The Jazz Times Halloween Scare

Dr. Judith Schlesinger By

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Jamison's research is full of holes, but her conclusions are popular because they confirm what so many people want to believe - that creative people must suffer for their talent.
In October of 2002, Jazz Times ran a cover story called "Hard Bop, Hard Time: Music, Madness and Roy Brooks. " It was good timing, since the article was as dark and scary - and as full of fantasy - as Halloween.

It warns that jazz musicians are especially prone to developing bipolar "disease," a "treacherous" mental "illness" that destroys creativity and careers and kills people. Using the sad story of drummer Roy Brooks as his outline, writer Jim Dulzo paints an overgeneralized picture of the dangers facing creative people, misrepresenting the nature of bipolar diagnosis and treatment. He's probably scared a lot of people, and it's completely unncecessary.

I don't doubt his good intentions; it's important to expose the lack of adequate health care for jazz musicians, and I'm glad to see the wonderful Jazz Foundation get some press. But this article is not only misleading, it's written in crescendo, which makes it sounds even more urgent and dire.

To be fair, Dulzo is no mental health professional. He's a music industry guy who interviewed one expert (Roberta Sanders, Roy Brooks's therapist) and read another (psychologist Kay Jamison, the most passionate proponent of the "mad creative" notion). I believe Dulzo misunderstood his first source and was suckered by the second - as so many are - into assuming her research is the definitive, scientific answer to the ancient questions about creative madness. Moreover, as an outsider, Dulzo would have little idea of the heated, long-term controversy within psychology's walls about the validity of diagnosis in general, the existence of mental "illness" in particular, and whether creative people are necessarily more susceptible to it.

This isn't the place to unspool all these controversies, since my goal is to shed some light on the darkness as quickly as I can (some of my credentials for doing so are at the end of this article). I'm told that Jazz Times might be open to printing a rebuttal, since they traditionally welcome differing opinions, but that process takes time, and the Halloween info has already been out there for two months.

So... let me take it from the top, and first reassure everyone of the following:

People with bipolar disorder - even assuming it's a verifiable medical entity, which is still unproven - are NOT invalids, and they are NOT doomed. Moreover, there is no proof that jazz musicians are more likely to be bipolar than anyone else.

In any case, the problem is usually manageable, whether by therapy, medication, lifestyle changes, exercise, better sleeping habits, greater self-awareness - or some combination thereof. What helps is as individual as the people who get the diagnosis; lithium doesn't do it for everyone, which is why they're experimenting with anti-seizure drugs, such as depakote. Besides, bipolar disorder has a much wider range of severity than Dulzo describes; you can get the diagnosis if you only have one qualifying episode in your life. And many people with that label - including those who've been hospitalized in the past - are living productive, stable, and even contented lives.

And now to the major inaccuracies in the article:

Bipolar disorder is a death sentence.

Dulzo's contention that "depression killed Thelonious Monk" is simply false. Monk's psychology may have derailed his career, but his life was ended by a stroke at age 64. In any event, bipolar disorder is not necessarily a "vicious," "merciless" "disease" that inevitably "whips its victim's mental state between crippling lows and maniacal highs." Dulzo overlooks the full range of official possibilities, including the Bipolar II category where the mania is less severe and called hypomania , literally meaning "under mania." There's also a relatively mild syndrome called cyclothymia , for people whose emotions tend to dip and rise (and who used to be called moody.)

Dulzo also warns that "Jaco Pastorius' fate offers a chilling reminder of just how quickly bipolar disease can kill," speculating that "his illness probably led to the confrontation and resultant brawl that killed him in a Fort Lauderdale bar." Who can prove it? It also troubles me how this evokes the insidious stereotype that the mentally "ill" are more violent than the "normal" - in fact, the opposite is true, and by a long shot.

  • People with bipolar disorder "have to [see] therapists daily" and require "long-term, publicly-funded, assisted living."

These claims, attributed to Roberta Sanders, startled me and all the colleagues I mentioned them to. Worse, they've unnecessarily alarmed the public.

Intensive treatment may be necessary for those in acute episodes, who are often hospitalized. But most diagnosed bipolars are not in continuous crisis, and can visit their therapists on a more relaxed schedule. (Some even function without them.) As the director of a mental health clinic, Sanders must know this. My bet is that she was quoted out of context, with Dulzo drawing on her 20 years of frustrated compassion for Brooks to paint a picture of universal doom. The truth is that not everyone slips through the cracks, and not every jazz musician is poised on the edge of darkness.

People who abuse drugs and alchohol are really bipolar.

To strengthen his case about the terrible psychological perils of jazz, Dulzo throws some famous addicts into the mix and suggests they were bipolar, too. Although clinicians have connected some dots betweeen substance abuse and bipolar disorder, they still can't tell chicken from egg: for example, do people get drunk and stoned to self-medicate their bipolar discomfort, or do drinking and drugs cause bipolar disorder? For the record, the bipolar spectrum contains a special category for "substance-induced mood disorder" (which can be either manic or depressive, or both), suggesting that if addicts were to quit, they might lose their mood disorders as well.

All jazz writers are qualified to make clinical diagnoses

As much as I admire Gary Giddins, Nat Hentoff, and Ira Gitler for their perceptive jazz criticism, Dulzo presents their opinions as if they were clinical evidence. For example, Giddins writes beautifully, and he's certainly entitled to speculate about "the very thin line between being eccentric and being truly ill," but that doesn't make it a psychological fact. Besides, trotting out the same old roster of troubled musicians to "prove" that all musicians are in danger is stretching it, to say the least. At best, it's selective reporting - what about Diz and Duke, to name just two of the many who managed to remain brilliant, prolific and sane? The media and public love those shooting stars - they're far less interested in long, productive, stable lives. That's why we get feature films about Chet Baker and Bird, rather than Ray Brown and Brubeck.

  • "Jamison cites formal biographical studies which indicate that between one-quarter and one-half of artists are mentally ill - two to five times above the 'normal' rate of the general population."

This is absolute nonsense. All of these numbers are estimates, and the ones about artists border on the hallucinatory (more on that soon). In the latest psychiatric bible, the DSM-IV, the lifetime prevalence rate of the most-serious Bipolar I disorder is estimated as being up to 1.6 % of the general population; the chances of getting Bipolar II disorder is allegedly .5%. This means that the total "normal" rate is about 2% of the population. Now, if we believe the worst-case guesstimate - that 50% of artists are "mentally ill" - we're actually hearing that artists are 25 times more likely to have this problem!!! This is horrifying and unsubstantiated, as well as bad math.

First of all, you cannot make a confident statement like this unless you're drawing on large-scale studies that compare bipolar frequency among creative and non-creative people - assuming you can define those things precisely and to everyone's satisfaction, which has so far been impossible. The truth is, nobody knows the actual percentage of artists among us.

What Jamison and others have done is project a number based on their selective focus on celebrities who fit the stereotypes of the disturbed or out-of-control artist. Few people notice that one of Jamison's most quoted claims - that 50% of poets are mentally ill - comes from only nine people in her 1989 study, but it still remains a headline. Unfortunately, her research is rarely examined closely, even by those with the training and responsibility to do it - including psychologists, textbook writers, and - as you will soon see - heads of major national studies. Moreover, some of her most influential conclusions about artistic "madness" were based on the same 47 people, all of them personally selected, interviewed, and judged by herself.

The large-scale research that could produce the definitive answer has not been done, and in fact a terrific chance to do so was recently botched. In 2001, the National Institute of Mental Health (NIMH) launched a $22 million study of bipolar disorder, the largest survey ever, recruiting 5000 participants at 18 centers across the country. Five thousand people filling out questionnaires was the moment to finally nail down, once and for all, and with real scientific validity, whether creative people are more vulnerable to bipolar disorder - but they dropped the ball. They're just not interested, according to the head of the study, whom I personally interviewed (and who referred me to Jamison's work for answers). Meanwhile, the wording of their occupational questions prevents freelance artists from clearly identifying themselves as such. As a result, even if this massive research does scoop up a number of jazz musicians (as well as other creative types), their responses will disappear into the larger mix. It's a sadly missed opportunity, in my opinion.

More on those "formal biographical studies"...

There's nothing "formal" about them, not in the sense of legitimate scientific method. These studies are what I call psychological autopsies , a pop-psych technique of diagnosing artists, most of them long-deceased, by looking at their letters and what their contemporaries had to say about their behavior. There are only a few documented cases of suicide or asylum visits to suggest a serious problem in the days before clinical psychology. Otherwise, these "formal" investigations consist of pawing through someone's history for "evidence" that supports the researchers' already-firm belief that creative people are nuts.

For example, if a woman writes that her brother the composer has his ups and downs, and a poet famous for his passion describes passionate moments of elation and despair, they're slapped with a bipolar label and added to the long roster this method invariably generates. The list is then published in a big book (Jamison's "Touched with Fire," or Ludwig's "The Price of Greatness"), together with lots of impressive charts, then swallowed whole by the public - and far too many professionals. Diagnosis in real time is difficult enough. Diagnosing someone who's been dead 200 years is flimsy. Using such blatantly biased techniques to shadow every artist with the threat of mental "illness" is nothing less than irresponsible, and a lot closer to outrageous.

I don't blame Dulzo, for how could he know all this? Jamison is the most vocal and prolific champion of the link between creativity and madness who co-wrote (not authored, as Dulzo says) a textbook on bipolar disorder, then became a media darling when she "came out" as a bipolar herself, in "An Unquiet Mind." She's spent much of her career making bipolar disorder an elitist badge of creativity. Again, this isn't the place to detail what's wrong with her theories, and why psychologists haven't mounted a greater public challenge to her claims. That's what my book is for. Let me just leave it at this: Jamison's research is full of holes, but her conclusions are popular because they confirm what so many people want to believe - that creative people must suffer for their talent.

What is this thing called bipolar "disease," anyway?

Officially, bipolar is not a "disease" at all, but a disorder. This reflects the profession's continued inability to find any diseased tissue, brain anomaly, genetic or blood markers that are reliably associated with this behavior (or any other psychiatric diagnosis, for that matter). Every guild member knows that diagnostic categories are based on practitioner agreement and political horsetrading, rather than hard science; they haven't been verified as discrete medical entities, and not for lack of trying. As it happens, the official definition of "mania" overlaps so thoroughly with the excited, productive creative state that many artists automatically qualify as "manic" just by doing what they do. In any case, all diagnoses, which change and grow (or disappear) with each revision of the manual, are made by an often-confusing symptom checklist which is notoriously subjective, and therefore prone to tremendous individual variation.

Funny: as I was writing this, in December of 2002, a new study popped up in the Journal of Experimental Psychology which confirmed, once again, what clinicians have always known but try to keep quiet: that their personal theories influence the diagnosis they give. The increasing tendency to throw pills at psychological problems gives the false impression that their physical causes are fully known and understood, when they are neither. You can take it straight from the new study, done at Vanderbilt University: "In the case of mental disorders, there is no basic understanding of the underlying causes of these conditions. As a result, expert theorizing can be idiosyncratic and is likely to lead to conflicting diagnoses." (Ironically, this study was also funded by NIMH.)

Defining psychological abstractions can never be precise, but the concept of bipolar has been particularly elastic. When the DSM-IV came out in 1994, it threw the diagnostic net so wide that it catches virtually anyone who's ever swung a mood. [The more disorders, the merrier - and, not coincidentally, the greater the chance for managed care reimbursement]. Meanwhile, the terms "bipolar" and its earlier, more romantic incarnation, "manic-depressive," have entered the language as descriptors of the peaks and valleys experienced by so-called "normal" people. As a result, bipolar diagnosis is increasingly common: more frequently made and more easily accepted, and, thanks to Jamison, rather chic. That still doesn't mean it's anything more substantive than a group of behaviors that professionals have chosen to call "bipolar." A "disease" it is not.

In conclusion, Dulzo has collected several pieces of the puzzle, but is working from the wrong picture. He lists some of the unique stressors that jazz musicians have to endure without recognizing how ongoing stress itself can cause psychological problems. And most "mad creative" researchers are so preoccupied with individual psyches that they ignore the inherent difficulty of trying to make a living as an artist in a world that isn't very kind to them. Besides, most of their information comes from writers, who are eager to verbalize (and often dramatize) their emotional turmoil. They're not talking to jazz musicians, who are more likely to vent through their music, and whose creative psychology may be very different, for all we know.

The bottom line is that artists should not fear they've got a ticking psychological time bomb in their heads. I encourage jazz musicians whose moods interfere with their functioning to seek help, but then I'd say the same thing to anyone who was stuck, stumbling, unhappy, feeling out of control, or making the same mistakes over and over again. Someday, science will know exactly how the brain creates differences in talent and temperament. Right now, it doesn't, and to claim otherwise - especially when it hurts and stigmatizes a whole group of valuable individuals - is... well, just crazy.

My credentials to say all this:

A partial list: PhD in psychology from NYU, psychotherapist, 17 years of teaching university-level psychology. Listed in the international academic data base as an expert on the psychology of music. Member, American Psychological Association (active in Division 10, for psychology and creativity), National Association of Science Writers, IAJE and Jazz Alliance International. Past consultant to psychology's flagship journal, The American Psychologist , currently on the board of Ethical Human Sciences and Services: An International Journal of Critical Inquiry, where my three-part series on creativity and madness has been appearing. Writing Dangerous Joy: The Mad Musician and Other Creative Myths" which traces the nonsense back to Plato and examines its crumbly, pseudoscientific foundation.

I welcome e-mail reactions , and would be happy to suggest other readings on the topic. For now, here are three good books that may be of interest:

Creativity and Madness: New Findings and Old Stereotypes , by psychiatrist and three-decade creativity researcher Arnold Rothenberg. Published in 1990 by John Hopkins Press. Real science, takes the myth apart piece by piece. The Mad Genius Controversy: A Study in the Sociology of Deviance by George Becker. Sage Publications, Inc. 1978. Out of print, but still available online. Worth hunting for. Making Us Crazy - DSM: The Psychiatric Bible and the Creation of Mental Disorders. The Free Press, 1997. Written for a general audience by professors Herb Kutchins and Stuart A. Kirk. Describes the history and politics of inventing diagnostic categories. A real eye-opener.


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