Creating the Elimination of Manic-Depression?
Jack Pettigrew
A link between creativity and manic-depression (bipolar disorder) is well-recognised but much argued because of two symmetrical difficulties:- the problem of assessing human creativity in the present, when diagnosis of manic-depression is more secure; and the problem of clinical diagnosis in historical figures whose creative genius has stood the test of time. The chances of finding a manic-depressive in the general population is just under 2% but this rises to 10% or even 20% in creative subpopulations like artists and poets. Perhaps the best documented study of the bipolar-creative link is Kay Redfield Jamisonís "Touched by Fire", where one can find striking demonstrations, like the cyclic relation between wild mood swings and the volume of musical creations produced by Robert Schumann in the years leading up to his suicide. A high-achieving manic-depressive herself, Jamison is presently campaigning internationally for a more open approach to suicide, a growing tragedy in our youth. In terms of the creative-bipolar link, the large proportion of suicides atributable to manic-depression also represents a terrible toll on the potential creative sub-population.
A cynical commentator on these facts recently pointed out that it was better to be a close relative of a manic-depressive because one then had the creative advantages without the negative side. This comment accurately represents the strong genetic component that is known for the disorder. But it omits the possibility that the recognition of the genetic predisposition could enable prevention. There is a very real possibility that the life-threatening manias and depressions could be eliminated without affecting the creative disposition. This prospect is raised by a number of recent advances in "bipolar neurobiology". For example, Robert Post and his team at the USPHS National Institute for Mental Health have good evidence that, while the first few attacks of depression or mania may be triggered by life stressors, subsequent attacks can become more spontaneous because of a process called "kindling". The implication of this work is that the disorder could be prevented altogether if vulnerable individuals could be recognised and protected before the first episode, which usually occurs in young adulthood.
But how could one recognise the predisposed? The complex multigenic inheritance of manic-depression makes it unlikely that genetic markers will be available anytime soon, but there are some promising candidates for biological markers.......tests measuring a trait that signifies predisposition to manic-depression without requiring the presence of either mania or depression. These traits could also help illuminate the bipolar-creative link since they seem to vary quantitatively across the whole population rather than being some qualitative new feature of brain function.
One possible trait involves an increase in amplification of signalling pathways that determine the brainís sensitivity to a variety of external stimuli. Her personal experience with this heightened sensitivity could help explain, for example, the excruciating reactions to minute nuances described by Virginia Woolf, whose creative genius and manic-depression are not under much dispute.
Another possible marker trait involves a genetic alteration in biological clocks that govern the rate of switches in the brain, particularly the switches between the complementary functions of each cerebral hemisphere. I discovered this trait by accident on my own manic-depressive brain, using an apparatus that I had built originally for studies on the brains of animals. My staff, as well as a large undergraduate class, all switched much faster than me and with the help of local general practitioners who sent me patients, I was able to show that the altered rhythm was common to most manic-depressives and not confounded by other factors like age or medication. This slower switch mechanism might possibly be relevant to creativity since it seems to increase the creative clash between the hemispheres. Unfortunately, slow switches are also more likely to get stuck, a downside that Steve Miller and I think explains the mania (stuck in the positive hemisphere) and the depression (stuck in the negative hemisphere). Supposing that this rough model of the disorder is right, and that one can identify predisposed individuals by the switch rate, how would one go about helping the "rhythm-challenged" to avoid those crucial, early, kindling episodes of getting stuck?
First, I would join Kay Jamison in pleading for more openness and acceptance, a change that should be facilitated by more recognition of the positive creative side. Putting manic-depression on the table for discussion and illumination can be the first step toward balancing denial and fear in their antithetical swing across the hemispheres. This balancing process itself may be as therapeutic as the host of life style strategies that have been successfully adopted and related to me by bipolars all over the world. And one should not forget Australia's own neuroprotective and mood-stabilising invention, lithium ions, discovered 50 years ago this year by John Cade and still giving the new-fangled mood stabilisers a run for their money. www.uq.edu.au/nuq/jack/jack.html
Jack Pettigrew is Professr of Physiology and Director of the Vision Touch and Hearing Research Centre, University of Queensland 4072