Interview: Psychiatrist and Author Richard Berlin
> 6/4/2008 11:04:13 AM

The myth of the tortured artist who draws inspiration from the act of suffering persists despite the near-total lack of evidence in its favor. We’ve been taught to admire the supposed depressive geniuses who sing our favorite songs, make our biggest films and, in a less-visible field, write our most celebrated poetry. This attraction leads to the misguided conclusion that mental illness feeds the creative personality and that affected individuals would be incomplete without their “madness.” The idea that mental illness facilitates brilliance is a very unfortunate stereotype that ultimately leads some to avoid or delay seeking treatment because they fear losing that supposed edge. But listening to the words of individuals struck by both creative ambition and mental illness should remind curious readers that the sound mind is most creative and that the act of maintaining such a state may require treatment. This very important distinction lies at the heart of the stunning new essay collection Poets on Prozac: Mental Illness, Treatment, and the Creative Process, edited by psychiatrist and published poet Richard M. Berlin, M.D.

Berlin contacted some of his favorite contemporary poets, asking them to write essays featuring various selections from their catalogue and detailing their relationship with mental illness and its treatment (if, in fact, such conditions had affected them). While the collection contains pristine examples of work by several modern poetry masters, readers with little knowledge of the style should not hesitate to seek it out in order to gain personal insight into the subtleties of living with mental illness and the importance of moving toward a state of treatment and recovery.

We communicated with Dr. Berlin via email in order to have him answer some of our most pressing questions about the ideas explored within his book, and here we’ve prefaced his thoughtful responses with some earlier answers to frequently asked questions that appear in the section of his personal website that’s been devoted to Poets on Prozac.

Treatment Online: What is the main finding of your book?

Richard Berlin: Poets on Prozac shatters the myth that psychiatric treatment will impair creativity. What the sixteen poet-essayists tell us is that effective treatment sets the stage for greater creativity.

TOL: What motivated you to edit this collection of essays?

RB: Many descriptions of the creative process are based on the stories of poets, artists, scientists, and musicians who are no longer alive. I wanted to ask creative people themselves – in this case some of our finest contemporary poets– to reveal the inner workings of their creative process and to show us how psychiatric treatment affected their creativity.

TOL: What questions were you hoping to answer?

RB: I hoped the essays would answer many of the key questions about psychiatric treatment and creativity. Do poets (and other highly creative people) need to be mentally ill to produce great work? Does mental illness enhance or diminish creativity? What is the impact of substance use/abuse? What are the benefits and risks of prescribed psychoactive medications? Is creativity heightened by treatment or does treatment reduce emotional pain to the extent that the poet no longer has anything to say? Does a person have to be “crazy” to write good poetry? What do poets themselves define as crucial elements in their creative process?

TOL: Do you believe in the "artist" archetype whereby certain individuals are predisposed to the act of creating, granted abnormal insights into the human condition, etc.?

RB: One answer to this fascinating question comes from more than fifty essay proposals I received from poets around the world: none mentioned this issue at all. None of the poet-essayists whose work was published in Poets on Prozac give any credence to this idea. And that was my purpose in putting together Poets on Prozac: to find out, from artists themselves, how they view the creative process.

This question refers to the many mythologies about creativity, including notions regarding the role of inspiration, artists possessing unique, extraordinary talents, and the idea that psychiatric treatment will impair creativity. I review many of the myths in the introduction to Poets on Prozac, but the best discussion I have found is in Albert Rothenberg M.D.’s book “Madness and Creativity,” published by Johns Hopkins University Press. Rothenberg’s thirty five year project included interviews with research subjects who were Nobel Prize winners and Pulitzer Prize winners in the arts and sciences. His group did not conform to the “artist” archetype.

TOL: Do we not all have some desire to create in the form of "leaving our mark?"

RB: I do, but my friends tell me they are impressed by how much energy I put into creative pursuits. And do any of us leave much more than the faint mark we can scrawl during Andy Warhol’s fifteen minutes of fame?

TOL: Is the issue purely a matter of perspiration over inspiration where some are just more willing to work this urge out?

RB: One of Rothenberg’s main findings was that the single theme that unites all highly creative people is intense motivation. Highly creative people work extremely hard to create, regardless of whether their fields are in the arts or sciences. Creativity doesn’t just “happen.”

My own impression is that there is a gradation in terms of how much sweat people want to put into their work; some are happy to write the first draft of a poem and leave it at that. Others want to craft their poem for a wider audience. Inspiration is often the start, but perspiration takes creativity to a level that might be appreciated by a wider audience.

TOL: How much does the awareness of our own mortality contribute to this tendency?

RB: I can only speak for myself on this question. When I was in my mid-forties, I became fully in touch with my mortality and decided I had to do two things before I died: become a writer and learn to play the guitar. Knowing that time was limited increased my tenacity to be disciplined, practice, learn, and work even harder. What surprised me was that I become a poet, a pursuit I had never imagined for myself.

TOL: Alternately, do you grant credence to the "addictive" or "compulsive" personality so central to the 12-step philosophy, and does this disposition also explain the obsessive attention to reflection, production and criticism (often aimed at the self) that these poets display?

RB: I don’t think so. For example, addictions are specific to individual susceptibility (some people prefer one drug to another), and each drug has its own unique neuropharmacology. For example, alcohol dependence is very different from cocaine dependence in terms of the receptors which are altered in the brain. At present, biological concepts hold sway in the world of addictionology.

These concepts relate to psychoanalytic explanations of personality. They have a certain poetic resonance, but don’t meet the scientific hallmarks of validity and reliability. Without getting too technical, these are “dimensional” concepts (like IQ in which intelligence is described as different points on a bell-shaped curve). To be considered “compulsive” a person can be more or less orderly, more or less perfectionistic, more or less controlling, and each trait is measured as a point on a continuum. When a person is more orderly than average and more perfectionistic than average, we lump these dimensions together and call the person “compulsive,” but this is just a convenient convention, and combines multiple dimensions into a single category. The concept of how to classify “personality” is a point of great contention in current psychiatric diagnosis.

TOL: Does this "condition" then lend itself to mental illness?

RB: That would be a pretty big leap.

TOL: And does it explain why so many writers seem to pursue craft to the point of self-punishment? Is it a kind of undiagnosed OCD that seems almost essential to the profession?

RB: The poet-essayists in Poets on Prozac did not describe themselves this way. Hard working, yes. Striving to improve their work, yes. But in most creative acts, the details are crucial, and, as we talked about earlier, artists have to work hard to create at their highest levels.

In my own creative world, I have always been blown away by the work ethic of my guitar teacher, a virtuoso musician who plays in a nationally known band. He begins practicing for his Saturday night gig on Monday, and builds up his performance skill all week. That’s what it takes for him to maintain his speed, accuracy, and sound. Daniel Levitan, in his book “This Is Your Brain on Music,” talks about musicians needing 10,000 hours of practice before they can achieve any degree of mastery with their instrument. I would say that this behavior fits with Rothenberg’s finding of intense motivation in creative people, rather than OCD.

TOL: Recent studies observe significantly lower average yearly earnings for those affected by one or more major mental illnesses. Do you think this is due to a compromised ability to perform the duties of a professional position or is it because the mentally ill more often seek uncompromising but difficult professions (like writing poetry) because of their greater tendency toward obsession and the need for validation?

RB: I just read a report about people with major mental illnesses earning, as a group, $192 billion less than the rest of the population. This is an astonishing number. When I began my psychiatric training, one of the things we learned about was the pattern of “downward mobility” in people with schizophrenia. From the Poets on Prozac essayists, my impression is that when they were suffering with the most severe symptoms of their disorder – addiction, schizophrenia, mania, depression, eating disorders, anxiety, etc. – that the symptoms impaired their ability to function at many levels, including planning, motivation, energy, and attention. Untreated mental illness certainly impairs creativity, and the message from the poet-essayists is that effective treatment helped them function at their highest levels of creativity.

TOL: A number of the authors discuss substance abuse and addiction. Do you believe that the false stereotype regarding drugs and creativity (namely that intoxication "opens the mind" to previously unconsidered perspectives and creates a deeper well of experience from which to draw material) also causes many ambitious people to seek out these substances in search of self-fulfillment?

RB: I came of age in the late sixties, and have wondered about these questions for a long time. People take substances for an array of reasons which range from personal exploration, curiosity, relaxation, recreation, to self-treatment of symptoms. The poet-essayists in Poets On Prozac who had significant substance use/abuse issues were consistent in their view that substance use impaired their creativity, though what they wrote when they were high looked good to them at the time. Dylan Thomas (I wish I could have asked him to write an essay!) basically stopped writing poetry during his last seven years of life because he was so impaired by his alcohol dependence. Steven King also talks about the importance of becoming sober as he developed his career. And many of the poets I invited to write an essay declined because they had never experienced a psychiatric or substance abuse disorder.

TOL: Writer JD Smith discusses how a poet, by seeking treatment, breaks some unstated "contract." He seems to be afraid that being treated will diminish the authenticity of his identity. This is in keeping with the larger myth of the mad genius that drives this book. How do you think this image came about? Does our romantic attachment to tragic figures give rise to such beliefs? How can we make treatment and particularly medication more appealing and reverse its reputation as evidence of a failed or faulty character?

RB: My impression is that JD Smith wanted to break the Romantic “contract” that the poet would be “the pack mule for the collective burden of consciousness.”

The “mad genius” myth has many sources. The Greeks started this myth with their concept of the Muse, who induced a kind of madness in the poet, and the Romantics reshaped the myth in the direction of sadness and melancholy. Many of our ideas about these issues come from literature ( like Goethe’s “The Sorrows of Young Werther”) and film. Not to mention the mythic stories of artists like Beethoven and Van Gogh.

Psychiatric treatment has never received an accurate portrayal in film. As Glen Gabbard, MD writes, if film makers actually showed a true version of psychiatric treatment, the audience would soon be yawning. Unfortunately, people with mental disorders are highly stigmatized (even Medicare provides lower reimbursement for treatment as compared to the treatment of other medical disorders), and providers of treatment are stigmatized as well. I believe education is the key to decreasing stigma, and I hope that the experiences of the poets in “Poets on Prozac” will help decrease stigma and give people a bit of reassurance that effective treatment (with medication and/or psychotherapy) will not impair creativity but will enable them to function at their highest creative levels.

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