Many people with psychiatric disorders engage in creative activities, from informal hobbies to highly accomplished careers. While some distinguish their symptoms from their creative talents, others avoid treatment, fearing it will impair mental and emotional processes they value. After a brief summary of the complex relationship between creativity and psychiatric illness, this article focuses on the treatment of such patients. Two cases—the mathematician John Nash and the author David Foster Wallace—are presented to illustrate a nuanced approach that integrates medical knowledge with patients’ perspectives.
A few years after the groundbreaking work that earned him a Nobel Prize, John Nash began to experience signs of schizophrenia. About his delusions, he explained, “the ideas I had about supernatural beings came to me the same way my mathematical ideas did. So I took them seriously.”1 Nash avoided psychiatric treatment, and the only productive mathematical work he accomplished after his first psychotic episode occurred during several months when he took trifluoperazine.
David Foster Wallace, a MacArthur Fellow whose fiction and essays caught the experience of a generation, suffered from recurrent depression. In 2007 he discontinued longstanding treatment with phenelzine in part because he thought it was interfering with his ability to finish a novel. Tragically, his depression relapsed, and he committed suicide without completing the book.2 While it is impossible to determine the validity of Nash’s and Wallace’s ideas about their illnesses, medication, and creative abilities, their beliefs that they were linked contributed to decisions that ended their productive careers and, in Wallace’s case, his life.
A century of biographical research has documented mental illness in the lives of individuals like Nash and Wallace; a recent example is a study of the poet Robert Lowell by Kay Redfield Jamison, PhD. Lowell’s racing thoughts, flight of ideas, and divergent thinking during times of rising mania generated highly original language, which required extensive revision during euthymic periods.3
Older case reports have explored these issues as well. Mogens Schou, MD,4 described varying effects of lithium on artistic productivity in 24 lithium responders. Half reported benefit, but several discontinued the medication, believing it interfered with their creativity. Schou attributed the variations to type and severity of illness, individual sensitivity, and whether the artist tended to use manic symptoms productively.
Dr. Woodward is Assistant Clinical Professor of Psychiatry, Boston University School of Medicine. He is in private practice in Newton, MA.
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