir of madness."ru It was Tennyson,s favorit" po.rrr,he would recite it over and over again-bleakiy, tirelessly-tf fam-ily and friends. Obs-essed by the "black blooi', of the T"rrrry.orrr,he struggled throughout his life not only with fierce and recurrentdepressions but with the fear of going mad as well. Even the mostfleeting glance over the Tennyson bloodline makes clear how sanehis fears of madness were. Melancholy, violence, and insanity canbe traced at least as far back as the seventeenth-century branchesof the clayton and Tennyson families.rT Both Alfied's father andgrandfather had recurrent attacks of uncontrollable rage and de-pression, and at least one of his paternal aunts, probably both,

GENEALOGIES OFTIIESE IIIGH MORTAL MISERIES 197

suffered from depressive illness. Tennyson's father's brother wasdescribed by Alfred's grandson, Sir Charles Tennyson, as also hav-ing inherited his father's melancholic "fretfulness and irritabili-ty."tt But it was George Clayton Tennyson, father of the poet, whosuffered most and caused the most suffering: "The black bloodwhich flowed in the veins of all the Tennysons had in his caseturned to bile."re Robert Bernard Martin, in his excellent biogra-phy of Alfred Tennyson, describes the elder Tennyson as havingbeen "ungovernable" from an early age, "inconstant in mood,""vacillating between frenzy and lethargy," an alcohol abuser, andsuffering from debilitating, black depressions.2o Later in his lifeGeorge Tennyson also experienced "ftts," whose nature remainsunclear. Interestingly, Alfred described having seizurelike trancesbut, although terrified of inheriting his father's "epilepsy," he wasreassured by his physician that he did not in fact have the disease.

Eventually, George Tennyson (Alfred's father) became insane,endangering his own life as well as those of others. Professor Mar-tin writes:

He kept a large knife and a loaded gun in his room, and he was withdifficulty persuaded not to ffre the gun through the kitchen window.In his mania he often had his time confused and probably thought hewas back in Cambridge as an undergraduate, firing through thechapel window of the college. . When he was persuaded to giveup the gun, he said he would take the knife and kill Frederick [hisson] by stabbing him in the jugular vein and the heart. "We maythank God that we do not live in a barbarous Country," said Fred-erick. "or we should have murdered each other before this."zr

The troubled inheritance of the Tennysons seems to havetaken its most virulent root in the males of the family: Alfred'sfather, grandfather, and two great-grandfathers, as well as all six ofhis brothers, suffered from insanity, severe melancholia, incendi-ary tempers, or manic-depressive illness. One of Alfred's brothers,Edward, was conffned to an insane asylum for almost sixty yearsand eventually died from manic exhaustion. Another, Septimus,"the most morbid of all the Tennysons," was described by Alfred ina concerned letter written to their uncle: "I have very little doubtbut that his mind will prove as deranged as Edward's . . . I havestudied the minds of my own family-I know how delicately they

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TOUCIIED WITI{FIRE

are organized- . . . At present his symptoms are not unlike thosewith which poor Edward's unhappy dl.ange*ent began_he issubject to fits of the most gloomy d"rpondrrly.,,nn errd,-.,r"ry

""rtyon in Alfred's own life, in 1831, his closest frlend Arthur-Hallanlnoting that Alfred's mind "certainly is in a distressing state," wrote:"Fare thee well. I hope you dg fare welr, and mak"e lr""a

"g"i"rt'despondency

and madness.' "B Alfred's uncre charr", "fp"'"r,

tohave shared in the..family temperament, as did ChurL'r,, ,o.r,George Hildeyard d'Eyncourt, and Julius, son of Alfred's erdestbrother Frederick.

-A$ed Tennyson's own two sons, Hallam and Lionel, weremarkedly different in temperament and interests:

Hallam was to become a highry conventional man, obedient, carefur,devoted to his parents almost beyond credibility. Lionel was'far moreinteresting, with some poetic ability, a mercurial personality, a talentfor getting into scrapes, and a charm that his

"1d", brother never

had. The headmaster of their first school correctly described them:'Lionel the more brilliant, Hallam by far the morl accurate.,%

Lionel, "the heir of the Tennyson's black blood,,,* i, turn hadthree sons, one of whom also "inherited the mental instability ofSomersby and Tealby"zo lthe sixth generation of Tennyson mendocumented here to be affected).

Threaded in and around the Tennysonian temperament wasan equally pervasive, similarly extraordinary, familylent and pas-sion for poetry. Three of the Tennyson brothers together publisheda b-ook of their poems prior to matriculating *i cu-bridge; asundergraduates they received the university's major literary prizes:Frederick, who went on to publish three volumes of u"rir, ,"-ceived the cambrid,ge prize for Greek odes; charles, who alsopublished several subsequent volumes of verse and who was re-garded by both coleridge and wordsworth as the most promisingof the-Tennyson brothers, received the cambridge prize for hisEnglish translation of the classics; and Alfred, who went on to writeln Memariam, Tears, IdIe Tears, Ulysses, ldglls of the King, andMaud, received the University prize for poetry. Arlhur, Seplimus,Edward, Mary, Cecilia, and Emily also wrote verse, and ilmily,sgranddaughter became a poet and novelist. Horatio, the youngestof the Tennyson children, although displaying "no literary tastes

GENEALOGIDS OFTIIESE HIGH MORTAL MISERIES a01

whatsoever"2T and who was wonderfully described by EdwardFitzGerald as "rather unused to this planet,"es had a son withconsiderable literary ability. Alfred Tennyson's grandson noted:

?he Somersby Tennysons could never have arisen in any previousage and the likes of them are not likely to be seen again. They wouldall now presumably be classed as, in some degree, manic depres-sives; they all succumbed at some time or other and for varyingperiods to some form of religious obsession. . . . Though only threeattempted to publish, all wrote verse and one feels that, given Al-fred's concentration and stamina, all might have found honourableplaces in the roll of British poets. . . .

Canon H. D. Rawnsley in 1892 asked the eighty-ffve-year-oldFrederiek Tennyson to which of their ancestors the poetic genius ofthe Somersby Tennysons could be attributed. Frederick replied fromJersey in a clear bold hand and in characteristically rotund, butslightly incorrect, phrases:

With respect to your query as to what fountain of inspiration theTennysons are indebted, the Creator himself only could give aperfectly definitive answer. From many generations of ancestorsposterity derives collective infuences, and therefore it is diffi-cult to assign to any single individual what may have been min-gled in an accumulated form in the last inheritor.2e

As for the poetic inheritance of Alfred Tennyson: He was,wrote T.S. Eliot-himself no stranger to melancholy-"not only aminor Virgil, he is also with Virgil as Dante saw him, a Virgilamong the Shades, the saddest of all English poets."3o

IT

"The storm-tossed body and soul"

ROBERT SCHUMANN

And so it is throughout human life-the goal we have attained isno longer a goal, and we yearn, and strive, and aim ever higherand higher, until the eyes close in death, and the storm-tossedbody and soul lie slumbering in the grave.

3 l-ROBERT SCHUMANN'

TOUCHED WITH FIRE

The youngest of ffve children, German composer Rotrert schu-mann was born one year after Arfred Tennysoir, in rgl0. A mer-ancholic and restless streak appears to have come from both sides-of his family. His father, ̂ tugust schumann, was an author, trans-lator, and publisher; from him Robert inherited

"r, u*f

"rrd sus-

tained passion for poetry and literature. Among the first to translateLord Byron's poetry, including Chitde naritts pilgrl.mnge, intoGerman, schumann's father was of "exquisite sensibiiity"; "his

firstreading of Edward Young's poetry "tooi so strong holi upon himthat he believed himself near madness."32 the llder s"^h,r-"rr'was also an unsettled, anxious, ambitious, and deeply broodingmgr who reputedly had a nervous breakdown, from *tii"t he neverfully recovered, in the year of Robert's birth. Like his son, Augustschumann worked in phenomenal bursts of energy and productiv-ity; during one eighteen-month period he *rotl, am^ong otherthings, seven novels. Robert's mother had recurrent atf,cks ofdepression, the dark moods of which were captured graphically ina letter he wrote to her in l82g: "oh, mother, again |o., carr't i"".y-ourse]f away from the grandfather chair, yor hu.,r" been sittingthere for two everlasting hours, saying not a word, singing a deadold song, stroking up and down the window with yoir f,and.,,sHer morbid letters, he said, left a "dreadful discord't i'hi, soul.e

other members of his family also showed signs of the mentalinstability that was to haunt schumann from the time he was eigh-teen until his death in an insane asylum at the age of forty-six. Hissister committed suicide, as did a physician cousin on his father'sside; one of schumann's sons went insane in his earry twenties andwas conffned to an a.sylum for thirty-one years; yet another becamea morphine addict.s

schumann himself was an intensely emotional man, soft-spoken, reflective, gentle, idealistic, absent- and dreamy-minded,and generous. He was well known, particularly during hi, d"y,

",a law student at the University of Leipzig, for his loie of cham_pagne and cigars, his financial extravagance, and his fervor formusic and poetry. As early as his student years he began to expe-rience the violent mood changes that characterized much of iherest ofhis life. when he was eighteen schumann described the firstepisode of what he called madness: "My heart pounds sickeninglyand I turn pale . . . often I feel as if I were dead . . . I seem to be

GENEALOGIES OFTI{ESE I{IGH MORTAL MISERIES 803

losing my mind. I did have my mind but I thought I had lost it. Ihad actually gone mad."36 The following year, 1829, found Schu-mann in a completely different state+bullient, active, and highlyproductive: "But if you only knew how my mind is always working,and how my symphonies would have reached op. 100, if I had butwritten them down . . . sometimes I am so full of music, and sooverflowing with melody, that I ftnd it simply impossible to writedown anything."37

Although one tends to associate Robert Schumann with mel-ancholic thoughts and writings, there was clearly much of the joy-ous in him. During his twenties, at various times, he describedthose feelings: "I am so fresh in soul and spirit that life gushes andbubbles around me in a thousand springs. This is the work of divinefantasy and her magic wand";s and, after publishing his first com-position, he wrote: "I doubt if being a bridegroom will be in thesame class with these ffrst joys of being a composer. The entireheavens of my heart are hung full of hopes and presentiments. Asproudly as the doge of Venice once married the sea, I now, for thefirst time, marry the wide world."3e

As music increasingly dominated his life, law school.<ver anendurance and rarely actually attended-became intolerable.Schumann wrote: "Chilly jurisprudence, with its ice-cold deffni-tions, would crush the life out of me from the onset. Medicine Iwill not, theology I cannot, study."ao He ffnally received permis-sion to study piano with Friedrich Wieck, father of Clara, thewoman Schumann was eventually to marry after many years ofseparations and crises. Wieck's vitriolic opposition to their mar-riage was based in part on paternal jealousy and in part on hisconcerns about Schumann's reputation for heavy drinking and ff-nancial irresponsibility. Schumann wrote to Clara in 1837: "Myinterview with your father was terrible. He was frigid, hostile,confused, and contradictory at once. Truly his method of stabbingis original, for he drives in the hilt as well as the blade."al

They finally married in 1840, Schumann's great "year of song."He composed more than 130 songs during what was undoubtedlyone of the most productive periods in the career of any composerin the history of music. By that time Schumann's highly disruptiveand painful mood swings had become part of his life. tn his work asfounding editor and critic of the Neue Leipziger Zeitschrift f{ir

TOUCHDD WTTIIFIRE

Musik, schumann introduced into his public writings two charac-ters who represented the _conflicting, but ofte' cJ*plementarysides of his stormy personality. Froreitan was portrayei as i-pui-sive, wildly energetic, impassioned, decisive-, masculine, high_spirited, and iconoclastic. Eusebius, in contrast, was the gentllr,more melancholic, pious, introspective, and inward_gazinipart ofhimself. schumann's extraordinary abirity to put his-feeliigs intohis music was closely matched by his ability to express the* inwords. In 1838 he described in a letter to ciara the-terrors of hisemotional life five years earlier:

As early as 1833 a certain melancholy made itself felt. . . . In thenight between the l7th and l8th of october I was seized with theworst fear a man can have, the worst punishment Heaven can in-flict-the fear of losing one's reason. It took so strong a hold of methat consolation and prayer, defiance and derision, were equallypowerless to subdue it. Terror drove me &om place to place. Mybreath failed me as I pictured my brain paralyzed. Ah, clara! no oneknows the suffering, the sickness, the despair, except those socrushed. In my terrible agitation I went to a doctor

"nd told hi*

everything-how my senses often failed me so that I did not knowwhich way to turn in my fright, how I could not be certain of nottaking my own life when in this helpless condition.a2

A diary entry in 1834 notes simply: "I was obsessed with thethought of going mad. "a3 Periods of remarkable creativity, produc-tiv!!,. and high spirits were woven into the otherwise frighteninglysad fabric of Schumann's liG. In 184I, Schumann's most importantyear of symphonic composition, Clara wrote in her diary: "OnTuesday Robert finished his symphony; so begun and ended in fourdays."a+ Schumann himself described his woik during this period:"It was born in a ffery hour. . I wrote the Symphony in thatflush of Spring which carries a man away even in his old age andcomes over him anew every year."n5 But the ffery times for Schu-mann were always outweighed by the melancholic. In 1g45 hedescribed his gradual recovery from yet another breakdown to hisfriend and fellow composer, Felix Mendelssohn: "I have a greatdeal to tell you-what a bad winter I have had; how

" "o*pl"t"nervous collapse, with an onslaught of terrifying thoughts in itstrain brought me to the verge of despair, that the prospect is

GENEAIOGIES OFTHESE HIGH MORTAL MISERIES 8O5

pleasanter now, and music, too, is beginning again to sound withinme, and I hope soon to be quite restored."ao

The year 1849 was another one of extraordinary productivityfor Schumann. Manfred, composed during this time, was basedupon Byroq's melancholic poem of the same name. Tellingly, Schu-mann wrote: "Never before have I devoted myself with such loveand outlay of energy to any composition as that of Manfred."a7Looking back over the year he wrote with awful prophecy of thetragic events to come: "I have been extremely busy this wholeyear. One has to work as long as the daylight is there."a8 Duringthat same period of time he wrote with characteristic understate-ment and modesty: "I cannot see that there is anything remarkableabout composing a symphony in a month. Handel wrote a compreteoratorio in that time. "ae

For Schumann there was not much daylight left, and "with theshadow of his insanity already hanging over him [Tchaikovsky'sdescription],"to h" wrote in l84g:

Lately I was looking for information about Diisseldorf in an old ge-ography book, and there I found mentioned as noteworthy: ..three

convents and a lunatic asylum." To the ffrst I have no objection if itmust be so; but it was disagreeable to me to read the last. . . . I amobliged to avoid carefully all melancholy impressions of the kind.And if we musicians live so often, as you know we do, on sunnyheights, the sadness of reality cuts all the deeper when it lies nakedbefore our eyes.5r

In 1854 his illness, perhaps complicated by general paresis(although recent evidence suggests Schumann may never havecontracted syphilis),52 became particularly virurent. His wife de-scribed in her diary what Schumann no longer was able to:

In the night, not long after we had gone to bed, Robert got up andwrote down a melody which, he said, the angels had sung to him.Then he lay down again and talked deliriously the who'ie night,staring at the ceiling all the time. when morning came, the arr[elstransformed themselves into devils and sang horrible music, tellinghim he was a sinner and that they were going to cast him into hell.He became hysterical, screaming in agony that they were pouncing

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GENFJ,I,OGIES OFTHESE HIGH MORTAL MISERIPS 2O7

on him like tigers and hyenas, and seizing him in their claws. Thetwo doctors who came only just managed to control him.53

Clara wrote this description on February l0; for the next severaldays his moods continued to fuctuate wildly fiom one extreme toanother. On February 27 Schumann rushed out of the house, sob-bing and without an overcoat, and threw himself into the Rhine.He was rescued and placed in the insane asylum in Endenich,where-never having left it-he died of self-starvation in 1g56.

Franz Liszt, having observed Schumann's struggles with hiscomplicated and self-lacerating temperament, added his ownpoignant commentary:

No one can fail to recognize that instead of venturing, conquering,discovering, schumann strove to reconcile his romantic personality,torn letween joy and pain, and often driven by a dark urge towardsthe fantastic and the bizane, with the modalities of clasiical form,whereas the clarity and symmetry of such forms lay beyond his char-acteristic spirit. . . . This struggle against his true nature must havecaused him great suffering, and it has stained even his most beautifulpages with the blood that has flowed from the open wound.il

-

"A whiff of mel.ancholg, things that sound a knell"

THE JAMES FAMILY

The natural inheritance of everyone who is eapable of spirituallife is an unsubdued forest where the wolf howls and the oir""rr"bird of night chatters.

-HENRv;eurs, Sn.s

Unsuspectedly from the bottom of every fountain of pleasure . . .something bitter rises up: a touch of nausea, a falling dead of thedelight, a whiff of melancholy, things that sound a knell, for

TOUCHDD WITH FIRE

fugitive as they may be, they bring a feeling of coming from adeeper region and often have an appalling convincingness.

-WTLLIAM JAMES56

Experience is never limited, and it is never complete; it is animmense sensibility, a kind of huge spiderweb of the ffnest silkenthreads suspended in the chamber ofconsciousness, and catchingevery airborne particle in its tissue.

-HENRY JAMESsT

Henry James, Sr.-writer, theologian, and philosopher, aswell as father of the psychologist and the novelist-was born in1811 to an enormously successful and cyclonically active business-man, William James, who had emigrated from Ireland and settledin Albany. His grandson, novelist Henry James, recounts in hisautobiography:

Our grandfather's energy, exercised in Albany from the greatyear 1789, appears promptly to have begun with his arrival there."Everywhere we see his footsteps, turn where we may, and these arethe results of his informing mind and his vast wealth. His plans ofimprovement embraced the entire city, and there is scarcely a streetor a square which does not exhibit some mark of his hand or someproof of his opulence. With the exception of Mr. Astor," this delight-ful report [New York Eoening Post, 1832] goes on to declare, "noother business man has acquired so great a fortune in this Statelthree million dollarsl."s

This singular success, F. O. Matthiesen points out, was in bittercontrast to the fate of Allan Melvill-another New York business-man who was to be father to a famous writer-who died bankruptand insane in the same year. Both men, however, were to pass ontheir power l temperaments to their sons.

By all accounts Henry James, Sr., was a roaming, restless,idealistic, and evangelical man, an expansive enthusiast whose"ballooning mind was filled with a heady cosmic gas that defiedcondensation."se He was also a fiercely and affectionately involvedfather who crisscrossed the Atlantic with his family in a freneticquest for an ideal and "sensuous" education for his children. Of

GENEALOGIBS OFTHESE HIGH MORTAL MISERIES S09

"high-strung sensibility,"* he wrote in his autobiography that his"earliest sensible foundations" were laid in a "horror of great dark-ness."6r While still young he became addicted to alcohol and,during his early thirties, suffered from a nervous breakdown thatlasted for more than two years:

In a lightning-flash as it were-'fear came upon me, and trembling,which made all my bones to shake.'To all appearance it was a per-fectly insane and abject terror, without ostensible cause, and only tobe accounted for, to my perplexed imagination, by some damnedshape squatting invisible to me within the precincts of the room, andraying out from his fetid personality influences fatal to life . . . thisghastly condition of mind continued with me, with gradually length-ening intervals of relief, for two years, and even longer.62

During this period of intense desolation, Henry James, Sr., like somany others of his era including the Tennysons, turned to themystical writings of Emanuel Swedenborg, a Swedish scientist,philosopher, and theologian. Of similarly expansive mind and liketemperament, he had himself experienced psychological crises of,to say the least, great mood and moment. Swedenborg was con-vinced that he had conversed with the inhabitants of all the planets(except Uranus and Neptune, which had not yet been discovered)and thought he could discern witches.6 In lgg6 British psychia_trist H. Maudsley described the controversy and impact of Swe-denborg's (almost certainly manic) hallucinations on his religiousfollowers, as well as on his dissenters:

The visitation was the forerunner of an attack of acute mania-sooverwhelming the pressure of supernatural influx upon the mentalequilibrium of the natural man-which lasted for a few weeks; onrecovery from which he was what he remained for the rest of hislife---either, as his disciples thrnk, a holy seer endowed with thefaculty of conversing with spirits and angels in heaven and hell, andin whom the Lord Jesus christ made His second comins for theinstitution of a new church, described in the Revelation rirder theffgure of the New Jerusalem; or, as those who are not disciples think,an interesting and harmless monomaniac, who, among many foolishsayings, said many wise and good things, attesting the wreck of amind of large original endowment, intellectual and moral.s

310 TOUCIIED WTTH FIRE

Henry James, Sr., passed on his melancholic strain, as well ashis vastness of spirit and energies, to at least four of his ffve chil-dren. William, the eldest, was, like his father before him, passion-ately committed to the problems of philosophy, religiin, andpsychology. Author most importantly of The principles if rsgchor-ogy and, The Varieties of Religious Erperience, Williamj"*",

", "young man had hoped to continue his studies of painting with fohnLa Farge and william Morris Hunt in Newport. (A strong artisticstreak in the James family was later remarked upon by HenryJunior, William's younger brother, the novelist: "No less than threeof our father's children, with two of the grandsons to add to these,and with a collateral addendum representing seven, in all, of ourgrandfather's, William James', descendants in three generations,should have found the artistic career in general and the painter'strade in particular irresistibly solicit them.";os Instead, his fatherencouraged him toward a more scientiffc education; in 1869 heobtained his medical degree from Harvard, although he neverprac-ticed medicine. For several years prior to and following his grad-uation William suffered from severe "nervous instability" anddepression. Described by his mother as possessing a "morbidlyhopeless"ffi temperament he, by his own account, spent all of onewinter "on the continual verge of suicide."67 As Jacques Barzun haspointed out, fames's "neurasthenia . . was no temporary troubleof late adolescence. It was a deep-rooted depression which held uphis choice of career till his mid-twenties, which he overcame inpart by an heroic effort of will, and which periodically returned,though less crippling, throughout his life."68

Later in his life James was to incorporate into The Varieties ofReligious Experience his own experience with dread and melan-choly. In the original accounting, before he acknowledged that thepassage was autobiographical, |ames wrote that "the worst kind ofmelancholy is that which takes the form of panic fear" and went on:

Suddenly there fell upon me without any warning, just as if it cameout of the darkness, a horrible fear of my own existence. Simulta-neously there arose in my mind the image of an epileptic patientwhom I had seen in the asylum, a black-haired youth with greenishskin, entirely idiotic, who used to sit all day on one of the benches,or rather shelves against the wall, with his knees drawn up against his

GENEALOGIDS OFTHESE HIGH MOKIAL MISERMS 211

chin, and the coarse gray undershirt, which was his only garment,drawn over them inclosing his entire ffgure, He sat there like a sortof sculptured Egyptian cat or Peruvian mummy, moving nothing buthis black eyes and looking absolutely non-human. This image and myfear entered into a species of combination with each other. Thatshape am I, I felt, potentially. Nothing that I possess can defend meagainst that fate, if the hour for it should strike for me as it struck forhim. There was such a horror of him, and such a perception of myown merely momentary discrepancy from him, that it was if some-thing hithe*o solid within my breast gave way entirely, and I be-came a mass of quivering fear. After this the universe was changedfor me altogether. . . . although the immediate feelings passed away,the experience has made me sympathetic with the morbid feelings ofothers ever since. It gradually faded, but for months I was unable togo out into the dark alone.6e

William James's melancholia, interspersed with intense andecstatic experiences as well, recurred throughout his life andcaused him to seek, in Tennysonian manner, endless remedies,reliefs, and cures. His younger brother Henry, although less se-verely affiicted, showed similar tendencies. In a brief portrait ofHenry, William wrote:

Harry is as nice and simple and amiable as he can be. He has coveredhimself, like some marine crustacean, with all sorts of materialgrowths, rich sea-weeds and rigid barnacles and things, and liveshidden in the midst of his strange alien [English] **rr1., and cus-toms; but these are all but 'protective

resemblances,' under whichthe same dear, old, good, innocent and at bottom very powerless_feeling Harry remains, caring for little but his writing, and full ofdutifulness and afection for all gentle things.To

O_n-the same day he also wrote, tellingly, that Henry was ..a

nativeof the James Family, and has no other country"; this was certainlytrue, in his common holdings of not only the Jamesian experiencebut the ]amesian temperament as well. Like william he sufferedthroughout his life from intermittent, often deep melancholy, "theblack devils of nervousness, direst damndesi demons.',7i Jeanstrouse, biographer of their sister Alice, points out: "It did seem asthough Henry and William were for yr"r, o., opposite ends of a

s1s TOUCHED WITII FIRE

scale: when one was healthy and productive, the other flounderedin illness and a sense of uselessness ."', ln his recent biography ofthe Jameses, R. W. B. Lewis quotes Henry's descripti,on of his"damnable nervous state." His "black depression-the thckness ofdarkness and the cruelest melancholi*,'- H"nry wrote, "were his'chronic

enemy and curse.' "t3 His friend, novelist Edith wharton.described a particularly deep depression experienced by Henry in1910 (during which time he was examined by the well-known phy-sician Sir William Osler, who had attended William James on anearlier occasion):

I sat down beside the sofa and for a terrible hour looked into theblack depths over which he is hanging-the super-imposed "abysses"of all his ffction. I, who have always seen him so serene, so com-pletely the master of his wonderful emotional instrument sosensitive to human contacts and yet so secure from them; I couldhardly believe it was the same James who cried out to me his fear, hisdespair, his craving for the "cessation ofconsciousness," and all hisunspeakable loneliness and need of comfort, and inability to be com-forted! "Not to wake-not to wake-" that was his refrain; "and thenone does wake, and one looks again into the blackness of life, andeverything ministers to it."7a

Robertson James, the youngest of the four james brothers,was melancholic, restless, and irritably sensitive from the time hewas very young. He appears to have been the one most clearlyaffected and debilitated by his temperament, a stormy and volatileone punctuated by wild mood swings. Robertson ("Bob") James,wrote F. O. Matthiesen: "seems to have been the most nakedlysensitive of the whole family. They spoke of the high-strung agi-tation and the morbid self-distrust that lurked behind his animationand his gift for talk."7s He was artistically inclined-he wrote po-etry, painted, and wished to be an architect-but, after servingwith valor in the Civil War as a white officer in one of the blackMassachusetts regiments (as had his older brother Wilkie, who waswounded fighting next to Colonel Robert Gould Shaw during hisdoomed attack on Fort Wagner, South Carolina), he became in-creasingly restless, erratic, and depressed. He had repeated ner-vous breakdowns-periods of violence and abusiveness followedby periods of morbid melancholy-which, combined with alcohol-

GENEAIOGIES OFTIIESE HIGH MORTAL MISERIES 218

ism, led to several extended periods of treatment in different asy-lums. His illness, unlike the lighter tincturing of moods andmadness experienced by William and Henry, took a far greater tollon both his personal life and his work. His brother William wrotethat Bob's "cure is hopeless, I think, his brain is getting more setin these irascible grooves. . . . The only manly and moral thing fora man in his plight is to kill himse6,"zo and Henry wrote of him:"There was much and of the most agitated and agitating-that hehad been dipped as a boy into the sacred stream; to some effectwhich, thanks to two or three of his most saving and often soamusing sensibilities, the turbid sea of his life might never quitewash away."77

Alice, the youngest of the fames children, shared the familyability for writing and its lively but melancholic temperament. Sheunderwent extensive treatments for her "nervous attacks" and de-pressions, which, evident from a very early age, resulted in herffrst major breakdown when she was nineteen years old:

I have passed thro'an inffnite succession ofconscious abandonmentsand in looking back now I see how it began in my childhood, altho'I wasn't conscious of the necessity until'67 or'68 when I broke downffrst, acutely, and had violent turns of hysteria. . Owing to somephysical weakness, excess of nervous susceptibility, the moral powerpauses, as it were for a moment, and refuses to maintain muscularsanity, worn out with the strain of its constabulary functions. As Iused to sit immovable reading in the library with waves of violentinclination suddenly invading my muscles taking some one of theirmyriad forms such as throwing myself out ofthe window, or knockingoff the head of the benignant pater as he sat with his silver locks,writing at his table, it used to seem to me that the only differencebetween me and the insane was that I had not only all the horrors andsuffering ofinsanity but the duties ofdoctor, nurse, and strait-iacketimposed upon me, too.78

Although Alice wrote long and lucidly about her "breakdowns"(which were usually characterized by mixed symptoms of bothmania and depression) and her preoccupations with suicide, shewas by no means a predominantly morbid person. She had greatvivacity, a fiery sense of life, and a stunning ability to reduce withscathing wit the lives and works of those less charged than she with

TOUCIIED \{IITHFIRE

joic dz oiore. After finishing George Eliot's letters and journals, forexample, she wrote in her diary:

There is a faint spark of life and an occasional, remotelv humoroustouch in the last half. But what a monument of ponderous drearinessis the book! what a lifeless, diseased, self-conscious being she musthave been! Not one burst of joy, not one ray of h,r.nou"., not..oneliving breath in one of her letters or journals. . . . whether it is thather dank, moaning features haunt and pursue one thro'the book, ornot, but she makes upon me the impression, morally and physically,of mildew, or some morbid growth-a fungus of a penduloui shap!,or as of something damp to the touch.Te

As one would expect, manic-depressive illness and its tem_peraments were not confined to the immediate family of HenryJames, senior. Jean strouse describes the brothers of the seniorJames as "a roster of dissipation-aimlessness, alcoholism, unin-teresting failures;"8o his niece Katharine Barber ]ames (daughter ofRev. William James, Henry Senior's older brother) spent a year, asa young woman, in an insane asylum. While there she fell in lovewith her physician, whom she later married, but she then spent therest of her life in and out of psychiatric hospitals.

The james family represents an extraordinary example of thepervasiveness of a psychotic illness and its milder variants in asingle, remarkable American pedigree.8r In a study addressing theadvisability of sterilizing individuals with manic-depressive illness,undertaken by the Committee on Heredity and Eugenics (a chill-ing context, and one to which we return in the final chapter) andpublished in 1941 in the Amprican J ournal of p sg chiatry, Dr. Abra-ham Myerson and Rosalie Boyle reported on the strikingly highincidence of manic-depressive illness in certain socially prominentfamilies. One thinly (not to say excruciatingly thinly) disguised"case history" clearly portrays the Jameses:

Two generations before the patients at the Mclean Hospital, animmigrant accumulated great wealth in America. He was a man ofgreat drive and intelligence. His son was an intimate of the greatliterary men of America and England and well known in his own rightas lecturer and man of ability. However, the history of his life showsthat {iom time to time he had depressions, and on one occasion the

GENEAIOGES OFTIIDSE HIGH MORTAL MISERIES 816

William b Henry JamesPartial Family llistory

". One of Henry, Sr.'s nbces was hospitalizeil repeateilly for psgchosis.b Wilkam lames's onlg daughter, Margaret (PeeCv), tufi"red ieaeral "breakdnans" from

recurrent depresston.' Probable mixed andlor hgpomanic states as well.

BrocRApHrcAL souncEs: Matthiessen, 1947; Edel, 196g, 1985: Strouse, lg80; Merher, lg86:Myers, 1986; Lewis, lggl. See text note 81.

attack lasted two years. He suffered greatly and ffnally reached areligious philosophy which comforted him a good deal. In the thirdgeneration there appeared a patient at the Mclean Hospital withmanic-depressive psychosis. His two brothers achieved fame of atype which may be described as international in the highest sense ofthe word, since the writings of both of these men have been trans-lated into all the languages. . . . In other words, although these menare dead and gone, they are still influential in the world of philoso-phy, psychology and literature. One of these men graphically de-scribes his own mental periodic illness. on one occasion he was sickffve years striving to recover some grip on life . . . he had otherbreakdowns and periods of nervous exhaustion. This man empha-sized that there was no sharp line between healthy and unhappyminds and that people who had neryous burdens to carry, hereditaryperhaps, could order their lives-fruiffirlly and derive some gain fromtheir degenerate sensitiveness. 82

Henry, Sr.''"1811-1889

MaryWalsh18tL1882

I tnipof-) Manic-depressive illness

Q *""urr".,t depressive illness

HENRYt843-I916

Garth Wilkinson1845-1883

Robertsonl&46-1910

A.lice"1.848-1892

816 TOUCIMD WTTH FIRE

The authors then go on to ask a heart-stopping question:"Whom could we have sterilized in this family line to prevent themanic-depressive state and at what cost of social riches, in the truersense, would this have been done?"

-

"(Jtter dnrkness is then his light"

HERMAN MELVILLE

The intensest light of reason and revelation combined, can notshed such blazonings upon the deeper truths in man, as willsometimes proceed from his own profoundest gloom. Utter dark-ness is then his light, and cat-like he distinctly sees all objectsthrough a medium which is mere blindness to common vision.Wherefore have Gloom and Grief been celebrated of old as theselectest chamberlains to knowledge? Wherefore is it, that not toknow Gloom and Grief is not to know aught that an heroic manshould learnPs

-HERMAN MELVILLE

The death of businessman William James in 1832, as noted byhis grandson Henry, was marked by extensive tributes to his fi-nancial acumen and his generous and energetic involvement withthe city and people of Albany. No such tributes tolled the passingof Allan Melvill. father of novelist Herman, who died manic, in-sane, and bankrupt in the same year. Melville's brother-in-law,instead, described the awful circumstances of his ftnal illness:

He was unwell. . . . But persisted in giving attention to his busi-

ness-He devoted himself so closely and assiduously, as to produce

a state of excitement, which in a great measure robbed him of his

sleep. . . . The excitement could not be allayed and yesterday he

occasionally manifested an alienation of mind. .- ' . today he presents

the melancholy spectacle of a deranged mind.8a

GENEAI,OGIES OFTHESE HIGH MORTAL MISERIES P77

Allan's brother Thomas, who was with him during his "excited

delirium," wrote of his own despair that, even if Allan survived, "in

all human probability-he would live, a Maniac!"ffiAllan Melvill (the spelling of the family name was changed in

Herman's generation) was born in 1782, the son of Major ThomasMelvill, an activist in the Boston Tea Party and a man who wasknown for "cultivating his eccentricities"; his brother, like Allan,had debilitating ffnancial problems and patterns of excess that even-tually led to his being put in a debtor's prison. In 1814 Allanmarried Maria Gansevoort, who also suffered from "nerves," al-though on the melancholic rather than manic end of the moodcontinuum. Her husband wrote frequently and with great concernabout her depressed spirits and at one point expressed his fearsthat she might not obtain "relief from mental excitement."s6 Oftheir children, Herman experienced clear and extended periods ofboth melancholy and manic excitement, although he never re-quired hospitalization. His wife wrote often of her concerns aboutHerman's "severe nervous affections,"87 his "constant working ofthe brain, and excitement of the imagination,"8s and his being in"such a frightfully nervous state."8e He talked of suicide to hisfriend Nathaniel Hawthorne, having "pretty much made up hismind to be annihilated."so He suffered from severe mood swingsthat ranged from expansive, energetic, and highly productive statesto irascible, bitterly morbid, withdrawn, and listless periods inwhich little was done and he was obsessed with death and fflledwith pessimism. Like Ishmael, Melville would, nowtake to the sea:

It is a way I have of driving off the spleen, and regulating the circu-lation. Whenever I ftnd myself growing grim about the mouth; when-ever it is a damp, dizzly November in my soul; whenever I findmyself involuntarily pausing before coffin warehouses, and bringingup the rear of every funeral I meet; and especially whenever myhypos get such an upper hand of me, that it requires a strong moralprinciple to prevent me from deliberately stepping into the street,and methodically knocking people's hats off-then, I account it hightime to get to sea as soon as I can.sr

Themes of madness, and its interlacings with visionary grandness,permeated Melville's writings in much the same way that his mel-

TOUCIIDD WITHFIRE

ancholic temperament wended its way in and around the lives ofhis ffctional characters. He wrote to a friend:

This going mad of a friend or acquaintance comes straight home toevery man who feels his soul in him,-which but fe* men do. For inall of us lodges the same fuel to light the same fire. And he who hasnever felt, momentarily, what madness is has but a mouthful ofbrains. What sort of sensation permanent madness is may be verywell imagined-just as we imagine how we felt when we were in-fants, tho'we cannot recall it. In both conditions we are irresponsible&-riot like gods without fear of fate.-It is the climax of a mad rrightof revelry when the blood has been transmuted into brandy.-But ifwe pralg much of this thing we shall be illustrating our own propo_sitions. e2

It was not only his own and his father's madness he had to fear. Hisolder bother, Gansevoort Melville-a lawyer and political speakerknown for his extravagances-iied at the

"g" of thirty: "-almost

manic and sometimes a little paranoid," "mad" for almost a monthprior to his death; and, according to his physician, suffering {iom adisorder that was "in some degree connected with the brail, and astate of nervous derangement."e3 Although it is uncrear what theimmediate cause of death was (one biographer has suggested abrain tumor), his symptoms and family history were co]nsistentwith manic delirium. Before effective treatment became available,death from acute mania was not uncommon. Herman's youngerbrother Allan got easily and often into debt; his depressive tem-perament was a source of ongoing concern in the letters of both hissister and mother. Herman's cousin Henry, son of his father'sbrother Thomas, was declared legally insane, and Herman's ownson Malcolm killed himself with a pistol at the age of eighteen. Thecoroner's initial verdict was suicide while "suffering from a tempo-rary aberration of mind," although-presumably in deference tothe family-the verdict was later changed to accidental death. It isdifficult to reconcile the second opinion with the fact that Malcolmwas found with his gun in his hand, alone, and with a builet holein the temple.

Throughout all his difficulties with his own moods, his work,his life, and his troubled family Melville displayed a remarkable, ifoccasional, vastness of spirit and grandiosity of scale; in his descrip-

GENEALOGIES OFTMSE HIGH MORTAI MISERIES 819

tion of the fossil whale, for example, his "comprehensiveness ofsweep" is truly Coleridgian:

Give me a condor's quill! Give me Vesuvius'crater for an inkstand!Friends, hold my arms! For in the mere act of penning my thoughtsof this Leviathan, they weary me, and make me faint with theiroutreaching comprehensiveness of sweep, as if to include the wholecircle of the sciences, and all the generations ofwhales, and men, andmastodons, past, present, and to come, with all the revolving pan-oramas of empire on earth, and throughout the whole universe notexcluding its suburbs.s

II

"SIow and slou that ship will go"

SAMUEL TAYLOR COLERIDGE

FINST VOICE

But why drives on that ship so fast,Without or wave or wind?

rhe air t, "',tnH?"H::And closes from behind.

Fly, brother, fly! more high, more highlOr we shall be belated:For slow and slow that ship will go,When the Mariner's trance is abated.

-SAMUEL TAYLOR COLNNTOCT95

My nerves have more phases than the moon--tarium et mutibilesemper feminc: I seem to be moon struek, and infected with herchangeful disposition-but her changes are all lovely, mine alldistressful.

-SARA COLERIDGE96

s80 TOUCHED WTTH FIRE

_ samuel Taylor coleridge-the most restless, unsettled, anddendritic of minds-was born in 1772, the youngest of ten chil-dren. His father, Iike those of Alfred Tennyion alnd william andHenry James, was both a cleric and writer. Also like the Tennysonand James families, the coleridges were an accomplished clan-soldiers and scholars in samuel's generation and, in the following,a "successful race of judges, bishops, and senior

""ad"-i"r."5fMoody and exquisitely suggestible from the earriest age, coleridgedescribed himself as a boy as "haunted by spectres;;'a dreamer;one who was "freffirl," "inordinately passionate"; and one who,from the time he was very young, possessed-like Melville, Blake,and whitman-a cosmic temperament, a sympathy with "a love ofthe Great and the whole." In a letter written to a friend, coleridgerecalled an early experience with his father:

I remember, that at eight years old I walked with him one winterevening from a farmer's house, a mile from Ottery-& he told me thenames of the stars-and how Jupiter was a thousand times larger thanour world-and that the other twinkling stars were suns that hadworlds rolling round them-& when I came home, he shewed mehow they rolled round, . . . my mind had been habitu ated to theVast-& f never regarded tnu senses in any way as the criteria of mybelief.e8

This love for the "vast," and easeful familiarity with the "Great andthe Whole," formed the heart of Coleridge's thought, and its im-portance in his originality cannot be overstated. The expansivenessof his thinking and the often mystical quality of coleridge's asso-ciational patterns, as well as other cognitive styles likewise associ-ated with hypomanic and creative thought, were discussed earlier.

The tumultuous as well as visionary side of Coleridge's naturebecame more aggressively apparent as he grew older. He matric-ulated at Cambridge in 1791 and during his undergraduate yearsthere accumulated massive debts; chaos, extravagance, and mel-ancholy became normal, if aberrant, parts of his life. BiographerRichard Holmes writes:

He began to live a kind of double life at Cambridge, his wild expen-diture on books, drinking, violin lessons, theatre and whoring (he

GENEAI,OGIES OFTHRSE HIGH MORTAL MISERIES zzr

later described this as the time of his "unchastities") alternating withftts of suicidal gloom and remorse. . .

The atmosphere was now subtly different from the scholarlytriumph of the previous year: there was much drinking and arguingwith Edward [his brother], much flirtation with local girls, and con-siderably more poetry. . .

By the end of October [f793] his "Embarrassments" buzzedround him "like a Nest of Hornets", and in November he gave up allattempts to get his afiairs under control. Instead he abandoned him-self to a whirl of drunken socializing, alternating with grim solitaryresolutions to shoot himself as the ftnal solution to bad debts. unre-quited love, and academic disgrace.s

Early in December, during a time when he was, in his ownwords, "a fool even to madness," he impulsively enlisted in theBritish A.my under an improvised name; it was a clearly disastrousand irrational act, led up to by weeks of similarly erratic and un-predictable behavior. Within four months he was discharged: "The

Regimental Muster Roll recorded succinctly: 'discharged

S. T.Comberbache, Insane; 10 April 1794."'r0o 1tt a letter to hisbrother, Coleridge recalled some of his mercurial experiences:

I laugh almost like an insane person when I cast my eye backward onthe prospect of my past two years-What a gloomy Huddle of ec-centric Actions, and dim-discovered motives! To real Happiness Ibade adieu from the moment, I received my ffrst Tutor's Bill-sincethat time since that period my Mind has been irradiated by Burstsonly of Sunshine-at all other times gloomy with clouds, or turbulentwith tempests. Instead of manfully disclosing the disease, I con-cealed it with a shameful Cowardice of sensibility, till it cankered myvery Heart . . . . How many and how many hours have I stolen fromthe bitterness of Truth in these soul-enervating Reveries-in build-ing magniftcent Ediffces of Happiness on some fleeting Shadow ofReality! My Af,airs became more and more involved-I fled to De-bauchery-fled from silent and solitary Anguish to all the uproar ofsenseless Mirth!1ol

Most of the rest of Coleridge's life was marked by these pe-riods of agitation, expansive but troubled restlessness, and "de-pression too dreadful to be described."lo2 He was intermittentlyaddicted to laudanum, a tincture of opium, and he turned to the

TOUCIIED WTTH FIRD

drug_frequently for relief from his mental perturbance and blackmoods. In a letter written in response to chastisements about hislaudanum use, Coleridge wrote:

The longer I abstained, the higher my spirits were, the keener myenjoyments-till the moment, the direful moment, arrived, whenmy-pulse began to fluctuate, my Heart to palpitate, & such a dreadfulfolling-abroad, as itwere, of my whole frame, such intolerable Rest-lessness & incipient Bewilderment, that in the last of my severalattempts to abandon the dire poison, I exclaimed in agony, what Inow repeat in seriousness & solemnity-"I am too poor to hazardthisl Had I but a few hundred pounds, but 200f, half to send to Mrs.Coleridge, & half to place myseH in a private madhouse, where Icould procure nothing but what a physician thought p.op"., & wherea medical attendant could be constantly with me iot

^t o or three

months (in less than that time Life or Death would be determined)then there might be Hope. Now there is nonel"-o God! how will-ingly would I place myself under Dr. Fox in his Establishment-formy Case is a species of madness, only that it is a derangement, anutter impotence of the volition, & not of the intellectual Faculties-You bid me rouse myself-go, bid a man paralytic in both arms rubthem briskly together, & that will cure him. Alasr (he ,,"ouiJ reply)that I cannot move my arms is my Complaint & my misery. r03

coleridge's letter, as we shall see, bears a more than slight familyresemblance to an essay on "Neryousness," written twe-nty yearslater by his daughter sara. Although manic-depressive illness andits temperaments were not as pervasive in the coleridge family asthey were in some other of the families under discrrrion. it is ofinterest that samuel coleridge's father's father, describei by thepoet as "half-poet and half-madman," went bankrupt; there wasalso some indication that he drank heavily. rq Francis^, one of cole-ridge's older brothers, committed suicide at the age of twenty-two,and Hartley, eldest child of samuel Taylor coleridge

"rri s*r"

frickel coleridge (whose sister had to be committel to an asy-lum), had symptoms consistent with manic-depressive illness.165But it was the_younger_sara coleridge who, in uddition to being anintriguing and talented person in her own right, was most like herfathgr in temperament. Born in 1802, she hal published two booksby the time she was in her early twenties ,rid -ur, as well, theeditor of her father's works. she suffered from severe depressions,

GDNEALOGIES OFTIIESE HIGH MORTAL MISERIES ZZ8

"recurrent hysteria," "nervous derangement," and, like her father,became a laudanum addict. With no little irony, she observed:"Every medical man speaks ill of the drug, prohibits it, & aftertrying in vain to give me sleep without it, ends with prescribing ithimself."rffi Like many, she emphasized that "nervous sufferings"could not be understood by the inexperienced. In recounting hernighttime fears in childhood-"that hideous assemblage of hor-rors-the horse with eyes of fsrns!"-she noted that unlike othermembers of her family, who laughed at her terrors, her fatheralone understood: "He insisted that a lighted candle should be leftin my room, in the interval between my retiring to bed and mam-ma's joining me. From that time forth my su$erings ceased."roTAlthough her childhood fears subsided, she was mentally ill muchof her adult life. Her biographer, Bradford Keyes Mudge, de-scribes one long period of disturbance, classically melancholic innature;

And so Sara's nervous illness continued unabated for more than twoyears, from September 1832 to January 1835. Her worst period oc-curred during the first six months of 1833 when she gave herself upto opium and hysteria, throwing two "ftts" a day, sleeping only everythird night, and eating so little that her menstrual cycle stoppedcompletely. . . . From all accounts, her "sad hysterical dejection"remained beyond the control of patient and doctors alike, an inex-plicable and overpowering "weakness" that robbed her ofall energy,all enthusiasm, all pleasure. . . . "O this dreadful restlessness ofbody-this deep dejection-nay, often blackening into despair!-Ihave a thousand strange bodily feelings-perpetually varying, yetever most alarming and distressing; but even that is nothing to thedespondency of mind. "lG

An astute, almost clinical, observer of her moods, Sara Cole-ridge described, counterintuitively and in detail, the relative in-dependence of true melancholia from external events, and shenoted that certain types of "hypochondria" (especially those ofdelusional proportion) and mania "may be two different species ofthe same genius [? genus]-but both are madness."lm Comment-ing on the varieties of "nervous illness," and their beholdenness tothe idiosyncrasies of the individuals they affect, she wrote: "Dis-eases are like tulips & auriculas which vary without limit accordingto unknown difierences of soil & situation."lro In "Neryousness."

TOUCHED WITII FIRE

she wrote out her suggestions, as applicabre today as then, for howphysicians might best help their depressed patients:

sympathy is like rain on the brown grass, Mingle admonitions withsympathy according to the Lucretian prescription-let them feel thatthey are understood.

To be a fully competent judge of the complaint, as to its trials &requisitions, you should have been within the charmed circle your-self. There is a sort of knowledge which experience only cangrve. . . .

[Do] not wonder at the change in a nervous person & think itinconsistent.

It is the capacity for comfort that is wanting.lrr

Sara coleridge, wrote virginia wooE was a "continuation" ofher father's mind and temperament. unfortunately, neither everfound much comfort from their grim, unsettled moods, but neitherdid they lose their grand and beautiful scale of the universe. saraonce said that her father was "almost always on the star-paved road,taking in the whole heavens in his circuit".rr2 but as foolfwrote.Sara herself was a "heaven-hunter. too."rr3

-t

"l feel certain I am going m,ad again"

VIRGINIA WOOLF

Dearest,I feel certain I am going mad again. I feel we can't go through

another of those terrible times. And I shan't recover thir ti*". tbegin to hear voices, and I can't concentrate. So I am doing whatseems the best thing to do, you have given me the glatestposs'ble happiness. You have been in every way all that anyonecould be. I don't think two people could have been happier tillthis terrible disease came. I can't fight any longer.

-VIRGINTA woolFttn

In his recent book The Flight of the Mind, Dr. Thomas Cara_magno documented in impressive detail the generations of depres-

GENEAIOGIES OFTHESE IIIGH MOKTAL MISERIDS 228

sive and manic-depressive illness in Virginia Woolfs family.lrs Hergrandfather, mother, sister, brother, and niece all suffered fromrecurrent depressions, her father and another brother were cy-clothymic, and her cousin James, who had been institutionalizedfor mania and depression, died of acute mania. Although fames hadsuffered an earlier head trauma, the injury appears to have been ofminimal severity and unlikely to have caused, though it may havetriggered, the pattern of symptoms that occurred. Virginia herselfwas repeatedly treated and admitted to hospitals for psychotic ma-nias and depressions and eventually committed suicide in 1941.116

"I am a porous vessel afloat on sensation," wrote Woolf, "asensitive plate exposed to invisible rays . . . taking the breath ofthese voices in my sails and tachng this way and that through dailylife as I yield to them."rr7 With the breath of voices in her sails,Virginia Woolf lived her life as a journey from one great individualmoment to the next. To an extraordinary degree she was able totransform from chaos into meaning her tumultuous thoughts andfeelings. In her struggle to understand her "violent moods of thesoul," she was able, as a consummate writer, to give eloquent voiceto the fragmented and wildly opposing ways of perceiving thatexisted within her. Like many other mercurial writers, she learnedto absorb what her fiery, violent, and desolate moods might teach.In their contrasts she saw different truths, and in seeking theirreconciliation she imposed a kind of order and rhythm unique inliterature.

Woolf's ability to express heightened moments of remem-bered intensity came in part, no doubt, from an exquisite sensi-tivity to the inconstancies and contrasts in her own psychologicallife. Like Edward Thomas, another writer of melancholic temper=ament, she sought always to catch the essence of such moments,whether bitter or sweet. What she took into prose he described inpoetryr

As for myself,Where ffrst I met the bitter scent is lost.I, too, often shrivel the grey shreds,Sniff them and think and sniff again and tryOnce more to think what it is I am remembering,Always in vain. I cannot like the scent,Yet I would rather give up others more sweet,With no meaning, than this bitter one.u8

TOUCIIED WTTIIFIRE

By woolf s willingness to examine the bitter as well as the tran-sient she gave name, meaning, and memory to the ephemeral:

*Stars, sun, moon," it seemed to say, ..the

daisy in the grass, fires,frost on the windowpane, my heart goes out to you. But,,, it alwaysseemed to add, "you break,-yo'prri, you go." And simultanuorrriyit covered the intensity of both these states of mind with

..I can't

reach you-I can'tget at-y9g, spol(gl wisffirlly, frustratJly. ,tndthe stars faded, and the child went.rte

- without question, much of Virginia woolf's ability to describethe transience and volatility of the natural world

"u*"-rro* t

",own rapid shifts of moods and thoughts. she believed unequivo-cally in the importance of melancholia and madness to h", im"ginative powers: "As an experience, madness is terriffc I can assureyou, and not to be sniffed at; and in its lava I still find most of thethings I write about. It shoots out of one everything shapeJ, final,not in mere driblets, as sanity does. And the sii months-notthree-fh?I I lay in bed taught me a good deal about what is calledoneself. "r2o

Yet the illness that drove the lava also killed her. unable tolive with the certainty that she was "going mad again,', ,he *rotua note to her husband, walked to the river, and &owned herselfi

we do not know our own souls, let arone the souls of others. Humanbeings do not go hand in hand the whole stretch of the way. Thereis a virgin forest in each; a snowffeld where even the print of birds'feet is unknown. Here we go alone, and like it better so. Ahvays tohave sympathy, always to be accompanied, always to be unJerstoodwould be intolerable. Butin health the genial pretence must be keptup, and the effort renewed-to communicate, to civilise, to share, tocultivate the desert, to educate the native, to work together by dayand by night to sport. In illness this make-believe cea-ses.r2r

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TOUCIIDD WITIIFIRE

-

"If Uou died Eou had done eoerything,,

ERNEST HEMINGWAY

My father was a coward. He shot himself without necessity. At leastI thought so. I had gone through it myserf untir I ftgur"d it in myhead. I knew what it was to be a coward and what ia *", ,o

"""r"being a coward. Now, truly, in actual danger I felt a clean feeling asin a shower. of course it was easy now That was because I no lorigercared what happened' I knew it was better to live it so that if ytudied you had done everything that you courd do about your work andyour enjoyment of life up to that minute, reconciling the two, whichis very difficult.

-ERNEsr gEMINcwAyr22

Ernest Hemingway's family-like those of Tennyson. Schu_mann, and woolf--was filled with depressive and manic-depres-sive illness.r* what is even more stiiking, however, is the un-nerving number of suicides-four, in just two generations of thefamily: Hemingway's father, brother, sister, and Hemingway him-self. Although not formally diagnosed as manic-depr"rrir", Hem_ingway-s_father (physician Dr. Clarence Hemingway) clearlysuffered from violent mood swings and erratic behavior. ileming-way's biographer Kenneth Lynn touches on the family reluctanceto label Dr. Hemingway in this way:

Thirty-four years after Dr. Hemingway took his father's ancientsmith & wesson revolver from a drawer of his desk and ffred a bulletinto his head, his oldest daughter was stiil unwilling to talk about thepossibility that for as long as she had known him hL had been strug-gling with some form of manic-depressive illness-that his corrroul-sive rages, feverish enthusiasms, and sporadic nervous collapses(which twice required "rest cures") were the contrasting part of apattern. r%

Similar rages, feverish enthusiasms, and morbid depres_5lens-ip addition to ceaseless frenetic, restless energies-hauntedhis son Ernest's life as well. In lg6l, following a psychiatric hos-

GENEALOGIES OFTIIESE HIGH MOKNAL MISERIES SS9

Ernest HeminguwyPariial F arnily H i,st ory

BrocRApHrcaL souncns: Baker, 1980; Yalom and Yalom, 1971; Hendrickson, 1987; Lynn,1987. See text note 123.

pitalization and electroconvulsive therapy for psychotic depres-sion, "Hemingway . . arose from his bed, went to the kitchen, gotthe key, opened the storeroom, selected a twelve-gauge, double-barreled English shotgun he had bought at Abercrombie & Fitch,pushed two shells into it, walked upstairs to the foyer, turned the

Clarence (Ed)

oGrace Hall

Marcelline Urmla Madelaine

oHadley

o-T-I

Iil

fohn

Pauline

I tntnof"tl Manie-depressive illness

X s"i"iau

ffil rost*head trauma psphosis

TOUCIIED I'TTITEIRE

gun against himself and fired. "ls The passing down of manic-depressive illness th-rough the generations was apparent in Hem-ingway's sons as well. Grego.yl hk" his grandfaihe,

" phyri"i"n,

described his own bouts with the iilness in an rggT interview:seven "nervous breakdowns," ninety-seven electroshock treat--9.b., and_ wreckage from three mairiages and dirror""r. iru purrick, the eldest son of Hemingway's ,""orrld marriage, ulro."""iu"delectroshock treatment fot a,.vei" psychosis, apparently triggeredby a head trauma reeeived following acar accide"t. trt:irro?l"tiu"mating," the intermarriage of individuals with similar tr-p"ru-1en_ts and genes, may-have taken place earlier in the Hemingwayfamily line; for example, Hemingway's mother, Grace ffJi (Or.Hemin-gway's wife), suffered from unspecified nervous com_plaints" and had a"major nervous breakdiwn.-rzs

-

"l collected bones from charnel_houses,,

MARY WOLLSTONECRAFTAND MARY SHELLEY

The grey cobweb-like appearance of the aged pines is a muchffner image of decay; the fibres whitening

"rih"y lor" their mois-

ture, imprisoned life seems to be stealing away. I cannot tellwhy-but death, under every form, appears to me like some_thing getting free.

-MARy woLLsroNECRAFTt2n

I collected bones from charnel-houses and disturbed, with pro-fane ffngers, the tremendous secrets of the human frame.

-r\,IARy sHELLnyr3o

Mary wollstonecraft, early feminist and author of A vindica-tion of the Rights of woman, was born in 175g and died within afew months of the birth of her daughter, Mary Shelley, in 17g7. Anadventurous, forceful woman, she was subject to "terrible swings of

GENEALOGIES OFTIIESE HIGH MORTAL MISERIDS S31

mood, from hectic noisy enthusiasm to almost suicidal depres-sion";r3l she in fact twice attempted suicide. r32 Her father was"unstable and drunken,"ls her sister Eliza suffered a severe de-pression following childbirth, and her elder daughter, Fanny Im-lay, committed suicide. Mary Wollstonecraft's only other child, herdaughter M"ry, was a writer and the second wife of Percy ByssheShelley. She, too, experienced long periods of "nervous depres-sion" and severe mood swings. After putting together Shelley'spapers and manuscripts in 1839 she suffered from a major'"nervousillness." In March of that year she wrote: "Illness did ensue-whatan illness--driving me to the verge of insanity-Often I felt thecord wd snap and I should no longer be able to rule my thoughft]swith feardrl struggles-miserable relapses-After long repose, Ibecame somewhat better."ry In a letter to Leigh Hunt she de-scribed some of the fears and anguish she had experienced: "Ireally felt in danger of losing my senses. My physician ordered meopium. . . . it certainly strengthened my head, which had gone farastray-you . . . will understand the sort of unspeakable sensationof wildness and irritation."l35 Her depression during the last yearsof her life was more or less chronic, and in one of the final entriesin her journal she recorded some of the toll it had taken: "My mindslumbers & my heart is dull-Is life quite over? Have the stormsand wrecks of the last years destroyed my intellect, my imagina-tion, my capacity of invention-What am I become?r36

-

"That depression of mind which enchains the faculties"

SAMUEL IOHNSON AND IAMES BOSWELL

. . . that depression of mind which enchains the faculties withoutdestroying them, and leaves rearion the knowledge of right with-out the power of pursuing it,

-SAMUEL ;OHNSOtlr3T

Burton's Anatomg of Melancholy, he said, was the only book thatever took him out ofbed two hours sooner than he wished to rise.

-JAMES BoswEr,Lrs

TOUCHDD WITHFIRE

^ samuel Johnson and james Boswell, two of the leading literaryfigures of t!9 eighteenth century, both suffered from ,"?"r" a"_pression and both had it in their families. Their relationship, in itsown11t!er odd way, represents a Iiterary form of "assortati-ve mat-ing." Johnson had an almost obsessive fear of insanity-"rra *"r,intermittently, suicidally depressed at different periods in his life.He had his first major breakdown, which lastei for two y""rr,

",the as9 of twenty; he remained "still in a rather shattered *rrai,io'for at least another thre,e years."tse Dr. Roy porter, who has putJohnson's illness in the broader and deeper context of his life andbeliefs, describes this early episode:

Kichng his heels at his parental home . . . after being forced by chillpenury to quit Oxford, degreeless and careerless, Johnson ,"ni intosuicidal lethargy, "overwhelmed [Boswell put it] with an horriblehypochondria, with perpetuar irritation, fr"ifirrtr"r, and impatience;and with a dejection, gloom and despair, which made existe'nce mis-ery. From this dismal malady he never afterwards was perfectlyrelieved."rao

He was convinced he had inherited his "vile melancholy"r4r fromhis father, a "morbid disposition both of Body and yiirr6,,'uz *"terrifying melancholy . .. . which he was sometimes apprehensivebordered on insanity."ra3 11" was again severely affiicied by de-pression when he was in_ his early fffties, writing in L76Ii*Mgterrours and perplerities haoe so mach increased, th"t r am undeigreat depression. . . . Almighty and merciful Father look downupon my misery with pity."raa

James Boswell, his biographer, was more cyclothymic in na_ture: Alternatingly melancholic, euphoric, and irritable, he suf-fered from clear-cuj depressions and hypomanias fromadolescence onward.las Drs. William Ober andH"nrv Kranzler.as well as Boswell himself, noted the strongly herediiary side oiBoswell's temperament: His brother became mentally ill while inhis twenties and had to be confined to an asylum; his father'sfather had a "melancholic turn;" and his father's brother sufferedfrom episodic-d^epressions. one of Boswell's daughters also hadmanic illness.ra6

GENEAIOGIES OFTIIESE HIGH MORTAL MISERIES 883

-

"The root of the eoil"

VINCENT VAN GOGH

The root of the evil lies in the constitution itself, in the fatalweakening of families from generation to generation, . . . Theroot of the evil certainlv lies there. and there's no cure for iL

-VINCENT VAN GOGH'-,

Vincent van Gogh's psychiatric diagnosis has been a subject ofdebate for a century; the argument that he suffered from manic-depressive illness, conceivably complicated by a complex partial

seizure disorder, was made earlier. One strong piece of the evi-

dence for the diagnosis of manic-depressive illness (the details of

which were given in chapter 4) is van Gogh's striking family history

of psychiatric disease, especially mood disorders and suicide. Theo,

Vincent's younger brother, su$ered from recurrent depressionsand had a psychotic illness-which included delusions, hallucina-tions, and violence-at the end of his life. Van Gogh's biographerMarc Tralbaut has noted that "Vincent's and Theo's mental andphysical disabilities were similar in every respect . . . the-proba-

Lihty of hereditary influences seems to be overwhelming,"ras and

Jan Hulsker has written recently that Theo's life was "characterized

by a melancholy that may have been even greater than his broth-er's,"l4e citing Vincent's and Theo's physician in Paris as sayingthat Theo's case was "far worse than Vincent's."150

Wilhelmina, their sister, suffered from a chronic psychoticillness and spent almost forty years in an insane asylum; Cornelius,their younger brother, committed suicide.lsl Dr. Peyron, Vin-cent's physician while he was in the asylum, noted that Vincent"told us that his mother's sister was epileptic, and that there weremany cases in this family";rsz the distinction between epilepsyand manic-depressive illness was unclear in nineteenth-centuryFrance, and the two diagnoses often overlapped or were usedinterchangeably. Two of Vincent's uncles on his father's side of thefamily-Hein and Cent, both art dealers-suffered from unspeci-fied recurrent illnesses. Interestingly, and consistent with the sea-

TOUCIIED WTTII FIRE

sonal component of mood disorders, one van Gogh biographerobserved that cent was "forever disappearing to the siuth ofFrance for the sunshi_le which herped iirt hi*-o"t of whatever itwas that ailed him."rs3

It is not difficult to understand why vincent would write toTheo: "[our neurosis] . . . is also a fatal inheritance, ,irr"" in

"i,r-ilization the wealcness increases from generation to generation. Ifwe want to face the real truth about our constitution, we mustacknowledge that we belong to the number of those *t o ,rrr",from a neurosis which already has its roots in the past.,'r;z

other artists and writers who almost certainl| suffered frommanic-depressive or depressive illness, and had strong histories ofsevere mood disorders or suicide in their families i.rcLde Frenchpairllgr Th6odore G6ricault,r55 Austrian composer Gustav Mah-ler,rs^American poets Robert Lo*"ll it?

J#;;;;;i$ ",16Anne Sexton,rse Swedish playwright e,rg,rst Stri"dberg,ffi A-"r_

Vincent oan CoghParti,al Farnilg History

Ttreodoruso

Anna

VINCENT Elizabeth Wilhelmina Cornehus

e&

! '.o.r-r-, Manrc-oepr€ss*e r'ness

Recurrent depressirre illness

Suicide

ffi Unrn""ifi"d psphosis

(insane asfumfor more then

30 years)

BIocRAptrrcAL soURcEs: Van Gogh, l9E9; Tralbaut, lg69; Hulsker, Igg0. See text notes147-145.

GENEALOGIES OFTHDSE HIGH MORTALMISERIES 935

ican dramatists Eugene O'Neillrol and Tennessee Williams,162 andFrench poet Victor Hugo.rs The family histories of these artistsare discussed briefly in the notes for this chapter. A listing of otheraffected families is qiven later in the text.

The families discussed in this chapter share in common certainthemes of madness, suicide, destructive patterns of drug and alco-hol use, and financial chaos; however, uncommon ability and orig-inality are often present as well. Clearly not every family thatshows signs of instability, eccentricity, moodiness, or alcoholism isaffected by manic-depressive or depressive illness. Rather, a con-stellation or pattern of symptoms evolves that is characteristic of ahighly genetic, relatively common, volatile, disruptive, and yetoccasionally-and only partially-advantageous psychiatric dis-ease. Because manic-depressive illness appears to be the mostgenetic of the major psychiatric illnesses, as well as the one mostdefinitively linked to creativity, if a particular madness or "nervous

affiiction" runs throughout certain families-especially highly suc-cessful ones-the odds are very strong that it is manic-depressiveillness.

Suicide runs in some of the literary and artistic families we havediscussed-for example, the Hemingways, the Gordon-Byrons, andthe Schumanns-but not in others. This is consistent with findingsfrom genetic studies in general,le and from studies of the Penn-sylvania Amish in particular. Investigation of their extensive pedi-grees, which go back several centuries, shows that a few familieswith manic-depressive illness account for a very high proportion ofthe suicides. 16 The influence of intermarriage between individualsof similar temperaments and possibly similar genetic backgrounds,or assortative mating, can also be seen in some of the familiesdiscussed. In those families where mood disorders appear to havebeen inherited from both sides of the pedigree there is a higherincidence of manic-depressive and depressive illness in the oFspring. The intermarriage of the Clayton and Tennyson lines, forexample, seems to have resulted in an extraordinarily high rate ofpenetrance ofthe presumptive manic-depressive gene. Similarly, inVirginia Woolf's family, the offspring of her mother's first mar-

TOUCIIED WTTH FIRE

riage (to Herbert Duckworth, who showed no evidence of havinga -moo-d disorder) were not affected by mental illness; ho-rrr..,whgn her mother, who suffered from recurrent depressions, *ar_ried Leslie stephen, who was cyclothymic, ail four of th"i,

"hirdr"r,suffered from signiffcant mood disorders. Likewise, st"ph"rr'sdaughter from his first marriage, who was mentaily reiarded, s,rf-fered from an unspeciffed psychosis that was characterized by in-termittent rapid speaking, outbursts of rage, and "sluggishness." Itis of significance here that her maternJ grandmotLr, IsabellaThackeray (wife of the novelist), suffered from what almost cer-tainly was manic-depressive illness. All these pedigrees demon-strate the wide range of expression of a genetic illiess, from itsmilder forms, which can appear as temperaments, to the morepsychotic and suicidal forms that appear as fuil-blown manic-depressive insanity.

- Obviously, many other writers, artists, and composers hadfamily members who suffered from manic-depressive ilLess or se-vere recurrent depressions, were declared insane and committedto asylums or hospitals, or committed suicide. Those with at leastone seriously affected ftrst-degree relative (often there were sev-eral) include Hans christian Andersen, Konstantin Batyushkov,Arthur and E. F. Benson, Elizabeth Bishop, Aleksandr Brok, char-lotte and Emily Bront6, Anton Bruckner, Thomas Campbell,Thomas Chatterton, Samuel Clemens, John Sell Cotman, GustaveCourbet, Richard Dadd,rffi Isak Dinesen, Ernest Dowson. ThomasEakins, Ralph waldo Emerson, Edward FitzGerald, Robert Frost,Thomas Gainsborough, Johann Wolfgang Goethe, Nikolai Gogol,Kenneth Graham, Thomas Gray, Hermann Hesse, Charles l,amb.Louis MacNeice, John Martin, Marianne Moore, Edvard Munch.Francis Parkman, Walker Percy, Sylvia Plath, Jackson pollock, ColePorter, Edwin Arlington Robinson, Dante Gabriel Rossetti, Gioc-chino Rossini, john Ruskin, Alexander Scriabin, Robert LouisStevenson, Peter Tchaikovsky, J.M.W. Turner, Walt Whitman,and Emile Zola. These ffndings are consistent with those of Drs.An&easen, McNeil, Richards, and Karlsson (presented in chapter3) showing that mental illness and creativity tend to aggregate incertain families and not in others.16T The high rates of mooJdiror-ders and suicide in the literary and artistic families portrayed in thischapter are also consistent with studies showing greatly increased

GDNEALOGIDS OFTIIESE HIGH MORTAL MISERIES 257

rates of manic-depressive and depressive illness in the first-degreerelatives of individuals who have manic-depressive illness.lffi

It is important to emphasize, however, that many writers andartists have no family history of these illnesses, nor do they them-selves sufer from depression or manic-depressive illness. Thispoint is critical. The basic argument of this book is not that allwriters and artists are depressed, suicidal, or manic. It is, rather,that a greatly disproportionate number of them are; that the manic-depressive and artistic temperaments are, in many ways, overlap-ping ones; and, that the two temperaments are causally related toone another. The genetic basis of manic-depressive illness providesnot only one part of this argument, but also the constitutional coreof a determining temperament, one providing in part the sealedorders with which so many sail:

As a man-of-war that sails through the sea, so this earth that sailsthrough the air. We mortals are all on board a fast-sailing, never-sinking, world-frigate, of which God was the shipwright; and sheis but one craft in a Milky-Way fleet, of which God is the LordHigh Admiral. The port we sail from is forever astern. Andthough far out of sight of land, for ages and ages we continue tosail with sealed orders, and our last destination remains a secretto ourselves and our o$cers; yet our final haven was predesti-nated ere we slipped from the stocks at Creation.

Thus sailing with sealed orders, we ourselves are t}e repos-itories of the secret packet, whose mysterious contents we long tolearn. There are no mysteries out of ourselves.

-HERMAN MELVILLET69

7.THIS I\[ET

THROWI\IE UPOI\TIIE

IIEA\MI\S-

Medicine and the Arts

Of Meridians. and parallels.Man hath weav'd out a net, and this net throwneUpon the Heavens, and now they are his owne.

-JoHN DoNNEI

View Along the Axis of the BDNA Double Helix(Courtesy of Dr. Robert Langridge, University ofCalifornia, San Francisco

O Regents of the University of California)

TOUCIIED WTTH FIRE

Occasionally an exhilarating and powerfully creative force, moreoften a destructive one, manic-depressive illness gives a touch offire to many of those who experience it. The melancholic side ofmanic-depressive illness is a source of intolerable suffering, tor-porous decay, and death; scarely less damaging, mania in its ex-treme forms can be violently psychotic and life threatening. yetthere is strong scientiftc and biographical evidence linking manic-depressive illness and its related temperaments to artistic imagi-nation and expression. Biographies of eminent poets, artists, andcomposers attest to the strikingly high rate of mood disorders andsuicide-as well as institutionalization in asylums and psychiatrichospitals-in these individuals, and recent psychiatric and psycho-logical studies of living artists and writers have further documentedthe link. Manic-depressive illness, then, is a very strange disease----{ne that confers advantage but often kills and destroys as it doesso. Not surprisingly, the clinical, ethical, and philosophical issuessurrounding such a paradoxically advantageous and yet destructiveillness are often difficult.

From the perspectives of both the clinician and the artist, one

THIS NET TIIROWNE I]PON THE IIEA\'ENS ?AI

of the most important of these issues is treatment. If manic-depressive illness and its associated temperaments are relativelycommon in artists, writers, and composers, and if the illness is, atleast to some extent, an important part of what makes their workwhat it is, what are the implications of treating the underlyingdisease and its temperaments? Edward Thomas once wrote, "Iwonder whether for a person like myself whose most intense mo-ments were those of depression a cure that destroys the depressionmay not destroy the intensity-adcsperare remedy?"z; and EdvardMunch, hospitalized on several occasions for his psychiatric illness,remarked, "A German once said to me:

'But you could rid yourself

of many of your troubles.'To which I replied: 'They are part of me

and my art. They are indistinguishable from me, and it woulddestroy my art. I want to keep those sufferings.' -3

This is a com-mon concern. Many artists and writers believe that turmoil, suf-fering, and extremes in emotional experience are integral not onlyto the human condition but to their abilities as artists. They fearthat psychiatric treatment will transform them into normal. well-adjusted, dampened, and bloodless souls-unable, or unmoti-vated, to write, paint, or compose. These fears have greatlyintensified as a result of the availability of a wide ratrge of highlyeffective mood-stabilizing medications. some concerns stem from amisunderstanding of the actions and side effects of these medica-tions, while others are based on a romanticized notion of "mad-ness" or psychopathology, a notion that does not take into accountthe severity and consequences of untreated manic-depressive ill-ness. Some of the mistrust is well placed, however, and we dealwith this issue first.

The short- and long-term effects on artistic creativity of themajor drugs used in the treatment of manic-depressive illness (lith-ium, valproate, carbamazepine, the neuroleptics, and the antide_pressants) remain unclear. we focus here on lithium because it isthe most important and frequently prescribed drug for manic-depressive illness and cyclothymia, and because more is knownabout its effects on temperament and cognition, as well as its otherside effects, than about any of the other medications used. It isnoteworthy that even the early lithium researchers were aware ofproblems created by lithium's dampening effects on certain usefulor enjoyable qualities of the illness and its associated tempera-

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ments (for example, decreasing or eliminating the "highs" of themilder manic states, or decreasing sexuality *d

"tt"rgy levels), as

well as by the untoward side-effects of lithium (occasi;l cognitiveslowing and memoryimpairment). Mogens schou, the Daniiir psy-chiatrist who, more than anyone else, is responsibre for the tens ofthousands of lives saved by lithium, .^r

"*"re of and concerned

abo-u! the drug's potential limitations. He noted that some patientson lithium reported feeling that life was flatter and more colorlessthan it had been before taking the medication.a other researchersobserved that patients occasionally felt less creative and produc-tive, and that some of them missed their hypomanic periods.sMissing the highs of hypomania is, in fact, an important reason whymany patients stop taking lithium against medical advice.6

Evidence for a strong eflect of lithium on personality and tem-perament came from several sources: studies of lithium effects onnormal subjects, prima facie evidence derived from both clinicaland systematic observation of lithium's profound therapeutic effecton behavior, mood, and personality in affectively ill patients, andcomparisons of personality studies completed in the prelithium erawith those completed after lithium treatment became widespread.TThe latter are quite consistent in showing that personality differ-ences between manic-depressive patients and "normal" compari-son groups pale considerably, and often entirely, once lithium isused effectively.s Several clinical researchers have also examinedthe effects of lithium on personality in normal subjects. Schou, theffrst to systematically describe the cognitive, behavioral, and per-sonality effects of lithium in normal individuals, found that at rel-atively low blood levels lithium had minimal effects on medical-student volunteers. In three medical researchers taking lithium athigher levels, however, effects were more pronounced. They re-ported experiencing a decreased responsiveness to their environ-ment, increased indifference and malaise, greater passivity, andcognitive changes:

The subjective experience was primarily one of indifference andslight general malaise. This led to a certain passivity. . . . The sub-jective feeling of having been altered by the treatment was dispro-portionately strong in relation to objective behavioral changes. Thesubjects could engage in discussions and social activities but found it

THIS MTTHROWNE I]PON THE HEA\IENS 2.43

difficult to comprehend and integrate more than a few elements ofthe situation. Intellectual initiative was diminished and there was afeeling of lowered ability to concentrate and memorize; but thoughtprocesses were unafiected, and the subjects could think logically andproduce ideas.e

Dr. Lewis fudd and his colleagues at the University of California,San Diego, also studied the effects of lithium on normal male vol-unteers. They found that their subjects, in addition to reporting amood-lowering efect of the drug, had less inclination and desire to"deal with the demands of the environment."ro Likewise, Drs.D. Kropf and B. Mriller-Oerlinghausen in Germany showed thatnormal men while on lithium had decreased social involvement.activity, and concentration, as well as increased boredom and leth-argy.rr Other studies of normal volunteers have also found a re-duced sense of well-being, fewer social interactions, fatigue, lack ofefficiency and initiative, and attenuated emotional responsive-ness.r2 A few studies have examined personality and *ood rt*bi-liz-ation over time in lithium-treated, affectively ill patients. Oneinvestigation of twenty-eight manic-depressive patients found thatlithium's most pronounced effects were in decreasing sociability,initiative, and impulsiveness;r3 others indicated that moods maybecome unusually stable in manic-depressive patients treated withlithium.14 Like many effects of lithium, the extent of personaritychange or emotional dampening appears to be a function of theblood level of the drug. Kropf and Mtiller-Oerlinghausen found,for example, that patients on higher levels of lithium were lessactive, less obsessive, and less elated than those on lower levels,who showed proportionately more initiative and assertiveness. aswell as greater sociability and sensitivity.ls Unfortunately, thosepatients who were maintained at a reduced lithium level were alsomore likely to become manic or severely depressed again.

since lithium's primary action is mediatei througli'the centralnervous system, it is not surprising that the drug can also causecognitive impairments of varying types and degrees of severity.Indeed, mental slowing and impaired concentration are among theside effects of lithium treatment that patients report ,rrori fr*-quently, and are most frequently implicated in an unwillingness tocontinue treatment. 16 It is important to keep in mind, how"o"r,

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that acute mania and depression also_cause pronounced cognitiveimpairment and inability to function;r7 depression can coniribute1o tlre tendency to overreport side effects, as well, especiaily dif-ffculties in memory and concentration.rs Likewise, a reient reviewof twenty-five neuropsychological studies of patients with manic-depressive illness found a quite consistent pattern of right-hemispheric (or nondominant) impairment. re This type ofimpairment-associated with problems in perception, spatial rela-tions, integration of holistic ffgures, and complex nonverbal tasks-was found not only in those individuals who had alreadyexperienced episodes of mania and depression but also in childrenof manic-depressive parents who were, subsequently, at ahigh riskfor developing manic-depressive illness but had not yet been ill.zoClearly, preexisting cognitive differences, as well as impairmentdue to the acute effects of mania and depression, can make itdifficult to sort out illness from treatment effects.

These and many other complex methodological problems haveled to conflicting interpretations of the data from studies of lithium's cognitive effects in both animals and humans.2r Some inves-tigators have concluded that there is "no convincing proof thatlithium causes memory disorder,"2z while others have found strongevidence to the contrary.2s In their review of lithium's effects onnormal subjects, Dr. Judd and his colleagues concluded that lith-ium:

often induces subjective feelings of cognitive slowing together withdecreased ability to learn, concentrate and memorize. In addition,controlled studies have consistently described small but consistentperformance decrements on various cognitive tests, including mem-ory tests. The available data suggest that the slowing of performanceis likely to be secondary to a slowing in rate of central informationprocessing.%

Evidence for lithium's effects on long-term memory, associativeprocessing, semantic reasoning, memory retrieval, and speed ofcognitive and psychomotor performance comes, in fact, from manystudies.s Results showing actual impairment in general intellec-tual functioning are less consistent, although certainly suggestive.26In most instances, the intellectual problems that occur in patients

THIS NET THROWND I]PON TIM HEA\IENS 245

taking lithium are probably due to some combination of lithiumside-effects and the underlying disease itself.

The specific effects of lithium on productivity and creativityare not clear. In 1971 Drs. P. Polatin and R. Fieve in New Yorkdescribed their clinical experience using lithium in creative indi-viduals:

In the creative individual who does his best work in the course of ahypomanic period, the complaint regarding the continued use oflithium carbonate is that it acts as a "brake." These patients reportthat lithium carbonate inhibits creativity so that the individual isunable to express himself, drive is diminished, and there is no in-centive. These patients also indicate that when they are depressed,the symptoms are so demoralizing and so uncomfortable that theywelcome the "mild high" when the depression disappears and preferto settle for a cyclothymic life of highs and lows rather than anapathetic middle-of-the-road mood state achieved through the use oflithium carbonate.

Their argument is tlat if lithium carbonate prevents the highand may possibly prevent dre "low," they prefer not to take lithiumcarbonate, since never to have a high as a result of the drug seemsequivalent to being deprived of an "addictiveJike" pleasurable andproductive state. Some of these patients are terriffed of having a lowagain, but insist on taking their chances without lithium carbonatetherapy, knowing that sooner or later they will be compensated bythe high, even if they do go into a low state.27

This is a common, and almost certainly valid, clinical observation,and clinicians who treat artists and writers who suffer from manic-depressive illness would concur with several of its essential points.However, in the two studies that actually asked artists and writersabout lithium's effect on their artistic productivity, the overwhelm-ing majority indicated that their productivity while on lithium hadeither increased (57 percent) or remained the same (20 percent).%Approximately one-fourth (23 percent) reported a decrease in pro-ductivity, and a significant minority (17 percent) stated they hadstopped lithium due to its adverse effects. schou, the author of oneof the two studies, emphasized the importance of individual dif-fe_rences in interpreting the ffndings. He noted that lithium mightaffect inspiration, the ability to execute ideas, or both. Likewise.

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artists and writers clearly vary in a number of important ways,including the severity and type of their illnesses, tlieir degree ofdependence upon manic periods for artistic inspiration,

"ni irrdi-

vidual sensitivities to the pharmacological actioi of lithium.qecognitive studies of particular relevance for artistic creativity

conflict in their results. Judd and his associates found no effects ofshort-term lithium use on creativity in normal individuals;3o a morerecent study, however, found substantial detrimental effects of lith-ium on associational processing in patients with manic-depressiveillness.sl Differences betrveenihese and other results may^be duein part to the fact that lithium's effect on cognition is almost cer-tainly quite different in manic-depressives and normals.32Individ-ual differences in clinical state, serum lithium levels, sensitivity tocognitive side effects, and the severity and type of affective illnessalso clearly affect the degree to which an individual will experienceimpairment in intellectual functioning, creativity, and productivity.

Although our discussion thus far has focused on ih" potentialdifficulties arising from treatment with lithium, three crucial andoffsetting points need to be kept in mind. First, most individualswho are on lithium experience few significant side effects of anykind,s3 and fewer than one-third report significant negativechanges in their intellectual functioning.3a In the great majority ofinstances the effective treatments now available do not hinder cre-ative ability. Indeed, competent treatment almost always results inlonger periods of sustained productivity. A major concern, how-ever, remains the study, public discussion, and aggressive devel-opment of treatments that will minimize the side effects that occurwith the currently available medications.

Second, modern psychiatric treatment for manic-depressiveillness is not limited to lithium alone. Two anticonvulsants, car-bamazepine and valproate (valproic acid), have been e$ective intreating many patients who cannot tolerate or do not respond tolithium.35 There is some anecdotal clinical evidence to sugglst thatcognitive side effects and emotional blunting may be less trouble-some with valproate, or with a combination of valproate with alower dose of lithium, than with standard lithium therapy alone.These clincial impressions, if confirmed by more systematic inves-tigation, may prove invaluable to the minority of individuals whonow suffer from their treatment as well as from their disease. Psy-chotherapy is also an important part of the treatment of manic-

THIS NET THROWNE I]PON THE HEA\IENS 247

depressive illness. While there is no evidence that psychotherapyalone can effectively treat or prevent manic-depressive illness, ev-idence is accumulating to show that psychotherapy, in conjunctionwith medication, can reduce the risk of relapse.s Researchers atthe University of California, Los Angeles demonstrated many yearsago that a combination of psychotherapy, family education, andmedication allowed clinicians to prescribe lower doses of antipsy-chotic medications for schizophrenic patients.3T One of the ulti-mate goals of doing psychotherapy with manic-depressive patientsmight be to permit lower levels of lithium, thereby minimizing thecognitive, temperamental, and other side effects of the drug. Sev-eral studies now show that the lower doses of lithium currentlyused (compared with early clinical practice, in which the bloodlevels were, on the average, 30 percent higher) result in fewer andmilder somatic side effects.38 There is evidence that cognitive sideeffects are also tied to blood level,3e and competent treatment ofmanic-depressive illness entails using the lowest possible level oflithium that is consistent with preventing recurrences of mania anddepression. Intelligent timing of dosages is also important; for ex-ample, a single daily dose of lithium can result in fewer side effectsthan several doses taken throughout the day.ao Recent studies,although quite preliminar), have found that side effects may bereduced even further in some individuals by administering 150percent of the usual daily lithium dose every forty-eight hoursinstead of every twenty-four.ar Interestingly, two of the patients inthese particular studies were artists who had stopped painting dur-ing the course of regular lithium therapy but resumed onci thetwo-day regimen was instituted. (These ffndings are preliminary,and any changes in lithium dosages should be carefuly discussedwithin the context of a good clinical relationship.) The judicious useof adjunctive treatments (such as antidepressants, antipsychoticmedications, electroconvulsive therapy, phototherapy, and sleepdeprivation) can also be important in minimizing the adverse ef-fects of treatment and maximizing the beneffts. Likewise, the dailycharting of moods in order to follow and utilize seasonal, di,r..ral,and other patterns of moods and productivity can be invaluable,recalling Emerson's remarks: "We are intent on Meteorology tofind the law of the Variable Winds to the end that we may not getour hay wet. I also wish a Farmer's Almanac of the Mental tvtoodsthat I may farm my mind. There are undulations of power & im-

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becility & I lose days sitting at my table which I should gain to mybody & mind if I knew beforehand that no thought *J,rld

"o*uthat ̂ day."l" *?nr -*t1E and writers, once stabifzed on lithium,opt for a low level of the drug in hopes of achieving a kind ofcontrolled cyclothymia, willing to take the "undulations of power &imbecility" in exchange.forperiods ofhigh enthusiasm, urrd flo*i.,gthoughts. when it works this can be a good solution to a Jifficultproblem; unfortunately, it is a strategylhat carries with it an in-creased risk of depressive and manic relapses.a3 The attempt tobalance the ebbings and fowings of imagination and temperamentwith the treatment for their extremes is captured by FrJnch poetAntonin Artaud, who spent many years of his life in a psychiatrichospital:

DocroR-There's a point on which I would have liked to insist: it'sconcerning the importance of the thing on which your injections act;this kind of essential relaxation of my being, this lowering of mymental waterlevel which, as one might think, doesn,t mean iy dim_inution whatever of my morality (my moral sour) or even of mvintelligence but, if you wish, only of my usable intellect, of *ypossibilities for thought, and which has more to do with the feeliniI have of myself than what I show to others. . . .

And now, Monsieur le Docteur, since you are quite aware ofwhat in me is capable of being artacked (and healed by drugs). . . .I hope you have the know-how to give me the qu".,iity oT subtleliquids, of specious agents, of mental morphine *hictt wiit uplift myabasement, balance what is crumbling, reunite what is separated,recompose what is destroyed.a

when discussing the very real problems associated with treat-ing manic-depressive illness, it is most important to be acutelyawaxe of the generally far worse, often fatal, consequences of nottreating it. There can be no serious question that liihium and theanticonvulsants are enormously effective in treating manic-depressive illness and preventing suicide. The scientificliteratureto support their efficacy is compelling.as while it is true that lith-ium has side effects, it is also true that the illness for which it isprescribed is serious and life-threatening. In this sense lithium isno different in causing side efiects (except that they are generallymilder)from drugs used in the treatment of other potentially lethal

THIS NETTHROWNE I]PON TIIE HMVENS ?'49

illnesses such as cancer and heart disease. No one is creative whenparalytically depressed, psychotic, institutionalized, in restraints,or dead because of suicide. While some writers and artists haveemphasized the roles of angst, turmoil, and a mercurial tempera-ment in their work, many have not. Robert Burns, for example,described the effect of his depression on his poetry: His body, hesaid, "was atacked by that most dreadful distemper,confirmed melancholy; in this wretched state, the recollectionwhich makes me yet shudder, I hung my harp on the willow trees,except in some lucid intervals."46 And Robert Lowell, nearly twocenturies later, wrote: "Mania is sickness for one's friends, depres-sion for one's self. Both are chemical. In depression, one wakes,is happy for about two minutes, probably less, and fades intodread of the day. Nothing will happen, but you know twelve hourswill pass before you are back in bed and sheltering your conscious-ness in dreams, or nothing. It isn't danger; it's not an accom-plishment. I don't think it a visitation of the angels but a weakeningin the blood. "a7 The list of writers and artists who ended theiilives by suicide is staggeringly long. Poets include Thomas LovellBeddoes, John Berryman, Barcroft Boake, paul Celan, ThomasChatterton, Hart Crane, John Davidson, Tove Ditlevsen, SergeyEsenin, John Gould Fletcher, Adam Lindsay Gordon, RandallJarrell,as Heinrich Von Kleist, Vachel Lindsay, Vladimir Mayak-ovslcy, Cesare Pavese, Sylvia Plath, Anne Sexton, Sara Teasdale,and Marina Ivanovna Tsvetayeva. Other writers who committedsuicide include Romain Gary, Ernest Hemingway, William Inge,Yukio Mishima, G6rard de Nerval, ]ohn Kennedy Toole, andVirginia Woolf. Among painters and sculptors who killed them-selves were Ralph Barton, Francesco Bassano, Francesco Borro-mini, Vincent van Gogh, Arshile Gorky, Benjamin Haydon, ErnstLudwig Kirchner, Wilhelm Lehmbruck, fules pascin, MarkRothko, Nicolas de Stadl, and Pietro Testa. (See Appendix B aswell.) Almost all these individuals suffered from depressive ormanic-depressive illness. We will never know what Thomaschatterton and virginia woolf might have written or vincentvan Gogh painted had they lived rather than committing suicide.van Gogh described this well: "If I could have worked withoutthis accursed disease-what things I might have done. . . . follow-ing what the country said to me. But there, this journey is over

aof

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and done with,"ae and Robert Loweil's publisher, Robert Giroux,observed poignantly:

of all our conversations, I remember most vividly [Loweil s] wordsabout the new drug, lithium carbonate, which had 2"h gooi."rult,[after almost twenty manic attacks and subsequent hospltalizations]and gave him reason to believe he was cured: "It's te#ble, Bob, tothink that all I've suffered, and all the suffering I've caused, mighthave arisen from the lack of a little salt in my f,rain. "il

suicide is not the only risk of not treating manic-depressiveillness. In addition to the suffering caused by individual attacks ofmania _and depression, the natural course of the disease, left un-treated, is to worsen over time (the attacks become more frequentand more severe). This pattern can be seen in the illnesses of irarrywriters and artists, for example, Byron, Clare, Coleridge, vanGogh, Hopkins, Poe, Roethke, Ruskin, Schumann, and-Woolf.Manic-depressive illness and cyclothymia not only worsen overtime, they also become less responsive to medicaiion the longerthey remain untreated (perhaps because the biochemical and an-atomical substrates change as a result of recurrent manic and de-pressive episodes).sr secondary problems are also created by theuse of alcohol, laudanum, cocaine, nicotine, and the many otherdrugs that artists and writers have used over the centuries io -ed-icate or induce the moods associated with manic-depressive illness.clearly these drugs are less speciffc and less effective and causemany more adverse effects and complications (including worseningthe nature and course of the illness; causing both shori- and longlterm damage to the brain and other parts of the nervous system;and compromising the functioning of the pulmonary and cardio-vascular systems) than do the medications now available for treat-ing the illness.

Artists and writers, like everyone else, ultimately decide forthemselves whether or not, and how, to be treated. Fortunatelythey also tend to bring to their treatment decisions the same in-dependence, imagination, skepticism, and willingness to take risksthat characterize the rest of their lives and their work. some endup choosing traditional medical treatment, others opt for idiosyn-cratic versions, and yet others choose no treatment at all, even

THIS NET THROWNE I]PON TIID HDAVENS 851

mindful of the suffering they might experience. It is clear that,whatever else, depth and intensity of human feeling must be a partof creation in the arts. But modern medicine now allows relief ofthe extremes of despair, turmoil, and psychosis; It allows choicesnot previously available. Most of the writers, artists, and compos-ers discussed in this book had no meaningful choice.

The capacity to blunder slightly is the real marvel of DNA. With-out this special attribute, we would still be anaerobic bacteria andthere would be no music.

-LEyIS 1HoMASsz

Very different issues of choice arise from the fact that manic-depressive illness is a genetic disease. These genetic issues are ofconsiderably more long-term concern than the ones surroundingpharmacological treatments. Inevitably, given time and increas-ingly sophisticated research, the development of new drugs shouldmake it possible to medicate individuals who have manic-depressive illness in such a way that the side effects are inconse-quential and, it is to be hoped, in such a way that those aspects oftemperament and cognition that are essential to the creative pro-cess will remain intact. The search for the gene, or genes, involvedin manic-depressive illness raises far more difficult ethical prob-lems, however;ss these issues become particularly complicated be-cause manic-depressive illness can confer advantages on both theindividual and society. Although unusual as a disease that bringswith it certain advantages, it is by no means alone. Carriers of thesickle-cell trait, for example, appear to have had relative immunityto certain types of malarial infections; in this context, David Suzukiand Peter Knudtson make the argument for a broad biologicalperspective when considering the notion of "defective genes":

The story of sickle-cell anemia does underscore the striking capacityof a seemingly defective gene to simultaneously ofier both advan-tages and disadvantages-depending on its quantities and surround-ings. Moreover, there is growing evidence that natural selection

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often routinely maintains a balance of such mutant DNA sequencesin populations of many species. The problem is that we are blirrd tothat fragile balance except in rare instances, such as sickle-cell ane-mia, where geneticists have managed to unravel the intricacies ofgene action in relation to hereditary disease.

But how many other "defective" genes responsible for heredi-tary disorders might harbor some unseen evoluiiorra.y value? And.until we know enough about human genetics to begin to grasp theiievolutionary roles, what price might we eventually f,ay'if weorrerzealously try to _'cure" these genetic abnormalities Ly'riddingthe human gene pool of these DNA sequences. . ?il

_ Manic-depressive illness appears to convey its advantages notonly through its relationship to the artistic temperament anJ imag-ination, but through its influence on many eminent scientists aswell as business, religious, military, and political leaders.s subtlereffects that derive from its being a common illness with a widerange of temperamental and cognitive expression have yet to beassessed; indeed, few studies have examined the possible evolu-tionary reasons for the survival of ang of the genes responsible forpsychopathology, although some writers have suggested thatschizophrenia, while devastating to those who suffer from it, mightconfer certain intellectual and temperamental advantages on ffrst-degree relatives.tr The complexities surrounding the search for thegenes responsible for manic-depressive illness are enormous. It ishighly unlikely, for example, that only one gene is involved and,even if an individual carries the gene (or genes), he or she maynever become ill (likewise, he or she may or may not have thetemperamental and cognitive characteristics associated with theillness). This suggests the likelihood of subtle, or not so subtle,interactions with the environment that might precipitate the firstmanic or depressive attack (for example, exposure to prolonged orsigniftcant changes in light, pronounced sleep reduction, drug oralcohol intake, childbirth) or the inheritance of other genes thatmight either trigger or protect against the disease. physical andpsychological factors also clearly play an important, although as yetunspecified role in the triggering and maintenance of, or protectionagainst, the underlying genetic predisposition to manic-depressiveillness. The complexity of locating the gene or genes underlyingthe inordinately broad range of temperamental, behavioral, andcognitive traits that constitute manic-depressive illness is bevond

TIIIS NET TIIROWNE IIPON TIIE IIEA\IDNS

our current ability to imagine. Too, it is not unlikely that yetadditional genetic, biochemical, and environmental factors may beat least in part responsible for both the illness and the cognitive andtemperamental characteristics associated with artistic genius.

Several genetic issues are especially relevant to the diagnosis,treatment, and social policies surrounding manic-depressive ill-ness; these include prenatal testing, abortion, forced sterilization,and gene therapy. Prenatal testing for manic-depressive illness andabortion based on a determination that a fetus is at risk for thedisease may be choices that are available before the end of thiscentury. The decision to abort any fetus obviously brings with itmajor ethical considerations-both for the parents involved andthe society in which they live.57 Treatable common diseases, suchas manic-depressive illness----ones that almost certainly confer so-cietal and individual advantage and that vary greatly in the natureof their expression and their severity-are particularly problem-atic. Dr. Francis Collins, the medical geneticist at the Universityof Michigan who was instrumental in ffnding the genes for cysticfibrosis and neurofibromatosis. was asked in an interview aboutprenatal testing for diseases that vary in severity or that first occuronly later in life:

This is where it gets muddy, and everyone is going to draw the linedifferently. Consider the situation with manic-depressive illness, areasonably common disorder. It is clearly genetically influenced,though not in a simple way. Now, manic-depressive illness can be aterrible cross to bear. The swings into depression are awful, and thehighs can be very destructive. Yet a substantial number of highlycreative people have suffered from this disease. Suppose we ftnd thegene responsible for manic depression. If every couple has a prenataltest to determine if a fetus is at risk for manic depression, and if everytime the answer is yes that fetus is done away with, then we will havedone something troubling, something with large consequences. Isthis what we want to do?s

Several related issues about prenatal testing have been raised:for example, the unclear boundaries between pathological condi-tions and normal traits, the important distinction between medi-cally treatable and nontreatable genetic defects, the wide spectrumofseverity ofdefects, and the variable ages ofonset ofthe diseasesin question.tn L"rry Gostin, the director of the American Society of

s53

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Law and Medicine, has addressed some of the difficurt issues in-volved in genetic testing:

Complex and often pernicious mythologies emerge from public ig_norance of genetically-based diagnostic and p.otnostic tlsts. Thecommon belief is that genetic technologies g""erated from scientificassessment are always accurate, highly predictive and capable ofidentifying an individual's or oflspring's inevitable pre-destination of$t-rt: disability. The facts are diametricaily opposei to this commonbelief' The results ofgenetic-based diagnosis and prognosis are un-certain for many reasons.

Predicting the nature, severity and course ofdisease based upona genetic marker is an additional dificulty. For most genetic diseasesthe onset date, severity of symptoms, and efficacy of treatment andmanagement are highly variable, Some people remain virtuallysymptom free, while others progress to seriousiy disabling illness.6

other scientists and ethicists have raised different concerns,including those of a more directly eugenic nature; for example, arethere societal advantages to getting rid ofcertain genes altoiether?on the other hand, might there be characteristics associated witha particular disease or trait that should be encouraged in the genepool?61 (It is of no little interest and irony that Francis Galton, acousin of charles Darwin and proponent of selective breeding inhumans in order to obtain a "hlghly gifted race of man," was him-self subject to "neryous breakdowns't; he was also appreciative ofthe "thin partitions" between greatness and psychop"it otogy. or.Daniel Kevles, in his book rntheNamc of Eiginlcs,-qrrotestaltonas saying that

'"men who leave their mark on the world are very

often those who, being gifted and full of nervous power, are at thesame time haunted and driven by a dominant idea, and are there-fore within a measurable distance of insanity.")62Involuntarily ster-ilization, a hallmark of the eugenics movement, and maniatoryabortion seem highly unlikely options in this iay arrd age, butmany provinces in china still have government policies requiringindividuals who have hereditable mental illness (especially ir"."d-itary psychoses, which_ is of speciffc relevance to manic-depressiveillness) to be sterilize-d; if pr_egnancy occurs, abortions are obliga-tory.ffi The historical precedent is chilling. Tens of thousands ofmentally ill individuals, including many with manic-depressive ill-

THIS NET THROWNE I]PON TIM HEA\IENS 855

ness, were sterilized or killed during the Third Reich, and manyother thousands of psychiatric patients were sterilized earlier thiscentury in the United States.s Ironically, one study carried out inGermany during the 1930s addressed the advisability of forcedsterilization of individuals with manic-depressive illness. The au-thor, who found that manic-depressive illness was greatly overrep-resented in the professional and higher occupational classes,recommended against sterilization of these patients "especially ifthe patient does not have siblings who could transmit the positiveaspects of the genetic heritage."s During the 1940s, in a studyundertaken by the Committee on Heredity and Eugenics, re-searchers at the Mclean Hospital in Boston studied the pedigreesof several socially prominent American families. They came to asimilar conclusion:

Perhaps the words of Bumke need to be taken into account before weembark too whole-heartedly on any sterilization program, "If wecould extinguish the sufferers from manic-depressive psychosis fromthe world, we would at the same time deprive ourselves of an im-measurable amount of the accomplished and good, of color andwarmth, of spirit and freshness," Finally, only dried up bureaucratsand schizophrenics would be left. Here I must say that I would ratheraccept into the bargain the diseased manic-depressives than to giveup the healthy individuals of the same heredity cycle.s

Dr. John Robertson had written in like vein in his psychiatric studyof Edgar Allan Poe twenty years earlier:

The qualities of the mind, as well as their morbid reactions, are toodelicate ever to be understood or scientifically prearranged. For theworld this is fortunate, however high an inheritance tax the victimsof heredity must pay. Eradicate the nervous diathesis, suppress thehot blood that results from the overclose mating of neurotics, or fromthat unstable nervous organization due to alcoholic inheritance, oreven from insanity and the various forms ofparental degeneracy, andwe would have a race of stoics-men without imagination, individ-uals incapable of enthusiasms, brains without personality, souls with-out genius. . . . Who eould, or would, breed for a hump-backedPope, or a clubfooted Byron, a scrofulous Keats, or a soul-obsessedPoe? Nature has done fairlv well bv us.67

s56 TOUCIIED WITHFIRE

Debates about sterilization and forced abortion have been re-placed, for the most part, by far more sophisticated debates aboutprenatal testing, voluntary abortions based on the results from suchtesting, and gene therapy. Many of the ethical problems remainvery much the same, however.

Gene therapies comprise a variety of types of genetic manip-ulation,68 and all of them raise enormously complicated issues intheir own right.6e The major ethical questions do not center pri-marily on the techniques designed to change the genetic code foronly one individual (for example, inserting normal genes into achromosome, removing defective genes, or using drugs that wouldtreat genetic illnesses by "turning off' certain genes or "turning

on" others). Even under those circumstances, however, one couldargue the advisability of changing genes that may be associatedwith subtle cognitive and temperamental characteristics vital to thewell-being of society (including, for our discussion here, those re-lated to the development of artistic imagination and expression).Certainly it is unclear what the alleviation of highly intense emo-tional experiences-including ecstatic or visionary states, psycho-sis, severe melancholia, or other types of mental su$ering-mightdo to the ultimate nature of artistic expression as well as to themotivations underlying the production of works of art. The primaryfocus of ethical debate, however, is on those techniques that in-volve introducing genetically altered material into the reproduc-tive cells (eggs and sperm), which could then be passed on to affectfuture generations as well. This, as Joel Davis points out, "violates

the primary canon of human experimentation-the consent of thesubject. The individual who agrees to have his or her germ cellschanged can consent [depending upon the age of the individual, ofcourse]. But that person's progenA are nou com,mitted to an ex-periment to ahich theE did not consent "To Society, as well as theindividual and his or her progeny, is bound to be deeply affectedby decisions such as these.

Many of these ethical issues are being brought to the fore-ground by the Human Genome Project, a vast fifteen-ye:u programestablished by the U.S. government in 1990 with the goal of iden-tifuing the exact location and function of all of the genes in thehuman body. The potential beneffts to health and basic science arelargely obvious; without question, individuals who have genetic

THIS NETTHRO\{NE IIPON TIIE HDA1IENS 267

diseases-including those with manic-depressive illness-will gainimmeasurably from the knowledge obtained about early identifi-cation and treatments, including the development of drugs that arebased on an understanding of diseases at their molecular level' Themitigation of suffering and prevention of early death in those whohave manic-depressive illness, or who are at risk for it, is a majorpublic health priority. Although manic-depressive illness is muchmore common in writers and artists than in the general population,it would be irresponsible to romanticize an extremely painful, de-structive, and lethal disease. Most people who suffer from manic-depressive and depressive illness are not unusually creative, andthey reap few benefits from their experiences of mania and depres-sion; even those who are highly creative usually seek relief fromtheir suffering. Molecular biology research and the scientific ad-vances ultimately provided by the mapping of the human genomehave the potential to provide more speciftc, more effective, andless troubling treatments than now exist. Already, only two yearsafter the Recombinant DNA Advisory Committee of the NationalInstitutes of Health approved the ffrst gene therapy trials in theUnited States, experimental treatment is being carried out in pa-tients with cancer, diseases of the immune system, inherited high-cholesterol disorder, and other illnesses. Clinical trials have beenproposed in several other countries as well and procedures viewedonly a short time ago as radical and controversial are beginning tobe used in medical research. The ethical ramifications of genetherapy and the Human Genome Project, however, are certainlyfar beyond our present capacity to comprehend. Because of themagnitude of potential social and ethical problems, 3 to 5 percentof the project's total budget (which is conservatively estimated atthree billion dollars) has been set aside for studies of the social,ethical, and legal implications of genetic research. This is an un-precedented commitment to ethical studies and will almost cer-tainly ensure that troubling issues such as those we have beendiscussing will be examined at length and with subtlety. But theyneed to be raised and vigorously debated. While it is inconceivablethat there will be any simple answer, awareness of the problem isa beginning. Dr. |ames Watson, co-discoverer of the structure ofDNA and the first director of the Human Genome Project, hasmade this point forcefully and repeatedly in his insistence on allo-

TOUCIIED WTTH EIRE

:::t:q_T*sive resources to the study of ethical issues in genetic

research:

It would be naive to say that any of these answers are going to besimple. About all we can do is siimulate the disc,rsrior,'-irrr"rr_tially lead the discussion instead of having it forced or, ,rr-bfp"opl"w-ho say, "you don-t know what you're d;g.;, w;1;" iiJ

"_"r"of the really terrible past of eugenics, wherl i""o-fi"L-r."oi"ag"was used in a very cavalier and rather araful way, Uott, t.."'i' tfr"united states and in Germany. we have to reassure people that theirown DNA is private and that no one else can get at it. We,re goingto have to pass laws to reassure them. [Andj i," ao"i,"nii"opt"rushing and passing laws without a lot of ,..io,r, discuss; hrst.rt

Fortunately it seems more rikery than not that the infinitevarieties and-complexities of life, with their inftnitu

""p""iti", fo,

change, will be more rather than less recognized and Jppreciatedas the genetic code begins to unwind:

Th.g rgal surprises, which set us back on our heels when they occurwill always be the mutants. we have already n"a

" f"*-oitrr"r",

sweeping across theffeld of human thought periodicaly, like comets.They have slightly different receptors 6. the infor*"ti*

""rcadingin from other minds, and slightly diferent machinery for processingit, so that what comes out to rejoin the flow is novel, *a ntJ *ittnew sorts of meaning. Bach was able to do this, and what

"*".t"d i.,

the, current were primordia in music, In this sense, the e.t of iugr"and the St. Matthew passion were, for the evoiving o.g-ir_ of!u*q thoughg feathered wings, apposing thumbs,

"""."t"y"r, of

frontal cortex.7z

_ Finally, tfrere must be serious concern about any attempt toreduce what is beautiful and original to a crinical,y"aro-", seneticflaw, or predictable temperament. It is frightening, arrd uitinatelyterribly boring, to think of anyone----c..iui.rly ,r-ot orrly *ri,"rr,artists, and musicial5-in such a limited way. The fear ihat med-icine and science will- take away from the ineffability of it all, ordetract from the mind's labyrinthian complexity, is as old as mar*

TIIIS NBTTHROWNE UPON TIIB HFAVENS 259

attempts to chart the movement of the stars. Even John Keats, who

had stu&ed to be a surgeon, felt that Newton's calculations would

blanch the heavens of their glory. The natural sciences, he wrote,"will clip an Angel's wings,/Conquer all mysteries by rule and

line,/Empty the haunted air, and gnomed mine-/Unweave a rain-

bow."73 What remains troubling is whether we have diminished

the most extraordinary among us-our writers, artists, and com-posers-by discussing them in terms of psychopathology or ill-

nesses of mood. Do we-in our rush to diagnose, to heal, andperhaps even to alter their genes--{ompromise the respect we

should feel for their differentness, independence, strength of mind,and individuality? Do we diminish artists if we conclude that theyare far more likely than most people to suffer from recurrent at-tacks of mania and depression, experience volatility of tempera-ment, lean toward the melancholic, and end their lives throughsuicide? I don't think so. Such statements seem to me to be fullywarranted by what we now know; to deny them flies in the face oftruth and risks unnecessery suffering, as well as not coming toterms with the important treatment and ethical issues that areraised by this complicated illness. American novelist Walker Percy,whose father and grandfather committed suicide and in whose fam-ily an unrelenting path of suicide, mania, and depression can betraced for at least two hundred vears. wrote:

Death in the form of death genes shall not prevail over me, for deathgenes are one thing but it is something else to name the death genesand know them and stand over against them and dare them. I amdifferent from my death genes and therefore not subject to them. Myfather had the same death genes but he feared them and did notname them and thought he could roar out old Route 66 and stayahead of them or grab me and be pals or play Brahms and keep them,the death genes, h"ppy, so he fell prey to them.

Death in none of its guises shall prevail over me, because I knowall the names of death.Ta

No one knows for certain where any of our knowledge-sci-entific or artistic.-will take us, but that has always been so. Un-certainty, romantic imagination, and mystery tend to weave theirway throughout both the scientific and artistic fields of thought and

TOUCIIED WITHFIRE

experience' Byron, the skepticar Romantic, gave testament to thesecommon threads and uncommon voyages:

rn which sir rsaac *",^X,i"Ti,lht"rT,*J -"0"

Through the therr unpaved stars the turnpike road,A thing to counterbalance human woes;

For ever since immortal man hath glowedWith all kinds of mechanics, and full ioonSteam-engines will conduct him to the Moon.And wherefore this exordium?_Why, just now,

In, taking up this paltry sheet ofpaper,My bosom underwent a glorious glow,

And my internal Spirit cut a caper:And though so much inferior,

", i krro*-

To those who, by the dint of glass and vapour,Discover stars, and sail in the wind's eve.I wish to do so much by poesy.

In the Wind's Eye I have sailed, and sail; but forThe stars, I own my telescope is dim;

But at the least I have shunned the common shore.And leaving land far out of sight, would skim

The Ocean of Eternity: the roarOf breakers has not daunted my slight, trim

But still sea-worthy skiff; and she may floatWhere ships have foundered, as doth many a boat.TE

The great imaginative artists have always saired "in the wind'seye," and brought back with them words or sounds or images to"counterbalance human woes."That they themselves were sibiectto more than their fair share of these woes deserves our appreci-ation, understanding, and very careful thought.

-

APPEI{DD( A

DIAGNOSTIC CRTTERIA FOR TIIEMA]OR MOOD DISORDERS

DTAGNOSTIC CRITERIA FOR MAJOR DEPRESSIVE EPISODE

Note: A "Major Depressive Syndrome" is deffned as criterion A below.

A. At least ffve of the following symptoms have been present during the sametwo-week period and represent a change from previous functioning; at leastone of the symptoms is either (l) depressed mood, or (2) loss of interest orpleasure. (Do not include symptoms that are clearly due to a physical con-dition, mood-incongruent delusions or hallucinations, incoherence, ormarked loosening of associations.)

(l) depressed mood (or can be irritable mood in children and adolescents)most of the day, nearly every day, as indicated either by subjectiveacrount or observation by others

(2) markedly diminished interest or pleasure in all, or almost all, activitiesmost of the day, nearly every day (as indicated either by subjectiveaccount or observation by others of apathy most of the time)

(3) significant weight loss or weight gain when not dieting (e.g., more than5% of body weight in a month), or decrease or increase in appetitenearly every day (in children, consider failure to make expected weightgains)

(4) insomnia or hypersomnia nearly every day(5) psychomotor agitation or retardation nearly every day (observable by

others, not merely subjective feelings of restlessness or being sloweddown)

(6) fatigue or loss ofenergy nearly every day

APPENDXA

feelings of worthlessness or excessive or inappropriate guirt (which maybe delusional) nearly every day (not merely slf_i"pro""h or guilt aboutbeing sick)diminished ability to think or concentrate, or indecisiveness, nearlyevery day (either by subjective account or as observed by otherj

'

recurrent thoughts of death (not just fear of dying), recurrent suicidalideation without a specific pran, or a suicide att#pt or a specific plan forcommitting suicide

B. (t) It cannot be established that an organic factor initiated and maintainedthe disturbance

(2) The disturbance is not a normal reaction to the death of a loved one(Uncomplicated Bereavement)Note: Morbid preoccupation with worthlessness, suicidal ideation,marked functional impairment or psychomotor retardation, or prolongedduration suggest bereavement complicated by Major D"prrr;;.

c. At no-time during the disturbance have there been delusions or hallucina_tions for as long as two weeks in the absence of prominent mood ,y_paorr*(i.e., before the mood symptoms developed or after they harre ,*iu"a).

D. Not superimposed on schizophrenia, schizophreniform Disorder, DelusionarDisorder, or Psychotic Disorder not otherwise specified.

(7)

(8)

(e)

DIAGNOSTIC CRITERIA FOR MANIC EPISODE

Note: A "Manic Syndrome" is deffned as incruding criteria A, B, and c below. A"Hypomanic syndrome" is deffned as including criteria A and B, but not c, i.e.,no marked impairment.

A. A distinct period of abnormally and persistently elevated, expansive, or ir-ritable mood.

B. During the period of mood disturbance, at least three of the following symp-toms have persisted (four if the mood is onry irritable) and have been iresentto a significant degree:(l) inflated self-esteem or grandiosity(2) decreased need for sleep, e.g., feels rested after only three hours of

sleep(3)(4)(D/

(6)

(7)

more talkative than usual or pressure to keep talkingflight ofideas or subjective experience that thoughts are racingdistractibility, i.e,, attention too easily drawn to unimportant or irrele-vant external stimuliincrease in goal-directed activity (either socially, at work or school, orsexually) or psychomotor agitationexcessive involvement in pleasurable activities which have a high po_

c.

D.

E.

F.

APPENDD(A S&9

tential for painful consequences, e. g. , the person engages in unrestrainedbuying sprees, sexual indiscretions, or foolish business investments

Mood disturbance sufficiently severe to cause marked impairment in occupa-tional functioning or in usual social activities or relationships with others, orto necessitate hospitalization to prevent harm to selfor others.

At no time during the disturbance have there been delusions or hallucinationsfor as long as two weeks in the absence of prominent mood symptoms (i.e.,before the mood symptoms developed or after they have remitted).

Not superimposed on Schizophrenia, Schizophreniform Disorder, DelusionalDisorder, or Psychotic Disorder not otherwise speciffed.

It cannot be established that an organic factor initiated and maintained thedisturbance, Note: Somatic antidepressant treatment (e.g., drugs, ECT) thatapparently precipitates a mood disturbance should not be considered an eti-ologic organic factor.

DIAGNOSTIC CRITERIA FOR CYCLOTHYMIA

For at least two years (one year for children and adolescents), presence ofnumerous Hypomanic Episodes (all of the criteria for a Manic Episode,Manic Episode . except criterion C that indicates marked impairment)and numerous periods with depressed mood or loss of interest or pleasurethat did not meet criterion A of Major Depressive Episode.

During a two-year period (one year in children and adolescents) of the dis-turbance, never without hypomanic or depressive symptoms for more thantwo months at a time.

No clear evidence of a Major Depressive Episode or Manic Episode during the6rst two years of the disturbance (or one year in children and adolescents).

Note: After this minimum period of Cyclothymia, there may be superimposedManic or Major Depressive Episodes, in which case the additional diagnosisof Bipolar Disorder or Bipolar Disorder not otherwise speciffed should begiven.

Not superimposed on a chronic psychotic disorder, such as Schizophrenia orDelusional Disorder.

It cannot be established that an organic factor initiated and maintained thedisturbance, e.g., repeated intoxication from drugs or alcohol.

Souncr: From American Psychiatric Association, Diagnostic and Statistbal Manual of Men-tal Disorders, Third Editian, Reoised, (Washington, D.C.: American Psychiatric Asso-ciation, 1987). Reprinted by permission of American Psychiatric Association.

A.

B.

C.

D.

E.

APPENDD(A

CLINICAL CRITERIA FOR CYCLOTHYMIA

GENENAL

l. Onset in teens or early adulthood2' clinical,presentation as a personarity disorder (patient often unaware ofmooo,s per se)3' short cycles-usually days-which are recurrent in an irregurar fashion, withinfrequent euthymic periods4' May not attain full syndrom_e for depression and hypomania during any onecycle, but entire range of affective manifestations occurs at various times5. "Endogenous" mood changes, i.e., often wake up with mooJ

BIPHASIC COURSE

l' Hypersomnia alternating with decreased need for sleep (although intermit-tent insomnia can also occur)

2. shalg self-esteem which alternates between lack of self-conffdence and naiveor grandiose overconffdence

3. Periods of mental confusion and apathy, alternating with periods of sharpenedand creative thinking

4. Marked unevenness in quantity and quality of productivity, often associatedwith unusual working hours

5' uninhibited people-seeking (that may read to hypersexuality) alternating withintroverted self-absorption

BEHAVIONAL MANIFESTATIONS

l. Irritable-angry-explosive outbursts that alienate loved ones2 Episodic promiscuity; repeated conjugal or romantic failure3. Frequent shift in lineof work, study, interest or future plans4- Resort to alcohol and drug abuse as a means for self-treatirent or augmenting

excitement5. Occasionalffnancialextravagance

souncr: From H.s. Ahskal, M. K. Khani, and A. scott-strauss, cycrothymic tempera-mental disorders, psgchiatric cllnics of North America, 2 ogns); szzisL. Reprintedby permission of W. B. Saunders Company.

APPENDD(A 865

DIAGNOSTIC CRITERIA FOR HYPOMANIA

MOODElevated, expansive, or irritable

PSYCHOMOTORMore energy than usualPhysical restlessness

SPEECHMore talkative than usual

SLEEPDecreased need for sleep

COGNITIVEInflated self-esteemSharpened and unusually creative thinkingOveroptimism or exaggeration of past achievement

BEHAVIORIncreased productivity, often with unusual and self-imposed working hoursUninhibited people-seekingHypersexualityInappropriate laughing, joking" punningExcessive involvement in pleasurable activities with lack of concern for painful

consequences, for example, buying sprees, foolish business investments, reck-Iess driving

Souncr: Based on diagnostic criteria from American Psychiatric Associatron, Diagnostic andStatistical Manual of Mental Disord.ers, Thinl Edition (Washington, D.C.: AmericanPsychiatric Association, 1980). Reprinted by permission of W. B. Saunders Company.

COMPOSERS WITH PROBABLEWRTTERS, ARTISTS, A\ID

CYCLOTITY]UIA. IUAJOR

APPEI\DIX B

DEPRDSSIOI\, ORMAI\I C -DEPRES SI\'E ILLI{ES S

a

A ' o

Antonin ArtaudKonstantin BatyushkovCharles BaudelaireThomas Lovell BeddoesJohn BerrymanWilliam BlakeAleksandr BlokBarcroft BoakeLouise BoganRupert BrookeRobert BurnsGeorge Gordon, Lord ByronThomas CampbellPaul CelanThomas ChattertonJohn ClareHartley ColeridgeSamuel Taylor ColeridgeWilliam CollinsWilliam CowperHart Crane

George DarleyJohn DavidsonEmily DickinsonErnest DowsonT. S. EliotrSergey EseninRobert FergussonAfanasy FetAnne Finch, Countess of

WinchilseaEdward FitzGeraldJohn Gould FletcherGustaf Fr<idingOliver GoldsmithAdam Lindsay GordonThomas GrayNikolai GumilyovRobert Stephen HawkerFriedrich HiilderlinGerard Manley HopkinsVictor Hugo

aI

f o

o

A O

!I

a

q

I. t a

!

I

0

a

Key: o Asylum or psychiatric hospital f Suicide 0 Suicide attempt

f o

a

a

a , a

a

a

f o

a

o

Randall Jarrell2Samuel JohnsonJohn KeatsHenry KendallVelimir KhlebnikovHeinrich Von KleistWalter Savage LandorNikolaus LenauJ.M.R. LenzMikhail LermontovVachel LindsayJames Russell LowellRobert LowellHugh MacDiarmidLouis MacNeiceOsip MandelstamJames Clarence ManganVladimir MayakovskyEdna St. Vincent MillayAlfred de MussetG6rard de Nerval

WRITERS

Hans Christian AndersenHonor6 de Balzac

James Barrieo Arthur Benson

E. F. Benson

James Boswell

john BunyanSamuel Clemens

Q joseph ConradCharles Dickens

O Isak DinesenRalph Waldo Emerson

APPEIVDX B

0a

a

f r0a

o

t r

Boris PasternakCesare PaveseSylvia PlathEdgar Allan PoeEzra PoundAlexander PushkinLaura RidingTheodore RoethkeDelmore SchwartzAnne SextonPercy Bysshe ShelleyChristopher SmartTorquato TassoSara TeasdaleAlfred, Lord TennysonDylan ThomasEdward ThomasFrancis ThompsonGeorg TraklMarina TsvetayevaWalt Whitman

a

+I

t eoa

ot o*I

cont.

Key: r Asylum or psychiatric hospital t Suicide Q Suicide attemptNote 1: This is meant to be an illustrative rather than a comprehensive list; for systematic

studies see text. Most of the writers, composers, and artists are American, British,European, Irish, or Russian; all are deceased.

Note 2: Many if not most of these writers, artists, and composers had other major problemsas well, such as medical illnesses (e.g., paul Gauguin, John Keats, Eiward Lear,Nikolaus Lenau, cole Porter, Hugo wolf), alcoholism or drug addiction (e.g., AntoninArtaud, John Berryman, samuel Taylor coleridge, F. scott Fitzgerald, Ernest Hem-ingway, Modest Mussorgsky, Eugene o'Neill, Raphaelle peale, EdgarAllan poe, Fran-cis Thompson, Tennessee williams), or exceptionally difrcult life circumstances (e.g.,Arshile Gorky, osip Mandelstam). They are listed here as having suffered from a mooddisorder because their mood symptoms predated their other mnditions, because thenature and course of their mood and behavior symptoms were consistent with a diag-nosis ofan independently existing affective illness, and/or because their family historiesof depression, manic-depressive illness, and suicide----coupled with their own symp-toms-were sufficiently strong to warrant their inclusion.

APPENDD(B 869

a

I

a

o

f r/ h o

f r

I

f r

a

0f r

William FaulknerF. Scott FitzgeraldLewis Grassic GibbonNikolai GogolMaxim GorkyKenneth GrahamGraham GreeneErnest HemingwayHermann HesseHenrik IbsenWilliam IngeHenry JamesWilliam JamesCharles [,ambMalcolm Lowry

Herman MelvilleEugene O'NeillFrancis Parkmanfohn Ruskin3Mary ShelleyJean StafiordRobert Louis StevensonAugust StrindbergLeo TolstoyIvan TurgenevTennessee WilliamsMary WollstonecraftVirginia WoolfEmile Zola

Orlando de LassusGustav MahlerModest MussorgskySergey RachmaninoffGiocchino RossiniRobert SchumannAlexander ScriabinPeter TchaikovskyPeter WarlockHugo WolfBernd Alois Zimmerman

Charles ParkerCole PorterBud Powell

Edward DayesThomas EakinsPaul GauguinTh6odore GdricaultHugo van der GoesVincent van GoghArshile Gorky

d a

COMPOSERS

Anton ArenskyHector BerliozAnton BrucknerJeremiah Clarkejohn DowlandEdward ElgarCarlo GesualdoMikhail GlinkaGeorge Frideric HandelaGustav HolstCharles IvesOtto Klemperers

NONCLASSICAL COMPOSERS AND MUSICIANS

. Irving Berlin O .

Noel Coward .

Stephen Foster .. Charles Mingus

ARTISTS

Ralph BartonFrancesco BassanoRalph BlakelockDavid BombergFrancesco BorrominiJohn Sell CotmanRichard Dadd6

A

a

. t a

I

t

!

I

d .

t

f r*I

27O APPENDD(B

Ia

a

af o

a

rI

a

o

Philip GustonBenjamin HaydonCarl HillErnst JosephsonGeorge InnesErnst Ludwig KirchnerEdwin LandseerTEdward LearWilhelm LehmbruckJohn MartinCharles M6ryonMichelangeloAdolphe MonticelliEdvard Munch

|ules PascinGeorgia O'KeeffeRaphaelle PealeJackson PollockGeorge RomneyDante Gabriel RossettiMark RothkoNicolas de StaelPietro TestaHenry TilsonGeorge Frederic WattsSir David WilkieAnders Zorn

a

a

a

I

I

II

Itt

5.y' . Asylum or psychiatric hospital f Suicide Q Suicide attemptI Although not formally hospitalized, Eliot had to take a three-montli leave ofabsence (for

a 'nervous

breakdown") in order to be treated in a Swiss clinic.2 See chapter 7, note 48, p. 34g.3 Ruskin had the equivalent ofpsychiatric hospitalization (his doctors arranged for twenty-_ four hour nursing care during his psychotic episodes).a See chapter 3, note 63, pp. 29?-298-5 Primarily a conductor.6 See chapter 6, note 166, p. 842.7 Landseer was confined to the care ofa physician.

1\OTES

CHAPTER ITHAT FINE MADNESS

l. Michael Drayton, "To my dearly loved Friend, Henry Reynolds,Esq.; of Poets and Poesy," lines l0Ll10, TheWorlc of MlchaelDragton,Esg., vol. 4 (London: W. Reeve, 1753).

2. Ernest f. I"ovell, ed., Lady Blessington's Conoersations of LordByron (Princeton, N.J.; Princeton University Press, 1969), p. 115.

3. George Becker, The Mad Genius Controtsersy: A Stuilg in theSociol.ogg of Dedance (Beverly Hills, Califl: Sage Publications, 1978), p.73.

4. Ibid., pp. 127-128.5. Ian Hamilton, Robert Lowell: A Biography (New York: Random

House, 1982), p. 208.6. George Gordon, Lord Byron, "The Lament of Tasso," line 5,

Lard Bgron: The Corrylzte PoeticalWorks, ed. Jerome ]. McGann (Ox-ford: Oxford University Press, 1986), vol. 4, p. 116.

7. Dante Alighieri, The Comcdy of Dante Alighiari: Cantical: Hell(L'lnfemo), canto XVII, lines 109-110, trans. Dorothy L. Sayers (Mid-dlesex, England: Penguin, 1949), p. 177.

8. Charles Lamb, "The Sanity of True Genius," Elia and the LastEsscys of Eka (New York: Oxford University Press, 1987), p. 213.

9. Seamus Heaney, "Elegy," lines 34-40, Agendn: Robert Lou:ellSpeciat fssaa (Autumn 1980), pp.2l-22.

272 NOTES

CHAPTER 2ENDLESS NIGHT, FIERCE FIRES AND SHRAMMING COLD

l. Dante, The Comedg of Dante Alighieri: Cantica l: Hell (L,ln_ferno), canto III, lines 86-87, p. 87.

2. Robert Lowell, "Visitors," lines Bb-41, Dag bg Dcy (London andBoston: Faber and Faber, lg77), p. l1I.

3. Robert Lowell, "For John Berryman, lgl4-I972," CollectedProse, ed' Robert Giroux (New york: Farrar, straus & Giroux, rggz), pp.104-118.

4. Hamilton, Robert Lowell, p. 351.5. Ernst Kretschmer, quoted in J. D, campbell, Manic-Depressirse

Disease: clinical and psgchiatrin significance (rhihdelphia: J. B. Lippin-cott, 1953).

6. Eliot slater and Martin Rath, clinical psgchiatry, srd ed. (Bal-timore: Williams & Wilkins, 1969), pp. 206-2A7.

7. Emil Kraepelin, Manic-Depressioe Insanity andparanoia, trans.R. M. Barclay, ed. G. M. Robertson (Edinburgh, E&S Livingstone, l92l;reprinted New York: Arno press, lg76).

H. S. Akiskal, Subafective disorders: Dysthymie, cyclothymicand bipolar II disorders in the "borderline" realm, esgchutrii clinics ofNorth Am,erica,4 (198f ): 2546.

H. S. Akiskal, The bipolar spectrum: New concepts in clas_fficatiol and diagnosis, in L. Grinspoon, ed., psychintry (Jpdite,iolrn*II (Washington, D.C.: American psychiatric press, lgg3), pp. 271_292.

H. S. Akiskal, A. H. Djenderendjian, R. H. Rosenthal, and M.f. {han!, cyclothymic disorder: validating criteria for inclusion in thebipolar affective group, Am,erican Journal ofpsgchiatry, rca g}iij, nZZ_1233.

H. S. Akiskal, A. H. Bitar, V. R. puzantian, T. L. Rosenthal, andP. w' walker, The nosological status of neurotic depression: A prospec-tive three- to four-year follow-up in light of the primary-r""ondury undunipolar-bipolar dichotom ies, Archiues of General p sy chiatry, 35 ( rg7g) :756-766.

_ R. A. Depue and S. M. Monroe, The unipolar_bipolar distinc_tion in the depressive disorders, psychological Bullain, s5 ir97B), 1001-1029.

B. G. H. Waters, Early symptoms of bipolar affective psychosis:Research and clinical implications, canadian psgchiatric AssociationJ ournal, 2 (1979) : 55-60.

R. A. Depue, J. F. Slater, H. Wolfstetter_Kausch, D. Klein.

NOTES 275

E. Goplerud, and D. Farr, A behavioral paradigm for identifring personsat risk for bipolar depressive disorder: A conceptual framework and ftvevalidation studies, Journal of Abnormal Psychologg Monograph, W(1981): 381-437.

R. A. Depue, R. M. Kleiman, P. Davis, M. Hutchinson, and S.P. Krauss, The behavioral high-risk paradigm and bipolar affective disor-der, VIII: Serum free cortisol in nonpatient cyclothymic subjects selectedby the General Behavioral Inventory, Amcrican Journal of Psychiatry,142 (1985): I75-18r.

8. Akiskal (f981), ibid.; Akiskal (tgS3), ibid.; Akiskal et al. (Ig7T),ibid.; Depue and Monroe (f978), ibid.; Depue et al. (1981), ibid.

9. H. S, Akiskal, M. K. Khani, and A. Scott-Strauss, Cyclothymictemperamental disorders, Psgchiatric Clinics of North Amnrica,2 (197g):527-554.

10. Akiskal et al., Cyclothymic disorder: Validating criteria (1977);R. A. Depue et al., A behavioral paradigm (1981); D. L. Dunner,F. D. Russek, B. Russek, and R. R. Fieve, Classiffcation of bipolar af-fective disorder subtypes, Comprehensioe Psychiatrq, 23 (f982): f86-189.

ll. A. Bertelsen, B. Harvald, and M. Hauge, A Danish twin studyof manic-depressive disorders, British ]ournal of Psgchiatry, L30 (1977):330-351.

12. Mania: An Ersoltsing Concept, ed. R. H. Belmaker and H. M.van Praag (New York: SP Medical and Scientific Books, 7980); Handbookof Afiectioe Disordcrs, ed. E. S. Paykel (New York: Guilford Press, lg82);Neurobiologg of Mood Disord.ers, ed. R. M. Post and l. C. Ballenger(Baltimore: Williams & Wilkins, 1984); P. C. Whybrow, H. S. Akiskal,and W. T. McKinney, Mood Dixord.ers: Toward a Neu Psgchobiologg(New York: Plenum, f984); W. Z. Potter, M. V. Rudorfer, and F. K.Goodwin, Biological ffndings in bipolar disorders, in American Psgchi-atric Association Annual Reoiew, vol. 6, ed. R. E. Hales and A. J.Francis (Washington, D.C.: American Psychiatric Press, 1g87), pp. 32-60; Depression and Mania, ed. A. Georgotas and R. Cancro (New York:Elsevier, 1988); F. K. Goodwin and K. R. Jamison, "Evolution of theBipolar-Unipolar Concept," Manic-Depresstoe lllness (New York: Ox-ford University Press, 1990), pp. 56-73.

13. Robert Burns, The l*tters of Robert Burns, vol. l, 1780-1789(letter 374, December 3, 1789), 2nd ed., ed. G. Ross Roy (Odord: OxfordUniversity Press, 1985), pp. 456-457.

14. John W. Robertson, Edgar A. Poe: A Psgchopathic Studg (NewYork: G. P. Putnam, 1923), p. 27;Edgar Allan Poe, The Latters of EdgarAllan Poe, vol. 1 (letter to John P. Kennedy, September ll, 1835), ed.

274 NOTES

John Wand Ostrom (Cambridge: Harvard University press, lg4g), p. 75.15' Hector Berlioz, The Memoirs of Hector Berliaz, trans. David

Cairns (St. Albans, England: Granada, lg70), p. 142.16. Ibid., pp.226-228.17. Burns, I-etters, vol. 2, f7g0-f7g6 (letter to Mrs. W. Riddell.

December, 1793).18, William Shakespeare, Hamlet, ed. T. J, B. Spencer (London:

Penguin, lg80), act II, scene 2, lines 2gS-903, p. ll2.lg. william cowper, The I'etters and prose writings of wttttam

couper, ed. James King and charles Ryskamp (oxford: o-ford univer-sity Press, l98l), vol. 2, p, 200.

20. F. Walker, Hugo WoIf: A Biography (London: J. M. Dent &Sons, 1968), p. 322. See also R. pauly and H. Hecaen, [Mania and mu_sical inspiration: Hugo wolfs casef, Annales M1dico-psgchologiques, g7(1939): 389-405; Hugo wolf, Letters to Melanie K6chert, ed. Fianz Gras-berger, English ed, and trans. Louise Mcclelland urban (New york:Schirmer, I99l).

2I. Walker, Hugo Wolf, p. 361.

_ 22. R. George Thomas, Eduard Thomas: A portrait (Oxford: Clar_endon Press, 1985), p. 64.

23' william cowper, !-eners ofwilliam cowper (letter to Lady Hes-keth, January 22, 1796), ed. W. Benham (London: Macmillan, tgt+), pp.310-311.

24. F. Niecks, Robert schumann: A supprementary and correctirseBiographE (London: J. M. Dent & Sons, lg21), p. I4Z.

25. David Cecil, The Stricken Deer: The Life of Couper (1929,reprint, London: Constable, fg88), pp. ZZ}-ZZS.

26. F. Scott Fitzgerald, "The Crack-Up," in The Crack_(Jp andOther Stories (New York: New Directions, lg56), pp. 6g_75.

t

27. Edward Thomas, The lcknield rvay (London: constable, r9I3),pp. 280-283.

28. James Clarence Mangan, Autobingraphy, ed. James Kilroy(Dublin: Dolman Press, lg68), p. 26.

29.30.

Ibid., p. 27.Ibid., p. 21.

31. James Clarence Mangan, "The Nameless One," lines 5_g, 17_20, and 25-28, Poems of James Clnrence Mangan, Centenary Ed., ed.D. J. O'Donoghue (Dublin: O'Donoghue, London, A. H. Bulien, l90g),p. 120.

32. Gerard Manley Hopkins, Gerard Manlny Hopkins, lnclud.ingHis correspondznce with coaentry patmare (lettei to A. w. M. Baillie.

NOTES 275

May 8, 1885), ed. Claude Colleer Abbott (London: Oxford UniversityPress, 1956), p.256.

33. Gerard Manley Hopkins, The Intters of CerardManl.ey Hopkinsto Robert Bridges (letter to Robert Bridges, September I, 1885), ed,Claude Colleer Abbott (London: Oxford University Press, lg35), p. 222.

34. Gerard Manley Hopkins, Retreat notes dated January l, 1888, aNew Year slip for L889, The Serm,ons and DeootionalWritings of CerardManleg Hopkins, ed. Christopher Devlin (London: Oxford UniversityPress, 1959), p.262.

35. rbid.36. Hopkins, The Latters of Gerard Manleg Hopkins to Robert

Bridges (letter to Robert Bridges, May 17, 1885), p. 219.37. Gerard Manley Hopkins, "No Worst, There Is None," The Po-

eticql Works of Cerard Manleg Hopkins, ed. Norman H. Mackenzie(Oxford: Oxford University Press, 1990), p. I82.

38. Lewis Grassic Gibbon, Cloud Howe (1933, reprint, Edinburgh:Canongate Classics, 1988), p. 20.

39. Quentin Bell, Virginia Woolf: A Biographu (London: HogarthPress, 1972), p. 11.

40. rbid.41. Sylvia Plath, The BeIl lar (New York: Harper & Row, lg7l), pp.

142-143.42, Theodore Roethke, "Elegy," lines 3-4, 13-16, The Collected

Poems of Theodore Roethke (New York: Anchor Press/Doubleday, 1975),p . 1 3 8 .

43. Walker, Hugo WoIf, p. 359.44. Walter Jackson Bate,lahn Keats (Cambridge: Belknap Press of

Harvard University Press, 1963), p. 98.45. Quoted in Allan Seager, The Glass House:The Lifu of Theodore

Roethke (Ann Arbor: University of Michigan Press, l99l), p. 101.46. Hamilton, Robert Inuell, p. 285.47. Hamilton, Rober-t Louell, p. 157.48. John Rosenberg, The Darkening Glass: A Portrait of Ruskin's

Genius (New York: Columbia University Press, 1986), p. 151.49. Leonard Woolf, Beginning Again: An AutobiographE of the

Years 1911 to 1918 (New York: Harcourt, 1964), pp. 172--773.50. Saul Bellow, Humboldt's Grt (Middlesex, England: Penguin,

1976), pp. 29-31.51. Edgar Allan Poe, "The Man of the Crowd," The FalI of the

House of Usher and OtherWritings, ed. David Galloway (London: Pen-guin, 1986), p. 179.

52. Joan Abse, lohn Ruskin: The Passionate Moralist (London: Quar-

276 NOIES

tet B-ooks, 1980), p. 302. For discussions of Ruskin's psychiatric illnesssee, for example, fohn Ruskin, Mr. Ruskin's illness as described by him-self, British Medicallournal, t (1900): 225-226; L. J. Bragman, The caseof John Ruskinr A study of cyclothymia, Amcrican Journai of psgchiatry,9f (f$5): 1137-1159; R. J. Joseph, John Ruskinr Radical and isychoticgenius, Psgchoanalytic Reoiew, 56 (f96g): 4ZS44L

53' Jonathan carroll, outsiilz the Dog Museum(New york: Double-day, 1992), pp. 16-17.

54. Hamilton, Robert Louell, p. 286.55. Ibid., p. 307.56. Ibid., p. 218.57. Delmore Schwartz, "May's Truth and May's Falsehood,,' Se_

lected poems (193s-lg58) : swrmer l(nowledge (New york: New Direc-tions, 1959) pp. 2lT2I4.

58. Kraepelin, Manic-Depressirse Insanity and paranoia, p. 54.59. John D. camplell,_Manic-Depressiae Disease: clinicai and psg-

chiatric Significance (Philadelphia: J. B. Lippincott, tg53), pp. ll2_ttg.60' Goodwin and Jamison, "Evolution of the Bipolar-unipolar con-

g"pt," pp. 5G40; f. R. Whitwell, Historical Notes on esgchlitry @artATimes-End of 16th Century) (London: H. K. Lewis & C;., fg36); S. W.Jackson, Melnncholin and. Depressian: From Hippocratic Times to Mod-em Times (New Haven, Conn.: yale University press, fgg6); G. Roccat_agliata, A History of Ancient Psgchiatry (New york: Greenwood press.le86).

61. Whiwell, HistoricalNotes on psgchiatry, pp. 168_164 , from Deacut, et diut, marborunt, causis, signis, et curatione (paris, lb54), trans.R. Moffatt.

62' Ibid., p. 175, from Trallianus Alexander, Medicilibri iluodncim,interpret. Guintherius (Basel, fS56).

63' Ibid., p.2r2, fiom Pratensis jason, De cerebri marbis (Baser.r54e).

&(. Michel Foucault, Madness and citsilization: A History of Insan-ity in the Age of Reason (New York: Vintage Books, 1SOS), p. t5e.

65. Jackson, Melancholi.a and Depressi.on, p. 25g; from RichardMead, The MedicalWorks of Richard Mead, U.D. (London: C, Hitch etal., 1762), pp. 485486.

66. M. J. Sedler, Falret's discovery: The origin of the concept ofbipolar affective illness, American Journal of psychlatry, I40 (fgm):LL27_II33.

67. Kraepelin, Manic-Depressioe Insanitg, pp. gg-116.68. Robertson, Edgar A. poe, p. 82; poe, Letters, vol. 2 0etter to

George Eveleth, 1848), p. 356.

NOTES 277

69. Donald W. Goodwin , Abohol and the Writer (Kansas City: An-drews and McMeel, 1988); Tom Dardis, The Thirstg Muse: Alcohol and,the American Writer (New York: Ticknor & Fields, 1989).

70. S. Foster Damon, Thomas Hollng Chh:ers: Friend o/Poa (NewYork: Harper, 1930), p. 170.

77. W. R. Bett, Edgar Allan Poe: The Oedipus complex and genius,in W. R. Bett, The lnfirmities of Genius (London: Johnson, 1952), p.74-75.

72. Ibid., p. 64; Poe, I*tters, vol. 2 (letter to Annie L. Richmond,November 16, 1848), pp. 401 and 403.

73. Ibid., p. 218; Poe, Letters, vol. I (letter to James Russell Lowell,June 2, 1844), p. 256. Professor Kenneth Silverman, who feels that theevidence is otherwise weak for Poe's use of opium, deseribes Poe's suicideattempt (with an overdose of laudanum) in his reeent biography Ed.gar A.Poe: Mournful andNeoer-endingRem,embrance (New York: Harper Col-lins, l99l), pp. 373-374.

74. Goodwin and Jamison, "Alcohol and Drug Abuse in Manic-Depressive Illness," pp. 270-226. Review of twenty studies of rates ofalcohol abuse or alcoholism in patients with manic-depressive illness, pp.213-2r5.

75. Ibid,, Review of thirteen studies of rates of affective illness inpatients with alcohol abuse or alcoholism, pp. 215-216.

76. D. A. Regier, M. E. Farmer, D. S. Raye, B. Z. Locke, S. J.Keith, L. L. Judd, and F. K. Goodwin, Comorbidityof mental disorderswith drug and alcohol abuse: Results from the Epidemiologic CatchmentArea (ECA) study, Journal of the American Medical Association, 2M(1990): 2511-2518.

77. I. E. Helzer and T. R. Pryzbeck, The co-occurrence of alcohol-ism with other psychiatric disorders in the general population and itsimpact on treatment, lournal of Studies on Alcohol, a9 (f988); 279-224.

78. Goodwin and Jamison, Manic-Depressioe lllness, review of sixstudies, pp. 219-220; S. Zisook and M. A. Schuckit, Male primary alco-holics with and without family histories of affective disorder, lournal ofStudies on Alcohol,48 (f987): 337-344.

79. Hamilton, Robert Inuell, pp. 300-301.80. Goodwin and Jamison, Manic-Depressioe ILJness, pp. 222-224.

F. N. Pitts and G. Winokur, Affective disorder VII: Alcoholismand affective disorder, lournal ofPsgchiatric Research, a (1g66): 37-50.

B. Liskow, D. Mayffeld, and J. Thiele, Alcohol and afiectivedisorder: Assessment and treatment, Journal of Clinical psEchiatry, 48(1982):144-747.

J. M. Himmelhoch, Mixed states, manic-depressive illness, and

the nature of mood, Psychiatric clinics of North Am.erica, z (lg7g): 44!-^459,

J. M. Himmelhoch, D. Mulla, J. F. Neil, T. p. Detre, and D. J.Kupfer, Incidence and significance of mixed affective states in a bipolarpopulation, Archioes of General psgchiatry, 33 (fg76): 1062_1066.

81. Goodwin and Jamison, Mani,c-Depressioe lllness, pp. 21&_2lg;T. W. Estrofl C. A. Dackis, M. S. Gold, and A. L. C, poitash, Drugabuse and bipolar disorders, rnternational Journal psychiatrg Med, rS(1985): 37-40,

82. Regier et al., Comorbidity of mental disorders (fg90).83. S. M. Mirin, R. D. Weiss, A. Sollogub, and J. Michael, A_fiective

illness in substance abusers, in s. M. Miri;, ed., substance Abuse andPsychopathol.ogy (washington, D. c.: American psychiatric press, lgg4),pp. 57-78.

T. R. Kosten and B. J. Rounsaville, psychopathology in opioidaddicts, Psgchiatric Clinics of North America, g (lgg6): 515_532.

s' M. Mirin and R. D. weiss, Affective illness in substanceabusers, Psychintric Clinics of North America, g (lgg6): 503_Sf4.

R. D. Weiss and S. M. Mirin, Subtypes of cocaine abusers,Psychi,atric Clinics of North Amcrica, g (f9g6): +gf_SOf .

R. D. Weiss, S. M Mirin, M. L. Griffin, and J. L. Michael,Psychopathology in cocaine abusersr changing trends, Jouinal of Nensousand Mental Disease, 176 (1988): 7Ig-725.

E, V. Nunes, F. M. euitkin, and D. F. Klein, psychiatric di_agnosis in cocaine abuse, psgchiatry Research,2g (fggg): 105*f14.

84' E. J. Khantzian, The self-medication hypothesis of addictive dis-orders: Focus on heroin and cocaine dependence, American Journal ofPsychintry,la2 (r9g5): L2SI-L26/'; F. H. Gawin and H. D. Kieber. Ab_stinence symptomatology and psychiatric diagnosis in cocaine abusers,Archioes of General Psgchiatry,43 (1986): 107-rl3; weiss et al., psy-chopathology in cocaine abusers (1988).

85. Weiss et al. Psychopathology in cocaine abusers, (lg8g).86. Regier et al., Comorbidity of mental disorders, (lgg0).

- 87. samuel Taylor coleridge, collected Letters of samuel Taglorcolnridge, vol. 4, r8r5-18r9 (letter to James Gillman, April 13, rg16),ed. Earl Leslie Griggs (O*ford: Oxford University press, t95S), p. 1002.

88. John Haffenden, The Lift of lohn Berrymnn (Boston: Routledge& Kegan Paul, 1982), pp.374-375.

89. W. Read, The Dags of DglanThomas (New york: McGraw_Hill.le64).

90. Kraepelin, Manic-Depresshse Insanity, p. 25.

NCnDS 279

91. Goodwin and Jamison, "Suicide," Manic-Depressioe lllness, pp.227-tu14.

92. O. Hagnell, J. Lanke, and B. Rorsman, Suicide rates in theLundby study: Mental illness as a risk factor for suicide, Neuropsychobi-ologg, 7 (1981): 248-253.

93. D. A. Brent, J. A. Perper, C. E. Goldstein, D. J. Kolko, M. J.Allan, C. J. Allman, and J. P. Zelenak, Risk factors for adolescent suicide:A comparison of adolescent suicide victims with suicidal inpatients, Ar-chioes of Cenerol Psychintry,45 (1988): 58f-588.

94. Bruce Kellner, The l-a.st Dandg: Ralph Barton (Columbia: Uni-versity of Missouri Press, l99l), p. 213.

95. Goodwin and famison, Manic-Depressiae lllness, pp. 231-234.

96. D. A. Regier, J. H. Boyd, J. D. Burke,Ir.,D. S. Rae, J. K.Myers, M. Kramer, L. N. Robins, L. K. George, M. Karno, and. B. Z.Locke, One-month prevalence of mental disorders in the United States:Based on five Epidemiological Catchment Area sites, Archhtes of GeneralPsychiatry, a5 (1988): 977-986.

97. Norman Sherry, The Life of GrahamGreene, ool. 1, 1%4-lg3g(New York: Viking Penguin, 1989), p. 159; reference for Graham Greene'sself-diagnosis of manic-depressive illness, Paul Theroux, "An Edwardianon the Concorder Graham Greene as I Knew Him." New York TimesBook Reoiew, April 21, 1991.

98. Sherry, The Life of Graham Greene, p. 155.99. George Gordon, Lord Byron, Byron's lztters and, Journal^s,

vol. 5, 1816-1817 (letter to Thomas Moore, fanuary 28, 1877), ed. LeslieA. Marchand (Cambridge: Belknap Press of Harvard University press,1976), p. 16,5.

100. Lowell, "I. A. Richards 2. Death," lines 7-8, History (London:Faber and Faber, 1973), p. 202.

101. Lowell, "Suicide," lines 46-55, Dog by Dog, p. 16.102. E. Robins, S. Gassner, J. Kayes, R. H. Wilkinson, and G. E.

Murphy, The communication of suicidal intent: A study of 134 consecu-tive cases of successful (completed) suicide, Amcrican Journal of psgchi-atry, 775 (1959): 724-733.

103. William Styron, Darkness Visiblc: A Memoir of Madness (NewYork: Random House, 1990), p. 62.

104. Leo Tolstoy, Confession, trans. David Patterson (New york:W. W. Norton, f983), pp. 28-29.

105. A. Alvarez, The Saoage God: A Studg of Suicidp (New york:Random House, 1973), p.75.

106. Ibid., pp. 95-97,

107. Ibid., pp. 79-80.

- 108. Kraepelin, Manir-Depresshse lnsanity; G. R. Jameison, Suicideand mental disease: A clinical analysis of one hundred cases, ArchNeurolPsychiatry,36 (f936): t-12; G. Winokur, p. J. Clayton, and T. Reich,Manic Depressir:e lllness (St. Louis: C. V. Mosby, 1969); J. Kotin andF. K' Goodwin, Depression during mania: clinical observations andtheoretical implications, Am,erican lournal of psgchiatry. r2g (rgz2):67L686; c' P' Miles, conditions predisposing to suicide: A review,Joumal of Neruous and Mentol Disease, tU 6SlZ) 2gI-'246.. 109. Percy Bysshe Shelley, "The Retrospectr Cwm Elan, lgl2,,,!n9s !54a, Shell.ey: PoeticalWorks, ed. Thomas Hutchinson (London:Oxford University Press, lg70), p. 874.

110. vladimir Mayakovsky, "It's After one," lines 1-12, in EdwardJ. Brown, Magakorsskg: A Poet in the Rerolution (New york: paragonHouse, 1988), p. 356.

rrr. rbid.112. George Gordon, Lord Byron, "Manfred: A Dramatic poem."

act III, lines 160-167, Lord Bgron: The compbte poeticalworks, ed,.J. J. McGann, vol. 4 (Oxford: Oxford University press, lgg6).

co uLD n ?Hlilrll r r-rn,r,1. Joyce Carol Oates, speech given to the Cosmos Club, Washing-

ton, D.C., Reprinted in Cowws Club Bull.efin, 44 (lanuary lggl): 5.2. Emily Dickinson, "The First Day's Night Had Come,' (poem

4 10), lines 17 -2O, The P oems of Emilg Dickins on, ed. Thomas H. Johnson,(Cambridge: Harvard University press, lg55)3. Robert Graves, TheCreekMyths, vol. I. (Middlesex, England:

Penguin, 1955), p. 9.4' Plato, Phaedrus and the setsenth and Eighth r*tters, trans. wal-

ter Hamilton. (Middlesex, England: penguin, lg74), pp. 4647.5. Ibid., p. 48.6. Aristotle, Probl.ems ll: Books XXII-XXXWV, trans. W. S. Hett

(Cambridge: Harvard University Press, lg36), pp. 155-f57.7. William Wordsworth, "Resolution and Independence," Williem

Wordsuorth: The Poems, vol. l, ed. John O. Hayden (New Haven: yaleUniversity Press, lg8l), p. 553.

8. Byron, "Childe Harold's pilgrimage," canto III, verse 7, lines55-60, Lord Byron: The Com,plete Poetical Works, vol. 2, p. 79.

9. Benjamin Rush, Medical lnquiries and Obseroations Upon the

NOTES 881

Diseases of the Mind. (Philadelphia: Kimber and Richardson, 1812), pp.153-154.

f0. J.-J. Moreau, La Psgchologie Morbide dans ses Rapports aoec laPhilosophie de I'Histoire. (Paris: V. Masson, 1859); Cesare Lombroso,L'Homnw d,e G1nie. (Paris: Alcon, 1889); P. J. M<ibius, "Uber das Stu-dium der Talente," Zeitschrift fiir Hgpnotismus, l0 (1902): ffi-74.

11. Lamb, "The Sanity of True Genius," pp.2l?.-213.12. David Cecil, A Porirait of Charles l-amb. (London: Constable,

1983), p. 55.13. William James, TheVarieties of Religious Experience: A Study in

HumnnNature (1902; reprint, Middlesex, England: Penguin, 1982), pp.23-24.

14. Kraepelin, Manic-Depressioe lnsanitE, p. 17.15. A. Myerson and R. Boyle, The incidence of manic-depressive

psychosis in certain socially important families, American lutmal of Psg-chutry, 98 (19af ): tI-21.

16. Lionel Trilling, The Uberal lmngination; Essays on Literatureand SocietE (New York: Harcourt Brace Jovanovich, 1950), pp. 152-153.

17. Rudolf Wittkower and Margot Wittkower, Born Und'er Saturn:The Character and Conduct of Artists: A Documpnted History from An-tiquity to the French Rersolution' (New York: W' W. Norton, 1963)' p.100.

18, Trilling, The Liberal lmagination, p. 165, 170.19. Francis Galton, Hereditary Genius: An lnquiry lnto lts Inws

andConsequences. (New York: D' Appleton & Co., 187f); J. F' Nisbet,The lnsanitg of Genius,5th ed. (London: Alexander Moring, 1891)'

20. C. Whilbey, The indiscretions of biography, English Reaiew, 39(r92a): 769-772.

J. A. Garraty, The interrelations of psychology and biography,Psgchological Bulbtin, 5r ( 1954): 569-582.

J. A. Chambers, Relating personality and biographical factors toscientiftc creativity, Science, f45 (1964): 1203-1205;

M. B. Shapiro, The single case in clinical psychological research,

Journal of Ceneral Psgchobgy 74 (1966): 3-23.M. Roffand D. F, Ricks, eds., Life History Research in Psgcho-

pathologg, vol. 1 (Minneapolis: University of Minnesota Press, 1970).M. Roff, L, Robins, and M, Pollack, eds., Lifu History Research

in Psychopathologg, vol. 2. (Minneapolis: University of Minnesota Press,1e72).

F. E. Kenyon, Pathography and psychiatry, Canadian Psychi'atric Associntion lournal, f8 (1973): 63-€6.

D. F. Ricks, A. Thomas, and M. Roff, eds., Life History Re-

se&rch in Psychopathology, vol, s (Minneapolis: university of MinnesotaPress, 1974).

L. Ross, The intuitive psychologist and his shortcomings: Dis-tortions in the attribution process, in L. Berkowitz, ed., Adoances inExperimental social Psgchology, vor. 10 (New york: Academic press,re77).

w. M. Runyan. A stage-state analysis of the life course, JournarofPersonalitg and Social psgchology, Bg (19g0): 951_962.H. A. Murray, Endearsors in psgchology: Selections from the

Personologg of Henrg A. Mumag, ed. E. S. Sf,neidman. (Nlw york:Harper & Row, I98l).

W. M. Runyan, Ltfe Hlstories and psychobiography: Erplora_ti'ons in Theory and Method (New york: oxford univ".iity rr"rr, rssal.

21. Anthony Storr, "The Sanity ofTrue Genius,,,rr.rpublirh"d manu_script.22' studies of suicide in- depressive and manic-depressive illnessare reviewed in Goodwi-n and Jamison, Manic-Depr"rriu" Iilness. seealso Hagnell' Lanke, and Rorsman, suicide .ates ii the-L""Juv ,a"ar,

l.' A. Egeland and J. N. Sussex, suicide und futnirf-r""Ji.,g-tll*-"",ir"disorders, Journar of the American Medic;r e^tto"uroili?trgs5l, grs-918.

For example, Galton, Hereditary Cenius, lg7l; Lombroso,L'Homme de G6nie, Iggg.24' A' Juda, The relationship between highest mental capacity andpsvchic abnormalitie s, Americanjournal

"f iri"no"ri', lio iiSinl ,nu_307.

25. C. Martindale,. Father's absence, psychopathology, and poeticeminence. Psgcholngical R?oryr,-Bl (1972): Sas-.gi.;c. Ulrti"a' e, Theclockwork Muse, Tie predictabtittv i irit"x change(New york: BasicBooks,1990).

29. I'J.schildkraut a1d A. J. Hirshfeld, Mind and mood in modernart: The New york School, CME Syilabu, ond proceed,ings Summnry,Amcrican Psgchiatric Associ,atian Aniuar Me.eting(New york: May r9g0),pp. 255-25' J. J. Schildkraut, A. J. Hirshfeld, ".d l. ll".pirr,'ill"a

""amood in modern art II: Depressive disorders, spirituality "iJ"u.iy

a*tr*in the abstract expressionist artists of the New york School, submitted forpublication. The artists studied were Bradley warker Tomti.r, aaout co,-tlieb, Mark Rothko, Arshire Gorky, cr1flo.J's.iil,wiil" -'i" ?"."#r, u*_net Newman, James Brooks, David Smith, Franz Kline, Wittiu* nurioa"r,Jackson Pollock, philip Guston, Ad Rein'hardt,

".rd n"u".i-rr.r"arrlr*ar.

27. W. H. Trethowan, Music and mental disorder, ln Uusic-and the!:!i";,Y.Critchley and R. E. Henson (London; ff"i""*"""1";S;; ,, ,O.398-442.

NOTES

28. A. M. Ludwig, Creative achievement and psychopathology:Comparisons among professions. American lournal of Psychotherapy, 46(1992): 330-356.

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lohnson and the Lrf" of Writing (New York: W. W. Norton, l97l);W. Jackson Bate, Samuel lohnson (New York: Harcourt Brace |ovanov-ich, 1977); R. Porter, "The Hunger of Imagination": Approaching Samuel

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(Cambridge: Harvard University Press, 1983)'Groncr Darusv. R. A' Streatfield, A forgotten poet: Darley,

Quarterlg Reoieu, 196 (1902): 367-402; The Complete Poetical worlcs of

d"orgu Da4ey, ed. Ramsay Colles (London: George Routledge & Sons'

1908; Chude Colleer Abbott, The Ltfe and Letters of George Darleg

(Lonlon, Humphrey Milford, lg28); Selected Poems of George Darleg,

ed. Anne Ridler (London: Merrion Press, 1979)'Hanrr-rv Cor.rnrocn' Poems bg Hartley Coleridge' With a

Memair of his Life bg hi"s Brother,2 vols. (London: Edward Moxon,

1g51); Eleanor A. Towle, A Poet's Children: Hartleg and sara coleridge

(Lonlon, Methuen, 19f2); E. L. Griggs, Hartley Coleridge: His Life and

Work (London: University of London, 1929); H' Hartman, Hartleg Col-

eridge: Poet's Son and Poet (London: Oxford University Press, 1931);

Lenlrs of Hariteg Col.eridge, ed. Grace Evelyn Griggs and Earl Leslie

Griggs (London: Oxford University Press, 1941)'Tnoms Hoop. J. C. Reid, Thomas Hood(London: Routledge

& Kegan Paul, 1963); John Clubbe, Victonan Forerunner: The Late Ca'

,u", il Tho*as Hood (Durham, NC: Duke University Press, 1968); Wal-

ter Jerrold, Thom,as Hood: His Lifu and ?irnzs (New York: Greenwood

Press, 1969); Lloyd N. Jeffrey, Thomas Hood (New York: Twayne, L972);

The Letters of Thomas Hood, ed. Peter F. Morgan (Edinburgh: oliver &

Boyd, 1973).Tnouas Lovnr-r- Bnooons.

Beddnes. ed. Edmund Gosse (London:The Letters of Thomas LorsellElkin Mathews & John Lane,

898 NOTES

1894;The Poems of Thomas r'ooellBed.dnes, ed. Ramsay coiles (London:George Routledge & sons, 1907); Royail H. snow, Thomas Lo'oelr Bed-daes: Eccentric tr Poet (New york: Covici-Friede, l92g); H. W. Donner,Thomas l,ooell Bed.does: The Making of a poet (oxford:-Basil Blackwell,1935); H. K. johnson, Thomas Lovell Blddoes, isgchiatric gui*uty, tz(19a3): 447-469; plaEs and poems of Thomas toaill Bediloi, ua. H. w.Donner (London: Rou^tledge & Kegan paul, 1950); Geoffrey W agner,Beddoes: centennial of a suicide, Hirtzon,lg (l%9I 417:ii;;James R.Thompson, Thomas Looell Beddoes (Boston: Twayne, fggs).

Rosrm Srepnru Hewxnn. The poeiicar woiks of RobertStephen Hauker, M.A., ed. AIfred Wallis (London, Jotn't n*i, fSSS),Sabine Baring-Goul d,. Tle Vi_car of Moru)enstuD, Beiig a Lifu of RobertStephenHawker, M.A. (London, frethue., & Co., lgggl Charlur'Bd*".dByles, The Life and Letters of R. S. Hauker(London: irf,,' i"r", rS,St,Margaret Florence p:.:oyr,_lobert_Stephen Uo*iri,-'i- iiriv of a*Thought and poetry (Oxford: Blackwell, 1SZO); pi"r, Sr"ndon,-Hi wker ofMorwenstow: portrait of a victorian Eccentric, (London: c"oo tntsl.

Jeuns Cu1yu.c1 MeNcaN. James Clarence-i""ii", nx s"_lectedPoems uith a studg by the Edrtor"I)uise rmogene Guineg(London:John Lane, f897); D. J. O Donogh u", ihu Ltfu and Writings of lameschrence M.angan (Dublin: y. H: cili, tasiii";;ii;",;;;"d,orun""Mangan, ed. D. J. o'Donoghue (Dublin: o,Donoghuei'C"liilal, rA,P.rosewriting-s of lames ctaren.c) Mangai,.ed o]r od;;;il (Dub-lin: O'Donoghue & Co., 1904); fhe iutobtogroeirV of lirir'dlornn"nMangan, ed. James Kilroy (ou6hn, nom"n,-igO8);la_", Kilr;, JamesClarence M angan (Lewisburg, p;,;;;;;f G;:;C i."r"rl,,orot,Henry J. Donaghy, James Clarence Uon[on (New york: Twayne, lg74);David Lloyd , Nationarism and Minor Lit"7o,ture, Jomes crareice Manganand the Em'e r ge nce of I ri"s h c urturar iaionax*( Berkeley r u niversity ofCalifornia press, l9B7)

30. I chose the poets.for study by surveying fffteen anthologies ofeighteenth- and nineteenth_ce'tury ;r;;. Thrr; ;11;i"i#",r'i"a"aThe Neu orford Book of lighteeni C;;;;rU Verse, The oxford Book ofNineteenth Century Engtish Verse, The Norton Anthology of EnglishLiterature, Eighteenth C:"y:V loetrr1 ori prorr, Engl*h Romnntic po_etry and Prose, rhe o.j{o(r Biok of icontsh verse, The orford Book oflrish Verse, and Engltsh Romantlc"Wrtters.Among the poets chosen, Samuel

,Johnson, Thomas Gray,william collins, chrisiopher smart,'oiiver?orismith, wiril;;;"*p"r,Thomas Chatterton, 9!o* Crabbe, Wifii"_ Blake, Rob"rt-Brrrrrr,william wordsworth, Sir warter scott, samu.r ruyb. dor#;, iou..,Southey, Walter Savage Landor, fho-", Cu_pbell, Thomas Moore.

NC/TES 893

Thomas Love Peacock, George Gordon, Lord Byron, Percy Bysshe Shel-ley, John Clare, John Keats, George Darley, Hartley Coleridge, ThomasHood, and Thomas Lovell Beddoes were represented in all or virtually allofthese anthologies.

A considerably smaller number were included in several collec-tions: Leiglr Hunt, James Clarence Mangan, William Lisle Bowles, JamesMacpherson, and Robert Fergusson. An equally small number were rep-resented in only afew of the anthologies: Robert Stephen Hawker, JoannaBaillie, Samuel Rogers, John Codrington Bampfrlde, and Joseph Warton.

3I. Kathleen Jones, I'unacg, Lau and. Conscience, 1744-lMS (Lnn'

donr Routledge & Kegan Paul, 1955); Andrew T. Scull, Museums ofMadness: The Soci,al Organization of lnsanitg in 79th Century England,doctoral diss., Princeton Universiy,lgT4; D. J. Mellett, ThePrerogatioeof Asglumd.om: social, cultural, and Adrninistratirse Aspects of the lnsti-

tutioial Treatment of the lnsane in Nineteenth Century Britai'n (New

York: Garland, f982); Margaret S. Thompson, The Mad', the Bad, andthe

sail: Psychintric core in the Rogal Edinburgh Asylum (Momingside),

1813-1894, doctoral diss., Boston university Graduate school, 1984; W.

F. Bynum, Roy Porter, and Michael Shepherd, eds., The Anatomg of

Mad.ness: Essays in the History of Psgchiatry. vol. ll: lnstitutions and

S ociety (London: Tavistock, 1985); John Crammer, Asglum History : Buck-

lnghamihlre Countg Pauper Lunatic AsElum-St. John's (London:

Gaskell, Royal College of Psychiatrists, 1990)'32. Robert Burns, Comtrwn Plnce Book, quoted in W' R' Bett, The

lnfirmities of Genius (New York: Philosophical Library, 1952), p' 147'

33. N. i. C. ettdt"asen and A. Canter, The creative writer: Psychi-

atric symptoms and family history, Com.prehensioe Psychiatry, 15 (1974):

f4-fif; N. f. C. Andreasen and P. S. Powers, Creativity and psychosis:

An examination of conceptual style, Archioes of General Psychiatry, 32

(rg75): 70-73; N. c. Andreasen, creativity and mental illness: Preva-

lence rates in writers and their ftrst-degree relatives, American lournal of

Psgchiatry, 144 (1987): 1288-1292.34. Hagop Akiskal, letters of September 20, 1988 and February l,

lgg0; H. s. Akiskal and K. Akiskal, Reassessingthe prevalence of bipolar

disorders: Clinical signiffcance and artistic creativity, Psgchiatry and PsE-

chobiologg, 3 (1988): 29s-36s.35. Akiskal, letter, September 20, 1988.36. K. R. Jamison, Mood disorders and patterns of creativity in

British writers and artists, PsEchiatry,52 (1989): 725-734'

37. One study conducted at Johns Hopkins found that the diag-

nostic measures utilized in the Epidemiologic Catchment Area (ECA)

study resulted in twice the number of people diagnosed as having major

depressive disorder compared with the rate obtained when using in-depth clinical interviews conducted by experienced psychiatrists (M. F.Folstein, A. J. Romanoski, c. Nestadi, n. ch"ir"1, A. ilerchant,S. Shapiro, M. Kramer, J. Anthony, E. M. Gruenberg, and p, R.McHugh, Brief report on the crinicar reappraisar or .h" Si"t rostic In-terview schedule carried out at the Johns-Hopkins site of tlie Epide_miologic catchment

_Area program of the NirrrH,

"ir);hobgl"ot

Medicine, 15 [1985]) 809-814,Other studies have found that only one person jn three whomeets the diagnostic criteria for a major -ooa ai*ia"rl"tr"tt1r."riu",

treatment for it.M, M. Weissman, J. K. Myers, and W. D. Thompson, Depres_sion and treatment in a u.s. urban'community: lg75- rgf6, Archloes ofGeneral psychiatry, 3g (f9gl): 4lT--42I.S. Shapiro,-E. A. Skinner, L. G. Kessler, M. Von Korfi, p. S.German, G. L. Tischler,. p. J. Leaf, L. Benham, L. C",i"r,-Jrd D. A.Regier, Utilization of health and mental health seruices, irrr"" upia"-i-

;lrr-$r::,*ment Area sites, Archhses of Cenerat iri"nttru, ni (rSAq,

M. M. Weissman, M. L. Bruce, p. J. Leaf, L. p. Florio, and C.Holzer, AfiecUve disorders, in L. N. fioUi"-, and D. A. Regier, eds.,Psgchiatric Disordnrs in Ameri,ca: rni nerimao;;';";;;tr;t AreaStndy (New york: Free press, lggl) . '

38. Weissman, et al., Depression and treatment in a U.S. urbancommunity, (1981).39' s' shapiro, et ar., utilization of health and mental health ser-vices, (1984).40. R. G. McCreadie and D. p. Morrison, The impact of lithium inSouthwest Scotland. I. Demograpf,i" u"a

"ii"i annarn{r, niixijournotof Psschintry, 146 (r9SS), 707i.

4l' J' I. Escobar,,J. c. Anthony, G. canino, L. cotler, M. L.Melville, and J. M. Goliing, ur" oin".,ij"pti;;;;fld"Ji"rlrrr, ""alithium by u's' community populations, psychopharmacology Burbttn,23 (1987): 190-200.

42. rbld.43, rbid.44. R. L. Richards, D. K. Kinney, I. Lunde, and M. Benet, Cre_

"!r,r:Y in manic-depressives, cyclothymes, and their

""r*Airra,i"r.""relatives: A preliminary report, lournal "f

A;;;;;;-iii"i"r"ro, n(1988): 28r-288.45 . Ib id . , p .287.46' G' R' De r,ong and A. Aldershof, Associations of speciar abirities

NOIES

with juvenile manic-depressive illness, Annals of Neurology, 14 (1983):362.

47. C. Banks, V. S. Kardak, E. M.Jones, and C. J. Lucas, Therelation between mental health, academic performance and cognitive testscores among chemistry students, B ritish J oumal of Ed'ucational Psgchol-ogg,40 (f970): 74-79; C. J. Lucas and P. Stringer, Interaction in univer-sity selection, mental health and academic performance, British Journalof Psychiatry, I20 (1972): 189-195.

48. Andreasen, Creativity and mental illness (1987), p. 1290'49. Lombroso, L'Hornme d'e Gdnie.

Galton, Hereditary Genius.W. Lange-Eichbaum, TheProblemof Genius, trans. E. Paul and

C. Paul (New York: Macmillan, 1932).

Juda, The relationship between highest mental capacity and psy-

chic abnormalities, (1949).

J. L. Karlsson, Genetic association of giftedness and creativity

with schizophrenia, Hereditas, 66 (f970): 177-182.

T. F. McNeil, Prebirth and postbirth infuence on the relation-

ship between creative ability and recorded mental illness, lournal of

Personolitg, 39 (1971): 391-406.

J- L. Karlsson, Genetic basis of intellectual variation in Iceland,

Hereditas, 95 (f98f ): 283-288.

J. L. Karlsson, Creative intelligence in relatives of mental pa-

tients, Hereditas, f00 (1984): $-46.Richards et al., Creativity in manic-depressives, (1988)'

Related issues and ffndings are reviewed in R' L' Richards'

Relationship between creativity and psychopathology: An evaluation and

interpretati,on of the evidence, Genetic Psychologg Monograph, L03

(1981): 261-atu4.N. C. Andreasen and I. D' Glick, Bipolar afiective disorder and

creativity : Implications and clinical managemen t, C omprehensioe P sychi'

atry, 29 (1988): 207-2L7.T. J. Crow, A single locus for psychosis and intelligence in the

exchange tugio.t of the sex chromosomes? In R. J' Sr6m, V'-Bulyzhenkov,

L. Prilipko, and Y. christen, eds., Ethical Iss/es of Mol,ecular Genetics in

P sychintry (Berlin: Springer-Verlag, 1991).

50. Karlsson, Genetic association of giftedness (1970); Karlsson, Ge-

netic basis of intellectual variation (198f); Karlsson, creative intelligence

in relatives (1984).

51. Richards, Relationship between creativity and psychopathology(1981); Andreasen and Glick, Bipolar afiective disorder (f988); J' A'

s9.5

Melvin and D' Mossman, Mental iilness and creativity , Americanlournarof psschiatry, r45 (198g): 908.

52. McNeil, prebirth and postbirth infuence (fg7f).53. Ibid., p. 40S.54. Goodwin and Jamison, Manic_Depressioe lllness, pp. 16 -173.

studies of social class have been hampered, and the interpre'u:tion of datahas been made difficurt, by two maioi types of methodolJgi"Jfrout"-r,diagnostic bias (and diagnostic ou"rin"luri.,reness) *a i""t*"nt bias.Together these factors can contribute to incorrect and inaccurate report-ing of incidence and prevalence rates of manic-deprerriu" irin"r, amongvarious social classes- For example, uppgr- and m'iddre-cl"rr-p"oplu

"."more likely to be diagnosed as *"ni"-d"p."ssive, whereas lower-crassindividuals, especially. among poor urban'bl""k ;p;i;i,o*, ?" rnor"Iikely to be diagnosed ",

,"f,i"ophrenic-(ofte, ;;;"k;;il'ro)**a "."consequently treated as such. Minorities are generally ,rrrdirr"ir"r"nt"d.in these studies as well. Further, criteria fo, ,ocial

"dr, ,"ry ;;ss stud_ies' some authors have used the Hoilingsh"ud arrd n"dr;"h;;;, othersused occupation alone or parentar sociil class, and stiil othi^ ur"d orrlyeducational achievement.

Two other nossibre sources of error include statisticar artifacts-where signift cant ."r,rltr. ;; il;.;";;;to other social factors, such asplace of residence, marital siatus, ""d

;;;"_""d gender biases. Genderbias enters in because women often do not drop ;. r;;i"i;;; throughillness but retain the social crass of tr,#rr"rulrar1,i.-oi"?;ra, m"incidence of psychoses in-various occupations, Intemational Journal afSocial psychiatry, 2 Lt9S6l: g5_r04). r-'--.

55. C. Bag\ey, Occupational status and symptoms of depression,Soci,al Science Medicine, Z IISZS;, SW_iSi, p. 3Bl.56. U. petterson, Manic_depresriu" ill.r"rr: A clinical, social andgenetic study, Acta psychiatrica icandinarsica (suppl. s69jJi9ZI f_93.57. M. M. weissman andJ. K. Myers, Affective disorders in a u.s.urban community: The use of nrru"r"h ni"g.rorti" criteria in an epide-miologic survey' Archioes of General isy"itotrg,3' (r97g): 1304-r3lr.58. E. s. Gershon and J. H. Liebiwitz, sociocurtural and demo_graphic correlates of

i$.ctr^v_e-jirord"., ir, l"rusalem, Journal of psgchi_atri,c Research, IZ (Ig7S): 37_50.

59. Myerson and Boyle, The incidence of manic_depressive psycho-

Hrltn.nt)t Bagley, occupational status and symptoms of depression

Unlike schizophrenia, there does not appear to be ..downwardsocial drift" in manic-depressive illness. rni, n", been attributed to as-pects of the natural history of the illnesr, 19 It is an illness with a good

NOTES

prognosis and without the progressive deteriorative course that wouldafect earning potential; (2) the onset of the illness is usually sudden, withno prolonged prepsychotic period; (3) the onset is usually after college ageso that it does not seriously interfere with opportunities for higher edu-cation; and (4) individuals with manic-depressive illness frequently havecompensatory energy and ambition (C Landis and J. D. Page, Modern So-ciety and Mental Disease [New Yorkr Farrar & Rinehart, Inc., 1938]).

60. Weissman et al., Affective disorders (1991).

61. Shapiro et al., Utilization of health and mental health services(1e84).

62. Harold Nicolson, The health of authors, Inncet,ll (1947):709-7t4.

63. W. A. Frosch, Moods, madness, and music. I' Major affectivedisease and musical creativity, Comprehensioe Psgchiatry, 28 (1987): 315-

322. Dr. Frosch, for example, argues that Beethoven experienced "mood

swings ., was clearly eccentric . . ' may even have been psychotic .' .

[but] there is no evidence that he was ever manic-depressive [p. 3f6]'" It

is certainly true that eccentricity and mood swings alone do not constitute

manic-depressive illness; there is at least some evidence, however, that

Beethoven may have suffered from affective illness. Suggestively,

Beethoven has been described by his contemporaries, as well as by schol-

ars, as having had several "nervous breakdowns," being suicidally de-

pressed at difierent times in his life, and drinking heavily (O. G. Sonneck,

"d., Beethooen: lmpressions bg His Contemporanes [New York:

G. Schirmer, 1925]; W. Schweisheimer, Beethoven's physicians, Musical

Quarterly,3l [1945]: 289-298; Thager's Life of Beethooen,2 vols., Znd

ed., Aliot Forbes [Princeton: Princeton University Press, 1967]; Edward

Larkin, Beethoven's medical history, in Martin Cooper, Beethorsen: The

Last Decad.e, 1817-27 [London: Oxford University Press, 1970], pp' 439-

466; Maynard Solomon, Beethooen [New York: Schirmer, 1977]; Maynard

Solomon, Beethooen Essays lCambridge: Harvard University Press,

1988]; John O'Shea, Ludwig van Beethoven, 1770-1827, in Music and

Medicine: MedicalProfi'Ies of GreatComposers, pp. 39-65 [London: J. M'

Dent, 1990]). Scholar Maynard Solomon has characterized Beethoven as

having had "sudden rages, uncontrolled emotional states, suicidal ten-dencies, melancholic disposition, and frequent feelings of persecution"(Solomon, Beethooen Essags,1988, p. 146); most of these traits and be-haviors predated the onset of his deafness (Solomon , Beethooen, 1977).Beethoven's family history is also of interest: His paternal grandmother

was an alcoholic who needed to be placed in a cloister for her care; his

father, likewise, was an alcoholic; his maternal grandmother reportedlyhad a "psychological breakdown" ofan unspecifted nature; and one ofhis

P;97

398 NOTES

brothers, who was himself of a violent and volatile nature, had a son whoattempted suicide (Donald MacArdle, The family van Beethoven, Musical

Quarterlg, 35 [1%9]: 528-550; Thayer's Uft of Beethooen; Solomon,1977). All these facts can be interpreted in difierent ways-and they havebeen-but the possibility that Beethoven suffered from a mood disordercannot be dismissed out of hand.

Relatedly, the possibility that two other great composers, Han-del and Mozart, may have suffered from manic-depressive illness or cy-clothymia has been raised. Handel has been thought by many scholars tohave been cyclothymic (8. Slater and A. Meyer, Contributions to apathography of the musicians: 2. Organic and psychotic disorders,Confinia Psgchiatrica, 3 [1960]: I29-L45 A. Storr, The Dynamics of Cre-ation llondon: Secker & Warburg, 1972]; M. Keyes, Handel's illnesses,Lancet,2 [f980]: 1354-1355; K. R. Jamison and R. Winter, Moods andMusic, Program notes for a concert performed by the National SymphonyOrchestra at the fohn F. Kennedy Center for the Per{orming Arts, Wash-ington, DC [November 1988]). Dr. Frosch has disputed this view, how-ever (W. A. Frosch, Moods, madness, and music. I. Major affectivedisease and musical creativity, Comprehensioe Psgchiatry. 28 [1g87]: 3f5-322;W. A. Frosch, Moods, madness, and music. II. Was Handel insane?Musical QuarterlE,74 [f990]: 3f-56). Although there are several stronglines of evidence that Handel did, in fact, suffer from a recurrent mooddisorder, the relative lack of autobiographical materials and reliable con-temporary medical accounts makes any diagnostic formulation necessarilytentative. More recently, Peter Davies has argued that Mozart had manic-depressive "tendencies," consistent with a diagnosis of cyclothymia (p. J.Davies, Mozart's manic-depressive tendencies, pts. I and 2, MusicalTimes[L9fl7]: 123-126 and 191-196; P. J. Davies, Mozart inperson: HisCharacter and Health [Westport: Greenwood Press, lg8g]). Froschagrees that Mozart may well have been hypomanic at times but attributeshis depressed periods to physical illness (W. A. Frosch, Book review of p.

J. Davies, Mozart in Person, Musical Quarterlg, % [fggO]: l70-f7g).This is consistent with Slater and Meyer's earlier formulation that, al-though Mozart had his "melancholic side," he was "not liable to severedepressive moods until . . . he was a dying man" (Slater and Meyer, p.l3l). Davies's work brings up very important questions, however, and itwill be interesting to see what develops from future research into thenature and patterns of Mozart's moods and mental states.

64. Nieolson, The health of authors (1947), p. 711.65. rbid.66. Ibid.67. rbid.

NOTES 899

68, rbid,69. S. Foster Damon, William Blake: His Philosophg and Srynbol.s

(New York: Peter Smith, L947), pp. 2O7-208.70. Northrop Frye, Fearful Sgmnwtry: A Studg of William Blake

(Princeton: Princeton University Press, 1969) , p. 12.71. Hubert J. Norman, William Blake, I ournal of M ental S cience, 6l

(1915): 216.72. MaxByrd, Visits to Bedlam: Madness and Literature in the Eigh-

teenth Century (Columbia: University of South Carolina Press, 1974), p.L62.

73. Norman, William Blake (f915), p. 240.74. The relationship between "madness" and visionary, religious,

or mystical states has been the topic of much speculation. William

James, of course, described it beautifully in The Varieties of ReligiousExperience: A Studg in Humnn Nature (Middlesex, England: Penguin,1982; originally published 1902)' Many other writers have described theoverlap between the extreme mood states and such acute religious ex-periences as conversions, mystical experiences, and religious exaltation(for example, H. Maudsley, Natural Causes and Supernatural Seemings

[London; Kegan Paul, 1886]; S. Arieti, Creatirsitg: The Magic Sgnthesis

[New York: Basic Books, 1976]; Sir Alister Hardy, The SpiritualNatureof Man: A StudA of Contemporarg Religious Erperience [Oxford: Clar-

endon Press, 1979]). The speciffc relationship between manic-

depressive illness, the spiritual "dark nights of the soul," and religious

""r-t"ry-", well the possible role of mood disorders in the lives of such

individuals as Martin Luther, George Fox, Sabbatai Sevi, and Emman-

uel Swedenborg-is discussed further in Goodwin and jamison, Manic-

Depressioe lllness (f990), pp' 360-364. More recently, Dr. LawrenceFoiter has explored the link between manic-depressive illness and cre-ativity in unorthodox or new religious movements (the nineteenth-century Shakers, the Mormons, and the Oneida Perfectionists). Thiswork, which includes a detailed description of Joseph Smith's probablemanic-depressive psychosis, is presented in Foster's book Women, Fam-ilg, and ()topin: Com.manal Experiments of the Shokers, the Oneid'aCommunitg, and' The Morm.ons (New York: Syracuse University Press,reer).

75. Psychoanalyst Albert Rothenberg, for example, has been critical

of studies whose ftndings purport to show a relationship between psycho-

pathology and artistic creativity. This is a view at odds with most of the

available historical, biographical, and scientiffe evidence. Some of his

confusion appears to be based on a lack of appreciation for the subtlety,

complexity, and fluctuation in the symptom patterns of manic-depressive

and depressive illness, as well as insufficient awareness of the cyclic orepisodic nature of these disorders.

76. william B. ober, Bosweil's clap and other Essags: Med.icalAnalyses of Literary Men's Affiiction (carbondale: southern Iilinois uni-versity Press, lg79), p. l3B.

77. Quoted in Louise J, Bragman, The case of John Ruskin: A studyin cyclothymia, American lournal of psgchi,atry, Si lt9aS): ll37_1f59.quotation on ll52-I153.

. 78 A. Roe, A psychological study of eminent psychologists and an_thropologists, and a comparison with biorogicar

"na'prrvri"ii scientists,

Psychological Monographs, 6Z (Number 352) (f953).R. B. Cattell and J. E. Drevdahl, A comparison of the person_

ality proffle of eminent researchers with that of eminent 1"""h"., "rrdadministrators, British lournal of psgchology, 44 (ISSS): 24g_261.

J.E. Drevdahl,,l1"!9rr of importance for creativity, Journal ofclinical-Psgchologv, 12 (1956): zL-26;1. E. Drevdahr "nd

n. b. c"ttutt,Personality and creativity in artists ani writers, Journar of crinical psg-chology, la (f958): 107-tll.

D. W. MacKinnon, The nature and nurture of creative talent,American Psychologist, 17 (f962): 4g44g1.D. W. MacKinnon, The personality correlates of creativity: Astudy of American architects, in i. s. Nielsen,

"d. proir"rttn[, oy tlr"F ourteenth International c ongress of Appried p ;a"h"l"e;:idn5"r,*g"r,

Munksgaard, 1962); vol. 2, pp-. tt_ig. ' '

P. G. Cross, R. B. Cattell, and H.^J. Butcher, The personalitypattern of creative artists, British Journar of'Educaniifitiii"i"gv, g7(1967): 29%.29s.F. Barron, CreatiaitE and personal Freed,om (princeton: VanNostand, 1968).F. Barron, Creatitse person and Creatir:e process (New york:

Holt, Rinehart & Winston, lg6g).R. B. cattelr, Abirities and Their structure Growth and Action(Boston: Houghton Miffiin, 1971).R. B. Cattell and H. J. Butcher, The prediction, selection andcultivation of creativity, in H. J. Butcher ur,a O. n. forn*,

"dr, i"oahg,i,n Human lntelligence (London: U"if,".", fg72): pp. 172--lgl,

Lucas and Stringer, Interaction in univeisity selection (IS7Z).D. W. MacKinnon, In Seqrch of Human i6""ttu"iir, 1N"*York; Creative Education Foundation, tgZg).K. O. Gritz and J. K. Gcitz, personality characteristics of suc_cessful artists, perceptual and Motor Sfri,rs, (lg7b;, SfUSea.

-- '

J. Mohan and M. Tiwana, personality and alienation of creative

N0TES 301

writers: A brief report, Personalitg of lnd.ioidual Dffirences, 8 (1g87):Mg.

79. Byron, Bgron's l*tters and Journak, 12 vols., ed. Leslie A.Marchand (London: John Murray, 1973-1982), vol. 8, p. 146.

80. For example, Nicolson, The health of authors (194f; Trilling,The Liberal Imagination; Wittkower and Wittkower, Born Under Saturn;A. Rothenberg, Creativity, mental health, and alcoholism, Creatiaitg Re-search lournal, 3 (f990): L7g*20L.

81. Thomas Carlyle, "Goethe," in Thomas Cadgln: Selncted Writ-dngs, ed. Alan Shelston (London: Penguin, 1971), p. 37.

82. Longinus, "On the Sublime," in Clnssical Li,terory Criticisrn:Aristotle, Hor&ce, andLonginus, trans. T. S. Dorsch. (London: Penguin,1965), p. 101.

83. John Keats, The Letters of lohn Keats, 7814-1821, vol. 2 (letterto Percy Bysshe Shelley, August 16, 1820), ed. Hyder Edward Rollins(Cambridge: Harvard University Press, 1958), p. 323.

84. Samuel Taylor Coleridge, Biographin Literaria, ed. GeorgeWatson (London: Dent, 1975), p. 3.

85. Studies of personality structure in individuals with manic-depressive illness are reviewed in Goodwin and Jamison, Manic-Depres-shse lllness (1990), pp. 281-317. Dr. Robert Hirschfeld and his colleagueshave studied the role of obsessionality in mood disorders; these ffndingsare presented in several articles and papers, including R. M. A. Hirsch-feld, "Personality and bipolar disorder," paper presented at the Sympo-sium on New Results in Depression Research, Munich, March 1985;R. M. A. Hirschfeld and G. L. Klerman, Personality attributes and af-fective disorders, Ameri,can lournal of Psgchiatry, 136 (1979): 67-7A;R. M. A. Hirschfeld, G. L. Klerman, P. J. Clayton, M. B. Keller,P. McDonald Scott, and B. H. Larkin, Assessing personality: Effects ofthe depressive state on trait measurement, Amzrican lournal of Psychi-atry, 140 (1983): 695-699.

It is relevant to note that recent studies have shown an increasedrate of obsessive-compulsive disorders in patients with manic-depressiveand depressive illness as well as in their families: L. N. Robins and D. A.Regier, Psgchiotric Disorders in America (New York: Free Press, 1991);L. Bellodi, G. Sciuto, G. Diaferia, P. Ronchi, and E. Smeraldi, A familyhistory of obsessive-compulsive patien ts, C linical N europharmacolo gg, 75(suppl. l, part B) (f992): 3088; P. Rocca, G. Maina, P. Ferrero, F. Bo-getto, and L. Raizza, Evidence of two subtypes of obsessive-compulsivedisorder, ClinicalNeuropharmncology, 15 (suppl. l, part B) (1992): 315 B.

86. Seamus Heaney, "Robert Lowell: A Memorial Address,"Agenda: Robert Louell Special fssue, 18 (Autumn 1980), p. 26.

308 NO]IS

CHAPTER 4THEIR LIFE A STORM WHEREON THEY RIDE

l. Byron, "Childe Harold's pilgrimage," canto III, verse 44, lines388-396, Lord Bgron: The Complete poeticalWorks, vol. 2, p. g2.

2. Arthur Koestler, The Act of Creation (New york: Dell, IgZf ),pp. 316-317.

3. william Butler Yeats, "A Remonstrance with scotsmen for Hav-ing Soured the Dispositions of Their Ghosts and Faeries." The celticTu:ilight and a selnction of Earlg poems (New york: signet classics,1962), pp. 106-107.

4. Sir Walter Scott, The Journal of Sir Walter Scott, ed.. W. F. K.Anderson (Oxford: Clarendon press,lg72), p. 9.

5. E. J. Lovell (ed.), Lady Blessington's Conoersations of LordByron (Princeton: Princeton University press, lg6g), p. 547.

6. Teresa Guiccioli, "Recollections of Byron, " cited in His verg selfandvoice: collected conoersations of Lord Bgron, ed. Ernest J. Lovell,Jr. (New York: Macmillan, lg54), p. 244.

7. J. P. Guilford, Traits of creativity, in H. H. Anderson, ed.,Creathsity and lts Cultioation (New york: Harper, l95g), pp. 142_16l;f. P. Guilford, A revised structure of intellect, Report of th" iry"hologciLaboratory, University of Southern California, no. lg. 1g67.

8. Frank Barron, The disposition towards originality, lournal ofAbnormal and social psychorogy, 5l (1955): 47g-4gs; t-iu* u.rdrorr,c^onlrlra lmaginations: A psychological stuilg of the English schootboy(Middlesex, England: penguin rgd); see arro tnt. oeilas-and n.-c"i.r,Identiftcation of creativity: The individuar, rry"t orng;;; Builetin,(1970): 55-73; D. M. Harrington, J. Block, and J. H. SIJ"L, pr"li"tirrgcreativity in preadolescenc-e ftom divergent thinking in earry childhood,Journal of Personahtv and social psvchorogg,4s (i9g3): obgazs.

9. Kraepelin, Manic-Depresshse lnsanitg, p. IS.I0. E. Bleuler, fytbgo\of psychiatry, English ed. A. A. Brill (New

York: Macmillan, lg24 [4th Geiman "d.]),

pp. 466, 46g.ll. M. E. Shenton, M. R. Solovay, and p. Holzman, Comparative

studies of thought disorders: II. schizoaffective disorde r, er"wiioycun-eral Psychiatry, 44 (l9g7): 2l-90.

12. M. R. Solovay, M. E. Shenton, and p. Holzman, Comparativestudies _of thought disorders: I. Mania and schizophrenia, ricilo", o1General Psgchiatry, 44 Q98T): lg-20.

13. Andreasen and powers, Creativity and psychosis (fg75), p. 22.14. rbid.15. Ibid.

NOTES 808

16. R. f. Larsen, E. Diener, and R. S. Cropanzano, Cognitive op-erations associated with the characteristic of Intense Emotional Respon-siveness, Journal of Personality ond Socinl Psgcholngy, 53 (f987): 767-774.

17. D. Schuldberg, Schizotypal and hypomanic traits, creativity, andpsychological health, C re otioitg Research J ournal, 3 ( f 9g0) : 218-290.

18. Kraepelin, Manic-Depressioe lnsanitg; G. Murphy, Types ofword-association in dementia praecox, manic-depressiyes, and normalpersons, American Journal of Psgchiatry, Tg (1g23): 5gg-52f .

I9. L. Pons, J. L Nurnberger, fr., and D. L. Murphy, Mood-independent aberrancies in associative processes in bipolar affective dis-order: An apparent stabilizing effect of lithium, Psgchiatry Research, 14(1985): 3L5-A22.

20. E. F. Donnelly, D. L. Murphy, F. K. Goodwin, and I. N.Waldman, Intellectual function in primary afiective disorder, BritishJournal ofPsychiatry, 140 (1982): 633-636.

21. A. M. Isen, K. A. Daubman, and G. P. Nowich, Positive affectfacilitates creative problem solving, Journal of Personal,itg and SocialPsgchologg,52 (f987): 7L2LLL37; T. R. Greene and H. Noice, Influ-ence of positive affect upon creative thinking and problem solving inchildren, Psychological Repor-ts, 63 (1988): 895-898.

22. Jamison, Mood disorders and patterns of creativity, (1989).23. R. Richards and D. K. Kinney, Mood swings and creativity,

C reatioity Research J oumal, 3 ( f 990): 202-217 .24. William Hazlitt, Lectures on the English poets, reprinted in

English RomanticWriters, ed. D. Perkins (San Diego: Harcourt, lg67),p . M L

25. Quoted in W. fackson Bate, Col,eridge (Cambridge: HarvardUniversity Press, 1987), p. 2ll.

26. Carlyle, "Coleridge," Thomas Carl4lz: Selpcted. Writings, pp.315-323.

27. John Keats, The l*tters of lohn Keats, 1814-1821, vol. 2 (letterto the George Keatses, lSlg), ed. Hyder Edward Rollins (Cambridge:Harvard University Press, 1958), pp. 88-89.

28. John Livingstone Lowes, The Road to Xanad,u: A Stud4 ln theWays of the Imngination (1927; reprint, Princeton: Princeton UniversityPress, 1986), pp. 3-4.

29. fohn Ruskin, Mod.ern Painters, ed. David Barrie (New york:Alfred A. Knopf, 1987), p. 248.

30. Olof Lagercrantz, Auguststrindberg, trans. Anselm Hollo (NewYork: Farrar, Straus & Giroux, f985), pp. 272.-273. See also E. W. Ander-son, Strindberg's illness, Psgchological Meilicine, f (197f ): f04-ll7.

31' Michael Meyer, strindberg (New york: Random House. tgg5).p. 331.

32. R.A. Prentky, Creatioitg and psgchopathoLogg: A Neurocogni_thte Perspectiae (New York: Praeger, lg80).

A. J. Rush, M. A. Schlesser, E. Stokely, F. R. Bronte, andK. Z.Altshuller, cerebral blood flow in depression and mania. psychopharmn-cology Bulletin,18 (1982): O-8.

M. E. Phelps, J. C. Mazziota, R. Gerner, L. Baxter, and D. E.Kuhl, Human cerebral glucose metabolism in affective disorders: Drug-free states and pharmacologic effects , J ournal of cerebral Btood Flow aiilMetabolism,3 (Supplement 1) (fg83): 7-8; M. S. Buchsbaum, L. E. DeLisi, H. H. Holcomb, J. Cappelletti, A. C. King, J. tohnson, E. Hazlett,S. Dowling-Zimmerman, R. M. Post, J. Morihisa, W. Carpenter,R. Cohen, D. Pickar, D. R, Weinberger, R. Margolin, and R. M. Kessler,Anteroposterior gradients in cerebral glucose use in schizophreniaand affective disorders, Archioes of ceneral p sy chiatry, 4l ( rgs4i: I rsg-1166.

M. E. Phelps, l. C. Mazziotta, L. Baxter, and R. Gerner,Positron emission tomographic study of afective disorders: problems andstrategies, Annals of Neurology, 15 (Supplement) (fgg4): f4g-f56.

L. R. Baxter, M. E. Phelps, J. C. Mazziotta, J. M. Schwartz,R. H' Gerner, c. E. selin, and R. M. sumida, cerebral metaboric ratesfor glucose in mood disorders: studies with positron emission tomographyand fluorodeoxyglucose F 18, Archiaes of General psgchiatry, +z irsbsj,44t-447.

R. J. Matthew, R. A. Margolin, and R. M. Kessler, Cerebralfunction, blood flow, and metabolism: A new vista in psychiatric research,Integratiae P sgchiatry, 3 ( 1985): Z|4-ZZS,

R. M. Post, L. E. De Lisi, H. H. Holcomb, T. W. Uhde. R.cohen, and M. s. Buchsbaum, Glucose utilization in the temporal cortexof affectively ill patients: Positron emission tomography , Blitoglcal psg-chiatry, 22 (L987): 545-553.

J. M. Schwartz, L. R. Baxter, l. C. Mazziota, R. H. Gerner. andM. E. Phelps, The differential diagnosis of depression: Relevance ofpositron emission tomography studies of cerebral glucose metabolism tothe bipolar-unipolar dichotomy, Journal of the American Medical Asso-ciation, 258 (1987): f368-1374.

E. A. Van Royen, J. F. de Brufne; T. C. Hill, A. Vyth, M.Limburg, B. L. Byse, D, H. O'Leary, I.M. de Jong, A. Hijdra, J. B.van der Schoot, cerebral blood flow imaging with thallium-20l dieth-yldithiocarbamate SPECT, lournal of Nuclear Medicine, 2g (fgg7):178-183.

NCTTES 305

H. A. Sackeim and B. L. Steifi Neuropsychology of depressionand mania, in A Georgotas and R. Cancro eds., Depression ani Mania(New York: Elsevier, 1988).

N. C. Andreasen, Brain Imaging: Applicati,ons in psgchiatry(Washington, D.C.: American Psychiatric Association press, I98g).

R. M. Cohen, W. E. Semple, M. Gross, T. E, Nordahl, A. C.King, D. Pickar, and R. M. Post, Evidence for cpmmon alterations incerebral glucose metabolisms in major affective disorders and schizophre-nia, N europsychopharmacologg, 2 ( 1989): 24I-254.

R. M. Dupont, T.L. Jernigan, J. C. Gillan, N. Butlers, D. C.Delis, and J. R. Hesselink, Subcortical signal hyperintensities in bipolarpatients detected by MRI, Psgchiatry Research,2l (f987): 357-358.

P. Silverskirild and J. Risberg, Regional blood fow in depressionand mania, Archioes of GeneralPsychiatry,46 (1989): 253-259.

L. Baxter, J. M. Schwartz, M. E. Phelps, J. C. Mazziotta, B. H.Guze, C. E. Selin, R. H. Gerner, and R. M. Sumida, Reduction ofprefrontal cortex glucose metabolism common to three types of depres-sion, Archioes of Ceneral Psgchiatry, 46 (f989): 243-250.

S. P. Springer and G. Deutsch, Left Brain, Right Brain, Srd ed.(New York: W. H. Freeman, 1989).

R. M. Dupont, T. L. Jernigan, N. Butters, D. Delis, j. R.Hesselink, W. Heindel, and J. C. Gillin, Subcortical abnormalities de-tected in bipolar affective disorder using magnetic resonance imaging:Clinical and neuropsychological significance, Archioes of General Psgchi-atry,47 (1990): 55-59.

Goodwin and Jamison, Manic-Depressipe lllness, pp. 247-280and pp. 503*540.

H. A. Sackeim, I. Prohovnik, J. R. Moeller, R. P. Brown,S. Apter, J. Prudic, D. P. Devanand, and S. Mukhedee, Regional cere-bral blood flow in mood disorders: I. Comparison of major depressivesand normal controls at rest, Architses of Ceneral Psgchiatry, a7 (fgg0):60-70.

L. L. Altshuler, A. Conrad, P. Hauser, X. Li, B. H. Guze,K. Denikoff, W. Tourtellotte, and R. Post. Reduction of temporal lobevolume in bipolar disorder: A preliminary report of magnetic resonanceimaging. Archiaes of Ceneral P sychiatry, 48 ( f 991): 482-483.

T. J. Crow. The origins of psychosis and "The Descent of Man,"British Journal of Psgchiatry, 759 (Supplement f4) (f991): 76-A2.

T. Hines, The myth of right hemisphere creativity, lournal ofCreatioe Behaoior, 25 (I99f ): 223-227.

G. A. Ojemann, Cortical organization of language, Journal ofNeuroscience, ll (1991):228I-2287; M. Niaz and G. S. Denunez. The

306 NSTDS

relationship of mobility-ffxity to creativity, formal reasoning and intel-ligence, loumal of Creathse Beharsior,25 (f 9gl); Z0S-217.

M. E. Raichle,J. Fiez, T. O. Videen, p. T. Fox, J. V. pardo, ands' E. Petersen, Practice-related changes in human brain functional anat-omy, Socictg for Neuroscience Abstracts, vol. 17, pt. I (Washington,D.C.: Society fbr Neuroscience, lggl), p. 21.

L. Squire, J. Ojemann, F. Miezin, S. petersen, T. Videen, andM. Raichle, A functional anatomical study of human memory, socicty forNeuroscience Abstracts, vol. 17, pt. l, (1991) , p. 4.

33. Most neuropsychological studies of manic-depressive illnesshave focused on deficits in the performance of cognitive tasks. It is not yetunderstood how differences in cognitive processing between normal andaffectively ill individuals might translate, if at all, into possible cognitiveadvantage (either from compensatory mechanisms or Ly altogether dif-ferent pathways). Neuropsychological ftndings from studies Jf patientswith afiective illness are extensively reviewed in Goodwin and J^amison,M,anic-Depressioe lllness (tggO), pp. 268-27g. See also p. Flor-Henry,The cerebral Basis of psychopathoLogy (Boston: John wright, lggi);P. Flor-He-nry and J. Gruzelier, Laterality anil piychopathltogy (Lm_sterdamr Elsevier, 1983); J. Gruzelier, K. Seymour, L. Wilson, A. Jolley,and s.- Hirlclr, Impairments on neuropsychiatric tests of tempo.oirippo-campal-and frontohippocampal functions and word fluency in remittingschizophrenia and asective disorders , Archioes of General psychiatry, 4s(f988): 623-629; H. A. Sackeim and B. L. St;if, Ne,rropJy"hology ofdepression and mania, in Depression and Mania, eds. A. Cuorgoi", *rraR, Cancro (New York: Elsevier, lg88), pp. 265_2g9.

Neuropsychological studies of patients with affective illness showa surpri-sing degree of consistency in their ftndings. patients with depres-sive and manic-depressive illness, as a group, typically demonstrate def-icits in right hemisphere or nondominant hemisphere functioning, longassociated with problems in perception, spatial relations, integraiion ofholistic ffgures, and complex nonverbal tasks (K. walsh,'Neuipsychol-9qA,,! Cliniral Approach, 2nd ed. [Edinburgh: Churchill Livingstone,1987])' Fragmented thinking and a general i"ability to integrate th-oughtsor relate elements in a complex pattern are also associat-ed with rightcortical damage (E. K. Daniels, M. E. Shenton, p.S. Holzman, L. I.Benowitz, s. Levine, and D. Levine, patterns of thought disorder asso-ciated with right cortical damage, schizophrenia, and Lan ia, AmpricanIguryal of Psychiatry, r45 lrggs]: s++-ws). This is counterintuitive tothe high rates of affective illness found in writers, but the speciffcity toright hemispheric impairment is most eonsistent and prorro,*""d i' d"-pressed rather than manic patients (sackeim and steil Neuropsychology

NOTES 3O7

of depression and mania [198S]). Cognitive functioning improves aftereffective treatment (such as electroconvulsive therapy or antidepressants)and during remission (R. D. Staton, H. Wilson, and R. A, Brumback,Cognitive improvement associated with tricyclic antidepressant treatmentof childhood major depressive illness, Perceptual qnd Motor Skirrs, 59[f981jr L2I9-234; D. Fromm-Auch, Comparison of unilateral and bilat-eral ECT; Evidence for selective memory impairment, Britishtournal ofPsychiatrg,l4l If982]:608-613; D. Fromm and D. Schopflocher, Neuro-psychological test performance in depressed patients before and afterdrug therapy, Biological Psychiatry,19 [f 984]: 55-72).It should be notedthat hypomanic and manic patients are notoriously difficult to test, andthat virtually all neuropsychological assessment to date has been carriedout with the goal of determining the negative e0lbcts of psychopathologyon cognitive functioning. It can be hoped that, in the future, neuro-imaging techniques will allow a far more subtle and imaginative under-standing of brain functioning-enhanced, diminished, or both--duringdepressed, manic, and normal states.

The extent to which hemispheric difierences are state or traitdependent, primary or derivative, relatively more pronounced in depres-sive or manic-depressive illness, remains unclear. Children, for example,who have one parent with manic-depressive illness, and are therefore atan increased risk for developing the illness show significant discrepanciesbetween their verbal and performance scores on intelligence tests (C. J.Kestenbaum, Children at risk for manic-depressive illness: Possible pre-dictors, American lournal of Psychiatry, 136 [1979]: 1206-1208;P. Decina, C. J. Kestenbaum, S. Farber, L. Kron, M. Gargan, H. A. Sack-eim, and R. R. Fieve, Clinical and psychological assessment of children ofbipolar probands, Amzrican Journal of Psgchiatry, faO [f9$]: 548-553).This discrepancy, reflected in verbal scores that are significantly higherthan performance scores, is also found in depressed children (R. A. Brum-back, Wechsler performance IQ deficit in depressed children, Perceptualand Motor Skills, 61[1985]: 331-335) and is consistent with an extensivepsychometric literature that demonstrates a similar pattern associatedwith right hemisphere damage caused by localized lesions (R. M. Reitan,Certain differential effects of left and right cerebral lesions in humanadults, lournal of Comparatioe and Phgsiological Psychologg, 48 [f955]:474477; H. Lansdell, Laterality of verbal intelligence in the brain, Scf-ence, I35 [f962]: 922-923; C. B. Blackenmore, G. Ettlinger, and M. A.Falconer, Cognitive abilities in relation to frequency of seizures and neu-ropathology of the temporal lobes in man, lournal of NeurologE, Neuro-surgerU, and Psychiatry, 29 [1966]; 268-272; P. Satz, Specific andnonspecific effects of brain lesions in man, J ournal of Abnormal Psychol-

308 NO|TES

ogA,77 [1966]: 65-70; P. Satz, W. Richard, and A. Daniels, The alterationof intellectual performance after lateralized brain-injury in man, psy-chonornic Science, T [f967]: 369-370; S. F. Zimmerman, J. W. Whit-myre, and F. F. J. Fieldo, Factor analytic structure of the wechsler AdultIntelligence Scale in patients with diffuse and lateralized cerebral dys-function, Journal of Clinical Psgchology,26 [f970]: 462=468; J. D. Mat-arazzo, wechslnt's Measuremcnt and Appraisal of Ailutt lntelligence, sthed. [Baltimore: Williams & Wilkins, 1972]).

34. Ruskin, Mod.em painters, p. 252.35. Arthur Rimbaud, Rimbaud: complete works, ser.ected r,etters,

(letter to Paul Demeny, 15 May l87I), trans. and ed. wallace Fowlie(Chicago: University of Chicago press, lg66), p. 307.

36. Keats, Letters, vol. I (letter to J. A. Hessey, October g, Iglg).p . 3 7 4 .

- 37. A. Roe, A psychological study of eminent biologists, psycholog_ical Monographs: Ceneral and Applied, 65 (331) (l95l).

A. Roe, A psychological study of eminent psychologists and an_thropologists, and a comparison with biologicar ani physiJl scientists.Psychological Monograplw: Ceneral and ,+pphed, 67 igSZ) (f953).

cattell and Drevdahl, A comparison of the personarity profire,(re55).

R. B. cattell, The personarity and motivation of the researcherfrom measurements of contemporaries and from biograpt y, in C. WTaylor and F' Barron (eds.), scientffic creatiaitg: Iti Recognition andDerselopment (New York: Wiley, lgO-S): pp. llg_l3l

J. A. Chamberc psgchological Monographs: General and Ap_plted,ze (58a) (196a;.

Banon, Creatir>itg and personal Freedom..Banon, Creathte person and Creatioe process.Cattell, AbiLities and Their Structure.MacKinnon, In Search of Human Effecthseness.

_ 38. John Berryman, writers at work: The paris Retsiew rntensieus,ed. George Plimpton 4th series. (New york: Viking press, 1976) , p. 822.

39. Roethke, "In a Dark Time," rines 7-r2, The coilected piems ofTheodore Roethke, p. 231.

_ 40. Percy Bysshe Shelley, "Julian and Maddalo,,, Shelleg: SelectedPaetry, Prose and r.etters, ed' A. s. B. Glover (London: Nones"uch press,l95l), p. 641.

41. Keats, Letters, vol. 2 (letter to the George Keatses, April 21,l8l9), p. 102.

42. Koestler, The Act of Creation, p. 35g.

NOTES

43. George Edward Woodberry, quoted in M. Wilhnson, TheWayof the Makers (New York: Macmillan, 1925), p. 13.

44. Edgar Allan Poe,"Eleanora," The Fall of the House of IJsher and,Other Writings, ed. David Galloway (London: Penguin, fg86), p. 2aS.

45. Vincent van Gogh, The CornpLete Letters of Vincent oan Gogh(letter 514) (Boston: New York Graphic Society, 1958) vol, 2, p. 620.

46. L. G. Sexton and L. Ames, eds., Anne Sexton: A Self-Portrait inIntters (Bostonr Houghton Miffiin, f977), p. 105.

47. Lowell, "A Conversation with Ian Hamilton." Collected Prose.p. 286.

48 . Ib id . , p .287.49. Lowell, "Home," lines 4546, Dag bg Dag, p. 114.50. Virginia Woolf, The Diary of VirginiaWoolf,5 vols., ed. Anne

Olivier Bell and Andrew McNeille (New York: Harcourt, 1976-1984),vol. 3, p. 112.

51. Myerson and Boyle, The incidence of manic-depressive psycho-sis, p. 20.

Dr. Philip Sandblom has emphasized the role of both psycho-logical and physical suffering in the creative process and has described theefiect of medical illness and mental anguish on the work of many greatartists, writers, and composers. Philip Sandblom, Creatiaity and Disease:Hou lllness Affects Literature, Art and Musdc (Philadelphia: Lippincott,rese).

52. S. E. Taylor and J. D. Brown, lllusion and well-being: A socialpsychological perspective on mental health, Psycholngical Bulletln, lO3(f988): 193-210; H. A. Sackheim, Self-deception, self-esteem, and de-pression: The adaptive value of lying to oneself, in Empirical Studies ofPsgchoanalgtic Theories, ed. J. Masling (Hillsdale, N.J.r Analytic Press,1983), vol. l, pp. l0I-157.

53. T. S. Eliot, Murdnr in the Cathedral (San Diego: Harvest/HBJ,1935), part 2, p. 69.

54. John Freccero, Dante: The Poetics of Contsersion, ed. RachelJacoff (Cambridge: Harvard University Press, 1986), p. 70,

55. Herman Melville, Pierce: Or, The Ambiguities (New York: Sig-net Classic,1964), p. 114.

56. John Keats, "Why Did I Laugh Tonight?" lines 1-14, The Corn-pl.ete Poetical Works and l*tters of John Keats (Boston and New York:Houghton Miflin, f899), p. f37.

57. Edward Thomas, "Melancholy," lines 7-8, The Collected Poemsof Edtaard Thomns, ed. R. George Thomas (Oxford: Odord UniversityPress, 1978), p. 193.

309

310

58. Thomas, "Liberty, " lines fu1-27, The C ollected p oems of E dward,Thomas, p.255.

59. Poe, "Romance," in The FaII of the House of tJsher and OtherWritings, p. 521.

60. Alfred, Lord Tennyson, In Memoriam, sectionSg, lines l_g, ThePoeticalworks of Alfred, Lord Tennyson (New yorkr croweil, Iggz), p.496.

61. Leon Edel, The madness of art, American J ournal of psgchiatry ,f32 (f975): 1005-1012, quote on p. 1008.

62. rbid.63. Randall Jarrell, "90 North," Randnll !a,ell: The Complete po-

enrs, lines 29-33 (New York: Farrar, Straus & Giroux, 196g), pp. ll3_l14.

64. Antonin Artaud, "Van Gogh, the Man suicided by Society(1947),"' Antonin Artaud: selectedwritings, ed. susan sontag (n"rk"l"yand Los Angeles: University of California press, fgg8), p. ag?,

65. Anthony Storr, The Dgnamics of Creation (London: Secker &Warburg, 1972).

66. Edel, The madness of art (fgZS), p. 1010.67. Sexton and Ames, Anne Sexton, p. 33S.68. Diane Wood Middlebrook, Anne Serton: A Biography (Boston:

Houghton Miflin, 1991).

_ 69. Cowper, The lntters and prose Writings of Wtlllam Cowper,ygl. 2, 1782-1786 (letter to Ladv Hesketh, octobJr ri, tzssi (tssr),'pp.382-383.

70. Hector Berlioz, letter to his father, February 13, 1g30, quoted inDavid cairns, Berlioz, a-o,l. .r, The Making of an Artilst (r'a0,3-r'si2) (t or,-don: Andr6 Deutsch, f989), p. 330.

7L. BL] ' vol. 3 (letter to Annabeila Milbanke, November zg, l8l3),p. 179.

72. 'f . S. Eliot, SelectedEssays (London: Faber and Faber, lg50), p.2r.- 73. John Donne, "The Triple Fool," The Complete poetry and Se_Iected Prose of John Donne ord rht complete roeiry oy itttioi ntot u(New York: Random House, lg4l).

74. Tennyson, ln Mem,oriam, section 5, lines 5_12, p. 4gl.75. Lowell' "Near the Unbalanced Aquarium," corlected.prose, p,

362.76. Lowell, "Unwanted," lines ll6-1f7, Dag bg Dag, p. Lful.77. Graham Greene, Ways of Escape (New york: Simon and

Schuster, 1980), p. 285.

NCITDS 311

78. Dante, The Corwdy of Dante Alighieri: Cantica l: HeIl (L'In-femo), canto ?4, lines 50-51, p. 22L.

79. Byron, "Childe Harold's Pilgrimage" canto III, verse 6, lines46-il, Lard Byron: The Conplcte PoeticalWorks, p.78.

80. Edel, The madness of art, p. 1012.81. Nathaniel Hawthorne, The House of the Seoen Gables (Toronto:

Bantam Books, 1981), p. 235.82. These lines from Paul Celan were used to close Israel Chalfen's

recent biography, Paul Celan: A Biographg of Hi"s Youth, trans. Maxi-milian Bleyleben (New York: Persea Books, lggl), p. 192.

83. Lowell, "Ten Minutes," lines 13-14, Dog bE Day, p. L08.84. George Gordon, Lord Byron, Don Juan, ed. T. G. Steffan,

E. Steffan, and W. W. Pratt (London: Penguin Books, 1982), notes tocanto XVI, verse 97, p.752.

85. Byron, Don tuan, canto XVI, verse 97, lines 817-824 in LordBEron: The Complete PoeticalWorks, p. &9.

Danish writer Hans Christian Andersen, who suffered from re-current depressions as had his father and grandfather before him (thelatter became insane), described the mobilitO of the artistic temperamentas well. "I am like water," he wrote to a friend. "Everything moves me,I suppose it is part of my poetic nature, and it often brings me joy andhappiness, but very often it is also a torment." (Quoted in E. Bredsdorff,Hans Christian And.ersen: The Story of His Life and,Work,1805-75 [NewYorkr Charles Scribner's Sons, 1975], p. 287,)

86. Richard Holmes, Coleridge: Early Visions (New York: Viking,1989), p, 132.

87. Virginia Woolf, The l*tters of Virginia Woolf, 6 vols. , ed. NigelNicplson and Joanne Trautmann (New York: Harcourt, lg7$-1980), vol.5, p. 209.

88. Keats, lntters, vol. I (letter to Richard Woodhouse, October 27,1818), p. 387.

89. Percy Bysshe Shelley, The Cornplete Works of Percg ByssheShelley,l0 vols., ed. Roger Ingpen (New York: Gordian Press, 1965), vol.l, p. 283.

90. Robert l,ouis Stevenson, Dr. JekgllanilMr. Hgdn, introductionby Vladimir Nabokov (1886; reprint, New York: Signet Classic, f9S0), pp.104-105.

91. Jerome J. McGann, Ficry Dust: Byron's Poetic Deoelopment(Chieago: University of Chicago Press, 1968), p. 65.

92. N. J. C. Andreasen and B. Pfohl, Linguistic analysis of speech inaffective disorders, Archhtes of GeneralPsgchiatry, 33 (f976): f36l-f367.

93. J. Zimmerman and L. Garftnkle, Preliminary study of the art pro-

ductions of the adult psychotic, psychiatric euar-terlg, 16 (1g42): 3lg-glg.F. Reitman, Psychotic Art (london: Routledge & Kegal paul,

reso).E. C. Dax, Experfuwntal Studies ln psgchotic Art (London:

Faber and Faber, 1953).c. Enachescu, Aspects of pictorial creation in manic-depressive

psychosis, Confinin Psychiatrica, 14 (fg7l): lgg-L4l.H. S. Wadeson and W. T. Carpeuter, Jr., A comparative study

of art expression of schizophrenic, unipolar depressive, and Lipolar manic-depressive patients, Joumal of Nercous ond Mental Disease,162 (rg76)r334-344.

94. Robert Schumann. [Letter to Simonin de Sire, February g,18381.

95. William Blake, "Auguries oflnnocence," lines 59*62, The Corn-plete Poetry and selected prose of John Donne and the complete poetryof William Blake, p. 598.

96. Quoted in Justin Kaplan, Mr. Clenwns and Mark Twain: ABiography (New York: Touchstone, lg66), p. 123.

97. Ibid., p. L24.98. rbid.99. virginia woolfi A Room of one's oran (New york: Harcourt

Brace Jovanovich, lg57).

^ _ 100- Among the many writers who have emphasized the importanceofthe reconciliation ofopposite states in the creative process

"r" Arirto-

tle, "on the Art of Poetry," classical Literary criticlsm, trans. T. S.Dorsch (London: Penguin, lg65).

_ Percy Bysshe Shelley, "A Defence of poetry,', Shell.eg,s CriticalProse, ed. B. R. McElderry, !r.(1821; reprint, Lincoln: University ofNebraska Press, lg67)

Maurice Bowra, The Rornnntic lmnginatian (Cambridge: Har-vard University Press, Ig50).

Barron, Creatioe person and Creathte process.Guilford, Traits of creativity.Storr, The Dgnamics of Creation.Koestler, The Act of CreationAlbert Rothenberg, The Emerging Coddzss (Chicago: Univer_

sity of Chicago Press, 1g7g).John Carey, lohn Donne: Life, Mind and Art (London: Faber

and Faber, -1981)' John carey's book contains an especially eloquentdiscussion of John Donne's use of opposite images and emotional states.

Karl Miller, Doubles: Studies in Literary History (Oxford: Ox-ford University Press, lg85).

101. Thomas Moore, The works of Lord Byron: with His Letters

NOTES

and lournals and His Lift, ed. Richard Henry Stoddard (1832; reprint,London; Francis A. Nicholls, 1900), vol. 16, p. 237.

102. Ruskin, Modern Painters, p. 250.103. W. Mayer-Gross, E. Slater, and M. Roth, Clinical Psgchiatry

(Baltimore: Williams & Wilkins, 1955), p. 211.104. T. A. Wehr and F. K. Goodwin, Introduction, in T. A. Wehr

and F. K. Goodwin, eds., Circadian Rhgthm.s in Prychiatry (PaciffcGrove: Boxwood Press, 1983), p. 5.

105. Quoted in Whitwell, Historical Notes on Psgchiatry, p. 757.106. Quoted in Roccatagliata, A History of Ancient Psychi,atry, p.

143.107. D. B. Weiner, Phillipe Pinel's "Memoir on Madness" of De-

cember L7, 1794: A fundamental text of modern psychiatry, AmericanJournal of Psychiatry, f49 (f992):725-732.

108. Kraepelin, Manic-Depressioe lnsanity, p. 139.109. There are many sources of possible error in the collection of

seasonality data. For example, hospital admission dates, although likely tobe meaningful markers for the onset of manic episodes, are unlikely torefect the true onset of depressive episodes. In fact, hospitalizations fordepression are more likely to reflect severity or lethality of illness thantime of onset. Clearly, however, the seasonality of maximal severity ismeaningful in its own right. Voluntary admissions and hospital schedules(rotation ofphysician staffor holidays) also may affect reported seasonalpatterns. Despite these methodological problems, the consistency of ftnd-ings in the seasonality studies of both affective episodes and suicide isimpressive. It gains further weight from the fact that virtually all thestudies were carried out after the widespread use of lithium had begun,which may have dampened the natural pattern of seasonal variability. Dr.Trevor Silverstone has noted:

It appears as if in more temperate climes, such as in the United Kingdom,Ireland and New Zealand . . , or where there is little seasonal variation intemperature, as in Hawaii the peak of manic admissions occurs insummer. In places with greater temperature swings, such as Hungary . . . ,Yugoslavia. . ., Greece. . ., andAustralia. . ., thepeakoccursin spring.These difierences are unlikely to be due simply to differences in latitude, asin Ontario, which spans the latitudes of much of Europe, no seasonal varia-tion was seen in admission rates for mania. . . . It is not known whether it isday length, the rate of temperature change, the amount of sunlight, airionization, or relative humidity which is the critical variable in determiningseasonal variation.

From T. Silverstone, Mania, Biological Aspects of Affectir:e Disordzrs,ed. R. Horton and C. Katona (London: Academic Press, lggl), pp. 27J-274.

313

The studies reviewed for ffgure 4-l (seasonal variations inPeak occurrences of Nlania and Depression) included s. H. K.aines,Mental Depressions and Their Treatmnnt (New york: Macmillan, lg57).

J. Angst, P. Grof, H. Hippius, W. pitldinger, and p. Weis, Lapsychose maniaco-d6pressive est-elle p6riodique ou intermittente? in cy-cles Biolngiques et Psgchiatrie, ed. J. de Ajuriaguerra (Geneva; George &Cie, SA" f968), pp. 33r35r.

C. Perris, A study of cycloid psychoses, Acta psychiatrica Scan_dinaoica (suppl. 2$) (f974): r-75.

W. W. K. Zung and R. L. Green, Seasonal variation of suicideand depression, Archhses of General psychiatrE,30 (fg74): gg_gf.

M. R. Eastwood and J. peacocke, Seasonal patterns of suicide,depression and electroconvulsive therapy, British !oirnat of psychiatryi,I29 (1976): 472-475.

V. Milstein, J. G. Small, D. Shelbourne, and I. F. Small,Manic depressive illness: onset, diurnal temperature and season of birth,Diseoses of the Neroous Sgstem, J7 (1g76): TTS-3T5.

R. L. Symonds and p. Williams, Seasonal variation in the in_cidence of mania, British Journal of psychiatry, f2g (f976): 454g.

V. Sedivec, [Etrect of seasons of year on the development ofpathological mood phases of affective melanchorial, ceskoslooeiska rsy-chiatrie, 7 2 (7976): 98-103.

S. D. Walter, Seasonality of mania: A reappraisal, British jour_nal of Psychiatry, t}t (1977): 345-950.

M. R. Eastwood and S. Stiasny, psychiatric disorder, hospitaladmission' and season, Archirses of General isgchiatry, s5 (rszs): zos-771.

D. H. Myers and P. Davies, The seasonal incidence of maniaand its relationship to climatic variables, psgchological Medicine,g (lg7g):433440.

E. Frangos, G. Athanassenas, S. Tsitourides, p. psiloliignos, A.Robos, N. Katsanou, and c. Bulgaris, seasonality of ihe episodJ, or r"-clrre-1t affective psychoses: Possible prophylactic intervention s, lournalof Affectioe Disorders,2 (f980): ZSg-247.

P. A. Carney, C. T. Fitzgerald, and C. E. Monaghan, Influenceof climate on the prevalence of mania, British lournar of psychiatry, ls}(1988): 820-823.

110. E' Takahashi, seasonal variation ofconception and suicide, To-hoku Journal of Experimental Medicine, 84 (f9&t): ZIS-ZZ7; G. parkerand s. walter, Seasonal variation in depressive disorders and suicidaldeaths in New south wales, British lournal of psychiatry, raO (Igg2):62M32.

NOIES

llf. A. J. Leor.y, T. A. Wehr, F. K. Goodwin, D. A. Newsome, andN. E. Rosenthal, Manic-depressive patients may be supersensitive tolight, Lancel, I (1981):383-384; A. J. Lewy, J. L Nurnberger, Jr., T. A.Wehr, D. Pack, L. E. Becker, R. Powell, and D. A. Newsome, Super-sensitivity to light: Possible trait marker for manic-depressive illness,American lournal of Psgchiatrg, fa2 (1985): 725-727, Some researchershave found the opposite pattern in seasonal affective illness, that is, sub-sensitivity to light: C. Reme, M. Terman, and A. Wirz-Justice, Are defi-cient retinal photoreceptor renewal mechanisms involved in thepathogenesis of winter depression? Archioes of Ceneral Psgchiatry, 47(f990):878-879; R. W. Lam, C. W. Beattie, A. Buchanan, R. A. Remick,and A. P. Zis, Low electrooculographic ratios in patients with seasonal af-fective disorder, American Journal of Psgchtatry, 148 (199f ): 1526-1529.

Interestingly, there is evidence that lithium reduces sensitivityto light in patients with manic-depressive illness: P. A. Carney, J. Seggie,M. Vojtechovsky, J. Parker, E. Grol and P. Grof, Bipolar patients takinglithium have increased dark adaptation threshold compared with controls,Pharm,acopsychtatry, 21 (1988): 117-120; J. Seggie, P. A. Carney,J. Parker, E. Grof, and P. Grof, Effect of chronic lithium on sensitivity tolight in male and female bipolar patients, Progress in Neuro-Psgchopharmacology and Biological Psgchiatry, f3 (f989): 5$-549.

112. J. L Nurnberger, Jr., W. Berrettini, L. Tamarkin, J. Hamovit,J. Norton, and E. S. Gershon, Supersensitivity to melatonin suppressionby light in young people at high risk for affective disorder: A preliminaryreport, N europsy chopharmncology, f ( f 988) : 2I7 -223.

It3. S. Kasper, T. A. Wehr, J. J. Bartko, P. A. Gaist, and N. E.Rosenthal, Epidemiological findings of seasonal changes in mood andbehavior, Archioes of General Psychiatry,46 (1989): 823-833.

ll4. M. R. Eastwood, J. L. Whitton, P. M. Kramer, and A. M.Peter, Infradian rhythms: A comparison of affective disorders and normalpersons, Archiaes of General Psgchiatry,42 (1985): 295-299.

ll5. These are reviewed in the pathophysiology chapters of Good-win and Jamison, Manic-Depressiae lllness.

I16. D. Kimura and C. Toussaint, Sex differences in cognitive func-tion vary with the season, Societg for Neuroscience Abstacts, vol. 17, partI (Washington, D.C.: Society for Neuroscience, 1991), p. 868. Manyneurobiological systems of relevance to mood disorders show pronouncedseasonal patterns; these include thyroid functioning, central nervous sys-tem transmitters, metabolism, and sleep and temperature regulators.A. Wirz-Justice, W. Piihringer, G. Hole, and R. Menzi, Monoamine ox-idase and free tryptophan in human plasma: Normal variations and theirimplications for biochemical research in affective disorders, Pharmakopsg-

315

chiatrNeuropsychopharmnkol, g (197b):310_317; A. G. H. Smals, H. A.Ross, and P. w. Kloppenborg, seasonal variation in serum TB and T4leversin man, I ournal of clinical Endocrinologg and Metabolism,aa ( 1g77): ggg-1001; G. H. Mclellan, W. J. Riley, and C. p. Davies, Season variation inserum-thyroxine, Lancet, i (lgz9):883-gg4; A. wirz-Justice and R. Rich-ter, Seasonality in biochemical determinations: A source of variance and a9lu9 t9 the temporal incidence of affective illness, psychiatry Research, L(1979): 53-60; A. Wirz-Justice, G. A. Groos, and T."A. W"t., The neu-ropharmacology of circadian time-keeping in mammals, inver-tebrqte cir-cadian Systems: Structure andphgsiologV, ed.J. Aschofl S. Daan, and G.A. Groos (Berlin: Springer-Verlag, lgg2).

117. N, E. Rosenthal, D. A. Sack, J. C. Gillin, A. J, Lewy, F. K.Goodwin, Y. Davenport, p. S. Mueller, D. A, Newso*", urrd t. e.wehr, Seasonal affective disorder: A description of the syndrome andqi"liTi"iw ffndings with light therapy, Arciioes of Generar psychiatry,4l (1984): 72-80.

ll8. Delmore Schwartz, "The Deceptive present, The phoenixYear," lines I-Ig, selected poems (rgsg-].gss): sunancr Knowledge,p . 2 I 2 .

119. T. S. Eliot, "Little Gidding,', lines 4_14, Four euartetr (Lon-don: Faber and Faber, fg44), p. 41.

120. Lombroso, L'Hommc d,e G6nie; C. l,ombroso, pensiero e me-teore, Biblioteca sci,entifica internazionare, vor. 16 (Dumolard, Miran,1872).

l2l. Jamison, Mood disorders and patterns of creativitv (Iggg).

_. _ L?2. Quoted i" J._y. and A. Tibble, lohn Ctnre: A Uf; (Toiowa,N.J.: Rowman and Littleffeld, lg72), p. 16g.

-I23. -K. R. Jamison and R. J. Wyatt, Van Gogh: M6nidre,s Disease?lgilgpsrt Psychosis? Joumal of the American Midtcal Associatiotn, z6s(r99r): 723-724.

I24. M. E. Tralbaut, Vincent oan Gogh (New york: Viking press,1969); Jan Hulsker, Vincent andTheo oan Gogh: A Dual Blograp'hg (nnnArbor, Mich.: Fuller Publications, lgg0).

1j5. V1n Gogh's physician in Arles, Dr. Urpar, cliagnosed van Goghas suffering from "acute mania with generalized delirium;'(Tralbaut, vin-cent oan cogh), and recorded that he "was affected by a severe nervousattack, _accompanied by complete mania and general d"ra.rge*errt" (Hul_sker, Vincent and Theo Van Gogh, p. 3S2); it was Dr. peyron, in hisadmitting note of May 188g, who mentioned epilepsy as well. Van Gogh,he concluded, had been-"affected by a severe nervous attack, accompa-nied by hallucinations ofsight and hearing," and *a, "srrbj""i to attacksof epilepsy, far distanced from each other;' (ibid. ).

NOTLS

126. The diagnosis of M6nidre's disease (a peripheral vestibular dis-order) was proposed by Dr. Arenberg and his colleagues in 1990 (I. K.Arenberg, L. F. Countryman, L. H. Bernstein, and G. E. Shambaugh,lournal of the American Medical Association,264 (f990): 491-493. Sharprebuttals appeared several months later in the Letters to the Editor sec-tion of tbe Journal of the American Med.ical Association. Dr. Wyatt andI (Jamison and Wyatt, Van Gogh: M6nidre's Disease? [1991])were amongmany others who disputed the validity of a diagnosis of a disease of theinner ear. The lack of substantiating symptoms for M6nibre's disease wasbrought up by several authors. We argued that it was difficult to fathomfocusing so exclusively on a few, ill-deftned somatic complaints when thepreponderance of van Gogh's symptomatology was psychiatric in nature.Clearly psychosis, violence, institutionalization in an insane asylum forover a year, and suicide are extremely unlikely to be the result of M6-nidre's disease alone. The letter cited by the authors as evidence that vanGogh suffered a hearing loss in fact contained no evidence for that at all.Indeed, van Gogh described in that letter, as well as others, an increasedsensory sensitivity-hyperacusis-which is a common symptom in manic-depressive illness. Van Gogh also described visual as well as auditorychanges in the same letter. The evidence for a diagnosis of manic-depressive illness, or, conceivably, manic-depressive illness and complexpartial seizures, is, on the other hand, compelling.

In the same Letters to the Bditor section of the journal (Journalof the Amarican Medical Association,26S [ 1991]: 723), Dr. Richard Kuninoutlined an argument that van Gogh might have suffered instead fromacute intermittent porphyria, a genetic disease characterized by gas-trointestinal, neurological, and psychiatric symptoms. Slightly less than ayear later Drs. Loftus and Arnold wrote an article in the British MedicalJournal also arguing for a diagnosis of porphyria (L. Loftus and W. Ar-nold, Vincent van Goghr acute intermittent porphyna? Britlsh Medical

J ournal, 3ffi [f99f ]: I589-f59f ).Dr. Wyatt and I wrote another letter, this time to the editor of

the British Medical lournal (3O [1992]: 577), again arguing for a diag-nosis of manic-depressive illness. We felt there were several reasons whythe latter diagnosis was far more probable than porphyria (although por-phyria is certainly a more plausible diagnosis than M6nidre's disease).First, although there is marked variability in the psychiatric symptoma-tology of porphyria (T. N. Cross, Porphyria-a deceptive syndrome,American lournal of Psychiatry, lI2 [f956]r l0t0-10l4), manic-depressive illness is one of the most clearly and reliably diagnosed ofpsychiatric disorders. Of ten cases of porphyria admitted to BellevueHospital, Roth found that "none showed symptoms typical of manic-

8t7

depressive psychosis" (N. Roth, The neuropsychiatric aspects of porphy-'ia, Psychosomntic Medicine, T lrg4sl:2gr-301; likewise, Tishler and hiscolleagues found that none of the porphyria patients in their survey of!,867 psychiatric inpatients met DSM-Lil criteria for bipolar illness (p. v.Tishler, B. Woodward, J. O'Connor, D. A. Holbrook, L. J. Seidman,M. Hallett, and D. J. Knighton, High prevalenee of intermittent acuteporphyria in a psychiatric patient pop,rLtiorr, American lournal of psy-chiatry, r42 [1985]: 14g0-1436). Drs. Loftus and Arnold ruled out bipol",illness in van Gogh's case on the basis of the 'facile

reversibilrty andrelatively short duration of Vincent's crises"; however, short duJion andreversibility are per ctly consistent with a diagnosis of manic-depressiveillness.

second, although the authors present van Gogh's famiry his-tory as an argument for porphyria, it is far more of an argument formanic-depressive illness. porphyria is autosomal dominant Lr the en-zyme deftciency, but- up to 90 percent of those with the d"ff"i"rr"y ."-main clinically free of the disease (A. Kappas, s. sassa, R. A. Galbraith,and Y. Nordmann, The porphyrias, in rhe Metaboric Basis oy-iolruntuaDisease, 6 ed., ed. C. R. Scriver, A. L. Beaudet, W. S. Sly, andD- Valle (New york: McGraw_Hill, 1989), pp. fS6S_fSOS;. O. tt"other hand, bilineality as a result of assortative mating is common inm_anic-depressive illness, not infrequently giving rise to1 hrge numberof affected familv members, In the-one study tfiat ,y;;;filf i.ru"r-tigated psychiatric illness in ftrst-degree .elatives

"i p",t*rGth por_phyria, only one relative was foundio harre a history^of .n"ntut-ittrr"rr,

this relative's symptoms and course were not consistent with a diagnosis9f manic-depressive illness (8. Ackner, J. E. Cooper, C, H. Gray, andM. Kelly,^Arcute porphyria: A neuroprylhiut.i"

""a Ui*t"_i""irt,ray,

lournal of psgchosomatic Research, 6 irs6zl, t_24). ih; ;;tio., ro"r*o.n the -nh11ical symptoms experienced by van Gogh's brother Theo atthe end of his life, but it shourd be noted that boiir Th; ;; vi.,"".,twrote about melancholia as their shared constitutional malady. vincent,soccasional gastrointestinal symptoms could have been du" io fu. *ur"probable causes than porlphyria (for example, poor nutrition, influenza,or depression itself); his convulsive disorder may have b""r, fr""ipi-tated by absinthe abuse or due to a coexisting comprex partial leizuredisorder. The nature and extent of both '*

-cogh! absinthe use andconvulsive disorder remain unclear (Hulsker, vincent and Theo 'an

9ogh)t in any event, van Gogh's affective symptomatology clearly pre_dates any history of seizures, and his famiry t"t"ry ir-*1..'JJ"Jtra"nawith manic-depressive illness.

Third, both vincent and his brother cor committed suicide.

NOTES 319

Suicide is a very uncommon behavior in the general population, and thereis no indication of elevated rates of suicide in porphyria. On the otherhand, 15 to 20 percent of untreated manic-depressives commit suicide, 70to 80 percent of all suicides are associated with afective illness, andsuicides tend to cluster in families with strong histories of manic-depressive illness (see chapter 6).

Fourth, manic-depressive illness is far more common in highlycreative artists and writers than in the general population; porphyriashows no such relationship, Indeed, although Drs. Wetterberg and Os-terberg found that cognitive functioning (except memory) was normal inporyhyria (L. Wetterberg and E. Osterberg, Acute intermittent porphy-ria: A psychometric study of twenty-ffve patients, lournol of Psychoso-mntic Research, 13: [1969]: 91-93), others have shown signiffcantneuropsychological impairment (Tishler, High prevalence of intermittentacute porphyria [1985]) as well as extremely poor functioning on tests ofmanual dexterity (Ackner, Acute porphyria If962]).

Finally, manic-depressive illness is a common illness, occurringin at least one percent ofthe population. Porphyria, on the other hand,occurs in only 0.001to 0.008 percent (Tishler, High prevalence of inter-mittent acute porphyria [1985]; Kappas, The porphyrias [f989]). Even instudies ofpsychiatric inpatients the prevalence ofporphyria is rare, rang-ing from 0.16 to 0.48 percent (Tishler, High incidence of intermittentacute porphyria [f985]). It is a basic truth in clinical medicine that whenone hears hoofbeats it is unlikely to be a zebra. This admonition againstdiagnosing rare disorders when a common disease equally, or better, fttsthe symptoms and course of an illness, is particularly apt in the case ofVincent van Gogh.

127. Van Gogh, The Compl.ete Letters; Jan Hulsker, Complete VanGogh Paintings, Drauings and Sketches (New York: H. N. Abrams,re80).

128. Van Gogh,TheComplctel*tters (letter504, June 1888), vol.2,pp. 598-599.

129. Lombroso. L'Hom:nw dp GCnie.130. John Clare,Thelnttersof JohnClare, ed. J. W, andA. Tibble

(London: Routledge & Kegan Paul, l95I).l3l. Rosamond Harding, An Anatomy of lnspiration (Cambridge:

W. Heffer & Sons, 19a8), p. 70.132. For further discussion of the importance of the rate of change of

light, see Wehr and Goodwin, 1983; N. E. Rosenthal, D. A. Sack, J. C.Gillin, A. J. Lewy, F. K. Goodwin, Y. Davenport, P. S. Mueller, D. A.Newsome, and T. A. Wehr, Seasonal affective disorder: A description ofthe syndrome and preliminary findings with light therapy, Archiaes of

General PsgchiatrE, 4f (I9g4): 7Z-g0; Goodwin and Jamison, Manic-D epres sioe lllne s s ( t9g0).

133. Lucretius, "Meteorology and Geology," on the Nature of theUnioerse, trans. R. E. Latham (London: penguin, lg5f), p. 22g.

134. E. Slater and A. Meyer, Contributions to a pathography of themusicians: l. Robert schumann, confinia psychiatrici, z (igs'g),'os_ga.

135. Sorley Maclean, "Glen Eyre,,, lines 49_60, Spring Tide andNeap Tidn: Sebctedpoems l9S2-72 (Edinburgh: Canongaie, tili1, p. ZO.

136. George Gordon, Lord Byron, "Manfred,"actirt, scene'r,rines_138-145, Lord Bgron: -The Complete poeticalWorks, vol. 4,

"J- 1"ro*"J, McGann (Oxford: Clarendon press, 1gg6), p. 92.

rHE MrND's cANcffiTlrt, ,ouo"E MooDL Byron, "The Lamelt of Tasso," lines 5_I0, lnrd Byron: The

Complcte PoeticalWorks, vol. 4 (1gg6), p. 116.2. Leslie A. Marchand, Bgron: A Biography, B vols. (New york:

Alfred A. Knop{ 1957), p. t3t.3. Bgron's lctters andJoumals, 12 vols., ed. Leslie A. Marchand

(London: John Murray, tgTg-1982), vol. 9, p. 37. Hereaftercited as BL!.4. Byron, "The Corsair," canto II, verse 10, lines 32g_30, Byron:

The Cornplete PoeticalWorks, vol. 3, p. fg2.5. Moore, The Works of Lord Byron, vol. 13, p. 24.6. BLI, vol .3, p. l I9.7. Julius Millingen, Memoirs of the Affairs of Greece (London,

l83l), p. 16.8. Byron, Don Juan, canto XVII, stanza

Compl.ete PoeticalWorks, vol. 5, p. 660.9. Lovell, Blessington, Lady Blessington,s Contsersations, p. ZZ0.(originally published in rg34 as the Joumal-of the conaersattnii iy rora

Byron by the Countess of Blessington.)10. Ibid., p. 7p.ll. Byron, "Manfred," act I, scene 2, lines 4041, Bryon: The

Complete PoeticalWorks, vol. 4, p. 63.f2. Ibid., line 41.f3. Ibid.. line 42.14. Percy Bysshe Shelley,

ed. David Lee Clark (New york:15. rbid.

17, Lord Bgron: The

"A Defence of Poetry," SheIIeU's prose,New Amsterdam, 1gB8), p. 2gS.

16. Keats, Letters (letter to his brothers, December lgl7), p. 193.

NOTES 391

17. Keats, Letters (letter to Richard Woodhouse, October 27, l8l8),p. 386.

18. Byron, "Childe Harold's Pilgrimage," canto III, stanza 44 , LordBgron: The Conrylcte PoeticalWorks, vol. 2, p. 92.

19. Lovell, Lady Blessington's Conoersatians, p. L79.20. Kraepelin, Manic-Depressioe lnsonitg; A. P. Zis, P. Grof,

M. Webster, and F. K. Goodwin, Prediction of relapse in recurrentaffective disorder, P sg chopharmacolo gg Bulletin, 16 ( 1980): 47 -49.

J. Angst, Course of aflbctive disorders, in H, M. van Praag, M.H. Lader, O. J. Rafaelsen, and E. J. Sachar, eds., Handbookof BiologicalPsgchintry (New York: Marcel Dekker, 1981), pp. 225-212.

F. K. Goodwin and K. R. Jamison, The natural course of manic-depressive illness, in R. M. Post and J. C. Ballenger, eds., Neurobiologyof Mood Disord,ers (Baltimore: Williams & Wilkins, 1984), pp. 20-37.

P. Roy-Byrne, R, M. Post, T. W. Uhde, T. Porcu, and D. Davis,The longitudinal course of recurrent affective illness: Life chart data fromresearch patients at the NIMH , ActaPsgchtatricascandinnoicaTl (Suppl.317) (1985): 1-34; Goodwin and Jamison, "Course and Outcome," Manic-Depressioe lllness, pp. 127-156.

21. Kraepelin, Manic-Depressioe lnsanity.F. I. Wertham, A group of benign psychoses: Prolonged manic

excitements: With a statistical study of age, duration and frequency in2000 manic attacks, Amprican loumal of Psgchiatry, I (1929): L7-78.

C. Perris, The course of depressive psychoses, Acta Psgchiat'rica Scandinarsica, 44 (1968): 238-2,t8.

A. W. Loranger and P. M. Levine, Age at onset of bipolaraffective illness, Archioes of General Psychintry,35 (1978): 1345-1348.

M. Baron, N. Risch, and J. Mendlewicz, Age at onset in bipolar-related major affective illness: Clinical and genetic implications, Journalof Psgchiatric Research, 17 (f983): 5-18.

Goodwin and Jamison, "Childhood and Adolescence," Manic-Depressioe lllness, pp. 186-200.

22. Goodwin and ]amison, Peak incidence of affective episodes bymonth: Review of 13 studies, "Epidemiology," Monic'Depressirse lllness,pp. 157-185. See discussion ofseasonality in chapter 4.

23. Kraepelin, Manic-Depressioe lnsanitg.Zis et al., Prediction ofrelapse (1980).Angst, Course of af,ective disorders,R. M. Post, D. R. Rubinow, and J. C. Ballenger, Conditioning,

sensitization, and hndling: Implications for the oourse of afiective illness,in Post and Ballenger, The Neurobialogg of Mood. Disord.ers, pp. 432-466.

388 NOTES

R. M. Post, D. R. Rubinow, and J. C. Ballenger, Conditioningand sensitization in the longitudinal course of affective illness, BritishJournal of Psgchiatry, I49 (1986): 191-201.

Roy-Byrne et al., The longitudinal course ofrecurrent affectiveillness (1985).

Goodwin and |amison, "Course and Outcome," Mani.c-Depressioe lllrwss, pp. 127-156; M. Maj, F. Veltro, R. Pirozzi, S. Lo-brace, and L. Magliano, Pattern of recurrence of illness after recoveryfrom an episode of major depression: A prospective study, AmericanJournal of Psgchiatry, f49 (1992): 795-800.

24. Iady Blessington's Corusersations of Lord Byron, "Journal," p.DD.

25. BLI (letter from Byron to Countess Teresa Guiccioli, Octoberl ,1820) , vo l .7 , p .189.

26. BLJ, (letter from Byron to John Murray, September 20, l82t),vol. 8, p. 216.

27. Quoted in Malcolm Elwin, Inrd Byron'sWde (New York: Har-court, Brace & World, I%2), p. ?52.

28. John Nichol, Bgron (New York: Harper & Brothers, 1880), p.12.

29. Marchand, Bgron, p.3.30. rbid.3I. Violet Walker, The House of Byron: A History of the Familg

from the Norman Conquest,1066-19BB (London: Quiller Press, lg88), p.l13.

32. Ibid., p. 45.33. Ibid., p. 44.34. Ibid., p. 45.35. Nichol, Bgron, p. 5; Marchand, Byron, p. 6; Walker, The

House of Bgron, p. II8.36. Ibid., p. 170.37. Nichol, Bgron,p.7.38. Walker, The House of Byron, p. Il8.39. rbid.40. Ibid., p. 174.41. Ibid., p. L72.42. Andr6 Maurois, Byron, trans. Hamish Miles (1930, reprint,

London: Constable, 1984), pp, 23-24.43. Walker, The House of Byron, p. f58.44. A. L. Rowse, The Bgrons andTretsanians (London: Weidenfeld

and Nicolson, 1978), p. 138.45. Ibid., p. 139.

NOTES 388

46. rbid.47. Doris Langley Moore, I-ord Byron: Accounts Rendnred (New

York: Harper & Row, 1974), p. 16.48. Doris Langley Moore, The I'ate Lord Byron: Posthumous Dra'

mas (Philadelphia: J. B. Lippincott, f96f ), p. 133.49. Moore, Lord Bgron: Accounts Rendered., p. 29.50. Maurois, Byron, p. 33; Moore, The Inte I'ord Byron, p. 82:

J. G. Kiernan, "Degeneracy Stigmata," Alienist Neurologist, 22 (f898)

[190r]: 50-57, 287-304.51. Maurois, Bgron, pp. 26-27.52. Marchand, Bgron, p. 18.53. Maurois , Bgron, p. 27; see also Byron's account of his grandfa-

ther's death, BLrI & letterfrom Byron to John Murray, September20, 182f ),vol. 8, p. 2I7.

54. BL] (letter from Byron to John Murray, September 20, f82f),vo l . 8 , p .217.

55. Moore, The Works of Lord Bgron, vol. 12, p. 15.56. BLJ, (letter from Byron to Augusta Byron, November 2, l8O4),

vol. l, p. 54.57. BLJ, (letterfrom Byron to Augusta Byron, November f 1, f804),

vol. I, pp. DD-DO.

58. Ibid., p. 56.59. BLJ, (letter from Byron to Augusta Byron, June 5, 1805), vol.

1, p. 68.ffi . BLJ, (letter from Byron to Augusta Byron, August 18, 1805), vol.

1, p. 75.61. Moore, The Works of Lord Byron, vol. 12, pp. 9$-100.62. Quoted in Marchand, Byron, p. 920.63. Ibid., p. 923.M. BLJ, (letter from Byron to Augusta Leigh, August 2, 1816), vol.

6, p. 62.65. Joan Baum, The Calculating Passion of Adn BEron (Hamden,

Conn.: The Shoe String Press, 1986), p. 40.66. Ibid., p. xvi.67. BLJ, (letter from Byron to Augusta Leigh, February 23, 7824),

vol. ll, p. I27.68. BL], (letter from Byron to John Murray, December f0, 1B2f ),

vol. 9, p. 77.69. Baum, The Calculating Passian, p. 65.70. Ibid., p. 57.7I. Ibid., p. 65.

72. rbid.73. Doris Langley Moore, Ad,a, Countess of Looelace: Bgron,s Le_gitimnte Daughter (London: John Murray,I}TT): p. 154.74. Ibid., p. 21975. Ibid., p. 2t776. "childe Harold's pirgrimge," canto III, stanza rlg, lines l0g4-

L096, Lord Bgron: The Comptete ioeticalWorks, uot. Z,p.'ifg.7,7. BLJ, "Cephalonia Journal,, (15 February I8Z4):*t. ff , p. Il3.78' B' s' Abeshouse, A Medicar History aj rordby-"inior*i"r,,

N.Y.: Eaton Laboratories, tg6b), S0 pp.79. BLJ, "Cephalonia Journal,', vol. ll, p. tl3.80. Moore, TheWorks of Lord Byron, rrol. 12, p. ll.8r. rbid.82. Ibid., p. 18.83. BLJ, "Journal of I8I3_tg14,,, vol. g, p. 25g.84. rbid.85. Moore, The Works of Lord Bgron, vol. 12, p. 2SS.

- 86. John Cam Hobhouse, lournal,l6 May 1g24, quoted in Moore,The Late Lord Bgron, p. lS.87. BL], (letter from Byron to Augusta Byron, April g, lg04), vol.I, p. 48.88. rbid.89. BLI, (letter from Byron to Augusta Byron, April4, lg05), vol.I, pp. 6%-63.90. Moore, The Works of Lord Byron, vol. 13, p. 447.9r. rbid.92. George Gor{on, Lord Byron, ..The

Deformed Transformed,,,patr I' scene l, lines Bl3-3r8, Lord Byron: The comprete pouil"oiior*r,vol. 6 (1991), p. S3l.

93. Marchand,, Bgron, p. ll3.

- 94. BL/, (letter from Byron to Augusta Byron, December 22, 1g0S),vo l . l , p .86 .

95. Marchand., Bgron; Moore, The Works of Lord. Bgron, vol. lB.96. BLJ , (letter from Byron to Augusta Byron, lanuari 7 , 1SOO), vol.

l, p. 87.97. Marchand, BEron, p. f25.98.

I, p. 106.99.

vol. I, p.100.

BLl, (letter from Byron to Earl of Clare, February 6, fg07), vol.

BLl, (letter from Byron to Edward Noel Long, April 16, lg07),114.BL/, (letter from Byron to Elizabeth Bridget pigot, October 26,

1807), vol. I, pp. 135-136.

NOTES 335

l0l. Moore, I'ord Bgron: Accounts Rendzred, p. 29'102, Quoted in Marchand, Byron, p. 923.IOg. BLJ, (letter from Byron to R. C. Dallas, January 20, 1808), vol.

l, p. 146.104. BLI, (letter from Byron to fohn Cam Hobhouse, February 27,

1808), vol. 1, p. 158.LOl. BLJ, (letterfrom Byron to Hobhouse, March 14, 1808), vol. l,

p . 1 6 0 .106. BL], (letter from Byron to Francis Hodgson, May 5, t8l0), vol.

1, p. 241.107. BLJ, (letter from Byron to Hobhouse, August 23, 1810), vol' 2,

p . 1 3 .108. BLl, (letter from Byron to Hobhouse, fune 19, l81l), vol' 2, p.

48.l}g. BLJ, (letter from Byron to Hobhouse, November 26, l8l0), vol'

2, p. 29.th}, BLJ, (Byron note to himse[ May 22,1811), vol. 2, pp. 47-48'lll. BLJ, (letter from Byron to Hobhouse, June 19, 1811), vol. 2, p.

5I. L cal.enture is atropical delirium characterized by an intensely fever-ish or passionate state.

112. Moore, The Works of I'ord Bgron, vol. 3, P. M6; Marchand,Byron, p. x.

LIg. BL], (letter from Byron to Henry Drury, July 7, 18ll), vol. 2,p. 59.

IL4. BLI, "RavennaJournal,"vol' 8, p.24.ILl. BLJ, (letter from Byron to R. C. Dallas, August 21, 18ll), vol.

2, p' 75.Ll6. BLl, (letter from Byron to Francis Hodgson, October 13, 1811),

vol .2, pp. l l l -112.IL7. BLJ, (letter fiom Byron to Hobhouse, October 22, l8l1), vol.

2, pp. 777-178.lLl. BLJ, (letter from Byron to Francis Hodgson, March 5, f8f2),

vol. 2, p. 167.ll9. Marchand, Bgron, p. 345.120. Ibid., p. 335.l2l. Marehand, BEron, p. 328.122. BL], (letter from Byron to Lady Caroline Lamb, May 19, 1822),

vol. 2, p. 177,I23. BLJ, (letter from Byron to Lady Melbourne, August 14, l8l2),

vol. 2, p. 188.124. Marchand, Bgron, p. 382.

I25. BLJ, (letter from Byron to Lady Melbourne, November 4,1813), vol. 3, p. 157.126. BLJ,"Journal" (December 10, lgl3), vol. 3, p. 236.127. BLJ,'Journal" (February 27, IgI4), vol. 3, p. ZiO.128. Byron, "Manfred," act II, scene l, lines Z+_iZ;act II, scene 2,lines 105-10g, Lord Byron: The Complete poetical W;rks, rrot. +, pp.f f i ,74.L29. BLJ, (letter &om Byron to Lady Melbourne, April 25, lgl4),vol. 4, p. 105.130. BLJ, (letter from Byron to Thomas Moore, May 31, lgl4), vol. 4,p, l2 l .l3r. rbid.732. BLJ, (letter from Byron to Thomas Moore, August S, lgl4), vol.4, p. I53.r33' BLJ, (letter from Byron to Lady Melbourne, october lg, rgl2),vol, 2, p. 231.134. Moore, The Late Lord Bgron, p. 251.135. Quoted in Elwin, Lord Bgron,sWtfe, p. ll9.136. BLI, (letter fiom Byron to Augusta Leigh, August 30, lgll), vol.2, p. 85.137. John Cam Hobho use, Recolhctions of a Long Lifu,6 vols. (Lon_don: John Murray, l90g-19[), vol. l, p. 196.138. Quoted in Marchand, Bgron, p, 547.139. Quoted in Elwin, LordBgronrrWrf", p. 32g.I40. Ibid., p. 256.141. Ibid., p. 544.142. Ibid., p. 413.143. Marchand., Bgron, p. 548.144. Marchand, Bgron, p. 9169.

- f45. Byron, "Don l_uan," canto I, stanzas, 2A_27, Bgron: The Com_plcte PoeticalWorks, vol. S, pp. f6_i7.146. Quoted in Elvrin, LordByron,sWxfe, p.3g2.747. BLJ, (letter from Byron to Sir Ralph Noel, February 2, lg16),vol. 5, p. 20.148. Moore, The Works of Lord Bgron, vol. 15, pp. 105_10g,149. Sir Walter S"2r:,

T!9 tntt2rs of Sir Walte, Siiu(letter to J. B.S. Morritt, November 22, tgt6), ed. H. J. C. Griersr. (i;;;;, Con_stable, f933), p. 297.

- 150. Shelley, Com.ple-teWorks, vol. g, (letter from Shelley to pea_cock, July 17, 1816), p. 18I.

I51. George Gordon, Lord Byron, The Works of Lord Bgron, Let_

N013S SZ7

ters andJournals,6 vols., ed. Rowland E. Prothero (London: John Mur-ray, 1899), vol.3, pp. 347-348.

152. BLJ, (letter from Byron to Douglas Kinnaird, December 17,1816), vol. 5, p. I40.

153. BLI, (letter from Byron to Augusta Leigh, December 18, 1816),vol .5, p. 141.

I54. BL], (letter from Byron to Thomas Moore, March 25, l8L7),vol. 5, p. 187.

155. John Cam Hobhouse, 14 October 1817, quoted in NormanPage, Bgron: lnteroiews andRecollcctdons (Atlantic Highlands, N.J.: Hu-manities Press, 1985), p. 54.

156. Marchand, BEron, p.7L7.L57. BLJ, (letter from Byron to Hobhouse, May 19, l8l8), vol' 6, p.

40.158. Shelley, Compbte Worles, vol. 9 (letter from Shelley to Pea'

cock, October 8, l8l8), p. 334.159. Ibid. (letter from Shelley to Peacock, December 22, 1818), p.

12.160. Mary Shelley, The l*tters of Mory Wollstonecraft Shelleg,

(letter from Mary Shelley to Hunt, April 6, 1819), ed. Betty T. Ben-nett (Baltimore: Johns Hopkins University Press, 1980), vol. l, p.92.

161. BL], (letter from Byron to John Murray, August 24, 1819), vol.6, p. 216.

162. BL], (letter from Byron to Hobhouse, August 23, 1819), vol. 6,p . 2 I 4 .

163. BLJ, (letter from Byron to Teresa Guiccioli, September 28,1820), vol. 7, p. 185.

L64. BL], (letter from Byron to Teresa Guiccioli, September 29,1820), vol. 7, p. 186.

165. BLJ, "RavennaJournal" (January 6, l82l), vol. 8, p. 15.f66. Ibid. (February 2, I82L)" vol. 8, p. 42.L67. BLl, (letter from Byron to Thomas Moore, October 1, 1821),

vol. 8, p. 230.168. BLJ, "Detached Thoughts," vol. 9, p. 47,169. Dr. James Alexander, quoted by Marchand, Byron, p. 1052.170. rbid.171. Moore, The Worles of Lord Byron, vol. 14, p. 4M.I72. I.ovell, Ladg Blessington's Conoersations, "Journal," p. 92.173. Ibid., p. 80.174. James Hamilton Brown, quoted in Marchand, Bgron, p. 1111.

3s8 NoIlBS

175. Ibid. , p. 1112.176. Byron, "On This Day I Complete My Thirty-Sixth year," in

Jerome McGann, ed., Byron (Oxford: Oxford University press, lg86),pp. 96F970.

177. Page, Bgron: lntensieus and Recollections, Ig8S, p. f52.178. Millingen, Memoirs of the Affairs of Creece, p. Ilg.179. Ibid. , p. l4 l .180. Pietro Gamba, A Narrathse of Lord Bgron's Last lourney to

Greece (London: John Murray, 1825), p. 263.l8l. Marchand,, Bgron, p. 1260.f82. "Childe Harold's Pilgrimage," canto IV, stanza 137, lines 1225*

1233, Lord Bgron: The Complete Poetical Works, vol. 2, p. 170.183. Quoted in Angus Calder, Byron (Milton Keynes, England:

Open University Press. 1985), p. 66.184. Quoted in David Perkins, English Romantic Writers (San Di-

ego: Harcourt Brace Jovanovich, 1967), p. 697.r85. Ibid., p. 696.186. Ibid.187. William Allingham, The Dinries, ed. H. Allingham and D. Rad-

ford; intro. John Julius Norwich (London: Folio Society, lgg0), p. J24.188. Quoted in Truman Guy Steffan, Lard Bgron's Cain: Tuehse

Essays and a Text oith Variants and Annotations (Austin: University ofTexas Press, 1968), p. 32a.

189. John Ruskin, Praeterita: The Autobiography of lohn Ruskin,intro. Kenneth Clark (Oxford: Oxford University Press, lg78), p. 134.

r90. rbid.l9l. Ibid.192. W. H. Auden, Byron: The Making of a Comic poet, Igffi.193. Ronald Stephenson, "Byron as Lyricist: The Poet Among the

Musicians," in Alan Bold, Byron: Wrath and Rhgme (London: VisionPress Ltd., 1983), pp. 78-79; Stephen Coote, Byron: The Making of aMgth (London: Bodley Head, 1988).

194. Moore, The Works of Lord Byron, vol. 13, pp. 38b-386.195. Leslie A. Marchand, "Byron and the Modern Spirit," in The

Major English Romnntic Poets: A Symposiumin Reappraisal (Carbondale:Southern Illinois University Press, 1957), p. l&.

196. Moore, The Late Lord Byron, p. 4.Ig7. BLJ, (letter from Byron to Lady Byron, December 31, lSlg),

vol. 6, p. 261.198. Bold, Byron: Wrath and Rhyme, p. 13.199. Byron,"Manfred," actII, scene 4, lines 160-161, Lord Byron:

The Complete Poetical Works, vol, 4, p. 86.

NOTES 3e9

200. "Childe Harold's Pilgrimage," canto III, stanza 77,lines726-732, Lord Bgron: The Complete Poetical Works, vol. 2, p. 105.

CHAPTER 6GENEALOGIES OF THESE HIGH MORTAL MISERIES

I. Herman Melville, Moby-Dick: or The Whale (1851; reprint,Berkeley: University of California, 1979), pp. 473474.

2. Robert Burton, The Anatomy of Melancholg, "Parents a Causeby Propagation," ed. J. K. Peters (New York: Frederick Unger, 1979), p.39.

3. Edgar Allan Poe, The FaIl of the House of Usher and OtherWritings (1839; reprint, London: Penguin Books, 1986), pp. 138-f45'

4. Detailed reviews of this important but very complicated field ofresearch can be found in Julien Mendlewicz, Genetics of depression andmania, in Anastasios Georgotas and Robert Cancro, eds', Depression andMania (NewYork: Elsevier, 1988)pp. 197-213; E. S. Gershon's chapteron genetics, in Goodwin and Jamison , Manic'Depressirse lllness, pp. 373-401; Ming T. Tsuang and Stephen V. Faraone, The Genetics of Mood.Disord.ers (Baltimore: The ]ohns Hopkins University Press' 1990); GeorgeWinokur, Mania and Depression: A Classifi,cation of Sgndrome and Dis-ease (Baltimore: The Johns Hopkins University Press, l99I).

5. Bertelsen et al., A Danish twin study of manic-depressive dis-orders (1977); A. Bertelsen, A Danish twin study of manic-depressivedisorders, in M. Schou and E. Striimgren, eds., Origin, Preoention andTreatment of Affectioe Disordzrs (London: Academic Press, 1979), pp'227-239, Reviews of twin studies can be found in J. I. Nurnberger, Jr.,andE, S. Gershon, Genetics;inE. S. Paykel, ed.,Handbookof AffectioeDisord.ers (New York: Guilford Press, 1982) pp. 126-145; Mendlewicz,Genetics of depression; Gershon, in Goodwin and Jamison, Manic-Depressirse lllness;and Tsuang and Faraone , Genetics of Mood Disorders.

6. Gershon, ibid., p. 377. Drs. Larry Rifkin and Hugh Gurlingof the Molecular Psychiatry Laboratory of University College and Mid-dlesex School of Medicine in London have recently summarized theeven stronger evidence for concordance in monozygotic twins: "Two se-ries of twins seleeted on the basis of BP [bipolar] disorder probandshave been the most thoroughly investigated over a particularly longtime. These are the twins investigated by Bertelsen and those at theMaudsley Hospital, A recent reassessment of the Maudsley twins hasnow shown that the concordance for all subtypes ofafiective disorder inthe co-twins is 1007o [(A. Reveley, 1990, personal communication]. Ber-telsen [1988, personal communication] has also followed up his series of

twins and if a diagnosis of suicide is counted as a case tlen t}e con-cordance amongst MZ twins is also La}vo." L. Rifkin and H. Curli.rg,Genetic aspects of affective disorders, Biobgical Aspects of e,ffectiiDisorders, in ed. R. Horton and c. Katona (t-ndon, AcadJmic press,l99l), pp. 305-334; quoted on p. 3lB.

7. J. Price, Neurotic and endogenous depression: A phylogeneticview, Brirdsh Joumal of psychiatry, U4 (f96g): tI$_120.

-{. The many family studies of manic_depressive illness are re_viewed by Gershon in_Goodwin and Jamison, Minic-Depressirse lilness.Recent, well-controlled studies include E. s. Gershon, I. uamovit, J, J.,Guroff, E. Dibble, J. F. Leckman, W. Sceery, S. D. Targum, J. I. Nurn_berger, J.., L. R. Goldin, and W. E. Bunney, Jr., A family study ofschizoafiective, bipolar I, bipolar II, unipoiar,- *d ,ror*ul controlprobands,-4rchir:es of General psychiatry, sb lfsaz;: 1157_1167.

M. M. Weissman, E. S. Gershon, K. K. Kidd, B. A. prusoflJ. F. Leckman, E. Dibble, J.-Hamovit, W. D. Thompson, D.-L. pauls,Td J: J, -Curof, Psychiatric disorders i, th" relativei of proUarra, *ithaffective disorders: The yale--National Institute of Mental lr"atrrlruu-orative study, Archirses of Ceneral psgchiatry, 4l (Igg4): 13_21.

M. T. Tsuang, S. V. Faraone, ""a

y. ,t. nirming, Familialtransmission of major affective disorders: Is there evidrrr"r r,rpioiirrg tt "distinction between unyn:^lar and biporar Jrsordersp Bdtish loumar ofP sychiatry, 146 ( 1985): 268_27 t.

9. Gershon et al. (fgg2).W. Coryell, J. Endicott, T. Reich, N. Andreasen, andM. Keller, British Journal of psychiatry, t4S (f9B )r 4g_Si.-

--"'

I.*l_d::*t:J.fr{ee, N. Andreasen, p. Clayton, M. Keller, andX:j3::tL ?l*tl' rr: c^ombine or keep ,;p^r;;,?'i;;;;;;li;r;i;Disordars, 8 (1985): t7-29.

J. R. De pa,ulo, Jr,, S. G, Simpson, J. O. Gayle, and S. Fol-stein, Bipolar II disorder in six sisters , p)mai iy d6""fio" biro)a"rr, ts(1990): 259-2M.10. Gershon, in Goodwin and Jamison, Manic-Depressirse lllness,p. 398.

Kidd, C. R. Allen, A. M. Hostetter, and D. E. Housmarr, fipoia, "fec-tive disorders linked to DNA markers on chromoso i" it,-ioi*", szs(1987): 783-787.

72. M Baron, N. Risch, _R. Hamburger, B. Mandel, S. Kushner,M. Newman, D. Drumer, and R. H. Belmaier, Genetic tirr't "g"

b"trr""r,X-chromosome markers and biporar affective iti".tt, i otuo, Tziirgez),289-292; J. Mendlewicz, p. Simon, S. Sevy, F. Charon, H. Brocas. S.

NCrrFS

Legros, and G. Vassart, Polymorphic DNA marker on X chromosome andmanic depression, Lancet, i (1987): L230-L232.

13. S. Hodgkinson, R. Sherrington, H. Gurling, R. Marchbanks,S. Reeders, J. Mallet, M. Mclnnis, H. Pertursson, and J. Brynjolfsson,Molecular genetic evidence for heterogeneity in manic depression, Na-ture, 325 (f987): 805-806.

E. S. Gershon, S. D. Targum, S. Matthysse, and W. E. Bun-ney, Jr., Color blindness not closely linked to bipolar illness, Archioes ofceneral Psgchiatry, 36 (1979): L423-I430.

J. R. Kelsoe, E. I. Ginns, J. A. Egeland, D. S. Gerhard, A. M.Goldstein, S. J. Bale, D. J. Pauls, R. T. Long, K. K. Kidd, G. Conte,D. E. Housman, and S. M. Paul, Re-evaluation ofthe linkage relationshipbetween chromosome llp loci and the gene for bipolar afiective disorderin the Old Order Amish, Nature,342 (1989): 238-243.

W. H. Berrettini, L. R. Golden, J. Gelernter, P. V. Gejman,E. S. Gershon, and S. Detera-Wadleigh, X-chromosome markers andmanic-depressive illness: rejection of linkage to Xq28 in nine bipolarpedigrees, Archioes of General Psgchiatry, a7 (1990): 366-373.

J. Mendlewicz, M. f,eboyer, A. De Bruyn, A. Malafosse,S. Sevy, D. Hirsch, C. van Broeckhoven, and J. Mallet, Absence oflinkage between chromosome llplS markers and manic-depressive ill-ness in a Belgian pedigree, Amprican Journal of Psgchiatry, 148 (1991):r6ffi-1687.

G. Vassart and P. Simon, Manic-depression locus onX-chromosome, Lancet, 338 (f99I): 82I-822.

14. Pat Conroy, The Prince of Tld'es (New York: Banham, 1987), p.52.

15. Alfred Tennyson, "Maud," Part I, lines l-8 and 53-56, SusanShatto, ed., Tenngson's Maud: A Definitiae Edition (London: AthlonePress, 1986), pp. 4742, 47.

16. Hallam, Lord Tennyson, Alfred Lord Tennyson: A Memnir(Londonr Macmillan, 1897), p. 396.

17. In addition to autobiographical writings and letters, biograph-ical information for the pedigree is based on ibid.; Harold Nicolson,Tenngson's Two Brothers: The l*slie Stephen I'ecture 1947 (Cambridge:Cambridge University Press, 1947); Sir Charles Tennyson and Hope Dy-son, The Tennysons: Background to Genius (London: Macmillan, 1974);Robert Bernard Martin, Tenngson: The Unquiet Heart (Orf,ord: Claren-don Press, 1980); Hallam Tennyson, ed., Studies in Tennyson (London:Macmillan, 1981); Christopher Ricks, Tennyson,2nd ed. (London: Mac-millan, 1989).

18. Tennyson and Dyson, The Tenngsons, p. 184.

331

338 NOTES

19. Nicolson, The health of authors (1947), p. 5.20, "Dr. Tennyson's breakdown: 1820-1827," Tennyson: The Un-

quiet Heart, pp. 32-51.21. Ibid., p. 64.22. Ricks, Tennyson, pp. 59-60.23. Ibid., p. 62.24. Martin, Tenngson: The Unquiet Heart, p. 378.25. Ibid., p, 506.26. Ibid. , p.523.27. Nicolson, The health of authors (1947), p.7.28. Tennyson and Dyson, The Tenngsons, p. 125.29. Ibid., pp. 195-196.30. T. S. Eliot, "In Memoriam," SelectedProse of T. S. Eliot (New

York: Harcourt Brace fovanovich, 1975), p. 246.31. Niecks, Robert Schumann, p. 290.32. Niecks, Robert Schumann, p. 10.33. Ibid., p. 27.34. Ibid.35. In addition to autobiographical writings and letters, biograph-

ical and medical information for the pedigree is based on F. H. Garrison,the medical history of Robert Schumann and his family, Bullctin of theNeus York Academg of Medicine, f0 (f934): 523-538.

Eliot Slater and Alfred Meyer, Contributions to a pathographyof the musicians: Robert Schumann, Confin. Psgchiat.,2 (f959): 65-94.

The New Grorse Dictionary of Music and Musicians, 20 vols.,ed. Stanley Sad;e (London: Macmillan, 1980), pp. 831-870.

Ronald Taylor, Robert Schumann: His Life and,Work(London:Granada, 1982).

Peter F. Ostwald, Robert Schumann and his doctors, AmpricanJournal of Social Psychiatry,3 (1983): S-ta.

Peter Ostwald, Schumann: The lnner Voices of a Musical Ge-nias (Boston: Northeastern University Press, 1985).

Nancy B. Reich, Cl.ara Schum,ann: The Artist and the Woman(Ithaca: Cornell University Press, 1985).

36. Quoted in Ostwald, Robert Schumann and his doctors (f983),p. 6.

37. J. Hermand and J. Steakley, eds., Writings of German Com-posers (New York: Continuum, 1984).

38. Quoted in R. H. Sehauffier, Florestan: The Life and, Work ofRobert Schumnnn (New York: Henry Holt & Co., 1945), p. 42.

39. rbid.

NOTES 338

40. Robert Schumann (letter from Leipzig, 1828), quoted inT. Dowley, Schumann: His Life and Times (New York: Hippocrene,7982), p. 24.

41. Schumann (letter to Clara Wieck, 1837), quoted in ibid., p. 5r8,42. Robert Schumann (letter to Clara Wieck, February ll, 1838)

Early Letters of Robert Schumann, trans. May Herbert (London: GeorgeBell and Sons, 1888; reprint, Mich.: St. Clair Shores, Scholarly press,1970), pp. 182-184.

43. Quoted in Taylor, Robert Schumnnn: His Lifu andWork, p. g7.44. Quoted in Niecks, Robert Schumann, p, 2lg.45. Ibid.46. Quoted in ibid., p. 244.47. Frank Cooper, Operatic and dramatic music, in Robert Schu-

rrurnn: The Man and His Music, ed. Alan Walker (New york: Harper &Row, 1972), p. 339.

48. Quoted in Taylor, Robert Schumann: His Life and Work, p.27r.

49. Quoted in ibid., p. 285.50. M. Tchaikovsky, The Lifu and Letters of peter Tchaikooskg

(London: fohn Lane, Bodley Head, 1g06).51. Quoted in Niecks, Robert Schumann, p. 25.52. Ostwald, Schumann: The lnner Voices, p. 305.53. Quoted in Taylor, Robert Schumnnn: His Life and Work, p.

314.54. Quoted in ibid., p. 206.55. Henry James, Sr., Substance and Shailnu (Boston: Ticknor &

Fields, 1863), p. 75.56. William James, The Varietips of Religious Experience, p. 136.57. Henry James, The art of fiction, inpartialportraits (New york:

Haskell, 1968), pp. 375-408, quotation on p. 388.58. Henry James, Autobiograplry (Princeton: princeton University

Press, 1983), p. 396. Originally published as A Small BoE and Others(1913)' Notes of a son and Brother (1914), and The Middle years (1917).

59. F. O. Matthiessen, The James Familg: Including Selectinnsfrom the Writings of Henry James, Senior, William, Henry, Cr Ahce Jamcs(New York: Alfred A. Knopf, 7947), p. t4.

60. Ibid., p. 5.6r. Ibid., p. 18.62. Ibid., p. 16l.63. J. F. Nisbit, The lnsanitg of Genius (London: Grant Richards.

1900), p. 299.

il. H. Maudsley, Natural Causes and Supernatural Seemings(London: Kegan Paul, 1886), pp.24l-242.

65. Henry James, Autobiography, p. 265.66. Jean Strouse, Alice Jamzs: A Biography (Boston: Houghton

Miffiin, f980), p. 25.67. Matthiesen, The tamzs Family, p. 213.68. Jacques Barzun, A StroLl uith William Jamcs (New york:

Harper & Row, 1983), p. 8.69. William |ames, Varieties of Religious Expericnce, pp. 160_16I.70. Matthiesen, The tames Family, p. 30S.71. Leon Edel, Henry James: A Life (New york: Harper & Row,

1985), p. 665.72. Strouse, Alice Jam,es, p. ll2.73. R. W. B. Lewis, The Jameses: A Familg Namatirse (New yorkr

Farrar, Straus Giroux, lggl), p. 581.74. Ibid., p. 580.75. Matthiesen, The James Familg, p. 267.76. Iewis, The lameses, p. 415.77. Henry James, Autobiography, p. 261.78. Alice James, The Dinry of Alice J ames (October 26, f g90) (Mid-

dlesex, England: Penguin, 1g82), p. l4g.79. Ibid., (June 28, 1889), pp. 404L80. Strouse, Alice lames, p. 58.81. In addition to autobiographical writings and letters, biograph-

ical information for the pedigree is based on Matthiessen, The'lamesFamily; J. Strouse, Alice James; Barzun, A Stroll uith William lames;Jan-e Maher, Biographg of Brolcen Fortunes: wilkie and Bob, Broihers ofWilliam, Henry, andAliceJanrzs (Hamden, Conn.: Archon Books, lgg6i;Henry James, AutobiographE; Alice lames, The Diary; Gerald E. Myers,williamJames: His Life andThoughf (New Haven: yale university press,1986); Leon Edel, The Life of Henry James,5 vols. (philadelphia: J. B.Lippincott, 19$-f972); Lewis, The Jameses.

82. Myerson and Boyle, The incidence of manic-depressive psy-chosis in certain socially important families. (lg4l), p. lg.

83. Melville, Pierre: Or, The Ambiguities, p. lgg.84. Neal L. Tolchin, Mourning, Gendzr, and Creatirsitg in the Art

of Herman Mebille (New Haven: Yale University press, lgBS), p. 2.85. Leon Howard, Herman Melaille: A Biographg (Berkeley: Uni-

versity of California, 1952), p.7.86. Edwin Haviland Miller, Meh:ille (New york: George Braziller,

1975), p. 75.87. Ibid., p. 284.

NCITDS 835

88. Michael Paul Rogin, Suboersitse Cenealngy: The politic;s andArt of H erman Meh:illp (Berkeley: University of California, lg85), p. 20.

89. Miller, Meloillz, p. 3rt.90 . Ib id , , p .287.91. Melville, Mobg-Dick, p. 2.92. Herman Melville, The l*tters of Hermnn Meloille, ed. M. R.

Davis and W. H. Gilman (letter to E. A. Duyckinck, 5 April l84g) (NewHaven: Yale University Press, 1960), p. 83.

93. Miller, Meloill.e, p. l0l.94. Melville, Mobg-Dick, pp. 465-466.95. Samuel Taylor Coleridge, "The Rime of the Ancient Mariner,"

part VI, lines 422-429, Samael Taylor Coleridge (The Orford Authors),ed. H. J. Jackson (Oxford: Oxford University Press, 1985), p. 59.

96. Sara Coleridge, Ietter to H. N. Coleridge, 3 November 1836.Quoted in Bradford Keyes Mudge, Sara Colerid.ge: AVictorian Daugh-ter: Her Lifu and Essays (New Haven: Yale University Press, p. 92).

97. Holmes, Colzrid.ge: Eady Visionr, p. 3.98. Samuel Taylor Coleridge, Colleaed l*tters of Sarwel Taylar

Cobridge, ed. E. L. Griggs, vol. l: f78L1800 (letter to Thomas Poole,16 October U97) (Oxford: Oxford University Press, lg59), p. 91.

99. Holmes, Coleridge: Early VMons, pp. 4L52.100. Ibid., p. 58.l0l. Colerid ge, C oll,ected l-etters of S amuel T aglnr C oleridge (letter

to George Coleridge, 23 February 1794), vol l, p. 36.102. Holmes, Colcrid.ge: Earlg Visians, p. 143.103. Coleridge, Colbcted. Letters of Samuel Taylor Cobridge, vol.

3: 1807-1814 (letter to Joseph Cottle, 26 April 1814), p. 919.104. Holmes, Colerid.ge: Eorlg Visions, p. 3.105. Hartley Coleridge, Poems bE Hartleg Coleridge (London: Bd-

ward Moxon, 1851); Sara Coleridge, Memair and Letters of Sara CoI-eridge, ed. her daughter (New York: Harper & Brothers, 1874); E. L.Griggs, Hartlny Colcrid"ge: His Ufe and Work (t ondon: University ofLondon, f929); H. Hartman, HartleE CoLerid,ge: Poet's Son and Poet(London: Oxford University Press, 1931); Hartley Coleridge, Letters ofHartley Coleridge, ed. G. E. Griggs and E. L. Griggs (London: OxfordUniversity Press, 1936).

106. Mudge, Sara Coleridge, p. 210.I07. Sara Coleridge, Memoir, p. 49.108. Mudge, Sara Colzridge, p. 58.I09. Ibid., p. 205.110. Ibid., p. 208.lll. Ibid., pp. 2L5-2L6.

336 NOtrDS

112. Virginia Woolf, "Sara Coleridge," The Death of the Moth andOther Essays (New York: Harcourt Brace Jovanovich, 1974), p. 114.

rr3. Ibid.114. Bell, VirginiaWoolf, p. 226.115. Thomas Caramagno, The Flight of the Mind: VirginiaWoolf's

Art and Manic-Depressioe lllness (Berkeley: University of CaliforniaPress, 1992).

l16. Biographical information for pedigree based on Woolf, The Let'ters of VirginiaWoolf; Virginia Wooll The Diary of VirginiaWoolf, eds'Anne Olivier Bell and Andrew McNeillie, 5 vols. (New York: Harcourt,f976-I984); Virginia Woolf, Mom.ents of Being: Unpublished Autobio-graphbal Writings, ed. Jeanne Schulkind (New York: Harcourt, 1985),2nd ed. ; Leonard Woolf, B e ginning Again ; Bell, V ir ginia W oofi CatherinePeters, Thackerag's lJnioerse: ShiftingWodds of lnwgination and Realtty(London: Faber and Faber, 1987); Caramagno, The Flight of the Mind.

1I7. Woolf, Moments of Being, p. 133.118. Thomas, "Old Man," lines 25-32, in The Coll.ected Poems of

Eduard Thomns, pp. 19, 21.119. Virginia Woolf, "Moments of Being," in A Haunted. House and

Other Shor-t Stories (New York: Harcourt, 1944), pp. 1M-105.120. Woolf, The l*tters of Virginia Woolf, vol. 4, p. 180.121. Virginia Woolf, "The Moment" and Other Essays (New York:

Harcourt, 1948), p. 14.122. Ernest Hemingway, canceled passage from Creen Hills of Af-

rica, quoted in Kenneth S. Lynn, Hemingway (New York: Simon &Schuster, 1987), p. 415.

123. In addition to autobiographical writings and letters, biograph-ical information for the pedigree is based on ibid.; Paul Hendrickson,"Papa's Boys," Washington Posf, July 29 and 30, 1987; I. Yalom and M.Yalom, Ernest Hemingway-A psychiatric view, Archioes of GeneralPsEchiatry, 24 (\971): 485494; Carlos Baker, Ernest Hemingwag: AUfe Storg (New York: Avon Books, 1980).

I24. Lynn, Hemingwag, p. 36.125. Ibid., p. 592.126. Hendrickson, "Papa's Boys."r27. Ibid.128. Lynn, Hemingway, p.99,129. Mary Wollstonecraft, A Short Residence in Suseden, Notwag

andDenmnrlc, ed. Richard Holmes (Middlesex, England: Penguin, 1987),p. 152.

130. Mary Shelley, Frankenstein Or, The ModernPrometheus (NewYork: Penguin, 1983), p. 53.

NOTES 587

131. Richard Holmes, Footsteps: Adtsentures of a Rornntic Biogra-pher (New York: Viking, lg85), p. 91.

132. William Godwin, Memoirs of the Author of the RightsWomnn, ed. Richard Holmes (Middlesex, England: penguin, lg87),250.

133. Holmes, Footsteps, p. 91.

ofp.

134. Mary Shelley, The lournals of Mary ShelleE: tB14-1844, vol. 2,7822-7U4, ed. P. R. Feldman and D. Scott-Kilvert (Oxford: OxfordUniversity Press, 1987), p. 563.

135. Mary Shelley, The l*tters of MaryWollstonecraft Shelleg, vol.2, ed. B. T. Bennett (letter to Leigh Hunt, 20 July f839) (Baltimore:Johns Hophns University Press, 1983), p. 318.

136. Mary Shelley, The Journals of Mary Shelleg, vol. 2 (26 Feb-ruary 1841), p.572.

f37. W. Jackson Bate, Samael lohnson (San Diego: Harvest/HBJ,1979), p. 383.

138. ]ames Boswell, Life of lohnson, ed. L. F. Powell (1770; re-print, Odord: Oxford University Press, 1934), vol. 2, p. 121.

139. Bate, Sarwel lohnrorc, p. ll9.140. R. Porter, 'The

Hunger of Imagination': Approaching SamuelJohnson's melancholy, in W. F. Bynum, R. Porter, and M. Shepherd,eds., The Anatomg of Madness: Essags in the History of PsEchtatrg (I-on-don and New York: Tavistock, f985), pp. 63-88.

I41, Bate, Samuel lohnson, p. I2I.142. Ibid., p. 348,r43. Ibid.144. Ibid., p. 371.145. M. Harris, The Heart of Boswell: Highlights from the lournals

of James Boswell (New York: McGraw-Hill, l98l); Henry R. Kranzler,Boswell's affective illness: A reappraisal, Connecticut Medicbw, $ (f989):225-228.

146. William B. Ober, Boswell's Clap and, Other Essays: MedicalAnalgses of Literary Men's Aff.ictions (Carbondale: Southern lllinois University Press, 1979); Kranzler, Boswell's affective illness (1989).

I47. Van Gogh, The Complzte Letters (letter 521, August lB88), vol.3, p. 8.

148. Tralbaut, Vincent oan Cogh, p. 286.149. Hulsker, Vincent and Theo Van Gogh, p. 12.150. Ibid., p. 4il.l5l. Ibid., p. 458.152. Tralbaut, Vincent oan Gogh, p. 276.

368 NOTES

153. David Sweetman, Van Gogh: His Life and His Arf (New york:Crown, 1990), p. 53.

154. Van Gogh, The Complcte Letters (letter 481, May lggg), vol. 2,p . D D i .

I55. Tufooonr Gfmceulr (179I-1824), French Romanticpainter, had a tumultuous emotional existence, alternating between pe-riods of ardent energy,and activity and deep melancholia (including para-noid delusions and at least one reported suicide attempt). His paintings,characterized by their violent but evocative beauty, often had macabrethemes, including severed heads and limbs, decaying corpses, murderand suicide, and insanity. Lorenz E. A. Eitner, in his biok ieruaultHk Life and work (London: orbis publishing lgg3), comments on theextensive history of insanity in G6ricault's family: "A strain of mentalillness ran through four generations of G6ricault's family on his mother'sside. His grandfather, J. V. charles caruel, was conffned to an asylumin 1773 and died insane in r77g; his uncle Frangois J. L. caruel, *asconffned in 1770 and died insane in lg05; his cousin, Louis-sylvestrecaruel, was institutionalized in lg45 and died insane in lggb; and hisown- son' Georges-Hippolyte G6ricault, by his aunt Alexandrine-Modeste caruel who was also the mother oi Louir-sylu"r,r", di"d i.,1882 under circumstances that suggest he was not of sound mind" (p.322).

156. Gusrev Mnnr_nn (1860-lgfl), Austrian composer, was thesecond el_de_st of a large family. of the ffve children who lived through thease of rilk for developing manic-depressive ilrness, Gustav *",

"y"tthy-mic, his brother otto committed suicide, his sister justine had recurrentdeath hallucinations and often hovered on the *rgl oiu

""^."-ri.""r.-down, and his brother Alois misrepresented hi-rJlf i' g.*Jior. *"y, ",well as manifesting an exceptionally extravagant life-styi-e. (et*" r'r"nt".,

Custao Mahler, Mem,ories and l*tters,2nd ed. trans. Basil CJghto'[L3_ndo1: John Murray, 1968]; Henry-Louis de La Grange,-ioii'r, uot.I [London: victor Gollancz, lgz4]; Egon Gartenberg, iahre* Th,e Manand His Masic [New York: schirmer-Books, r97g];lnud M"rt.rer, se-le_cted I'etters of Gustaa Mahlcr, trans. by Eithne wilkins and ErnstKaiser [New York: Farrar, Straus & Giroux, lgTg]; Donald Mitchell,Gustao Mahler: The Early years fLondon: Faber *d F"b"r, lgg0]; Nor-man Lebrecht, Mahl.er Remernbered [London: Faber and r"u"r, igaz].)

157. Rornnr Lownr-l (1917-1977), American poet, was hospitar-ized repeatedly for manic and depr-essive episodes. HL gr*ur""i", po",James Russell Lowell, also suffered from extended periods of severe de-pression, heavy drinking, paranoia, and fears of going mad. James RussellLowell's mother was institutionalized at Mclean rsychiatric Hospital (as

NOTES

was Robert Lowell, many times), his sister Rebecca suffered from severemood swings and other symptoms that were similar to those of theirmother, and his brother Charles reportedly suffered from the same illnessas did their mother and sister. (C. David Heymann, Americsn Aristoc-racg: The Lioes and Times of James Russell, Amy, and Robert Lousell[New York: Dodd, Mead, 1980]; Hamilton, Robert Louell: A Biographg;Jeffrey Meyers, Manic Porper: Robert Louell and hls Circle, (New york:Arbor House, 1987; Lowell, Collected Prose).

158. JonN Bnnnyuen (born John Allyn Smith, Jr., in 1914) was afellow poet and friend of Robert Lowell. His father shot and killed hmselfand one of his father's sisters also committed suicide. In Ig72, after yearsof struggling with manic-depressive illness and alcoholism, John Beny-man jumped to his death from a bridge over the Mississippi River. (Haf-fenden, The Lifu of John Berrym,an; E. M. Halliday, John Berryman andthe Thirties: A Memair [Amherst: University of Massachusetts press,l987l; Paul Mariani, Dream Song: The Life of lohn Berrymnn [New York:William Morrow, f9901.)

His father's suicide haunted Berryman, and he described itslasting and dtturbing effects in many of his poems . In The Dream Songshe wrote:

The marker slants, flowerless, dav's almost done.I stand above my father's grave with rage,often, often beforeI've made this awful pilgrimage to onewho cannot visit me, who tore his pageout: I come back for more,

I spit upon this dreadful banker's gravewho shot his heart out in a Florida dawnO ho alas alasWhen will indifference come .

(John Berryman, "384: The Marker Slants," lines l-10, The Dream Songs[New York: Farrar, Straus and Giroux, f96g], p. aOO.)

159. ANNn SnxroN (f928-1974), American poet, had a strong familyhistory of mental illness and suicide. Her maternal great-aunt was hos-pitalized and received electroshock therapy for a major "nervous break-down"; her paternal grandfather was also hospitalized for a nervousbreakdown. Her father was an alcoholic, and his sister committed suicide.one of Anne's sisters also committed suicide. (sources are sexton andAmes, Anne Serton: A Self-Poftrait in Letters [Boston: Houghton MiflinCompany, lS77]; Diane Wood Middlebrook, Anne Serton: A Bi.ography.IBoston: Houghton Miffiin Company, Iggf].)

339

84O NSIES

_ Although Anne sexton does not appear to have been given thediagnosis of manic-depressive illness (the primary diagnostic Imphasiswas placed on the depressive side of her illness, as well as her alcoholism."hysteria," and other personality difficulties), the case for manic-depressive illness is very strong. In addition to sexton's extensive familyhistory of suicide and mental illness, as well as her own suicide, hersymptoms-pronounced swings and lability in mood, expansiveness, im-pulsivity, anger, altered sleep and energy patterns, seasonal variations inpoo{-are highly characteristic of manic-depressive illness. so, too, areher alcoholism and the worsening, rapidly cycling quality of the course ofher illness. sexton's "hysterical" symptoms may well have been hysteri-cal; they also may have been a manifestation of the emotional extremesand lability that go along with manic-depressive illness. women who haveaffective illness not uncommonly are diagnosed as "borderlines" or "hys-terics" and, in sexton's case, she may well have had both a perso.ralitydisorder and manic-depressive illness,

Sexton reportedly was given lithium in rg72, but without ther-apeutic effect (Diane wood Middlebrook, personal communication, let-te-r, september l99l). She was, however, drinking heavily at the time,which may well have undermined both the drug's Lfficacy-and her com-pliance in taking the medication as prescribed. Likewise, nonresponsive-ness to lithium by no means rules out a diagnosis of manic-depressiveillness, even assuming lithium was given (and taken) in the nl""rruryamount for the necessary period of time. Given the nature and durationof sexton's psychiatric illness, by the time she was prescribed lithium itis quite likely that anticonvulsants and/or thyroid medication would havebeen necessry to effect a change in her clinical condition.

160. eucusr sTRTNDBERG (I849-fgf2), Swedish playwright andnovelist, suffered from severe manic-depressive psychosis, characterizedby extreme mood swings, grandiose and paranoid delusions, and halluci-nations. His mother was described as being of "nervous temperament,"his sister Elisabeth had severe persecution mania, recurrent dlpressions,and had to be admitted to a mental hospital, and strindberg's daughte.Kerstin was paranoid and "mentally unbalanced." primary sources forbiographical information about strindberg are Lagercrantz, AugustStrindberg (1985); and Meyer, Strindberg: A BiographrT, as well asA. Brett, Psychological abnormalities in August Strindberg, Joumal ofEnglish and German PhilologE,20 (1921): 4-98; B. M. E. Morier,."r,

"r,dB. W. Downs, Strindberg: An lntrodaction to hX Ufe andWork (Iron_don: Cambridge University Press, 1g4g); E. Sprigge, The Strange Ufe ofAugus-! Strindberg (London: Hamilton, fg4g); S. Hedenberg, Auguststrindberg: opinions of German psychiatrists. criticism of studies by

NOTES

Jaspers, Rahmer and Storch, Acta Psgchiatrica Neurologica, suppl. 34(f959): 325-339; E. W. Anderson, Strindberg's illness, PsgchologicalMedicine, f (197f ): f04-117.

16I. ructuE o'NEILL suffered from severe recurrent depressions,was an alcoholic, often suicidal, and attempted suicide when he was in hismid-twenties. His mother was a morphine addict (she used morphine,she said, for her "nerves'), his father a heavy drinker, and his brother analcoholic. One of O'Neill's sons was hospitalized for "shock," was a nar-cotics addict and an alcoholic, and on more than one occasion tried to killhimself. Another son, who had been a professor of Greek drama at Yale,committed suicide at the age of forty. See Croswell Bowell, with theassistance of Shane O'Neill, The Curse of the Misbegotten: A Tale of theHouse of O'NeilI (New York: McGraw-Hill, 1959); Louis Sheaffer, O'Neill:Son and Plnguright (NewYork: Paragon, 1968); Arthur Gelb and BarbaraGelb, O'Neill, enlarged ed. (New York: Harper & Row, 1973).

162. rrNNsssEE wILLIAMs's "deep neryous problems" began whenhe was sixteen years old. Throughout his life he suffered from what hedescribed as his "dreadful depressions," as well as from alcoholism anddrug abuse. At one point he had to be committed involuntarily to a psy-chiatric ward. His sister was also committed to a psychiatric hospital as aresult of a severe psychosis; eventually she underwent a lobotomy.Williams's mother was hospitalized for psychosis as well, and Williamswrote in his Memoirs that on both sides of her family there had been"alarming instances of mental and nervous breakdowns." TennesseeWilliams, Memoirs (New York: Doubleday, 1972), quotation on p. 116;Dakin Williams and Shepherd Mead, TennesseeWilliams: an lntimate Bi-ography (New York: Arbor House, 1983); Donald Spoto, The Kindness ofStrangers: The Life of Tennessee Williams (New York: Ballantine Books,1985); Tennessee Williams, Fioe O'CInck Angel: I*tters of TennesseeWillinms to Mario St. Just: 1948-1982 (New York: Alfred A. Knopf, 1990).

163. vrcron HUGo, who had very real difficulties with his ownmoods, had both a brother and a daughter who were committed to insti-tutions because of "incurable insanity."

164. The role of genetics in suicide is reviewed in S. Kety, Geneticfactors in suieide, in A. Roy, ed., Suicid.e (Baltimore: Williams & Wilkins,f986), pp. 47-45; A. Roy, Genetics of suicide, in J. Mann and M. Stanley,ed., Psychobiology of Suicidnl Behaoior (New York: New York Academyof Sciences, 1986), pp. 97-105; Mendlewicz, Genetics of depression andmania, p.207; A. Roy, N. L. Segal, B. S. Centerwell, andC. D. Robi-nette, Suicide in twins, Archioes of GeneralPsychiatry,48 (fggt): Z$;}Z.

165. Egeland and Sussex, Suicide and family loading for affectivedisorders (f985).

WL

842 NOTES

- 166. Although British painter RT.HARD nepp is usually character-ize{ as having suffered from paranoid schizophrenia, it is in fact morelikely that he suffered from a severe, relativery unremitting form of manic-depressive illness. First, his extremely strong family histoiy of psychiatricillness (of seven children from his father's ffrst marriage, thrie becameinsane and a fourth required a "private attendant") is more consistentwith what is known about the genetics of manic-depressive than withschizophrenic illness, second, his pre-illnerr p"rron"lity and social ad-justment were more like those seen in manic-depressive illness. Third,his age at the onset of his illness and the fact that hls psychosis coincidedin time with prolonged exposure to light (in fact, his contemporariesattributed his insanity to sunstroke) suggest a possible bipolar iul.r"."-bility. Fourth, his symptoms of violent behavior, extreme restlessness,paranoia, religious preoccupations (he murdered his father under theinfluence of the delusion that his father was the devil or the devil's agent),and feverish excitements, along with the episodic nature of at least theearly course of his illness, are also consistent with manic-depressive ill-ness. Hallucinations and delusions can occur in both schizoihrenia andmanic-depressive illness. After Dadd was admitted to sethle; Hospital,and later transferred to Broadmoor Hospital for the criminally Insane, hisillness showed some signs of remissionf it

"try event, it did not appear to

deteriorate further. It seems, from the hospital records, that he ,"iui.r"adeluded, but clinical observations were infrequent and inadequate (forexample, entries of "no change," written every six months). Eximinationof Dadd's letters and other writings reveals a strongry manic quality tomany of them.

167' Andreasen, creativity and mental illness (rgs7); McNeil, pre-birth and postbirth influence (rg7r); Richards, creativity in manic-depressives (1988); Karlsson, Genetic basis of intellectual variation (lggr);Karlsson, Creative intelligence (1984).

- 168. Drs, Ming Tsuang and Stephen Faraone of Harvard Universityhave summarized the risk of major mood disorders among relatives ofmanic-depressive probands and concluded:

overall, family studies of bipolar probands strongly support the hy-pothesis that their first degree relatives are at greater rltk ofbipol",disorder than is the general population. The riik to relatives rangesfrom a low of 1.2 percent to a high of 24.9 percent. All of these valuesare greater than the general population risk of0.5 percent suggestedby epidemiologic studies. . . More important, each of th!-threedouble-blind, controlled studies found high rates of bipolar disorderamong relatives ofbipolar probands in comparison to control probands

NOTES

[one study found a 4.5 percent risk in the relatives and 0 percent riskin the controls; the other two studies found ten to twenty times therisk]. Tsuang and Faraone, Cenetic.s of Mood Disord.ers, p. 47.

A recent review of studies found that the morbid risk of bipolardisorder in ftrst-degree relatives of bipolar patients ranged between5.8 and 7.8 percent, again showing a greatly inereased risk over that foundin the general population (L. Rifkin and H, Gurling, Genetic aspectsof affective disorders, in Biobgical Aspects of Affictioe Disordcrs, ed.R. Horton and C. Katona (London: Academic Press, 199I), pp. 305-334.

169. Herman Melville, White-l acket or The W orld in a Man-of-W ar(Oxford: Odord University Press, 1990), pp. 402-403. Originally pub-lished in 1850.

CHAPTER 7THIS NET THROWNE UPON THE HEAVENS

l. fohn Donne, The Epithalamions, Annioersaries and Epicedns,ed. W. Milgate (Oxford: Oxford University Press, 1978), p. 30.

2. Quoted in Thomas, Eduard Thomas: A Portrait (letter to Gor-don Bottom, 2l May 1908) p. 162.

3. Quoted in Ragna Stang, E&sard Munch: The Man and Hls An,trans. Geoffrey Culverwell (New York: Abbeville Press, 1979), p. I07.

4. M. Schou, P.C. Baastrup, P. Grof, P. Weis, and l. Angst, Phar-macological and clinical problems of lithium prophyla:ris, British lournalof Psychiatry, tl6 (1970): 6lHI9.

5. P. Polatin and R. R. Fieve, Patient rejection of lithium carbonateprophylaxis, lournal of the American Medical Association,2lS (1971):864-866; R. G. Fitzgerald, Mania as a message: Treatment with familytherapy and lithium carbonate, Amcrican Journal of Psychother&p7,26(1972): 547-553; T. Van Putten, Why do patients with manic-depressive illness stop their lithium? Com.prehensioe Psgchiatry,f6(f975): 179-183; R. J. Kerry, Recent developments in patient man-,"/agement, in F. N. Johnson and S. Johnson, ed., Lithium in MedigdlPractice (Baltimore: University Park Press, 1978), pp. 337-353. /

6. K.R. Jamison, R. H. Gerner, and F. K. Goodwin, Pati6nt andphysician attitudes toward lithium: Relationship to compliance, Archioesof GeneralPsychiatry,36 (f979) 866-869; K.R. Jamison and H.S. Akiskal,Medication compliance in patients with bipolar disorders, PsgchiatricClinics of Nonh America,6(f983): l71>I92.

7. These studies are reviewed in Goodwin and famison, "Person-

843

ality and Interpersonal Behavior," and "Maintenance Medical Treat-ment," Manic-Depressh:e lllness pp. 281-317, ffiS-TZ4.

8. Ibid. pp.29T297.9. M. Schou, Special review of lithium in psychiatric therapy and

prophylaxis, Journal of psychlatric Research, o1rs6a1, 67-gs, quotationon p. 78.

10. L. L. Judd, B. Hubbard, D. S. Janowsky, L. y. Huey, and p. A.Attewell, The effect of lithium carbonate on affect, mood, andpersonalityof normal subjects, Archioes of General psgchiatry, s4 (rg77it g46-g51.

ll. D. Kropf *g B. Mtiller-Oerlinghausen, Changes in learning,memory, and mood during lithlum treatment: Approach to a researchstrategy, Acta Psychiatrica Scandinaoica, Sg (197g): g7_I24.

12. R. H. Belmaker, R, Lehrer, R. p. Ebstein, H. Lettik, ands. Ku-gelmass, A possible cardiovascular effect of lithium, American lour-nal of Psgchiatry, 736 (1979): ST7-579; K. White, R. Bohart, K. Whipple,and J. Boyd, Lithium effects on normal subjects: Relationships to plasmaand RBC lithium levels, International pharmacopgsychintry, 14 (rg7g):17&183.

13. U. Bonetti, F. Johansson, L. Von Knorring, C. perris, andE. Stra-ndman, Prophylactic lithium and personality vlriables: An inter-national collaborative study, rnternatiinal phannacopsgchiatry, 12(1977):14-19.

74, M. F. Folstein, J. R. De paulo, Jr., and K. Trepp, Unusualmood stability in patients taking lithium, tirtilsn Journal oy irg"hlotry,140 (1-982): 188-191; I. R. D9 paulo, Jr., E. L Co'ea, and M. F. i,olstein,Does lithium stabilize mood? Biological p sychiatry, lg (19g3): r093-r0g7.- 15. D. Kropf and B. Mtiller-oerringhausen, The influence of lithiumlong-term medication on personality anJ mood, pharma"op*r"iiotrg, B(1985): r04-r05.

16. G. N. Christodoulou, A. Siafakas, and p. M. Rinieris, Side ef_fects of lithium, Acta psychiatrica Belg, TZ (1977):26a-266;summaries ofpublished and unpublished ffndings otr the subject are reviewed in Good-win and Jamison, Manic-Depresshse lllness, pp.76V762.

17. Goodwin and Jamison, "Thought Disorder, perception, andCognition, "' Manic-D epressioe lllne s s, pp. 247 =2gO

18. A. Coppen, C. Swade, and K. Wood, platelet_5_hydroxytrypt-amine accumulation in depressive illness, clin chim Acta, g7 irs*),l6F-168; M. T. Abou-saleh and A. coppen, subjective side effects ofamitriptyline and lithium in affective disorders, nnnth Journal of psy-chiatry, f42 (1983): 391-397; F. Engelsmann, J. Katz, e. lt. Chaiirian,and D. schachter, Lithium_and memory: A long-term follow-up study,I ournal of C linical P sg chopharmacolo gy, 8 (l ggg) : 207 -2I2,

NOTES 345

19, See Goodwin and Jamison, "Thought Disorder, Perception, andCognition."

20. C. J. Kestenbaum, Children at risk for manic-depressive illness:Possible predictors, American Journal of Psgchiatry, 136 (1979): 1206-1208; P. Decina, C. J. Kestenbaum, S. Farber, L, Kron, M. Gargan,H. A. Sackeim, and R. R. Fieve, Clinical and psychological assessment ofchildren of bipolar probands, American lournal of Psgchiatry,laO (1983):548-553.

21. These issues have been reviewed by E. D. Shaw, J. J. Mann,P. E. Stokes, and A. Z. Manevitz, Efects of lithium on associative pro-ductivity and idiosyncrasy in bipolar outpatients, Amprican Journal ofPsychiatry, f43 (1986): 1166-1169; J. Anath, A. M. Ghadirian, andF. Engelsmann, Lithium and memory: A review, Canadian lournal ofPsychiatry,32 (1987): 312-316; L. L. judd, L. R. Squire, N. Butters,D. P. Salmon, and K.A. Paller, Effects of psychotropic drugs on cognitionand memory in normal humans and animals, in H. Y. Meltzer, ed.,Psgchopharmacologg: The Third Ceneration of Progress (New York:Raven Press, 1987), pp. 1467-1475i8. D. Shaw, P. E. Stokes, J.J. Mann,and A. Z. A. Manevitz, Effects of lithium carbonate on the memory andmotor speed of bipolar outpatients, Journal of Abnormal Psgchologg, 96(f987): 64--69.

22. Anath, et al., Lithium and memory (1987).23. J. W. Jefferson, J. H. Greist, D. L. Ackerman, and J. A. Carroll,

Li,thium Encgclopedia for Clinical Practice, 2nd ed. (Washington, D. C.:American Psychiatric Press, 1987); Judd et al., Effects of psychotropicdrugs (1987).

24. Ibid., p. 1468.25. L. L. Judd, B. Hubbard, D. S. Janowsky, L. Y. Huey, and K, L

Takahashi, The effect of lithium carbonate on the cognitive functions ofnormal subjects, Archioes of Cenerol Psgchintry, 3a Q977): 35F357;I. G. G. Karniol, J. Dalton, and M. H. Lader, Acute and chronic effectsof lithium chloride on physiological and psychological measures in nor-mals, Psychopharmncology (Berlin), 57: 289-294, (f978); Kropf andMriller-Oerlinghausen, Changes in learning, memory, and mood (f979);H. Weingartner, M. V. Rudor r, and M. Linnoila, Cognitive effects oflithium treatment in normal volunteers, Psychopharmacology (Berlin), 86(1985): 472474; P. W. Glue, D. J. Nutt, P. j. Cowen, and D. Broadbent,Selective effect of lithium on cognitive performance in man, Psychophar-macologg (Berlin), 9f (f987): 109-111,

26, Studies reporting detrimental effects of lithium on cognitive abil-ities and speed of performance include, among others, R. G. Demers andG. R. Heninger, Visual-motor performance during lithium treatment: A

846 NC;1ES

prelim inary r eport, J o urnal of c linic al p harmac olo gy. I I (r 97 r ) : 247 -27 g ;V. L Reus, S. D. Targum, H. Weingartner, and R. M. post, Effect oflithium carbonate on memory processes in bipolar affectively iil patients.P_sychopharmacology (Berlin), $ (fg7g): Jg42;y. Lund, M. Nissen, ando. J. Rafaelsen. Long-term lithium treatment and psychological func-tions, Acfa Psgchintrica scandinarsica, 6.5 (r9g2): 2JJ-244; L. pons, J. LNurnberger, Jr., and D. L. Murphy, Mood-independent aberrancies inassociative processes in bipolar affective disorder: An apparent stabilizingeffcct of lithium, psychiatry Research, 14 (rgg5): 3t5-i22; shaw et al.,Effects of lithium on associative productivity (tegb); shaw eial., Eff""t, oflithium carbonate (rg8z); p. lauhar, cognitive impairment in long-termf it]rium therapy, Clinical N europharmnito eA, 15 (Supplement l, part B)(1992): 2llB.

studies reporting no signiftcant effect of lithium on memory or othercognitive abilities include R. Telford and E. p. worrall, cogrriiiue furrc-tions in-manic-depressives: Effects of lithium and physostiguriirr", Britishlournal o!_Psy,chiatrV,,133 (197g): 424_42g; n. f. i;ellmin, B. f. fa.l_berg, and L. H. Thorell, cognitive and affective functions in patients withaffective disorders treated with lithium, Acta psychiatrica siandinaoica,62 (1980): 32-46; A. M: Ghadirian. F. Engersmalnn, and i. e"",rr'rra".,,-ory functions during lithium therapv, Jouirwl rl cit"t tirtyii"inarnub991-oe!,3 (1933): 31F315; Etg"is*a.,n et al., Lithium irrd'rr,"*o.y(1e88).

27. Polatin and Fieve, patient rejection of lithium, p. g64.28. M. H. Marsh-all, C. p. Neumann, and M. nobirro., Lithium,creativity, and manic-depressive illness: Review and prospec tur, irU"lro_somatics,ll (1970): 406--488; M. Schou, Artistic productivity

"rri lithiu.nprophylaxis in manic-depressive iilness, Briti^si lournit if pririrorrv,

r35 (1979): 97-103.29. Schou, Artistrc productivity and lithium prophylaxis (lg7g).30. Judd et al., The effect of lithium carbonai.lSllZl.31' shaw et al., Effects of lithium on associative productivity (r9s6).32. Pons et al., Mood-independent aberrancies (lgg$.33. Goodwin and Jamison, Review of thirteen studies (1,094

!:ltl investigating lithium side effects, Manic-Depressiae lrlness,760-762.

34. rbid.35. Reviews of efficacy studies ofcarbamazepine and varproate are in

Goodwin and Jamison, Manic-Depressirse lllnesi, pp. Tl;ii;. i"", fo,instance, R. M. Post, J. C. Ballenger,T. W. Uhde, and W. E. Bunney,jr', Eficacy of carbamazepine in manic-depressive illness: Implicationsfor underlying mechanisms, in Neurobioligy of Mood Disorhirs. ed.

pa-pp.

NOTES 547

R. M. Post and J. C. Ballenger (Baltimore: Williams and Wilkins, 1984),pp. 777-Bf6; J, R. Calabrese and G. A. Delucchi, Spectrum of efficacy ofvalproate in 55 rapid-cycling manic-depressives, Americanlournal of Psy-chiatry,la7 (1990): 437434; H. G. Pope, S. L. McElroy, and P. E. Keck,Jr., Valproate in the treatment of acute mania, Archioes of Ceneral Psy-chintry,48 (f991):62-68; J. R. Calabrese, P. J. Markovitz, S. E. Kimmel,and S. C. Wagner, Spectrum of efficacy of valproate in 78 rapid-cyclingbipolar patients, Journal of Clinical Psgchopharmacologg, 12 (suppl. l)(f992): 535-565; R. H. Gerner and A. Stanton, Algorithm for patientmanagement of acute manic states: Lithium, valproate, or carbam-azepine? lournal of Clinical Psgchopharmncologg, 12 (suppl. f) (1992):575-635; S. L. McElroy, P. E. Keck, Jr., H. G. Pope, Jr., and J. I.Hudson, Valproate in the treatment of bipolar disorder: Literature reviewand clinical guidelines, Journal of Clini.cal PsychopharmacologE, 12 (sup-pl. 1) (19e2):425425.

36. S.D. Cochran, Preventing medical noncompliance in the outpa-tient treatment of bipolar affective disorders, lournal of Consuhing andClinical P sgchologg, 52 (f 984): 87H78;

L D. Glick, J. F. Clarkin, J. H. Spencer, G. L. Maas, A. B.Lewis, J. Peyser, N. DeMane, M, Good-Ellis, E. Harris, andV. Lestelle,A controlled evaluation of inpatient family intervention: Preliminary re-sults of the six-month follow-up, Archioes of General Psgchiatry, a2(1985):882-886,

D. J. Miklowitz, M. J. Goldstein, K. H. Nuechterlein, K. S.Snyder, and J. Mintz, Family factors and the course of bipolar affectivedisorder, Archiaes of Ceneral Psgchiatry,45 (f988): 225-23L

37. M. J. Goldstein, E. H. Rodnick, J. R. Evans, P. R. A. May, andM. Steinberg, Drug and family therapy in the aftercare of acute schizo-phrenia, Archioes of Ceneral Psgchiatrg,35 (1978): ll69-f177.

38. A. Coppen and C. Swade, Reduced lithium dosage improvesprophylaxis: A possible mechanism, in H. Hippius, G. L. Klerman, andN, Matussek, ed., N eut Results in D epression Research (Berlin: Springer-Verlag, 1986), pp. 126-130.

P. Vestergaard and M. Schou, Prospective studies on a lithiumcohort, I. General features, Acta Psychiatrica Scandinaaica, TS (f988):421426.

A. J. Gelenberg, J. M. Kane, M. B. Keller, P. Lavori, J. F.Rosenbaum, K. Cole, and J, Lavelle, Comparison of standard and lowserum levels of lithium for maintenance treatment of bipolar disorder,Neu England.lournal of Medicine,321 (1989): f490-1493.

39. Shaw, et al., Effects of lithium on associative productivity (1986).40. P. Plenge, E. T. Mellerup, T. G. Bolwig, C. Brun, O. Hetmar,

348 NOTES

f. Ladefoged, S. Larsen, and O. J. Rafaelsen, Lithium treatment: Doesthe kidney prefer one daily dose instead of two? Acta Psychiatrica Scan-dinaoica, 66(f982): L2l-128.

4L. H. V. fensen, K. Olafsson, A. Bille, J. Andersen, E. Mellerup,and P. Plenge, Lithium every second day, A new treatment regimen? Lith-ium, | (f990): 55-58, p. 353; P. Plenge and E. T. Mellerup, W. H, O.Cross-cultural study on lithium every second day, ClinicalNeuropharmn-col.ogy, (Supplement 1, Part A): (f992) 487A-488A. This experimental reg-imen of lithium dosing is now being tested in ten different centersworldwide with the specific hope that side effects such as "lack of initiativeand emotional colour" will be minimized.

42. Ralph Waldo Emerson, Emerson in His Journals, ed. Joel Porte(Cambridge: Belknap Press of Harvard University Press, 1982), p. 430.

43. Gelenberg et al., Comparison of standard and low serum levels(1989); Goodwin and Jamison, "Maintenance Medical Treatment,"Manic-Depressiae lllness, pp. 66*-724; T. Suppes, R. J. Baldessarini, G.L. Faedda, and M. Tohen, Risk of recurrence following discontinuation oflithium treatment in bipolar disorder, Archipes of General Psgchiatrg, 48(I99r): 1082-1088.

44. Antonin Artaud, Anthologg (San Francisco: City Light Books,f965), pp. 27-28 (passage translated by David Ossman).

45. See F. N. Johnson, ed. Depression and Mania: Mod.ern LithiumTherapg (Oxford: IRL Press, 1987); A. Georgotas and R. Cancro, eds.,Depression and Mania (New York: Elsevier, 1988); Goodwin and Jami-son, "Maintenance Medical Treatment," Manic-Depressiae lllness, pp.665-724.

Patients taking lithium make fewer suicide attempts and commitsuicide less often than manic-depressive patients not taking lithium:D. W. K. Kay and U. Petterson, Mortality, in U. Petterson, Manic-depressive illness: A clinical, social, and genetic study, Acta PsychiatricaScandinaoica (Supplement 269) (1977): 5ffi0; A. J. Poole, H. D. James,and W. C. Hughes, Treatment experiences in the lithium clinic at St.Thomas' Hospital, lournal of the Rogal Societg of Medicine, 71 (1978):890-894; H. Hanus and M. Zapletalek, Sebevrazedna aktivita nemocnychafektivnimi poruchami v prubehu lithioprofrlax e, C e skoslooenska P sychi-atrie, 8O (f984): 97-1fi); B. Causemann and B. Miiller-Oerlinghausen,Does lithium prevent suicides and suicidal attempts? in Lithium: lnor-ganic Pharmacologg and Psgchiatric Use, ed. N. J. Birch (Oxford: IRLPress, 1988), pp. 2&-24; A. Coppen, J. Bailey, G. Houston, and P. Sil-cocks, Lithium and mortality: A 15 year follow-up, Clinical Neurophar-macologg,15 (Supplement l, Part A) (f992): 448A.

46. Robert Burns, Comrnnn Place Book, March 1784, quoted in

NCITBS 849

David Daiches, Robert Burns (London: Andr6 Deutsch, 1966), p. 67.47. Lowell, "A Conversation with Ian Hamilton," in Robert Louell:

Collected Prose, ed. Robert Giroux (New York: Farrar, Straus & Giroux,1987), pp. 267-290, quotation on p. 286.

48. There remains uncertainty about whether Randall Jarrell'sdeath-he was hit by an oncoming car at night-was an accident or asuicide. Several of his friends (including Robert Lowell and Peter Tay-lor), as well as biographer Jeffrey Meyers, believe he did commit sui-cide; the occupants of the car that hit Jarrell described the poet ashaving "lunged" in front of the car. Jarrell's wife, and biographerWilliam Pritchard, disagree, and the medical examiner concluded thatthe death was accidental, with a "reasonable doubt" about its being asuicide. Of relevance to the discussion is the fact that he had been hos-pitalized for both mania and depression several months earlier and, atthe time of his death he was still recouperating from having attemptedsuicide by slashing his wrists ([. Meyers, The death of Randall Jarrell,The Virginia QuarterlE Reoiew [Summer f982]: 450-467; Randall ]ar-rell's l*tters, ed. Mary Jarrell [Boston: Houghton Miffiin, 1985]; W. H.Pritchard, Randnll larrell: A Literary Life [New York: Farrar, Strausand Giroux, 19901).

49, Van Gogh, The Complete Letters (May 1890, letter 630), vol. 3,p. 263.

50. Lowell, Colleaed Prose, pp. xiii-xiv.51. R. M. Post, Transduction of psychosocial stress into the neuro-

biology of recurrent affective disorder, Amprican Joumal of Psgchiatry,149 (f992): 999-1010; R. J. Wyatt and R. M. Post, Early and sustainedintervention alters the course of schizophrenia and affective disorders,submitted for publication.

52. Lewis Thomas. "The Wonderful Mistake," The Medasa and theSnail: More Notes of a Biologg Watcher (New York: Viking Press, 1979),pp.27-aO.

53. Some of these potential problems are shared by most geneticdiseases. Drs. Eric Juengst and James Watson have outlined three gen-eral sets ofethical issues that are relevant to the study ofhuman disease:issues involved in the integration of new genetic tests into health care (forexample, insuring the accuracy of genetic tests), issues involved in edu-cating and counseling individuals about the results of genetic tests, andissues of privacy concerning the results of genetic tests (that is, maximiz-ing conffdentiality of test results by protecting accessibility to employers,researchers, and insurance providers). E. T. Juengst and J. D. Watson,Human genome research and the responsible use of new genetic knowl-edge, lnternational lournal of Bioethics, 2 (1991): 99-f02. Many articles

and books have been written about the tremendously important ethicalissues surrounding genetic research. These include:

W. F. Anderson-and J. C. Fletcher, Gene therapy in humans:when is it ethical to begin? Neu Engl.and.Journal of Medicire,303 (19g0):1293.

united states President's commission for the study of EthicalProblems in Medicine and Biomedical and Behavioral Research, s"rnrn-ing and' counselingfor Genetic conditions (washington, D.c. r'Govern-ment Printing Office, February 1gB3).

Jonathan Glover, what sort of people shouldThere Be? GeneticEngineering, Brain control, and Thilr rmpact on our Future wodd(New York: Penguin, Ig84).

W. F. Anderson, prospects for human226 (1984): 401-409.

gene therapy, Science,

- Le Roy walters, Ethical issues in intrauterine diagnosis andtherapy, Fetal Therapu, t (lgg6): gZ--J|.

Le Roy Walters, The ethics of human gene therapy, Nature, J20(1986): 22,5-227.F. D. Ledley, Somatic gene therapy for human disease: Back-ground and prospects, parr il, Joimat of peiiatrtcs, iio'irgg?), :i;z-tz+.H. Pardes, C. A. Kaufmann, H. A. pincus, and A. West, Ge-netics and psychiatry: past discoveries, current dilemmas, and futuredirections, American Journal of psgchla,trg, f46 (lgg9): 4JS_4A,

_ Le Roy Walters, Genetics and reproductive technologies, inMedical Ethics' ed' R. M. veatch (Boston: Jones and Bartrett, rg5g), pp.201-228.Z. Bankowski and A, M. Capron, Genetics, Ethics, and HumanValues: Human Genomz Mapping, Genetf,c Screening ona i"n"-it

"rop,J(Geneva: council for Internatioial organizations ol Medical sciences,leer).J' A. Robertson, Issues in procreation liberty raised by the newgenetics, I*gal and Ethical Issue,s Raised by the Hurnnn G"nooin project,

ed. M. A. Rothstein (Houston: Universitytf Ho,rrtor,, lrrlt ^

D' J' Kevles and L. Hood, The codn of codcs: scientific and.social Issues in the Humnn Genome project (cambridge, rr"*^ii u"r-versity Press, lg92).

54' D. suzuki and p. Knudtson, Genethics: The clash Betueen theNeu Cenetics and Human Lifu (Cambridge: Harvard Urrirrersity p.urr,1990), pp. 183-184.

55. Goodwin and,Jamison, ..Manic_Depressive lllness, Creativity,

and Leadership," Manic-Depressiae lllness, pp. 382_367.56. M. Hammer and I. Zubin, Evolution, culture, and psychopa-

thology. lournal ofGeneral psychology, TS (196g): f'l_i64; l. f. farvik

NOIIES 361

and B. S. Deckard, Neuropsychobiology,3 (f977): l7$-l9l; L. Sloman,M. Konstantareas, and D. W. Dunham, The adaptive role of maladaptiveneurosis, Biological Psgchintry, f (f979): %7-972; f. S. Price and L.Sloman, The evolutionary model of psychiatric disorder, Archioes of Gen-eral Psgchiatry, 4l (I98a): 211; J. M. Himmelhoch and M. E. Garffnkel,Sources of lithium resistance in mixed mania, Psgchopharmacologg Bul-

l.etin, 22 (1986): 613-620.

57. Dr. Leon Kass has discussed at length the arguments againstabortions based on information derived from genetic tests (L. R. Kass,Tounrd a More Natural Science: Biolngg and Human Affairs [New York:

Free Press, I9S8]). Here he summarizes succintly his own views, which,

although certainly controversial, are important to note:

I have failed to provide myseH with a satisfactory intellectual and moraljustiffcation for the practice of genetic abortion. Perhaps others more ablethan I can supply one. Perhaps the pragmatists can persuade me that weshould abandon the search for principled justiffcation, that if we just trustpeople's situational decisions or their gut reactions, everything will turn outffne. Maybe they are right. But we should not forget the sage observation ofBertrand Russell: "Pragmatism is like a warm bath that heats up so imper-ceptibly that you don't know when to scream." Before we submerge our-selves irrevocably in amniotic fuid, we should note its connection to our ownbaths, into which we have started the hot water running. (p. 98)

58. Interview with Dr. Francis Collins, "Tracking down killergenes," Time, September 17,1990, p. 12.

59. Committee on Mapping and Sequencing the Human Genome:Board on Basic Biology, Commission on Life Sciences, National ResearchCouncil, Mapping and Sequencing the Human Cenom'e (Washington,D.C.: National Academy Press, 1988).

60. Larry Gostin, quoted in Designing Genetic lnformntion Policg:The Need for an Indnpend.ent Policg Reoi.ew of the Ethical, Legal, andSocial lmplications of the Humnn Genome Project. Sixteenth report bythe Committee on Government Operations (Washington, D'C.: U.S.Government Printing Office, 1992), p. ?t4,

6L B. Onuf, The problem of eugenics in connection with the manic-depressive temperament, Nero Iork lournal of Medicine, 3 (1920): 402-4L2,46t465.

Glover, What Son of People Should. There Be? (1984)'D. J. Kevles , ln the Name of Eugenics: Genetics and the Uses of

Humnn Hereditg (New York: Alfred A. Knopf, 1985).E. K. Nichols, HumnnGeneTherapy (Cambridge: Harvard Uni-

versity Press, 1988).

congress of the united states ofrce of Technorogy Assessment.Mappingour Genes: Genomc projects: Hou Bigp now riitr (n"ii-or",Johns Hopkins University press).

Z. Bankowski and A. M. Capron, ed., Genetics, Ethics and Hu-man Values: Human Cenom,e Mapping, Cenetic Screening anrd. CeneTherapy (Geneva: council for Internatio*nal organizations offuedical sci-ences, l99I).

62. Kevles, ln the Name of Eugenics, p. L0,63. N.D. Kristof, "parts of china Forcibly sterilizing the Retarded

Who Wish !o Marry," Newyo*Timps, Augusi lb, 1991, ip. ef and Ag.(Although the title of this article refers to tf," poli"ie, "r"iiing

ir* -""-tally retarded, policies afecting those with hereditary ,n"n,-"t"ittr,"r, *ualso reported in the article,)64. Kevles, ln the Name of Eugenics.65. H, Luxenberger, Berufsglied und soziale Schichtung in denFamilien erblich Geisteskranker, iugenik,3 (fg$): 3440.

-

66. Myerson and Boyle, The inciden"" oi*"rri"_depressive psycho-sis in certain socially prominent families, (lg4l): 20.67. John W. Robertson, Edgar A. po,e: A bsychopathic Study (NewYork: G. P. Putnam, lg23), p. lI'5.68. A few of the basic_ strategies for human gene therapy have beensummarized by Suzuki and Knudtson in their biok Genethlir,

- -

l. Gene Insertion.. The. most. straiShtforwal$ approach to gene therapywould be gene insertion, which in"oirr", the simpre insertion of one ormore coDies of the normal version of a gene into the "hro**o_",

of "diseased cell. Once express"d, th"r" ,ipplementary genes could pro_duce sufficient quantities of

" ,nirri"t

"iry*" or structurar protein, forexample, to overcome the inherited ieffcit.

2' Gene Modification._A more dericate feat, gene modification,wourd entailthe chemicar modification "f

th;d#;;i oNa sequence right where itIies in the living cellr in an efiort t" .""ri" its genetic message to matchthat of the ttor*"I allere. In pri""ipr., iilir appioach would bEless'likelyto disrupt the intricate geographiiul'f"y""i "f

g;;;, ;;h;oioro,,'"r,thereby reducing the poistbiitl, oi rn"i*tua ,i;";tr ;. -'

3. Gene Surgery. pven mor-e daring would be,bona frde gene surgery+theprecise removal of a faurty geni from a chromosomE, fonor,ild"by it,replacement with a croned su"bstitute. The notion "f

ilr;i;;ti;freshlysynthesized DNA sequences to reprace oelective ones is the urtimatedream of gene th-erapy, But it *orld j"-"rrd ; ;;"ry ;h;;; g*netics that, for the moment at least, ,i_ply ;;;;ii'h; g;";il"irf,grasp.

69. See notes 53, 57, and SB.

NOTES 353

70. Davis, Mapping the Code, pp. 252-253.71. James D. Watson, quoted in ibid., p.262.72. Lewis Thomas, "Notes of a biology watcher: to err is human,"

B. Dixon, ed., From Creation to Chaos: Classic Writings in Scienco,(Oxford: Basil Blackwell, 1989), pp. 199-201.

73. John Keats, "Lamia," lines 234-237, The PoeticalWorks of JohnKeats (Cambridge Edition), rev. P. D. Sheats (Boston: Houghton Miffiin,1975), p. 156.

74. Walker Percy, The Second Coming (New York: WashingtonSquare Press/Pocket Books, f98f), p. 314,

75. Byron, DonJuan, canto X, verses 2-4, lines 10-32, LordByron:The Cornplete Poetical Works, vol. 5, pp. 437-438.

In our own time, Sorley Maclean has described this with graceand power:

Who is this, who is this in the night of the heart?It is the thing that is not reached,the ghost seen by the soul,A Cuillin rising over the sea.

Who is this, who is this in the night of the soul,following the veering of the fugitive light?It is only, it is only the journeying oneseeking the Cuillin over the ocean.

From Sorley Macl-ean, "The Cuillin," Part VII, lines 164-183, in FromWood to Ridge (Manchester, England: Carcanet Press Ltd., l99l).

ACKI\O\IILEDGMEI\TS

Several biographers were kind enough to read early drafts of mybook and make very helpful comments. Professor Leslie Mar-chand, preeminent biographer of Lord Byron, was especially gen-erous in taking time with my work; Professor Jerome McGann,editor and scholar of Byron's poetry, also reviewed early chaptersand made several thought-provoking comments about Byron's psy-chological life and temperament. Professor Robert Bernard Mar-tin, whose outstanding biography of Alfred Tennyson I foundinvaluable, read not only my material on Lord Tennyson but whatI had written about Gerard Manley Hopkins as well. He gener-ously sent me an advance copy of his recent biography of Hop-kins, and we spent a delightful afternoon in Oxford discussing ourmutual fascination with the life, poetry, and moods of this ex-traordinary poet. I was also particularly helped by conversationsand correspondence with the eminent Hopkins scholar, and ed-itor of his poetry, Professor Norman MacKenzie. Professor Rob-ert Winter kindly reviewed what I had written about Beethoven

356 ACKNOWLEDGMENTS

and Professor Diane Middlebrook of-stanford University, biog_rapher of Anne sexton, read earry drafts of ro"r ffii'"r, ".rdmade several useful suggestions that I took to heart. profbssor

Kenneth silverman looked over what I had writt"r, "fo,ri

EdgarAllan.Poe and provided me with a very interesting perspective,as well as useful information about poe's drug

"r; ";i hJsuicide

attempt. Dr. Tom lgamagno, who has recently written a bookabout Virginia woolf and her manic-depressive ittrr"rl-ir,

", rhave noted in the text, responsibre for fastidio"r ;;J i;;ortant

research into woolfs famiry psychiatric history. n"r fuiigr"",dllyn up in chap,:r G, is based'largely on his *ort . r -"rn

,rp"_cially indebted to Dr. Iain McGirchiisi for making e"trem.ry de-tailed and helpful comments on my manuscript. His backgroundas a physician, as well as a former recturer in English literatureat the u^niversity of oxford, made his observatiois f"rti""rurrymeaningful' Professor peter sacks of the Johns Hopkins urriver-sity Department of English was likewise helpful ani encouragingin his remarks.

several other individuals arso read earry drafts of the book. Iam extremely indebted to Dr. Anthony Storr, who has been atremendous friend and colreague; his book The Dgnarniics iy crr-ation remains a classic in the field, and I have flund our manyconversations about artistic creativity and psychopathology veryhelpful. john Julius No:wich has given *" ,n,r"h irr"o,rr"!L-"rrtover the years and made many useful comments. on occasion he-suSgg1t9.a several poets, long dead, whom he thought ..perhaps

abitodd." They were, in fact, more than a bit odd,

""i r

"i sratefulto him for his leads. J. carter Brown read an'ea.ly draft-or,n"manuscript and made several very helpful suggesti,ons; I am in-debted to him as well for having made me more aware of the poemfrom which I took the book's tiile. Dr. |ames watson, Director ofthe cold spring Halbol Laboratory, was kind enough JiuL" trr"time to read an early draft; his usuar crarity of thJught was ex-tremely useful and much appreciated. Molecular biolofists Franciscollins, of the university of Michigan, and samuel ilarondes, ofthe university of california, san Francisco, reviewed the geneticssections and made several very helpful comments. My edilor, Er-win Glikes, understood long before I did what I wanted to say, andbelieved there was a point in saying it. He has a clear, y", -"r-

ACKNOWLEDGMENTS 467

velously dendritic mind, and his help was enormously important.Editing supervisor Edith Lewis and copy editor Sue Llewellynmade many useful suggestions and improvements. Art directorNancy Etheredge took my original ideas for illustrations and turnedthem into a beautifully designed book.

It is my pleasure to express my appreciation to the staffs of theWilliam H. Welch Medical Library of the Johns Hopkins Univer-sity School of Medicine, the Georgetown University Library, theClinical Center Library of the National Institutes of Health, theNational Library of Medicine, the Radcliffe, Bodleian, and MertonCollege Libraries of the University of Odord, and the NationalGallery of Art Library in Washington, D'C. The warm and won-der l atmosphere of the London Library defies description; it is,without question, the nicest place I have ever found to read, write,or procrastinate.

I am grateful to Oxford University Press for permission to usematerial previously published in Manic-Dopresshse lllness, a bookI wrote with Dr. Frederick Goodwin, Director of the NationalInstitute of Mental Health. All the material used was based onchapters that I had written, or sections that I had written for otherchapters (for example, material about the cognitive side effects oflithium, which appeared in a chapter about maintenance medicaltreatment), except for a brief discussion of biological rhythms in

normal and afiectively ill populations. Dr. Goodwin was kind

enough to grant me permission to use this material, which is basedon hii work with Dr. Thomas Wehr. Drs. Audrey Burnam andMyrna Weissman provided assistance with epidemiologic findings.The study of mood disorders in British writers and artists, dis-cussed in chapter 3, was originally published in the journal Psy-chiatry; I remain grateful to the many outstanding writers andartists who participated and gave their time and thoughts. Portionsof my remarks about Virginia Woolf in chapter 6 were first pub-lished in the Afterword I wrote for Dr. Tom Caramagno's bookTheFlight of the Mind: Virginia Woolf s Art and Manic-Depressit:elllness, published in 1992 by the University of California Press.The description of Robert Schumann's life, also in chapter 6, wastaken from a biographical sketch I wrote in program notes for"Moods & Music," a concert performed by the National SymphonyOrchestra at the John F. Kennedy Center for the Performing Arts

ACKNOWLEDGMEI\TS

in Washington, D.C. The concert was produced with pianist andmusic scholar Robert Winter.

For their friendship over the years I am deepry indebted to Dr.Daniel B. Auerbach, without whom this book

"oria noi r,"Ju u""nwritten; David Mahoney, who has been a particurarly cros" and s,rp-portive friend for many years; and Alain Moreau, who did the art_work for the cover and two iilustrations in the book. r,r"i" Bry"n,,

Judy Hoyer, Dr. Audrey Burnam, Dr. Barbara p*ry, Or. f"."*yWaletzky, Dr. Harriet Braiker, professor errdr"*'ComrJi, Or.Raymond De Paulo, Dr. Robert,Faguet, Dr. Robert Gerner, Dr.Michael Gitlin, the late Lt. Coloni David L;i;, R;;;ilr*ylte{ical Corps, the late professor William McGlothlin,

'prof"rro,

Paul McHugh, Ben Magliano, Victor and Harriet potik, br. nobertPost, Professor Mogens Schou, and profess", L";i; j"ly"n W"rtprovidedfriendship and encouragement as weil. rr,rr. witti"* cor-'ns ryped the entire manuscript with intelrigence, styre, and con-siste-ntly good-humored ability to work arourrd _y l"rt-*lrrut"deadlines.I orve IV 9ryity and Frances Lear my greatest debt. My

fr]: l,?: Y t1 *l t:'" i s on-a '" "tu o,oro gi;. ;;;-f b ;; ;.;iJ;;*:.Y11,:d l?,:' Aii Force-g"u" -u " b;:'ilil;;ffi i#;Jlbeautiful, and turbulent.- My"sir,"r, ,r,"r" ,hi,ffiffi;, ;i:IirlT_"':_"nd understandin j

"a;; ;;;,5 "ii;;',ff #:deeplv affected not onrv melut

"';'t";;;il;#ffi1."rr," ,,I T 9 I I

fi:,tf:llf_Y -lll*a,lg interest in blogr"pr,y

".,a prv"r,ior.Y "T:.:n::,, ?_'. o,"li ; air i s on,' i' t"'l " -i"'^,' d.. i;# J""'i::fi :,nephews Julian and Eliot, and niece L";ilh";;;;;;;",h;one could ask for in a familv.

Frances Lear, a- remarkable and generous friend, has givennew meaning to the lines from Willia; Butler yeats:

Think where man,s glory m.ost begins and ends,And say mg glory was I had such frlends

Il\DEX

Af,ective illness: sez Depression;Manic-depressive illness

Akiskal, Hagop, 74:75, 88Akiskal, Kareen, 74-75, 88Alcohol and drug use, 36-41, 73

personal accounts:John Berryman, 40George Gordon, Lord Byron,

175Samuel Taylor Coleridge, 40,

222Robert Lowell, 38Edgar Allan Poe, 36-37Dylan Thomas, 41

Alexander of Tralles, 34-35Allingham, William, 188Alvarez, A,,4546Amniocentesis, 8, 253-254Andersen, Hans Christian, 236,

268, 3lln.85Andreasen, Nancy, 72-74, 82-84,

88, 89, r07,236Anticonvulsants, T, 17, 24L, 246,

346-347n.35

Antidepressants, 7, L7,241, 247use by writers and artists, 77,

80Arensky, Anton, 269Aretaeus of Cappadocia, 34Aristotle, 5lArtaud, Antonin, 60, l2l, 122,

248,267,268Assortative mating, 194, 235-236Auden, W. H., 188

Bagley, C., 86-87Baillarger, Jules, 35Baillie, Joanna, ffi, 287n.29Baker, Carlos, 229Balzac, Honor6 de, 268Bampfulde, fohn Codrington, 62,

6,72, 285n.29Barrie, James, 268Barron, Frank, 106Barton, Ralph, 42, 249,269Barzun, Jacques, 210Bassano, Francesco, 249, 269

Batyushkov, Konstantin, 296, 267Baudelaire, Charles, I8g, 267Becker, George,4Beddoes, Thomas Lovell, 62,71.

72, 249, 2G7, 291-292n.29Beethoven, Ludwig van, 2g7-

298n.63Bell, Quentin, 26, 227Bellow, Saul, 30Benson, Arthur, 236, 268Benson, E. F., 296, 26gBerlin, Irving, 26gBerlioz, Hector, lg-20, f22, lgg.

269Berryman, John, 12, 30,96, 40,

II4-u5, 234, 249, 267, 269.339n.158

Bett, W. R., 36Bipolar disorder: see Manic-

depressive illnessBlake, William, l, f I, 69, 65,72,

92-95, ll0, 128, 220,267,286n.29

Blakelock, Ralph, 269Bleu]er, Eugen, 107Blok, Aleksandr, 286, 267Boake, Barcroft, Z4g, 267Bogan, Louise,267Bold, Alan, 190Bomberg, David, 26gBorromini, Francesco, 249, 269Boswell, James, ZSI-292, 269Bowles, William Lisle, 66,

287n.29Boyle, n. D., 55, l l8-119.214-

2t5.255Brontd, Charlotte, 236Bront€, Emily, 236Brooke, Rupert,267Brown, Edward, 47Bruckner, Anton, 236, 269Bunyan, John, 268

Burns, Robert, 17-18, 62, ffi,72,144, 24!9, 2G7, 286n.29

Burton, Robert, 4, Ig2, 231Byrd, Max, 93Byron, Hon. Augusta Ada (later

Countess of Lovelace), 16l-163, 7M, 177

Byron, Hon. Augusta (later Mrs.George Leigh), l5g, 160,l&, 168, r72, t73, t76, t77.179

Byron, Mrs. Catherine Gordon.159,160-161, 164, 166, 170

Byron, George Gordon, 6th Lord,2,7, 7t5, 122, 149_190.267

biographical sketch, 165-lg5diagnosis of manic-depressive

illness, 6l-62, Og, 153-lSS.Iffi-r65

discipline and self-control. I52*t53, 165, L7I_r72, 186_187.t90

dissipation and dissolution, 153,168*169, lg0

family history of mental illness,72,84,155_164, 235

fears of madness, 7, tlg, lTS,l8r, r84

finances, I53, 168, IZ6, l7glucidity and reason, 154, lgg_

190melancholia, lS0, l53, f67,

16g, 169, L70, I7l, L72,174, 175, 776, 177_179,l8l , 182

mutability of temperament,150*t52.154

on constitutional basis of hismelancholia, I5S, 160, I77.r8l-182, 192

on imagination, 124, 260on his lameness, 167-16g

INDEX 361

on his temperament, L53,I77-178

seasonal patterns to moods,154-155, 168, 180-181

suicidality, 43, rff, 176, I7g,182, 185

use ofdrugs and alcohol, 154,169, 175, 776

volatility and violence of tem-perament, 150, 153, lM,165, 166, 774-175, 176,182-184

wit, 160, 166, 168-169,r70, t7I, r72, r75, t7g,185

Byron, George Gordon, 6th Lord(works)

Childe Harold' s Pilgrimage, 52,l0r, r24,170, l7l, 178-179,185, 190, 202

The Corsair,173The D eformed Transformed,

167-r68Don luan, vii, 126, l5l, 176-

177, rB0,186-187, 188, 190,260

The Lamant of Tasso, 749I-ara. I52Manfred, 48, 747, 152, 173,

179, r99,205On This Dag I Complete Mg

Thtrty-Sixth Year, I84Byron, Lady (n6e Annabella Mil-

banke), 151, 161, 164,174-178, 189-190

Campbell, John, 34Campbell, Thomas, 62, 68,

72, 236, 267, 289n,29Caramagno, Thomas, 224,

227

Carbamazepine, 17, 24I, 246,346-347n.35

Carey, John, 312n.100Carlyle, Thomas, 97-98, 109Carroll, Jonathan, 3l-32Cecil, Lord David,22Celan, Paul, 125, 249,267Chatterton, Thomas, 52, 62,

65, 72, 236, 249, 267,285n.29

Clare, John, 62, 69, 72, L4I, I44,250, 267, 290n.29

Clarke, Jeremiah, 269Clemens, Samuel, I28, 236, 268Coleridge, Hartley, 62, 70,72,

222, 267, 29In.29Coleridge, Samuel Taylor, 7, 40,

53, 62, 67,72,98, r09-rr0,Itl, 200, 2r9-2tut, 250, 267,268,288n,29

Coleridge, Sara, 219, 222,-224Collins, Francis, 253Collins, William, 62, 63, 95, 267,

283n.29Conrad, Joseph, 268Conroy, Pat, 195Cotman, John Sell, 236,269Courbet, Gustave, 236Coward, Noel, 269Cowper, William, 20-21, 22-?3,

62, 64, 72, 9I-92, 95, 122,267,284n.29

Crabbe, George, 65,72, L44,285n.29

Crane, Hart,249,267Cyclothymia

clinical description, 13-16diagnostic criteria, 263-264genetics, 16relationship to manic-depressive

illness, 13-16treatment. 16

Dadd, Richard, 60, 236, 269,342n.Iffi

Damon, S. Foster. gPDante Alighieri, l, Ll, IZ, 124Darley, George, 62,70, 267,

29In.29Davidson, John, 24g, 267Davis, loel,256Dayes, Edward, 26gDepression

clinical description, lB, 17-27diagnostic criteria, 26L-262epidemiology, fO-lZ, 72, 88-g9literary accounts:

Lewis Grassic Gibbon. 26Sylvia Plath, ZG-27Theodore Roethke. 27William Shakespeare, 20

personal accounts:Hector Berlioz, lg-20Robert Burns, 17-18Ceorge Gordon, Lord Byron,

L72William Cowper, ZO-2I,

22-23F. Scott Fitzgerald, 23Gerard Manley Hopkins, 25James Clarence Mangan, 24Edgar Allan Poe, l8-lgRobert Schumann, 22, 204Edward Thomas, ZI, ZJ-24Hugo Wolf, 2lVirginia Woolf, 26

rates in artists, writers, andcomposers, 60-80, 88-89,267-270

relationship to manic-depressiveillness, 17,27\n.l2

Depression and creativity; see alsoMania and ereativity; Mooddisorders and creativity

art as healer, LZL-IZI

literary accounts:John Donne, I23Randall Jarrell, l2lJohn Keats, llgEdgar Allan poe, 120Theodore Roethke, ll5Percy Bysshe Shelley, Il5Alfred Lord Tennyson, 120,

123Edward Thomas, 119-120

personal accounts:Hector Berlioz, 122John Berryman, l4-ll5T. S. Eliot, IZZ-tZsJohn Keats, ll5Robert Lowell, ll7Anne Sexton, ll7Vincent van Gogh, ll7Virginia Woolf lt8

uses of melancholy, ll7-lhsuses ofordeal and pain, ll4-

1t8Dickens, Charles, 268Dickinson, Emily, 45, 267Dinesen, Isak, ggO, ZO8Dionysus, 50-51Ditlevsen, Tove, 24gDNA analysis, 59Donizetti, Gaetano, 189Donne, John, 123, 239,312n.100Dowland, John, 26gDowson, Ernest, 236, 267Drayton, Michael, IDyson, Hope, 199

Eakins, Thomas, 236, 2OgEastwood, M. R., 135Edel, Leon, l2t-L22,124, ZlsElectroconvulsive therapy, 247

use by writers and artists, 76,77 .229

II\'DEJ( 363

Elgar, Edward, 269Eliot, George,214Eliot, T. S., 32, llg,l2Z-I23,

r37.20L.267Ellis, Havelock, 59Emerson, Ralph Waldo, 236, 247-

248,268Epilepsy,59, f4l, 142, 163-164,

316n. 125. 3I7 -319n. 126Escobar, Javier, 80Esenin, Sergey, 249, 267Eugenics, 8, 214-216, 254-256Evans. David. 75

Falret, Jean Pierre, 35Faulkner. William. 269Fergusson, Robert, 62, 64, 267,

284-285n.29Fet, Afanasy, 267Fieve, Ronald, 245Finch, Anne (Countess of Win-

chilsea), 267FitzGerald, Edward, 201, 236,

267Fitzgerald, F. Scott, 7, 23, 36,

268, 269Fletcher, john Gould, 249,267Foster, Stephen, 269Foucault, Michel, 35Fr<iding, Gustaf, 267Frosch, William, 91, 297-298n.63Frye, Northrop, 92

Gainsborough, Thomas, 236Galton, Francis, 59,84, 254Garrison, F. H., 206Gary, Romain,249Gauguin, Paul, 268, 269Gene therapy, 8, 253, 256-258,

352n.68

Genetics of manic-depressive ill-ness,7, 8, f91-237, 25f-259

abortion, 8, 253-2il, 35In.57amniocentes is, 8, 253-254assortative mating, 194, 235-

236complexity, 25?--258conferred advantage, 82-86,

25r-252.255-256ethical issues, 25f-259, 349-

350n.53eugenics, 8, 214-216, 254-

256family studies, 193-194, 342-

343n.168gene-environment interactions,

194-195. 25%-253gene therapy, S,253, 256-258,

352n.68genetic enhancement, 254Human Genome Proiect, 256-

258literary accounts:

Ernest Hemingway,228Herman Melville, l9l, 237Walker Percy, 259Edgar Allan Poe, 192-193Alfred Lord Tennyson, 196

prenatal testing, 8, 253-254,349-350n.53

privacy of genetic information,349-350n,.53

sterilization (involuntary), 8,214-216,253-255

twin studies, 193, 329--330n.6G6ricault, Th6odore, 234, 269,

338n.155Gershon. Elliot. 194Gesualdo, Carlo, 269Gibbon, Lewis Grassic, 26, 269Glinka, Mikhail, 269Goes, Hugo van der, 269

Goethe, Johann Wolfgang, gZ-98,188. 236

Gogol, Nikolai, 2SO, 269Goldsmith, Oliver, 62, M,267,

284n.29Goodwin, Frederick, 86, l3l,

132-133Gordon, Adam Lindsay, 24g, 267Gorky, Arshile, 268, 269Gorky. Maxim, 26gGostin, Larry, 253-254Graham, Kenneth, 296, 269Gray, Thomas, 63, 22, 2g6, 267.

283n.29Greene, Graham, 49, lZ4, 269Guiccioli, Teresa, 1S4, lSS, lB0Guilford, J. P., t05-106Gumilyov, Nikolai, 267Guston, Philip, 270

Holmes, Richard, 126, 220Holst, Gustav, 269Hood, Thom as, 7 l, 2gln.2gHopkins, Gerard Manley, 25,

250,267Hudson, Liam. 106Hugo, Victor, 189, 2J5,267,

341n, 168Hulsker, Jan,2BS,234Human Genome Project, 256-25}Hunt, Leigh, 68, 72, ZSl, 28gn,2gHypomania: see Mania

Ibsen, Henrik, 26gInge, William, 249, 26gInnes, George,2TOIves, Charles,26g

Hamilton, Ian, 4*SHandel, George Frideric, 205,

269.298n.6JHarding, Rosamond, 144Hawker, Robert Stephen, 71,72,

267,292n.29Hawthorne, Nathaniel, IZ4_LZS,

2r7Haydon, Benjamin, 28, 249.270Hazlitt, William, 109, lggHeaney, Seamus, 8, g, g8-ggHemingway, Ernest, 7, 36, ZZ8-

230,235, 249,268, 269Hendrickson, Paul, 22gHesse, Hermann, f5, 236, 269Hill, Carl. 270Hippocrates, l3lHirshfield, A. J., Of, 88, 89Hobhouse, John Cam, 166, L7b,

r77, r7gHrilderlin, Friedrich. 267

Jameison, G. R., 46James, Henry, 7, 84, 207-2}:6.

22A.269James, William, T,54, g4, Z0T_

216, 220,269Jarrell, Randall, lZ, I2l, Z4g,

268,349n.48Johnson, Samuel, G9,72, ZJI-

232,268,283n.29Josephson, Ernst, 270Juda, Adele, 59, 00. 84Judd, Lewis, 249, 244, 246

Karlsson, Jon, 84-85, 236Kasper, S., 135Kass, Leon, 35ln.5TKeats, John, 28,70,72, 98, 109-

110, tl4, 115, 1r9, L26.152.259, 268, 29tn.29

Kendall, Henry, 268Kevles, Daniel. 254

INDEX 365

Khlebnikov, Velimir, 268Kinney, Dennis, 108Kirchner, Ernst Ludwig, 249,270Kleist, Heinrich Von, 249, 268Klemperer, Otto, 269Knudtson, Peter, 25I-252,

352n.68Koestler, Arthur, 103-104, ll5-

116Kraepelin, Emil, 34, 36, 41,54,

106-107, t3IKranzler, Henry,232Kretschmer, Ernst, 14Kropf, D.,243

Lagencrantz, Olof, 111Lamb, Lady Caroline, I7I-I72,

176Lamb, Charles, 53-54, 236,269Landor, Walter Savage, 62, 68,

268.288-289n.29Landseer, Edwin, 270Lange-Eichbaum, W., 84Lassus, Orlando de, 269Lear, Edward, 268,270Lehmbruck, Wilhelm, 249, 270Lenau, Nikolaus, 268Lenz, J. M. R., 268Lermontov, Mikhail, 268Lewis, C. Day, 185Lewis, R. W. B., 272,275Lindsay, Vachel, 249, 268Liszt, Franz, 189,207Lithium, 7, 16

effects on productivity, 245-246

efficacy, 77,248, WvASpossible adverse effects, 241-

248use by writers and artists, 77,

80

Lombroso, Cesare, 53, 59, 84,137-138, t42,743

Longinus, 98Lowell, James Russell, 37, 268,

338n.157Lowel l , Robert , 4-5,7,8,9, l l ,

12, 13, 28-29,32, 36, 38, 43,48, 99, tr4, 7r7, 723-724,72t726, 234, 249,268, 338-339n.157

Lowry, Malcolm, 269Lucretius, I44Ludwig, Arnold, 61, 89Lynn, Kenneth S., 229

MacDiarmid, Hugh, 268Maclean, Sorley, 145, 353n.75MacNeice, Louis, 236, 268Macpherson, James, 64, 284n.29Maher, Jane, 2I5Mahler, Gustav, 234, 269,

338ru.156Mandelstam, Osip, 268Mangan, James Clarence, 24, 62,

71,72, 268. 292n.29Mania

clinical description, 13-14,27^33

diagnostic criteria, 262-263,265

expansiveness and grandiosity;visionary states, 13*f4, 28,ffi, 67, 69, 70, 92-95,229n.74

literary accounts:Saul Bellow, 30Jonathan Carroll, 3l-32Herman Melville, 219Edgar Allan Poe, 3l

personal accounts (hypomania,mania, or mixed states):

866 INDH(

Mania (cont.)George Gordon, Lord Byron,

782_784Robert Lowell, 44, 28-29,

32Theodore Roethke, 28John Ruskin, 29, glVirginia Woolfl 29-30

religious mania, 29, 63, 2ggn.74seasonal patterns, 131-135

Mania and creativity; see also De-pression and creativity; Mooddisorders and creativity

boldness and ardor of tempera-ment, ll3-114, 116

combinatory thinking, 107-108grandiosity and expansiveness,

109-l12personal accounts:

George Gordon, Lord Byron,105

Samuel Taylor Coleridge,109-110

John Keats, 114Edgar Allan Poe, 116Arthur Rimbaud. 114John Ruskin, ll3August Strindberg, lf l-f l3

rapid, fuid, and divergentthought, l0b-l13

rhyming and punning, 108Manic-depressive illness; see also

Depression; Genetics; Manja:Suicide; Treatment

age of onset, 17clinical description, 11-48diagnostic criteria, 26I, 265epidemiology, 16-L7, 88-89mixed states. 35-36natural course, 16, 250oscillating pattern, 33-36, 98,

L25-729

rates in artists, writers, andcomposers, 60-80, 88+9.267-270

seasonal patterns, L6, I2VL44:see also Seasonal patterns

social class, 86-87, 2g6n.S4Marchand, Leslie, 156, 180, lgg-

184, 189Martin, John, 236, 270Martin, Robert Bernard, lg7, lggMartindale, Colin, 60Matthiesen, F. O., 212, ZlsMaudsley, H., 209Maurois, Andr6, 157Mayakovsky, Vladimir, 47, Z4g,

268Mayer-Gross, W., 130McCreadie, R. G., 80McGann, Jerome, 127McNeil, Thomas, 85-86. 236Mead, Richard. 35Melancholia: see DepressionMelville, Herman, 7, ll0, llg,

162, lgt, 216_219, 220,237,269

Mendelssohn, Felix, 204M6nidre's disease, I4l, l4Z,

317n.726Meredith, William, 28-29M6ryon, Charles, 270Metabolic disorders; see also por-

phyriathyroid, 59, 315-316n.lIG.

340n. I59Meyer, A.,lM-L46,206Meyer, Michael, ll2Michelangelo, 270Middlebrook, Diane Wood, t22,

339-340n.159Millay, Edna St. Vincent, 268Mingus, Charles, 269Mishima, Yukio, 249

INDEX ffi7

Mixed states. 35-39Mcibius, Karl August, 53Monticelli, Adolphe, 270Mood disorders and creativity;

see also Depression and cre-ativity; Mania and creativity;Seasonal patterns

confusion and controversy, 3-6,49,90-99, r02

effects of treatment, 241-248evidence:

biographical studies, ffi-72,88-89,267-270

family studies, 82-86studies of living writers and

artists, 72-82,88-89history of relationship, 50-56role ofcognitive changes, 105-

n3role ofopposite and fluctuating

states, 5, 6, 125-129role of temperament, 97, 102-

r29Moore, Doris l,angley, 162, 169,

L74, r89Moore, Marianne, 236Moore, Thomas, 43, 68, 128-129,

150-151, 160-161, t66, L74,189. 289n.29

Moreau, Jacques-Joseph, 53Morrison, D. P., 80Mozart, Wolfgang Amadeus,

298n.63Mudge, Bradford Keyes, 223Miiller-Oerlinghausen, 8., 243Munch, Edvard, 2,36, 24I,

270Musset, Alfred de, 189, 268Mussorgsky, Modest, 268, 269Myers, Gerald, 215Myerson, A., 55, 118-119, 214-

2L5.255

Nerval, G6rard de,2.,119, 2ffiNeuroimaging techniques, lll-

112. 3M-306n,.32Neuroleptics, 24L, 2tl7Neuropsychological studies, I 12,

30G-308n.33Nicolson, Harold, 90-92, 199Nisbet, J. F., 59Norman, Hubert, 92-93, 94

Oates, Joyce Carol, 49, 90Ober, William, 95-96, 232Obsessiveness, 98, 301n.85O'Keeffe, Georgia,270O'Neill, Eugene, 235, 268, 269,

341n.16LOsler, Sir William, 212Ostwald, Peter, 206

Parker, Charles, 269Parkman, Francis, 236, 269Pascin, [ules,249,270Pasternak, Boris,268Pavese, Cesare, 45, fulg,

268Peacock, Thomas Love, 69,

289n.29Peale, Raphaelle, 268, 270Percy, Walker, 2"36, 259Phototherapy, 247Pinel, Phillipe, l3lPlath, Sylvia, 26-27, 236, 249,

268Pla to ,51 ,56 ,96 , t tgPoe, Edgar Allan, 18-19, 31, 36,

37, ffi, 110, 116, 120, 762,192-193, 250, ?55,zffi.277n.73

Polatin, P.,245Pollock, Jackson, 236, 270

368 Ili'DEx

Porphyria, l4l, 142, 317-379n.726

Porter, Cole, 236, 268, 269Porter, Roy, 232Posidonius, 131Pound, Ezra, ffi,268Powell, Bud, 269Powers, Pauline, 107Pratensis, Jason, 35Prenatal testing, 8, 253-254Psychotherapy, 7, 17, 240-247Pushhn, Alexander, l8g, 208

Rachmaninoff, Sergey, 26gReich, Nancy, 206Richards, Ruth, 81-82, 108.

236Riding, Laura, 268Rimbaud, Arthur. ll4Robertson, John, 255Robinson, Edwin Arlington, 236Roethke, Theodore, 12, 27, 28,

174, 775, 7I7,250,269Rogers, Samuel, 66, 287n.29Romney, George, 270Rosenthal, Norman, 135Rossetti, Dante Gabriel, 236,270Rossini, Giocchino, 189, 236, 269Roth, Sir Martin, 15. 130Rothko, Mark,249,270Rowse, A. L., f58Rush, Benjamin, 52-53, 54Ruskin, John, 29, 31, 60, 96-97,

110-lll, 113, l2g, rgg, 236,250,269.270

Russell, Bertrand, 189

Sandblom, Philip, 309n.51Schildkraut, Joseph, 61, 88, 89Schizophrenia, 3-4, 59_60, 73,

'74, %, r07, 141, 154,247,255,342n.766

Schoenberg, Arnold, 18gSchou, Mogens, 242.-243, 245-

246Schubert, Franz, 12I, L28Schumann, Robert, 6,7, 22, ffi,

84, l2r, l2g, l4l, lgg, 22g,235, 250, 269

biographical sketch, 201-207compositional patterns, 144-146family history of mental illness,

202,2MSchwartz, Delmore, 12, 30, 33,

136. 268Scott, Sir Walter, 67, 105, l7B-

179.287-288n.29Scriabin, Alexander, 236, 269Seasonal patterns, 50-51, l2g-

144, 313-316n.109-116artistic productivity, L37-144cognitive functioning, 135, Bfs-

316n.116cyclothymia, 15depression, 131-135mania. l3l-135neurobiological systems, 135,

3lA{16n.116suicide. f3f-135van Gogh's artwork, 741*144

Sexton, Anne, 12, lL7, I22,295,249, 268, 339-340n.189

Shakespeare, William, 20, 53Shelley, Mary, 84, f6l, f80, 230-

231,269Shelley, Percy Bysshe, 46,62, G9,

gl, gg, ll5, 126, 152, 16l,169, 179, 180, 182, 231,269,290n.29

Shuldberg, David, 108Slater, Eliot, 15, 130, 144-146,

206

INDD( 369

Smart, Christopher, 62, 63, 95,110,268, 283-284n.29

Socrates, 51Southey, Robert, 67, 288n.29Spender, Stephen, ixSta€l, Nicolas de, 249,270Stafford, Jean,269Stevenson, Robert Louis, 126-

t27,236,269Storr, Anthony,57, I2IStrindberg, August, 60, ltl-

II2,234,269, 340-341n.160

Strouse, Jean,2l4,275Styron, William, 44Suicide, 16, 41-47, 267-270

literary accounts:John Berryman, 339n.158Ernest Hemingway, 228Robert Lowell, 43Vladimir Mayakovsky, 47Percy Bysshe Shelley, 46

personal accounts of suicid-

A. Alvarez. 4546Ralph Barton, 42George Gordon, Lord Byron,

43, 176, l8tGraham Greene, 43William Styron, 44Leo Tolstoy,4445Virginia Woolf,224

rates in artists, writers, andcomposers, 61,73-74,88-90,267-270

Suzuki, David, 25I-252,352n.68

Syphilis, 2I, 62,71, 205Swedenborg, Emanuel, 209,

299n.74Swinburne, Algernon Charles,

92-93

Tasso, Torquato, 149, 268Taylor, Ronald, 206Tchaikovsky, Peter, 189, 205,

236.269Teasdale, Sara, 249, 268Tennyson, Alfred, lst Baron, 7,

84, 119, 120,123, lgg, 192,196-20I, 2ll, 220, 229, 235,268

Tennyson, Sir Charles, 199Tennyson, Hallam, 199Testa, Pietro, 249, 270Thomas, Dylan, 41,268Thomas, Edward, 2I, 23-2tt,

ll9-120, 225,24L,268Thomas, Lewis, 251,258Thompson, Francis, 267, 268Thomson, Virgil, 189Tilson, Henry, 270Tolstoy, Leo, 4445,269Toole, John Kennedy, 249Trakl, Georg, 268Tralbaut, M. E., 234Treatment, 247-257

anticonvulsants (carbamazepineand valproate), 7, l'7, 241,246,346-347n.35

antidepressants, 7, 17, 24I,247use by writers and artists,

7 7 , 8 0artists'concerns about, 7, 8,

247,245,248electroconvulsive therapy, 247

use by writers and artists, 76,77 .229

lithium, 7, t6effects on productivity, 245-

246efficacy, 77, 248, 348n.45possible adverse e$ects, 241-

248

Treatment (cont.) (lithium)use by writers and artists, 77,

80neuroleptics, 241, 247phototherapy, 247psychotherapy, 7, 17, 24G-247rates of treatment in writers

and artists, 74,76-77, 80,267-270

risks of no treatment, 24L, 248*251

sleep deprivahon,24TTrethowan, W. H., 60-61Trilling, Lionel, 55, 50Tsvetayeva, Marina, fu19, zffiTuberculosis, 70,7lTurgenev, Ivan, 269Turner, J. M. W., 189, 2gG

Valproate, 17, 241, 24.0, 3/rG-M7n.35

van Gogh, Vincent, 6,7, 46, 47,60, 96, tt7, t44,2419,zfi,270, 3r74rgn.L26

family history of mental illness,74r,233-2U

seasonal patterns, l4I-I44Verdi, Giuseppe, l8g

Walker, Violet, 158Warlock, Peter, 26gWarton, Joseph, 64, 2\4n.2gWatson, James, 258-259, 349n.53

Watts, George Frederic, 270Wehr, Thomas, 130Weissman, Myrna, 80Wharton, Edith, 2f2Whitman, Walt, 920, 936, 26gWilkie, Sir David, 270Williams, Tennessee, 36, 23S,

268, 269,341n.162Willis, Thomas, 3bWittkower, Margot, 55, 56Wittkower, Rudolf, 55, 56Wolf Hugo, 21, 27, 45,zGB,269Wollstonecraft , Mrry, 2J0-25I,

269Woodberry, George Edward, 116Woolf, Leonard, 29-30Wool{ Virginia, 7,2O, Zg-gO, ffi,

84, ll7-llg, 126, 129, 249,250, 269

family history of mental illness,22,'4,-227, 229, 235_236

Wordsworth, William, SZ, 67,200,287n.29

Wyatt, Richard, 141-143, gl7*319n.126

Yal lom, L ,229Yal lom, \L,229Yeats, William Butler. I04

Zimmerman, Bernd Alois, 26gZola, Emile, 236, 269Zorn, Anders, 270

About the Author

Kay Redfteld Jamison, Ph.D., is professor of psychiatry at the Johns Hophnsuniversity school of Medicine and co-author of the definitive medical textManic-Depressioe lllness. Dr. ]amison is a member of the National Advisorycouncil for Human Genome Research. she is also the executive producer andwriter for a series of award-winning public television specials about manic-depressive illness and the arts.