Thursday, June 5, 2014

Artists and Mental Illness, part 2

I am not a scholar. Bear that in mind as you read this. I have worked with scholars, having spent nearly a decade working at an academic press and having helped out with the odd PhD dissertation here and there, so I can sometimes sound scholarly. And I do have a fascination with the brain and how it works (I have already bought my ticket to The Amazing Meeting in July, which this year has a theme of "Skepticism and the Brain"). But academic research is not my trade. I looked at online sources, talked to a few people, and digested all this information from my own point of view as a working caricature artist. I had my own questions to answer, like:
From Ellen Forney's Marbles: Mania, Depression, Michelangelo, & Me
(more about Michelangelo later . . .)

--Am I or my coworkers more at risk for mental illness because of our trade?

--How can a link like that be measured? 

--Is the actual link exaggerated by journalists, and therefore in the public's mind?

So, with a week to look around, here's what I found. 

First, A Meta-Review of the Numbers

There have been quite a few studies about creativity being entwined with madness; and it's a popular topic to get snatched up by journalists, so nearly everyone can remember reading some article, somewhere, that states artists are more likely to have mental health issues. A 2012 meta-review looked at 32 such studies and found "the effect sizes were heterogeneous, but the overall mean effect size was small (r = .16)." That's not a very impressive coefficient of correlation. (If you don't want to download a statistics refresher PDF file, like I was forced to: r can be between -1 and 1, and zero indicates no linear effect). The coefficient went up when a particular test was used and "uniqueness" was the index of creativity, but that smacks of cherry-picking, so I'd trust the initial r value.

So, with this in mind, I kept wondering as a I read articles: are we making a mountain out of a molehill? Popular science writers often sway from the real meaning of studies to "dress up" otherwise drab findings into a snazzy eye-catching headline. It's amazing how many scientists are "baffled!" or "astounded!" according to popular headlines, even though the actual studies they quote are more blah than astounding or baffling. Plus the idea of creativity being associated with mental illess was such a pervasive one; the association first appeared in the 1970s, but a link between "genius" and "madness" dates back as far as the time of Aristotle, if Wikipedia is to be trusted. I waded through a bunch of articles to see what's out there.

Popular Science Articles

A 2012 BBC article titled "Creativity 'Closely Entwined with Mental Illness'" summarizes the research of a Swedish team at the Karolinska Institute and makes some general statements about creative types, especially writers but also visual artists. The article states that "those in the creative professions were no more likely to suffer from psychiatric disorders than other people. But they were more likely to have a close relative with a disorder." This article, too, tries to link the traits of some mental illness with the drive that leads some to enter an artistic field: "The restrictive and intense interests of someone with autism and the manic dive of a person with bipolar disorder might provide the necessary focus and determination for genius and creativity."

An earlier article by the same BBC health editor, titled "Creative Minds 'Mimic Schizophrenia,'"reports that "Brain scans reveal striking similarities in the thought pathways of highly creative people and those with scizophrenia. Both groups lack important receptors used to filter and direct thought." This study, too, draws on work from the Karolinska Institute, which apparently has been studying crazy artist types for a while now. The article goes on to state that "Creativity is known to be associated with an increased risk of depression, schizophenia, and bipolar disorder," but does not elaborate on how that was determined. But it quotes Professor Fredrik Ullen's findings that the brain's dopamine (D2) receptor genes (which experts think govern "divergent thought") might be key. People who did well on tests of divergent thought had a lower than expected density of D2 receptors in the thalamus--schizophrenics also show this lower density. The thalamus is a filter, parsing information and relaying it to the cortex (the seat of cognition and reasoning). So, this line of theorizing goes, some people have faulty filters, which means more of the everyday data that constantly hits us gets to the higher reasoning centers. That sounds like a good thing, I mean who doesn't want MORE information to get into their cortex (stupid brain, censoring what I get to think hard about!) . . . but if one's cognition center overflows constantly with every little bit of life's minutia (Look! A squirrel!) then it's easy to see how mental illness is the end result. The article ends on a happy note, quoting a psychologist who coaches people to be more creative: "The result is typically a significant rise in their well being, so as opposed to creativity being associated with mental illness it becomes associated with good mental health."
Art can be a way to cope.

So creative endeavors like art might actually be a recipe for mental health . . . I guess that makes sense, right? Art therapy happens in the mental health profession all the time.

A Science Daily news release mentions a small Stanford study from 2005 that found children of bipolar parents scored higher on creativity tests than "the healthy children." It goes on to repeat that many studies have found links and that "artists and writers may have two to three times more incidences of psychosis, mood disorders or suicide when compared with people in less creative professions." Rather than a filtering problem, like the schizophrenia link is theorized as, the bipolar-creativity link is explained as "mobilizing energy that results from negative emotion to initiate some sort of solution to their problems. 'In this case,' [says Dr. Terence Ketter,] 'discontent is the mother of invention.'"

So in this model, art can also be viewed as a means of quieting a mind, not stirring it up more. A coping mechanism. Again I'm thinking of the art therapy given in mental health facilities.

But already we have differing mechanisms to explain links of different cognitive disorders with "creativity," which can be described so broadly as to either mean "uniqueness" or working in a creative field, or doing well on a creative problem-solving test. These are all very complicated areas, no wonder people spend their lives working on some small aspect of these big, big questions. How can we simplify such complicated notions?

Nearly all these articles appear with a few choice examples of famous artists who were well-known sufferers of mental illness--or just really odd ducks. Along with writers like Plath, Hemmingway, and Poe, there were snippets about Van Gogh, Warhol, and Dali. Journalists do love sticking in some celebrity information to spice up any article, and by putting a famous face to a disease, or a trend, the article gets more tread and readers identify with the concepts more easily.
Turns out that soup cans weren't the only thing he held onto.

I learned that Andy Warhol was apparently a hoarder . . . 20 years after his death, archivist Matt Wrbican has only made it through 19 of the artist's 610 "time capsules," according to an article on the science of hoarding published in the Pacific Standard. The reporter goes on to share the thoughts of Randy Frost, a psychology professor who authored the first systematic study of hoarding: "the neurological hallmarks of hoarding might indicate a giftedness in the aesthetic appreciation of the physical world, rather than pure illness . . . People who hoard tend to live their lives visually and spatially instead of categorically, like the rest of us do." Sound artistic to you? I had heard that hoarders, who in the DSM-4 are placed on the OCD spectrum, had a higher-than-average sense of 3-D visualization and recall, but I was unable to find any articles mentioning that.
WTF was wrong with Michelangelo anyway?

But the online lists of artists, or famous people in general, who had (or may have had) mental illness go on and on. A list of "historical geniuses" from Mental Floss speculates as to whether Michelangelo had autism. Painters Paul Gauguin and Jackson Pollock are believed to have suffered from bipolar disorder according to a snippet on the "Top 5 Mad Geniuses" (interestingly, though, only one visual artist made that top five--Vincent Van Gogh; there was also John Nash, a mathematician; Sir Isaac Newton, a physicist; Edgar Allen Poe, a writer; and Ludwig van Beethoven, a composer). Content provider Brainz has a not-so-gently-titled list "10 Great Painters Who Were Mentally Disturbed" in which Michelangelo is suspected of having depressive tendencies or bipolar disorder, but not autism. Cracked.com featured a list titled "7 Eccentric Geniuses Who Were Clearly Just Insane" and yep, Michelangelo made this list too . . . this time for ignoring personal hygiene and being unable to converse with people, so we're back to autism with him. If you have several hours to kill, you could google your brains out looking up more of these lists. Clearly there is a market for them, people are interested to know exactly what the fuck was wrong with Michelangelo, at least.

So, these lists frame the question one way: How many artists are (or were) mentally ill? What about approaching it from the other direction: How many of the mentally ill are artists?

I was able to speak with an old friend of mine who has spent the last 20 years working with troubled kids. The teens he sees are suffering from depression, anxiety, sometimes schizophrenia or bipolar disorder. While it still is anecdotal evidence, I wanted his take on the whole "creativity-mental illness" link. He told me, to my surprise, that he found these kids as a whole to be "not really a creative group." Out of the couple thousand or so young people he has worked with, he said he only remembered two that could draw pretty well. Two out of two thousand? Not exactly the kind of ratio that I'd expect after reading all those articles. I told him about all the stuff I'd been reading and asked, "so, in a group home for troubled youngsters, you don't exactly walk in and see half of them sitting in corners doodling?" He laughed. No, definitely not, he said. These kids have enough trouble doing typical life-skill things.

Suicide Rates

Mental illness can lead to suicide, so I thought that looking into suicide rates listed by profession might be illuminating. Oddly enough, the few lists I surveyed online didn't even mention artists! Though lawyers, farm managers, dentists, and chiropractors (among others) were all listed in the Business Insider's 19 Jobs Where You're Most Likely to Kill Yourself, artists were nowhere mentioned. And these lists (there are many) looked more like typical trumped-up clickbait than serious data. The American Psychological Association takes a more reserved stance in a 2001 overview: "Experts on suicide say that statistics on its relation to occupation are not clear. There is no national data set on occupation and suicide." The article quotes Ronald Maris, PhD, director of the Center for the Study of Suicide and Life-Threatening Behavior: "Occupation is not a major predictor of suicide and it does not explain much about why the person commits suicide." Though the APA goes on to say there were some larger studies in the last few years that have provided some thought-provoking questions. One 1997 study analyzed death certificates from 1980-1984 and did find statistically significant elevated rates for:
  * White male physicians.
  * Black male guards (supervisors, crossing guards, police, protective service)
  * White female painters, sculptors, craft-artists and artist printmakers.

So . . . we're in the top three! In fact, I, specifically, as a white female sculptor/craft-artist made it into the top three! Woooo! At least, in the early 1980s.

Much of this older data doesn't even mention soldiers, who, thanks to over a decade of conflict, are in the news more and more for elevated suicide risk. USA Today reported just last month that the Army suicide rate, which has historically been "far lower than the civilian figure, surpassed it in 2008 and kept climbing." Mental health issues have risen 65% in the military since 2000, and there are serious efforts underway to treat the depression and post-traumatic stress disorder that soldiers are returning home with.

Environmental Factors

Soldiers at war have obvious environmental factors at work against their mental well-being. Yet caricature artists, I can easily state, do not face the occupational risks and trauma that soldiers at war have to deal with. People who earn their living by art have, historically, had problems with poverty, persecution, alienation, and stress, which are all associated with higher risks for mental illness.

Do we, specifically as caricature artists, deal with being poor? Yes, certainly that's true for most of us at some point or another. Do we have social or family alienation issues? Many do. (I once worked with a crew of artists who discovered, that out of all four of us, not a single one was on speaking terms with their father). Do we deal with jerks? Well, yes, sometimes daily. Do we deal with annoying customer-service issues, overbearing moms, and aggravating crowd-control issues? Yes, yes, and yes. But what we deal with is also dealt with by so many other service workers, from retail staff to mall photographers. And I find that, generally, these experiences temper us, make us stronger and better at dealing with people. I have witnessed it not just in myself but in other colleagues, who were awkward at first but became much better at dealing with people given the practice.

If you think hard enough about the environment versus the inborn tendencies, it becomes like the chicken and the egg. Do creative fields simply attract people who have neurological dispositions that are more prone to mental illness? Or does the job itself change you in ways that are detrimental to your sanity? What about artists who work hard to cultivate a quirky or eccentric persona just for the marketing advantages . . . anyone know the story of Salvador Dali showing up to his gallery show wearing a scuba suit? I cannot verify this online, but had heard that when questioned about why he was wearing such a thing, he said "because no one will forget it." Mad, or just a marketing genius?

Not everyone is a marketing genius--or a genius of any kind. And I'm just speculating at this point, based on personal interaction and meeting a LOT of artists over the years. How much of the depression, anxiety, narcissism, and so on, can be attributed to (for lack of a better, more clinical term) "unfulfilled dreams"? So many people get into the visual arts, just as they get into music, singing, sports, or writing the great American novel, with an underlying hope of "getting discovered" and becoming famous. It might be harder for artists to face their own mediocrity--for there is no age cap on success in this field. Once youth fades away, athletic hopefuls must put away their dreams of the NFL or Major League Baseball and readjust their career goals to coaching high school or college ball. Not many singers in their 50s believe they can be the next American Idol. But Grandma Moses didn't even start painting until she was in her 80s. I have worked with quite a few folks who honestly believed that artistic recognition, even fame, was always just around the corner, they just had to schlep caricatures until they could be "discovered" by someone. One old timer asked me to edit his autobiography, which he had been working on obsessively for decades. Guys (and gals) like this usually are overly dramatic when they get a caricature rejected by a customer, and they take it as a paper-cut to their soul rather than an everyday part of the business. (Well hopefully not every day, but you gotta take 'em when you get 'em and move on.)

Though I'm not sure I'd categorize that particular brand of artists as having mental illness. Maybe their mom told them one too many times that they were a brilliant artist, and they believed her. Maybe it's an ingrained sense of entitlement coupled with an inability to train their eye. Maybe they're just insufferable pricks who can draw passably well but "think they're the next funny picture messiah" (that's an exact quote from one of my old managers about a cocky young upstart who, oddly enough, went on to display quite a few of the problems that plague bipolar sufferers, including substance abuse and bouts of homelessness). Still, there's annoying and then there's mentally ill, and plenty of room between the two. If only there were a category for folks that aren't quite "crazy" themselves but drive people around them up a wall. Oh wait, there is . . .

Personality Disorders

The DSM, which has gone through many revisions and attempts at grouping mental health issues under various models, currently lists clinical disorders under Axis 1 and personality disorders under Axis 2. While the things listed as Axis 1 include schizophrenia, bipolar, anorexia, depression, anxiety, and many others that are recognizable to the layperson as clinical issues, the Axis 2 disorders are a bit less overtly clinical: intellectual disabilities and a whole litany of personality disorders. A non-diagnostic shorthand way of thinking of personality disorders is the immediate classification of "Wow, that person is an ASSHOLE!" In my first clinical psychology class, the first day, the professor asked the class how many people wanted to work in the mental health industry, with patients. About half the class raised their hands. Then he said "You realize they're jerks, right? Just so you know, you won't like them. You'll be irritated and annoyed and really, really want to hate them. Be aware of that." Personality disorders seem like a clinical way of sorting out different types of jerks.

That friend of mine who works in the mental health profession admitted that he uses a few "red flag" shortcuts when identifying clients with personality disorders--a trick he said he got from his mother, who also spent decades in the field. One was rings: if a white, suburban woman came in and was wearing an overabundance of rings, it was a marker (not a clinical marker, more like an informal clue) that she might have a personality disorder. I remembered instantly my days caricaturing at Ocean City, Maryland, where a shiver ran up my spine whenever an overly-made-up woman with tons of rings and super long fingernails would sit down for a caricature: the rings were a marker for me, too, of a customer that would likely be a problem.

There are many types of personality disorders, which aren't a solidly differentiated scientific class; these disorders tend to blur into one another and are described more as models, sometimes vague and imprecise but still helpful to psychologists and psychiatrists. Rather than list all of them, I'm going to copy and paste Dr. Neel Burton's description of just the "cluster B" disorders, labelled as "erratic/dramatic" and comprising the antisocial, borderline, histrionic, and narcissistic. I am making a judgment call by doing so, as I think the "troubled" artists I have known, especially in the entry-level ranks of caricature recruits over the years, tend to group more under this umbrellas than the others.



Until Schneider broadened the concept of personality disorder to include those who ‘suffer from their abnormality’, personality disorder was more or less synonymous with antisocial personality disorder. Antisocial personality disorder is far more common in men than in women, and is characterized by a callous unconcern for the feelings of others. The person disregards social rules and obligations, is irritable and aggressive, acts impulsively, lacks guilt, and fails to learn from experience. In many cases he has no difficulty finding relationships, and can even appear superficially charming (the so-called ‘charming psychopath’). However, his relationships are usually fiery, turbulent, and short-lived. People with antisocial personality disorder often have a criminal record or even a history of being in and out of prison.

In borderline personality disorder, the person essentially lacks a sense of self, and as a result experiences feelings of emptiness and fears of abandonment. There is a pattern of intense but unstable relationships, emotional instability, outbursts of anger and violence (especially in response to criticism), and impulsive behaviour. Suicidal threats and acts of self-harm are common, for which reason people with borderline personality disorder frequently come into contact with healthcare services. Borderline personality disorder was so-called because it was thought to lie on the ‘borderline’ between neurotic (anxiety) disorders and psychotic disorders such as schizophrenia and bipolar affective disorder. It has been suggested that borderline personality disorder often results from childhood sexual abuse, and that the reason why it is more common in women is because women are more likely to be victims of childhood sexual abuse. However, feminists have argued that borderline personality disorder merely appears to be more common in women, since women presenting with angry and promiscuous behaviour tend to be diagnosed with borderline personality disorder, whereas men presenting with identical behaviour tend to be diagnosed with antisocial personality disorder.

People with histrionic personality disorder lack a sense of self-worth, for which reason they depend on the attention and approval of others. They often seem to be dramatizing or ‘playing a part’ (‘histrionic’ derives from the Latin ‘histrionicus’, ‘pertaining to the actor’) in a bid to attract and manipulate attention. They may take great care of their physical appearance and behave in a manner that is overly charming or inappropriately seductive. As they crave excitement and act on impulse or suggestion, they may put themselves at great risk of having an accident or being exploited. Their dealings with other people often seem insincere or superficial, which can impact on their social and romantic relationships. This is especially distressing for them, because they are especially sensitive to criticism and rejection and react badly to loss or failure.

Narcissistic personality disorder
Narcissistic personality disorder takes its name from the myth of Narcissus, a beautiful youth who fell in love with his own reflection. In narcissistic personality disorder the person has a grandiose sense of self-importance, a sense of entitlement, and a need to be admired. He or she is envious of others and expects them to be the same of him or her. He or she lacks empathy and readily exploits others to achieve his or her goals. To others he or she may seem self-absorbed, controlling, intolerant, selfish, and insensitive. If he or she feels slighted or ridiculed, he or she may be provoked into a fit of destructive anger and revenge-seeking. Such ‘narcissistic rage’ can have disastrous consequences for all those involved.

Are you a stock photo?

Now, did anyone read through those and immediately think of coworkers--or even, of yourself? Don't feel guilty, it's a normal reaction when you read something like that. These are lists of traits . . . but it's not categorized as a disorder unless those traits are so overwhelmingly present, and exaggerated, that it impedes one's career, social life, family life, and well-beling. I mean, we all get satisfaction out of being admired: when you're the life of the party and everyone absolutely loves your drawings, it's hard not to bask in that. But unless that takes over to the point of pissing everyone off around you, all the time, then it's not a disorder.

The Forer Effect: Hey, That Sounds Just Like Me!

The Forer Effect, which is said to be behind just about every horoscope ever written, is the tendency to interpret general statements as being accurate about oneself, even when they are not. It's also called the Barnum Effect (yes, named after the "sucker born every minute" fellow). It's amazing how natural it is to apply whatever you're reading to your own life. Back when I worked as an editor, I spent a few weeks on a book called The Guide to Living with Bladder Cancer. I swear, never have I spent so many worried moments on the toilet. How many times have I peed today? Is my pee looking a little pink? I think my bladder feels funny, I should really get this checked out. Meantime one of my coworkers was working on a book about skin cancer and spent considerable time scrutinizing the freckles on her arm.

When I talked to a few of my caricature artist friends about their thoughts on this topic, they responded by pointing out that they did see hints of "mental illness" in their own dedication to the craft. Not in a pathological way but in the way they felt their brain worked. Like that example of being "a bit OCD" because you're capable of focusing really hard on a project and redoing something 85 times until it looks "just right." They had read an odd article here and there, and though they couldn't remember particulars, it all made sense. We're artists, we're a little "off."

After reading about all this, though, I think many of my friends (and I myself) are displaying the Forer Effect. Which doesn't mean we're gullible or self-aggrandizing. Just that we're human, and we like participatory narratives. It's how we think.

Regardless of whether or not I'm at a higher risk of mental illness because of my job, I gotta step back and look at my luck. I get to draw funny pictures of people, and I get paid to do it.

That's a career I'd have to be crazy to turn down.

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