Delusions & grandeur

Touched by madness: Beethoven may have suffered from bipolar disorder; Nikola Tesla claimed to have invented ‘death rays’; Charlie Chaplin’s mother Hannah was committed to an asylum; Virginia Woolf’s depression led to her suicide; John Nash suffered from paranoid delusions; Lucia Joyce was diagnosed with schizophrenia

”Great wits are sure to madness near allied, and thin partitions do their bounds divide.”

John Dryden, 1681

”There is no great genius without a tincture of madness.”

Seneca, 1st century AD

There does seem to be some truth in these assertions. Many great artists and scientists have gone slightly mad after their lofty achievements - Isaac Newton, Vincent Van Gogh and Ludwig van Beethoven are among those who spring to mind. They are not alone.

Nikola Tesla was an exceptional applied scientist whose inventions rivalled those of Thomas Edison. He obtained around 300 patents in radio and electricity technologies, pioneering alternating current and hydroelectric power. He also claimed to be in communication with other planets and to have invented “death rays”, and he suffered from bizarre compulsions (love of pigeons and fear of germs being two major obsessions).

Wilhelm Reich made major contributions to psychoanalysis and marital and sexual therapy. However, he had delusions of persecution, believed he represented a special advanced version of the human species and developed “cures” for cancer based on his theory of the “orgone”, a new type of energy that only he and his followers were able to detect. He died in prison in 1957 after being convicted of fraud for selling his “orgone accumulators”.

John Nash, the Nobel prizewinning mathematician who developed “game theory” for the social sciences, also suffered paranoid delusions throughout his career. He was hospitalised involuntarily and had to feign sanity to be released. He still heard the voices but learned to live with them and not to talk about them.

“I wouldn’t have had such good scientific ideas if I had thought more normally,” he claimed.

Sometimes it seems to be a matter of chance or social milieu that determines whether an individual is deemed brilliant or crazy. Galileo Galilei may not have been mad exactly in the eyes of the Counter-Reformation Church (more heretical, perhaps) but its leaders clearly failed to recognise his genius and he was subject to house arrest in order to suppress his views. In other times and places, Pablo Picasso and Albert Einstein might have been committed to the insane asylum rather than revered for their original thinking.

Many lists of creative achievers throughout the ages - along with the mental health symptoms and diagnostic categories retrospectively assigned to them - have been compiled. Unfortunately, these are mostly anecdotal, speculative and lacking in proper controls for comparison. Some have argued that the connection between genius and madness has been over-egged because of a few high-profile cases such as those described above.

The best evidence in support of the genius-madness link comes from behaviour genetic studies. The close relatives of creative people are more likely to be schizophrenic and vice versa (psychotics having more creative relatives).

Einstein, for example, had a son who suffered from schizophrenia, while Bertrand Russell had many relatives with the condition. According to Dean Keith Simonton, author of Origins of Genius: Darwinian Perspectives on Creativity (1999), “creative hits and crazy misses” are mixed within many illustrious family pedigrees, including the Darwins, the Galtons and the Huxleys.

Similar thought processes, such as unusual and grandiose ideas, together with the determination to promote them, are seen in both the genius and the deranged. Certain neurotransmitters and gene loci have been cited as common to both, including the male sex hormone testosterone; a growth factor involved in neural development and plasticity called Neuregulin 1 (NRG1); and genes modulating dopamine transmission in an area of the brain called the striatum (for example, DARPP-32).

Dopamine function (or dysfunction?) has been widely invoked to account for the link between genius and madness. Dopamine is the chemical messenger in the mesolimbic and cortical areas of the brain that are concerned with approach, reward, positive mood and achievement-seeking. Genes that modulate dopamine levels are reported to affect novelty-seeking behaviour and to relate to impulsivity as a personality trait. Recreational drugs that are addictive and sometimes lead to delusions and hallucinations (for example, amphetamine psychosis) usually raise the levels of dopamine in the brain. By contrast, anti-psychotic medications are nearly always dopamine antagonists (this being one of the reasons why compliance with such treatments is difficult).

Many theorists have proposed that the link between genius and psychosis is one of “loose associations”. In laypeople’s terms this is “thinking outside the box”, and such flexibility of thought seems to be increased by dopamine. It can be observed in unusual responses on a word association test or in some of Salvador Dalí’s surrealism, such as the Lobster Telephone (1936) and the Mae West Lips Sofa (1937).

One description of the schizophrenic thinking style is that it tends to be “overinclusive”, since the boundaries of relevance seem to have been set more broadly. To most people, an apple falling off a tree and the movement of planets in the solar system would appear to have nothing in common, but Newton was insightful enough to connect them under the grand unifying concept of “gravity”. Of course, not all such generalisations turn out to be that useful.

According to my mentor at the Institute of Psychiatry, H.J. Eysenck, unconventional thinking is characteristic of a constitutional personality trait called “psychoticism” (P). P has many facets, including tough-mindedness, lack of empathy, impulsiveness, risk-taking, adventure-seeking, bizarre thinking and a refusal to adhere to social norms. High levels of P, he reckoned, predispose to psychopathy and clinical psychosis as well as to creativity, and it is this that accounts for the overlap between them (mediated, of course, by genes, hormones and brain processes). A good deal of research over recent decades has supported this theory.

Could the environment also be involved? Many researchers have reported that traumatic events in childhood and orphan status seem more common in those that make outstanding contributions to art and science. The “school of hard knocks” could provide needs and experiences that are utilised in some way by the victims (Charles Dickens and Charlie Chaplin come to mind here). However, this idea opposes the often mooted idea that parental support and encouragement, rather than maltreatment and deprivation, is beneficial to achievement. We also need to recognise that parental pathology may be genetically transmitted to children, thus accounting for some of the associations reported. Modern behaviour genetics points to the conclusion that in so far as parents influence the personalities of their children, they do so more by the genes they pass to them than the way they treat them.

Exactly how loose associations or over-inclusive thinking promote genius is unclear. If enough crazy ideas are generated, one or two might hit the target by chance alone. This approach is deliberately harnessed in “brainstorming” sessions, which use random “flashcards” as a means of generating fresh ideas. It is difficult to be creative when operating within received wisdom, and it is no accident that some of the greatest artists and composers were the “rebels” least shackled by the traditional rules of their art. Still, the “shotgun” theory smacks slightly of “monkeys on typewriters”: it would take a long time for them to come up with the complete works of Shakespeare. Outstanding advances in science, such as the theories of evolution and relativity, and great works of art, such as Richard Wagner’s Der Ring des Nibelungen, cannot be generated by chance alone. Profound imagination and high-level spatial intelligence often feature.

Application to the point of “work addiction” is another common trait among highly creative people. Edison famously said that genius was 1 per cent inspiration and 99 per cent perspiration. Simonton reports that the most creative people are also the most productive. There is a positive correlation between quality and quantity of output, implying that each masterpiece is likely to be interspersed with much that is mediocre. Wolfgang Amadeus Mozart may be an exception. He wrote so many works in his short lifetime that most people could not copy them by hand in an equivalent period of time, yet there don’t seem to be too many duds among them.

The human tendency to “apophenia” may be implicated in both creativity and madness. This refers to seeing meaningful patterns where they do not exist and underlies magical ideation and belief in paranormal phenomena (such as seeing a ghost in the shadows or hearing someone call your name when there is no one there). Such perceptions have evolved because failing to spot a predator in the forest is a bigger (and potentially fatal) mistake than seeing one where it does not exist.

Exaggerated apophenia is characteristic of schizotypal individuals, and high levels of dopamine facilitate this tendency. It is possible that great theories such as evolution or relativity arise out of the imagination required to impose broad, linking systems upon fragmented observations.

Schizoid thinking is not without survival value. Loose associations can make individuals dangerous and disorganised but by promoting their creativity they can also make them more sexually attractive. Creativity has been shown to promote mating success in humans as well as bowerbirds, the males of which species build elaborate, colourful mosaics and constructions to attract a female. However, if the thinking becomes too bizarre, there is such a disconnection from reality that effective social functioning becomes impossible. It follows that some tendency towards schizoid thinking can be beneficial, thus accounting for its genetic maintenance, whereas too much is disadvantageous, even catastrophic. It is notable that creative artists and writers have profiles similar to those of psychotic patients on clinical scales of the Minnesota Multiphasic Personality Inventory but are less extreme - in fact, roughly halfway between normal controls and full-blown schizophrenics.

Apart from schizophrenia, another type of mental “pathology” linked with creativity is bipolar mood disorder (previously called “manic-depressive psychosis”). It is characterised by extreme mood swings, occurring over a period of months, and seems particularly to afflict artists, writers, musicians and comedians. Among the highly talented people who appear to have suffered mood disorder are Peter Tchaikovsky, Robert Schumann, Van Gogh, Virginia Woolf, Spike Milligan and Stephen Fry. The pianist John Ogdon was treated for mood disorder in the Maudsley Hospital when I worked there, as was the improvisational comedian Paul Merton. Fry has presented a television documentary on bipolar disorder in which he describes his experiences. Such people are usually most productive when recovering from the depressed phase of their cycle and moving back towards “mania”.

Again, there are genetic links between bipolar disorder, schizophrenia and Eysenck’s P dimension. Sufferers are often tortured souls, particularly when the “Black Dog” afflicts them, and their feelings sometimes give greater depth to their art. However, the exhilarating “flight of ideas” experienced in the positive phase is indicated in the title of Kay Redfield Jamison’s 1996 book Touched with Fire: Manic-depressive Illness and the Artistic Temperament, and it is this that enables sufferers to be productive. As with the trade-off between madness and genius, bipolar disorder balances troughs with peaks in a way that might account for its evolutionary survival. Treatments are available for the disorder but there is a danger that by smoothing mood they impede the creative forces.

Then there are the autistic-spectrum disorders (such as Asperger’s syndrome), in which a deficiency in social communication is sometimes accompanied by “savant” skills in fields such as music, maths and spatial intelligence. In Rain Man (1988), Dustin Hoffman plays Raymond Babbitt (loosely based on real-life “megasavant” Kim Peek), whose exceptional memory is exploited by his brother Charlie (Tom Cruise), who persuades him to count cards in Las Vegas casinos. Autism has been construed by Simon Baron-Cohen, professor of developmental psychopathology at the University of Cambridge, as extreme “systematising”, ie, the search for grand patterns such as Newton’s idea of gravity, even though it is often accompanied by an excessive narrowing of focus that reduces its usefulness. Autism and Asperger’s are more common in males than females and have been linked with prenatal exposure to testosterone.

All of these mental aberrations can promote extraordinary contributions to art and science, and their potential function as spectacular courtship displays could account for their survival in the gene pool. However, to be truly creative, an individual needs to retain some contact with reality and some capacity to manage their condition: they cannot be totally and permanently “away with the fairies”. Consider the case of James Joyce’s daughter Lucia, who was treated by Carl Jung for schizophrenia in 1934. Joyce doubted that she could be schizophrenic because her thought patterns seemed so similar to his own. Jung disagreed, comparing father and daughter to two people who had arrived at the bottom of a river. According to Jung, James had dived there, whereas Lucia had fallen in.

Clearly, genius and madness have much in common but there are important differences between them. Mostly these are to do with high intelligence, control of behaviour and insight into one’s own condition. Dalí once said: “There is only one difference between a madman and me. The madman thinks he is sane. I know that I am mad.” Certainly, Dalí was eccentric, self-absorbed and grandiose, with a flamboyant moustache and a manic stare. But he was also a skilled draughtsman who produced brilliant, imaginative artworks that made him rich, famous and able to enjoy a life of luxury. Obviously, he was not totally mad.