The Bipolar Spectrum and The Artistic Temperament PHD

THE BIPOLAR SPECTRUM AND THE ARTISTIC TEMPERAMENT
Running header: THE BIPOLAR SPECTRUM AND THE ARTISTIC TEMPERAMENT
The Bipolar Spectrum and The Artistic Temperament:

The Effects of Treatment on Exceptional Artistic Talent
NIBERCA (GIGI) POLO

The New School for General Studies
Human salvation lies in the hands of the creatively maladjusted.

Martin Luther King
To God, for all the blessings, strength and perseverance.

To my husband, for his patience and support.
To MariaBeln, my unborn child, who has changed my life for the best.
Table of Contents
1.
Abstract .5
2.

The Effects of Treatment on Exceptional Artistic Talent ....6
3.
Methodology ...11
4.
Literature Review .......14

a. From Divinity to Pathology .....14
b. Pathology or Social Construct .....16
c. The Perpetuation of Stigma .....18
d. Bipolar, Creativity and Genius ....21
5.
Findings ......30
6.
Discussion of Findings .......36
7.
Conclusion ......49
a. Production ....49
b. Future Studies ......50
c. Media Activism Plan ...50
8.
Appendices .............51
1. Glossary of terms (All glossary terms are in bold throughout this paper) ..51
2. Interviewees bios ....62
3. Interview protocol ....65
4.
Dr. Swann interview transcript ...67
5. Survey ....101
6. Media Activism projects ....104
9.
References ........109
Abstract
Bipolar Disorder is a deteriorating affective illness believed to be a source of
exceptional artistic creativity. Throughout history, artistic talent and madness have been linked
and mystified. Many studies have explored the relationship between pathology and the madgenius notion, with no conclusive results (Ivcevic, 2009; Gilman, 1985; Ludwig, 1989; Becker,
2000-2001; Hillard, 2002; Richards, 1993; Engel, 1977; Eysenck, 1992; Akiskal, Hantouche, and
Allilaine, 2003; Foucault, 1965). In modern times, the media have created sinister depictions of
madness that have misled public opinion and perpetuated deceitful symbols of insanity. This
paper presented the results of interviews of five bipolar artists who shared their experiences,
views and concerns regarding the illness and the stigma that surrounds it; six experts of the
medical community interviewed gave recommendations to recognize the episodes and manage
the illness. It also presented the results of a convenience survey of Dominican art students and art
professionals living in the Dominican Republic and in the Diasporamostly in the United
Statesin order to assess the incidence in diagnosis based on seasonal episodes and cultural
tolerance, and the level of stigma among artists. The research set out to discover the effects of
treatment on exceptional artistic talent and the ways in which the illness can be managed without
affecting creative processes. Survey results showed that environmental stressors are the main
triggers of episodes of the illness, and cultural context determines the incidence of diagnoses
among artists. Most interviewees agreed that psychotropic treatments lower creativity in softbipolar patients but they are needed for severe-bipolar patients to function. The results of this
research were presented in a one-hour documentary called Madly Gifted, which will be used as a
tool for media advocacy.
Keywords: artistic talent, artistic temperament, bipolar, creativity, genius, greatness,

mood disorders, psychopathology, social construct, madness

The Effects of Treatment on Exceptional Artistic Talent
"It is only too true that a lot of artists are mentally illit's a life which, to put it mildly,
makes one an outsider. I'm all right when I completely immerse myself in work,
but I'll always remain half crazy."
Vincent Van Gogh
The concept of madness has been seen as both a blessing and a curse. Throughout history
it has carried different meanings, and the perception of the madman has been re-examined and reformulated through a multitude of cultures. For the Greeks, some forms of madness were divine
intervention, a sign of a direct connection with the gods, which implied a certain special talent or
a touch of genius (Dodds, E. R., 1968; Ludwig, 1989; Becker, 2000-2001; Schlesinger, 2009;
Weisberg, 1994). This desirable disturbanceperceived as a virtuewas clearly differentiated
from clinical insanity, a state in which only the suffering was present (Ludwig, 1989).
In todays society, insanity is considered a psychopathology; a general definition of
insanity is a spectrum of behaviors characterized by certain abnormal mental or behavioral
patterns. Insanity may manifest as violations of social norms, including becoming a danger to
themselves and others (Wikipedia, 2011). Both Foucault (1965) and Gilman (1985) expressed
how different and insane become synonyms.
The concept of mental disorders has been stigmatized in both private and public
conversation, alienating those who suffer from any kind of mental disorder by labeling them
outsiders. The media perpetuates this sign of disgrace (Byrne, 2000, p. 65) casted upon those
suffering from mental disorders when they depict the madman as a psychopath, serial killer, and a
monstera stereotype that accentuates social difference (Levin, 2001).
Movies like Memento, Dr. Brooks, Girl Interrupted, Secret Window, Psycho, to mention
a few, have depicted the mentally ill as monsters, portrayals that have contributed to the growth
of stigma in disproportionate levels.
However, the media are also the means by which stigma can be challenged, redefined,
and eradicated. Golden Globe Award-winning actress Glenn Close is currently in a conscious
awareness campaign to break the perpetuation of stigma in mental illness by engaging the media
in open conversation. In an interview with The Huffington Post she stated: I have no illusions
that BringChange2Mind.org is a cure for mental illness. Yet, I am sure it will help us along the
road to understanding and constructive dialogue.every society will have to confront the issue.
The question is, will we face it with open honesty or silence? It will help deconstruct and
eliminate stigma (Close, 2009, para. 9).
The Diagnostic and Statistical Manual (DSM) defines mental disorders as the risk of
suffering or losing freedom, and a behavioral and psychological affliction, associated with
distress (APA, DSM-IV, 1994; as cited by Lauronen, Veijola, Isohanni, Jones, Nieminen,
Isohanni, 2004, p 83). As a result of the advancement of diagnostic medicine and the expansion
of criteria of mental illnesses, many people are being diagnosed with mental disorders, especially
Bipolar Disorder, an Affective Disorder also known as Manic Depression.
According to the National Depressive and Manic-Depressive Association, Bipolar
Disorder affects 2.5 million adult Americans sometime during their lifetime; the typical age of
onset is between 18-22, and 15 to 20% of untreated people commit suicide (DBSA Boston,
former MDDA Boston, 2011). The National Institute of Mental Health found that Bipolar
Disorder affects 5.7 million adults and an estimated 1.1 million children in the United States
(Rutzen, 2010). Lifetime cost per patient goes from $12,000 for a person with a single manic
episode to $600,000 for those who suffer multiple episodes; $7.6 billion in direct healthcare costs
in the United States, annually (Nami, 2003).
Due to the similarities between the artistic personality and symptoms of the illness,
Bipolar Disorder is also known as the disorder of the artistic temperament, which Jamison
(1993) refers to as the artistic voyagefierce energy, volatile moods, restlessness, feverish
temperament, imaginative powers, passion, intense emotional response.and a sense of the
visionary and the grand (p. 2). Some authors have suggested that the propensity of this
diagnosis among artists is high (Frantom & Sherman, 1999; Simonton, 2006; Jamison,
1989/1990, Andreasen, 1987; Ludwig, 1992), although results are inconclusive and more
extensive research is needed (Rothenberg, 1990).
Since I was diagnosed with Bipolar Disorder in 2007, I have been researching this
illness and the treatments available. As an artist suffering from the disorder, I have struggled
with medications and doctors that have undermined the value of creativity in my life; the doctors
have expressed that if losing my artistic talent is the price that I have to pay in order to be
normal, stable and functional in society, then I shouldnt question the validity of the treatment.
Throughout this journey I have met other bipolar artists who like me, have had similar
concerns and frustrations and have experienced huge changes in their lives as a consequence of
the illness. Since Bipolar Disorder is considered a chemical imbalance of the brain, antidepressants, anti-psychotics, and mood stabilizerscalled psychotropic treatmentshave
become the most common treatment options, often in combination with psychotherapy.
The main problem today is that some artists suffering from Bipolar Disorder have a lot
of fear that the available psychotropic treatments might lower their creativity andbecause of
this fearavoid treatment, preferring to manage the illness on their own without the supervision
of a health professional. Others dont seek help because they are afraid of what the stigma of
being labeled mentally ill could bring to both their professional and personal lives (J. Banks,
personal communication, November 21, 2009).
A number of contemporary artists suffering from Bipolar Disorder have expressed how
episodes of maniaor hypomaniaenhanced their creative thinking when they werent taking
medication, whereas psychotropic treatments numbed their senses to the point of exhaustion, and
lowered their ability to create (Shenfeld, 2007, para. 9). Teresa Hsu, an artist from northern
California, says that, Being Bipolar has enhanced my urge to make art.it has heightened my
artistic sensibility, but she adds that, my depressions take me to a very dark place (Shenfeld,
2007, para. 9-10).
Today this disorder is considered to manifest on a continuum, called the Bipolar
Spectrum (Akiskal & Pinto, 1999; Angst, 2007) a term introduced in order to alleviate the
problem of under-diagnosis and under-treatment of Bipolar Disorderan approach that could
face the risk of pathologizing temperament and personality traits, jeopardizing our basic human
need for individualism and uniqueness.
Creativity expert Mihaly Csikzentmihalyi writes in his book Creativity: Flow and the
Psychology of Discovery and Invention: Whats considered crazy in one culture isnt in
another. We have a long list of shunning all kinds of creative people and their works and calling
them crazy when we are not yet ready for their ideas (Csikzentmihalyi, 1996; cited by Castle,
2006, p. 6).
Bipolar Disorder might be a by-product of creativity, or maybe Bipolar Disorder is in
the gene that carries creativity. Perhaps creativity is what makes artistsdue to their sensibility
towards the world and events surrounding themmore prone to stress and thus causing Bipolar
Disorder. Or maybe everybody, at a certain point in his or her life, falls in an area of the Bipolar
Spectrum. Is it maybe that Bipolar Disorder gives those who suffer it, the potentiality to
greatness?
An extensive exploration of syntonic personalities (Claridge, 2006) and psychoticism
(Eysenck, 1992) within the character of the Bipolar Spectrum is needed in order to understand
where artistic temperament ends and the illness starts, and to differentiate between personality
traits and psychopathology. This is all in order to protect artistic talent, and hopefully, reshape
the perception of the mentally ill to reduce stigma. If artistic talent must be regarded as an
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enduring trait of the personality.as one of the cognitive functions of the ego (Noy, 1972, p.
243), doctors have to acknowledge that using treatments that affect the artistic talent will not
only damage a career path, it will seriously damage a persons psyche.
Today the question remains: is mental illness a bi-product of the artistic temperament?
Or is it creativity the spark that ignites the illness? Are highly creative minds more prone to
suffer mental illness? Dietrich (2007) argues that, mental illness does not have a link with
creativity; it has a link with a specific kind of creativityif that (p. 26, as cited by Bryant,
2007, p. 4).
This research paper considered the available theory on Bipolar Disorder and the Bipolar
Spectrum, its historical context, diagnosis and treatments available today, the relationship
between the Bipolar Spectrum, artistic talent, impulsivity and greatness; the anti-psychiatry
movement and the disorder as a social construct; and the stigma that surrounds it, perpetuated by
the media. This research argues that, instead of trying to eradicate the illness at the cost of
creativity, artistic patients should be placed on a personalized holistic-treatment plan that keeps
them in a hypomanic state for most time, with manageable periods of controlled sadness to reboot
energy, and continue their creative process (R. Johnson, personal communication, May 25, 2010).
The results were presented in a one-hour documentary titled Madly Gifted.
Neither the Madly Gifted documentary nor the research paper are intended to discover a
scientific truth or accurately present each and all dimensions of the Bipolar Spectrum; instead
they aim to allow the viewer to experience the world through the eyes of five bipolar artists
their frustrations, concerns, achievements, and fearsand the recommendations of six experts of
the medical community.
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Methodology
All data was gathered using a convenience survey and personal interviews. A glossary of
terms has been added in Appendix 1.
Participants
o
Five artists, who defined themselves as such, regardless of their career choices: three
diagnosed with Bipolar Disorder, one with an undetermined diagnosis between severe
Depression and Soft Bipolarity, and one with a misdiagnosis of Bipolar Disorder. Out
of the five participants, two of them currently on a treatment plan with medication and
psychotherapy, two with no medication but following psychotherapy, and one with no
treatment of any kind. (See Appendix 2a for bipolar artists brief biographies)
Six health professionalsfour psychiatrists and two psychologistswho treat bipolar

patients regularly in their private practice. (See Appendix 2b for health professionals
brief biographies)
51 Dominican art students and professionals living in Dominican Republic, and the
Diaspora
Methods
Interviews
Five bipolar artists were interviewed, who shared their experiences, views, and concerns
regarding not only the illness but also the perception of the mentally ill in our society; these
interviews were focused on their experiences, concerns, and biographical history. Six experts of
the medical community were interviewed in order to discuss diagnosis, treatment plans, and
recommendations to patients. (See Appendix 3a for bipolar artists questionnaire protocol and
Appendix 3b for health professionals questionnaire protocol. Appendix 4 for Dr. Swann
interview transcript; other transcripts available upon request)
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Survey
I conducted a convenience survey of art students and professionals, in order to assess the
correlation between artistic temperament and the Bipolar Spectrum, the level of stigma
towards the mentally ill among this particular group, and how stigma affects their behavior and
choice to seek help; also, to find if the prevalence of a diagnosis and treatment of Bipolar
Disorder changes depending on social norms.
Questions on mood and lifestyle were adapted from the Mood Disorder Questionnaire
(MDQ) and the Eysenck Personality Questionnaire (EPQ) and formatted using the Likert Scale
for accuracy. (See Appendix 5a for Spanish survey, and 5b for English survey)
I chose to conduct a survey because of its easy creation using SurveyGizmo.coman
online open sourceand fast distribution coverage via Madly Gifted Facebook group, my
personal contacts and Twitter. Even though this was not a predictive index sample, the survey
showed the important role played by cultural context, and behavioral trends among artists that
helped me brainstorm strategies for media activismwebsite, iPhone app, and art exhibition
that will be developed in the near future.
Film
Madly Gifted is a one-hour documentary that presented the findings of my research.
Through a combination of interviews, reenactments, and my artwork, I explored the complexity
of the artistic talentwhich has been defined as a special ability to use [such] specific kinds of
communication the ability to express [himself/herself] via a specific medium of a given art
(Noy, 1972, p. 243)and its relation to the Bipolar Spectrum.
This documentary will also be used as a tool for social activism to (a) educate and reduce
stigma, (b) demonstrate that psychotropic treatments, e.g. anti-depressants, anti-psychotic and
mood stabilizers, have a negative impact in exceptional artistic talent, and (c) encourage more
extensive investigation to find treatments specially aimed to the artistic community that keep
artists in a hypomanic state in order to preserve cyclothymicinvolved in exploration and
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creativityand hyperthymicinvolved in territoriality and leadershiptemperaments

(Akiskal et al., 2003).
As part of my efforts to start a conversation among the medical community in order to
find answers to these concerns, Madly Gifted will be screened in the 164th American Psychiatry
Association Annual Meeting, to be hosted in Hawaii, on May 18th, 2011. (See Appendix 6a for
Madly Gifted promotional poster)
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Literature Review
Even though the connection between creativity and clinical insanity is a modern
concept, madness has been seen, throughout history, as both a blessing and a cursea state from
where to achieve genius with a high price to pay: a life sentence of suffering (Foucault, 1965;
Gilman, 1985).
This literature review covers the perception of madness from a historical contextFrom
Divinity to Pathology, Pathology or Social Construct, and The Perpetuation of Stigmaand the
relationship between Bipolar, Creativity and Genius.
From Divinity to Pathology

In antiquity, madness was perceived as a supernatural phenomenon until it became
pathology in modern times.
For the Greeks, some forms of madness were considered divine intervention (Dodds, E.
R., 1968; Ludwig, 1989; Becker, 2000-2001; Schlesinger, 2009; Weisberg, 1994), a concept
supported by Platos doctrine of The Divine Madness or Enthousiasmos. According to Platos
(1974) Phaedrus and the Seventh and Eighth Letters, Madness, provided it comes as a gift of
heaven, is the channel by which we receive the greatest blessings [it] is a nobler thing than
sober sense.Madness comes from God, whereas sober sense is merely human (p. 46-47, as
cited in Becker, 2000-2001, p. 46). These popular attributions of inspiration to higher powers are
formulated today as primary processes, pre-logical thought and dissociative thinking
(Jamison, 1993, p.103-104).
The Renaissance used the term genio to describe those individuals with superior
creative achievement (Becker, 2000-2001); mental illness became alienated madness (Foucault,
1965). The Enlightenment had a new conception of genius where imagination, judgment,
common sense and memory were the four powers needed for the new model of man; humanistic
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psychologists (e. g. May 1975; Rogers, 1954/59) argued that, creativity is the outcome of the
well-adjusted individual fulfilling his/her potential to the upmost (Andreasen, 1987).
The 16th century valued and recognized what the 17th century was to misunderstand,
devalue and reduce to silence (Foucault, 1965, p. 77). During the 19th century, Romanticism
revived the notion of divine madness; episodes of mania differentiated the extraordinary
individualthe so-called geniusfrom the ordinary man, the bourgeoisie and the merely
talented. The poet Byron referred to his future with apprehension: I picture myself slowly
expiring on a bed of torture, or terminating my days like [Johnathan] Swifta grinning idiot
(Sanborn, 1886, p. 126, as cited by Becker, 2000-2001, p. 50).
The anti-romanticism of modernism and post-modernism treated the mad person and the
eccentric artist as an outsider, accentuating social differences (Becker 2000-2001; Schlesinger,
2009). Society found ways to justify what could not be understood and contained those who were
different from the established norm by creating institutions to remove and separate, not only the
mentally ill, but also all individuals considered unproductive (Foucault, 1965).
The discovery of the insanethrough their art productionwas precipitated during the
20th century by the need to define the avant-garde movement as the antithesis of the established
order (Gilman, 1985, p. 586). The bourgeoisie labeled the avant-garde crazy and ill in a
quest for supremacy upon the other (Gilman, 1985).
The blossoming of psychiatric photography in the second half of the 19th century proves
the idea that the mad exhibited differences in appearance that doctors could learn to recognize
and label by recording and documenting the physiognomy of madness (Jaynes, 1976). Wilhelm
Griesinger, a biological psychiatrist of the 19th century, declared that, mind illness is brain
illness (Gilman, 1985, p. 582), a moment that marked the beginning of mental illnesses being
defined as pathology, and the search for psychotropic treatments.
The concept of genius madness and divine intervention continued into the 20th century.
Cesar Lombroso (1836-1909), an Italian criminologist, was seeking the essence of genius beyond
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biographical dictionaries, letters, autobiographies and creative products, by scrutinized facial

anomalies, that he called Stigmataa term that conveys the awe geniuses inspire as well as the
doom that surely awaits them (Schlesinger, 2009, p. 63). His theory of degeneracy as the
central explanation of deviancyfrom sociopathic and psychopathic to creative artsbecame a
cornerstone of modern psychiatry. Other psychiatrists followed this trend (e.g. Galton,
1869/1962; Morean, 1859; Stekel, 1909/1917), and linking genius with pathology became the
predominant view of the period (Schlesinger, 2009).
Pathology or Social Construct

The stigmatization of madnessa process by which the mentally ill are stereotyped and,
most of the time, wrongly depictedreinforces the ideas of Roland. D. Laing, Thomas Szazs, and
Michel Foucault, that mental illness is not pathology but a social construction.
In 1920 the definition of outsiders was used by society to control and neutralize the
avant-garde movement. Many psychopathologies were labeled degenerate, or, as Foucault
(1965) puts it, unproductive citizens (p. 589). Important figures of 19th century German
psychiatry such as Emil Kraepelin, Richard Krafft-Ebbing, and Theoordore Kirchhof all agreed
that, the Jew was inherently degenerate and, as such, was especially prone to madness
(Gilman, 1985, p. 589). The Nazis took the equation of artist equals madman equals Jew, as a
program to eradicate the Jews, and to shut down the avant-garde movement because it threaten
the stability of the rgime, by defining it as degenerate while healthy meant traditional (Gilman,
1985, p. 592).
Difference was ruled to be pathology and asylums were created to isolate these
individuals. With the beginning of the institutionalization of those considered outsiders, and the
opening of asylums and new classification of illness, segregation and stigmatization was set in
motion. Exclusions depended on culture, which defined geographical separation, material
separation, and potential separation, not visible from the outside; this was the framework for the
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perception of madness. To Foucault (1965), the mad are forced to communicate through their
same cause of madness (family, society) and those who deny them insight (medicine); it is not a
phenomenon of nature as doctors diagnosed but a configuration of culture (p. 78, as cited by
Gilman, 1985, p. 575).
Foucault explains how society long viewed the mentally ill as antisocial, and how our
perception today is the result of history and societal standards of behavior. In his book Madness
and Civilization; A History of Insanity in the Age of Reason, he defines this phenomenon as a
social construction used by power structures to make sense of conflicts of difference, and control
those labeled as outsiders for not complying with societal norms. He exposes the ways in which
the so called insane are isolated because they stand out from the general population and, since
society cant find resolution to this contradiction, it prefers to alienate consciousness hence
alienate the other (Foucault, 1965).
In The Rhetoric of Originality: Paul Celan and the Disentanglement of Illness and
Creativity, Derek Hillard (2002) describes the relationship between genius and madness as
follows:
Both [the genius and the madman] are seemingly self[-]absorbed, act
independently, and define their reality without reference to exterior authorities.
Autonomous, they appear to speak to and address either themselves or no one. This
autonomy, however, reveals a paradox and a price to pay. The creative individual
can only posit itself by liberating itself from societal constraints, prevailing
ideologies, and frustrating aesthetics norms. Yet madness describes genius fate;
for the very act by which he asserts himself also makes him ill (p. 395).
During the 1960s Laing, a Scottish psychiatrist, started the anti-psychiatry movement
that challenged the Kraepelinian theories. Laings argument was that psychiatric disorders were
not mentally illness but a diagnostic designation, arbitrarily fixed by society and confirmed by
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psychiatrists (Laing, 1960, p.7, as cited by Greene, 2007, p. 364). Thomas Szasz, an American
psychiatrist, argued that the strict definition of disease or illness does not allow for mental
disorder to be considered illness because illness affects only the body hence the concept of mental
illness is not plausible. Szasz claimed that, psychiatry diagnoses are stigmatizing labels, phrased
to resemble medical diagnoses and applied to persons whose behavior annoys or offends others
(Szasz, 1974, p. 267, as cited by Greene, 2007, p. 364).
Similarly, the artistic temperament seems to be definedand re-definedby societies
based on the context and cultural traditions of the current times, without any further investigation
of the underlying biology of this condition. Societal standards stress the need to fix the artist
who has been labeled as an outsider, hence insaneand turn him/her into a normal and
productive citizen.
As Bernice Pescosolido, director of the Indiana Consortium for Mental Health Services
Research, says, When you attach a feeling of permanence to this [mental illness], then it
justifies, in some ways, a persons sense of otherness or less-than-humanness (National Public
Radio, NPR, 2010).
American sociologist David Rosenhan in 1973 enlisted seven normal associates and
asked them to visit a doctor with complaints about hearing voices that said: thud, empty or
hollow, and provide their original life histories. All of them were not only given a diagnosis of
schizophrenia but also were hospitalized for at least nine days. His study concluded that mental
health professionals had no clue of the difference between sane and insane (Greene, 2007).
The Perpetuation of Stigma

Mental illness has been portrayed as the embodiment of dangerousness and violence; a
deceitful depiction that alienates those who suffer it, and perpetuates the process of stigmatization
regardless of the information available (Pescosolido, Phelan, Link & Stueve, 2000). Bipolar
Disorder is not an exception.
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The assumption that violence and madness are intertwined has over time helped form a
public register of violently insane people that prevents media images of the mentally ill from
becoming too much like us (Wearing, 1993, as cited by Cross, 2004). Myths, misconceptions
and misrepresentations of the mentally ill post a challenge when providing care and support
(Harper, 2005, p. 461-462). It is important to eradicate the stigma by promoting positive
representations of mental patients because it refrains mentally ill patients from seeking help and
follow their treatments because of fear of rejection (Cross, 2004, as cited by Nairn, 2007).
People form ideas of mental illness from many different sources: personal experience,
family, peer interactions, and media portrayals (Link, Struening, Neese-Todd, Asmussen &
Phelan, 2001, p. 1621). Stigma affects people in the ways in which they related to others, and
their self-esteem is seriously damaged becoming a big impediment of recovery. As a result,
hospitalized patients are less confident to the point that some avoid complete contact with their
environment, which can take them to a low-satisfaction life, unemployment and loss of income
(Link et al., 2001).
Barbara Luri, associate director of programs for the Entertainment Industries Council in
Los Angeles says: Campaigns to change the [mass] media can work if they are constructive but
not confrontational (Levin, 2001, para. 19). George Gerbner, Ph.D., a professor of
telecommunications at Temple University, is not so hopeful that this change will happen and said
Ill believe in change when a headline reads: Ex-Mental Patient Appointed Head of Rotary
Club (Levin, 2001, para. 22).
Cross (2002/2004) examined the ways in which the mad have been portrayed (Gilman,
1982/1988, as cited by Nairn, 2007). Words are the most obvious discourses resources, terms
used are crazy, mad, nuts/nutter, demented, twisted, deranged, wacko and psycho (Blood et al.,
2002; Wilson et al., 2000, p. 441; as cited by Nairn, 2007, and Cross, 2002, p. 3); psycho is a
word also related to mental illness in the mass media (Wahl, 1995). Images we conventionally
associate with madness are: red-veined, staring eyes; muttered imprecations; fists shaken at
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things that are not there; outspoken dialogues to the different parts of oneself. These visual
depictions demarcate a symbolic but very strong boundary between us and them (Wahl,
1995).
Gilman (1985) suggested that our need to recognize madness as difference underlines a
reassuring message that the devastation of mental illness is not likely to happen to ourselves or to
the people around us. He has argued that the iconography of illness is an indicator of the way in
which society deals with and conceptualizes disease: The portrait of the sufferer, the portrait of
the patient is the image of the disease anthropomorphized (p. 2, as cited by Cross, 2004, p.
199). Consistent with Gilman (1985) five studies indentify mischievement, dishevelment, show
as wild, unkempt hair and tattered clothing, being used to signify madness and loss of control
(Gaines, 1992, as cited by Nairn, 2007).
Crosss (2004) analysis of representations of madness in television documentaries opens
up a good avenue to be explored in depth. Another underdeveloped area of study is the semiotic
analysis of images of madness across media, how they are absorbed by the culture, appropriated
and internalized by the masses. Many films use mental illness as the means to present social
alienation and political resistance, disregarding the reality of the illness; in these cases these
depictions are used as symbols of radical political and social protest. Movies like Memento, Dr.
Brooks, Girl Interrupted, Secret Window, Psycho, dont show the truth of mental illnessas
opposed to movies like The Shine and A Beautiful Mindbut instead are molded by the culture in
service of the society (Harper, 2005, p. 479).
Fred Wisemans documentary Titicut Follies (1967) questions the concept of normalcy
and the depiction of the insane in a society that mistreats patients and where inmates, guards and
psychiatrists look equally mad. Shadow Voices (documentary), Manic (docu-drama), and Youre
Gonna Miss Me (personal essay) show patients relationships to authoritarian figures and family
life.
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Bipolar, Creativity and Genius

The link between the Bipolar Spectrum, creativity and the mad-genius (Frantom &
Sherman, 1999; Simonton, 2006; Jamison, 1989/1990, Andreasen, 1987; Ludwig, 1992) has a
long history of debate, with no conclusive results; the association between notions of mad
geniuses and artistic temperament has been long embedded in Western culture and is well
documented in eminently creative individuals (Jamison, 1993; Andreasen, 2005; Ludwig, 1995)
but it is mostly anecdotal, a problem pointed out by Rothenberg (1990); these studies, in his
opinion, are limited in size, scope and number.
Bipolar Disorder is a degenerative affective disorder (Coffman, Bornstein, Olson,
Schwarzkopf, and Nasrallah, 1990). The roots of the illness are still unknown, but a genetic
component has been implicated (Schmidt, 2005; Craddock and Jones, 1999; Rutzen, 2010). It is
considered a biological illness produced by a chemical imbalance of the brain (Crow, 1998).
Psychiatrists like Freud, Jung, and others, explored several modelsPsychological,
Descriptive, Biological, Socialin an attempt to grasp the roots of the dilemma of mental illness
within a specific domain but the problem with these models is that they have a reductionist
approach, in which only one dimension of the illness is taken into account and treated (Simonton,
2003).
On the other hand, the Biopsychosocial model (Engel, 1977; Dilts 2001) combines the
different models previously mentioned, looking for a more thorough description of problems,
integrating data from different levels of organizationfrom the molecular level to the
communityand affirming that mental disorders have at once biological, psychological and
social dimensions, and all these dimensions must be integrated into a unified assessment and
treatment plana holistic approach (Double, 2004).
Because of the biological component of the illness, psychotropic medication is the
treatment most commonly used (Klein et al, 1992, as cited by Bogousslavsky, 2005; Gonzales
and Suppes, 2008; as cited by Goodwin and Jamison, 2007). These medications may impair
22
cognitive functioning and noontropics are used to help regenerate cognitive functions (Goodwin
and Jamison, 2007) even though none of these stimulants is FDA (Food and Drug
Administration) approved to be used in combination with other medication for Bipolar Disorder
(Gonzales and Suppes, 2008, p. 33)
However, Bipolar Disorder is not only a biological illness, it has also a component of
the mind that is affected by its relationship to the environment and the stressors provided by such
environment that trigger the illness (Bentall, 2003). Even though a cure has not been found,
treatment planslike psychotheraphy and medication can help reduce the frequency and
severity of episodes, which over time can cause deterioration of cognition (Double, 2004).
Since the illness needs to manifest in at least one manic episode before a diagnosis can
be reached, no preventive treatments are available, and misdiagnosis is common. The National
Depressive and Manic-Depressive Association 2000 survey found a 70% misdiagnosis rate
(Goldberg, 2008); for Goodwin and Jamison (2007) most patients with recurrent depression have
some form of Bipolar Disorder. Due to this problematic of misdiagnosis, it is believed that the
illness manifests in a continuum, which has been called the Bipolar Spectrum (Akiskal, 1999).
Facets of the Bipolar Spectrumhypomania and depressionbut not Bipolar
Disorder itselfmay confer advantages for creativity (Kretschmer, 1931; Andreasen, 1987;
Akiskal and Akiskal, 1988; Richards et al. 1988, as cited by Strong et al., 2007, p. 42). In 1920,
Emil Kraepelin introduced the notion of an enhancement of creative thinking as a result of manic
states (Weisberg, 1994).
Nancy Andreasen (1987) investigated possible relations between manic-depression and
creativity, and the positive influences of psychopathology (Facklemann, 2009). According to
Andreasen, primary-process thinking incites creative work when affective disorders are present
due to the evocation of emotion-laden associations and memories attached to concepts or
images, called endocepts, that are more prone in manic states. The conclusions of her study
supported the hypothesis that due to the ways in which information is processed and integrated,
23
creativity is directly connected to affective disorders, specially to mild manic periods

(hypomania) that manifest when de-focused attention and disorganized thinking is present. In the
hypomanic state there is a diminished control of behavioral response, inhibition and increased
flow of responses with decreased in rule governance; social, moral and legal responsibilities are
swept aside (Crow, 1998, p. 58).
There is no great genius without some touch of madness

Seneca (as cited by Ludwing, 1995, p. 4)
Creativity is a bi-product of primary processes (Dilts, 2001), where primary processes

come into play as a creative response to cope with difficult situations (Skinner, 1972, as cited by
Bergquist, 2007), a regression in service of the ego (Earnst, 1952; as cited by Ludwig, 1989, p.
10), which could potentially make artist feel bettera behavior recognized as the sublimation of
sexual drives in psychoanalytic theory (Jung, 1953, as cited by Arieti, 1976; Freud, 1958, as
cited by Dilts, 2001). Between Madness and Art, Hidden Gifts: the Mysterious Case of Angus
MacPhee, and In a Dream are documentaries that explore the act of creation within the realm of
mental illness, and Outsider Art, but not specifically to Bipolar Disorder.
As Gregory J. Feist (1999) wrote, one of the most distinguishing characteristics of
creative people is their desire and preference to be somewhat removed from regular socialcontact, to spend time alone working on their craftto be autonomous and independent of the
influence of a group (p. 158).
Art is 99% perspiration 1% Transpiration

Einstein
24
Beyond the connection between creativity and the Bipolar Spectrum, there is the notion
of genius being a potential part of the illness (Ludwig, 1995). A high number of eminently
creative individuals appear to suffer from depression and related mental illnesses, particularly
Bipolar Disorder.
Many artists, including writer Ernest Hemingway, painter Jackson Pollack, poet Silvia
Plath, and film director Francis Ford Coppola, have been diagnosed with suffering from Bipolar
Disorder (Shenfeld, 2007; Richards, 1993; Kaufman, 2002; Bryant, 2007).
Many features of hypomaniaoutgoingness, increased energy, intensified sexuality,
increased risk-taking, persuasiveness, self-confidence, and heightened productivityhave been
linked to increased achievement and accomplishments (Jamison, 1993, p. 87; Ludwig, 1995).
Shuldberg (1990) found that creative cognition was very particular to hypomanic states.
Ludwig (1994) also studied living writers, using the DSM-III-R and the Lifetime
Creative Scale, developed by Richards and colleagues (1988, p. 393). In their findings, writers
were more likely than the general population to have episodes of mania and depression, were
more prone to suicidal attempts, panic attacks, drug abuse and eating disorders (Goodwin and
Jamison, 2007, p. 393).
Both concepts of eminence and creativity are social process because in order for them
[eminence and creativity] to happen society needs to accept them as novel, new and
extraordinary; they are measured by social and cultural standards (Csikszentmihalyi, 1996).
Authors such as Csikszentmihalyi (1996) have written about the relationship between reputation
and society, in which eminence implies reputation because it involves the judgment of people
within a domain, profession, societies, and cannot exist unless it is recognized as such.
Undiscovered genius does not exist; genius is a label defined by society (p. 28).
Jamison (1993) sees eminent artistic temperament as a condition of the Bipolar
Spectrum, where circumstances, temperaments, intellect, imagination, happenstance, energy
and discipline facilitate the blossoming of original and sometimes revolutionary work.
25
The life of Vincent van Gogh clearly illustrates the conflict between the mad-genius
notion and social validation. In his brief career he sold only one painting but he produced
during the years when he was in and out asylums suffering from deliriumsan impressive
number of masterpieces (Bogousslavsky, 2005). Even though Van Gogh was highly productive
at times, his drastic changes of mood combined with both auditory and visual hallucinations,
segregated him from society; he was alienated due to his mental condition and never achieved
either recognition or social validation in his lifetime.
Van Gogh's finest works were produced in less than three years in a technique that
grew more and more impassioned in brushstroke, in symbolic and intense color, in surface
tension, and in the movement and vibration of form and line. Van Gogh's inimitable fusion of
form and content is powerful; dramatic, lyrically rhythmic, imaginative, and emotional, for the
artist was completely absorbed in the effort to explain either his struggle against madness or his
comprehension of the spiritual essence of man and nature
Templeton Reid, LLC, 2008
As stated by David Schuldberg and Louis A. Sass (1999), What merits the honorific
creative will vary according to the context of production and the perspective in which it is seen,
interpreted, and judged (p. 512). Nowadays, Van Gogh is praised as one of the greatest minds of
the 19th century, his paintings exhibited all over the world as masterpieces of the Impressionist
Movement.
A close relation to temperament differences, addictive personalities, and impulsivity
might explain the prevalence of the illness among both creative and eminent people; Jamisons
theory suggests that there is a correlation between certain behavioral, personality traits and
affective disorders, especially the Bipolar Spectrum. Individuals with temperaments liable to
26
emotional extremes may be more likely to choose artistic careers, thereby increasing the chances
of an interaction between a biological vulnerability and psychological stress.
Many critics that oppose the idea of a link between psychopathology and artistic ability
express concern that labeling artists as mentally ill ignores the enormous discipline, will, and
rationality that are essential to truly creative work (Jamison, 1993, p. 97). Even though the
acquisition of expertise is important, it has been noted that eminent artists had a pronounced
precocity in their creative output hence needing less training than the regular population
(Simonton, 2006). Our species has become dependent on creativity. Evolution has been
transformed from being almost exclusively a matter of mutations in the chemistry of genes to
being more and more a matter of changes in memes in the information that we learn and in turn
transmit to others. But we need to pick the right memes in order to survive. The culture we
create will determine our fate (Csikszentmihalyi, 1996, p. 318).
In this respect, Ruth Richards (1988), one of the leading researchers on creativity,
discusses how biology explains sickness and health using three biological models based on
evolutionary theories where sickness and health are connected from an evolutionary standpoint:
immunity, conservatory advantage, and outmoded genetic blueprints. She found that
depression withdraws the individual from the world, increasing the quality of the creative work
but diminishing the quantity, in contrast with the overlapping productivity during mania and
hypomania. Her study of the composer Schumann confirmed that affective instability and change
in mood affect the quantity of production but not the quality of the work (Weisberg, 1994).
Others (Jamison, 2007) have stated that depressive statesnot manic stateactivated
creative processes and they find resolution when energy kicks in during hypomanic states
(Richards, 1981; as cited by Weisberg, 1994). We might then argue that creativity is inherent to
the being (Schmidt, Fall 2005) and that it is part of a persons personality, whereas the intensity
of the product is directly related to the illness.
27
Using an empirical-based study with 54 visual artists (28 undergraduates, 26 faculty; 34

women, 20 men), Catherine Frantom and Martin F. Sherman (1999) found connections between
Affective Disorders and creativity, by giving participants a battery of questionnaires that
measured personality characteristics of creativity and biographical profile (Sensation Seeking
Scale -SSS- Zuckerman, 1975; Zuckerman, Eysenck and Eysenck, 1978; and Kathena-Torrance
Creative Perception Inventory -SAM- Kathena and Torrance, 1976) and family history (General
Behavior Inventory -GBI- Depue, Krauss Spoont and Arbisi, 1989). These personality measures
assessed levels of creativity in combination with attitudes, values, sensibility, believes and
motivations, among others, and found a set of traits: introspective, adventurous, independent,
risk-taker, non-conformed, optimum level of arousal.
Several researchers have shown that bipolar patients, unlike normal individuals and
schizophrenics, have more combinatory thinking and patterns, characterized by humor and
playfulness (Shenton et al., 1987; Solovay et al., 1987; Russ, 200-2001; as cited by Goodwin and
Jamison, 2007, p. 397). Santosa and colleagues (Santosa, Strong, et al., 2007) found that bipolar
subjects score higher on creativity tests than normal controls and unipolar depressive subjects.
Richards and colleagues (1988) explored the idea that people with cyclothymic temperaments
are the real creatives, and not the bipolar patients; they found greater overall creativity
achievement in a combined group of bipolar and cyclothymic patients and their healthy firstdegree relatives.
Some studies suggest that Neuroticism/Cyclothymia/Dysthymia factor and the Openess
factor, across varied groups, may differentially contribute to components of creativity captured
by the Barron-Welsh Art Scale. Some authors (Kretschmer, 1931; Andreasen, 1987; Akiskal and
Akiskal, 1988; Ricards et al., 1988; Akiskal et al, 2005 a, b) have found a relationship between
cyclothymia and creativity, where cognitive (e.g. Openess) and affective (e.g. Neuroticism)
dimensions are components to creativity (Russ, 1993; Eysenck, 1995; Strong et al., 2007, p. 45)
28
Neuroticism/Cyclothymia/Dysthymia provides a creative advantage by increasing

access to a range of affective experience, particularly negative affect (neuroticism) and
changeability of affect (cyclothymia). The ability to experience unusual intense (neuroticism)
and varied (cyclothymia) affect might propel innovation on talented individuals dissatisfied with
the current status of art, science or industry. Inducing positive affect resulted in creative problem
solving (Isen, Daubman, and Nowiscki, 1987) where in creativity the frequency of expression
super-exceeded the importance of integration of the primary-process.
Sensation seeking is a strong need for stimulation, excitement, complex sensations and
experiences; and maintenance of an optimum level of arousal (Frantom and Sherman, 1999),
clear characteristics of the DSM criteria for diagnosis.
This intense pleasure-pursuit can potentially result in high achievement, mastery and
resource acquisition, but the same tendency of addiction-like pleasurable-pursuit can result in
more harmful consequences associated with mania, and related clinical syndromes like addiction
disorders (Meyer, Rahman and Shepard, 2007, p. 801).
Hypomanic personalities have high risks of developing Bipolar Disorder and other
adjustment problems (Cassano, Akiskal, H. S., Savino, Musetti, and Perugi, 1992; Kwapil Miller,
Zinser, Chapman, L. J., Chapman, J., and Eckblad, 2000). Theres a high co-morbidity between
bipolar and addictive disorders (Brown and Kasser, 2005). By definition, addiction is a behavior
over which the person has impaired control and which is associated with harmful consequences;
they need stimuli that give pleasure, relief and excitement (West, 2001, as cited by Meyer et al.,
2007). General tendencies to develop addictionsany potentially pleasurable substances,
activities or contexts, may be one of the mediators by which a biologically determined bipolar
or hypomaniavulnerability is expressed at the behavioral level (Brown, 2005). Hypomanicprone individuals are more likely to have an addictive personality and be intensely engaged in
the pursuit of pleasurable activities (Meyer et al., 2007, p. 801).
29
Hypomanic personality traits have been shown to predict manic episodes, substance
abuse, and engagement with pleasurable but potentially harmful leisure activities (Meyer et al.,
2007, p. 801), and have been measured using the Hypomanic Personality Scale (Eckblad and
Chapman, 1986). Hypomanic proneness correlates with general addictive tendencies in specific
domains; a hypomanic individual equals addictive personality features, regardless of the specific
substance or activities (Meyer et al., 2007, p. 802).
30
Findings
In Touched with Fire, Jamison (1993) writes:
Another argument set forth against an association between madness and artistic
creativity is that a bit of madness and turmoil is part and parcel of the artistic
temperament, and that artists are just more sensitive to life and the experiences
of life than are other people. This is almost certainly true, and it would be foolish
to diagnose psychopathology where none or little exists (as cited by Castle,
2006, p. 5).
Interviews
Bipolar Artists
All five bipolar artists agree that there is a relation between creativity and Bipolar
Disorder, in which the disorder maximizes creative thinking and artistic talent. Other findings, as
follows:
o
Three were in favor of medication, one felt that doctors need to be more cautious
when prescribing medication but wasnt completely against psychotropic treatment. One
felt very strongly that medication was harmful for her well-being, both physically and
mentally. Most believe that medications, although they might cause cognition
deterioration, are necessary to keep the illness under control.
o
One, who was misdiagnosed as depressive, says that she developed the illness,
Bipolar Disorder, because of the anti-depressants given to her.

o
One talks about the ways in which the media creates scary images of the mentally
ill, perpetuating stigma. One discusses how both the medical community and
pharmaceutical complex have pathologized every aspect of mental illness.
o
One says she wants to be cured, even if it is at the cost of her creative talent.
Health Professionals
31
All six experts agree that there is some connection between Bipolar Disorder and
creativity, but two of them believe that the incidence of artists being diagnosed bipolar is not
high. One discusses the idea of first-degree relatives of bipolars being the real creatives while
the bipolar patient is paying a genetic cause by carrying the illness. Other findings, as follows:
o
One out of six thinks that creative people are more productive and more creative
during manic and hypomanic phases, but not during depressive phases. One believes that
patients cannot be creative neither in manic nor depressive states but only in hypomanic
states, which is when they can be functional.
o
All agree misdiagnosis is common.
All agree that, in the United States, psychotropic treatments are the most
common way to treat the illness and, even though other treatments could also be of use,
medication is needed in severe cases. All agree that some patients complain about
medication making them drowsy and numb, and making their lives dull. One saw
electroshock therapy as a good choice during pregnancy and people with severe illness
who dont respond to psychotropic treatments.
o
One suggests that less severe patients could learn to manage the illness without
medication by making lifestyle changes: having enough hours of sleep, exercising,

learning copying mechanisms against stressors. One believes in four components for
treatment: medication, some kind of therapy, family support, and faith.
o
All agree that Bipolar Disorder is a debilitating and dangerous disorder. Two
stress the fact that Bipolar Disorder has one of the highest rates of suicide amongst
mental disorders, and one discusses impulsivity as an important trait to Bipolar Disorder
and a determinant factor to suicide.
o
All agree the illness is not a social construction but it is treated differently
depending on cultural standards of normalcy and tolerance.
32
Survey
In order to clearly identify patterns of behavior, the strongly agree/agree responses
were added to get percentages of agreement and the strongly disagree/disagree responses to get
percentages of disagreement, whereas the neutral responses were kept as is, to be able to
compare and contrast the findings between the two groups. Results, shown below as
percentages, first present responses of Dominicans living in Dominican Republic followed by
responses of Dominicans living in the Diaspora.
In questions related to the Bipolar Assessmenttaken from the Mood Disorder
Questionnaire42.2% and 86.1% agreed in having flash of ideas (question 1) whereas 73.7%
and 72.2% disagreed on having had any trouble with the law due to impulsive behavior (question
5). In terms of questions related to artistic temperament (taken from Eysenck Personality
Questionnaire), 59.9% and 47.2% agreed on having high-energy levels for days when involved in
creative work (question 2); 83.2% and 58.4% agreed on being called moody and eccentric
many times (question 4), whereas being the life of the party (question 3) was 52.1% and 36.1%
agreed, closely followed by 47.7% and 47.2% neutral. Most participants recognized themselves
as artists (84.2% and 79.4%) but didnt feel more creative when sad (question 6), 42.1% and
66.6% disagreed. Questions related to climate/seasons, 42.1% and 38.9% agreed on sunny days
making them more creative (question 7), followed by 31.6% and 38.9% neutral responses.
Seasons (question 8) have a similar result with 52.7% and 47.2% agreed with tight responses
between neutral (26.3% and 36.1%) and disagreed (21.1% and 16.7%).
In questions related to stigma, 42.1% and 47.7% agreed that mentally ill people are less
reliable than normal (question 9) with 42.1% and 45.5% disagreed. However, 63.1% and 47.4%
agreed when asked if they would sustain a relationship with a mentally ill person (question 10),
and 15.8% in both groups disagreed.
Even though 84.2% and 79.4% consider themselves artists (question 11), only 15.8% and
22.2% have been diagnosed with a mental illness (question 12), and 5.3% out of the 15.8%, and
33
13.9% out of the 22.2% feel comfortable telling others they suffer from a mental illness (question
13). Out of the 15.8% and 22.2% diagnosed, 10.5% and 11.1%, respectively, are on treatment for
the illness. In the results of Dominicans living in the Diaspora there is a discrepancy of 5.5% of
diagnosed respondents, who responded not applicable to this last question.
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36
Discussion of Findings
Stress is the result of things that happen to you.

Depression is the inability to deal with stress
Wootton, 2005, p. 9
Bipolar Disorder is a very common brain disease, says Jair Soares, MD, chair of the
Department of Psychiatry and Behavioural Sciences at the University of Texas Medical School at
Houston (UTHHealth), that can lead to ruined personal relations, bad job performance, and
suicide (Rutzen, 2010). Studies reflect that over one-third of the US population will experience
psychiatric problems in their lifetime, such as hallucinations, delusions, mania, substance
dependence, anxiety, family problems and inner conflict (Dilts, 2001).
Even though both a genetic predisposition (Craddock and Jones, 1999), and an imbalance
of neurotransmittersnorepinephrine and serotoninhave been implicated (Crow, 1998;
Krishna, 2008), some believe that environmental stressors trigger the illness (Engel, 1977;
Bentall, 2003). All bipolar artists interviewed agree that a very difficult situation, or a traumatic
event, triggered the episode that caused them to be diagnosed with Bipolar Disorder. Survey
results showed that environmental stressors are the main trigger of episodes of the illness and
that cultural context determines the incidence of diagnoses among artists. Ivcevic (2009) agrees
that the cultural context must be taken into account in order to find the right diagnosis and
treatment, and urges writers and medical researchers to be more specific when describing what
they are really observing: if they are concentrating on traits and processes or observable behavior
and accomplishments.
As expected, more people are diagnosed bipolar in the Diaspora, especially in the United
States, maybe because society has become less tolerant or because diagnostic standards are more
developed. Overall most participants fit the characteristics of the artistic temperament but not
37
the Bipolar Disorder assessment; in order for this assessment to be accurate, in accordance with
the DSM-IV standards of diagnosis, the Mood Disorder Questionnaire needs to be included in its
entirety.
Biological psychiatrists, like Wilhelm Griesinge, believed that mind illness was brain
illness whereas psychiatrists such as J. M. Charcot and Sigmund Freud studied the emotions as
the root of illness. In 1905 J. Rogues de Fursc wrote on the idea that art products were the
manifestation of the illness in concrete form (Gilman, 1985, p. 583).
The question of treatment among those diagnosed was addressed but no question on why
they answered yes or no was included. An open-ended question to know why they do not take
medicationmaybe because their illness is not severe, or because they dont want to be
stigmatizedwas missing. The majority of both diagnosed and non-diagnosed responders had, in
general, similar responses.
On August 16, 2003 six psychiatric survivors with history of mental health treatment
began a hunger strike to challenge the American Psychiatry Association (Mind Freedom Online,
2004). The central issue seems to be the meaning of the assertion that mental disorders affect or
are mediated by the brain defining mental illness as a biological disorder creates a reductionist
tendency to treat people as brains that need to be circuit-cured, and psychosocial interactions tend
to be ignored. If only biological and genetic factors came to play, the implications would be that
no effortpersonal and socialcould improve these states, and that only psychotropic therapy
could be the answer (Double, 2004, p. 155), which has become a misconception embraced by
both pharmaceutical and insurance companies pushing for profit.
It is for this reason that health professionals have to find treatments where the right
combination and dosage of medication, nutrition, and overall lifestyle changes, give the artistic
patient quality of life and the ability to keep creatinga holistic approach. As both an artist and a
psychiatrist, John Ruskin is very aware of artists stressors and lifestyles; he recommends that,
therapists can help creative patients set up healthier schedules (Shendfeld, 2007, para. 18).
38
Most of the health professionals interviewed agree that psychotropic treatments lower
creativity in soft-bipolar patients but they are needed for severe-bipolar patients to function.
Franton and Sherman (1999) ask the question: at what price art? At what cost the artist? They say
that, to ensure that the treatment of an affective illness does not come at the expense of
creativity, the development of treatment strategies necessarily requires meaningful deliberation
so that the prevailing ethic of society and thoughts from the creative community can be
considered fully (p. 22).
Dr. Terrence A. Ketter, a psychiatrist from Stanford University, says that, medications,
per se, dont cause trouble, but creativity can be hindered if you medicate people to the point that
their emotions or cognitive abilities are blunted (as cited by Shenfeld, 2007, para. 13).
Several writers have agreed that creativity is the production of something both new and
valuable (Rothenberg, 1990, as cited by Castle, 2006) but this definition in itself is very
problematic since the concepts of new and valuable are delimitated by social standardsthat
shift from culture to culture and from time to timethat are defined by trends. Creativity has
also been defined by self-perception, biographical profile and willingness to take chances; affect
was measured as a manifestation of depressive-like and hypomanic-like behavioral fluctuations.
Individuals with this Bipolar Disorder refuse to comply with authority, ignore
convention, have anti-social and impulsive behavior, and lose the selfs sense of unity
(Schuldberg & Sass, 1999)traits that overlap with characteristics of the artistic temperament
(Jamison, 1993). Due to the low diagnosis rate among the group of artists that were surveyed, it
is important to stress the difference between average and exceptional artistic talent and explore
the possibility of the Bipolar Spectrum being a facilitator for exceptional artistic talent to
develop (Ludwig, 1995; Richards, 1989), so a clear distinction between exceptional artistic talent
and average creativity and talent has to be stated.
39
Creativity goes from average to talent to genius; there are creative people on areas of
everyday-problem solving, and others with exceptional intelligence and talent (Andreasen,
1987). Paul Torrance (1984), the originator of the best-known standardized creativity tests,
recommends that creativity be measured by taking into account decision-making, multiple
talents, and that culturally different individuals be given tasks that evaluate the kinds of
excellence that are valued by the particular culture or subculture of the evaluated individuals (p.
155-156).
The bipolar temperament is a virulent psychotic illness or mood (Jamison, 1993).
Moody, volatile, irascible, highly temperamental; all these are characteristics of both Bipolar
Disorder and artistic personalities (Ludwig, 1995, p. 63). People with hyperthymic
temperament, and soft Bipolar Disorder, have qualities of leaders, entrepreneurs, and inventors,
and their increased energy, sharp thinking, and self-confidence are virtues that allow them to
perform such roles.
A new pathological diagnosis has been developed to make sense of this artistic
temperament Do artists create in spite of their often debilitating problems with mood? (p.
102), Jamison asks; her theory is that there is something about the experience of prolonged
periods of melancholiabroken at times by episodes of manic intensity and expansivenessthat
lead to a different kind of insight, compassion and expression of the human conditionthe debate
between mad-genius versus psychologically healthy artists (Jamison, 1993, p. 102).
Impulsivity is a big factor related to the illness but also might be what marks the
difference between being exceptional instead of average. Maybe subjects from the survey are
average-talented people but not exceptional, and thats why they have what has been called the
hyperthymic temperament but not the illness; in order to achieve greatness one might have to
experience the episodes of the illness.
Dr. Swann believes that creative achievement is relatively uncommon among those with
the manic forms of this disorder, which is too severe and disorganizing to permit the necessary
40
concentration and dedication (personal communication, June 198, 2010). It is among those with
the soft Bipolar Disordersespecially Cyclothymic Disordersthat notable artistic
achievements are found (Richards, 1993); psychosis, including severe bipolar swings, is generally
incompatible with creativity, which is something discussed by Dr. Swann (personal
communication, June 18, 2010) when he explains that bipolars can not be creative or productive
during severe episodes because the episodes are too impairing.
The evolutionary approach suggests that mood changes must have evolutionary benefits
only in mild forms of mania, and that depressed episodes allow slowing down, withdrawing from
the world, and going into a state of mental hibernation, saving resources for better times. This is
an important area to explore, a reasoning associated with the rise of evolutionary psychology,
which has become a field onto itself (McGuire; 1998). My conversations with bipolar artists
support this theory that people with Bipolar Disorder are more creative when effectively treated
than when not, but psychotropic treatments are not enough. Only early phases of mania
contribute to creativity (Schou, 1979).
Dr. Swann also discusses a different possibility: that bipolar people enhance the
creativity of their siblings not their own, they pay for the creativity of others. Maybe part of the
evolutionary advantage is not an advantage to the patient but to their siblings who tend to be more
creative than patients and controlled groups; this seems to be the price paid by patients. This
hypothesis was not confirmed in my research study since questions about family history were not
included; these questions should be added to future studies for more complete results.
Is it simply that pathological personalities are more attracted to creative fields? Or is
there something intrinsic in the creative process that predisposes the emotional illness? Is
madness the risk they run, the price to pay for creativity?
Unlike the romanticists, clinically insane patients found in art their mode of expression,
feelings and experiences impossible to externalize using words; for them, art is not a mode of
criticizing society but a way of sublimating their internal struggle and cope with the world around
41
them (Gilman, 1985, p. 587). Many artists use the creative process to repair defects within the self
and its inner world of object relations. All bipolar artists interviewed feel that their art helps them
heal from traumas, voice their anguish and manage stressful events in their daily life.
No one has ever written, painted, sculpted, modeled, built,
or invented except literally to get out of hell
Antonin Artaud, French poet
In a study conducted by Ludwig (1995), artistic types (10%) have much higher lifetime
rates of mania than investigative types (0%). They start to succumb to mania at greater rates than
other types after the age of 25 (p.139). Overall, the artistic types (50%) seem about twice as
likely as social (27%) investigative (24%), and enterprising types (20%) to suffer from
depression during their lifetimes. They also begin to succumb to depression at a greater rate
than other types after the age of 25, and even more so after the age of 40, which could enhance
scientific creativity (p.138). This was not supported in my survey since most of them disagreed
on being more creative when sad, maybe because of the small sample used.
The incidence of suicide among female poets has been so prominent that some experts
call it the Sylvia Plath Effect (Kaufman and Baer, 2002, as cited by Bryant, 2007). Sylvia Plath
who had a diagnosis of Manic-Depression and committed suicide at age 32expressed in one of
her poems, her agitation and despair, and her desire to die:
Darling, all night
I have been flickering, off, on, off, on.
Not him, nor him
(My selves dissolving, old whore petticoats)
To Paradise
American poet Sylvia Plath, Fever 103
(Ariel, 1966; as cited by Shenfeld, 2007, para. 1)
42
Two of the health professionals interviewed stress the fact that one of the highest
percentages of suicide is among bipolar patients, maybe as a result of impulsivity as a trait of the
illness. Jamison (1995) explains how:
[M]anic Depression [Bipolar Disorder] distorts mood and thought, incites
dreadful behaviors, destroys the basis of rational thought, and too often erodes the
desire and will to live. It is an illness that is biological in its origins, yet one that
feels psychological in the experience of it, an illness that is unique in conferring
advantages and pleasures, yet one that brings in its wake almost unendurable
suffering and, not infrequently, suicide (as cited by Rutzen, 2010, para. 7).
Similarly, Nancy Andreasen supports this theory whereas Rothenberg completely
disagrees. If artistic tendencies and temperament are defined as both a gift and pathology, what
happens then, how should it be treated? Could it be cured? At what cost? What is the role-played
by syntonic personality traits? If society assumes no connection, then creativity wont be taken
into account when finding the right treatment, but if a connection is undeniably proven, how
should it be treated?
Not all bipolar patients are creative nor are all creative bipolar, but those who are both
bipolar and creative have a special condition, where affect and impulse become important
elements in the development of the illness, and creative genius (Eysenck, 1992; Ludwig, 1995).
Artists are both psychologically sicker (score higher on psychopathologies) and healthier
(elevated scores on self-confidence and ego-strength) (Jamison, 1993).
For evolutionists, mental disorders are disturbances of repression, which reveals infantile
behavior or archaic forms of the personality (Foucault, 1965). But these theories are wrong in
seeing these returns as the origin and essence of pathology. Neurotic distortion can occur when
the conscious mind inhibits the [creative] process by rigid use of symbolic functions (Kubie,
1958; as cited by Ludwig, 1989, p. 10). All forms of creativity are permanent operant variables
of personality (L. Bellak, 1958, as cited by Bergquist, 2007); The future artist learns to
43
disassociate with real objects and falls in love with the world as a whole (Greenacre, 1957; as
cited by Bergquist, 2007).
Two of the bipolar artists interviewed agree that people who suffer the illness might be
attracted to creative and artistic domains because they are trying to find ways to deal with their
way of thinking (A. Cutler, personal communication, March 7, 2010) and trying to compensate
for feeling left out (T. Zwerling, personal communication, March 6, 2010); one expressed how
the illness maximizes her creative gifts (B. Rodriguez, personal communication, May 24,
2010). If creativity promotes psychic self-help, even health, why does it heal some and not
others? (Kavaler-Adler, 1993, p. 47).
In survey questions related to the Bipolar Assessment both groups disagreed on having
trouble with the law, 73.7% and 72.2% respectively, and having flash of ideas 42.2% and 86.1%,
but 59.9% and 47.2% agreed on having high-energy levels. 83.2% of the art students and
professionals living in the Dominican Republic agreed having been called moody and
eccentric, whereas those living in the Diaspora, even though most of them agreed, the
percentage is still a lower number, 58.4%. This may be because of the culture of the Diaspora, in
contrast to the traditional culture of the Dominican Republic; being the life of the party
responses were close in both groups, 52.1% and 47.2%.
Lombrosos first major work, Genius and Madness (1864), analyzed people of genius and
saw themin an Aristotelian manner as mad; he became famous for his concept of
degeneracy as the central explanation of deviancy (from sociopathic and psychopathic to creative
arts) and became a center pillar, a cornerstone of modern psychiatry, from where we can
delimitate 2 main concerns: (a) to find the psychopathology origin of greatness and (b) to
discover the greatness in madness.
In order for art to be recognized as such it needs societys validation, the same society
that the mad man fights against. If Outsider Art remains as such, its value as real art does not
exist, it becomes the language of the insane and nothing more, and the mentally ill keeps his
44
status as an outsider; if the art is elevated beyond a means of communication to real art, the
mentally ill status also changes, from the insane to an artist maybe a genius (Bogousslavsk,
2005; Jamison, 1993).
The existentialist philosopher Karl Jasper (1926) maintained that, the greater
manifestation of mental illness in geniuses was the result of societys selective granting of fame.
For Jasper, a general mood or inclination in Western society craves mysterious, the unusual, the
indefinable, and the blatantly diseased (as cited by Becker, 2000-2001, p. 52). The 19th and 20th
centuries have shown a distinct preference for those creative individuals who are diseased; the
same society that praises them also condemns them (Foucault, 1965).
Eccentricity seemed to be determined by culture and geographical context as opposed to
being intrinsic to the individual; survey responses of being called eccentric and moody were
higher among those living in the Dominican Republic compared to those living in the Diaspora,
especially the Unites States, possibly because Dominican Republic is a more traditional and
conservative society. On the other hand, artists might think that to be considered as such they
need to have a little madness and accept their condition, or act out; this problem of selfadmission and projection of images in artists is discussed by George Becker (2000-2001), who
argued this issue as part of the reason why so many artists are being diagnosed with Bipolar
Disorder.
In his discussion, Becker (2000-2001) does not take into account a different possibility:
that artists might instead be making a statement to break the stigma around mental illness, to
erase the assumption that mad is something bad and that being mad means having no periods of
rational thoughts and connections with realitywhich has been proven to be a misconception
(Jamison, 1993); Freud didnt believe in the concept of normal, for him everybody had some
type of pathology (Ludwig, 1995, p. 64). For Jamison madness is the extra sensibility to life and
experiences that defines the true artistic temperament; because of this it would be irrational to
diagnose psychopathology where it does not exists (Jaminson, 1993, cited by Castle 2006), a
45
statement also made by Dr. Swann (personal communication, June 18, 2010).
Ludwig (1995) discusses how differentness equals eccentricities, which in the context of
society mean oddities, peculiarities, idiosyncrasies, or otherwise unusual behavior that deviates
from the norm, does not fit societal standards of normal, its rules and trends, and could
sometimes be confused with social-obtusenesslack of intellect or sensitivity (p. 64).
In the survey question about reliability of the mentally ill and the concept of being
normal, I expected to have more disagree responses because I thought the group would assume
that the mentally ill are also normal but it wasnt the case.
Social alienation is a personal price that has to be paid by those carrying the genes of
geniusthat helped define the creative individual within levels of creative complexity and mania
gives access to the mental edge of chaos where new ideas and insight occurs (Ludwig, 1995, p.
126). The world cannot offer a solution to contradictions; as described by Foucault (1965): The
disappearance of affective relations between men, and the mechanization or mechanistic
rationality excludes the continuous spontaneity of the affective life.In alienating consciousness,
the freedom of the world cannot acknowledge its madness.
Foucault argues that mental illness is a social construction to repress free expression,
even though all health professionals I interviewed agree that Bipolar Disorder is not a social
construct. In Schuldbergs (1999) words:
Difficulty in making distinctions between products of art and madness reflects the
social embeddedness of such judgments.to complicate the issue, much creative
work is like Outsider Art and not appreciated in its own time. These views tried
to separate the illness from the personality of artists, which is also a manifestation
of the societies pressures to fix the artistic temperament (Schuldberg & Sass,
1999, p. 503).
Society re-frames and redefines the concept of insane to suppress, control and isolate
46
those who dont follow social standards of conduct and behavior. Herzfelde perceived the crazy
man as the modern artist. For the German Expressionists the insane were the accurate
representation of the artist in constant opposition to social structures and authoritarian symbols
(Gilman, 1985).
If validation comes from a society that alienates the artistic temperament and treats the
artist as an outsiderand then praise for his/her work of art in retrospectthere will always be
misconceptions and stigma around creative forces and mental illnesses.
Why is art/creativity valuable? It is an expression of culture, a medium to denounce
social injustice, a vehicle to record historic events, social challenges. A way to push society to
make changes, move forward, advance civilization. Beyond art for the sake of art, we challenge
current views and tendencies, criticize the ways of doing things, and denounce atrocities.
If art is a needed form of communication, mode of expression, for the mentally ill then is
both the need to communicate and the product of the communication equally important, for the
medium is the message, art becomes both. The content of drawings can express what words
cant. The unconscious is unleashed, uncensored and revealed using a system of symbols and
codes that have then to be decipheredthe honesty and lack of censorship that comes from the
unconscious is the added value of the illness.
Psychiatrist Hans Prinzhorn perceived four stages in the scientific treatment of the art of
the insane: first, the awareness that the insane do produce works of art (Tardie); second, that
these works of art could have value in diagnosis (Simon); third, that an intrinsic approach was the
appropriate one to the study of this material (Mohr); fourth, that the question of the relationship
of this art to real art should be part of the investigation (Rja) (Gilman, 1985, p. 584).
For Prinzhorn the creations of the insane are the result of the process of an illness, and
even though the work of the ill and the avant-garde artists could be confused, the context in which
the work has been produced clears up this confusion.
47
Contemporary education created a world for children, separated from adulthood to

preserve the child from adult conflicts, hence accentuating the distance between past and present,
a contradiction between childhood and real life, where childhood becomes a past left behind in
order to achieve maturity (Foucault, 1965).
The media have been a key element to the creation of deceitful symbols of insanity that
fill up the imagination of the masses with terrifying and violent scenes, misleading the public and
provoking negative reactions towards the mentally ill (Nairn, 2007; Mia [pseudonym], personal
communication, March 29, 2011). Stigmatization is found everywherenot only in the public
space but also in private life, where families and friends feel ashamed and avoid talking about this
issue as if it didnt exist, hiding this fact to other relatives and friends hence making the ill feel
inappropriate, rejected and alone. It is understandable that fear of the unknown makes us feel
powerless and anxious but are we really interested in understanding it? Are the families of the
patients ready to get out of their denial and help?
Across Anglophone societies analyses show that media portrayal of the insane
emphasizes violence, harm, unpredictability and forms of social incompetence (Nairn, 2007, p.
138). The banality of mental illness comes in conflict with our need to have the mad
identifiable, different from ourselves. Our shock is always that they are really just like us. This
moment, when we say, they are just like us, is most upsetting (p. 13, as cited by Cross, 2004,
p. 199).
Sander L. Gilman (1985) studies how those labeled as mad internalize the stereotypes of
madness; the depictions of madness created by the mad will show characteristics of the same
stereotypes because they shape the self-representation of the mad person (Cross, 2003, p. 210).
R. D. Laing, considered the psychiatrist guru of the 60s, saw madness as a response to
an unbearable world; the mad are only externalizing the craziness that surrounds them. Now the
question shifted: we started with the notion that madness was a condition for genius but
madness was not clinical insanity; madness was the manifestation of supernatural forces.
48
All bipolar artists interviewed were asked the same question: If there were a cure for
Bipolar Disorder, would you take it? All but one answered no to this question because they
would not want to risk losing their creative gift. The bipolar artist who responded yes said that
she wants to be cured even if it is at the cost of her creativity because being creative,
extroverted, colorful and eccentric has not given me anything in return.I cant design, I cant
function.This illness is a verdict for lifewe are dispossessed (E. Ti, personal
communication, May 26, 2010).
In todays society it all comes down to being the able to be productive and self-sufficient
in a very demanding and competitive world. If we were to find a cure, would this cure be worse
than the illness? Dr. Swann suggests that it could be a great thing for people with severe Bipolar
Disorder but might not be necessary for those with soft Bipolar Disorder, who could manage
the illness without psychotropic treatments. He also points out that, like other cures, it might not
be perfect, and might be more damaging than beneficial, and could take away the positive aspects
of the illness, and that is the dilemma with Bipolar Disorder that you dont want to take
everything away (A. Swann, personal communication, June 18, 2010).
49
Conclusion
Even though not predictive, the research study was effective in finding peoples opinion
about their illness, and doctors recommendations. Also missing was the discussion on
alternative treatments, such as acupuncture and phototherapy, among others, that could enhance
the management of Bipolar Disorder and contribute to the development of holistic treatment
plans. (See Appendix 2c for interview protocol)
Another important topic that arose during the research process, but was out of the scope
set forth, was the economics of the illness, and the role of insurance and pharmaceutical
companies, its relationship to health professionals, and the ways in which those relationships
might cloud doctors judgment when prescribing certain psychotropic treatments. Many lawsuits
against atypical antipsychotics have been filled in the past few years; a good example of this
situation is AstraZeneca civil lawsuit for paying kickbacks to doctors to prescribe Seroquel for
unapproved purposes, an issue worth looking into (Cross a Line, Pay a Toll, 2011).
Production
In terms of production, it was challenging to condense all the information gathered into a
1-hour documentary without feeling that there were interesting parts left out, and still making it
engaging, well paced and entertaining. I wish I had more technical skills to fine-tune the visuals
(color correction, effects, transitions, timing and pacing) in Final Cut Pro because even though I
was able to manage I needed more expertise. Sound, especially, became a big issue because of
my inexperience using Pro-Tools, so I had to mix and edit in Final Cut Pro and then ask a music
engineer to clean up the final track. Overall, it was a great experience that allowed me to see all
the things I have yet to learn.
50
Future Studies
Moving forward I will design a 4-year study to collect hard data, in which subjects are all
visual artists, both trained as such, and those untrained who create Outsider Art. Subjects will
be observed, and their work documented, when on medication and off medication, to assess the
effects of medication on their productivity, inventiveness, impulsivity, and overall creativity;
findings will be compared to controls.
Media Activism Plan

Future projects involve the development of an iPhone app, called Poised (See Appendix
6b for Poised app functionality and graphics) that will help artists manage their illness by
learning how to recognize episodes and getting recommendations for different mood states. The
design of this iPhone app has been based on the Manchester Color Wheel (Carruthers, Morris,
Tarrier, and Whorwell, 2010) and The Feeling Wheel (Willcox, 1982), and will be ready to
launch in November 2011. An art exhibition, called Under the Umbrella (See Appendix 6c for
Under the Umbrella design brief and call for entry) that invites artists to re-design an umbrella to
express their point of view about the illness, as an artist suffering from the illness, as a relative of
a Bipolar, or as a mere spectator, in order to start the conversation and reduce stigma and fear.
The exhibition will include 15 Dominican artists and will open in November 2011, at the
Museum of Modern Art (MAM) in Dominican Republic, and will close with the screening of
Madly Gifted and the launch of Poised, and a panel discussion with health professionals and
bipolar artists.
51
Appendices
Appendix 1
Glossary of Terms
Addiction: Persistent, compulsive dependence on a behavior or substance. The term has been
partially replaced by the word dependence for substance abuse. Addiction has been extended, however, to
include mood-altering behaviors or activities. Some researchers speak of two types of addictions:
substance addictions (for example, alcoholism, drug abuse, and smoking); and process addictions (for
example, gambling, spending, shopping, eating, and sexual activity). There is a growing recognition that
many addicts, such as polydrug abusers, are addicted to more than one substance or process (The Free
Dictionary, 2011).
American Psychiatric Association (APA): A medical specialty society, with over 35,000
American and international member physicians, who work together to ensure humane care and effective
treatment for all persons with mental disorders, including mental retardation and substance-related
disorders. It is the voice and conscience of modern psychiatry. Its vision is a society that has available,
accessible quality psychiatric diagnosis and treatment. The APA is the oldest national medical specialty
society in the US (MedicineNet, 2011).
Affect: External manifestation of emotion (Kaplan, B. J. Sadock, and V. A. Sadock, 2007).
Emotion or mood, e.g. sadness. Within abnormal psychology, patients may display different types of
affect disturbance, e.g. blunted, flat or inappropriate affect (ITS Tutorial School, Online Psychology
Dictionary, 2011).
Affective Disorder: See Mood Disorders
Artistic personality: An artistic personality type uses their hands and mind to create new things.
They appreciate beauty, unstructured activities and variety. They enjoy interesting and unusual people,
sights, textures and sounds. These individuals prefer to work in unstructured situations and use their
creativity and imagination. This personality type is especially sensitive to color, form, sound and feeling.
They have a lively spirit and a lot of enthusiasm and can often stay focused on a creative project and forget
everything around them. An artistic personality type solves problems by creating something new. Their
52
ideas may not always please others, but opposition does not discourage them for long. These individuals
are creative, impulsive, sensitive and visionary (123 Test, 2011).
Artistic talent: A special ability to use [such] specific kinds of communication the ability to
express [himself] via a specific medium of a given art (Noy, 1972, p. 243).
Artistic temperament: the artistic voyagefierce energy, high mood, and quick intelligence; a
sense of the visionary and the grand; a restless and feverish temperamentcommonly carry with them the
capacity for vastly darker moods, grimmer energies, and, occasionally, bouts of madness (Jamison,
1993, p. 2).
Behaviors: Actions (Dilts, 2001, p. 3).
Bipolar Disorder: Also known as Manic-Depressive illness, is an Affective Disorder that
causes shifts in a persons energy levels and ability to function, characterized by drastic changes in mood,
from mania an abnormal elevated, expansive or irritable mood accompanied with inflated selfesteem, distractibility, and grandiosity, decreased need of sleep, pressure of speech, flight of ideas, goaldriven activities, psychomotor agitation and excessive involvement in multiple activitiesto depression
(DMS-IV, 1994). Types of Bipolar Disorder: Bipolar I (296.4x, 296.6x, 296.5x, 296.7), in which manic
or mixed episodes last at least seven days; or a severe manic episode requires hospitalization, and
depressive episodes last at least two weeks. Bipolar II (296.89), which follows a pattern of depressive
episodes shifting back and forth with hypomanicmild form of maniaepisodes but not to the point of
full-blown manic or mixed episodes. Bipolar not otherwise specified (BP-NOS) (296.80) is diagnosed
when symptoms are present but dont last enough [time], or are too few symptoms but behavior is out of
persons normal character. Cyclothymia (301.13) refers to a mild form of Bipolar where episodes of
hypomania go back and forth with mild depression for at least two years but do not meet the criteria of
other types of Bipolar Disorder (DSM-IV, 1994).
Bipolar Spectrum: Refers to a wide range of disorder levels; an expansion of the Bipolar
Disorder classification (Psychom, 2011).
Bipolar Spectrum Diagnostic Scale (BSDS): Developed by Ronald Pies, MD and was later
refined and tested by S. Nassir Ghaemi, MD, MPH and colleagues. The BSDS arose from Piess
experience as a psychopharmacology consultant; where he was frequently called on to manage cases of
53
treatment-resistant depression. In Piess experience, most of these cases eventually proved to be

undiagnosed Bipolar Spectrum disorder (Psychiatric Times, 2011).
Character: Aspect of an individual which bears a moral stamp and reflects the persons
integrative and organizing functions (Goodwin and Jamison, 2007, p. 324).
Combinatory Thinking: A type of thinking that merges perception, images and ideas in
unconventional ways (Shenton et al., 1987).
Creativity: The production of something that is both new and truly valuable (Rothenberg,
1990, p. 10); creative individuals are those who have changed our culture in some important respect
(Csikszentmihalyi, 1996 p. 27).
Cognitions: Basic abilities of intelligence such as memory, attention, calculation and language
(Dilts, 2001, p. 3).
Cognitive functions: Intellectual processes by which one becomes aware of, perceives, or
comprehends ideas. It involves all aspects of perception, thinking, reasoning, and remembering (The Free
Dictionary, 2011).
Degeneracy: Corrupt, vulgar, vicious behavior, especially sexual perversion (The Free
Dictionary, 2011).
Degenerate: Having sunk to a condition below that which is normal to a type; especially, having
sunk to a lower and usually corrupt and vicious state (Merriam-Webster Dictionary, 2011). Inability of a
group to compete successfully in society (Gilman, 2003, p. 589).
Degenerate Art: A term adopted by the Nazi regime in Germany to describe virtually all
modern art. Such art was banned on the grounds that it was un-German or Jewish Bolshevist in nature,
and those identified as degenerate artists were subjected to sanctions. These included being dismissed from
teaching positions, being forbidden to exhibit or to sell their art, and in some cases being forbidden to
produce art entirely (Wikipedia, 2011).
Deviance/Deviant behavior: Behavior that is contrary to the accepted standards of a community
or culture (The Free Dictionary, retrieved on February 2011). A recognised violation of social norms
(ITS Tutorial School, Online Psychology Dictionary, 2011).
54
Diagnostic and Statistical Manual (DSM): Primary standard system to classify and diagnose
mental illness (Wikipedia, 2011).
Diaspora: A dispersion of a people from their original homeland. The community formed by
such a people (The Free Dictionary, 2011).
Difference: The quality or condition of being unlike or dissimilar; A distinct mark or
peculiarity (The Free Dictionary, 2011).
Dissociative thinking: Mental disconnection of one's thoughts, feelings, memories, actions, or
sense of identity (Steam Boat Counseling, 2011).
Dissociative Disorder: Condition, often caused by trauma, in which a person disconnects from a
full awareness of self, time, or external circumstances as a defence against unpleasant realities or memories
(ITS Tutorial School, Online Psychology Dictionary, retrieved on February 2011).
Divergent thinking: Creative thinking that may follow many lines of thought and tends to
generate new and original solutions to problems (Merriam-Webster, 2009, retrieved February 2011).
Depression: An illness that involves the body, mood, and thoughts. According to DSM a major
depressive disorder occurs without history of manic, mixed or hypomanic episodes. A major depressive
episode must last at least two weeks and typically a person with this diagnosis also experiences at least four
symptoms from a list that includes changes in appetite and weight, changes in sleep activity, lack of energy,
feelings of guilt, difficulty thinking and making decisions, and recurring thoughts of death or
suicide (Kaplan, Sadock, B. J., and Sadock, V. A., 2007).
Dysphoria: Unpleasant mood, sadness, restlessness (Ludwig, 1995, p.137).
Dysthymia: A mild-low mood that gets chronic or long-term (DSM-IV, 1994).
Ego-Strength: In psychotherapy, the ability to maintain the ego by a cluster of traits that
together contributes to good mental health. The traits usually considered important include tolerance of the
pain of loss, disappointment, shame, or guilt; forgiveness of those who have caused an injury, with feelings
of compassion rather than anger and retaliation; acceptance of substitutes and ability to defer gratification;
persistence and perseverance in the pursuit of goals; openness, flexibility, and creativity in learning to
adapt; and vitality and power in the activities of life. The psychiatric prognosis for a client correlates
positively with ego strength (The Free Dictionary, 2011).
55
Eminent/Eminence: A person of high station or great achievements (The Free Dictionary,

2011).
Emotion-laden associations: Associations made by a driven emotion (Kaplan, B. J. Sadock and
V. A. Sadock, 2007).
Emotion: A pattern of intense changes in physiological arousal, behaviour, cognitive processes
and environmental influences that are described in subjective terms such as happiness, fear or anger (ITS
Tutorial School, Online Psychology Dictionary, retrieved on February 2011). Complex feeling state with
psychic, somatic and behavioral components (Kaplan, B. J. Sadock and V. A. Sadock, 2007).
Endocepts: Memories attached to concepts or images, more prone in manic states (Russ, 20002001).
Evolutionary Models: (See the following subsets) Acquired Immunity Model: Biological
advantage against diseases after being exposed by getting a resistance to stronger future disease. Exposure
to difficult childhoods, emotional distress, physical disability and emotional deprivation, instead of
incapacitating, provide some sort of psychic immunity to stressful situations later in life. Compensatory
Model: Presence of disease may increase resistance to other disease. The Outmoded Genetic Blueprint
Model: Species that best adapt to environmental changes are more successful in perpetuating themselves
in the evolutionary pool (Richards, 1988, p.126).
Extroversion: The act of directing ones interest outward or to things outside the self. The state
of having thoughts and activities satisfied by things outside the self (The Free Dictionary, 2011).
Eysenck Personality Inventory (EPI): Personality test designed to measure the traits of
extroversion and neuroticism (ITS Tutorial School, Online Psychology Dictionary, 2011).
Feelings: Subjective emotional states, like sadness and happiness (Dilts, 2001, p. 3).
Functional: Capable of functioning; working (The Free Dictionary, 2011).
Genius: Refers to both brilliance and creativity. Implies high intelligence (Csikszentmihalyi,
1996 p. 27).
Holistic: Used to describe an approach that focuses on the whole person, rather than their
constituent parts (ITS Tutorial School, Online Psychology Dictionary, 2011).
56
Hyperthymic temperament: endowed with high levels of energy, extraversion, and humor,
will assume leadership positions in society or excel in the performing arts or entertainment. In talented
persons the cycloid temperament, which alternates between sadness and elation, could provide the
inspiration and the intensity needed for composing music, painting, or writing poetry (Akiskal, 1995, p.
1125).
Hypomanic personalities: Extraverted, energetic, intensely emotional, hyper-confident,
ambitious and impulsive (Eckblad and Chapman, 1986, p. 802); they need less sleep than other people and
tend to be somewhat rude, irritable and irresponsible (A. Swann, personal communication, June 18, 2010).
Hypomanic Personality Scale (HPS): Developed by Eckblad and Chapman (1986), it is a selfreport scale used to identify behavior styles that characterize by episodes of hypomanic euphoria in order to
assess any risks of developing Bipolar Disorder (Goodwin & Jamison, 2007).
Impulse/Impulsivity: Inability to resist an impulse, drive or temptation to perform some action
(Kaplan, Sadock, B. J., and Sadock, V. A., 2007).
Insane/Insanity: A severely disordered state of the mind usually occurring as a specific disorder
(as paranoid schizophrenia). Unsoundness of mind or lack of the ability to understand that prevents one
from having the mental capacity required by law to enter into a particular relationship, status, or transaction
or that releases one from criminal or civil responsibility (Merriam-Webster, retrieved February 2011).
Madness: See Insanity
Magnetic Resonance Imaging (MRI): Painless diagnostic tool which uses a magnetic field and
radio waves to see inside the body without using x-rays or surgery; a computer then interprets the radio
waves and creates a picture of the internal body tissues (ITS Tutorial School, Online Psychology
Dictionary, 2011).
Mania: Manifests as an emotional high, elation, grandiosity, excessive energy, unusual poor
judgment, racing thoughts, social intrusiveness, prolonged insomnia, and excessive buying. Major mood
swings with heightened wellbeing; marked irritability, diminished sleep, lapses in judgment, and increased
physical activity. Manic cycles may be severe and often lead to impaired functioning (Ludwig, 1995, p.
139).
57
Manic: Refers to a mood disorder in which a person seems "high", euphoric, expansive,
sometimes agitated, hyper-excitable, with flights of ideas and speech (DSM-IV, 1994).
Meme: Relatively newly coined term, which identifies ideas, behaviors, or styles that
spreads from person to person within a culture.
[2]
The concept comes from an analogy: as genes
transmit biological information, memes can be said to transmit idea and belief information
(Wikipedia, 2011).
Meyerian Psychobiology: The psychobiological life history approach to psychiatry is perhaps
the most important of Adolf Meyer's contributions to psychiatric thinking. The author outlines the
implications of that approach for current concepts and practice. He reviews the literature regarding the
causative role of life experiences in the genesis of psychiatric disorder, the extent to which the effects of
stressors are situation- specific, the effects of stress on the organism, the reason for individual variations in
the response to stress, and the cause of life stressors (The American Journal of Psychiatry, 2011).
Models of mental illness: Several models intend to explain mental illness by concentrating in a
specific dimension of illness. Psychological Model: mental disorders are problems in the areas of
thoughts, feelings, perceptions, cognitions, and behaviors.outward manifestations of internal mental
states (Dilts, 2001, p. 3). Descriptive Model: the appearance of mental illness without delineating the
causes; Biological Model: the disorder as a result of tissue and cell pathology, with a hereditary
predisposition. The Biological Model reasserted its dominance during the 1960s and 1970s in the USA, as
the power and attractiveness of Freudian Psychology and Meyerian Psychobiology declined (Roth and
Kroll, 1986, as cited by Double, 2004); Social Model: mental illness as the result of dysfunctional
interpersonal interactions (Dilts, 2001).
Mood: Pervasive and substantial feeling tone that is experienced internally and that, in the
extreme, can markedly influence virtually all aspects of a person's behavior and perception of the world
(Kaplan, Sadock, B. J., and Sadock, V. A., 2007).
Mood Disorder: A mood disturbance, characterised by emotional extremes, alternating between
extreme depression and mania (ITS Tutorial School, Online Psychology Dictionary, 2011). Have been
classified in: Depressive Disorders, Bipolar Disorders, Mood Disorder due to general medical condition,
Substance-Induced Mood Disorders (DSM-IV, 1994).
58
Neurosis: A mental or personality disturbance not attributable to any known neurological or

organic dysfunction (ITS Tutorial School, Online Psychology Dictionary, 2011).
Neuroses of regression: Unconscious defense mechanism in which a person undergoes a partial
or total return to earlier patterns of adaptation (Kaplan, Sadock, B. J., and Sadock, V. A., 2007).
Neuroticism: A fundamental personality trait in the study of psychology. It can be defined as
an enduring tendency to experience negative emotional states (ITS Tutorial School, Online Psychology
Dictionary, 2011).
Non-conformity: Refers to situations whereby an individual withstands the tendency to conform
to the attitudes judgements or behavior of the majority (ITS Tutorial School, Online Psychology
Dictionary, 2011).
Noontropics: Also known as smart drugs; memory and cognitive enhancers (Goodwin and
Jamison, 2007).
Norepinephrine or 'noradrenaline': Neurotransmitter that is important in the regulation of
mood; disturbances in its tracts have been implicated in depression and mania (ITS Tutorial School,
Online Psychology Dictionary, 2011).
Normal: Defined as not deviant from a norm, rule, or principle free from mental disorder:
sane (Merriam-Webster, 2009).
Outsider: unproductive citizens.all forms of social uselessness (Foucault, 1965, p. 54).
Outsider Art: Coined by art critic Roger Cardinal in 1972 as an English synonym for art brut
(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
(Wikipedia, 2011).
Pathology: The study of disease; branch of medicine which treats of the essential nature of
disease (MedicineNet, 2011).
Perceptions: Functioning of the five sensory modalities: sight, hearing, touch, taste and smell
(Dilts, 2001, p. 3).
Personality: Refers to unique aspects of an individual, especially those most distinctive or likely
to be noticed by others in social interactions. It is stable across time and situations; it encompasses an
59
organized set of traits forming a coherent personality style; and it is the underlying psychological cause
of a persons specific behaviors and beliefs. Personality is altered by Affective Disorders (Goodwin
and Jamison, 2007, p. 324-325).
Phototherapy: Or light therapy, is the administration of doses of bright light in order to
normalize the body's internal clock and/or relieve depression. Phototherapy is prescribed primarily to
treat Seasonal Affective Disorder (SAD); a mood disorder characterized by depression in the winter
months, and is occasionally employed to treat insomnia and jet lag. The exact mechanisms by which the
treatment works are not known, but the bright light employed in phototherapy may act to readjust the
body's circadian (daily) rhythms, or internal clock. Other popular theories are that light triggers the
production of serotonin, a neurotransmitter believed to be related to depressive disorders, or that it
influences the body's production of melatonin, a hormone derived from serotonin that may be related to
circadian rhythms (The Free Dictionary, 2011).
Physiognomy of madness: Know a lunatic when you see one became a professional concern
for those formally charged with managing and treating the mad. The ability to catalogue mental pathology
form outward appearances underpins psychiatrys discovery of madness as a phenomenon amenable to a
clinical gaze.The blossoming of psychiatric photography in the second half of the 19th century bears
witness to the idea that the mad exhibited differences in appearance that doctors could learn to recognize
and label (Showalter, 1978; Gilman, 1976, p. 200).
Primary processes: In psychoanalysis, the mental processes directly related to the functions of
the id and characteristic of unconscious mental activity, marked by unorganized, illogical thinking and by
the tendency to seek immediate discharge and gratification of instinctual demands (The Free Dictionary,
2011).
Pre-logical thought: A form of concrete thinking characteristic of children, to which
schizophrenic persons are sometimes said to regress (The Free Dictionary, 2011).
Productive: Defined as yielding or devoted to the satisfaction of wants, or the creation of
utilities (Merriam-Webster, 2009).
Prognosis: When used in clinical psychology, refers to the expected eventual outcome of a
disorder (ITS Tutorial School, Online Psychology Dictionary, 2011).
60
Psyche: The mind functioning as the center of thought, emotion, and behavior and consciously or
unconsciously adjusting or mediating the body's responses to the social and physical environment (The
Free Dictionary, 2011).
Psychosis: In the general sense, a mental illness that markedly interferes with a person's capacity
to meet life's everyday demands. In a specific sense, it refers to a thought disorder in which reality testing
is grossly impaired (ITS Tutorial School, Online Psychology Dictionary, 2011).
Psychosocial: The psychological and/or social aspects of health, disease, treatment, and/or
rehabilitation (ITS Tutorial School, Online Psychology Dictionary, 2011).
Psychotic Symptoms: In the form of hallucinationsperceptions in a conscious and awake
state that manifest in the absence of external stimuli with qualities of real perceptionand delusions
erroneous belief that is held in the face of evidence to the contrary; deception by creating illusory ideas
can also manifest (DSM-IV, 1994).
Psychopathology: The behavioral manifestation of any mental disorder; a mental disorder or
illness, such as schizophrenia, personality disorder, or major depressive disorder (The Free Dictionary,
2011).
Psychoticism: One of Eysencks three dimensions of personality and temperament (the other two
are neuroticism and extraversion. In his description of psychoticism, aggressive, cold, egocentric,
impersonal, impulsive, antisocial, unempathic, creative, and though-minded, are interrelated traits of this
dimension of personality (Eysenck, 1992).
Psychotropic: Any medication capable of affecting the mind, emotions, and behavior
(Psychiatry On-Line, 1995-2007).
Rapid-Cycling: Refers to four or more episodes of major depression, mania, hypomania or
mixed symptoms within a year; this is more common in people with severe Bipolar Disorder or those who
had their first episode at a younger age, and tends to affects more women than men (DSM-IV, 1994).
Reactions: Response to another event (the Free Dictionary, 2011).
Reputation: The opinion of contemporaries revisited by posteritybased upon a favorable
appraisal of a mans character and natural abilities (Csikszentmihalyi, 1996, p. 17).
61
Sameness: According to Leibniz's law two things sharing every attribute are not only similar,
but are the same thing. The concept of sameness has given rise to the general concept of identity, as in
personal identity and social identity (The Free Dictionary, 2011).
Sane: See Sanity
Sanity: Refers to the soundness, rationality and reasonableness of the human mind, as opposed
to insanity. A person is sane if they are rational. In modern society, the terms have become exclusively
synonymous with compos mentis (Latin: compos, having mastery of, and mentis, mind), in contrast with
non compos mentis, or insane (the Free Dictionary, 2011).
Seasonal Affective Disorder (SAD): A form of depressive illness only occurring during winter
months, associated with overeating and sleepiness; responsive to antidepressants and phototherapy. Little
researched and scientifically controversial (Psychiatry On-Line, 1995-2007).
Secondary processes: In psychoanalysis, the mental processes directly related to the functions
of the ego and characteristic of conscious and preconscious mental activities, marked by logical thinking
and by the tendency to delay gratification by regulation of actions based on instinctual demands (The Free
Dictionary, 2011).
Social norms: Expected standards of acceptable and appropriate behavior and attitudes for
members of a group or society (ITS Tutorial School, Online Psychology Dictionary, 2011).
Soft Bipolar: Mild form of Bipolar Disorder, less deteriorating and less recurrent (Akiskal,
2006).
Stable: Not subject to sudden or extreme change or fluctuation; not subject to mental illness or
irrationality (The Free Dictionary, retrieved February, 2011).
Stereotype: An oversimplified, generalised and often inaccurate perception of an individual
based upon membership of a particular group. Can often underlie prejudice and discrimination (ITS
Tutorial School, Online Psychology Dictionary, 2011).
Stigmata: As a term of medicine, Stigmata refers to the physical marks and characteristics
that suggest an individual is abnormal. For Lombrosos, atavistic Stigmata were those physical
characteristics that suggested an individual to be atavisticrecurrence in an organism of a trait or character
typical of an ancestral form and usually due to genetic recombination (Merriam-Webster, 2011). Such
62
Stigmata included abnormal skull sizes, hawk-like noses, large jaws and cheekbones, and fleshy lips
(Terms of Criminology, 2011).
Stressor: Any event or stimulus (internal or external), which triggers a stress response in an
individual (ITS Tutorial School, Online Psychology Dictionary, 2011).
Syntonic personality: Normally responsive and adaptive to the social or interpersonal
environment (Merriam-Webster, 2009).
Talent: Is different from creativity in that it focuses on an innate ability to do something very
well (Csikszentmihalyi, 1996, p. 27).
Temperament: According to Allport (1961, p. 33-34), temperament refers to the
characteristic phenomena of an individuals emotional nature, including his susceptibility to emotional
stimulation, his customary strength and speed of response, the quality of his prevailing mood, and all
peculiarities of fluctuation and intensity in mood, these phenomena being regarded as dependent upon
constitutional make-up, and therefore largely hereditary in nature. Has always been viewed as having a
more constitutional, genetic and biological bias than either personality or character (as cited by Goodwin
and Jamison, 2007, p. 324).
Thoughts: Ideas, concepts, internal dialogs with oneself (Dilts, 2001, p. 3).
Thought blocking: The unpleasant experience of having one's train of thought curtailed
absolutely, often more a sign than a symptom (Psychiatry On-Line, 1995-2007).
Appendix 2
Participants brief biography (provided by participants)
a. Bipolar Artists
Alex Cutler (NY): Alex Cutlers career spans three decades of media administration, film
production, and teaching. He began his career at Republic Pictures while attending UCLAs MFA
producer program and Southwestern University Law School, eventually leaving Republic to join his wife in
Australia. He quickly established himself in Sydney, working for Australias two largest production
companies, Grundy Television and Hoyts Theatres, where he was closely involved in many of the countrys
best-known film and television productions. Cutler soon embarked on his own producing career,
63
culminating with the production of one of the highest profile Australian films of all time, The
Delinquents, starring international pop star Kylie Minogue in her feature film debut. After returning
stateside, he became a distinguished schoolteacher, administrator, and charter school developer. Eager to
return to media and producing, Cutler is currently finishing a master in media studies at New School
University in New York, co-producing a new feature film, Pig, now in post-production, and consulting to
Educational Video Center, a youth media nonprofit, as a mentor to other teachers."
Tatiana Z. (NY): Artist and filmmaker, and Jane-of-all-trades. She has lived all over the United
States, and has recently settled in NYC to complete a Masters of Media Studies at The New School.
Estrella Tio (DR): Upon request.
Bethania Rodriguez (DR): Bethany G. Maria Rodriguez Colon. Born in Santo Domingo, September
25, 1968. Degree in Advertising, University Apec. In 1996 married to Gregorio Jose Quintero Salazar, a
native Santa Cruz de Tenerife, Canary Islands where she had a daughter and resided for five years. She
returned to the Dominican Republic in 2001. Currently working as a Graphic Design freelancer and fulltime employee in her own business, Memos... of coarse!, a cork craft company.
Mia (NY): Entrepreneur, textile designer, art advocate, former ballet dancer, and mother of twins,
Mia (a pseudonym used to protect her identity) balances her domestic life with her artistic passion. In
2010 she founded her luxury lifestyle brand, which encompasses a wide array of creative ventures, always
driven by collaboration towards socially responsible causes.
b. Experts
Dr. Nicholas Norton (NY): Clinical psychologist in private practice in New York City and an
Assistant Clinical Professor in the Department of Psychiatry at New York University School of Medicine.
Dr. Norton received his Ph.D. from the University of Texas at Austin in 1988. He wrote his dissertation on
the relationship between fantasy use and psychological and somatic complaints. From 1985 to 1987 Dr.
Norton received a Fulbright Scholarship in order to pursue research at the University College London,
England. During those same years he completed his clinical internship at the Tavistock Centre in London,
England. He received his B. A. from Columbia University in New York in 1979.
Dr. Josette Banks (NY): Upon request.
64
Dr. Alan Swann (TX): Pat of the R. Rutherford Professor and Vice Chair for Research at the
University of Texas Medical School at Houston. He also serves as Professor of Psychiatry and Behavioral
Sciences at the University of Texas Medical School. Dr. Swann received his Bachelor of Science degree
from Tulane University and his medical degree from the University of Texas Southwestern Medical School
in Dallas. He completed a medical internship at Columbia-Presbyterian Medical Center in New York and
his psychiatry residency at Yale University School of Medicine. Dr. Swann also completed a research
fellowship at Yale University. Dr. Swann belongs to many professional societies, including the American
College of Psychiatry and the Society for Neuroscience. In addition, he has served on two federal
government advisory committees and has been principal investigator on many industry- and governmentsponsored research projects. Dr. Swann has designed acute treatment studies of experimental
anticonvulsants, antipsychotics, and antidepressive agents for manic and depressed episodes of Bipolar
Disorder and major depressive disorder. He has also studied behavioral sensitization, antisocial
personality, and suicide. Dr. Swann is a member of The University of Texas Houston Health Science
Center Committee for the Protection of Human Subjects and has published more than 60 articles addressing
issues in the area of psychiatry.
Dr. Manuel Naranjo Daz (DR): Native of Santo Domingo and born on January 25, 1968. He
currently resides in Santo Domingo. Studied his general medical career, from 1985-1992, at the
Universidad Autnoma de Santo Domingo, Dominican Republic. In 1994, he traveled to Villahermosa,
Tabasco, in Mexico, where he did a first year of pediatrics. Later he enrolled at the Universidad Jurez
Autnoma de Tabasco, where he specialized in psychiatry during the years 1995-1998. Dr. Naranjo
performed work for Major League Baseball as a consultant in cases of substance abuse in 1995, and also as
a professor in different hospitals in the Dominican Republic, such as The Armed Forces Hospital and the
Hospital Luis E. Aybar, and coordinator of psychiatry internships program at Universidad Central Del Este
(UCE) and Universidad UNIB. Currently, Dr. Naranjo is fully committed to private practice as a
psychiatrist.
Dr. Rafael Johnson (DR): Psychiatrist, specialist in addiction.
Dr. Jacobo Fernndez (DR): Upon request.
65
Appendix 3
Questionnaire Protocol:
Qualitative Data: INTERVIEWS PROTOCOL
a. Bipolar artist (5 participants)
a. Define your personality
b. Does your mood affect your creativity? How
c. When are you more creative?
d. Do you consider yourself an artist? Why?
e. Did you pursue a career in the arts? Why or why not?
f. When were you diagnosed? Any event triggered your diagnosis?
g. How does it feel?
h. How does it look like? How do you perceive you environment when manic? When
depressed?
i. Have you been hospitalized?
j. Are you on medication?
k. What's your experience with and without medication?
l. Have you had other treatments besides medication?
m. Do you see now any behavioral patterns repeated from your childhood
n. Directives for the HTP (House-Tree-Person) psychological test
b. Health Professionalpsychologists and psychiatristsinterview (6 participants)
a.
What kind of patients do you treat?
b.
How can you define Bipolar Disorder?
c.
How does the symptoms manifest?
d.
What is the process to diagnose the disorder?
e.
Would you say it is biological, neurological or behavioral?
f.
Have you had artists among your bipolar patients?
g.
Do you think there is a connection between Bipolar Disorder and artistic talent? Why,
why no?
h.
Are artists more prone to suffer Bipolar disorder?
i.
How can you define artistic talent?
j.
Can you describe the artistic temperament?
k.
Can you describe the bipolar personality?
l.
Do you think personality and illness can be separated?
m. What are the most effective treatments available now?

n.
Do you take artistic talent into account when searching for the right treatment?
o.
Does medication affect creative processes? How?
p.
If a cure is found, do you think it would remove the artistic temperament/talent?
q.
What is the key to impulsivity in the Bipolar spectrum
r.
Are impulsivity and creativity connected?
s.
Why is creativity increased in non-bipolar relatives of bipolar patients?
c. Alternative-medicine interview
a.
What kind of patients do you treat?
b.
c.
How does the symptoms manifest?
d.
What is the process to diagnose the disorder?
e.
Would you say it is biological, neurological or behavioral?
f.
Have you had artists among your bipolar patients?
g.
Do you think there is a connection between Bipolar Disorder and artistic talent? Why,
why no?
h.
What does it mean to have a holistic treatment?
i.
Please explain the components of a holistic treatment?
j.
What are the most effective treatments you suggest your patients?
k.
Do you take artistic talent into account when searching for the right treatment?
l.
Can you describe the artistic temperament?
m. Can you describe the bipolar personality?

n.
66
67
o.
p.
If a cure is found, do you think it would remove the artistic temperament/talent?
q.
Is bipolar an evolutionary trait?
r.
Is there a spiritual explanation to Bipolar Disorder?
Appendix 4
Transcript of Dr. Swann interview
Interviewed on June 18, 2010
1.

No one knows what Bipolar Disorder is.
Bipolar Disorder...
can tell some things about what it looks like, don't know what it is,
but people with Bipolar Disorder are prone to have mood problems, so
that they have depression, where they lose motivation and pleasure, and
are sad, and have trouble thinking and acting, and they can also have
mania, where you can argue that they have too much motivation and
pleasure, and they might be grandiose and they might do all sorts of
wild things and get in big trouble, or they can have times when they
have both features of depression and mania at the same time, and so the
thing about Bipolar Disorder is that a lot of things can cause
depression, and a lot of things can look like mania.
So what Bipolar Disorder is, is a livelong condition, where part
of the condition is that there is a susceptibility to these mood
problems that people without Bipolar Disorder don't have.
So the
first thing about Bipolar Disorder is you are susceptible to mood

problems and very severe ones, for some people.
The second one is
that this recurs, usually over the course of a lifetime, and for some
people it gets worse over the course of a lifetime, so the mood
episodes get more frequent, and so forth.
And then, other thing about Bipolar Disorder is that whatever it
is about your brain that is involved with being depressed or being
68
manic is also related to basic aspects of how your brain works, which
includes things like motivation, the ability to act, the ability to
experience pleasure from rewards, things like that.
So people with Bipolar Disorder if you are susceptible to mood
troubles you'll also gonna be susceptible to other problems that are
related to those aspects of behavior and those problems are things like
substance use problems, or anxiety, things like that.
And so those
are part of Bipolar Disorder, the susceptibility to substance use is

part of Bipolar Disorder, and the susceptibility to severe anxiety is
part of Bipolar Disorder, is not just depression and mania.
But the
importance thing about Bipolar Disorder is that it's a life-long

condition and, we tend to confuse it with the episodes of illness that
are only a part of it.
2.
What is the process to diagnose Bipolar Disorder?

The way we diagnose Bipolar Disorder is to try to get a history
of whether somebody has experienced these mood episodes of being

depressed or being manic, and whether they are recurrent, and the
hallmark of Bipolar Disorder is being manic because there's more other
causes for depression, there's something called major depressive
disorder, where you only get depressed and never get manic and so,
that's tricky, because the diagnosis of Bipolar Disorder has a paradox
in it.
Most people with Bipolar Disorder get depressed before they
ever get manic.
Yet, to have a diagnosis of bipolar disorder you have
to be manic, or at least have a mild form of mania, so you see where

the trouble is, it could be a long time before somebody with Bipolar
Disorder has their first mania.
Then there are some other differences between Bipolar Disorder
and just major depressive illness, where you just get manic, and the
biggest difference is how recurrent the illness is, and that if you
69
look at somebody who has only depressions, and then they get manic, and
so it turns out that they have bipolar disorder, you compare them with
other people that were sick for the same period of time with depression
but didn't get Bipolar Disorder, one of the biggest differences is that
the folks that got Bipolar Disorder had actually had more depressions
because the illness that was causing their depression was more
recurrent, because it was Bipolar Disorder, so and then of course they
are also more likely to have other problems like substance abuse, and
so on.
So you diagnose them by looking for the mood problems even
though that you know that there is really more than that.
3.
What about new imaging testing?

That's very interesting.
There are several kinds of brain
imaging that you can use to try to see how the brain is functioning.
You can use MRI where you measure the size or shape for that matter
of specific brain structures that are involved in behavior, and you can
do another kind of Magnetic Resonance Imaging, where you measure the
activity of the structures in response to different, doing different
tasks, or different stimuli, and they suggest that people with Bipolar
Disorder perhaps have a problem with certain parts of their brain that
are inhibitory, where especially if they had the illness for a while,
that some inhibitory brain structures don't work so well, and they are
smaller than you expect, and that perhaps some other structures are
involved in activation might be larger.
However that is not the kind of data that you can use for
diagnosis because there is a lot of variation, and there is a lot of
other conditions, there is a long list of things that cause the same
kind of abnormalities for imaging that Bipolar Disorder does, so
imaging is right now not of any use for diagnosis but is a useful way
to study the illness.
70
4.
Would you say its biological, neurological or behavioral?

Since it involves the brain, since it involves thinking and
feeling, we tend to think of that of being something separate from

biological stuff sometimes, but is not.
Our brain is biology, is
matter, is living cells just like we are, and so it doesn't make sense
to say that Bipolar Disorder is not biological, it is biological that's
what it is, it's the brain.
However the brain is a little more elegant, in some ways maybe,
than an organ like the heart because the brain creates kind of
subjective experience and self-awareness and so Bipolar Disorder is a
different kind of experience not just Bipolar Disorder but depression
or schizophrenia, or anything like that has a different kind of
experience, so Bipolar Disorder is a biological illness, what it tells
us is that biology might be bigger than we think it is.
5.
Do you think there is a connection between Bipolar Disorder and
the artistic talent? Why, or why not?

Well, it's hard to tell.
So there is this question about the
relationship between Bipolar Disorder and the temperament of artistic

or creative people, and so is that part of Bipolar Disorder.
it's hard to tell.
Well,
And people have done I don't know, studies isn't
the right word, but people have gone and looked at the biographies of
famous writers, musicians, artists, and many of them had
characteristics that resembled Bipolar Disorder, and also there is this
idea about a relationship between creativity and things like being
mildly manic and so forth, but I think we need to be kind of careful
with that.
Most people with Bipolar Disorder are suffering, they do
not have an illness that makes them more creative, they have an illness
that ruins their life.
That's what Bipolar Disorder usually is.
71
If you look at people with Bipolar Disorder who are creative or

artists, and there have been surveys done about this, they will tell
you that when they've accomplished things it's not when they are having
the symptoms of their illness, is when their illness is relatively
under control because when you are depressed you may have profound-dark
thoughts about the luck of humanity but you can't do anything about it.
And when you are manic you can't censor your ideas, which of course is
very important for creative work, you ask anybody that is a writer or a
musician or anything.
You gotta be able to sensor your ideas, you
gotta be able to work in a committed kind of forward-looking, step by

step way, in many you can't do this, so that makes us realize that is
not so simple as just to say that Bipolar Disorder is related to
artistic creativity and stuff, yet we do see many artists, many
musicians that if you look at their lives it looks like maybe they had
Bipolar Disorder, you know like Van Gogh, although he may have also had
lower-temporal lobe epilepsy or he may have had digitalis toxicity or,
there's a gazillion things that he might had, and that's the trouble if
somebody is sitting in my office, I've been concentrating pretty much
on Bipolar Disorder for thirty some more years, and all I can do to
diagnose somebody who is sitting in my office, it's asking a bit much
to diagnose somebody who lived two hundred years ago, and I'm looking
at things about this person's live through a filter of that persons
biography and our biases that we have about this person, and so we
should be careful not to go overboard but it is kind of an interesting
thing.
And this is what interests me about it, particularly.
I wish I
remembered her name, there is a woman, she was a Harvard psychologist,

and she was interested in this question, and she knew something which
is being reported many times in the literature, which is that, if you
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look at people with Bipolar Disorder, on average, and of course

artistic people are not average, they are exceptional, but if you look
on average at people with Bipolar Disorder they have a hard time, it's
a very hard illness to overcome.
It's amazing to me the courage and
perseverance that our patients with Bipolar Disorder have.
They
overcome that, which is more than most of us could ever accomplish but
their relatives...When the relatives of people with Bipolar Disorder
are compared just to regular people that aren't the relatives of people
with Bipolar Disorder, these relatives do better in every respect, they
do better economically they tend to have higher job function, they tend
to be more likely to have accomplishments, I'm not talking about, you
know, genius like Mozart, but accomplishments...
they seem to do
better.
And then, so this person at Harvard that I was talking about was
interested in creativity and Bipolar Disorder and so she looked at what
she called "real-life creativity", I think that's what she called it,
she was saying, "ok, if we look at people that lived two hundred years
ago we are gonna have a lot biases, it's gonna be hard to sort out what
was wrong with them or what they had, or anything else, and also we are
looking at a different time, society was different, normal behavior was
different, etc, you know, and so she wanted to look at contemporary
people; the other thing is that she felt that if Bipolar Disorder made
people creative, that the way to find that out was not to look for
exceptional you know, famous artists, because there is bias there,
because that only involves certain neuro-spheres of activity, and so
she looked at what she called "real-life creativity" and she developed
a scale to measure it, and it was all very creative actually on her
part, and so she compared Bipolar Disorder to people with something
called cyclothymic disorder, where you have a lot of ups and downs of
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your mood but you don't have the kind of sustained, severe episodes
that Bipolar Disorder has, and she looked at normals, or people who
don't have any kind of mood problems and she also looked at their close
relatives, what they called first-degree relatives: parents, children,
siblings, and what she found surprised her.
She though that people with cyclotymic personality would be the
creative ones because she thought that Bipolar Disorder is too severe
and too impairing, and so people that have inherited a little bit of
Bipolar Disorder would be the most creative people, because there are
some interesting physiological things about Bipolar Disorder where you
think well, you know, they can get outside the box better, they can
pour energy into something better, they experience a wide range of
emotions, maybe that's helpful in terms of creativity.
This is what
she found: that the cyclothymics were not that much more creative than
normals, that the bipolars were not that much more creative than
normals, but the relatives of the bipolars were more creative than
anybody, they were the ones who were creative.
And so, one thing about
Bipolar Disorder and kind of creativity, and adaptability that, it kind

of make you think about other medical illnesses that are genetic, that
are much less complicated than the genetics of Bipolar Disorder, like
cycocel disease, and you know, "men, why would anybody have cycocel
disease, why is that in the geno?" Well, it's because if you have
cycocel trait, which is common, you are resistant to malaria, and you
know, and so if you have a large population of people and a certain
number of them have this gene that they are carrying, it helps a large
number of them to be able to live, but there's a price that is paid,
and the price is that some of them have cycocel disease and they have a
serious illness.
And so she thought: "Maybe this is like the case with
Bipolar Disorder, and you have this relatively small number of people
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that have the whole thing, Bipolar Disorder, and they are very
unfortunate, because that even though they can have rich-good lives,
they have these severe mood symptoms, which are quite a challenge to
overcome, luckily it's much more treatable now that it's ever been and
it's gonna get even more treatable because treatments are always been
refined and improved on, but never the less is a challenging medical
illness but the price, or the kind of, what you want a call it, the
reward for that is this larger number of people that share some of
their genetic characteristics perhaps, who are more creative or more
able, or more enterprising perhaps than the average person, and so the
person who has Bipolar Disorder is paying a genetic cause you know, for
these people who don't have as much of the genetics of the illness, so,
it looks kind of like that...
but there's no proof for that.
There's
no proof.
6.
Can Bipolar Disorder be considered an evolutionary trait?

You could argue it that way.
The thing about evolutionary
explanations for things like psychiatry is this: it is impossible to

prove them, it is impossible to disprove them, and so you can use them
for metaphors and you can use them for ways to design studies where you
might then be able to learn more about it, but that kind of rings true
to me, looking at, you know, situations with patients that we see here,
and the lives of other people and the occasional person who has Bipolar
Disorder and is talented, you could argue that, in order to overcome
what you have to overcome if you have Bipolar Disorder that the person
who is able to do that must really be exceptionally talented.
Sort of like Ginger Rogers, who was talking about what it was
like, you know, who was a better dancer, her of Fred Astaire, and she
said, "I have everything he does but backwards", you know, so it's
really kind of like that, that if you have a musical talent, say, or
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literally talent and you have Bipolar Disorder, that may be helpful in
terms of, you know, you experience more emotions, or when you are
mildly manic but not completely manic you can pour out more energy and
what not, that's impossible to know whether that's true or not, but it
could be, but there's also kind of a filter there, which is that if you
are gonna make it in spite of your illness you gotta be damn good, you
know, and so we see, and so there's...
so I think there are some
things that may interact because I think that in spite of my overall,

you know, kind of natural skepticism about the idea of Bipolar Disorder
and the artistic temperament and so forth, the fact is that there are
some very talented creative people in the past who really look that
they had Bipolar Disorder, and of course you would have to compare them
to people with similar situations who didn't have Bipolar Disorder and
overall that nest but it is still very suggestive.
7.
Does the treatment of Bipolar Disorder affect creativity?

You know, there is this question about, "if you treat Bipolar
Disorder, does that due away with the potential creativity that may
comes with the illness", and there's a lot of expressions like that,
like you know, people say: well, what would it happened if Vincent Van
Gogh would have had Depacote, you know, he would have had a happier
life and not kill himself but we wouldn't have had those paintings, you
know and so there's all this...
I mean, nobody really knows whether
that's true or not, and so this question about whether treatment of

Bipolar Disorder reduces creativity of creatively talented people with
Bipolar Disorder, is one which has come up a lot, and when people have
tried to look at, the results have been kind of interesting, and there
was the first time this was looked at was back when people first
shortly after it was discovered that Lithium was effective and changed
the course of live considerably for a lot of people.
Very few
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medicines have changed the whole landscape of an illness the way

Lithium did with Bipolar Disorder, even if is not used that much
anymore.
So, a group did a study where they got a hold of all the
people they could that had Bipolar Disorder, who's careers where in a
creative field, like literature, visual arts, music, drama, etc. who
were being treated for their Bipolar Disorder, and they asked them
"what is the effect of your treatment on your creativity", and it
turned out there's a rule for this called the rule of thirds, with very
often you have this kind of three outcomes that they found.
They found that about a third of the people said, "before I was
treated I was more creative because I had this times when I could just
really pour things out, I could work for days on end, and I could
produce a novel in a week, and then I would crash, and now that I'm
taking Lithium that doesn't happened anymore", that was a third.
Another third, said, "before, I had great ideas but I'd be manic and I
just couldn't make any sense to all the great ideas that I had because
I couldn't slow it down, and when I was depressed I just couldn't do
anything.
So now I'm taking Lithium and, even though I dont have
these flashes of inspiration anymore I am actually more creative".

And then, a third of them, they said "it all evened out, and that they
felt that it probably wasn't much difference".
And so, the outside of
that is, it's very individual and somebody with Bipolar Disorder who is
artistic and who is in the category of people who needs to be a little
manic in order to be there most productive, for one thing, it helps if
they have a good relationship with their doctors because their
treatment can be a very subtle balance, where treatment can keep
somebody out of trouble and keep them from being too depressed, but can
let somebody have, they called it hypomania, when somebody is not all
the way to being manic where they are delusional and they gotta talk to
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the president and stuff, you know, but where they have more energy and
they don't need so much sleep and that can be very useful, and so, but
it's a very delicate thing, you know, to make it, you know, where
somebody has their hypomania so they can be creative but then you keep
the worst parts of the illness away.
of people, you know, handle that now.
It can be done.
It's how a lot
Because that's the dilemma with
Bipolar Disorder, you don't want to take everything away.

8.
What is the relationship between impulsivity and Bipolar Disorder?

The relationship between impulsivity and Bipolar Disorder is
probably pretty basic because you look at how Bipolar Disorder is

related to the brain works, how the brain works, that part of the
situation with Bipolar Disorder is, and you can measure this, there's
different types of tests that are done with the EEG, that measure how
brain waves react to different kinds of stimuli, and you can show that
basically someone who has Bipolar Disorder when the brain sees a
stimulus it says "go for it", more than is the case with somebody who
doesn't.
Impulsivity is when, in response to a stimulus, your brain
says "go for it" and so you do something that you never really had a
chance to think about, and it's something that if you had a change to
think about maybe you wouldn't have done it, but you never get to think
about it, and that behavior that has you before you get to think about
it, that's what's impulsivity and people with Bipolar Disorder have a
very strong propensity towards impulsivity and, of course you can be
impulsive when you are manic and then is real clear, but there's also
subtle increase in impulsivity when someone is not manic, and of course
if someone is depressed and impulsive, that can be actually a very
tragedious time, because then all the ideas that are not gonna run in
your brain are negative ideas, and there is not much inhibiting your
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actions, and so depression and impulsivity is a dangerous situation in

Bipolar Disorder.
Impulsivity is a basic part of the illness, people with Bipolar
Disorder are just about as impulsive as any other illness that I know
of, the proneness towards things like substance use sort of makes it
worse, because substance use makes it potentially worse, impulsivity
makes substance use worse, substance use probably makes Bipolar
Disorder worse because of the things that it does to the brain, you
know, so it all gets mixed up, in a very tragedious thing, but
impulsiveness is very common.
And yet, you can also see well, like anything else, there's a
good side to a little bit of impulsivity, because it means that you can
be more likely to get outside the box a little bit, so there might be a
relationship between impulsivity, when is not at it's very most severe,
and creativity because you are able to get outside the box more
readily, and pour energy into something more readily have a little bit
of impulsivity, and so actually the relationship between impulsivity
and creativity and Bipolar Disorder, there's a guy at Stanford named
Terry Ketter, that is studying that, you know, I think it's very
interesting, it's a very interesting question.
So impulsivity, we
think of it as being bad, because it gets people in big trouble, you do

something that you weren't even able to think about and it gets you in
trouble for the rest of your life, but in a little milder form it can
also probably help you, make you a little more flexible.
9.
If there was a cure for Bipolar Disorder

You know, kind of depends, so the question if you can cure
Bipolar Disorder, and so if everybody had Bipolar Disorder could be

cured and not have it.
Of course, for most people that have Bipolar
Disorder that would be, at least at first glance, that would a boomer,
79
because they would still have their natural abilities, they would still
have their intellect, Bipolar Disorder doesn't make you more or less
intelligent doesn't make you more or less strong, etc., and so in that
way you say "well, you are taking away the mania that can ruin your
life taking away depression when somebody could be suicidal or be
unable to function, and who wouldn't want that, but as going along in
line with other questions that you've been asking, there's probably
something favorable about Bipolar Disorder, at least potentially and so
this "cure" for Bipolar Disorder would more than likely, because this
is the way things are with cures anyway, be a cure that really isn't
quite perfect, isn't quite that good.
If you have a cure that isn't
quite that good, then I think it could be a real boomer if not perfect.
Cause the other thing is that this cure for Bipolar Disorder, this is
another reason why it's good, it would not affect the relatives of
people with Bipolar Disorder, who are more likely to be creative than
anybody else, and it might not affect the creative part of Bipolar
Disorder that much, because it's hard to tell exactly, it's true that
with mania, you know, there's the lack of inhibition, and there's an
energy and there's that you don't need to sleep, and so forth, that if
you are lucky enough to be creative and have creative abilities that
can use that, that can make hypomania or mania into a catalyst for
increased creativity.
Only a small percentage of people with Bipolar Disorder have that
situation.
If there is a cure for Bipolar Disorder then it's up to
anybody that has the illness and their physician to decide whether they
should have that cure or not.
Some people might be better off without
it, but I think the average person would be better off with.
Interesting, so then there's the other question that you know
because there are these favorable properties that may go along with
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Bipolar Disorder, if you can cure it, would you take those favorable
properties out of the genome and make it where we would lose that.
And probably, especially since the cure wouldn't be perfect, and people
who are able to sort of harness the illness in the service of being
creative would probably find ways not to get themselves cured, and they
would not be a large percentage of people, and so, I think that things
might sort of continue like they were in now, because there are
characteristics that are not necessarily there when somebody who has
obvious Bipolar Disorder but that are there for most people who have
Bipolar Disorder, or their relatives, they can be very attractive and
probably helpful with natural selection and stuff because you got
somebody who is full of ideas, you know, and they are vivacious, and
they're energetic, and stuff like that, which is a very attractive kind
of person, and the cure for Bipolar Disorder probably is not gonna
affect the relatives who have those characteristics, and it may not
take, if really have a cure for Bipolar Disorder, maybe it will just
take away the big depressions and the big manias, and leave everything
else.
10.
We are a long ways from cures for Bipolar Disorder.

What's missing today in the research?
There's this question of what's missing in research, I guess in
biomedical research in Bipolar Disorder and, this is a funny time in

terms of researching Bipolar Disorder.
So, we sequenced the genome,
for example, and so people thought that when that happened, you know,
Bipolar Disorder runs on families, and it's quite hereditary, and so
people thought "once we figure out this genome, we will be able to find
the gene or genes for Bipolar Disorder and we'll have it made", well,
guess what: that hadn't happened.
It has also been very disappointing because the situation is more
complicated than we thought it was, so there's probably the model of
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how Bipolar Disorder is inherited is not the same as the way we used to
think that genetic illnesses were passed on, it isn't just Bipolar
Disorder, but Bipolar Disorder is a real good example of it, you know,
so we see it runs in families and that turns out to be the most useful
as genetic thing, so when people start looking for specific genes then,
you run into dead ends, or you'll find something that seems to be
increased in Bipolar Disorder and that accounts for two percent of the
illness and stuff like that.
So we don't know how the illness works
well enough to understand how it's an extra gonna be.
This is true of
a lot of medical illnesses that are similar to Bipolar Disorder, and

being very hereditable but having complicated genomes.
So then there's the question about treatments and how the brain
works, and there's been big strides in studying how the brain works,
you know, for example there's neuro-imaging which is very elegant, and
we can look at the living brain, and see how it reacts to stuff, and
it's this sort of thing that 20 or 30 years ago people would have
thought it was some kind of science-fiction world what we can do, is
like what was in the original Star Trek movies except better, but that
hasn't given us the answer either.
And the reason is that we still
don't have a good model for what the illness is, we don't know where to
look, and so we found a bunch of treatments that are very useful for
people, and that are life-saving, and give people their life back, even
when the person wouldn't have survived anyway.
These treatments were discovered by accident, it's amazing how
little has been discovered on purpose, this is true for any medical
illness of course, including the use of digitalis for heart disease,
and so forth, but never the less, with Bipolar Disorder and all
psychiatry illnesses, there are very effective and useful treatments
that would were mostly discovered serendipitously.
And then, we look
82
at some of that we discovered by accident, which means it wasn't put on

earth specifically as an antidote for the illness, and we look at how
it works, and then when we see how it works we think the illness must
be related to how this treatment works that we discovered by accident.
And so then we try to find other treatments that work the same or
similar to the ones we discovered by accident, and then we get to the
point, somebody says, which is very trendy to say this actually, that
we haven't found any treatments that are that much better really than
the ones we had 30 years ago, except they have fewer side effects, and
that's not surprising, because so far as knowing what the targets are
for treating the illness we don't know that much more we know a lot
more about how to find drugs that are specific to different receptors
in the brain, and we know a lot more about how everything works, but we
need to know more about the target, what we are trying to treat, which
we don't, so we are very good at using the treatments that we have, I
think they could be better, and the treatments have been refined, but
we've come up to the place where we've gone maybe as far as we can with
the kind of treatments that we have, and we're gonna have to think
about what are the brain mechanisms that we really need to be aiming
at.
Our treatments are all aimed at episodes, they're aimed at, you
know, because it's like the drug can run, you know, "why are you
looking for your keys under the street light? Well, because I can see
here you know", and you can see mania, you know, and so it's something
big and you can treat mania and you can see when it goes away, but
Bipolar Disorder is a life-long illness and you know, how do you treat
a life-long illness, there ought to be some way that if you knew how
this mechanism was and made people susceptible to mania rather than
mania, and if you knew why it was recurrent, and why it seems to
accelerate for some people, but not everybody, over time, and you could
83
aim a treatment to that mechanism then maybe you could treat somebody
when they were in their teens, and you wouldn't have to treat them
again, you just never know.
11.
So it's an interesting time now.

Any kind of life-long illness, and especially when the illness
also is treated with powerful treatments that work in the brain is, do
the treatments somehow impair brain function? or even cause some kind
of deterioration of brain function?, and the second question is, does
the illness do that? It's hard to answer either question.
For a long
time, what was thought about Bipolar Disorder was that it was an
illness where nothing changed, basically except that you had these mood
episodes and, unlike schizophrenia where it was believed that something
changed and there was deterioration across a lifespan, with Bipolar
Disorder there was not, and your brain stayed the same and you had mood
episodes.
Then it turned out that people began to see that maybe
that's not the case, and that there are subtle cognitive changes that
happen over time with Bipolar Disorder and they are subtle but that
they happen, so there is this possibility that people may vary, just
like people with Bipolar Disorder vary in their course of illness, some
have lots of episodes and they get more and more often, and some people
just have the occasional episode, and just have some different things
about their personality and may not need to be treated as, you know,
nearly as big as treatment.
So there's that question with Bipolar Disorder which is not
answered, but a lot of people with Bipolar Disorder are sharp as attack
when they are 90 years old, then you have the treatments and you think,
well, man you know, you take some of the most sedating treatments for
Bipolar Disorder, and if they are given in a dosage too high, you know
somebody can say they feel like a zombie, you know, and can sort of
84
lose, you know, can lose a year or two, so you know, so then there's
this question, is this some sort of long lasting toxicity from
something that does that, which most people don't think there is, but
it's kind of hard to know whether there is or not.
There's a flipped side of this, which is that there is a lot of
evidence, none of which quite convinces me but there's a lot of
evidence, mostly from animal studies, that Lithium for example is
neuro-protective, and protects the brain against degeneration, maybe
that goes along with other, with different causes of dementia and maybe
it would otherwise happened with severe Bipolar Disorder or whatever,
there's something neuro-protective about Lithium, it's neuro-protective
in pefreditius, and it's neuro-protective in rats and mice, I don't
know whether that translates into it being neuro-protective in people,
maybe we should all take Lithium and we won't get Alhzaimer's disease,
you know, but I think we are a ways from that.
Similarly other
treatments for Bipolar Disorder have also being found to have effects
that are thought as being neuro-protective because they activate
biochemical systems and brain cells that protect them against
degeneration and celdea, but that's a long ways from whether something
is going to be good or bad for somebody's brain as they go about living
their live, and what most of us think about that is, that the role of
treatment is to protect somebody against the known bad consequences of
an illness and help them to live the best life that they can live.
That's the role of treatment, and that's a really individual thing, and
so the important thing is rather than fantasizing about something being
neuro-protective when maybe it doesn't help the person's illness, or
being concerned that maybe something isn't neuro-protective when it
does help the person person's illness is that you look at what's in
front of our face, if somebody is doing well then, this is what we are
85
aiming at, if somebody is having lots of episodes of illness, and all

the time they have problems with their mood and their behavior so they
can't function, then something needs to be changed.
I'm kind of
concrete and pragmatic about this stuff, but it's interesting to think
about whether some treatments can be neuro-protective all the time, and
whether some treatments may have the opposite effect, can't answer
that.
Now we're stuck with saying "what's gonna make somebody do
better".
If something makes somebody feel like a zombie and they can't
function that's not the treatment for them, you know, gotta find
something else.
12.

People wonder about that.
Because the guy, might not have been
the best, but he was one of the best people at describing what these
illnesses were like, his name was Kraepelin, he worked in Switzerland I
think, and he wrote a great book, "Manic Depressive Insanity and
Paranoia", which is definitely worth reading, he wrote it about like a
hundred years ago, and he said that exactly, you know, that there was a
fine line between illness and personality, and so that illness you know
sort of continuously gets milder and milder and milder and get more and
more like personality.
That's being kind of hard to prove, and then
however, lately, it's being a comeback, particularly in Europe, there's

a lot of attention pointed to something called temperament, and so the
idea that someone is a certain way, and that that's related to how
their brain works, and that's fine with me.
I think the way we are
it's gotta be related to how our brain works, because our brain is what
makes us go, and there is the hyperthymic temperament, which is the
person, you know, who doesn't need to sleep and is always the life of
the party, and is optimistic but is also maybe a little shallow, and
then there is the cyclothymic temperament where your mood is up, where
86
your mood is down, where your mood is rarely not up or down, either
one; there are about four basic temperaments, I think.
And, it may be that people with certain temperaments are
susceptible to Bipolar Disorder or other illnesses, or maybe that the
temperament is a mild form of the illness, I have no idea, you know,
there's no way of knowing one way or the other, but I think that if
somebody were to look at one of these temperament scales, and they were
to look at a question, and say whether what's "being the life of the
party" has to do with an illness? I would have to agree with them, you
know.
Being the life of the party may just have to do with the fact
that somebody is spontaneous and somebody is clever, and I think that

we make a big mistake when we confuse personality traits with illnesses
because we wind up making everything in the illnesses, and that's just
not the way to live.
13.
When does personality become pathology?

What if somebody does cross over that line between personality
and illness, how do you know? I guess there's two ways that you know,
sometimes you probably never really know.
One way that you know is
that, if somebody has the illness Bipolar Disorder, according to our

diagnostic system which has plenty of wrong with it, but one good thing
about it is that it does provide certain definitions that usually
everybody can pretty much agree on when they see them.
If somebody actually had episodes of depressions, and or mania,
or do they have certain personality characteristics but they never had
these manic or depressive episodes, and if that's the case, then you
could say, is it because they have sort of mild Bipolar Disorder and
they're lucky? or is it that there is no relationship, and that some
people are vivacious or mercurial and some people are not.
And I have
no idea which is true, and there is absolutely no way to prove which is
87
true except to watch somebody for their whole lifetime and see if they
have an episode because that's the way our diagnostic system works now.
When we now more about the physiology of Bipolar Disorder and
stuff, then we could sort of tell because this is related to the
question I've always had about Bipolar Disorder as a researcher, and
that is that Bipolar Disorder is an illness of that which we know quite
a bit, in terms of what it looks like and what its course is, and we
have very effective treatments for it, for the most part, even with all
the problems that I mentioned, the treatments for Bipolar Disorder if
you compare it to other medical illnesses that have the same severe
gene communist, we have pretty good treatments, even though we don't
know what it is, you know, we are kind of lucky, but we have to wait
until somebody has a depressive or manic episode before we can say they
have Bipolar Disorder, and I think that's crazy, you know, if I had an
illness where, I later found out that nobody could tell I had this
illness until it almost killed me, I'd be a little frustrated with the
state of modern medicine, you know, but that's the way it is.
You
can't tell that somebody has Bipolar Disorder until they've been manic,
you can kind of know, you can suspect very strongly that someone has
Bipolar Disorder if they've had a whole bunch of depressions or if
they've had depressions plus their mood is all over the place, or
something like that, but still you have to wait until there's trouble
and then you know they have the illness.
It's like, you say, "how you diagnose diabetes?" and I say,
"well, I know how to diagnose diabetes, I can diagnose diabetes when
somebody has what they called diabetic ketoacidosis where their blood
sugar goes way up and they have all these terrible biochemical
disturbances and then they nearly die", then you know someone's got
diabetes, right? But you don't wanna wait for that.
Or you can tell
88
that somebody has high-blood pressure, "I can tell very easily, I just
see if they've had a stroke or not, jajaja".
That's the situation with
Bipolar Disorder; it's like waiting until somebody has a stroke.
When
we can diagnose Bipolar Disorder without having to wait until somebody

just have an episode, then we can answer these questions about
personality, and we can say "well, is it just that some people just
have their personality and that's just the way we are?, and that's only
coincidentally related to Bipolar Disorder, and then on top of that
there's a few people with Bipolar Disorder and they may also have
personalities, or is there some relationship?.
Can't tell that now, because there is no good way to tell who has
Bipolar Disorder.
Somebody who is very persuasive might be able to
argue into thinking one thing or another but that's just that somebody
was persuasive.
14.
It's not science.
Is Bipolar Disorder a social construct?

So there's this question about the extent to which mental
illness, or psychiatric illnesses are social constructs? Saying that

"well, maybe it's because somebody's behavior or feelings or something
are outside the social norms and that's not tolerated.
I think that's
a very tempting idea, I don't think is true.

There's an interesting test that a friend of mine, who is
interested in this very thing, you know, once applied, he says "well,
if somebody has a real illness that means that if they were on a
dessert and there were no other people, they would still have trouble,
right? People who have severe Bipolar Disorder, if they were on a
desert island, they would still have problems they would still feel
depressed, and when they were depressed they would not be able to
function, they would not be able to get food.
It would be a very bad
situation, it's a lot better if you live in society and somebody else
89
can help you.
If they were manic, they would also get in trouble
because they would think that "that tiger can't hurt me", you know, so
this is a desert island illness and most severe psychiatry disorders
are desert island illnesses.
It is true that anything that we do is modified by society
because there's never been a species that dominated the world like we
have, at least through our eyes, maybe could look at it in other ways
but because we live in a society everything or most of what we see was
made by other people, and most that we associate with is other people
and everything we do is shaped by other people.
If somebody has
Bipolar Disorder then that's going to greatly influence the way that
they interact with other people, for good or for ill, depends on the
individual, depends on the other people.
And that will shape the way
their illness looks.

That's not so true with mania, mania is pretty much the same the
world over, it's very true with depression, that you look at different
societies people express depression differently but they still had it,
they have it in every society that you look at.
Luckily life is very
elegant, and there's an interaction between the individual as an animal

with a brain, and the individual as a member of society.
And then you
get a town like New York, which is a very high-energy crowded city, and
so people are gonna, even though they would like to think otherwise, is
one of the most conformist cities in the world, so things like Bipolar
Disorder are gonna become trendy.
15.
Have people being misdiagnosed because of their temperament?

In terms of the misdiagnosis of Bipolar Disorder, this is
typical, there's two ways that misdiagnosis happens.
The first is,
that people would get misdiagnose because they have Bipolar Disorder
90
but they are not diagnose with it; somebody who has lots of depressions
and they have mild manias but everybody misses them.
People don't
remember of mild manias being illness, you know, "gees doc, I'm on the
top of the world, I don't need to sleep, everybody likes me, I'm
working on a great American novel, could you give me some medicine to
make me tired? Probably not.
So, in some misdiagnosis the illness is missed, or it's diagnosed
as being something else, like depression or schizophrenia; people with
Bipolar Disorder can have psychotic episodes, especially in their
teens, and then be misdiagnosed as having schizophrenia, or it can be
confused with attention deficit disorder, they have great overlap and
they often do occur in the same people.
And so they can be
misdiagnosed because your illness is not diagnosed and it's there, or

you can think misdiagnosed because is diagnosed and it's not there.
don't know which of those is worse.

There's this situation with temperament, so somebody has an
ethereal temperament, everybody says he has Bipolar Disorder, maybe he
does maybe he doesn't.
Somebody has lots of depressions and they are
hard to treat, they think well this person has Bipolar Disorder, well,
maybe, maybe not.
So it's misdiagnosed both ways, and like every other
human endeavor, in medicine, you know, we get stuck in trends and

facts, and stuff like that, and so in some circles Bipolar Disorder is
the diagnosis of the hour, and people are diagnosed with Bipolar
Disorder and if you don't have Bipolar Disorder you are kind of an
outsider probably, you know, because everybody goes to parties and
talks about their Bipolar Disorder; it's terrible to be a psychiatrist
at a party like that.
But the disease of the year will be something
else in a couple of years, if that's the case.
91
It's because we are humans, we live in society and so there's

this interaction between our brains as individuals and our brains as
members of society.
It's a good thing we have it but since we don't
have a good way to identify the physiology of the illness yet, even
though we can identify evidence that the physiology is present, that
makes it hard to answer a lot of questions about diagnosis and stuff.
16.
Are we better off without knowing the diagnosis?

There's this question about whether one is better off sometimes
not having being diagnosed with Bipolar Disorder, and you could take
somebody who had a life that was full of ups and downs but a good life,
and then that person has something happened that triggered mania or
psychosis and they got treated and now they have the illness and they
need to be treated for it, and what if they had never done whatever
precipitated the episode, would they be better off? The trouble with
that is, assuming, and I think this is probably the case, that the
Bipolar Disorder is actually there, if it's not the Wellbutrin to quite
smoking in 1997, it's the losing two nights of sleep traveling across
the ocean in 2001.
If it's not the losing two hours of sleep traveling
across the ocean in 2001, it's when the business went the belly up in
2003.
When somebody has Bipolar Disorder it's a little bit of a
ticking time bomb, and then what is going to cause an episode is

different from one person to the next.
Part of adapting to the illness
is, in protecting oneself against having episodes, to make so that

somebody can live their life.
Medicine is part of that.
Some lucky
people can probably do that without medicine or using medicine

judiciously.
Most people need to use medicine in some way.
It's very
important not to confuse the average patient with an individual,

because there's individuals who if they were not treated the illness
would kill them, and there's individuals who not being treated can
92
learn to live their life so it works out better and then, between those
two groups of individuals there's the average person with Bipolar
Disorder who gets a lot better with treatment, in terms of, you know,
things like being able to keep a job, and have a family, and stuff like
that.
17.
Why psychotropic treatments have become so important to the
treatment of Bipolar Disorder?

Medicine is usually a very important part of treatment.
people it's all they gotta do.
For some
They take their Lithium, come in every
year or so to have blood tests, that's it.
Some people need all kinds
of complicated treatments and things are never quite working, and are
always having to change things, so "what treatment is" means a lot.
Some people get by with only medicine for treatment.
Most people probably have the maximum benefit from a combination
of medicine treatment plus non-medicine treatment, and some of the nonmedicine treatment might be psychotherapy, some kind of formal kind of
psychotherapy, and some of it isn't, some of it is more a matter of
managing certain things about somebody's life.
Protecting their daily
rhythm of activity and sleep, you know, for example, getting regular
activity, you can call it exercise, you can call it activity, I don't
care what you call it, but getting it.
Learning how to develop buffers
against the kinds of situations and stressors that cause problems.

Learning how to recognize trouble early, because if someone is gonna
have an episode of illness the average person, not everybody, but the
average person, things are different a week or two before they are
really in the middle of a depression or a mania, and somebody can learn
how to recognize that, and can head things off.
So there are a lot of
things that people can do, and then of course theres different kinds
93
of psychotherapy that are very useful for the right person.
Everybody
have their own combination of things that works the best.

18.
How do people react to the diagnosis?

I think there is this question of why being diagnosed would
caused someone to be lost? Somebody can be very creative and productive

and stuff, and have hypomanias that are exciting, and then go a long
time without having any hypomanias even though I understand there's not
any treatment now, in terms of medicine.
So very often, people go off
their Bipolar Disorder medicine because they miss their highs.
The
natural history of Bipolar Disorder, again this is for the average

person with Bipolar Disorder, if there is any such thing, is that over
the course of a lifetime, mania gets less and depression gets more, but
then you gotta look at also the fact that some people with Bipolar
Disorder have mostly mania, their first episode was mania and that's
what they mostly have, and others have mostly depression, the first
episode was depression, that's what they mostly have, the mostly
depression people are the most common, most people with Bipolar
Disorder are like that.
So when someone talks about, "well, mania gets
less common and depression gets more common as the course goes on" it's
that just because your adding together a bunch of people that are
different, and one group is more common than the other one is, so I
don't know.
There are different things to value, so I don't know what to tell
in terms of advice.
I think that if I were in the situation of having
Bipolar Disorder and not wanting to be treated for it, of being in a

situation where I kind of miss some real productive hypomanias that I
used to have and now I'm not having them, that may be even more not
want to take medicine because that might take away some hypomania that
during the future that I would have had, even though you never know.
94
think that the best thing to do in that situation, because Bipolar

Disorder can be neutral, it can be beneficial or it can be a tickingtime bomb.
Because Bipolar Disorder is not the individual, any more
than if I had diabetes, I would not be diabetes, I would be somebody

who had it, if I had Bipolar Disorder, I would be somebody that had
that, but that wouldn't be me, you know, it would be something that
I've got, and that maybe I can use, or maybe I just need to sort of do
something to keep it in check.
I think that the best thing you do in
that situation is to find a psychiatrist who understands about Bipolar

Disorder and isn't gonna force you to take medicine but is gonna tell
you when he or she thinks you need it, and that your part of the
contract is gonna be that you are gonna listen, you know, to what this
person says, I think that that's probably the best thing to do.
And I
would like to think, though I have no idea, I would like to think that
if I was in that situation that's what I would do.
19.
Is ok for a person suffering from Bipolar Disorder to have kids?

Bipolar Disorder runs in families.
If somebody has Bipolar
Disorder, the chance of their child having Bipolar Disorder is one in

five, one in four, which is ten times what it is for the normal
population.
If somebody has two parents with Bipolar Disorder, the
odds in favor of their child having Bipolar Disorder are three to one,
so they are much more likely to have it than not.
And so people come
in here and ask, because they have Bipolar Disorder, and they will come
in here with their spouse, you know, and theyll ask, "because I have
Bipolar Disorder should I not have children".
interesting question.
I think that is a really
My gut answer to that is, "no, you should have
kids" because of two reasons: the first is, that for most people the
treatment of Bipolar Disorder is much more effective than it was a
generation ago, and there is no reason to suspect there's not gonna be
95
more effective still a generation from now, that's reason number one.
Reason number two is that, if a parent has Bipolar Disorder, on
average, because you know it's like flipping a coin, somebody can have
ten kids and they all have Bipolar Disorder, somebody else could have
ten kids and none of them has it, but, on average, you know, they have
four kids one of them is gonna have the illness so, how about the other
three.
They are gonna be first-degree relatives of bipolars, those are
the lucky people.

It sounds kind of funny but it's true.
So their kids have a
three to one shot in their favor of being a first-degree relative of

someone with Bipolar Disorder that's gonna have the good genes of the
parent who's asking the question without having the illness that he or
she has, the other one is gonna have the illness too but it's a fairly
treatable, I mean, people with Bipolar Disorder can have either very
good lives or very awful lives, like any other illnesses, but it's an
illness that is potentially treatable.
So when somebody ask me that
question I usually figure they got something some other issue that
they're wrestling with besides Bipolar Disorder about whether or not
they want a have kids or not.
If your child is awesome it doesn't matter whether he has Bipolar
Disorder or not, you know, I mean, awesome is awesome.
20.
What are the recommended treatments during pregnancy?

That depends on the medicine and depends on the person.
Because
some people have illness that is more severe so they are likely, much
more likely to get severely depressed or to get severely manic and it
may be that it's just not gonna work, for someone to risk get severely
depressed or severely manic while they are pregnant because the first
thing that'll happened is they'll start drinking, and there is no
psychiatric medicine that is worse for a developing baby than drinking
96
too much, there's probably not many that are worse than smoking as far
as that goes, and then somebody might not take such good care of
herself and so forth, and so you gotta balance that; it's always better
if someone is not taking any medicine.
The usual thing people recommend is that if somebody is taking
medicine all the time and they gotta take it and they even want a take
it and they're gonna get pregnant is that they try to tapper as many
medicine as they can, so by the time they have they're last period
before they're hoping to get pregnant that they go off medicine, so
there is a period of period of time before they, between ovulation,
that their medicine, that the medicine is being washed out of the body.
And then, in different stages of pregnancy there's different kind of
risks from medicine, so some medicine causes structural defects in the
kid, like Lithium can cause certain heart defects, or Depacote or
Tegratol or a bunch of other anti-convulsants can cause certain nervous
system defects.
These are not very common, but they happen enough that
is better someone is not taking the medicine.
You don't want your kid
to have one chance in a hundred of having spina bifida, if you can

possibly help it.
So you are off the medicine.
The nice thing is that those
structures, the brain, the heart, that stuff, those structures are all
made between one and two months of pregnancy, and so when someone gets
into the second trimester of pregnancy, most medicine if they need them
they can take them, if they need them to keep their Bipolar Disorder at
bay.
Other medicines cause different kinds of problems later in
pregnancy, certain anti-depressants cause problems later in pregnancy,

for example.
Lithium can cause problems anytime during pregnancy
because first it can cause problems with organ development and later it
causes problems because of side effects that the fetus has from being
exposed to Lithium.
97
But it's not uncommon, you know people with
Bipolar Disorder are more likely to have post-partum depression than

people who don't have Bipolar Disorder, some people believe that, of
course post-partum depression is not a matter of believe, a third of
post-partum depressions happen during the start before the person has
their baby, start during their third trimester, so it's good to have a
good relationship with the physician and stuff and so they're
monitoring yourself because many medicines, not all of them, can also
be safe during the third trimester if somebody needs to take them for
depression, for example, because it's better to take the medicine that
it is to be depressed when you have a newborn.
And then, so far as breastfeeding goes, any medicine that anybody
takes gets into the breast milk, some more than others, anticonvulsants don't get into the breast milk very much, Lithium gets in
the breast milk a lot, other things are sort of in between, so anything
that gets in the breast milk, the kid gets, and so people have looked
at the extend to which kids develop side effects from medicine and them
being nursed by mothers who were taking them, and usually is a matter
of, if you don't really need something, you avoid it, if you need
something, you take exactly what you need but no more, if it is lifethreatening that you need to take, I mean, for some people taking their
medicine not taking their medicine is life-threatening and if it's
something that is contra-indicated, that is against breast-feeding, and
it's a matter of life and death, then the woman has to take the
medicine and not feed the baby.
I am real much in favor of breast-
feeding, but you know sometimes that's the way it is.

It'll be good to be to have somebody that you're monitoring that
with, who can say, "yes, we can continue like this, or we should
consider doing x, these are the pros and cons" because nobody can
98
predict what's gonna happened.
Pregnancy, in and on itself, and people
have looked at the extend to which people relapse when they were
pregnant, when they continued with medicine versus when they didn't, or
looked at relapses when people discontinued medicine when they were not
pregnant and when they were didn't make any difference.
Electroshock can save your life, but most people don't need it.
The nice thing about electroshock is that when someone cannot take any
other medicine, like say somebody has the kind of Bipolar Disorder
where they get psychotic and where they have really severe lifethreatening depressions and manias, and here they are at the very
beginning of their pregnancy, and this happens to them, and all the
medicines that you might think would be helpful for this person they
can't take them.
Believe it or not, that the safest thing you could do
in terms on treatments so far is as long as the developing baby is

concerned is shock treatment.
So during the first beginning of
pregnancy, when you don't want to get medicine, it's a way to avoid
giving medicine, and it doesn't seem to do anything to the fetus; later
in pregnancy when it's easier to take medicine, the occasional woman
would go into premature labor so it's a little more something to be
concerned about.
21.
What about long-term effects of shock treatment?

Nobody knows.
that's my impression.
There are probably some long-term memory effects;

You read the literature, you see both sides of
that, but I don't think they are permanent problems but I think they
are persistent problems because some people that, you know, medicine is
a nightmare, and they had electroshock therapy and it works great, and
as they stop having shock therapy and they go back home and the
medicine, it's going back to the nightmare again.
So the ideal thing
is to say "well, ok, let's go with this maintenance electroshock
99
therapy every few months" and some people just do brilliant that way,
others become very forgetful and to the point that they just don't want
to do it, so you gotta stop and when you do that, and so the person
comes in and they say, "this is terrible, I think I never gonna know
anything again in my life, I can't find my way home..." and so on and
so forth, then in about six months they are back like they were before
they ever had it.
There's sort of a circular logic: mania is if you
are high and you get in trouble.

22.
Can medication permanently damage our brain function?

That's not a common thing with medicine.
Some medicines might,
while someone is taking them, can certainly do that.
Seroquel is
pretty sedating, and it can interfere with concentration and the

ability to focus attention on things and so, Seroquel plus mild
symptoms could probably cause some real problem.
Seroquel is a pretty
short-acting medicine and so I imagine that when you stop taking

Seroquel you stop getting lost around your home.
But that would be a
very alarming thing; I think that if I was taking it, yes, I would have
probably stopped taking it; and go to the doctor, and the doctor might
lower the dosage or give me another medicine.
You gotta think about, in the future things may change in any
direction, and so you gotta be careful not to close off options for
yourself, and there are lots of medicines out there besides Seroquel,
and there are lots of medicines out there besides Lamictal, and there
are lots of things out there that can help you besides medicine.
You
just gotta lineup what you think it's going to be your armamentarium
and use that to help you.
23.
What about alternative medicine like vitamin B12 and Omega-3?

If you take them, thats good, you should keep doing it.
24.
But why do they help?
100
You got me there!

People can come up with fantasies about why Omega 3 fatty acids
work because they have different effects on how cells function.
That
could be seeing as being favorable and also, they are good for brain
development, so you take the Omega 3 while you are pregnant might be
good for your kid.
I don't think they are as good as regular medicine
for severe problems but I think they can be good at kind of taking the
edge off of things.
Besides, they are also good for your heart, so
anyways it's a good thing to take.

Vitamin B12 helps? I have no idea.
But vitamin B12 does all
kinds of things for the nervous system, and vitamin B12-deficiency is

involved in many of the problems of the central nervous system
problems.
So mainly, what you are doing by taking them is doing what's
good for your brain.
Exercise is also good for your brain; it actually
helps things to be produced that are good for brain cells.

Anybody for that matter, but especially if you have Bipolar
Disorder, anybody who's got a brain should figure out what is an
optimal amount of exercise for them.
Some people might need very
little because they have some physical problems, some people might need
a lot because they are athletes.
right for you, and do that.
So it is important to find what's
Not where it gets compulsive.
Find a way
to do something that you enjoy that you can make into a habit.
25.
Any final recommendations for creative people?

The situation that creative people are in, in some ways is the
same as everybody else, but in some ways it's a little bit more
complicated.
They have to do the same thing, except more of it.
Somebody who is an artist or something like that so they have these

concerns about treatment and creativity and plus the illness, they need
to have a good psychiatrist who can be a little bit flexible with
101
treatment perhaps but can also be firm about it when it's necessary.
They need to learn what they can about the illness so that they can
live with it and be healthy.
Some people start learning about an illness and then they get
into a hobby; I think that's a mistake.
But I think they should learn
about the illness so they can learn how to live with it and keep it out
of the way so they can live their life.
There's a very useful depressive-bipolar supporter lines, DBSA,
they have educational materials, and they have support groups, and
stuff like that.
For some people it's extremely useful, it depends on
somebody's personality.
And the thing about the DBSA is they have
different chapters and the personalities on these chapters tend to be

very different.
There are some people that are very high functioning
and creative, and some people that are barely surviving.
But it's a
good source of information, and so forth.
Appendix 5
Quantitative Data: SURVEY
a. Spanish version
Gracias por tomar 3 minutos de su tiempo para llenar esta encuesta sobre su experiencias de vida
como artista. Al compartir sus valiosas experiencias, usted me ayudar a explorar las dimensiones del
temperamento artstico. Aunque las respuestas sern compiladas, su identidad ser totalmente
annima.
1. Algunas veces las ideas vienen a mi tan rpido que no puedo expresarlas
O Muy en desacuerdo O En desacuerdo
2.
O De acuerdo
O Muy de acuerdo
Cuando estoy creando no puedo dormir por das porque estoy lleno de energa

3.
O Neutral
Soy el alma de la fiesta
O Neutral
O De acuerdo
O Muy de acuerdo
102

4.
O Neutral
O De acuerdo
O Muy de acuerdo
Muchas veces he sido llamado temperamental y excntrico

5.
O Neutral
O De acuerdo
O Muy de acuerdo
Mi comportamiento impulsivo me ha trado problemas con la ley

6.
O Neutral
O De acuerdo
O Muy de acuerdo
Soy ms creativo cuando me siento triste, melanclico y desesperanzado

7.
O Neutral
O De acuerdo
O Muy de acuerdo
O De acuerdo
O Muy de acuerdo
O De acuerdo
O Muy de acuerdo
Los das soleados me hacen ser ms creativo
O Neutral
8. Mi personalidad cambia con las estaciones del ao

9.
O Neutral
Las personas con desrdenes mentales son menos confiables que las personas normales?
O Neutral
O De acuerdo
O Muy de acuerdo
10. Continuaras una relacin luego de saber que la persona sufre de un desorden mental?
O Si
O No
O No s
11. Te consideras artista?

O Si
O No
O No s
12. Algn professional de la medicina te ha dicho que sufres de algn tipo de desorden mental?
O Si
O no
Si respondiste Si a la pregunta #12:

13. Por favor especifica tu diagnstico
14. Te sientes cmodo dicindole a otros que sufres de un desorden mental?
O Si
O No
O No aplica
15. Ests bajo el cuidado de un especialista?

O Si
O No
O No aplica
b. English version
Thank you for taking the time to complete this brief 5-minute survey about your life experiences as
an artist. By sharing your invaluable experiences, you will help me explore the dimensions of the
artistic temperament. Answers will be compiled but individual respondents will be completely
anonymous.
103
1.
Sometimes ideas come to me so fast that I cannot express them
O Strongly disagree
2.
O Neutral
O Agree
O Strongly Agree
O Disagree
O Neutral
O Agree
O Strongly Agree
O Disagree
O Agree
O Strongly Agree
O Neutral
O Disagree
O Neutral
O Agree
O Strongly Agree
Im more creative when Im feeling sad, down, and hopeless
O Strongly disagree
7.
O Disagree
My impulsive behavior has gotten me in trouble with the law
O Strongly disagree
6.
O Strongly Agree
Ive been called moody and eccentric many times
O Strongly disagree
5.
O Agree
Im the life of the party
O Strongly disagree
4.
O Neutral
When Im creating I dont sleep for days because Im full of energy
O Strongly disagree
3.
O Disagree
O Disagree
O Neutral
O Agree
O Strongly Agree
O Neutral
O Agree
O Strongly Agree
O Neutral
O Agree
O Strongly Agree
Sunny days make me more creative
O Strongly disagree
O Disagree
8. My personality changes with the seasons

O Strongly disagree
9.
O Disagree
Do you think people with mental disorder are less reliable than normal people?
O yes
O no
O I dont know
10. Would you continue a relationship after learning that the person suffers from a mental disorder?
O yes
O no
O I dont know
11. Do you consider yourself an artist?

O yes
O no
O I dont know
12. Has a health professional ever told you that you suffer from some type of mental disorder?
O yes
O no
If you answered, "Yes" to question #12:

13. Please specify your diagnosis ..
14. Do you feel comfortable telling others that you suffer from a mental disorder?
O yes
O no
O not applicable
15. Are you under the care of a specialist?

O yes
O no
O not applicable
Appendix 6
Media Activism Projects
a. Madly Gifted promotional poster
104
b. Poised iPhone app graphics
105
106
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The Bipolar Spectrum and The Artistic Temperament PHD

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THE BIPOLAR SPECTRUM AND THE ARTISTIC TEMPERAMENT

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