Creativity and Bipolar Disorder: A Fresh Look

BOOK REVIEW

Robert Lowell, Setting the River on Fire: A Study of Genius, Mania, and Character

by Kay Redfield Jamison; New York: Alfred A. Knopf, 2017

560 pages • $29.95 (hardcover)

Reviewed by Burns Woodward, MD

Robert Lowell, Setting the River on Fire is an investigation of one of the most famous and well-documented cases of manic-depressive illness (the former term for bipolar disorder), as well as a fresh look at the relationship between mood disorders and artistic creativity. Kay Redfield Jamison’s previous books have taught us a great deal: Manic Depressive Illness, the textbook she co-wrote with Frederick Goodwin, is an essential reference.¹An Unquiet Mind, her bestselling memoir of her own bipolar illness, showed us what it means to experience extreme mood swings.²Night Falls Fast was a fearless consideration of suicide.³

[[{"type":"media","view_mode":"media_crop","fid":"59300","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9723936994846","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7501","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 120px; height: 180px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Now she returns to questions about mood and creativity raised by her groundbreaking 1993 book, Touched With Fire.⁴Setting the River on Fire goes much further, drawing on the words of Lowell and his highly articulate family members, friends, and doctors to give us one of the richest portraits ever written of bipolar illness and its effects on patients and those who care about them.

Lowell (1917-1977) was one of the most original and influential poets of the mid-20th century. His work drew extensively on his life experience, family history, and public events. From adolescence he experienced episodes of psychotic mania, followed by depressive remorse about his hurtful behavior. “I remember all the mean things I said and did while I was sick,” Lowell wrote. “One by one . . . I just shrivel with shame.” Yet he not only produced elegantly crafted poetry but maintained rich and lasting relationships with friends and family, especially his second wife, Elizabeth Hardwick, who is in some ways the heroine of the book. He addressed his experiences of mental illness explicitly in poems like “Waking in the Blue,” “Home After Three Months Away,” “Man and Wife,” and “Skunk Hour.”

Jamison obtained consent from Lowell’s daughter to review the medical and psychotherapy records of his 20 hospitalizations. She juxtaposes Lowell’s distinctive observations of his mental status with the medical language of his doctors. Lowell’s mania responded well to the treatments of the times-ECT and later chlorpromazine. In the late 1960s, lithium gave him a few years of relatively stable moods. Jamison also discusses the role of Lowell’s psychotherapy in the generation of his poetry.

The poet and critic Dan Chaisson writes that “Jamison’s study tells us a lot about bipolar disorder, but it can’t quite connect the dots to Lowell’s work.”⁵ Arguing that while rates of mood disorders are elevated in creative individuals, and features of manic speech (such as clang associations) are similar to poetic devices (like rhyming), most poets do not have bipolar disorder, and most people with bipolar disorder are not especially creative. Furthermore, he says, for most poets-especially Lowell-rhyme indicates the “calculation and aesthetic design” that emerge from disciplined revision.

Jamison proposes that the intense emotional states of mania enable the artist with bipolar disorder to focus on single ideas, similar to the way stimulants focus the minds of people with ADHD.

Although Jamison does not fully resolve the conundrum of creativity and madness, she advances our understanding. After describing the knight’s-move thinking in manic flight of ideas, she proposes that the intense emotional states of mania enable the artist with bipolar disorder to focus on single ideas, similar to the way stimulants focus the minds of people with ADHD.

Although Lowell’s poetry emerged from his mood states, his artistry was far more than the ramblings of a manic patient. In Jamison’s words, “When mania swept through Robert Lowell’s brain it . . . came into dense territory, thick with learning, metaphor, and history. . . . The words of Dante, Shakespeare, Pasternak, Hardy, and Milton were not just in his mind but were his mind, kept alongside the place he kept for Dutch paintings and Beethoven’s late quartets. . . . Mania, when it came, shook his memory as a child shakes a snow globe.” And, as Chaisson notes, discipline was crucial.⁵ “My trouble,” Lowell wrote, “is to bring together in me the Puritanical iron hand of constraint and the gushes of pure wildness. One can’t survive or write without both but they need to come to terms. Rather narrow walking-”

The subject of the book is more literary than biological, but Jamison mentions a fascinating genome-wide association study of the inheritance of creativity and bipolar disorder,⁶ another finding that the tendencies to elated versus irritable mania can be distinguished genetically,⁷ and interesting experimental work on induced positive moods.⁸ An appendix on Lowell’s medical history by Jamison’s husband, cardiologist Thomas Traill, briefly discusses the reduced life expectancies of persons with bipolar disorder, to which the strongest contributor is the cardiovascular disease that killed Lowell at the age of 60.

Jamison emphasizes another element in Lowell’s success, which she calls character-a combination of resilience, the ability to maintain loving relationships, and courage: “Lowell ran the race set before him aware of the precariousness of his mind, uncertain after each break whether he would write again, love again, teach again. Or whether he could regain the edge to write poetry that would ‘change the game.’”

Jamison’s paragraphs vibrate with quotations from Lowell, his wives, family, friends, literary colleagues, and physicians, as well as her own original language. She offers fascinating new readings of a number of Lowell’s poems. At the end of the book she discusses what many consider his greatest poem, “For the Union Dead.” The author meditates on its subject-the first all-black regiment to fight in the Civil War, Saint-Gaudens’s great memorial sculpture on Boston Common, the courage of Colonel Shaw and his soldiers in their mortal fight, and Lowell’s courage in fighting his way back from repeated episodes of insanity.

Psychiatrists and the lay public will find in Robert Lowell, Setting the River on Fire a uniquely rich case study of bipolar disorder by a great psychiatric writer, illuminated by a courageous, perceptive, and articulate patient; his doctors; family; and friends. Those interested in creativity and mental illness will find a new exploration of this complex area, and literary readers will appreciate Jamison’s perspectives on Lowell’s poems. People with mood disorders and those who care about them are likely to experience a healing reconsideration of their own experiences as they read this wonderful book.

This article was originally published on 5/8/17 and has since been updated.

Disclosures:

Dr. Woodward is Clinical Assistant Professor of Psychiatry at Boston University School of Medicine.

References:

1. Goodwin FK, Jamison KR. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression. 2nd ed. New York: Oxford University Press; 2007.

2. Jamison KR. An Unquiet Mind: A Memoir of Moods and Madness. New York: Alfred A. Knopf; 1995.

3. Jamison KR. Night Falls Fast: Understanding Suicide. New York: Alfred A. Knopf; 1999.

4. Jamison KR. Touched With Fire: Manic-Depressive Illness and the Artistic Temperament. New York: Free Press; 1993.

5. Chaisson D. The mania and the muse. Did Robert Lowell’s illness shape his work? The New Yorker. March 20, 2017:94-97. http://www.newyorker.com/magazine/2017/03/20/the-illness-and-insight-of-robert-lowell. Accessed April 24, 2017.

6. Power RA, Steinberg S, Bjornsdottir G. Polygenic risk scores for schizophrenia and bipolar disorder predict creativity. Nat Neurosci. 2015;18:953-955.

7. Greenwood TA, the Bipolar Genome Study (BiGS) Consortium. Genome-wide association study of irritable vs. elated mania suggests genetic differences between clinical subtypes of bipolar disorder. PLoS One. 2013;8:e53804.

8. Hennessey BA, Amabile TM. Creativity. Ann Rev Psychol. 2010;61:569-598.