Friday, August 9, 2013

Wagner's Abnormal Mind - Part 1

Wagner was very far from normal. (I’ve already outlined that here to a large degree.) Virtually everyone who met him—friend and foe—noted how unusual he was in a wide variety of ways. Many of his contemporaries felt he suffered from this or that mental illness, and the literature on what pathology he may or may not have suffered from is quite extensive. Clearly, as well, he was an incredibly gifted man. He was also well-aware of his difference from everyone else, and made frequent reference to it. Wagner, who was beset by both mental and stress-related physical problems his entire life, believed—and I will argue he is generally correct on this— that his stark differences from seemingly everyone else were both pathological and the source of his genius. Yet, whether stemming from or just coexisting with that pathology, he was extraordinary productive. His creative drive overrode whatever pathology stood in his path, as well as the multiple physical ailments that plagued him, and he succeeded in creating an incredible body of work, overcoming massive practical impediments along the way.

In the next several posts, I will be exploring all the above. I will be laying out pieces of the puzzle of his brain and, in my last post in the series, assembling all of them to try to create a coherent story. I should note that I have no particular expertise in the field. But I do feel I have a solid lay understanding of the area, as I have spent years studying the brain and mental illnesses and have a lot of practical experience with people who suffer from a wide variety of mental challenges, disorders, differences or illnesses...whatever you want to call it.

I am going to save the issue of the connection between his particular genius and “madness” for the next several posts. In this one, I just want to give an overview of my understanding of the issues, and my assumptions and understanding about the brain, mental illness and creativity, before tackling his specific case. But everything I touch on here will come back in his unique story, so pay attention!

I would like to start by (re)emphasizing my belief that a discussion of anyone’s mind must be put in the context of modern neurosciences understanding of the brain; to wit, our free will, if it exists at all, is severely limited. I wrote about the issue of free will here, and if you didn’t read it before, I suggest that as the starting point for this section. But for a quick review, the neuroscientist Sam Harris, who does not believe we have any free will, puts it this way: Free will is an illusion. Our wills are simply not of our own making. Thoughts and intentions emerge from background causes of which we are unaware and over which we exert no conscious control.” David Dennett opposes this view in general but agrees that free will doesn’t exist to any appreciable degree if we are not “wired right,” that is have retardation, brain damage, or mental illness.

The Brain

First, we all have unique brains. One of the key findings of modern neurology is the plasticity of the brain. In a nutshell, the brain’s experience alters its structure, therefore each of us has a very singular brain. An interesting article about the human mind from Salon summarizes this point:
Because each life path is uniquely personal, our individual patterns of neuronal connections are likewise uniquely constructed. Far more complex than a fingerprint, the intricate pattern of synapses makes every brain one of a kind, distinguishing even between identical twins, who share the same DNA code. The 1,000,000,000,000,000 or so neuronal connections that compose each brain’s structure form its unique signature, unprecedented and unrepeatable.
These structural changes can be minimal or, in the case of intensive study and work, much more significant:
Some alterations amount to no more than heightened sensitivity of the connections between neurons. A more significant form of adaptation is the formation of new synapses, which supports longer-term knowledge and skill development. The most radical structural change entails rewiring large sections of the cortex. Although we are used to thinking about learning along the timeline of minutes or hours, wholesale brain rewiring can occur over the course of many years. We see manifestations of significant neurological “remodeling” in the neural organizations of professional violinists and taxi drivers. Such remodeling might even include brain enlargement.
I am pretty sure that Wagner “rewired” his brain to be a finely tuned emotional machine. I can’t prove this contention, of course, but one study of professional musicians gives a clue to what I am proposing. These musicians, in contrast to the control group, were shown to have an increased ability to process emotion in sound. The study’s author said: “In essence, musicians more economically and more quickly focus their neural resources on the important -- in this case emotional -- aspect of sound. That their brains respond more quickly and accurately than the brains of non-musicians is something we'd expect to translate into the perception of emotion in other settings.”1

Mental Abnormality and Mental Illness

While we are all unique, there are certainly patterns of behavior that people have labeled as “normal or “abnormal.” This whole issue is rather fraught, as more often than not the “abnormal” has been viewed as pathological. However, sometimes things that were once considered pathological have been relabeled as okie-dokie. In my lifetime, for example, my lesbianism went from being considered a mental disorder that was criminalized behavior to being seen as mentally healthy and quite legal!

Obviously, just because something is abnormal doesn’t mean it is a necessarily a pathology; instead, it could be just a part of normal human variation. That said, in the US, the principal direction is clear: more and more behaviors are being identified as pathological. In a speech in 1939, Carl Jung noted with disgust that “we cannot stand abnormal people any more so there are apparently very many more crazy people”2

The blogger Steven Novella sums up the debate within the psychology profession of the issue of so-called “abnormalities”:

The question is essentially how we should think about symptoms of mood, thought, and behavior. At one extreme we night consider all aspects of human mentality as being part of the normal spectrum, with differences being just that – differences. Those who follow the position of Thomas Szasz consider labels on mental differences to be largely politically and culturally motivated forms of repression.

At the other end is the obsessive partitioning of every nuance of human behavior into one or another abnormal category – the medicalization of all human problems. This may be connected to an overly reductionist approach to psychology, seeing all behavior in terms of neurotransmitters and brain function and giving insufficient attention to higher order situational and cultural factors.

Clinically speaking, if a pattern of behavior is harmful to the individual or to others in society, it is generally considered pathological. The more severe the harm to the self or others, the more the person is perceived to be mentally ill. But what if the reason the person is harming themselves—i.e. the person has developed a mental disorder or a drug dependency, for example—is because of a reaction to long-term persecution for their “abnormal” behavior? Who is the person with the real mental illness, the persecutor or the persecuted? Returning to the issue of the historical labeling of homosexuality (and other “queer3 thoughts and behavior) as a pathology, I believe that there was—and is—a pathology related to the issue. However, it wasn’t queer people who had the mental illness (except as so driven by their persecution.) Instead, to my mind, it was the people who wanted to persecute those who were different who had the true mental illness, as they had a pathological fear or hatred of the “other” (often codified in religious dogma).

I am not arguing that mental illnesses that develop from persecution aren’t real, of course. Many queer people did and do, in fact, have mental problems stemming directly from the societal taboo on their behavior or thoughts. While the relatively broader acceptance of queer behavior has helped to lessen this problem, the taboo still remains fierce in many parts of the country, particularly for those people who cross gender boundaries. The flip side is that those intolerant behaviors that should be seen as pathological are not labeled as such due to a societal cultural paradigm accepting this behavior—such as persecution of those who are different than the general population—as normal and part of “human nature.”

The etiology of mental illness is, of course, complex and well beyond the scope of this blog. But, I do want to highlight one of the important precursors to its development: stress. To be persecuted or to be poor or to have a dysfunctional family environment brings on stress. There is large body of evidence that this can both can trigger the initial onset of mental illness as well as be a factor in the continuation of the illness and relapses into severe episodes. Read here for evidence on the relationship of mental illness and stress.  As well, it is linked to all sorts of physical problems as well, from long-term problems such as heart disease to an increased susceptibility to the common cold.4 This is particularly true for chronic stress.

Creativity and Mental Illness

There has long been an academic debate whether “madness” and creativity are linked. The debate is getting tantalizingly close to consensus with both long-term studies and neurological science finding clear links between several mental conditions and creativity, including depression and bipolar disorders, schizophrenia, ADHD and autism.  For a good overview of the topic with many references to the scientific research, see here

The fact that they are linked doesn’t mean, of course, that the majority of creative people have mental problems.5 But what has been repeatedly proven is that the numbers of highly successful creative folks who have had mental problems far exceed any control group.  This is the finding that has fueled the neurological and biochemical search.

One of the scientists who is unconvinced that there is a casual connection between creativity and mental illness is Johns Hopkins researcher Albert Rothenberg.6 In Creativity and Madness, he argues that madness and creativity are functionality incompatible: “Although creative people may be psychotic at various periods of their lives, or even at various times during a day or week, they cannot be psychotic at the time they are engaged in the creative process, or it will not be successful.”7 He then acknowledges that creative thinking “involves a great deal of mental and emotional strain,” which could lead to mental problems.8 

The problem is that he is arguing against no one. Researchers who believe that creativity and mental illness are often linked are not arguing that people create during psychotic episodes, but that mental illnesses can emotionally inform those artists about the human condition through their own suffering or, for that matter, euphoria.  The idea is that they then channel into their emotional revelations into their art during periods of relative or complete sanity.

Rothenberg did show through his research that there is one universal factor for creative success: extraordinarily high motivation, that is, a strong creative drive.9 The poet Carol Ann Beeman argues in her compelling book Just This Side of Madness that it is this drive itself which is can tip over to mental illness unless it is able to be satisfied:

The drive to create is explored through an increased affectivity and sensitivity to emotional stimulation into a total, unique, and individual expression of his or her experience of life. The artist just like the rest of us becomes burdened with the affective build-up associated with any biological or psychological drive state. Creative self-expression is the only constructive means through which artist can reduce the tensions inherent in the drive state to any effective degree. Without a suitable outlet to ensure the constructive channeling of the emotional content collected from his or her reactions of the world, the artist will inevitably break-down.10

However, the strains of the “constructive” act of artistic creation itself can lead breakdown. For instance, Leonard Woolf reports about his wife Virginia: “It was mental and physical strain which endangered her mental stability....Thus the connection between her madness and her writing was close and complicated, and it is significant that, whenever she finished a book, she was in a state of mental exhaustion and for weeks in danger of a breakdown.”11

While the link between creativity and “madness” has been all but proven, the main thing to reemphasize is that the act of creation generally requires sanity and detailed control, certainly for works that require skilled craft such as creative writing, composing, etc. (I mean, there could be exceptions: Jackson Pollack’s work looks nuts to me, and I can imagine it could have been done in a psychotic state without any problem.) As Salvador Dali said, “There is only one difference between a madman and me. The madman thinks he is sane. I know that I am mad.”

Note on the Diagnostic Statistical Manual (DSM)

Before I continue with this line of argument, I just want to interject that the whole concept of disorders as we understand them—the DSM being the standard reference for classification of mental disorders—is suspect, and there is now a large push-back to the symptom-based view of mental illness that it is not grounded in science. The recent release of the DMV-V has crystallized this debate. The new edition, though greatly criticized for some of its tweaks, doesn’t really change much from DSM-IV. The National Institute for Mental Health (NIMH) has publicly criticized its approach, not because of a radical break with the past, but because it hasn’t done so, which they believe in the modern era is essential. The organization's central argument is that the new techniques of brain science—still in their infancy— are the best way forward, and the DSM way of categorizing is, essentially, without scientific underpinning and therefore a dead-end. The director of the NIMH, in this open letter writes:

The weakness [of the DSM] is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.

He goes on to indicate his bottom-line: “But it is critical to realize that we cannot succeed if we use DSM categories as the ‘gold standard.’ The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories.”

Since all brains are completely unique, that too argues against any sort of reductionist model in which people suffering from a variety of mental—and often physical—symptoms can easily be slotted into this or that disorder. That said, it is hard to even discuss the subject without referring to the dominant model—the DSM—that exists in our culture now. I am hoping to avoid reductionism, as I absolutely believe that is impossible with Wagner, but I will of necessity refer to DSM disorders when I turn to Wagner.

Creativity and the Bipolar Disorder Spectrum

The strongest evidence showing a link to creativity consists of disorders on the bipolar spectrum. These disorders are characterized by cyclical mood changes between manic and depressive states. The changes can be extremely rapid or a person can be stuck in a “manic” or “depressive” episode for long periods. Sometimes both symptoms co-exist. On the mild end of the spectrum, it is called Cylothymia disorder, with the less-severe manic episodes termed hypomania. There are various subtypes, but the most severe is Bipolar I and the relatively more moderate is Bipolar II.

Kay Redfield Jamison, the author of Touched with Fire about creativity and bipolar or depressive disorders, writes in her book, “Mania is characterized by an exalted or irritable mood, more and faster speech, rapid thought, brisker physical and mental activity levels, quickened and more finely tuned senses, suspiciousness, a marked tendency to seek out other people and impulsiveness.”12 As for the depressive cycle, it “affects not only mood but the nature and content of thought as well. Thinking processes almost always slow down, and decisiveness is replaced with indecision and rumination. The ability to concentrate is usually greatly impaired and willful action and thought become difficult if not impossible.”13

The paradox of the disease is that many people who have it like aspects of it, and don't want to lose those parts of the disease. In this small study of people diagnosed with bipolar illness most viewed it “as a gift.”  The actor Stephen Fry, who has been diagnosed with the disorder, created a film to explore this conundrum.14  (Watch it here.)  He asked everyone he interviewed who had been diagnosed with the disorder if they would push a button to make it disappear. Only one would have done so. The three folks pictured below—Fry, Richard Dreyfuss and Carrie Fisher—all said that they preferred to keep their disease.  

At the time of the film, Fry had never even treated the disorder because he actually liked his manic self, believed it was essential for his creativity, and didn’t want that to go away.  However, the depression that accompanies the disorder has led him to make repeated suicide attempts (and according to this article about a recent suicide attempt, he seems to be treating the syndrome now).

There are a number of explanations and theories from neuroscience and psychiatric literature exploring this connection between bipolar and creativity. I can only provide a small smattering of them, and I am leaving out the scientific grounding as it would require many more pages. However, please follow the links below in the footnotes to get started on the biochemical and neuroscientific literature.15

The most obvious connection is that during the hypomanic state the artist has both the drive, stamina and confidence to express their emotional insights, often gained at the depressive trough. In this article by the psychiatrist Neel Burton, he highlights a study by Jamison of artists diagnosed on the bipolar spectrum, in which the majority self-reported that the hypomanic state led to “‘increases in enthusiasm, energy, self-confidence, speed of mental association, fluency of thoughts and elevated mood, and a strong sense of well-being.’ Participants also reported a noticeably decreased need for sleep and feelings of elation, excitement, and anticipation.” That such feelings and thoughts would potentially aid the creative process seems clear.

An article on the subject in Wired puts it this way: “The extravagant high descends into a profound low. While this volatility is horribly painful, it can also enable creativity, since the exuberant ideas of the manic period are refined during the depression.”

A New York Times article on the same subject suggests, “One idea is that since there is a genetic basis for affective disorders, the same gene may also produce artists. Geneticists suggest that because the way a manic depressive episode arouses brain activity -- triggering extreme swings of emotion -- the brain may become more adaptive to synthesizing incongruous thoughts. That process -- of reorganizing disparate emotions into a new order -- may be the essence of creativity.” 

Burton cautions in his article: “Thus, whilst there can be little doubt that bipolar disorder and creative genius are associated, evidence of causation and of the direction of causation is still lacking.”  Thus, he postulated that it was possible that the creative drive and the acts of artist expression itself that could trigger the disorder in some individuals and not the other way around as is generally imagined.

End Notes

1  See here.
2  As quoted in Beeman, Just This Side of Madness, page 32. It is easy to track this trend through the Diagnostic Statistical Manual of Mental Disorders (DSM). Each edition has led to an ever greater numbers of identified disorders; some of this is just refining and distinguishing but some of it is, in fact, pathologizing that which was not seen as pathological in the past. The DSM-I, from 1952, listed 106; the DSM-III, from 1980, listed 265, and the current DSM-IV has 297. The chair of the DSM-5 task force, David Kupfer, announced that the total number of disorders in DSM-5 would not increase, but subtypes were added!
3  I understand that some people aren’t comfortable with the use of the word “queer” to define the gamut of folks who are gay, bisexual, transgendered, transsexual and otherwise outside the norm of heterosexual and gender conformity. Oh well, get used to it. It’s a great term and so darned economical for writing!
4  See for instance this or this.
5  Though in the case of famous poets it is close to a majority, as a number of studies have shown the incidence of psychopathology to be around 50% for them; musicians and prose writers tend to follow with about 35-30% rates. See page 62 of Jamison, Touched by Fire and the whole of chapter 3.
6  Rothenburg, Creativity and Madness; this book came out in 1990, which in the world of brain science is in the relative dark ages.  I don't know if he has moderated his position with the changing evidence.
7  Ibid, 36 (emphasis in the original)
8  Ibid, 161
9  Ibid, 9
10  Beeman, Just This Side of Madness, 73
11  Ibid, 141
12  Jamison, Touched with Fire, 27. Jamison is both a professor of Psychiatry at Johns Hopkins (though a trained psychologist) and has suffered from the disease herself since early adulthood.
13   Ibid, 21
14   Fry obviously likes to tackle conundrums, in that he did the previously-linked documentary exploring his love for Wagner in the context of his Jewish heritage, too.
15  For some of the scientific underpinnings of the links between creativity and madness, see here and here on dopamine and the mesolimbic and mesocortical pathways; see here where you can either read or watch a Glenn Wilson lecture covering creativity and psychoticism, schizotype, apophenia; see here for the connection of a lower latent inhibition (LI) threshold to creativity and mental illness.

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