Saturday, May 14, 2011

Hypomania and Creativity

In September 1992 I underwent a 2-hour assessment at the George Washington University Medical Center Department of Psychiatry, performed by Napoleon Cuenco, M.D. (under the supervision of attending psychiatrist, Daniel Tsao, M.D.)  Dr. Cuenco assigned the diagnosis bipolar disorder (rule out: schizoaffective disorder.)   Dr. Cuenco's assessment report noted the mood-congruent psychotic features of racing thoughts; pressured, rapid speech; loose associations; and fight of ideas.

It appears unlikely that I ever suffered from bipolar disorder; rather it appears that bipolar disorder was, in fact, a misdiagnosis.  I started treatment with an SSRI medication in December 2000 (and am currently treated with the SSNRI Effexor, 150 mg/day).   Mania or hypomania are possible side effects of SSRI use. Users with some type of bipolar disorder are at a much higher risk; SSRI-induced mania in patients previously diagnosed with unipolar depression can trigger a bipolar diagnosis.  Further, bipolar disorder tends to worsen over time, and not improve.  I have never suffered a fully-blown manic phase on antidepressant medication.

Is it possible that some other condition could mimic the "symptoms" noted by Dr. Cuenco?  Yes!  Creativity can be associated with an adaptive form of hypomania.

Hypomania is correlated both with measures of creativity potential (e.g., self-perceived creativity) and creative behavior (e.g., involvement in creative activities). Hypomanic moods increase awareness and enhance the breadth, fluency, and flexibility of thinking.  Ivcevic, Z. and Mayer, J.D. "Creative Types and Personality." Imagination, Cognition and Personality, 26(1/2): 65-86, 2006-2007.

Creative thinking can encompass traits that to an unsophisticated observer might appear to be manic symptoms, namely, loose associations and flight of ideas.  These traits include a highly-developed verbal fluency, an unusual capacity to bring together remote associations, and the ability to extend effort in idea production (ideational fluency). Guilford, J.P. The Nature of Intelligence (New York: McGraw-Hill, 1967); Mednick, S.A. "The Associative Basis of the Creative Process." Psychological Review 69: 220-232 (1962); Parnes, S.J. "Research on Developing Creative Behavior." In: Widening Horizons in Creativity. Edited by C.W. Taylor. (New York: John Wiley & Sons, 1964).

Further the symptom paranoia noted in Dr. Cuenco's assessment chart might be partly explained by the high reality-testing potential exhibited by some creative persons. 

Hypomania (literally, "below mania" ) is a mood state characterized by persistent and pervasive elevated (euphoric) or irritable mood, as well as thoughts and behaviors that are consistent with such a mood state. Individuals in a hypomanic state have a decreased need for sleep, are extremely outgoing and competitive, and have a great deal of energy. However, unlike with full mania, those with hypomanic systems are fully functioning, and are often actually more productive than usual. Specifically, hypomania is distinguished from mania by the absence of psychotic symptoms and grandiosity, and by its lower degree of impact on functioning. Hypomania is a feature of bipolar II disorder and cyclothymia, but can also occur in schizoaffective disorder. Hypomania is sometimes credited with increasing creativity and productive energy.  A significant number of people with creative talents have reportedly experienced hypomania or other symptoms of bipolar disorder and attribute their success to it. Classic symptoms of hypomania include mild euphoria, a flood of ideas, endless energy, and a desire and drive for success.

It is ironic that the George Washington University Medical Center Department of Psychiatry was chaired by the late Jerry M. Wiener, M.D. throughout my out-patient treatment that lasted from September 1992 to June 1996.  Dr. Wiener had served as President of both the American Psychiatric Association as well as the American Psychoanalytic Association.  I had transmitted a copy of my written self-analysis, The Caliban Complex, to Dr. Wiener some time during the summer of 1992.  I telephoned Dr. Wiener in August 1992 in connection with my plans to embark on out-patient psychotherapy at GW.  Dr. Wiener acknowledged that he had received the paper, and that he had given it to Dr. Tsao.  I do not know if either Dr. Wiener or Dr. Tsao ever read the paper.  Dr. Cuenco, who performed the initial assessment in September 1992, had been given the paper by Dr. Tsao; Dr. Cuenco said he read the paper.  The paper suggests the presence of some creative potential in me.


Gary Freedman said...

Dr. Akman: you need to come out of the racketeering closet and tell the FBI what you know.

Gary Freedman said...

Much Ado About Sturgeon

The question of whether I -- and Hamlet, for that matter -- am psychotic reminds me of a question that has bedeviled rabbis for centuries:

Is sturgeon kosher?

As they say in the law, it's a question about which reasonable minds might differ.

Gary Freedman said...

What happens when you put two GW psychiatrists in the same room?

You get three misdiagnoses!!