Madness and Creativity - What's the Connection?

Back in 2003, I had one of those breakthrough moments, the type you associate with light bulbs switching on. I was at the American Psychiatric Association's annual meeting attending a symposium on genetics. Robert Freedman MD of the University of Colorado started explaining his research into schizophrenia.

"The DSM-IV was not designed with human gene function in mind and genes do not encode for psychopathology," he said. Instead, "genes encode simple molecules in cells that alter cell function and brain information processing."

I had kind of been aware of this, but this time I went, "Aha!"

Dr Freedman had been exploring the link between "sensory gating disturbance" and why people with schizophrenia crave nicotine. A normal person, for instance, can tune out the second of two repetitive sounds. Many people with schizophrenia, however, cannot, and so have great trouble concentrating.

It turns out that the alpha7 nicotinic receptor mediates sensory gating, and thanks to the work of Dr Freedman and others, drug manufacturers have a nicotinic agonist in development.

The upshot of my Aha! moment was the realization that to better understand my own illness (bipolar) I needed to research other illnesses as well, such as schizophrenia. The brain, after all, doesn't organize itself according to the DSM.

A couple of years ago, at the APA, I listened to various schizophrenia researchers talk about the thinking processes of the brain. To vastly oversimplify, individuals with schizophrenia have trouble tuning out distractions from competing neurons; yet what is also in play is the potential for novel neuronal alignments to generate novel thoughts.

At the same APA meeting, Nancy Andreasen MD, PhD of the University of Iowa discussed her research into creativity, which began with a hunch based on schizophrenia.

What we seem to be looking at is that fine edge where productive novel thinking ventures close to the precipice of pathologically delusional thinking. I raised this issue in an earlier blog about John Nash and in another blog about evolutionary psychiatry.

The other day, I came across a blog post on Psychology Today by author Scott Barry Kaufman PhD, entitled Schizophrenic Thought: Madness or Potential for Genius?

Eureka! Cue up the light bulbs.

Dr Kaufman talks about "latent inhibition" (LI), the brain's ability to unconsciously filter out information. High latent inhibition is conducive to rational thought. Low latent inhibition is associated with psychosis and schizophrenia.

But can there be an upside to low latent inhibition? Writes Dr Kaufman:

"Recently researchers have wondered whether a reduced latent inhibition can actually be beneficial for creativity. After all, decreased LI may make an individual more likely to see connections that others may not notice."

In support of this, Dr Kaufman cites research by Shelley Carson PhD of Harvard showing that those with a high IQ and decreased LI reported increased creative achievement. The key here appears to be adequate levels of executive function to ride herd on the stampede of incoming information. The catch is people with schizophrenia tend to score very low on measures of executive function.

Another point that Dr Kaufman raises is that people with schizophrenia have difficulty sorting out their emotions. Again, they are overwhelmed. Here's where it gets interesting: A lot of these emotions may be intuitions that are accurate, thus enhancing the potential for making a creative connection.

Dr Kaufman is engaged in research on subjects with normal levels of executive function. This involves measuring LI. In the first part of the task, subjects need to screen out certain irrelevant input to achieve success; in the second part, processing that same irrelevant information is vital to arriving at the right answer.

According to Dr Kaufman:

"I found that those who reported a higher faith in intuition displayed decreased latent inhibition. In other words, those who reported higher faith in their intuitions allowed the information that was tagged as irrelevant in the first phase to be treated as novel and interesting in the second phase, and by doing so were faster at figuring out the answer."

Alas, it seems, those with schizophrenia lack the necessary executive function to cope. Way too much information. "Indeed," says Dr Kaufman, "this idea of 'sensory gating' has been quite influential in the literature on schizophrenia."

Sensory gating! Where have I heard that before?

Much more research is needed, Dr Kaufman acknowledges. "Nonetheless, an understanding of the biological basis of individual differences in different forms of implicit processing and their relationship to openness to experience and intuition will surely increase our understanding of how certain individuals attain the highest levels of creative accomplishment."

And in conclusion: "Perhaps such research will even allow us to stop rehashing old ideas about the potential links between madness and creativity and re-conceptualize the thought processes that are prone to psychosis not as madness at all but as potential for creative greatness."

Further reading from mcmanweb:

The Thought Spectrum

If all that sounds way too simple, Dr Krystal rolled out a far more complicated scenario involving glutamate’s tag team partner, GABA (the main inhibitory neurotransmitter), in particular a group of GABA neurons referred to as chandelier cells. In this context, GABA helps prevent glutamate from running wild. When involved in working memory, GABA tunes out distractions from competing neurons, allowing the brain to focus. But a deficit in NMDA glutamate receptor function effectively disables GABA chandelier cells. ...

Industrial Disease: What Are We Doing To Ourselves?

Consider:

The average working couple in America spends 20 minutes a day together.

"Family time" has become a goal, an achievement, rather than a natural consequence of being a family.

Most Americans are trapped in a vicious cycle of overwork and over-consumption.

Dropping in on a neighbor is practically nonexistent.

Keeping busy and multitasking are praised, while slowing down is frowned upon.

This from Therese Borchard, writing on the Huffington Post. She was drawing from a book by Abby Sexias, "Finding the Deep River Within."

"The disease of a-thousand-things-to-do," is how Ms Seixas describes it. I would give it another name: industrial disease.

In 2004, a major World Health Organization survey of 14 countries and two Chinese cities found Nigeria and Shanghai with the lowest prevalence of mental illness, way lower than the US and Europeans. In mood disorders, the Nigerians were at the very bottom (less than one percent over 12 months compared to nearly 10 percent in the US).

Maybe Nigerians are too worried about where their next meal is coming from to ruminate on the things we do. But I have a strong suspicion that they have something we haven't got, things we lost a long time ago, things our kids will never know about.

The beginning of the industrial revolution in the mid-eighteenth century coincided with a sudden explosion in mental illness. It didn't take people long to finger the stresses of urban life as the culprit. The asylums - literally sanctuaries - that sprang up in nineteenth century were beautiful country estates with farms attached. They were the product of the various reform movements of the age that included abolition, self-improvement, and enlightened Christianity.

In other words, way back when, people actually recognized that if you treated the mentally ill with compassion, took them away from stressful environments, and gave them opportunities to take pride in their work then their condition might actually improve.

The inaugural 1844 issue of the American Journal of Psychiatry (then called The American Journal of Insanity) reported on an institution in Utica, then in operation for 18 months. According to the report, of 433 patients admitted, 123 had recovered.

It was only later that these same institutions became the chambers of horrors that shame us as humans.

So, have we learned anything over the intervening years?

Yes. If we place families under impossible financial obligations with absurd expectations, force both partners to labor late into the night in high pressure corporate sweat shops devoid of fresh air and natural light, sleep-deprived and alienated from nurturing communities, sooner or later they will go crazy and drive other people crazy.

Not only that, see what happens when we over-school and over-regiment their kids.

Our brains simply weren't built for this.

If you scroll back to some of my recent blogs, you will note a number of short home-made nature videos. They are there for a reason. Since moving to a rural environment more than two years ago, I noticed something astonishing - my mental health improved, dramatically so. I work from home. I keep my own schedule. When I need a mental health break, I take it. All I have to do is step outdoors.

Welcome to my world.

Your world - and your responsibilities - are certainly a lot different. But your brain undoubtedly has the same limited warranty as mine. This is a tough world, growing tougher by the day. Survival depends on your creativity in carving out sanctuary - asylum.

It's a principle as old as the hills. Our ancestors understood it. Nigerians and other societies probably still do. We are incredibly slow learners in a painful process of relearning.

My Good Friend Kevin - Six Months Later

Yesterday, my former wife Susan reminded me that it is coming up to six months from when a very good friend of ours, Kevin, threw himself in front of a train. He was 28.

Four and a half years ago, when I was in my second marriage, I was facilitating a DBSA support group in Princeton, NJ. In walked Kevin, exuding a goofy charm, baseball cap on backward. But there was something about his presence that indicated he was no mere goofball. The others in the room felt it, too.

Over the weeks, I couldn't help but be impressed by the way Kevin carried himself. He would walk up to newcomers and introduce himself and start up a conversation. In the group, he was a great listener, dispensing the wisdom of a sage, leavened by a keen sense of humor.

It was amazing to observe him with people much older. At once, he was deferential, compassionate, and exuding great authority. You simply forgot you were talking to someone much younger. You simply wanted to be around him, laugh with him, seek advice from him.

He had his setbacks, his dark moments. Yet, over time - in group, over coffee, over sandwiches, hanging out - I watched him blossom. With his extraordinary people skills, the sky was the limit.

In late 2006, my marriage broke up. Kevin was the first to offer me support. He also reached out to Susan.

Suddenly, I had my life in seven or eight FedEx cartons and a one-way ticket to San Diego. I popped into the DBSA group one last time. Kevin was facilitating. He gave me a heartfelt tribute. I felt the goodness in the man. Goodness, true goodness. That was the last time I saw him alive.

He had so much to live for, so much to offer. Yet, on a miserable muggy New Jersey morning, his brain tricked him into believing otherwise. Six months later, Susan and I, plus all those he left behind, are still dealing with it.

I've been suicidal. So has Susan. We fully understand, yet - we totally don't understand.

My way of coping was this suicide prevention video, "The Road to Nowhere." The message is simple: Don't be fooled. You are really somewhere. I shot it two or three weeks after the horrible news.

Kevin, you still shine a light on the world. Nothing - nothing - is ever going to extinguish it.

More Desert Wildflowers

Desert Wildflowers!

On Friday, I drove two hours from my home 40 miles east of San Diego to meet up with a good friend of mine from LA in the middle of the desert. The Anza-Borrego Desert has a subtle stark beauty all its own. But this time of year, thanks to winter rains, the desert floor and slopes are loud with wildflowers.

This is a year that seasoned observers are describing as "good to very good."

Enjoy ...

Rush Limbaugh, Nihilism, and Antipsychiatry - Where is the Off-Button?

Only in America:

Yesterday, right-wing radio blabbermouth Rush Limbaugh challenged President Obama to a debate. From the transcript of his March 4 show:

"Why doesn't President Obama come on my show? We will do a one-on-one debate of ideas and policies. ... I am offering President Obama to come on this program - without staffers, without a teleprompter, without note cards - to debate me on the issues. Let's talk about free markets versus government control. Let's talk about nationalizing health care and raising taxes on small business."

Do the words grandiose and delusional come to mind?

And didn't Limbaugh earlier say he hopes the President will fail?

How about nihilist to describe the guy?

Funny thing - call it my own internal Rorschach test - when I think nihilist I think antipsychiatrist. In his blog on Psychology Today, Nassir Ghaemi MD of Tufts University writes:

"I suggested that many critics of academic psychiatry, especially those who attack links to the pharmaceutical industry, suffer from postmodern nihilism. They do not believe in any truths; thus they see the manipulative interests of private enterprise and the greedy search for wealth behind everything."

Wait, here's the kicker: "Scientologists cannot be accused of that motivation. If anything, they are true believers ..." Say whatever you want about Scientologists, at least they stand for something.

So, is it possible to be in sync with antipsychiatry and not be an antipsychiatrist? Yes, as long as you don't let "anti" define you. Let me give you an example:

Back in 2003, I attended a two-day Non-Pharmaceutical Approaches to Mental Disorders conference in Pasadena, sponsored by Safe Harbor, which is the best source of non-meds info on the web. Founder Dan Stradford has connections with Scientology, which I'm only bringing up before someone else does in a negative guilt-by-association way. When you hear Dan speak you can't help but be moved by his story about his late father.

At the conference, I heard Lewis Mehl-Madrona, MD, PhD discus integrative psychiatry and Native American healing, Julie Ross on natural supplements, William Walsh PhD on methylation and metal poisoning, Doris Rapp MD on toxins, Kathleen Crowley on procovery, and much much more

I love Ms Crowley's advice, by the way: "Just start anywhere."

Intriguingly, a panel of parents of bipolar kids testified on the progress of their kids on natural regimens. Mind you, we didn't hear any failure stories, but in strong contrast to the antipsychiatry party line we did hear explicit recognition that bipolar in kids is horrific and real.

Naturally, I was interested in what the people who paid to attend thought of the proceedings. It's fair to say they were not exactly bullish on psychiatry, but neither did they identify themselves by what they were against. Instead, they were hopeful that people could live better lives, and to a person they wanted to be part of that process. One group of very pleasant women was interested in forming a "NAMI Natural" branch to their local NAMI.

Clearly, these people weren't antipsychiatrists. Far from it. And because they actually had something to say, not to mention showing an interest in where I was coming from, I was all ears. With antipsychiatrists, take my word for it, you wish you had a button to turn the audio off. Ah - so that's why they remind me of Rush Limbaugh.

Conflict of Interest - Considerable Room for Improvement

"Conflict of Interest," read the first part of a commentary headline appearing in this month's American Journal of Psychiatry, published by the American Psychiatric Association. "An Issue for Every Psychiatrist," ran the second.

More than 25 prominent psychiatrists (and one prominent PhD researcher) were listed as authors. These included Robert Freedman MD, Nancy Andreasen MD, PhD, John Rush MD, Myrna Weissman PhD, and others.

Clearly, they had something important to say.

"To many psychiatrists’ dismay," the commentary opened, "unresolved conflicts of interest between parts of our profession and the pharmaceutical industry continue to be a focus of concern. ... Our standards should address not only the conduct of high-profile opinion leaders, but also our responsibility as individual physicians to deliver to our patients the highest-quality evidence-based medicine."

So far, so good.

The commentary acknowledged reality, namely that if journals didn't publish industry-supported clinical trials, there would be little in the way of new meds research to report. As a bulwark against the industry pushing its own PR disguised as research, the commentary pointed to the AJP's rigorous editorial review standards.

Hold on a second ...

In Feb 2006, the AJP published an Eli Lilly-supported study that found:

"Compared to placebo, olanzapine delays relapse into subsequent mood episodes in bipolar I disorder patients ..."

In other words, according to the study, patients on Zyprexa stayed well much longer than patients taking a sugar pill.

The study also revealed that only 21 percent of the Zyprexa patients actually completed the long-term (48-week) phase of the study. These were patients who had responded well to the med during the initial phase of the study.

To phrase this another way, eight in ten patients stopped taking their Zyprexa. Transposing this result to life in the real world, a doctor might think twice before prescribing Zyprexa over the long term. After all, even the best med in the world is useless if patients refuse to take it. Or, based on this information, a doctor might spend extra time informing the patient of the value of staying on the med.

Surely, such an important finding would be highlighted toward the beginning of the article. Surely, it would appear in the article abstract (which is the part most doctors actually read).

Well, no. The finding was buried deep in the study.

Are these the high editorial standards this month's AJP commentary was referring to? If so, heaven help us all.

Guest Blog - The Night I Died

Following is an excerpt from Katy Sara Culling's new book: Dark Clouds Gather: The True Story About Surviving Mood Disorders, Eating Disorders, Attempted Suicide and Self-Harm.
Katy was working on a PhD at Oxford when her brain suddenly quit on her. Her story how she fought back from madness makes compelling reading. Katy now works for Equilibrium - the Bipolar Foundation, a charity based in Oxford. It was through my association with Equilibrium that I met Katy.

Without further ado ...

At 10 PM, clad in pyjamas, all the patients slowly gathered to collect their night meds from the clinic room. I joined the line wearing trainers, socks, purple and black cycling shorts, my bright, luminous yellow cycling jacket, cycling gloves, detachable bike lights, keys (hidden in my pocket) and my purple cycling helmet, strapped securely in place on my head. I had a plan: though not such a good one as to think less obvious clothing might have been sensible. I stood tapping my feet impatiently. I said, “Hi,” to Neil, the nurse handing out the meds, quickly downed the concoction, and then walked to the garden door to leave.

One of the night nurses asked me, “Princess, where are you going?” “Just for a quiet fag on the step, I can’t face the smoking room,” I replied, showing her my lighter and menthols. And she let me go… against Dr. Ogilvie’s orders! And that was how I found myself heading straight for my flat on Iffley Road at about 10: 30 PM on the 13th November 2002: the night I died.

When I arrived home I knew I had to get on with things immediately because at some point I would be missed. I locked and bolted my door, and was grateful that my home address was probably quite hard to find. I pushed my huge antique dressing table across the door – it was so heavy I could hardly move it. I looked for alcohol, but all I had was the bottle of Gordon’s gin I kept for my sister’s visits. I started to swig it neat from the bottle, expecting to hate it, but not actually tasting anything at all. I knelt in front of my tiny attic window, and began to prepare the entire £20 ball of heroin for injection.

Someone missed me: Tony. He called me on my mobile to ask were I was. I told him I was fine and to go away. He asked me if I was going to “do something stupid.” I replied that I was fine, but that I was busy and couldn’t talk. I hung up and ignored my phone. I filled a 5ml syringe with what I knew was a concentrated and lethal dose many times over, and, without pausing or hesitation, pushed the needle into a vein. There were no thoughts about upsetting people I left behind; I could not connect with the world or those I love. I just wanted all the thoughts in my head to stop. So, after checking I was in a vein, I started to push the murky brown heroin solution into my body. I thought I could hear the sound of horses galloping in the distance, quickly getting closer and closer.

I continued to force the lethal mixture into my vein, all of this taking less than 10 seconds. I felt a calm unlike ever before in my life, and pictured horses galloping in the English countryside through the pouring rain. At first they were far away, but their gambolling hooves became louder and louder. Perfectly serene, I waited for their smack against my skull, spilling my life force from within. Then everything went black…

…And I died.

Purchase Dark Clouds Gather From Barnes and Noble

Katy's Website

Philosophy: Because We're Mindless Without It

Check out the image on the right. I can think of no better way to illustrate what this blog, "Knowledge is Necessity," is all about. The guy pointing to the sky is Plato, the one with his palm facing the ground is Aristotle.

The two form part of a much larger painting by Raphael - his masterpiece - entitled "The School of Athens." The canvas portrays more than twenty identifiable Greek philosophers - as well as a bunch of unidentifiable ones - clumped in small groups engaged in enlightened discourse.

What's so important about philosophy? Last year, I happened to catch the first three or four episodes in a 60-lecture video series, entitled, "Great Ideas In Philosophy." Oxford scholar and Georgetown professor-emeritus Daniel Robinson PhD explained that something extraordinary happened in ancient Greece.

Prior to Greek philosophy, Professor Robinson pointed out, thinking was essentially religious. Entire cultures were organized around the principle of encouraging everyone to think the same. No one questioned handed-down beliefs.

What the Greeks did essentially changed everything. Socrates and others urged their followers to think for themselves, to take nothing for granted, to challenge everything. In the face of Socrates' withering inquisitions, lazy thinking didn't stand a chance. Athens, it appears, wasn't quite ready for this, and Socrates paid in full measure.

His student, Plato, managed to die in bed, as did Plato's student Aristotle. Without them, our frontal lobes would have nothing to do. Not only did they turn thinking into a profession, they gave us the tools to think. The world was never the same.

Every field of human enquiry bears their indelible stamp: Science, government, the arts, human nature ...

Even religion. The way we appreciate Jesus is through the intellectual framework built by Plato and Aristotle. "The School of Athens" hangs in the Vatican.

The image that illustrates today's blog post is Diogenes. You might refer to Diogenes as the anti-philosopher. When Plato described man as a "featherless biped," Diogenes handed him a plucked chicken.

In Raphael's painting, Diogenes is seated alone, as if shunned by the others. Diogenes serves as a forceful reminder that even today's bold free-thinking is tomorrow's mind-crushing orthodoxy. This tends to happen when we organize our connected thoughts into schools of thought.

The antidote is to be our own philosopher. We learn, then challenge everything we learn. Then we relearn.

Knowledge is necessity, but knowledge is also elusive. It is something we strive for, rather than possess. If someone claims to have it, and offers you a piece of it - stop, think. What would Socrates do?

Meds and Wellness: Like Rolling a Rock Uphill?

"How do you rate your meds in managing your illness?" I asked my readers here in survey that ran through the month of February. The results, quite frankly, astonished me.

Fifty percent responded that meds were their single most important tool and another 32 percent that their meds were "important, but no more so than their other tools." In other words, four in five patients put meds at the top of their list, either as a solo act or with a dance partner.

As for the one in five: A mere three percent said meds were less important than their other tools, just five percent said their other tools were way more important, and another five percent assigned no importance to meds (or were not on meds).

Why am I surprised? In the 10 years that I have immersed myself full-time in researching my illness and listening to patients and loved ones, never once have I come across an "end-user" who has told me of writing a letter of appreciation to Eli Lilly or some other manufacturer or talked about starting up, say, a Seroquel fan club.

To the contrary, all I hear is complaints. Meanwhile, over the same 10-year period, I have witnessed the rise of the recovery movement, which acknowledges the role of meds in our getting better but takes a dim view in their ability to get us well.

What gives? Has everything I've heard all these years been wrong? Have meds been given a bad rap? Are they really much better than patients have been letting on, way decidedly better?

Not exactly. No, in fact. Make that unequivocally no. The month before, I polled my readers on how well they are doing. One in four replied they were "in crisis or close to crisis." Four in ten reported they were "stable but not well." Just one in five said they were on the way to recovery, and only 14 percent responded that they were back to where they wanted to be or better than they ever could have imagined.

Granted, neither poll was scientific. My readership may not reflect the patient population at large. Moreover, those who answered my second poll may not be the same people who responded to my first. But even taking all that into account, we are looking at numbers that boggle the mind, namely:

82 percent who rate their meds as their number one management tool vs 14 percent who are actually well.

Holy crap!

Four years ago, I came across a far more scientific survey conducted by Melbourne researcher Sarah Russell PhD. Dr Russell recruited a hundred bipolar patients who were doing well (either symptom-free and behaving normally or having a sense of control over their illness) and asked them what they did to stay well. Meds figured in the equation, but they were way down low on their list of priorities.

Instead, the people Dr Russell talked to emphasized various mindfulness and stress reduction techniques, rigorous sleep management, smart life decisions, and so on.

Dr Russell's findings are more in accord with my own experiences and those of "well" patients I have encountered, namely:

When we're new to our diagnosis, or in crisis or heading into crisis, our meds loom large. "Snapping out of it" and "getting a grip" are simply not options. Our brains are overwhelmed. We don't know what hit us. We need our meds to do the heavy lifting.

That changes further into the game. Our brains start to boot up. Our thinking comes back on line. We start finding out everything we can. Over time, we acquire much greater wisdom and insight. We pick up a vast range of coping and management skills.

As we become more adept, our meds assume far less importance. We may still be taking them (generally in reduced doses or on an as-needed basis), but we're simply not thinking about them as much. We are thinking far more, instead, about the things that have an impact in the here and now, such as stress and sleep.

For instance, for many of us, missing a good night's sleep is far more likely to result in personal disaster than missing a meds dose. Paradoxically, the key to getting a good night's sleep may be taking a sleeping pill.

The "well" patient understands this. Unfortunately, if my two polls are anything to go by, way too many of us are not there yet.

Much more on Dr Russell's study and related issues in future blogs ...

From mcmanweb:

Staying Well

The patients informed Dr Russell that they were extremely mindful of their diagnosis and “how they were responding to their mental, emotional, social, and physical environment.” Rather than simply taking their meds and forgetting about their illness (an impression created by their doctors), patients would “move swiftly to intercept a mood swing.” Moving swiftly often meant a decent night’s sleep and other strategic stop and smell the roses moments.