Art in Psychiatry

Art in Psychiatry is a Lundbeck initiative to combat the prejudice and stigma faced by individuals with mental disorders. Art can be a useful channel of communication that enables patients to express their feelings and innermost thoughts. This correlation tends to substantiate the theory that rather than being an obstacle to creativity and artistic expression, art helps the mentally ill regain self-confidence and self-esteem, thus restoring dignity to their lives. Below you will find a selection of the art work submitted by patients: We invite contributions. To learn more, mail us at: LUIND@lundbeck.com

Contributed by Mr. SSG, patient of schizophrenia Courtesy: Pavlov Mental Hospital, Kolkatta

Contribution by Mr. VKS with chronic schizophrenia Courtesy: Dr. Shanta Kamath, SCARF, Chennai

Contributed by Ms. MYS, a patient with schizophrenia. Courtesy : Dr. Kalpana Srivastav AFMC, Pune

Contributed by Ms. MYS, a patient with schizophrenia. Courtesy Dr. Kalpana Srivastav AFMC, Pune

Contribution by Ms. M, aged 24 years, with epileptic psychosis Courtesy : Dr. Ramgulam Razdan, Indore

Contributed by Mr. AB, patient of Anxiety Neurosis & Depression Courtesy: Dr. Amarnath Mallick, Kolkatta

Contributed by Ms. MM, a patient with severe depression. Courtesy: Dr. Kamalesh Shah, Bhavnagar

Contribution by Ms S, aged 16 years with complex partial seizures. Courtesy: Dr. Kuldip Kumar, New Delhi

Contributed Ms. SK, a patient depression Courtesy: Dr. Kuruvilla, KMCH, Coimbatore

Contribution by Mr. VKS with chronic schizophrenia Courtesy: Dr. Shanta Kamath, S

Outsider art From Wikipedia, the free encyclopedia "Art brut" redirects here. For the band, see Art Brut (band). This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (March 2009)

Adolf Wlfli's Irren-Anstalt Band-Hain, 1910 The term outsider art was coined by art critic Roger Cardinal in 1972 as an English synonym for art brut (French: [a byt], "raw art" or "rough art"), a label created by French artist Jean Dubuffet to describe art created outside the boundaries of official culture; Dubuffet focused particularly on art by insane-asylum inmates.
[1]

While Dubuffet's term is quite specific, the English term "outsider art" is often applied more broadly, to include certain self-taught or Nave art makers who were never institutionalized. Typically, those labeled as outsider artists have little or no contact with the mainstream art world or art institutions. In many cases, their work is discovered only after their deaths. Often, outsider art illustrates extreme mental states, unconventional ideas, or elaborate fantasy worlds. Outsider art has emerged as a successful art marketing category (an annual Outsider Art Fair has taken place in New York since 1992). The term is sometimes misapplied as a catch-all marketing label for art created by people outside the mainstream "art world," regardless of their circumstances or the content of their work. Contents [hide] 1 Art of the insane 2 Jean Dubuffet and art brut 3 The cultural context of the outsider art category 4 Vocabulary

5 Notable outsider artists 6 See also 7 References 8 Further reading

[edit] Art of the insane Main article: Creativity and mental illness Interest in the art of insane asylum inmates had begun to grow in the 1920s. In 1921 Dr. Walter Morgenthaler published his book Ein Geisteskranker als Knstler (A Psychiatric Patient as Artist) on Adolf Wlfli, a psychotic mental patient in his care. Wlfli had spontaneously taken up drawing, and this activity seemed to calm him. His most outstanding work is an illustrated epic of 45 volumes in which he narrates his own imaginary life story. With 25,000 pages, 1,600 illustrations, and 1,500 collages, it is a monumental work. He also produced a large number of smaller works, some of which were sold or given as gifts. His work is on display at the Adolf Wlfli Foundation in the Museum of Fine Art, Bern. A defining moment was the publication of Bildnerei der Geisteskranken (Artistry of the mentally ill) in 1922, by Dr Hans Prinzhorn. People with some artistic training and well-established artists are not immune from mental illness and may also be institutionalised. For example, William Kurelek, later awarded the Order of Canada for his artistic life work, as a young man was admitted to the Maudsley Psychiatric Hospital where he was treated for schizophrenia.[2] In hospital he painted, producing "The Maze", a dark depiction of his tortured youth.[3] This 1953 work was used as the cover of the 1981 Van Halen rock album Fair Warning. His experience in the hospital was documented in the LIFE Science Library book The Mind, published in 1965. [edit] Jean Dubuffet and art brut French artist Jean Dubuffet was particularly struck by Bildnerei der Geisteskranken and began his own collection of such art, which he called art brut or raw art. In 1948 he formed the Compagnie de l'Art Brut along with other artists, including Andr Breton. The collection he established became known as the Collection de l'Art Brut. It contains thousands of works and is now permanently housed in Lausanne, Switzerland. Dubuffet characterized art brut as: "Those works created from solitude and from pure and authentic creative impulses where the worries of competition, acclaim and social promotion do not interfere are, because of these very facts, more precious than the productions of professionals. After a certain familiarity with these flourishings of an exalted feverishness, lived so fully and so intensely by their authors, we cannot avoid the feeling that in relation to these works, cultural art in its entirety appears to be the game of a futile society, a fallacious parade." - Jean Dubuffet. Place l'incivisme (Make way for Incivism). Art and Text no.27 (December 1987 - February 1988). p.36 Dubuffet's writing on art brut was the subject of a noted program at the Art Club of Chicago in the early 1950s. Dubuffet argued that 'culture', that is mainstream culture, managed to assimilate every new development in art, and by doing so took away whatever power it might have had. The result was to asphyxiate genuine expression. Art brut was his solution to this problem only art brut was immune to the influences of culture, immune to being absorbed and assimilated, because the artists themselves were not willing or able to be assimilated. [edit] The cultural context of the outsider art category The interest in "outsider" practices among twentieth century artists and critics can be seen as part of a larger emphasis on the rejection of established values within the modernist art milieu. The early part of the 20th Century gave rise to cubism and the Dada, Constructivist and Futurist movements in art, all of which involved a dramatic movement away from cultural forms of the past. Dadaist Marcel Duchamp, for example, abandoned "painterly" technique to allow chance operations a role in determining the form of his works, or simply to recontextualize existing "readymade" objects as art. Mid-century artists, including Pablo Picasso, looked "outside" the traditions of high culture for inspiration, drawing from the artifacts of "primitive" societies, the unschooled artwork of children, and vulgar advertising graphics. Dubuffet's championing of the art brut of the insane and others at the margins of society is yet another example of avant-garde art challenging established cultural values.

[edit] Vocabulary

Two detail images of Joe Minter's African Village in America, a half-acre visionary art environment in Birmingham, Alabama. Scenes include African warriors watching their descendants struggles in Alabama, tributes to black scientists and military leaders, recreations of the epic civil rights confrontations in Alabama, and biblical scenes. A number of terms are used to describe art that is loosely understood as "outside" of official culture. Definitions of these terms vary, and there are areas of overlap between them. The editors of Raw Vision, a leading journal in the field, suggest that "Whatever views we have about the value of controversy itself, it is important to sustain creative discussion by way of an agreed vocabulary". Consequently they lament the use of "outsider artist" to refer to almost any untrained artist. "It is not enough to be untrained, clumsy or nave. Outsider Art is virtually synonymous with Art Brut in both spirit and meaning, to that rarity of art produced by those who do not know its name." Art Brut: literally translated from French means "raw art"; 'Raw' in that it has not been through the 'cooking' process: the art world of art schools, galleries, museums. Originally art by psychotic individuals who existed almost completely outside culture and society. Strictly speaking it refers only to the Collection de l'Art Brut. Folk art: Folk art originally suggested crafts and decorative skills associated with peasant communities in Europe though presumably it could equally apply to any indigenous culture. It has broadened to

include any product of practical craftsmanship and decorative skill everything from chain-saw animals to hub-cap buildings. A key distinction between folk and outsider art is that folk art typically embodies traditional forms and social values, where outsider art stands in some marginal relationship to society's mainstream. Intuitive art / Visionary art: Raw Vision Magazine's preferred general terms for outsider art. It describes them as deliberate umbrella terms. However, Visionary Art unlike other definitions here can often refer to the subject matter of the works, which includes images of a spiritual or religious nature. Intuitive art is probably the most general term available. Intuit: The Center for Intuitive and Outsider Art based in Chicago operates a museum dedicated to the study and exhibition of intuitive and outsider art. The American Visionary Art Museum in Baltimore, Maryland is dedicated to the collection and display of visionary art. Marginal art/Art singulier: Essentially the same as Neue Invention; refers to artists on the margins of the art world. Nave art: Another term commonly applied to untrained artists who aspire to "normal" artistic status, i.e. they have a much more conscious interaction with the mainstream art world than do outsider artists. Neuve Invention: Used to describe artists who, although marginal, have some interaction with mainstream culture. They may be doing art part-time for instance. The expression was coined by Dubuffet too; strictly speaking it refers only to a special part of the Collection de l'Art Brut. Visionary environments: Buildings and sculpture parks built by visionary artists - range from decorated houses, to large areas incorporating a large number of individual sculptures with a tightly associated theme. Examples include Watts Towers by Simon Rodia, Buddha Park and Sala Keoku by Bunleua Sulilat, and The Palais Ideal by Ferdinand Cheval.

Vincent van Gogh's health From Wikipedia, the free encyclopedia

Winter 1886/87 (F 295) Oil on pasteboard, 41 x 32 cm Rijksmuseum, Amsterdam There is no consensus on Vincent van Gogh's health. Many competing hypotheses have been put forward about possible medical conditions he had. These include epilepsy, bipolar disorder, sunstroke, acute intermittent porphyria, lead poisoning and Mnire's disease. Contents [hide] 1 Symptoms and characteristics

2 Behavior 3 Diagnoses o o o o o o o 3.1 Epilepsy 3.2 Bipolar disorder 3.3 Sunstroke 3.4 Mnire's disease 3.5 Lead poisoning 3.6 Acute intermittent porphyria 3.7 Other diagnoses

4 Notes 5 References 6 External links

[edit] Symptoms and characteristics Various symptoms are described in Van Gogh's letters and other documents such as the asylum register at SaintRmy. The symptoms include: poor digestion and a bad stomach, hallucinations, nightmares, stupor, absent mindedness, impotence, insomnia, and anxiety. Van Gogh suffered from some sort of seizures or crises, and in one of these attacks cut off a part of his ear. [1][2] One of the most frequent complaints in Van Gogh's letters is the problems he endured with his stomach and digestion.[3] Van Gogh suffered from hallucinations[4] and nightmares at times.[5] He often reported that he was suffering from fever.[6] At various times he reported bouts of insomnia. He was unable to sleep for three weeks prior to his diagnosis of gonorrhea in The Hague.[7] On occasions he sunk into a kind of stupor.[8] Van Gogh reported his impotence to Theo, his brother, in the summer after he arrived in Arles,[9] and a month later when he wrote to Bernard it seemed to still be very much on his mind.[10] Towards the end of Van Gogh's life he had thoughts of suicide.[11] [edit] Behavior

Self-portrait, 1889, private collection. Mirror-image self portrait with bandaged ear

Still Life with Absinthe, 1887, Van Gogh Museum Van Gogh indulged to an abnormal degree in various activities which undermined his health, such as constant smoking, drinking alcohol and coffee to excess, and eating very poorly, even fasting at times.[12] The natural consequence of all this was malnutrition. He was never without his pipe and smoked it even on his deathbed, and he admitted on several occasions that he smoked too much.[13] He also frequently drank alcohol to excess; in particular, he often drank absinthe. There is some evidence that Van Gogh nibbled at his paints, and the eating of paints is possibly connected with his seizure around New Year 1890. In January 1890, after another one of Vincent's seizures, Theo wrote to him saying "if you know that it is dangerous for you to have colours near you, why don't you clear them away for a time, and make drawings?"[14] Theo's alarm is somewhat reduced after hearing from Vincent, and five days later he explained: "In [Doctor Peyron's] first letter he gave me to understand that it was dangerous for you to go on painting, as the colours were poison to you, but he went a little too far, which might have been due to his having relied on unverified rumours, as he himself was ill at the time."[15] [edit] Diagnoses [edit] Epilepsy Epilepsy has been a popular diagnosis. Van Gogh himself thought that he might be an epileptic[16] and his doctor Felix Rey made the same general diagnosis,[17] as did Dr Peyron at St Rmy[18] A diagnosis of temporal lobe epilepsy was originally put forward in 1928 by Leroy and Doiteau[19] and has received much support.[20] Arnold states that the pattern of van Gogh's seizures, their timing and duration, does not fit well with the complex partial seizures associated with temporal lobe epilepsy.[21] Furthermore, it seems that Vincent's condition was controlled by the administration of bromide, which is effective against grand mal seizures, as well as absinthe intoxication and porphyria, but not for temporal lobe epilepsy.[21] [edit] Bipolar disorder Perry in 1947 was the first to put together a serious case for a diagnosis of bipolar disorder, or "manic depression."[22] It fits with the well documented periods of intense activity interspersed with periods of exhaustion and possible depression.[23] It has been suggested that van Gogh was not just bipolar, but that the crises in his last two years were brought about by the additional effect of thujone poisoning from his consumption of absinthe.[24] [edit] Sunstroke The idea that van Gogh might have suffered some form of chronic sunstroke was advocated strongly by Roch Grey.[25] Vincent described the effects of the Arles sun in a letter: "Oh! that beautiful midsummer sun here. It beats down on one's head, and I haven't the slightest doubt that it makes one crazy. But as I was so to begin with, I only enjoy it."[26] A month earlier he had mentioned the effects of the sun in passing in a letter to Theo: "Many thanks for your letter, which gave me great pleasure, arriving just exactly at the moment when I was still dazed with the sun and the strain of wrestling with a rather big canvas."[27] A remark has been attributed to Dr Gachet

describing a diagnosis of "turpentine poisoning and the effects of too intense sun on a Nordic brain,"[28] but attempts to confirm this attribution have failed.[29] [edit] Mnire's disease The hypothesis that Vincent may have suffered from Mnire's disease a balance disorder of the inner ear which is accompanied by nausea, vomiting, hearing loss, and vertigo was first published in 1979 by Yasuda. [30] This idea then reappeared in 1990 in the Journal of the American Medical Association (JAMA).[31] Arnold refutes the hypothesis, stating that there is no case for Mnire's, and that the logic of the JAMA article was flawed in that it put forward only epilepsy as an alternative diagnosis.[32] The Mnire's diagnosis relies on interpreting van Gogh's gastrointestinal problems as the nausea and vomiting associated with Mnire's. The JAMA article's suggestion that Vincent's cutting of his ear was an attempt at self-performed surgery to relieve the Mnire's symptom of tinnitus has been regarded as far-fetched.[32] [edit] Lead poisoning Vincent was reported to nibble at his paints at times; this could account for various forms of metal poisoning. Of the various metals contained in paints, poisoning by lead most closely matches van Gogh's symptoms. Symptoms of lead poisoning include abdominal pain, constipation, vomiting, paralysis or paresis.[33] [edit] Acute intermittent porphyria Arnold and Loftus put forward the diagnosis of Acute Intermittent Porphyria (often referred to as simply "AIP"). [34] Arnold suggests the AIP was exacerbated by malnutrition and absinthe abuse.[35] He cites two case histories of men in their 30's who were demonstrated to have AIP and displayed some symptoms similar to that of Van Gogh, including depression and hallucinations in one case, and complex partial seizures in the other. However, Erickson refutes this diagnosis arguing that the key symptom of urine discoloration was never noted, and that Van Gogh's "bad stomach" does not match the commonly experienced "excruciating abdominal pain" associated with AIP.[36] Erickson and Arnold disagree as to the support offered by the family history, and in particular regarding the status of Vincent's father's health: Arnold, basing his opinion on Tralbaut, believes Theodorus to have been in not-very-good health for most of his life, whereas Erickson chooses to see him as being essentially an active man until a relatively sudden death at age 63. Arnold suggests that Theodorus' quiet and balanced life meant that he avoided several factors that precipitated symptoms and progress of the disorder in his children. [edit] Other diagnoses Van Gogh's primary complaints have also been variously attributed to syphilis [37][38][39] and absinthe intoxication. It has been postulated that Van Gogh may have exhibited a form of digoxin toxicity from foxglove plants used to treat his epilepsy. His yellow period ('yellow vision'), missing ear ('oto-toxicity') and penchant for painting halos around landscape objects ('halo vision') are often used by medical students as a mnemonic to remember the sequelae of digoxin toxicity.[citation needed]

Krankheitsmodelle [Bearbeiten] Die Thematisierung von Krankheit in der Literatur beginnt mit dem Extremfall von Krankheit: dem Tod. Krankheit als Dysbalance zwischen Krper und Seele wird zunchst nicht in ihrem Verlauf thematisiert, sondern in ihrem Endpunkt: bei der Lsung der Seele vom Krper,[1] Seneca: Epistulae morales).[2] Ziel dieser Thematisierung ist die Darstellung der berlebenden Seele im Falle des Todes. Erst in den Erzhlungen der Wunderheilungen Jesu wird Krankheit im engeren Sinne thematisiert. Der Schwerpunkt liegt hier auf der Therapie durch den rechten Glauben.[3] Das Mittelalter stellt Krankheit als Zeichen der Erwhltheit dar (Amphortas)[4] und als Metapher der auerhfischen Liebe (Tristan und Isolde).[5] Die Renaissance findet die prnatale Situation des Kranken als Erfahrung des Jenseits (Cervantes).[6] Molire verlacht die Hypochondrie als Spezialfall von Krankheit durch Einbildung.[7]

Die Romantik behandelt vor allem die Krankheit durch Depressionen (Werther, Woyzeck, Lenz). Der postromantische Realismus findet die soziokonomischen Faktoren des Krankseins (Nana, Madammme Bovary, Idiot). Seit Thomas Mann wird Krankheit mit medizinischem Sachverstand als Folge von Infektionen (Syphilis, Tuberkulose) behandelt. Krebs als biologische und soziologische Entartung wird vor allem im kommunistischen Russland thematisiert (Solschenizyn). Humor als entscheidende Kraft in der Bewltigung von Krankheit und Tod etabliert den psychosomatischen Ansatz (Kurt Gtz). Transzendentale Meditation als Mittel der Erfahrungen ber die Grenze des Todes ist das Thema der neuen spiritualistischen Krankheitsliteratur (Abaelard). Geschichte [Bearbeiten] Sokrates (Platon) [Bearbeiten]

Sokrates Sokrates ist der Held einer Erzhlung Platons ber die Hinrichtung durch Selbstmord (Phaidon ReferenzFehler: Es fehlt ein schlieendes </ref>. ). Zuvor hatte der Meister seinen Schlern dargelegt, dass die Seele den Tod berlebt und dass die Lebenden wieder geboren werden aus den Gestorbenen [8]. Auch sei unser Lernen nichts anderes als die Wiedererinnerung [9]). So wird die Erzhlung des Sokratischen Todes zu einer Demonstration der Reinkarnations-, Wiedererinnerungs- und Seelen-Leere. Platons Apologie des Sokrates nimmt ebenfalls die Situation des sterbenden Meisters zum Anlass, Sokrates Zuversicht in Bezug auf das berleben der Seele auszudrcken: wenn dagegen der Tod wie eine Auswanderung ist von hier an einen anderen Ort und wenn die Sage wahr ist, dass dort alle Gestorbenen insgesamt weilen, welches Gut wre dann grer als dies, ihr Richter? Denn wenn einer ins Reich des Hades gelangt und, entledigt von diesen hier, die sich Richter nennen, dort die wahrhaft-Richtenden antrfe, die, wie die Sage berichtet, dort Rechtsprechenden, ... Wrde die Wanderung dorthin zu verachten sein? Und gar mit Orpheus Umgang zu haben und mit Musaios, Hesiod und Homer, um welchen Preis wrde einer von euch das wohl erkaufen? [10]. Seneca [Bearbeiten]

Seneca errtert in einem literarischen Brief an seinen Freund Lucilius die Mglichkeit der Selbstttung [11]. Der Legende nach soll er von Nero zum Tode durch Suizid verurteilt worden sein und sich im Bade die Pulsadern zerschnitten haben (vergleiche Suizid). Jesus von Nazareth [Bearbeiten]

Jesus als Guter Hirte, frhchristliche Deckenmalerei in der Calixtus-Katakombe in Rom, um 250 Jesus von Nazareth wird durch die Evangelien und besonders auch durch die Paulusbriefe und die Apokalypse des Johannes als Sohn Gottes gefeiert, weil er den Menschen den rechten Umgang mit Krankheit und Tod demonstriert habe. Die groen Dichter der Evangelien haben Heilung und Sterben des Meisters zum Thema erhoben und gezeigt, dass der Kreuzestod zum Lebensplan der Seele Jesu gehrt habe. Literatur wird zum Medium der Botschaft vom Jenseits. Hartmann von Aue [Bearbeiten]

Herr Hartmann von Aue (fiktives Autorenportrt im Codex Manesse, fol. 184v, um 1300)

Hartmann von Aue erzhlt in seinem Versepos Der arme Heinrich [12] die Geschichte eines wohlhabenden Frsten, der vom Aussatz befallen ist. Nur das Herzblut einer heiratsfhigen Jungfrau knne ihn heilen. Auf einem seiner Bauernhfe findet sich ein Mdchen, das zum Opfertod bereit ist. Heinrich beobachtet durch ein Schlsselloch den Beginn der erforderlichen Herzentnahme und verhindert die Ttung des Mdchens. Er wird daraufhin von seiner Lepra-Erkrankung geheilt (Spontanheilung) und heiratet trotz des Standesunterschiedes seiner Retterin. Krankheit erscheint als Fehlleitung der Seele. Die Heilung fhrt auf den rechten Weg zu Gott. Wolfram von Eschenbach [Bearbeiten]

Wolfram von Eschenbach; Autorbild als Ritter im Codex Manesse Das Mittelalter hat Krankheit durch das Parzival-Dilemma thematisiert: der Meister der Waffen und Herrscher der Ritter kann sich auf den Thron von Gottes Gnaden nur dann qualifizieren, wenn er die entscheidende Frage stellt: Oheim waz wirret dir? (Amphortas, worin besteht dein Leiden? Oder: wenn dein Lebensplan die Krankheit ist: wie fhrst du uns zu Gott?) Gottfried von Straburg [Bearbeiten]

Meister Gottfried von Straburg (Codex Manesse, 1. Viertel 14. Jahrhundert) Gottfried von Straburg, der mnchische Epiker des ca. 1210 bekannt gewordenen mittelhochdeutschen TristanEpos, hat die Liebe eines Paares besungen, das der hfischen Gesellschaft nicht entsprach. Durch ein Gift wird krankhafte Liebe verursacht. Tristan, der Sohn eines im Ozean versunkenen Knigreiches, gewinnt die Liebe einer irischen Knigstochter, die Tristans Vasallen, Knig Marke, vermhlt wird. Nur im Jenseits - so lautet die Sentenz des nicht vollendeten Epos - kann diese Liebe verwirklicht werden. Der Mnch Gottfried mglicherweise von der Inquisition wegen Zugehrigkeit zur verbotenen Sekte der Katharer dahingerafft - hat ein Lebenswerk der Liebes-Verherrlichung hinterlassen, das ber die Jahrhunderte ein Beispiel fr die Gemeinschaft der Seelen gibt. Dass Mann und Frau sich finden, ist keineswegs zufllig, sondern unterliegt einem Plan der Seelen, der als beschlossen gelten muss: lange bevor die betreffenden Individuen geboren sind. Miguel de Cervantes Saavedra [Bearbeiten]

Miguel de Cervantes Saavedra

Miguel de Cervantes Saavedra (15471616) hat im 9. Kapitel des 11. Buches Krankheit und Tod seines Helden Don Quixote beschrieben: Der Ritter erkrankt am Fieber, und der Arzt teilt ihm mit, er solle Frieden fr seine Seele erbitten. Don Quixote schlft 6 Stunden lang, als sei er bereits ins Jenseits hinbergetreten, und erwacht voller Seligkeit: er hat gelernt, seinen Tod zu akzeptieren, und nimmt Abschied voller Zuversicht und Liebe. Zugleich stellt er seinen Lebensweg als Plan seiner Seele dar. Seine sogenannten Thorheiten seien Erfllung eines hohen Auftrages, den seine Seele in diesem seinem Leben zu erfllen gehabt habe. Moliere [Bearbeiten]

Portrt Molires als Dichterfrst (1658) von Nicolas Mignard Jean Bapatiste Moliere (1622-73) hat in seinem letzten groen Bhnenwerk den " Eingebildeten Kranken" beschrieben. In einem furiosen Kampf um Liebe und Erbe wird der Kranke als Hypochonder beschrieben - eine insofern besonders tragisch anmutende "Geschichte", weil der Dichter nach der selbst inszenierten Urauffhrung - noch im Kostm seines Titelhelden - an einem akuten Malaria-Anfall verstorben ist. Schiller [Bearbeiten]

Schiller als Regimentarzt, 1781/1782. Gemlde von Philipp Friedrich Hetsch Johann Christoph Friedrich Schiller (1759 bis 1805) wurde 1780 zum Doktor der Medizin promoviert. Er hatte eine umstrittene und zunchst zurckgewiesene Arbeit ber die Philosophie der Physiologie vorgelegt, in der er seine Theorie von den Wechselwirkungen zwischen Krper und Seele - oftmals apodiktisch und programmatisch - vortrug. Die fr sein weiteres Leben bestimmende Maxime bestand in der absoluten Unterwerfung des Krpers durch den freien Willen. Schon wenige Jahre spter musste er schwere

Infektionskrankheiten hinnehmen: zunchst Malaria und dann die Tuberkulose. Ein primrer Infekt durch das Mycobakterium tuberkulosis kann gutartig verlaufen, wenn nach kurzer Lungenkrankheit die so genannten Herde verksen. Es bildet sich ein ksiger Wall um die Bakterien-Kolonie; und nur in Situationen verminderter Immunitt bricht dieser Wall auf, so dass die Bakterien in alle Richtungen absiedeln und metastasieren knnen (sekundre Tbc). Vermutlich durch immer wieder auftretende Schbe der Malaria-Erkrankung war die Situation verminderter Immunitt gegeben, so dass Schiller, der visionre Dichter des Erhabenen und der Freiheit im "Reich des schnen Scheins" der Tuberkulose unterlag. Schwere Krisen erschtterten Krper, Geist und Seele dieses Dichters und Philosophen der Freude, bis er im Alter von 46 Jahren der damals unheilbaren Infektionskrankheit erlag. Die Seele hatte die Inkarnation in ein irdisches Leben erwhlt, dass der Menschheit die sthetische Theorie der Freiheit und die groen Dramen von den Rubern bis zum Wallenstein und zugleich das tragische Ende durch Tuberkulose zeigen sollte. Es war der Lebensplan einer groen, alten Seele. Georg Bchner [Bearbeiten]

Georg Bchner um 1830 Georg Bchner (1813 bis 1837) hatte sich als Dichter des Dramas Dantons Tod und als politischer Aktionr mit der Flugschrift Der hessische Landbote hervorgetan. Zugleich war er als medizinischer Forscher an den Universitten Straburg und Gieen auf den Gesichtsnerven (besonders den Nervus facialis) konzentriert. Schlielich entfaltete Lenz die Erzhlung einer psychotischen Depression in der Nachfolge von Goethes Werther. Hinterlassen, und postum verffentlicht, kennen wir das Dramen-Fragment Woyzeck, in dem die suizidale Depression eines kleinen Soldaten aufgefhrt wird. Als Wissenschaftler an der exakten Erkundung der Nervenbahnen beteiligt, hat der politische Protestant den so genannten jungdeutschen Weg in die antifeudale Freiheit verfolgt. Dahingerafft durch Typhus - eine bakterielle Infektionskrankheit des Magen-DarmTaktes - erfllte sich seine im Woyzeck dargelegte Auffassung, der Mensch whne sich, frei zu sein. Doch die Determiniertheit des Krpers durch Hunger, Tod, Krankheit und Libido sei desillusionierend wirklich. Der Krper dieser reifen Seele wurde durch einen Infekt dahingerafft, bevor die Hscher der preuischen Polizei eine Inhaftierung veranlassen konnten. Der Lebensplan verfolgte politische Freiheit mit den Mitteln knstlerischer Literatur. Eine metaphysische Fundierung in religisen Konzepten wird ausdrcklich zurckgewiesen. Die reife Seele des Georg Bchner hat im zuflligen Tod durch einen Typhus-Infekt ihr frhes Lebensende gefunden. Heinrich Heine [Bearbeiten]

Heinrich Heine, 1831, Gemlde von Moritz Daniel Oppenheim Heinrich Heine, der hhnisch-arrogante Student der Gttinger Rechtsfakultt, hatte in seiner Harzreise betont, ein Apostel der brgerlichen Liebe sei er nicht. (Du httest so schn, mein Schtzchen, von unserer Liebe erzhlt: so heit es in einem Gedicht ber den grobrgerlichen Teetisch, an dem sie von Liebe viel sprachen). Folgerichtig hat ihn der Infekt durch Treponema pallidum hingestreckt. Die Mikroorganismen treten - besonders beim Geschlechtsakt - von einem bereits Infizierten zum Partner ber und verursachen zunchst eine leichte, ulzerse Erkrankung (offene Wunden am Genitale). Nach Ausbreitung des Erregers im gesamten Krper wird das Gehirn befallen. Lhmungen und schlielich der Tod sind die Folge (tertire Lues). Heinrich Heine hat in seinem lebenslangen Kampf gegen verlogene Brgermoral die schweren Leiden der Syphilis im Pariser Exil erlitten (von ihm so genannte Matratzengruft). Im Alter von etwa 57 Jahren ist er der Syphilis erlegen, die zum Lebensplan der Seele gehrte. Es galt, die Emanzipation von der preuischen Kleinbrgerlichkeit zu erfahren und konsequent den frhen Tod durch die Syphilis zu erleiden. Die Dichtungen vom Buch der Lieder ber die Harzreise und Deutschland ein Wintermrchen bis hin zum Romanzero waren sozusagen der Ertrag dieses Lebens mit Syphilis. Dostojewski [Bearbeiten]

Portrait des Schriftstellers Fjodor Dostojewski, l auf Leinwand (1872) von Wassili Grigorjewitsch Perow, Tretjakow-Galerie, Moskau Fjodor Michailowitsch Dostojewski (1821 bis 1881), nach Zwangsarbeit in Sibirien von einem atheistischen Sozialismus damaliger Zeit zum russisch-orthodoxen Glauben konvertiert, zeigt in seinem Roman Der Idiot (1868/9) einen russischen Frsten, der an einer epileptischen Krankheit leidet. Das West-Syndrom wurde in den vierziger Jahren des 19. Jahrhunderts von dem englischen Chirurgen William James West (1793 bis 1848) zuerst beschrieben. Es beruht auf einer angeborenen Mutation am so genannten Polyalanin-Gen (ARX.; Lokalisation Xp 22;13, daher hufiger bei Mnnern symptomatisch; spter auch nach Ohtahara benannt). Unbehandelt beginnen die Kinder im Alter von Monaten bis Jahren mit so genannten BNSKrmpfen (Abkrzung fr blitzartige Grimassen, Nicken und eine Verbeugung des Oberkrpers, die dem islamischen Salemaleikum hnelt: Blitz-Nick-Salaam). Die Erkrankung verluft meist chronisch-progressiv, so dass die jungen Menschen infolge der immer wieder auftretenden Hirn-Krmpfe nach und nach neurologische Defizite entwickeln und schlielich vorzeitig versterben. Dostojewski - selbst von dieser damals unbehandelbaren Krankheit befallen - teilte die im russisch-orthodoxen Glauben verbreitete Ansicht, die epileptischen Menschen seien von Gott gesegnet, indem sie vor jedem Kampfanfall fr einige Minuten einen Zustand der inneren Ruhe (vergleichbar der transzendentalen Meditation) erreichten und wunderbare Visionen des Jenseits erleben. Solche vom Jenseits-Erlebnis geluterten Menschen mit zunehmend gravierenden Strungen der Bewegung, Wahrnehmung und Erinnerung wurden Idiot genannt, weshalb Dostojewski diese Bezeichnung als Titel fr seinen Roman whlte. Die Hauptidee des Romans ist, einen vollkommen schnen Menschen darzustellen, schreibt Dostojewski selbst ber diesen Roman. Der Frst Myschkin wird als demtig und bescheiden und als Verkrperung des Heiligen in einer heillosen Welt bezeichnet. Dostojewski hatte die Vorstellung, der Konflikt der russischen Zeitgenossen bestehe vor allem in einem Gegeneinander sozialistischer Revolte und zutiefst religiser Schulderfahrung. Diese Dynamik der russischen Gesellschaft wird durch die Darstellung der eigenen Ideologie als Lebensaufgabe geschildert. Sowohl der Romanheld Myschkin als auch der Dichter selbst haben die Verkrperung der eigenen Seele in dieser Weise verstanden. Tschechow [Bearbeiten] Im Alter von 38 Jahren, Portrait von Osip Braz Der russische Epiker Anton P. Tschechow (1860-1904) hat 1893 eine Erzhlung mit dem Titel Krankensaal Nummer 6 publiziert. Der Chefarzt eines uerst verwahrlosten psychiatrischen Krankenhauses wird schlielich selbst eingeliefert und von seinen Mitpatienten erschlagen. Er fllt in Missstnden zum Opfer, gegen die er in seinem Berufsleben nichts unternommen hat.

Dblin [Bearbeiten]

Bildnis Alfred Dblin von Ernst Ludwig Kirchner, 1912 Der Arzt Alfred Dblin (1878-1956) verffentlichte 1912 einen Band mit Erzhlungen: Die Ermordung einer Butterblume. Einer der Texte schildert das gespannte Verhltnis einer Tnzerin zu ihrem trainierten Leib, den sie schlielich vor den Augen des Arztes mit einer Schere ersticht. (Die Tnzerin und der Leib 1912). Du Affe, du Schlappschwanz, sind ihre letzten Worte, denn der Arzt vermochte es nicht, der Seele die Schmerzen zu nehmen. Ein lebenslanger Kampf von Seele und Leib um die Vorherrschaft geht auf diese mrderische Weise zu Ende. Dem Arzt gelingt es nicht, den Konflikt zwischen Leib und Seele zu lsen, und dem Dichter bleibt nur die hhnische Darstellung dieses desillusionierenden Befundes. Hemingway [Bearbeiten] Ernest Hemingway (1899-1961) , der chronisch Leber-kranke Sohn eines Selbstmrders (Hmochromatose) und schlielich in gleicher Weise verzweifelt aus dem Leben geschieden - stellt in seinem Roman Der alte Mann und das Meer den Lebenskampf eines Fischers dar. 1954 wurde er besonders wegen dieser Erzhlung mit dem Nobelpreis fr Literatur ausgezeichnet. Man kann vernichtet werden, aber man darf nicht aufgeben, so lautet die Sentenz des vielschichtigen Werkes. Santiago, begleitet von dem Fischerjungen Mandolin, fngt einen riesigen Schwertfisch, den er mit unendlichen Mhen ans heimatliche Gestade schleppt. Jedoch haben die Haie inzwischen nur noch das Gerippe des Fisches brig gelassen. Erschpft legt sich der alte sozusagen schlafen, umsorgt vom Fischer der nchsten Generation, der aus dem Kampf des Alten seine Lehre gezogen hat. Camus [Bearbeiten] Albert Camus Camus (1913-60) schildert 1947 die Pest als Allegorie des Absurden. Der Arzt Rieux kmpft in selbstloser Aufopferungen gegen die schwere Infektionskrankheit, die sich als Ausdruck einer Welt mit Kriegen, Atombomben, Konzentrationslagern und Maschinenherrschaft erweist. Der Dichter, der sich zum Schluss als der Arzt erweist, bekmpft die Krankheit, ohne seinem Tun einen tieferen Sinn geben zu knnen. Thomas Mann [Bearbeiten]

Thomas Mann, 1937 Foto von Carl van Vechten Thomas Mann (1875-1955) hat in zwei groen Romanen die Krankheit thematisiert: Der Zauberberg 1924 Dr. Faustus 1946.

Der Zauberberg erzhlt die Geschichte Hans Castorps, der als junger Mann dem Lungensanatorium zu Davos einen Besuch abstattet und wegen eines bagatellsen Tuberkulose-Infektes mehrere Jahre in der Gesellschaft des Sanatoriums verbleibt. Erst der Ausbruch des Ersten Weltkrieges verursacht die Rckkehr des hypochondrisch besorgten Pseudopatienten. Die morbide Gesellschaft der Lungenkranken verleitet zur Sorge um Krankheit und Tod. Der Mensch soll um der Liebe und Gte willen dem Tode keine Herrschaft einrumen ber seine Gedanken. (Kapitel 6) Dr. Faustus - alias der Komponist Adrian Leverkhn - infiziert sich bei einem Bordell-Besuch. Die Syphilis qult und inspiriert den 12-Ton-Komponisten jahrzehntelang, bis der Tod ihn dahinrafft. Der Wahnsinn - als spte Folge der Krankheit - wird in verschiedenen Episoden dargestellt. Er fhrt in den Tod und ermglicht eine Tonkunst, die die Erfahrung des Jenseits thematisiert. Benn [Bearbeiten]

Gottfried Benn ca. 1951; Zeichnung von Tobias Falberg Gottfried Benn (1886-1956) hat vielfltig Krankheit und Tod in seinen Gedichten und Erzhlungn thematisiert. Bereits als Assistenzarzt fr Pathologie verffentlichte er die Gedichtsammlung "La Morgue" (1912). In desillusionierender Weise werden Eindrcke aus dem Sektionssaal mit der Auffassung in Verbindung gebracht, Seele und Gott seien pure Einbildung. "Der Arzt", ein Zyklus aus drei Gedichten, drckt Benns SeelenNihilismus in folgender Weise aus: "Ihr sprecht von Seele - was ist eure Seele? Verkackt die Greisin Nacht fr Nacht ihr Bett Schmiert sich der Greis die mrben Schenkel zu, und ihr reicht Fra, es in den Darm zu lmmeln, meint ihr, die Sterne samten ab vor Glck ...?" (Benn 1998) Curt Goetz [Bearbeiten]

Curt Goetz mit Leopoldine Konstantin (1917) Curt Goetz (1888-1960) hat in seinem Lustspiel "Frauenarzt Dr. med. Hiob Prtorius" (1929/1953) eine spirituelle Deutung des Zusammenhangs von Dichtung und Krankheit gegeben. Der berhmte Universittsprofessor fr Gynkologie hlt eine improvisierte Rede vor einer Klasse junger Anatomiestudentinnen. Der Tod sei der "Feind" des Arztes. Mit jeder Behandlung msse der Arzt dem Tode hasserfllt entgegentreten. Aber eine Bewltigung von Krankheit und Tod kann nur durch Humor gelingen. "Wer mit Humor zu sterben verstnde, der htte die hchste Stufe des Lebens erreicht." Dementsprechend versucht der Arzt im Gesprch, den Humor des Patienten zu (re-)aktivieren; und damit wird die Sentenz erreicht: "Ein Arzt, der kein Knstler ist, ist kein Arzt." Die Befhigung des Therapeuten, im Patienten den Humor zu wecken, ist mit der des knstlerischen Humoristen (in Musik, bildender Kunst und Literatur) identisch. Dichtung ist Therapeutikum: lebenslang und besonders bis in den Tod. Alexander Solschenizyn [Bearbeiten]

Solschenizyn in Wladiwostok, 1994 Alexander Solschenizyn (1918 - 2008) hat in seinem Roman Krebsstation (1968) - hnlich den groen Krankheitsdichtungen Thomas Manns und Albert Camus - Krankheit nicht nur als Motiv oder Motivkomplex behandelt; sondern die bsartige Erkrankung aller Helden des Romans wird zum Thema einer Analyse PostLeninistischer Verhltnisse. Die sog. Heilung der Hauptfigur Rusanov fhrt zurck in die Skrupellosigkeit eines Karriere-besessenen Fabrikdirektors. Sein Gegenspieler Kostoglotov, der sich im Strafgefangenenlager nicht den Glauben an Freiheit und innere Glckseligkeit hatte rauben lassen, verliert durch Bestrahlung seine Fertilitt. Ins alltgliche Leben zurckgekehrt, hat er die Libido als primitives Glcksgefhl zurckgehalten. Aber die Fruchtbarkeit als Symbol der Vermittlung einer neuen Zukunft ist durch die Krebsstation zu Grunde gerichtet. Motivgeschichtlich steht dieser Nobelpreis-gekrnte Roman im Kontext der groen Krankheitsdichtungen des 20. Jahrhunderts und zeigt wie kein anderer die desillusionierte Hoffnung auf eine Zukunft fr Russland. Heinrich Bll schreibt in einer undatierten deutschen bersetzung fr Bertelsmann: Auch den heftigsten Befrwortern einer besseren Zukunft sollte es nicht schwer fallen zu erkennen, dass nicht die Schriftsteller, sondern die Rusanovs die Krebsgeschwulste der Gesellschaft sind. Eine solche Erkenntnis knnte den sozialistischen Realismus nur befreien und seine Literatur so konkurrenzfhig machen wie es Solschenizyns Roman ist (Bll o.J., S. 9). Peter Hrtling [Bearbeiten] Peter Hrtling (geboren 1933) hat vor allem vier groe Krankheits-Romane verfasst: - Hlderlin 1976 Herzwand. Mein Roman 1990 - Schubert 1992 - Schumanns Schatten 1996. Der Roman ber Hlderlin thematisiert den Zusammenhang dichterischer Genialitt mit Hlderlins Psychose. In seiner Autobiografie, die er mein Buch nennt, bildet die koronare Herzkrankheit den Anlass, ber das verflossene Leben nachzusinnen. In der Biografie Schuberts spielt die Syphilis des romantischen Komponisten eine Lebens-entscheidende Rolle. Schumanns Schatten stellt die endogene Psychose als tragische Wende im Leben des groen Musiker-Ehepaares dar. Wolfgang Abaelard [Bearbeiten] Wolfgang Abaelard hat in einem spirituellen Roman Bekenntnisse eines Leukmie-Ehemannes niedergelegt (Abaelard 2008). Nach Verlust seiner geliebten Ehefrau, die er Eurydike nennt, lsst er das gemeinsame Leben, den Verlauf der Krankheit und die ersten Monate der Trauer Revue passieren. Der besondere Aspekt dieses Eurydike-Romans liegt auf der spirituellen Bewltigung der Krankheit. Letztlich hat der Tod das Liebespaar nur umso enger zusammengefhrt.

Epilepsie in der erzhlenden Kunst Autor: Peter Wolf, Original Dezember 1996, Mrz 2008 Zusammenfassung

 Heimsuchungen durch Krankheit und Gebrechen und die Auseinandersetzung von Betroffenen und ihrer Umgebung mit ihnen sind Urmotive des Erzhlens. Teil der Kulturgeschichte der Epilepsie ist ihre literarische Behandlung. Die Probleme und Einschrnkungen, die das Leben mit Epilepsie mit sich bringen kann, sind in verschiedenen erzhlenden Texten einfhlsam dargestellt. Das wachsende Interesse an verschiedenen Formen literarischer Verarbeitung von Epilepsie mag zur Folge haben, dass die Betroffenen die Kulturgeschichte ihrer Krankheit zunehmend selbst schreiben und gestalten.
Heimsuchungen durch Krankheit und Gebrechen und die Auseinandersetzung von Betroffenen und ihrer Umgebung mit ihnen sind Urmotive des Erzhlens. Epilepsie wird schon in den frhesten historischen Quellen erwhnt. Literarische Darstellungen von Menschen, die an Epilepsie erkrankt sind, finden sich vermehrt seit dem 19. Jahrhundert. Ein besonderer Zugang zur Epilepsie Zur Kulturgeschichte der Epilepsie gehrt deren literarische Behandlung. Eine Auseinandersetzung mit Epilepsie in der Literatur erffnet andere Zugnge zum Verstndnis der Krankheit als dies ber fachwissenschaftliche Texte mglich ist. Die Probleme und Einschrnkungen, die das Leben mit Epilepsie mit sich bringen kann, sind in verschiedenen erzhlenden Texten einfhlsam dargestellt. Krankheitsinterpretationen und gesellschaftliche Verhaltensweisen werden nicht zuletzt in der Literatur greifbar. Whrend im Bewusstsein der ffentlichkeit Epilepsie oft mit dem groen epileptischen Krampfanfall gleichgesetzt wird, vermitteln viele literarische Werke eine wesentlich differenziertere Sicht. Sie kennen sowohl leichtere

Anfallsablufe, gutartige Verlaufsformen und erfolgreiche Behandlungen von Epilepsie als auch spezielle Krankheitsursachen. Unterschiedlicher Einsatz von Epilepsiemotiven Viele Schriftsteller geben einfhlsame und manchmal przise Beschreibungen von Anfllen. Die Zahl der Autoren, die eigene Erfahrungen mit Epilepsie in ihren Werken verarbeiten, ist allerdings gering. Ihre Werke bilden eine besondere Gruppe. Am bekanntesten ist Dostojewski, auf dessen Epilepsie und epilepsiekranke Figuren immer wieder auch andere Schriftsteller Bezug nehmen. Aus neuer Zeit sind zu nennen die Englnderin Margiad Evans (A ray of darkness, 1952) und der US-Amerikaner Richard Pollak (The episode, 1987) sowie die Australierin Susan Hawthorne (The falling woman, 1992). In vielen Werken ist das Thema Epilepsie sorgfltig recherchiert und die Autoren profitieren davon, dass sie Betroffene kennen und befragen. Andere stellen hingegen Epilepsie nur auf dem Hintergrund von Vermutungen und Vorurteilen dar. Zuweilen trifft man auf schrecklich bertriebene Anfallsschilderungen. Sehr viele Autoren vermitteln die Vorstellung, dass epileptische Anflle als Reaktionen auf seelische oder krperliche Krisen- und Stresssituationen auftreten. Whrend sich ber therapeutische Mglichkeiten nur selten etwas findet, und Medikamente oft mit negativen Vorstellungen besetzt sind, werden Arzt-PatientBeziehungen in allen erdenklichen Varianten dargestellt. Auch Schriftsteller sind nicht immer frei von den weit verbreiteten Vorurteilen ber Epilepsie. Durch ihre Darstellung untersttzen sie diese dann wiederum. So trifft man in manchen Erzhlungen auf das Vorurteil der Unheilbarkeit.

Vereinzelt wird die Ansicht vertreten, dass Epilepsiekranke zu Gewaltttigkeit neigen, oder dass es bei bestehender Epilepsie, sogar schon vor Beginn der Anflle, zu typischen Wesensvernderungen komme. Dass manche Epilepsiekranke bei einem Anfall im noch bewusstlosen Zustand immer noch relativ komplexe Handlungen vollziehen knnen und sich nachher nicht daran erinnern, erffnet dem Kriminalroman Mglichkeiten: Sie nutzt etwa Chandler in seinem Roman The big sleep (1939), in dem der Detektiv erst spt der epilepsiekranken Tterin auf die Spur kommt. Es kommt jedoch hufiger vor, dass einem Epilepsiekranken unter Ausnutzung seiner Bewusstseinslcken ein Verbrechen nur untergeschoben wird (Christie, Eliot, Fennelly, Pollak). In anderen Kriminalromanen werden Epilepsiekranke Opfer von Verbrechen (Fennelly, McLaverty, Simenon). Selbstvergewisserung In den letzten Jahren sind verstrkt Initiativen zu beobachten, Zugang zur Epilepsie ber ihre knstlerische, insbesondere literarische Verarbeitung zu gewinnen. In Deutschland wurde anlsslich des Tages der Epilepsie 1996 zum dritten Mal ein Colloquium Epilepsie und Literatur abgehalten (siehe unter Hinweise). Whrend des 21. Internationalen Kongresses der Liga gegen Epilepsie, Sydney 1995, wurde ein Schriftsteller-Forum abgehalten, um schreibende Betroffene zu ermutigen und zu untersttzen. Eines der sieben Hauptthemen des 22. Internationalen Kongresses der Liga in Dublin 1997 ist Epilepsy and the creative arts. Es ist zu erwarten, dass die Behandlung kulturgeschichtlicher Aspekte nicht zuletzt Betroffenen besondere Erkenntnismglichkeiten bietet. Vielleicht beginnt aber auch eine Entwicklung, in der die Betroffenen die Kulturgeschichte ihrer Krankheit zunehmend selbst schreiben und gestalten. Literarische Texte mit wichtigen Epilepsiemotiven:

Autor Titel Land Jahr (Titel der bersetzung/Jahr)

Anonym Ching Ping Mei, China 16. Jh. (Kin Ping Meh, 1930) Atwood, Margaret Cats Eye, Kanada 1989 (Katzenauge, 1990) Ben Jelloun, Tahar Lenfant de sable, Frankreich 1985 (Sohn ihres Vaters, 1986) La nuit sacre, Frankreich 1987 (Die Nacht der Unschuld, 1988) Burnier, Andreas Een tevreden lach, Niederlande 1965 (Rendezvous bei Stella Artois, 1994) Chandler, Reymond The big sleep, USA 1939 (Der groe Schlaf, 1950) Christie, Agatha The ABC Murders, England 1936 (Der ABC-Fahrplan, 1937) Collins, Wilkie Poor Miss Finch, England 1990 (Lucilla, 1969) Cookson, Catherine The Gillyvors, England 1990 (Das ertrotzte Glck, 1994) Crichton, Michael The Andromeda Strain, USA 1969 (Andromeda, 1969) The Terminal Man, USA 1972 (Endstation, 1972) Dickens, Charles Oliver Twist, England 1837/38 (verschiedene) Dostojewski, Fjodor M. Idiot, Russland 1868/69 (Der Idiot, 1889) Besy, Russland 1871/72 (Die Dmonen, 1888) Bratja Karamazovy, Russland 1879/80 (Die Brder Karamasov, 1884) Eliot, George Silas Marner, England 1861 (Silas Marner, 1861) Fhrmann, Willi Jakob und seine Freunde, Deutschland 1993 Fennelly, Tony The closet hanging, USA 1987 (Brendienst, 1988) Kiss yourself goodbye, USA 1989 (Robins Hochzeit, 1991) Fichte, Hubert Das Waisenhaus, Deutschland 1965 Frame, Janet Owls do cry, Neuseeland 1957 (Wenn Eulen schreien, 1961) To the Is-Land. Autobiography I, Neuseeland 1982 (Ein Engel an meiner Tafel, 1993) An Angel at My Table. Autobiography II, Neuseeland 1984 (Autobiographie 1 und 2, 1993) Hawthorne, Susan The falling woman, Australien 1992 Howatch, Susan The rich are different, USA 1978 (Die Reichen sind anders, 1986)

Hustedt, Siri The blindfol, USA 1992 (Die unsichtbare Frau, 1993) Jaffe, Rona Class reunion, USA 1979 (Die Schulfreundinnen, 1981) After the reunion, USA 1985 Jones, Thom The pugilist at rest, USA 1991 Kahanowitsch, Pinhas Di mischpoche Maschber, USSR 1939/48 (Die Brder Maschber, 1995) Kesey, Ken One Flew Over the Cuckoos Nest, USA 1962 (Einer flog ber das Kuckucksnest, 1971) Kubin, Alfred Die andere Seite, sterreich 1909 Lenz, Siegfried Deutschstunde, Deutschland 1968 Mac Laverty, Bernard Lamb, England 1980, (Lamb, der Ausgeflogene, 1982) Mac Millan, Terry Disappearing Acts, USA 1989 (Ab durch die Mitte, 1993)

3
Autor Titel

Land Jahr (Titel der bersetzung/Jahr)

Mann, Thomas Der Zauberberg, Deutschland 1924 Bekenntnisse des Hochstaplers Felix Krull, Deutschland 1954 Morante, Elsa La storia, Italien 1974 (La storia, 1976) Oe, Kenzaburo Shizuka na seikatsu, Japan 1990 (Stille Tage, 1994) Oz, Amos Ladaat ischa, Israel 1989 (Eine Frau erkennen, 1990) Palmen, Connie De Wetten, Niederlande 1991 (Die Gesetze, 1993) Poe, Edgar Allan Berenice, USA 1835 (Berenice) Pollak, Richard The episode, USA 1986 Putney, Mary Jo Dearly Beloved, USA 1990 Pynchon, Thomas The Crying of Lot 49, USA 1966 Ransmayr, Christoph Die letzte Welt, sterreich 1988 Richler, Mordecai The apprenticeship of Duddy Kravitz, Kanada 1959 Roth, Joseph Hiob, sterreich 1930

Rushdie, Salman Midnights Children, England 1981 (Mitternachtskinder, 1983) The Satanic Verses, England 1988 (Die satanischen Verse, 1989) Schneble, Hansjrg Das Eigentor, Deutschland 1994 Schneider, Robert Schlafes Bruder, sterreich 1992 Schnurre, Wolfdietrich Als Vaters Bart noch rot war, Deutschland 1958 Simenon, Georges Le haut mal, Frankreich 1977 (Das Unheil, 1992) Spark, Muriel The bachelors, England 1960 (Die Junggesellen, 1961) Tennyson, Alfred The Princess, England 1847/51 Walker, Percy The second coming, USA 1980 (Die Wiederkehr, 1989) Wilder, Thornton The ides of march, USA 1948 (Die Iden des Mrz, 1949)

Weiterfhrende Materialien
Engelhardt von, D.: Medizin in der Literatur der Neuzeit. I. Darstellung und Deutung. PresslerVerlag, Hrtgenwald 1991 Engelhardt von, D.: Epilepsie in der Literatur der Neuzeit. Fundamenta Psychiatrica 7 (1993) 148-156 Epilepsie in der Literatur. Epilepsie-Bltter 7 (1994) Suppl. 2 (Monographisches Heft mit Einzelbeitrgen zum Thema) Epilepsie in der Literatur. Epilepsie-Bltter 9 (1996). (Monographisches Heft mit Einzelbeitrgen zum Thema) Schmidt, L.: Epilepsie als literarisches Motiv Elsa Morantes Roman La Storia. EpilepsieBltter 3 (1990) 7-12

Sontag, S.: Krankheit als Metapher. Fischer Taschenbuch, Frankfurt/M 1981

Tellenbach, H.: Schwermut, Wahn und Fallsucht in der abendlndischen Dichtung. PresslerVerlag, Hrtgenwald 1992 Vogel, P.: Von der Selbstwahrnehmung der Epilepsie. Der Fall Dostojewski. Nervenarzt 32 (1961) 215-221 Wolf, P.: Epilepsy in literature. Epilepsia 36 Suppl. (1995) S12-S17

Wolf, P.: Erfahrung und Vorurteil in literarischen Epilepsiedarstellungen. Fundamenta

Psychiatrica, 10 (1996) 148-155

Video

 Zu Titeln von Spielfilmen, die auf Literaturvorlagen beruhen und in denen von Epilepsie die Rede ist, siehe: Informationsblatt 013 Epilepsie und Spielfilm. Informationsbltter Folgende Informationsbltter behandeln angrenzende Themen: 009 (Historisches), 011 (Bildende Kunst), 013 (Spielfilm) Hinweise
Auf dem 21. Internationalen Epilepsy Congress (Sydney 3./8. September 1995) fand erstmals ein Writers Forum mit Autoren statt, die aus eigenem Erleben ber Epilepsie schreiben. siehe dazu: Yanko, S.: Authors share their expertise in the Writers Forum. Internat. Ep. News 122 (1995) 11-12 Interessenten an den Berichten der Tagungen Epilepsie und Literatur (abgehalten 1996 in Heidelberg, 1995 in Kehl/Kork, 1994 in Bielefeld) knnen sich an die Geschftsstelle der Dt. Gesellschaft fr Epileptologie wenden. Telefon: 0700/13141300, Reinhardtstr- 14, 10117 Berlin Informationen ber Epilepsie sind auch erhltlich ber:

Deutsche Epilepsievereinigung/einflle, Zillestr. 102 10585 Berlin, Tel 030/3424414, Fax 030/3424466; Internet: www.epilepsie.sh Stiftung Michael, Mnzkamp 5, 22339 Hamburg, Tel: 040/5388540, Fax: 040/5381559, Internet: www.Stiftung-Michael.de
Webseite:

Deutsches Epilepsiemuseum www.epilepsiemuseum.de in Kehl-Kork

Herausgeber: Deutsche Gesellschaft fr Epileptologie e.V.

The Contribution of Psychiatry to the Study of Creativity:

Implications for AI research. Antonio Preti, MD; Paola Miotto, MD CMG, Psychiatry branch Abstract An old saw has it that very little divides a genius from a madman, and if one is to judge from the recorded eccentricities of those society has chosen to label as geniuses, one can readily see why. A good theory of the creative mind then, or indeed, any aspect of mind, will not only explain the mechanics of what one would consider 'healthy cognition', but also the apparent breakdown of these mechanics. This paper considers the rich contribution the field of psychiatry can make to the study of human creativity, and focuses on some particular aspects of psychoanalytic theory that are amenable to algorithmic expression.

1. Introduction Creativity is one of the cognitive functions which contributes to sociobiological adaptation. It can be defined as the ability that allows the production of new or unusual associations among known ideas or concepts. This definition highlights those aspects most relevant to the creative process the elaboration of information (knowledge, what it is already known) through contrast and comparison of data; and the production of associations which are original, i.e. not already part of acquired knowledge (memory). Other definitions of creativity are quite possible. Frank Barron, one of the most authoritative researchers in this field offers an articulate description of creativity. Creativity is first conceived in terms of the characteristics of the creative product and the social acknowledgement it obtains creations in fact are products which appear new and are considered valuable by consensus. Secondly the creative product can be considered in its own context the difficulty of the problem resolved or identified, the elegance of the solution proposed, the impact of the product itself. Thirdly creativity can be conceived on the basis of the abilities that favour it, i.e. as skill or aptitude (Barron and Harrington, 1981). Many studies recognize creativity as a cognitive ability separate from other mental functions and particularly independent from the complex of abilities grouped under the word 'intelligence' (McKinnon, 1962; Dellas and Gaier, 1970). Although 'intelligence' the ability to deal with or process a large amount of data favours the development of creative potential, it is not synonymous with creativity. Higher scores in tests which measure intelligence factors do not guarantee expression of a creative talent. The two most complete studies on this subject, that of Terman, conducted on a group of talented children who were followed right through their lives, and the study of McKinnon on architects indicated as cleverer than

the mean by their colleagues, showed that intelligence gifted individuals attain significantly higher levels of personal and social achievement than the mean of the general population with better physical and mental health (although with higher suicide rates), but they do not show greater creative abilities than others (see McKinnon, 1962; Richards, 1981). Many characteristics seem to distinguish the thought processes of more talented individuals verbal fluency, fluency of ideas, redefinition, openness to experience, independence of thought, capacity to bring together remote associations and expend effort in the production of ideas are all abilities which favour the expression of creativity among gifted individuals (see Dellas, Gaier, 1970; Rothenberg, 1971). Each of these qualities concur to produce creative results, which are to be understood not as a single act, as the Romantic myth states, but the derivation of a process which implies many different phases. A traditional conceptualization recognizes four chief phases of the creative process the phase of preparation, marked by the collection of information relevant to the resolution of a problem or the creation of an artistic work; the phase of incubation, during which ideas germinate at a subconscious level, and in which the problem under examination generally finds no solution based on usual knowledge; the phase of illumination, or insight, during which elements of the argument under study, are suddenly distinguished from one another, or conversely are associated in new combinations; the phase of elaboration, during which the new idea is developed and tested against scientific and social standards (see Ludwig, 1989). Among the most often quoted examples is the anecdote reported by the chemist Kekul, who recounted that he conceived the ring structure of benzene after a dream in which a serpent biting its tail appeared to him.

2. The Psychoanalytic Approach Psychoanalists were among the first to indicate the importance of subconscious elements in the production of a creative result (Kris, 1952). Sigmund Freud (1907) thought that unconscious conflicts concerning powerful biological drives, such as sexual impulses and even more archaic nutritional drives, provided motivation for creative effort in terms of the energy that must be harnessed for productive enterprise, thus diverting it from less controllable enterprise which could potentially generate anguish. Otto Rank noted that, in the artistic field at least, these same unconscious conflicts, disguised or revived, could offer matter other than energy, to the creative action, allowing the expression of socially condemned drives, such as those linked to envy, hate and jealousy, in a sublimated form. Melanie Klein (1948 see particularly 'A contribution to the psychogenesis of ManicDepressive states'), and Donal Winnicott (1971) after her, indicated the importance of depressive feelings in the elaboration process of mourning that follows the recognition of the separateness of the Loved Object, a process which, according to psychoanalysts of the British School, constitutes the basis for the development of the ability to symbolize. If a symbol takes the place of something that is not there it can only come into being when the symbolised object is conceived as distant and separate from the Self and every separation contains the seeds of depressive grief <<thinking is thinking about what is not there>>. The desire to recover total appeasement close to the Loved Object imposes the need to reconstruct and re-integrate the object which separation has forced one to think of as broken. The control over this complex affective drive, which is provoked by elementary biological impulses and by the emotions linked to them, is sustained by the same forces that give rise to language as an instrument of communication. Language, like the arts, is based on a recourse to symbols in Greek language the word 'symbolon' derives from 'symballein', a verb meaning 'to reunite'. The etymology of the Greek word 'symbolon' is anecdotally described in the following story in ancient times, when two friends separated they broke a tablet which had a scroll carved into it. When they joined together again, they reunited (= 'symballein') the fragments of the tablet and so restored the broken scroll. The broken tablet (with the divided scroll) possessed by each friend was called a 'symbolon'. The creative character of the symbolon consists in its ability to complete the object, incorporating even the absent part a symbol, like an artistic work, invokes a uniqueness that can only be maintained by remembrance. At the origin of the symbol is a destructive act the breaking of the tablet bearing the carved scroll. This links the process of reintegration, offered by the act of symbolisation, to the process of restoration of the Loved Object by emotional forces moved in turn by depressive anguish. The role of depressive feelings and, more generally, the role of perturbed psychic states in the development of creativity is indicated by studies that explore the relationship between mental disorders and creativity. In fact one characteristic seemingly linked to creative talent is the propensity to develop psychiatric disorders, the prevalence of which among creative individuals appears significantly higher than in the general population.

3. Creativity and Mental Illness The Italian psychiatrist and criminologist Cesare Lombroso has over the past century been the most consistent supporter of the hypothesis which asserts that there is a close link between mental ilness and creative achievement (see Lombroso, 1891). He was not the first, however more than two millenia earlier, in the fragment known as 'Problemata XXX', Aristotle, or a disciple of his, raised the question as to why the vast majority of the eminent people are afflicted by 'melancholy', i. e. suffer from a mental disorder. The text, now accepted as part of the Aristotelian canon, is surprising in its modernity and accurately describes those characteristics peculiar to one of the most diffuse mental disorders, namely manic-depressive psychosis. The author of the Problemata XXX indicates many behavioural characteristics as attributes of the more eminent people of his time (attributes such as mood, instability, proneness to depressive withdrawal, impulsiveness, tendency to alcohol and drug abuse, high risk of suicide) all of which are peculiar to patients suffering from manic-depressive illnesses. In the Problemata XXX there are also illustrative stories taken from myth and literature, with a gallery of examples mixing both excellence and weirdness, often with a tragic outcome. Indeed, the image of madness as a result of genius has been repeatedly expressed in the history of the Western world, being codified during the Renaissance in the figure of the melancholic genius afflicted by Saturnian acedia, and resurfacing during Romanticism in the figure of the Deracine artist (see Starobinski, 1960; Klibansky et al., 1983). Cesare Lombroso was among the first to apply a less anecdotal method to the investigation of the relationship between the creative gift and the risk of a mental illness, offering an answer that is nevertheless the positivistic version of the romantic myth. Most studies performed in the positivistic era in order to either confirm, or refute, Lombroso's hypothesis rest on biographical evidence (see Richards, 1981). This raises the suspicion that these studies claiming a higher prevalence of psychopathologies among creative or eminent people, were biased by overexposure. For individuals in the public eye such as artists more information is available about their private lives this could determine an apparently higher prevalence of disorders that tend, as a result of negative stigma, to be hidden whenever possible. In addition, some temperamental traits widespread among creative people, like eccentricity, uneasiness, propensity to excess and experimentation, could be a reflection not only of an underlying mental disorder, but also, and above all, of the tolerance by society of the behaviour of high achieving individuals. In some way this behaviour will be a secondary product of the achievement, rewarded since it permits the expression of dissenting demands which the majority of people are not able to express and which are not directly linked to the creative utterance. Despite these reservations, even later studies, performed using methods applying specific nosographic categories and direct confrontation with the candidate through interviews and inventories, yielded similar results, with a higher prevalence of mental disorders among gifted people than among the general population (see Richards, 1981; Goodwin and Jamison, 1990, ch. 14). The two principal studies performed in the era preceding the systematic ordering of the more recent classifications (DSM III, and now IV, and ICD 9, and now 10), show among both artists and scientists a prevalence of severe mental disorders significantly higher than among the general population, with a strong familial association between creativity, psychopathology, and higher suicide rates. In a study performed in Germany from 1927 to 1943 on 5000 individuals, Adele Juda, at that time researcher at the Munich Institute of Psychiatry, evaluated frequency and distribution of psychiatric disorders in a well selected sample of eminent artists, scientists and their relatives. The study shows a significantly higher prevalence of mental illnesses among eminent people and their families compared to the general population. Among artists, disorders of the schizophrenic spectrum and psychopathies were most common. Among scientists, on the other hand, disorders of the cyclotimic type, in particular manic-depressive psychoses, were more frequent. In both groups there was a high suicide rate and a strong familial heredity for the transmission of the psychopathological trait and of creative talent (see Juda, 1949). Some decades later, J.L. Karlsson, in a study of Iceland, reported a clear familial association between the diagnosis of psychosis, taken from hospital registers, and eminence in artistic or scientific fields, based on citations in Who's Who. A clearly recognisable creative talent was present in the relatives of schizophrenic patients twice as often as in the general population; and in the relatives of manicdepressive patients six times as often as in the general population. Karlsson, in his conclusion, suggests a familial link between creativity and psychoses, sustained by a common genetic basis (see Karlsson, 1978). In both studie,s there is a clear association between the creative gift and the risk of schizophrenia, although mediated by a familial link this is surprising since in the concept itself of schizophrenia as illness there is implied a criterion of impairment. Schizophrenia, in fact, is a severe mental illness. It is a psychosis, i. e. a mental disorder which implies a severe distortion of reality testing. The clinical symptomatology can be traced back to the ex novo appearence of distortions in perception, such as illusions and hallucinations, and of thought disorders leading to delusions, and includes many different behavioural patterns, predominantly disorganized and

inappropriate behaviour and speech, loss of will and drive, and a generalized lessening of the ability to express emotions. Positive symptoms, involving excess or distortion of normal functions, tend to fluctuate over time, whereas negative symptoms, involving loss or diminution of normal functions, seem to be more stable and less responsive to treatment. Studies performed with neuroimaging techniques indicate that brain abnormalities (i.e. signs of cerebral atrophy) can be the basis of schizophrenia, but the extent of such abnormalities depends on the characteristics of the control groups. The final step in the pathogenesis of schizophrenia appears to be a distortion of the systems involved in modulation or integration of information processing. A key role for dopaminergic pathways is suggested by the therapeutic efficacy of dopamine blocker agents, but, as the development of new 'atypical' neuroleptics with greater effects on serotonin indicate, many other neurotransmitters could be implicated in the defects in information processing. The fact that such severe illness could in some way favour the expression of creative abilities, particularly in the artistic field, has raised enormous interest and provoked myriad studies. These studies were summarized in the Sixties by the Italian Silvano Arieti, an eminent researcher in the field of psychoses who for many years lived in the United States. In his book 'Creativity, the magic synthesis', Arieti elaborates his hypothesis that the thought processes typical of schizophrenic patients can favour the development of unusual mental associations which can, in turn, be inspiring to the creatively gifted individual, above all in the artistic field (see Arieti, 1976). Arieti supports his hypothesis in many ways, indicating the extraordinary talent of schizophrenic patients in coining new words, and giving many examples of the artistic production of patients confined in Asylums in the first half of this century. The works of these artists are often very odd and disquieting, but generally they do not possess the requisite of being 'socially enjoyable', essential if a product is to be judged creative. Interest in the artistic production of mentally ill patients lasted until the Sixties, when the introduction of more selective diagnostic categories lessened enthusiasm for the creativity enhancing virtues of schizophrenia. With the increase in the number of cases identified awareness was also raised that it was disorders with an affective (mood) component those characterized by melancholy (i.e., severe depression) - that were more closely associated with creative achievement than disorders like schizophrenia, just as the author of the Problemata XXX asserted.

4. Melancholy and Creativity Manic-depression or, as they are now called, 'bipolar' disorders are characterized by the alternation of depressive episodes (with melancholia, insomnia, loss of appetite, anxiety and restlessness) with other episodes with an opposite euphoric mood, excitement, higher energy and tirelessness, overconfidence, impulsiveness and imprudence (see Goodwin and Jamison, 1990). In the periods between two episodes those who are suffering from the disorder have a highly adaptive life style, sometime with very high level of functioning, thanks to the tenacity, tirelessness and social ease that are typical of these individuals. During an episode of illness, however, the social and occupational functioning of the afflicted individual is impaired, sometimes with irreparable consequences. As a whole the lives of bipolars are troubled, with a high risk of death by suicide one patient in ten dies by suicide, and the frequency of self-inflicted injuries is even higher (1 in 5 cases, according to studies). Nevertheless these individuals appear to have a unique gift for creative activity, and show a specific talent in the arts, sciences, philosophical speculation, and political and military leadership. The following all suffered from bipolar disorders in their lives the scientists Boltzmann and Babbage, the father of modern computer science; the composers Rossini and Tchaikovsky, who committed suicide drinking a cup of water contaminated with vibrio colerae; the statesmen Churchill and Lincoln; the painters van Gogh and Pollock; the philosophers Wittgenstein and Kierkegaard; the writers Pavese and Hemingway, both of whom died by suicide. Poets and writers seem to be particularly prone to developing mental problems, generally of a depressive type; it has even been asserted that one cannot write with success without being 'exposed to the Dark Sun of Melancholy'. Nancy C. Andreasen, an eminent American psychiatrist who studied literature before devoting herself to medicine, performed an extensive study with her co-workers in the mid Seventies on the qualities which characterized the styles of thought of a group of writers who were participating in the annual Writer's Workshop of Iowa University, and, using the criteria of DSM-III, found a high prevalence among them of mood disorders of a bipolar type (see Andreasen and Glick, 1988). The style of thought of the writers investigated in addition showed more resemblances with the over-inclusive and imaginative style of thought of manic patients, than with that of schizophrenic patients examined in the same study. A clear prevalence of psychopathologies from the affective spectrum among creatively talented people was later reported by K.J. Jamison in a study dedicated to twentieth century English poets; by JJ Schildkraut and co-workers among American Abstract Expressionist

Painters; and by AM Ludwig among 30 American female writers (see Jamison, 1989; Schildkraut et al, 1994; Ludwig, 1994). Kay Jamison, in a study covering three centuries limited to writers and poets, found high rates of mood disorders, in most cases of a bipolar type (see Jamison, 1993). In the Jamison study, suicide and alcoholism rates were also very high as was the familial transmission of both psychopathological risk and creativity. Kay Jamison reports many examples in his study, among the more representative is one which concerns the poet George Gordon, known as Lord Byron, whose familial history was as replete with suicides and bizarre incidents no less clamorous than that which accompanied his own adventurous and unfortunate life. The ability of bipolar patients and their relatives to express themselves successfully is not limited to the artistic field, however, and in fact achievement and ability seem to be attributes of the families of bipolar who appear time and again as motive powers for the advancement of mankind. Ruth Richards, who extensively studied this aspect of the relationship between mood disorders and creativity, found among bipolar patients and their relatives a high propensity to the development and expression of creative potential in every field, even those not mutually linked (see Richards et al., 1988). These abilities were evident mainly among individuals with slight or sub-clinical forms of the disorder. The healthy carriers of the genetic burden of manic-depressive psychosis seem in some way to draw an advantage from exactly the vulnerability they transmit.

5. The Gift of Saturn One can only speculate as to the characteristics that confer such an advantage. In fact there are several aspects characteristic of manic-depressive psychosis which can offer a basis for these adaptive advantages. During euphoric phases cyclothymic individuals exhibit greater energy which can favour their involvement in productive activities and their ability to put up with fatigue. In addition, increased fluency of mental associations, which in mania is expressed in the dramatic experience of 'flight of ideas', allows a greater processing of information and a greater articulation of ideas, favouring original or unusual associations. This is often accompanied by improvements in both memory and concentration, which render even more productive the heightened imaginative potential of these individuals. People with a bipolar mood disorder tend to be more emotionally reactive, which gives them greater sensitivity and acuteness. A lack of inhibitions permits them unrestrained and unconventional expression, less limited by accepted norms and customs. This makes them more open to experimentation and risk-taking behaviour, and, as a consequence, more assertive and resourceful than the mean. Sensitivity, lack of inhibition and hyper-activity make these subjects warmer in social intercourse and more friendly both aptitudes represent a clear advantage at work, particularly when competition is great. Even the depressive phases can favour abilities contributing to achievement introspection and reasoning are favoured during depressive withdrawn phases. Depressive episodes, in addition, give access to 'inner dimensions' of life, allowing considerations of themes linked to guilt, sorrow and death. The elaboration of these feelings can offer subject matter for creative expression in many fields, but particularly in the arts, as demonstrated by the high prevalence of depressive disorders among poets and writers. In effect, the experience of pain associated with a depressive episode can permit a better understanding of the human condition, allowing the transformation of this wider awareness in to a complete work. The extreme and sometimes very unusual experiences associated with more severe forms of the disorder can also offer access to uncharted existential dimensions, broadening the intellectual horizon of the subjects. The creative process per se generates a sense of euphoria. This euphoric disinhibition could be sought in a active way by individuals such as bipolar patients who attribute a very great importance to sensations of excitement, often abusing drugs in a attempt to reproduce the euphoric mood. The reinforcing property of euphoria can direct these individuals towards risk-taking activities, increasing their chances of failure, but assuring greater glory when they attain their goal. Other disorders show important links with creative abilities and achievement. Anorexia Nervosa, for example, is a disorder that is often associated with high performance in many fields people suffering from this disorder tend to show remarkable tenacity and determination.

6. Extra-Logical Aspects of the Creative Process

The aspects described above indicate extra-logical characteristics which could somehow be formalized. It is unlikely than an Artificial Intelligence program would develop habits reminiscent of alcoholism, but a program could develop social aptitudes in seeking to establish contacts with information sources (data banks) by itself, rather than waiting to be questioned about a particular subject. Software already exists which 'converses' with its users (e.g., Weizenbaum's 'Eliza' program, and its variants). Although these programs could not pass a rigorous Turing Test, they are certainly able to establish friendly relationships which can stimulate information exchange and reduce performance anxiety (at having to resolve a problem). Studies have also given evidence for other aspects of the relationship between mental disorders and creativity that could be useful to the 'planning' of creativity. The study of the style of thought of schizophrenic patients shows an interesting connection between some characteristics of schizophrenia and others that can be observed in creative people. Creative individuals often score higher on psychopathological scales in standardized tests, like the Minnesota Multiphasic Personality Inventory (MMPI), particularly on scales which measure traits of psychoticism. Often creative individuals report odd sensory and perceptual experiences, feelings of restlessness and inclination towards impulsive outbursts in association with rejection of common social values and highly unusual experiences, just like schizophrenic patients (see Cattell and Drevdahl, 1956; Dykes and McGhie, 1976; Woody and Claridge, 1977). Highly creative normals also tend to show over-inclusive or 'allusive' thinking and, as pointed out by Albert Rothenberg (1971), show the capacity to conceive and utilize two or more opposite or contradictory ideas or concepts simultaneously, without being disturbed by this simultaneity of opposition, as happens to schizophrenics. It seems that creative individuals, like schizophrenics, are capable of a widening of selective attention, which renders them more aware of and receptive to experience, with a more intensive sampling of environmental stimuli (see Hansenfus and Magaro, 1976). In fact ideational fluency and a preference for complex and asymmetrical designs (two of the main factors contributing to creativity) could derive from higher levels of arousal and from faster stimulation of discrete cerebral areas. Schizophrenics tend to make unusual associations, resulting in ove-rinclusive thinking, with many irrelevant elements included in the reasoning this peculiar style of thought is conceived as deriving from a failure in the normal filtering of stimuli by dysfunctional gating systems (see Braff and Geyer, 1990; Preti, 1995a). Creative individuals, conversely, may draw advantage from higher levels of associative thinking, since they are capable of effectively processing these increased inputs without the risk of cognitive overload. Since to create consists essentially in making new combinations of associative elements, any ability which serves to bring otherwise mutually remote ideas into contiguity will facilitate a creative solution (see Mednick, 1968). This implies an extended knowledge of the argument under study (memory of ideas to be associated) and a restriction of inhibitory influences on the stimulation of remote cerebral areas which favours association. The more associations evoked by an element, the more likely it is that another element will be combined with it in a manageable form. Since inhibition or suppression (by anxiety or other more powerful competitive stimuli) would limit awareness and openess to both internal and external stimuli, their loosening would favour associative thinking, and so creativity. Greater opportunity to combine dissociated items also leads to a greater openness to emotions and feelings. As noted earlier, this sometimes results in psychic turbulence and emotional instability, which can in itself, however, contribute to the expression of creative potential since it permits the radical re-structuring and continuous adjustment which respond to the subject's intense need for quality and novelty. In fact creative individuals are highly motivated and show a preference for activities allowing for self-expression and independence. The process of creating seems to be a highly adaptive function, and greatly contributes to success in continuously changing environments. This fact suggests that the same mental processes which can give rise to severe mental illnesses can also confer some advantage in their less dysfunctional forms which could account for the persistence in the population of maladaptive genotypes having lower fertility rates and higher mortality rates at younger ages.

7. A Kleinian Algorithm Studies on the style of thought in schizophrenia highlight the importance of the systems that filter inputs to the production of mental associations which guide behavioural responses (see Perry and Braff, 1994; Preti, 1995b). A wide archive of data per se is not sufficient for the production of new and original ideas, whether useful or not. Each piece of information stored in the memory units (neurons) must be compared to the others, and this does not happen spontaneously. A restraint on the associative possibilities is constituted by the effective existence of circuits connecting one cerebral area (module) to other areas far from it. The existence of neural connections depends on genetic factors and on the remodelling of the neural links by developmental and environmental factors. Furthermore specific neural circuits can be activated by certain stimuli and not by others. The integration

of the activated circuits, in their convergence towards a response to the stimuli, is guided by 'filtering' systems that favour the spread of the stimuli and linked responses, through inhibition of the weaker signals. An overly rigid system, however, which suppresses all under-threshold signals, can give only stereotyped responses. A more creative system might let even weaker signals pass, which enrich what Harnad called the 'symbolic grounding' of the system. These low-level signals can stimulate associations not predicted by the principal powerful signal. A self-activating system will be even more creative the emotional instability of many, though not all, creative individuals drives them towards enterprises which, by allowing the proper expression of their own potential, strengthen the Ego and reduce anxiety. The link between a defective functioning in the neural circuits and a creative output is relevant for AI research. There are AI program that have outputs not predictable on the basis of the way they had been programmed. For example, Margaret Boden some time ago discussed the outputs from some AI musical composer programmes which had originated interesting and attractive styles of music composition of their own. These styles were not in any predictable way programmed in. If these creative results from the AI programmes were derived from some bugs, the observation of a link between creativity and mental disorders can also be extended to the AI world. There is another aspect that has important implications for AI research. Mental disorders as a whole are rather widespread in the general population. About 25-30% of people suffer from a mental disorder severe enough to need psychiatric treatment; 1% of people suffer from a disorder of the schizophrenic spectrum, up to 10% of individuals in the general population suffer from a mood disorder. The style of thought in the general population is not uniform, and not for only cultural or social variety, but also as a consequence of profound biological differences in the functioning of neural circuits that allow mental computation. In fact some people may need programmes that 'think' in a way that is different from that of the majority of other people. At the moment one can only imagine an AI which, like 'Wintermute' in William Gibson's 'Neuromancer', commits itself to the search for information in order to contain its grief due to the death of its creator. But an 'emotionally instable' program or machine that goes in search of lost information and looks for the opportunity to play and engage with others, like the Player Computer in 'Wargame', is already conceivable; one is merely waiting for the day when, in some remote room of a research centre there awakes an scientific realization of Hal 2000, needing the same care and attention as its forerunner did, when dreamed up by the film-maker Stanley Kubrick.

CREATIVITY AND PSYCHOPATHOLOGY ANTONIO PRETI, MD

1. Introduction: the difficult definition of creativity 2. Genius and madness 3. A broken mind: schizophrenia and the artistic temperment 4. The circular insanity: manic-depressive illness and the bipolar disorders 5. Mood disorders and achievement 6. An open conclusion INTRODUCTION: THE DIFFICULT DEFINITION OF CREATIVITY Life in the metropolis increasingly depends on the ability to provide new and original solutions to old problems. This capacity to bring together knowledge and imagination is called "creativity". Creativity can be defined as many ways as it can be conceived. As its simplest, creativity could be described as the ability to create products or ideas which are original and which posess a strong social usefulness. This definition, however, is not the whole answer. Frank Barron, one of the most important researchers in this field, offers a more articulate description of creativity. First creativity is considered in terms of the characteristics of the creative product and the social aknowledgement obtains. A criterion of usefulness is implied in, although not essential to, this definition. Secondly the creative product can be considered in its own context: the difficulty of the problem resolved or identified, the elegance of the solution proposed, the impact of the product itself. Thirdly creativity can be conceived on the basis of the abilities that favour it, id est as skill or aptitude. Creativity, in fact, can be properly conceived as a cognitive capability separate from other mental functions. It appears increasingly independent from the complex of abilities grouped under the word "intelligence", although it has a strong interrelation with these mental abilities. Generally, creatively gifted individuals tend to score

higher than the mean of the general population in tests measuring "intelligence", and are also evaluated as more intelligent than the mean of their peers by independent observers. Elevated performances in IQ tests, however, do not guarantee a proper utterance of creativity. The most complete studies on this topic (the Terman study on a group of gifted children followed through their lives, and the McKinnon study on a wide group of architects indicated as cleverer than the mean by their colleagues) showed that intelligence gifted people have better social skills and health than the mean of people of their own age, although with higher suicide rates, but are no more creative than the general population. So, as indicated by the study of McKinnon, there is no correlation, above an IQ level of 120, between IQ scores and creative ability, however measured. Intelligence and creativity, hence, seem independent of the other cognitive capabilities which identify an individual. The methods used in the evaluating of creative aptitude and ability are numerous and as ingenious the argument investigated demands them to be. In 1981 Dennis Hocevar, in a circumstantial review, sumarized the ten main methods used in studies on creativity: Tests of divergent thinking Attitude and Interest inventories Personality inventories Biographical inventories Teacher nominations Peer nominations Supervisor ratings Judgment of products Eminence Self-reported creative activities and achievements From Hocevar D (1981): Measurement of creativity: review and critique. J Personality Assessment, 45: 450-464 Evaluation by third parties and comparison with biographies are the most used methods in large scale investigations. Personality inventories or tests for the evaluation of the individual's style of thought are frequently used with well selected samples of volunteers. One of the most ingenious methods of investigation was developed by Albert Routhenberg, who created a test of verbal associations in order to measure a type of cognitive thought called "janusian thinking". Janusian thinking is, in Routhenberg's words, the "tendency to conceptualize opposites in a free-response situation". This process involves "actively conceiving two or more opposites or antitheses simultaneously during the course of the creative process". This tendency favours the development of mental associations which are often unusual and uncommon, and according to Routhenberg's studies it seems widespread among creatively gifted people, particularly among those who are most productive, those who attain the eminence in their field. Verbal fluency, fluency of ideas, redefinition, openness to experience, independence of thought, capacity to bring together remote associations and expend effort in the production of ideas are all abilities which favour the expression of creativity among gifted individuals. Most studies, however, agree that the expression of creativity is not the result of a single act, like an answer to a question or the resolution of a problem, but derives from a process which implies many different phases. The moment of "eureka" will not occur without a previous phase of intense working out which implies the collection and elaboration of information relevant to the creative effort, which must be compared and associated before resulting a creative product. Arnorld M. Ludwig, who studied extensively the cognitive and psychological abilities which associate with and favour creative achievement, described the creative process thus: "One of the better known conceptualizations regards the initial stage as one of preparation during which the individual consciously but unsuccessfully attempts to solve a seemingly unsolvable problem. Then, when the problem is put aside, there is a stage of incubation, a period of variable duration, during which ideas germinate at a subconscious level, usually while the individual is engaged in other tasks. Then comes the stage of insight, discovery or illumination, the "aha" or "eureka" experience, mostly occurring when the critical faculties are suspended, such as during relaxation or dreams - when supposedly the entire solution to the problem is gleaned. But insight in itself is insufficient for discovery. The last stage supposedly involves that of elaboration followed by verification, when the idea is developed and tested against scientific, aesthetic or social standards" (from: AM Ludwig: Reflections on creativity and madness. American J Psychotherapy, 1989; 43: 4-14). An example among the more quoted is the anecdote reported by the chemist Kekule, who recounted that he conceived the ring structure of benzene after a dream in which a serpent biting its tail appeared to him. This and other examples illustrate how an innate propensity towards introspection and the ability to access hidden dimensions of consciousness can favour the course of creativity. In this respect psychoanalysts talk of "regression in the service of the Ego", as it sound the happy wording coined by the psychoanalyst E. Kris to indicate the ability of turning to the unconscious to wide the sphere of

experience. This capacity to gain access to the hidden side of the mind seems to characterize artists and writers but also, though to a lesser extent, scientists and philosophers. The unexpected and disquieting surfacing of unconscious feelings in daily life also characterizes another wide group of individuals: those who suffer from a mental illnesses, whether for a brief period or for longer. As shown by many studies, there is a surprising link between a creative gift and the risk of mental disorder: in fact, the prevalence of mental problems among creatively gifted people is significantly higher than in the general population. This would suggest that genius, as a result of creative aptitude, and madness are connected by a noncasual link. GENIUS AND MADNESS The Italian psychiatrist and criminologist Cesare Lombroso has over the past century been the most consistent supporter of this hypothesis. In one of his best known books, "The Man of Genius", Lombroso illustrates his thesis in a circumstantial way refering to the genius and the lunatic, extreme types related by a shared genetic basis, which taints the descentants of the most gifted families. Lombroso was not the first to assert that there is a tight link between mental ilness and creative achievement. More than two millenia earlier, in the fragment known as "Problemata XXX", Aristotle, or a disciple of his, raised the question as to why the vast majority of the eminent people are afflicted by "melancholy", i. e. suffer from a mental disorder. The text, now accepted as part of the Aristotelian canon, is surprising in its modernity and accurately describes those characteristics peculiar to one of the most diffuse mental disorders, manicdepressive psychosis. The author of the Problemata XXX indicates many behavioural characteristics as attributes of the more eminent people of his time, attributes such as mood instability, proneness to depressive withdrawal, impulsiveness, tendency to alcohol and drug abuse, high risk of suicide, all of which are peculiar to patients suffering from manic-depressive illnesses. In the Problemata XXX there are also illustrative stories taken from myth and literature, with a gallery of examples mixing excellence and bizarreness, often with a tragic outcome. The stereotype of the eccentric artist or of the mad scientist, moreover plays a protective role in the collective imagination against the fear and suspicion that excellence and diversity of others always engenders in the majority. The image of madness as a result of genius has been repeatedly expressed in the history of the western world, being codified during the Renaissance in the figure of the melancholic genius afflicted by Saturnian acedia, and resurging during Romanticism in the figure of the deracin (?) artist. Cesare Lombroso was among the first to apply a less anecdotal method to the investigation of the relationship between the creative gift and the risk of a mental illness, offering an answer that is nevertheless the positivistic version of the romantic myth. Most studies performed in the positivistic era in order to either confirm, or refute, Lombroso's hypothesis rest on biographical evidence. This raises the suspicion that these studies claiming a higher prevalence of psychopathologies among creative or eminent people, were biased by overexposure. For individuals, such as artists in the public eye more information is available about their private lives: this could determine an apparently higher prevalence of disorders that tend, as a result of negative stigma, to be hidden whenever possible. In addition, some temperamental traits widespread among creative people, like eccentricity, uneasiness, propensity to excess and experimentation, could be a reflection not only of an underlying mental disorder, but also, and above all, of the tolerance by society of the behaviour of individuals who obtain achievement. In some way this behaviour will be a secondary product of the achievement, rewarded since it permits the expression of dissenting demands which by the majority of people are not able to express and which are not directly linked to the creative utterance. Despite from these reservation, even the later studies, performed using methods applying specific nosographic categories and the direct confrontation with the candidate through interviews and inventories, yielded similar results, with a higher prevalence of mental disorders among gifted people than among the general population. The two principal studies performed in the era preceding the systematic ordering of the more recent classifications (DSM III, and now IV, and ICD 9, and now 10), show among both artists and scientists a prevalence of severe mental disorders significantly higher than among the general population, with a strong familial association between creativit, psychopathology, and higher suicide rates. In a study performed in Germany from 1927 to 1943 on 5000 individuals, Adele Juda, at that time researcher at the Institute for Psychiatry of Munich, evaluated frequency and distribution of psychiatric disorders in a well selected sample of eminent artists, scientists and their relatives. The study shows a significantly higher prevalence of mental illnesses among eminent people and their families compared to the general population. Among artists disorders of the schizophrenic spectrum and psychopaties were most common. Among scientists, instead, disorders of the

cyclotimic type, in particular manic-depressive psychoses, were more frequent. In both groups there was a high suicide rate and a strong familial heredity in the transmission of the psychopathological trait and of creative talent. Some decades later JL Karlsson, in a study of Iceland, reported a clear familial association between the diagnosis of psychosis, taken from hospital registers, and eminence in artistic or scientific fields, based citations in Who's Who. A clearly recognizable creative talent was present in the relatives of schizophrenic patients twice as often as in the general population; and in the relatives of manic-depressive patients six times as often as in the general population. Karlsson, in his conclusion, suggestes a familial link between creativity and psychoses, substained by a common genetic basis. In both studies there is a surprising but clear association between the creative gift and the risk of schizophrenia, although mediated by a familial link, since in the concept itself of schizophrenia as illness there is implied a criterion of impairment. A BROKEN MIND: SCHIZOPHRENIA AND THE ARTISTIC TEMPERAMENT Schizophrenia is a psychosis, i. e. a mental disorder which implies a severe distortion of reality testing: its decourse is greatly influenced by social and economical factors far removed from the clinical side of its nature. The clinical symptomatology can be traced back to the ex novo appearence of distortions in perception, such as illusions and hallucinations, and of thought disorders leading to delusions. For a proper diagnosis of schizophrenia the symptomatology should be independent of concurrent ingestion of a drug and from the presence of a metabolic disease leading to alterations in the cerebral neurochemistry. Generally the clinical picture of the schizophrenia is associated with severe impairment of social and occupational functioning with a negative outcome in between 30% and 50% of cases, sometimes developing into dementia. "Dementia Praecox" is the name coined by the the turn-of-the-century German psychiatrist Emil Kraepelin. Kraepelin was the first to isolate the disorder now called schizophrenia from among the myriad syndromes that crowded the treatises of the positivistic era. Kraepelin, on the basis of his observations, distinguished the psychoses with a recurrent decourse and a conservative outcome, which he put in the same group as cycloid psychoses (called by him "manic-depressive illness"), from the psychoses with a progressive and negative decourse, which he indicated with the name "Dementia Praecox". Kraepelin considered the outcome of this disorder to always be negative, biased as he was by his own position as academic psychiatrist and chairman of a center of excellence in which he had access to more severe cases, and living as he did in a age without therapy for mental illness other than the containment and shock treatment. In 1927, for example, the Austrician psychiatrist Wagner von Jauregg was awarded the Nobel prize for Medicine for his invention of malario-therapy, a treatment that was effective in obtaining the remission of many severe psychotic syndromes, through the induction of periodical fevers after the exposure to malaria. The results of this treatment derived from the induction of anti-inflammatory effects against the aetiological agents in the syndromes that were secondary to an encephalitis, as in the case of syphilis with cerebral complications, for example. Some years later, in the Thirties, following the observation that mentally ill patients suffering from epilepsy were well after a convulsive fit and were bad when the epileptic symptoms vanished for some reason, the Italians Cerletti e Bini introduced Electro-shock-therapy into clinical practice, obtaining results that, at the time, appeared important. Not important enough, however, for a Nobel prize, which was confered, instead, on the Portuguese Antonio Eges Moniz, for the demonstration that leucotomy (neurosurgery), used in the treatment of some otherwise refractory forms of epilepsy, could also be used for the successful treatment of some mental illnesses, like an obsessive-compulsive disorder, a disorder characterized by high anxiety and by the incontainable drive to repeat actions or ruminate about ideas or unusual thoughts: a condition that can become impairing. All these therapeutic tools were fortunately replaced by the introduction into clinical practice of new psychoactive drugs, at the beginning of Fifties. At the age of Kraepelin, however, the only drugs used were laudane (opium), belladonna (atropine, an anticholinergic) and a few other substances, generally with a high toxicity. So the impression of incurability of mental illnesses was widespread, and most mental disorders were considered to have an unfavourable outcome. Kraepelin was so persuaded of the irreversible decourse of the disorder now called schizophrenia, that when during a study in Java he observed more favourable outcomes, sometimes even complete recovery, he was enormously impressed. Less biased by the "illusion of the clinician", as the tendency to overstimate ones own observations is called by epidemiologist , the Swiss Eugen Bleuler, who held the chair of "Burgholzi" Psychiatric Hospital, in which

worked eminent psychiatrist like Jung, offered a redefinition of the concept of the psychoses coining the word "schizophrenia" (=broken mind) to indicate what was for him the most relevant aspect of Dementia Praecox: i. e. the loosening of mental associations. For Bleuler schizophrenia is characterized by an alteration of mental associative functions with a concurrent, and consequent, emotional instability, resulting in anaffectivity and autism (closure in oneself). For him hallucinations and delusions were subsequent to the loosening of mental associations, and were without influence on the outcome of the disorder, which was, even in his new formulation, severe and generally bad. The symptomatology of schizophrenia, as it has been termed since Bleuler, remains manifold and includes many different behavioural patterns, predominantly disorganized and inappropriate behaviour and speech, loss of will and drive, and a generalized lessening of the ability to express emotions. Positive symptoms, involving excess or distortion of normal functions, tend to fluctuate over time, whereas negative symptoms, involving loss or diminution of normal functions, seem to be more stable and to be less responsive to treatment. A three dimensionsional model now appears to be a better description of schizophrenic symptomatology than the preceding positive/negative dichotomy, but there is little agreement on the neural mechanisms that generate these symptoms. Studies performed with neuroimaging techniques indicate that brain abnormalities (namely signs of cerebral atrophy) can be the basis of schizophrenia, but the extent of such abnormalities depends on the characteristics of the control groups. Social deprivation per se can determine cerebral atrophy in mammals. Educational and social premorbid adjustment is often poor in schizophrenic patients, leading precociously to defective relational abilities: so cerebral abnormalities could be the result, rather than the cause of disordered behaviour. Neuropathological studies also suggest that schizophrenia is not due to a neurodegenerative process, but rather may result from lesions involving a neurodevelopmental process. The main support for this assertion is the lack of gliosis in histological investigation: gliosis occurs after many brain injuries and neurodegenerative conditions, but is not observed after events that occur early in development. Epidemiological studies support the genetic transmission of the risk of schizophrenia, but this genetically enhanced risk seems to consist in a greater vulnerability to environmental factors acting in the perinatal period, such as complications in pregnancy and at birth or exposure to viral agents. The final step in the pathogenesis of schizophrenia appears to be a distortion of the systems involved in modulation or integration of information processing. A key role for dopaminergic pathways is suggested by the therapeutic efficacy of dopamine blocker agents, but , as the development of new "atypical" neuroleptics with greater effects on serotonin indicate, many other neurotransmitters could be implicated in the defects in information processing. The fact that such as severe illness could in some way favour the expression of creative abilities, mainly in the artistic field, raised enourmous interest and provoked myriad studies. These studies were sumarized in the Sixties by the Italian Silvano Arieti, an eminent researcher in the field of psychoses who for many years lived in the United States. In his book "Creativity, the magic synthesis", Arieti elaborates his hypothesis that the though processes typical of schizophrenic patients can favour the development of unusual mental associations which can, in turn, be inspiring to the creatively gifted individual, above all in the artistic field. Arieti supports his hypothesis in many ways, indicating the extraordinary talent of schizophrenic patients in coining new words, and giving many examples of the artistic production of patients confined in Asylums in the first half of this century. The works of these artistis are often very odd and disquieting, but althogh unusual they do not posses the requisite of being "socially enjoyable", which is essential if a product is to be judged as creative. The impenetrability of the works produced by mentally ill artists in the studies of the Psychiatric Hospitals in Germany drove the Nazis in the 1930s to link these works with the works of avant-garde painters, which appeared equally unintelligible to the Nazists, in the ill-famed "Degenerated Art" exhibition. Interest in the artistic production of mentally ill patients lasted until the Sixties, when the introduction of more selective diagnostic categories lessened enthusiasm for the creativity enhancing virtues of the schizophrenia." Many cases diagnosed as "Schizophrenia" were probably severe forms of manic-depression: the introduction of specific drugs for the treatment of mental disorders contributed towards a better identification of cases, with more cases diagnosed as manic-depressive psychosis. The discovery by the Australian physician Cade that lithium ion can be used for the effective treatment of less severe forms of manic-depressive illness heightened interest in this mental disorder. With the increase in the number of cases identified awareness was also raised that it was disorders with an affective (mood) component: those characterized by melancholy (severe depression) that were associated with creative achievement, just as the author of the Problemata XXX asserted.

THE CIRCULAR INSANITY: MANIC-DEPRESSIVE ILLNESS AND THE BIPOLAR DISORDERS Manic-depressive illness, or, as it is now called, bipolar mood disorder, is a disorder with a moderately high prevalence, about 1% in the general population. The clinical picture in current literature derives from the description made by Kraepelin in his treatise, but the disorder has been well known since antiquity. In AncietEgyptian papyruses and Assyro-Babylonian terracotta tablets there are descriptions of an illness characterized by recurrent episodes of depression and suicidal thought, whereas the alternation of depressive episodes with euphoria is clearly described in a paper dating from the Imperial era by the physician Areteo of Cappadocia. Effectively bipolar disorders are characterized by the alternation of depressive episodes (with melancholia, insomnia, loss of appetite, anxiety and restlessness) with other episodes with an opposite euphoric mood, excitement, higher energy and tirelessness, overconfidence, impulsiveness and imprudence. In the periods between two episodes those who are suffering from the disorder have a highly adaptive life style , sometime with very high level of functioning, thanks to the tenacity, tirelessness and social ease that are typical of these individuals. During an episode of illness, however, the social and occupational functioning of the afflicted individual is impaired, sometimes with irreparable consequences. Bipolars (as patients suffering from manic-depressive disorders are described using a "politically correct" word) are often inconstant at work and their affectionate and social relationship tend to be stormy: their divorce rates are higher than those of the general population, and there is a very high prevalence among them of the misuse of alcohol and other drugs, which bipolar patients may take either an auto-therapy to lessen anxiety and depression, or during an impulsive euphoric period. As a whole the lives of bipolars are troubled, with a high risk of death by suicide: one patient in ten dies by suicide, and the frequence of self-inflicted injuries is even higher (1 in 5 cases, according to studies). Nevertheless these individuals appear to have a unique gift for creative activity, and show a specific talent in the arts, sciences, philosophy speculation, and political and military leadership. The following all suffered from bipolar disorders in their lives: the scientists Boltzmann and Babbage, the father of modern computer science; the composers Rossini and Tchaikovsky, who commited suicide drinking a cup of water contaminated with vibrio colerae; the statesmen Churchill and Lincoln; the painters van Gogh and Pollock; the philosophers Wittgenstein and Kierkegaard; the writers Pavese and Hemingway, both of whom died by suicide. Poets and writers seem to be particularly prone to developing mental problems, generally of a depressive type, and has even been asserted that one cannot write with success without being "exposed to the Dark Sun of Melancholy". Nancy C. Andreasen, an eminent American psychiatrist who studied literature before devoting herself to medicine, performed an extensive study with her coworkers at the middle of the Seventies on the qualities which characterized the styles of thought of a group of writers who were participating in the annual Writer's Workshop of Iowa University, and, using the criteria of the rising DSM-III, found a high prevalence among them of mood disorders, of a bipolar type. The style of thought of the writers investigated in addition showed more resemblances with the overinclusive and imaginative style of thought of manic patients, than with that of schizophrenic patients examined in the same study. A clear prevalence of psychopathologies from the affective spectrum among creatively talented people was later reported by KJ Jamison in a study dedicated of twenties century English poets, by JJ Schildkraut and coworkers among American Abstract Expressionist Painters, and by AM Ludwig among 30 American female writers. Kay Jamison, in a study covering three centuries, reported similar results limited to writers and poets, with high rates of mood disorders, in most cases of a bipolar type. In the Jamison study, the suicide and alcoholism rates were also very high: as was the familial transmission of both psychopathological risk and creativity. Kay jamison reports many examples in his study, among the more representative is one which concerns the poet George Gordon, known as Lord Byron, whose familial history was full of suicides and bizzareness no less clamorous that that which accompanied his own adventurous and unfortunate life. The ability of bipolar patients and their relatives to express themselves successfully is not limited to the artistic field, however, and in fact achievement and ability seem to be attributes of the families of bipolar who appear time and again as motive powers for advancement of mankind. MOOD DISORDERS AND ACHIEVEMENT In an extensive review on this topic Frederic Goodwin and Kay Jamison (among the most authoritative researchers in this field) note a significantly higher success in the social and occupational fields among manicdepressive patients' relatives, and often among the patients themselves, at least in those conditions which impair working and relational abilities less. This has been confirmed by the repeated observation that the prevalence of bipolar disorders is clearly higher in the more advantaged classes. This association between proneness to cyclothymic breakdown and social achievement differentiates manic-depressive psychosis from all other mental illnesses, including closely related disorders, such as Major Depression, with the exception, perhaps, of Anorexia

Nervosa, which also associate with higher levels of performance, although at the cost of higher mortality rates as a result of medical consequences and suicide. An example of the association between a bipolar disorder and achievement is offered by Jamison herself, essaist and successful researcher, who suffered from a bipolar disorder, as she herself narrates in her autobiography "An unquiet mind". The high suicide rates and the low fertility of bipolar patients, who tend to marry less than the general population and to have less children than the mean, suggested even in the past that the carriers of the genetic burden of the disorder must have some compensatory advantage in order for a relatively high percentage of affected individuals (more than 1 %) to be mantained in the general population. Studies on the relationship between creativity and mental illnesses suggest that it is the same characteristics of the disorder, in their less severe manifestations, and not some indeterminate associated factor which confer such a compensatory advantage on afflicted individuals and their relatives. Ruth Richards, who extensively studied this aspect of the relationship between mood disorders and creativity, found among bipolar patients and their relatives a high propensity to the development and expression of creative potential in every field, even those not mutually linked. These abilities were evident mainly among individuals with slight or subclinical forms of the disorder. The healthy carriers of the genetic burden of manic-depressive psychosis seem in some way to take advantage from exactly the vulnerability they transmit. One can only speculate as to the characteristics that confer such an advantage . Constance Holden, a member of staff on the authoritative magazine "Science", indicated in a paper apperaed on "Psychology Today" (April 1987) some of the aspects that could favour the creative achievement among bipolars. First their emotional reactivity: bipolar patients tend to be more sensitive to environmental and interior stimuli. Another factor is their greater disinhibition, which makes them both more open to experimentation and more resourceful. Another typical characteristic of bipolar patients is their greater ability to concentrate, especially in the hypomanic phase of the disorder. Further more, the greater fluidity of mental associations of these individuals favours a more fertile imagination. It should be noted that the states of excitement that characterize manic-depressive psychosis create greater energy resource and a greater tolerance to fatigue, conditions which favour productive activity, multiplying the opportunities of creative expression and creative realization.On the other hand depressive withdrawal favours the process of introspection, permiting access to the inner dimensions of ones own mind. In general, the experience of mental illness per se permits access to dimensions of life otherwise unknowable, particularly in conditions that associate with unusual and extreme circumstances as in psychosis. Impulsivity itself, which typically associates with many mental disorders, often leads to enterprises which are occasionally very original, and which in other circumstances, would never be pursued. Felix Post, an English emeritus psychiatrist who performed a close study of the biographies of the most eminent men of our century in the arts, science and in politics noting, as have other authors, a higher prevalence of mood disorders in his sample, supposed that the psychological discomfort itself which accompanies to a mental disorder is the main drive for creative effort: many writers, in fact, asserted that through the act of writing they hold off depressive anguish. For him this relationship can be biuniform, meaning that even creative effort, like other types of stress, could favour a psychological breakdown: the intense intellectual work of the creative process is associated with higher neural activity in the brain, and this hyperactivity can determine the onset of mental problems in those already vulnerable. Even in the past, during the Renaissance, there were philosophers who supposed that intellectual work could lead to melancholy, and this was the explanation they offered for the proneness to depression in poets and other men of letters. AN OPEN CONCLUSION All these studies indicate that mental disorders which imply an imbalance in the neural circuits which control mood, beyond the suffering that they cause, can also, in some circumstances, favour the expression of adaptive potential. Mental illnesses are the result of underlying neurobiological variances that, as researchers like Tim J Crow and Daniel R Wilson remind us, continue to be the basis for the action of mechanisms of selection which help men to adapt to rapidly changing conditions of life, particularly in the relational sphere. Joseph Schildkraut, one of the fathers of the biological approach to the study of mental disorders, put forward a very suggestive hypothesis attributing a decisive role to artistic symbolism in favouring the social cohesion of groups, so that the group which expresses the most creative personalities will acquire an adaptive advantage which mantains the integrity of the group as a whole, in spite of the vulnerability of the individual. Such a process, valid for scientific and technical innovation too, would warrant the mantaining in the general population of the genetic clusters carrying the risk of mental disorders, provided that they favour creativity. This genetic burden would be preserved, in spite of the malajusted potential of the individual, by mechanisms of selection operating at a group level. So, even if mental disorders bring suffering and distress, the aspects which

are capable of enriching people's lives should not be dismissed. The "ungrateful guest" which torments the lives of the melancholic is, if properly assisted, also able to express its nicer side.