I AM ILLITERATE: musically, that is; although I expect that there are many who would not think it necessary to add the qualification. Anyway, I can’t read music; yet it has always been a necessity, in every aspect of life. I do not have a favourite piece of music, because that is an impossible concept, but, if I had, it would be The Marriage of Figaro.1
I listen. It is never a background, and I could not work if any were being played. And, though I have no favourite, I do tend to listen to the same piece over a long time, until something else takes its place.
I had just finished writing a film, Images, for an educational series, and the music that had coincided with that time was Benjamin Britten’s “Serenade for Tenor and Horn”. The combination of horn with the timbre of Peter Pears’ voice was seductively lovely. It was the late morning of 16 April 1980, and I was listening to that record. In mid-phrase, everything changed. The horn and the voice were a threat, seductive still, but seducing me with death. I had to switch off quickly and get out of the room.
The next thing I remember is that I was standing in the kitchen, the sunlit kitchen, looking over a green valley with brook and trees; and the light was going out. I could see, but as if through a dark filter. And my solar plexus was numb.
Some contraption, a piece of mechanical junk left by one of the children, told me to pick it up. It was cylindrical and spiky, and had a small crank handle. I turned the handle. It was the guts of a cheap musical box, and it tinkled its few notes over and over again, and I could not stop. With each turn, the light dimmed and the feeling in my solar plexus spread through my body. When it reached my head, I began to cry with terror at the blankness of me, and the blankness of the world.
A scene from Eisenstein’s “Alexander Nevsky” swamped my brain: the dreadful passage in which Nevsky dupes the Teutonic Knights onto the frozen lake, and the ice breaks, and their faceless armour takes them under. The cloaks float on the water before being pulled down, and the hands clutch at the ice floes, which flip over and seal in the knights.
All that helplessness, cold and horror comprised me. I was alone in the house, and throughout the afternoon I turned the tinkle tinkle tinkle of the broken toy, which became the sound of the ice. My body was as heavy as the armour and the waterlogged cloaks as I slid beneath the ice.
When the family came home, I was lying on the kitchen settle, in a foetal position, without moving or speaking, until I went to bed at midnight. Sleep was unconsciousness without rest until the morning, when I had to face what I now dreaded: the camera and the crew, and speaking for five days into an unblinking lens to communicate with the millions of people on the other side of it, to generate emotional energy for them from my dead heart.
I was incapable of emotion except that of being incapable of emotion. I had no worth. I poisoned the planet. I noticed, but did not wonder at how the finished film showed none of this. I knew that the man was me, but I did not know him.
The following year, Images won the First Prize at the Chicago International Film Festival; but by that time I had spent twelve months of twelve hours each day on the settle, my face to the wall, waiting only for the twelve hours in bed. My small children would, instinctively, stroke the back of my neck, not speaking. Their stroking was the only thing that reached me.
The doctor diagnosed “endogenous depression”, which meant depression without external cause, and prescribed, progressively, the pharmacopoeia of antidepressants. None of them worked. For two years I lay either in the kitchen or in bed. There was no feeling except of a wretched superfluity. I was the grape skin after the harvest; and even that gave me the weight of reality I did not feel.
Then, one morning, almost two years to the day, I woke to find that I had come back. It was instant. Nothing was wrong. What had all the fuss been about?
Two events followed, almost coincidentally. My doctor, who was a fine doctor, retired and a younger partner took me on. And I had a long letter, with a longer C. V. attached, from a Dr Kay Redfield Jamison, Associate Professor at the Neuropsychiatric Insitute Center for the Health Sciences at the University of California, Los Angeles, to ask whether I was willing to take part in a survey of mood disorders and patterns of creativity in “eminent” British writers and artists. Her criterion of choice was that the participants should have won at least one prestigious award in their field. I agreed to try, noting to myself that the prolific intensity of the C.V. suggested that the doctor knew from personal experience more than she was saying.
A familial connection between mental illness and creativity had been suggested by other surveys. But Dr Jamison’s structure of questioning enabled her to elicit more precise facts. The protocol I had to fill in was a thoroughgoing grilling, and took several days to complete. And the subsequent analysis of the data was more than significant.
In brief: 38 per cent of writers and of artists had been treated for a mood disorder, of whom 75 per cent had had antidepressants or lithium prescribed, or had been hospitalized. For poets, the figure was 50 per cent on lithium. 63 per cent of playwrights had been treated for depression, and more than half through psychotherapy. 89 per cent of the survey, including all novelists and poets, reported periods of high productivity, lasting usually betwen two and four weeks, and extending into most other areas of living.
Dr Jamison knew exactly what questions to ask, thereby producing an overall response much more detailed and informative than I have outlined. In her summary, with grave understatement, she said that the percentage of treatment was “extremely high”, since the prevalence rates for manic-depressive and depressive illness, in the general population, are 1 per cent and 5 per cent respectively.
For a complete understanding of the implications, I would recommend the book she went on to write, which incorporated the British survey: Touched With Fire: Manic-Depressive Illness and the Artistic Temperament (The Free Press, New York, 1994).
At least I was not alone. And, with greater understanding and hindsight, I could see that the whole of my life had had a pre-echoing pattern, at a low level, of mania and inertia. But why had this pattern become without an apparent trigger a full-blown state of near-catatonia and wretchedness, in the form of cold self-loathing for me, and desperation for my family? I was soon to find out.
Fourteen months after returning to “normality”, yet without any ideas that had enabled me to work, I was hit as unexpectedly by the most demanding task of my life, so far: work that occupied me, at full stretch, without a diminution of energies, for two months short of twelve years. I was firing on all cylinders, including many I did not know I had. The stress, though different, was no further from the unendurable, either for me or for the family, than the two-year dark. But it was exciting and it was positive. And that gave me a clue, or at least a model. I had had to be totally incapacitated, in order to build the energy, to fill the reservoir, that would be needed. The analogy with an enforced hibernation fitted. If I could live with this self-loathing, and see it as a signal to let the waters rise, it could remain a necessary though unpleasant part of a positive and creative process. As long as that thought stayed, I could endure.
There were tough periods during the first six years, at irregular intervals, but not the bottomless pit. I kept going. And they lasted hours, days, but not often weeks. The importance lay, as I faced the wall from the settle, in knowing that: a) this would pass. b) there was nothing I could do, so I should go with its purpose. c) it would also, having passed, return. d) it would pass.
In 1989, after six years of working and living on this unstable raft, I sensed the ice floes tinkle again, in the distance. I also realised, and wondered why the importance of it had not struck me, that none of the antidepressants had ever worked. So I took myself off to the doctor and gave him this fresh insight. He asked me to tell him in detail the rhythms of my work patterns, checked through the encyclopaedia of my medical notes, relating the two, and said, “There has been a misdiagnosis. You are clearly manic-depressive.” It remains the best news that I have ever heard.
To anyone who is in any way ill, let me assure you that there is nothing that brings greater relief and solace, no matter what is wrong, than an accurate diagnosis. With that weapon, you can act on the wisest medical advice in the world, given by the first century Roman, Persius: Venienti occurite morbo: “Don’t muck about: hit disease head on.”
That is why Montgomery kept the portrait of Rommel with him all the time: to learn the man. To know is to respect and not to fear. I found myself walking out of a doctor’s surgery almost weeping with euphoria that, at last, I knew that I was wading in the shallows of psychosis. Where did the continental shelf end? Where was the abyss? I should learn to take soundings.
I remembered the analogy of enforced hibernation. It could be made more positive; it could be moved further and be interpreted as a chance to incubate ideas. Then a line of Theodore Roethke (himself a manic-depressive) appeared: “In a dark time, the eye begins to see.”
With a speed that I could hardly keep up with, the whole was revealed. (What happened, incidentally, is a typical example of manic connection, of “finding”. It was as if a computer were cross-referring its files.)
I had been here before, at Oxford, as a Classicist. From that I saw the universality of the personal. It was the ancient, mystical experience of “black sight”. Prophets are often blind. Oracular caves, where vatic priests go to find truths that cannot be found in the light, are a part of our history. That history, which is the history on which all Western thought is based, is Classical Greek. What we call logic may just as well be defined as “the way adult Athenian males of the fifth century BC think”. Yet Greek culture and art (especially the tragic theatre), which we perceive to be the height of human achievement, descends from the worship of Dionysos, whose epithet was in Greek “mainomonos”, “raving mad”, and the theatre started as his temple, where illusion was the reality. A modern definition of madness is the taking of illusion for reality. The Greeks sat in the temple of their mad god and, for a while, watched illusion as reality. To behave so is madness. Herodotus reported that the Scythians blamed the Greeks for the introduction of insanity to the world, since it was not an act of reason to adopt a god who drives humans mad.
So we have a fascinating paradox, where the source of our criteria for stability of thought is built on a culture that appears to have based itself on the worship of madness, while this same mainomenos Dionysos also represented indomitable life. In Classical Greek there are two words for life. One is “bios”, which means simply life, or a life. The other is “zoe”, which is the eternal life force. To have “zoe” associated with “mainomenos” could not be more instructive.
Later, it seems that Christ built into his ministry metaphors and rituals taken straight from the cult of Dionysos that flourished amongst non-Greeks between the lake of Genesareth and the Phoenician coast, which he would have come to know, if he did not know already, on his journey to Tyre. Which is again instructive, and may legitimately lead to an hypothesis.
To look at Christ the man, removed from his divinity, which is how most of the world sees him, leaves little to the imagination or to prejudice. A Jew, for instance, recognises him as an inspired Rabbi; but a psychiatrist, at the same time, has to suspect the symptoms, since a strand running through almost everything recorded of that ministry, psychologically and physically, could be seen as an account of manic-depression. Only his divinity set him apart; and there he may have modelled the imagery on raving Dionysos.
I am aware that what I am saying may be surprising to many and obnoxious to some. But the link cannot be easily avoided. In Minoan Crete, where the worship of Dionysos arose, his name, “Dios nusos”, meant “Son of God”. He was a god who suffered, and triumphed over suffering. And a clue to the connection with Christ may be found as late as AD 691, when the Second Council of Constantinople decreed that wine treaders should be forbidden their traditional cry of “Dionysos!” and must replace it with “Kyrie eleison!” Walter Otto, in considering the Greek word “mania” in connection with Dionysos, called it a visionary attempt to explain a state in which the vital powers of Man are enhanced to the limit, in which consciousness and the unconscious merge to a breakthrough, which he equated with “the Dionysian”, and I recognise as “creativity”.
There is a deal more to be said, but let this stand for all.
Jesus could, by making much of Psalm 80, and by reference to the Septuagint Jeremiah, if he knew it (God to Israel: “Yet I planted thee a chosen vineyard.”), have claimed Biblical authority and fulfilment for what he said and did, as happens so often in the Gospels. And, by taking the symbolism of wine, equating it with his blood, and referring to himself as “the true vine” (John 15.1 ff), he was likening himself to the Dionysos that we know through the Orphic texts. He may even have tried to usurp him.
The peculiar story of Christ’s cursing of the fig tree out of season, recorded in Mark 11, has puzzled Biblical commentators. A plausible argument, given the Bible’s constant use of metaphor, is that Christ was privy to the Dionysiac Mysteries, the climax of which was the removal from the sacrificial goat, in great secrecy, of an organ called “the heart”, “kradiē” in Ionic Greek, and its preservation in a basket. It was not the heart that was removed but the phallos, and so sacred was this act that it could be mentioned only obliquely and by punning. “Kradē” is the Greek for “fig”; and in a myth of Dionysos he makes a ritual phallos by carving a fig branch. Hence the profound pun, “kradiē” and “kradē”, of the Mysteries.
Also, but here the modern novelist may be at work (although the commentators have no more credible answer), a further instance can be seen in John 1.48, where Nathanael is perplexed that Jesus should have recognised him. Christ’s apparently meaningless reply, “When thou wast under the fig tree, I saw thee,” could have been an encoded, “I remember you from when we were both at a celebration of Dionysos.” The Mediterranean wine culture was the common concrete background to two divergent realities: the founding of Christianity and everything that can be subsumed under the term “Dionysian Mystery”. Such an initial convergence would be seen as a threat by the early Church.
On no account should it be thought that I am seeking to undermine a religion, or that I should want to criticise faith. The opposite is the case. If my hypothesis were ever found to be fact, I should hold that Christianity had been strengthened, not diminished. A tenet of the Church is that God entered History by becoming Man. If that were to be a truth, I have said nothing outlandish. If Christ was Man, he was of his own will open to all of Man’s experiences, even unto death. There can be no dispensations. I should not want my god to be unable to understand me and my experience; but I am unequivocally and emphatically not saying, “Manic-depression means God. Hallelujah.”
The most poetic aspect of all, for me, is that the first word of the oldest complete sentence to have survived in the West is “madness”. The opening line of the Iliad is an invocation to the goddess to sing the fury of Achilles; and the word used is menin, which relates to the outward loss of control through the mind’s insanity.
The road we travel could scarcely be longer.
Meanwhile, Dr Jamison has co-authored, with Fredrick K. Goodwin, the definitive, nine hundred and thirty-eight page exegesis: Manic-Depressive Illness (OUP, 1990), which, to her other multiple honours and academic qualifications, added the Most Outstanding Book in Biomedical Sciences, chosen by the Association of American Publishers; while I have undertaken the via dolorosa of arriving at the correct level of lithium carbonate for my body, the only drug to control manic-depression.
From here onwards I must be careful to differentiate between the personal and the general, because manic-depression is only a simple label for a complex and varied condition. It took Kay Jamison nine hundred and thirty-eight pages to deal with it, and here I am just trying to be helpful. My only qualification for speaking is that I have found ways to live a profitable life with a most dangerous and, so far, incurable condition, and I have read the literature.
Kay Jamison found that there was a tendency for creative minds to refuse to continue with lithium. The freedom from the “lows” did not compensate for the loss of the “highs”. So it was with me. There was no stress, no grief, no animation, no laughter, no thought, no ideas. I was socially safe and could be taken anywhere. I stopped work. I had no interests. It was unique, for me, and I translated it as, “If this is what normality is, give me back my madness.” I refused to continue with the lithium treatment.
If it had not been for something else, the result could have been almost anything. I may never know. However, I started work again, and the final six years of the novel involved me entirely in anthropology: the embracing of the philosophy and thought patterns of a highly sophisticated so-called primitive society. For our purposes, all I need say is that one of their models is that the cosmos is built of nine temporal dimensions, all capable of being simultaneously present.
Coming to terms with the demands of this society, especially after my training in formal logic and Hellenistic thought, took up my concentration, and it was about four years into the discipline that I became consciously aware that I had had no manic-depressive episodes.
That is not strictly true. At one level, I go through the cycle every twenty-four hours, but that level is low. All my life, my metabolism has made me severely dysfunctional in the morning. I take a long time to wake up, and feel rotten, and can’t think. But also, now, every morning, in the middle of the gloom, I go through a depression. It is slight, and normally lasts minutes. But it can threaten worse, so I always check, with a measure of my own devising.
I am amazed, and delighted, that one of the stone flags of the kitchen floor has the fossil footprints of a small dinosaur on its surface. When I feel myself entering the blackness, I look at the footprints. If my reaction is still of awe (“How terrific to have this frozen moment of two hundred million years ago still active!”) then I know that the blackness is a railway bridge flicker, not a tunnel. If the reaction is a panicky: “How can you bear not to be able to move for two hundred million years?” I take that as a warning, and apply one of the “primitive” mental exercises that are concerned with the handling of time. I side-step, as it were, the blackness.
The method can be adapted to any place or circumstance. It is personal to me, but I feel that it should be examined medically, to discover what is behind the metaphor, in case there is something potentially of general value.
I am by no means complacent. Manic-depression is devious, in that it is not always a cyclical or wave-like phenomenon. To hit “low” when “high” can be fatal. The greatest threat in manic-depression is of suicide. A quarter to a half of sufferers are going to kill themselves, if something is not done.
I have always had the strongest philosophical, social and ethical objections to suicide. And, even at my worst, suicide has never offered itself as the way to help either me or the rest of the world. It is a particularly vile act, because it loads friends and relatives, the closest, the most dear, with a sense of guilt that cannot easily be assuaged, each one thinking that they must be personally responsible for what the suicide has done; and this frequently triggers mental breakdowns, alcoholism and further suicide through the generations, since manic-depression is genetic. Its pattern is clear, through my maternal line, for a hundred and fifty observable years, though never diagnosed until now. Usually, we have been “under the doctor with nerves”.
Even now I know that I can never drop my guard. I have too much to do, for one thing, and my greatest concern is to help bring about the future. I am not here to kill it.
Manic-depression can ambush. It can hit when least expected. Most sufferers know that, and take precautions. Winston Churchill, for instance, always stood as far away as possible from the edge of a railway platform. I try never to be out of instant reach of a sympathetic mind. There is something of a joke here. I am by nature a loner. I find my own company stimulating. I abhor cities, crowds and social events. I seek the isolation of woods and hills. My work of necessity is isolate. Yet I try, when indoors especially, never to be out of reach of the safety that one human being, who need not be in the same room, secures.
It is particularly important when I am drawing on the enormous energies provided by a “high” in order to sustain a piece of work; so that, when I finish, or pause, if the rebound of a “low” were to meet the remains of a “high”, I could distract, or adjust, my emotions by having a fragment of “normality” to refer to. The end of a book, and the end of a lecture, are the times of greatest need. So much for me. Now, is there anything I can say about this chameleon madness that is of general use? I shall try. First, let me speak to the family.
The most important hurdle to be crossed before any progress can be made is for the family, and particularly the sufferer, to acknowledge the illness and to seek, and follow, medical advice. Then, do not let the sufferer (despite my example) give up on the treatment without your fighting, and do report the matter. It is almost diagnostic that a manic-depressive, once the agony is mediated, will react with a feeling of omnipotent well-being, and insist that a cure has taken place. There is no cure.
Never, at any time or under any stress, lose patience and say something to the effect of: “Why don’t you pull yourself together?” Learn, and keep before you, so that you will recognise why you cannot even begin to realise what the other is experiencing, Gerard Manley Hopkins’ lines from his poem “No worst, there is none”:
. . . mind has mountains; cliffs of fall,
Frightful, sheer, no-man-fathomed. Hold them cheap
May who ne’er hung there.
Hold them cheap, may who ne’er hung there. He is saying, because he knew, that only the manic-depressive can truly understand the manic-depressive. Accept that you cannot feel what the other feels; that your sympathy will, no matter how great, be taken to the edge of breaking. It is here that sympathy and empathy must be most clearly differentiated between, and here you cannot empathise.
Remember that everyone in the equation will be touched by it, and do not hesitate to go for help on your own account. It may be a unique event for you, but it will not be for the doctor.
There is a paradox that is so easy to miss that I must stress it here. I may have spent a disproportionate time on the experience of depression, because it is then that the individual is in most pain, which is hard for the family to stand by and watch in a feeling of helplessness. But there is a worse helplessness for the family, and that, strangely, is the “high”, not the “low”, since the sufferer is so energetic, so persuasive and persuaded, that there is no appealing to reason, and the family, in self-defence, must close ranks, or, inevitably, be ground down.
Contrariwise, if there is reason and it can be appealed to, then everyone may share in the excitement, because the “high” could have produced something new, good, and true. It is all a matter of balance.
To the manic-depressive, I would say: don’t try to deceive yourself, nor feel sorry for yourself. Apply what I have said to the family to your point of view. Stick with the treatment. Devise your own defensive and diagnostic measures, the equivalent of my dinosaur footprints, if you are able. Listen to your family, even if you have to preface what they say with: “they don’t know what they’re talking about, but I’m big enough to humour them”. Then keep your word, and humour them. You are not alone. You have worth. You are loved. There is help.
Let me end by taking a longer perspective. It is an interesting question whether, from a Darwinian point of view, manic-depressives evolved, and, if so, why; and an even more interesting question why they are not extinct. Our son, who is a postgraduate biologist, has suggested, in what he would call a “coffee-time” idea, that an answer may lie in the fact that we are still savannah apes. Since a significant proportion of manic-depressives have creative minds, and are dominant when “high”, evolution would select for them, because they would be likely to have made their innovative contribution, and to have bred, before their condition became fatal.
If you have seen the film 2001, you will remember the ape picking up a bone and looking at it, this way, then that way; turning his head, this way, then that way. His eyes light up as he sees the connection. He is the inventor of the first tool. In a moment of elation, he throws the bone into the air. As it revolves it becomes a space vessel. We may have seen the first manic-depressive. And if he has reproduced before this moment it is biologically acceptable for him to die now.
It is frequently observed that innovators have been manic-depressive. A common retort, and one that applies to me, is that innovators do not “think”. They create by “seeing” involuntarily, and only then refine the creation by thought. For me, a novel is a series of connections which have always existed, but which no one else has seen.
The fortunate manic-depressive, in this way, invents a device that benefits humanity, discovers a cure (perhaps, one day, for manic-depression, should that be desirable), or creates a work of art. The unfortunate manic-depressive “sees” as does the fortunate; but it is not a true connection, and there is not available, in the degree of insanity, the logic to think out not the refinement but the absurdity. The connection then is more likely to be: “I shall buy two hundred lawnmowers, and shall have solved the problem of global warming.”
The differences are so slight. If you alone can see the “truth”, you need good friends who understand that you have “knowledge that is sad to have to know”.
The worst case I have come across is that of an American psychiatrist, who was so successful in his accurate, intuitive and non-rational insights, that a special faculty was set up for his work. Shortly afterwards, he became ill, and was diagnosed as manic-depressive. How, then, could he himself trust his intuitive genius? And how were the admiring colleagues who had gathered around this great man to react to his hunches in the future?
I am only a writer, a maker of dreams. You can dismiss me and no harm is done. If I were your lawyer, or your bank manager, it would have been imprudent of me to have spoken today.
Kay Jamison, however, now Professor of Psychiatry at the Johns Hopkins University School of Medicine, having established her position as world authority on manic-depression, sits at her desk, takes up her pen, and writes An Unquiet Mind: a Memoir of Moods and Madness (Knopf, New York, 1995; Picador, London, 1996), which is a detailed and uncompromising account of her life-long dialogue with her own experience of relentless manic-depression. It is the bravest, and the most hopeful, document that I have ever read.
It made me, after sixteen years, dare to put on that record of “Serenade for Tenor and Horn”, and to listen.
1 This lecture was delivered at an event organised by Stockport Health Care for World Mental Health Day at Stockport on 5 December 1996.