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Creativity and Bipolar Illness

By Elizabeth Evitts Dickinson
Kay Redfield Jamison is a professor of psychiatry at the Johns Hopkins School of Medicine and co-director of the Mood Disorders Clinic.

Bipolar disorder, a disabling mental illness, affects 5.7 million Americans. Marked by extreme cycles of mood—the highs of mania to the lows of depression—the brain disorder is treatable but incurable. Too often, it can lead to suicide. Kay Redfield Jamison is one of the world’s leading authorities on the subject. She coauthored the medical profession’s primary text on bipolar illness and has spent her career trying to understand its biology and clinical features in order to develop more effective therapies.

Jamison knows the anguish of bipolar illness. She had her first manic episode in high school. In her 1995 best-selling memoir, An Unquiet Mind, she writes a bracing account of her struggles with the illness, and her fight for sanity. The seductive pull of mania—where imagination is often unleashed in extraordinary ways—can dissuade some from treatment. Jamison, who experienced such creative bursts, now studies the boundaries between normal and abnormal moods, and has written about the relationship mental illness has with art, creativity, and productive output.

In her latest book, Jamison takes a deep dive into the life of Pulitzer Prize–winning poet Robert Lowell, who grew up in a storied New England family with a history of the disorder. For Robert Lowell, Setting the River on Fire: A Study of Genius, Mania, and Character (2017), Jamison obtained unprecedented access to his medical records and offers a rare insight into the creative mind of one of America’s most compelling writers.

When did you first read Lowell?

I was a senior in high school, and I had had my first breakdown. My English teacher said I might like Lowell’s work. I don’t know what he knew, or did not know, about me, but something obviously resonated in him, and he gave me his books to borrow. I was completely floored.

Why does Lowell resonate?

It’s not just that Lowell was so articulate in terms of describing depression and suicidal thinking, but the fact that he had gone through such real and palpable suffering. It’s important to know that somebody has gone through that, and made something out of it, and come back into his life again.

Lowell was a kind, gentle man, and his mania was so different from his normal self. That was hard for him.

Yes, what does it feel like to know that you have been completely awful to the people in your life? And you don’t remember all of what you did, but you do remember some of it. It’s a horrible thing and he just went on. I have real respect for that.

Do you see poetry, like Lowell’s, as something that might reach others living with the disorder?

What I have found, and what others have as well, is that as people get better, and the longer they stay well, they respond to the writings of people who have been there. It provides a different meaning to what they’ve been through.

The median onset of this illness is age 25. You often talk to college students. What do you tell them?

I tell them this diagnosis is really hard. There’s nobody who will bail you out of this one. Medication may help, therapy may help, parents and friends may help, but at the end of the day, it’s you and how you deal with it.

Manias can be seductive, particularly if you have an artistic temperament. This is something both you and Lowell struggled with. How do you talk to patients about living with medication?

If somebody comes into your office and says, I feel like a certain amount of my originality and creativity comes from this illness, how do I know it’s not going to be crushed or annihilated? you have to take that question very seriously. You have to explain that they’ve got a progressive illness, and it is likely to get worse, and it can kill you. But you also tell them you hear them, and we’re going to deal with it.

There can be damage to the brain in a manic episode. If you’re somebody who’s creative, that’s important to know. You don’t want to do something that’s going to be damaging over the long haul. A couple of studies indicate that artists and writers who have been put on lithium actually feel they are as productive, or more productive, than they were before medication. Lowell thought lithium was the best treatment he had had, that it had given him a new chance at a normal life. You want to keep people at the lowest possible medication where they respond well.

What else can people do to help manage bipolar disorder?

One thing is seeking psychotherapy. Another is regular monitoring of moods. There are apps now where you can rate your moods, and over time they show you important things, like moods can be seasonal. They’re related to all sorts of cycles, including premenstrual cycles.

You’ve brought Lowell into the medical classroom as well.

I have used his work in teaching medical students about mania and depression. We can learn only so much from diagnostic criteria. There’s what you as [residents] have as an idea of what mania is, versus the real experience of mania, or of profound depression.

A pedagogy of empathy.

I always encourage residents—when you have people in your office, ask them what it feels like. Of course you have to go through the diagnostic evaluation and the history, but if they say they have racing thoughts, ask them, what does that feel like? Because that’s what this is all about, really understanding what’s going on.

Kay Redfield Jamison
Illustration by Montse Bernal

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