Monday, October 15, 2007

All the colors of madness

It is said that bipolar disorder, also known as manic-depressive illness, while only affecting about 1% of the general population, rises to nearly 30% among writers, artists, and composers. Everybody can think immediately of the obvious and widely popularized cases of Byron, van Gogh, and Schumann. Johns Hopkins professor and world expert on manic-depression, Kay Redfield Jamison, wrote a beautiful book "Touched with fire" where she carefully investigated the close ties between this severe form of mental illness and the "artistic temperament". There is on the other hand a complete lack of specific studies of the incidence of manic depression in another range of creative profession: science, and especially the fundamental sciences like mathematics and theoretical physics. Anybody close enough to the field can immediately point out the historically well documented cases of severe bipolar illness among famous mathematicians: Georg Cantor, Ludwig Boltzmann, Norbert Wiener. If one is close enough to the current community of practitioners, one will inevitably be able to name quite a few more among friends and colleagues, who are known to suffer from a varying range of forms of mood disorders. One can recount not a few stories of young and brilliant, but troubled, mathematicians tragically ending a promising career in suicide. Then why is the "artistic temperament" so much openly discussed in, well yes, the artistic circles, and so little is said of the same phenomenon when it strikes with high incidence among scientists? It is partly due to some kind of prejudice: a mathematician or a physicist might be generally more reticent than a painter or a poet in admitting to violent and uncontrollable mood swings. After all the profession of scientists is supposedly based on the most refined form of rational thought and any interference from the emotional sphere is viewed as highly inappropriate, to say the least. While, of course, for an artist, well, that's a completely different story. Or is it? We, scientists, know very well deep down that mathematics is not just a purely rational function of the brain, much as music is not, even when one follows the strictest rules of counterpoint in designing one's compositions. There is a lot more going on: there is visual imagination, the capacity for free association, for seeing beyond the appearance of things to uncover deeper structure. There is a lot of emotional stuff going to, that we like it or not, just look at the immensely strong and often violently emotional attachment scientists have for their own work: it has none of the detached rationality the stereotype image would like to portray. Science, or at least that kind of science like mathematics or theoretical physics, which is much more a brain activity than an experimental one, is much like the arts and literary or musical experiences as far as involvement of the emotional brain is concerned. That the problem to admitting of bipolar disorder is mostly an issue of image is further confirmed by the fact that among scientists who know each other well enough, it is not uncommon at all to discuss at length the effects and triggers of mood swings and exchange recipes and accumulated experience on how to "keep things under control". While there are stories of bipolar disorder that end tragically, most of the scientists affected by the disease are affected by what one might refer to as a highly functional cyclothymia. They can conduct their professional and sometime private lives in a way that stays just this side of the dysfunctional. They conduct their research, often very productively, teach their courses in whatever institution of higher learning they happen to be affiliated with, manage a career all the way to tenure, and so on. They rarely end up in the psychiatrist office for consultation, even on occasion when they really should. It is maybe true that the rational side of science, which surely exists and has a prominent and very visible role in the profession, also teaches one ways to reason around things, analyze symptoms, anticipate the next move of the opponent - in this case the illness - as in a chess game. That might give bipolar scientists a bit of en edge in controlling the course of their illness better than other patients and ward off the worst forms of the disease for a longer time. Nonetheless, by looking closely at a large sample of this specific population, you will find all the usual complications: broken relationships, financial problems, substance abuse, several depressions, that one finds in the general prognosis for this type of disorder. I hope that one of these days Kay Redfield Jamison or someone else in the field of psychiatry will conduct a careful and well documented study of bipolar disorder among scientists, maybe even just restricting to mathematician to pick the category that is, in my view at least, closest to the "artistic temperament" she so well described in her book. There are famous cases where a specific diagnosis is difficult to formulate: there has been much discussion around the schizofrenia diagnosis of John Nash (wouldn't schizoaffective have been a more appropriate diagnosis? see the very nice and detailed discussion on differential diagnosis between schizofrenia and mood disorders in another great book of Redfield Jamison, "Manic-depressive illness" coauthored with
Frederick Goodwin). Another mysterious case, as far as a precise psychiatric diagnosis is concerned, is the trajectory of Alexander Grothendieck from the superstar role of one of the greatest heroes of twentieth century mathematics, producing thousands of pages that revolutionized the field of algebraic geometry, to his progressive descent into paranoia and withdrawal, to the dark and seemingly delusional flavor of his latest writings. I think it would be very interesting if an expert could look into this wealth of material, with the same lucid analysis that has been carried out in the case of artists. It would do a lot of good to our understanding of creativity and the functioning of some of the most cherished inventive capacities.

Incidentally, I do not hide the fact that I am not extraneous to mood disorders myself. I am recently going through what is classified as a "mixed state" where symptoms of both mania and depression manifest themselves simultaneously. With a shaky self-esteem activating all kinds of triggers for irritability, phases of accelerated thought as in the manic spectrum taking on the dark quality of depression, irregular sleeping patterns, I am getting worried that this concoction of mood pathologies is going to pile up into something big. Get out of the frenzy while it is still possible, the voice inside is insistently saying, slow down, get out, break the circle before it hardens itself too much.

While flying over the Atlantic again last night (I lost count of the number of times I did this in the past year: so much for the irregular sleeping patterns), I entertained myself with another fairly good book on my favorite psychiatric subject, "Bipolar disorder" by another one of the Johns Hopkins experts, Francis Mark Mondimore. It does not have the broad view and deep touch of those early Redfield Jamison books I mentioned above, but it is a fairly concrete and informative resource, which I might like to pass on to friends who struggle with more difficult forms of the disease, if the occasion arises. It makes also a very good reading for the so called "normal people" (whatever that means) who have little or no clue as of what a mood disorder really means.

The main difficulty in explaining mood disorders to "normal people" is that they just do not understand the fact that mania can be just as frightening as depression. Everybody knows what depression means, just because, nobody being immortal, everyone at some point in life goes through the normal reactive depression of bereavement caused by the death of a loved one. Everybody knows that depression hurts, that it is a heavy burden and a long dark tunnel of pain. Hardly anybody can understand mania: they give you the strange look of the "why, isn't it good to be high?". It is, for a while. What people don't understand is that it hurts a lot too. Imagine you walk by a green field on a nice sunny day. A pretty sight ordinarily, yet something in it hurts. That color, you realize, is tuned up too high, as if all the leaves were simultaneously screaming their silent green scream. It is frightening because all the while your brain knows that leaves don't scream and that the trees and grass are just their normal photosynthetic chlorophyllic green, and yet that visual scream is so loud and so intense that it hurts. Imagine you walk down the streets of a big city, all cement, glass and steel. The busy flow of people, the street noises, everything seems tuned up too high once more. The visual poem of glass and steel sings its mermaid song right through your flesh and bone. It is too intense, it hurts. And all the same, again, your brain knows that cement does not sing and that some receptor that transmit the visual information to the brain must have gone out of tune, like a microphone that begins to spit out a sequence of loud distorted sounds. What is frightening is this acute sensitivity, which lowers the threshold of reaction to stimuli. Thoughts rush fast through the mind, but this does not mean that you think better or more clearly, not at this stage, because they hurt and the pain blurs the clear vision. Mania is not part of the people's ordinary experience of life, so why should they know. Yet it is mania that connects to the "artistic temperament", though it is both mania and depression that play a role in the bipolar scientific creativity, each of them relating to a different phase of the process of invention in science: the free imaginative one, and the slow moving constrained one that implements the idea in the appropriate mathematical language. The latter has a role which is just as essential as the first.