Book Review

Touched with Fire: Manic-Depressive Illness and the Artistic Temperament

N Engl J Med 1993; 329:1133-1134October 7, 1993

Article

Touched with Fire: Manic-Depressive Illness and the Artistic Temperament
By Kay Redfield Jamison. 370 pp. New York, Free Press, 1993. $24.95. ISBN: 0-02-916030-8

Great wits are sure to madness near allied,

And thin partitions do their bounds divide.

-- John Dryden

Medicine has a long tradition of taking an interest in the ailments of the historically notable, in part to enrich its teaching with relevant and memory-enhancing case examples, but also to see how medical conditions may have affected the lives of those who shaped our culture or history. Psychiatrists have been particularly interested in psychoanalytically oriented biographies of the well known, trying to establish what developmental forces impelled or shaped the adult trajectories of the subjects. Such biographies, while intellectually stimulating, have been -- because of the highly inferential nature of their explanations of purported mental mechanisms -- more creative and perhaps more allegorical than scientific. Since psychiatry has moved toward more emphasis on reliable, descriptive diagnostic criteria and the empirical study of mental disorders in the past couple of decades, a new book that examines the lives of historical figures using such up-to-date tools seems particularly timely.

Kay Redfield Jamison is a highly regarded researcher of bipolar (manic-depressive) illness and the coauthor (with Frederick Goodwin) of the definitive textbook on this condition (Manic-Depressive Illness. New York: Oxford University Press, 1990). Although earlier writers have examined the relation between creativity and “madness” more broadly or have focused on the psychodynamics of the creative process itself, she has turned her attention in this book to the specific relation between creativity and bipolar illness. Jamison uses a skillful blend of modern diagnostic criteria, illness-outcome data and course research, and genetics to examine the lives of writers, artists, poets, and musicians for evidence of affective disorders, and she speculates thoughtfully about the possible ties between illness and success in the arts.

She begins with a very readable review of the signs and symptoms of bipolar and related disorders, highlighting particular symptoms that might enhance or inhibit creative success. She discusses the course of the illness over time, explaining why certain phases may be correlated with increased productivity and others with little or none. She then reviews the empirical studies conducted to date on the incidence of mood disorders among living writers and artists. These studies have examined factors such as psychiatric care sought, medications, hospitalizations, suicide attempts, and family histories, all far more reliable and verifiable findings than features such as unconscious conflicts. She also reviews the historical records of numerous artists now dead, using comparable objective data provided by their biographers. She makes a compelling case that the incidence of bipolar-spectrum illness in these groups is staggeringly high, especially so for poets, in comparison with the background rates in the population.

Jamison next fleshes out the statistical data with accounts of the lives of many such artists, highlighting the temporal relation between documented mood swings and creative productivity. She pays particular attention to the family trees of her subjects, showing how melancholia, irritability, insanity, and suicide affect many families yet leave in their wake immense contributions to our cultural heritage. The text is liberally sprinkled with quotations from her subjects documenting their ecstasies, their torments, and their reflections on both.

Jamison then addresses the implications of this correlation, explaining that although mental illness is no prerequisite for creativity and at times may confer a definite disadvantage, both the manic and the depressive phases of bipolar illness may also offer something to augment the creative process. She reviews current thinking about the genetics of the illness and makes the critical point that although eradication of the gene or genes responsible for it would prevent much suffering and illness, it might also have a devastating effect on future creativity and genius. Here she makes the apt analogy to the sickle-cell gene -- namely, that a mutation may confer adaptive advantage (in this case, against malaria) but that the full expression of the gene may create disabling illness. The book has detailed appendixes of diagnostic criteria, lists of affected artists, and notes for the body of the text.

Anyone even remotely interested in this topic will find Touched with Fire a clear and enjoyable book. Students of biography will want it next to their psychohistorical books, and the rest of us will find it a stimulating respite from the usual dry medical textbooks.

Larry S. Goldman, M.D.
University of Chicago, Chicago, IL 60637