Manic Depression and Creativity - www.questia.com

One of the best books I have ever read !! A fine blend of art, history, biographies and science.
Marco Rodrigo.

Manic Depression and Creativity
Book by D. Jablow Hershman, Julian Lieb; Prometheus Books, 1998
Subjects:
Genius And Mental Illness, Genius And Mental Illness--Case Studies, Manic-Depressive Illness, Manic-Depressive Illness--Case Studies
Collections: Psychology, Entire Library
From Plato, who originated the idea of inspired mania, to Beethoven, Dickens, Newton, Van Gogh, and today's popular creative artists and scientists who've battled manic depression, this intriguing work examines creativity and madness in mystery, myth, and history.

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Contents
Preface
D. Jablow Hershman
1
1.
A Dissection of Genius
7
2.
Manic-Depression
19
3.
Newton
39
4.
Beethoven
59
5.
Dickens
95
6.
Van Gogh
139
7.
Diminishing Creativity
177
8.
Augmenting Genius
197
Epilogue
Julian Lieb, M.D.
207
Bibliography
217
-v-
Questia Media America, Inc. www.questia.com Publication Information: Book Title: Manic Depression and Creativity. Contributors: D. Jablow Hershman - author, Julian Lieb - author. Publisher: Prometheus Books. Place of Publication: Amherst, NY. Publication Year: 1998. Page Number: v.

Excerpt:

Epilogue
Julian Lieb, M.D.


People ask: "Where are today's geniuses? Where are our Newtons, Beethovens, Einsteins, Edisons, Picassos? Our Byrons, Mozarts, and Verdis? It is an interest- ing question.Perhaps instant commercial success deprives some creative people of motivation. Or might it be that our institutions, in the name of political cor- rectness and in ignoring the adverse effects of academic tenure on the pursuit of truth, suppress genius in the sciences, while overvaluing it in the field of enter- tainment? One need go no further than to examine the intellectual achievements of many who deliver commencement speeches at our colleges and universities for insight into our values as the millennium draws to an end.
Warfare on a massive scale and genocide depleted the twentieth century of legions of potential geniuses. How many of those who fell at the Somme, at Tannenberg, at Verdun, on Guadalcanal, at Midway, on Iwo Jima, at Stalingrad, or in the Sinai, or met their deaths over Hamburg or Berlin would, had they lived, permanently enriched humankind? How many who would have followed in the footsteps of Rubinstein, Horowitz, Oistrakh, Bernstein, Chaplin, Chagall, Sabin, Salk, and Bohr, perished in Auschwitz, Treblinka, and other concentration camps? Will the England of Shakespeare, Keats, Shelley, Blake, Tennyson, Milton, Wordsworth, Dickens, Stevenson, and Churchill ever recover fully from the dreadful drain on its manpower during two world wars? Drawing to a close is a century in which paranoid tyrants in the USSR, Cambodia, and elsewhere made the extinction of intellectuals a matter of state policy, an epoch in which a mon- ster such as Josef Stalin thought nothing of murdering a Maxim Gorky.
This century has produced its geniuses, some in the arts and sciences, many in the field of entertainment. Among the latter are: Irving Berlin, Alan Jay Lerner, Frederick Loewe, Cole Porter, Richard Rodgers, Oscar Hammerstein, Jerome Kern, Charlie Parker, Thelonius Monk, Bud Powell, Oscar Peterson, Charles Mingus, John Coltrane, Wes Montgomery, Dave Brubeck, Stevie Wonder, Neil Diamond, John Lennon, Paul McCartney, George Balanchine, Arturo Toscanini, Richard Burton, Laurence Olivier, George Gershwin, Steven Spielberg, Francis Ford Coppola, Alfred Hitchcock, Michael Crichton, Walt Disney, and Jim Henson.
Although many have had a powerful impact on society, history will place few of them in the company of Leonardo da Vinci, Beethoven, Newton, van Gogh, Dickens, and other towering creators of the past.Posterity will decide who among them provided humanity with work of supreme and lasting value. As we mentioned earlier, genius is a relationship, and one's reputation as a genius varies in longevity, depending on the field of endeavor. Scientists may wear their crown for millennia; entertainers are quickly forgotten.
Many of the entertainers mentioned above are known to have had episodes of depression or manic-depressive disorder. The lives and careers of Elvis Presley, Marilyn Monroe, and David Helfgott recapitulate, in the twentieth cen- tury, the themes of the lives of manic-depressive geniuses from previous eras. Elvis and Marilyn, after achieving unprecedented artistic and commercial success and international fame, were felled by manic-depression's paradoxical, adverse effects.The same disorder brought David Helfgott fame and commercial success, but deprived him of virtuosity and critical acclaim.
Marilyn Monroe's talent as an actress won her the accolade of genius from no less than Lee Strasberg, the founder of method acting.But while the public elevated Marilyn to legendary status, her private life was marred by frustration, despair, and defeat. Marilyn's biographers collectively portray her as a person with an underlying chronic depression characterized by low self-esteem, persis- tent insomnia, anxiety, panic attacks, paranoia, and impaired memory and con- centration.Not surprisingly, she was often late to arrive on the set, had difficulty memorizing her lines, and often flubbed them.
Marilyn Monroe had a family background of mood disorders and suicide. Her mother, Gladys, was chronically depressed, suffered depressive delusions, and spent much of her life in psychiatric hospitals. Marilyn herself suffered from prodigious mood swings, switching from apparent calm to towering rages which, according to Lee Strasberg's daughter Susan, evaporated quickly.When Marilyn couldn't sleep, she often exceeded the dose of the hypnotic her physician pre- scribed. Strasberg concluded that the medication was ineffective, even in higher doses.While Marilyn lived with the Strasbergs, their pharmacist would call to express his concern about the prescriptions for sleeping pills she kept filling.
Susan describes Marilyn as explosive, impulsive, easily distracted, self-crit- ical, and given to swearing.When nothing was happening in her life to distract her, she became restless and agitated. By contrast, her hypomanic episodes were characterized by "tremendous energy, which came out in herculean bursts of activity." These were followed by "total depletion and depression ... there were more mountains and valleys in her life than in the Himalayas." Marilyn joked about her depression and about suicide, and frequently threatened it.Once, when traveling with the Strasbergs, she suddenly exclaimed, "if it wasn't for the work, I'd throw myself out of the car."
Marilyn spent hundreds of hours in a futile ritual of Freudian psychotherapy. Worn down by the wear and tear of her anxiety, mood swings, chronic insomnia, and sensitivity to stress, she flirted with suicide by self-medicating with barbitu- rates and other sedatives. According to Donald Spoto, author of the biography Marilyn Monroe, Marilyn's chronic use of barbiturates such as Amytal and Nembutal drew her into "a vicious cycle of insomnia, drug-induced sleep, a stu- porous morning, and a vaguely unhappy day endured by taking more pills." Spoto writes that these agents induced chronic constipation, which Marilyn relieved with enemas.
On February 7, 1961, Marilyn accepted her psychoanalyst's advice and admitted herself to the Payne Whitney Clinic in New York City to be withdrawn from barbiturates and to rest.When Marilyn discovered she was in a psychiatric ward with locked doors, she persuaded ex-husband Joe DiMaggio to pressure the hospital into discharging her.After recuperating in a private room at Columbia Presbyterian Hospital, Marilyn fired her psychoanalyst who, she believed, duped her into the initial admission, and flew to the West Coast to resume Freudian psy- chotherapy with a former psychoanalyst, Ralph Greenson.
Spoto's biography is unsparing in its condemnation of Greenson, who fos- tered a dependency relationship.He met with Marilyn five to seven times a week, and spoke to her on the phone every day.He failed to keep therapeutic distance, even encouraging Marilyn to have contact with his family.Just as Lee Strasberg had previously blurred the roles of teacher and father, Greenson became a Svengali in Marilyn's life.In the weeks that preceded her death, Marilyn and Greenson were in the process of discussing termination of therapy, an event which for helplessly dependent, depressed people is often hugely stressful and painful.It may help intensify depression and even precipitate an attempt at or suc- cessful suicide. At this stage Marilyn had become so dependent on Greenson that he had to approve virtually everything she did.
Ted Jordan, a former lover of Marilyn who remained her friend, wrote after her death:
Norma Jean Baker, a.k.a. Marilyn Monroe, committed accidental suicide some- time during the late hours of August 4 or the early hours of August 5, 1962.
The death climaxed a period of approximately ten years, in which, for var- ious psychological reasons, she was preparing to kill herself. No one had to mur- der Marilyn Monroe, for she was intent on murdering herself.Toward the end of her life she had become so self-destructive, it was simply a matter of time before she committed the one act that would give her the final release from the tortures that afflicted her mind.
Of Elvis Presley, the musician Scotty Moore said:
He was like a young bull. Never seen the like of energy in one person. We'd do a show, then get out of town a ways before we'd stop to eat. One of us would tell Elvis, "Come on, let's walk." We'd start walking with him down the road, and the car would catch up with us later.Just trying to get him where he'd pass out. He'd stay up all night talkin' and drivin'. He was a good driver, too. But somebody had to stay up with him 'cause he had no sense of direction. He wouldn't read a road map or nothin'. Just drive.
Elvis Presley's mood swings were recognizable in early adulthood.After his relationship with his girlfriend Dixie dissolved, he entered a deep, protracted depression.According to biographers Earl Greenwood and Kathleen Tracy,
His reactions were extreme, because he'd been such an extreme outcast all his life. The hurt was so strong in him that he resembled a mental patient who'd had one too many electroshock treatments. His senses were deadened, and his body sagged inward. I'm sure he was clinically depressed, but psychiatric help wasn't well accepted then.
In his heyday Elvis was the consummate entertainer, whose singing and erot- ic dancing appealed not only to teenagers and young adults, but to people of all ages.There were few countries in which people didn't hum Elvis's songs, dance to his recordings, or see his movies.Proper, refined matrons who shunned popu- lar music fell for Elvis.His performances were characterized by their high ener- gy; the quality of the singing and the songs; and the frenetic, suggestive body movements.
A telltale sign of Elvis's manic-depressive disorder was his overt paranoia. According to Greenwood and Tracy, " Elvis was suspicious of any new person in his life and ready to believe at the slightest provocation that they were only around him because they wanted something from him, prestige, or a job." Intermingled with Elvis's manic restlessness and promiscuity was his depressive, phobic obsession of not having sex with anyone who was a mother.
In public, Presley appeared carefree and a man who was on top of the world. According to Greenwood and Tracy, this image was orchestrated by Presley's manager, Colonel Parker, to hide the real Presley who at home was moody and depressed.Eventually, Presley became totally dependent on the adoration of his fans for his self-esteem.
As he aged, Presley became increasingly paranoid, especially of the press and, having developed the delusion that people were out to get him, began carry- ing a gun.In similar fashion to billionaire J. Paul Getty, Presley developed the delusion of being poor, a symptom which may emerge in the deepest levels of depression.
Elvis's career and death typify those of a talented, untreated manic-depres- sive performer.By the time of Elvis's death he was obese and had various diges- tive and cardiovascular disorders which often accompany mood disorders.He self-medicated, to a prodigious degree, with opiates, amphetamines, and sleeping pills, which he obtained from obliging physicians and pharmacists. Based on the toxicology reports and retrieval of copies of prescriptions, Elvis, during the months leading up to his death, was taking as many as fourteen stimulating, sedating, pain-killing, and sleep-inducing drugs.Many combinations of these drugs could have caused death from cardiorespiratory collapse. Nonetheless, the official ruling was that Elvis died from heart disease.
Creative composers, authors, and some performers with mood disorders can hide when impaired by depression, as Vladimir Horowitz did when he did not per- form, for mysterious reasons, for ten years.By contrast, high-energy performers who appear in front of live audiences night after night may, when depressed, lapse into a pattern of using stimulants to enliven them for a show, and barbiturates after- ward. Such was the fate of Elvis.And someone did recognize the depression, as the toxicology report showed traces of the antidepressants Elavil® (amitriptyline) and Aventyl® (nortiptyline) in Elvis's liver.Antidepressants can remit a variety of gastrointestinal disorders, ranging from peptic ulcers to irritable bowel syndrome. And research shows that depression is associated with a variety of potentially lethal arrhythmias of the heart, some of which respond to antidepressants.
A combination of drugs may well have caused Elvis's death, but to interpret it as a suicide, as some have done, is pure speculation.However, Elvis was ipso facto self-destructive.Sound judgment, a strong ego, and the drive for self‐ preservation would have guided the singer into an institution or the hands of a psychiatrist specializing in chemical dependency.
There is a temptation to do a psychological postmortem when deaths such as Elvis's occur.Who among his intimates was aware of his mood disorder? Did anyone knowing of his drug dependency attempt to place him in the care of a hos- pital for detoxification and treatment? Did Elvis refuse treatment, or did his inti- mates undermine it? Was the court correct in absolving of negligence and crimi- nal conduct the physician who prescribed most of the drugs?
Such questions can satisfy our thirst for accountability, but they tend to obscure the identity of the real culprit: it is manic-depressive disorder, and it alone, which can elevate a person to the pinnacles of success, and then send him crashing to destruction.
Today, psychiatrists are better armed to treat manic-depressive disorder than they were in the lifetimes of Marilyn Monroe and Elvis Presley.They have at their disposal lithium carbonate and other drugs with antimanic properties, and a range of antidepressants. However, there are many patients whose symptoms are so severe that their treatment becomes difficult, at times impossible, to manage. Broken appointments, suicide threats or attempts, self-medication, noncompliance, sub- stance abuse, legal problems, family crises, hostility, rage, psychosis, and violence may create problems for patients, people close to them, and their psychiatrists.
Fame or celebrity may pose additional unique problems. Celebrities are used to having their wishes and desires catered to. If the psychiatrist lacks strength of character and is charmed by the patient's fame and wealth, he may forsake his training and better judgment and make concessions he would normally not make. Marilyn's and Elvis's physicians made concessions that ultimately led to reverse compliance; the patient was now in control and the physician complied.
The psychiatrist may wish to impress his family with the celebrity's presence in his home, and nourish his ego with his patient's fame. He may find her sexual allure irresistible, and take advantage of his power to draw her into a sexual rela- tionship, which, he rationalizes, she initiated by her seductive behavior.
Even with successful treatment the psychiatrist's job is not over, as he needs to be wary of the ominous signs of relapse, due to the development of immunity to lithium and/or antidepressants. This phenomenon is referred to as tachyphy- laxis, from the Greek "tachy," meaning rapid, and "phylaxis," meaning the erec- tion of a guard or barrier.It is a huge, largely unrecognized problem in the treat- ment of patients with mood disorders, and it has received virtually no attention by the pharmaceutical industry and little interest by academic psychiatry.
Tachyphylaxis is linked to paradox, in which a drug has an effect directly opposite to what was intended.In a paradoxical reaction to an antidepressant, a patient may become more rather than less depressed, to the point of becoming suicidal or homicidal. Paradox is at play when a drug induces weight gain, dimin- ished libido, and insomnia in some patients and weight loss, increased libido, and excessive sleep in others. It is a problem in treating mood disorders which has likewise attracted scant interest from academics and the pharmaceutical industry.
There are patients with mood disorders who, despite all efforts, do not respond to mood-regulating drugs or to electroshock therapy, and appear to be treatment resistant. With perseverance, sometimes over a span of years, some will eventually find an effective medication. Unfortunately, after failing to respond to one or a few trial drug trials, many patients give up and drop out of treatment.
The hero of the hit movie Shine is the Australian pianist David Helfgott.In the film Helfgott is portrayed as a prodigy who suddenly, and with no prior evidence of mental illness, breaks down during a performance of the Rachmaninoff Third Piano Concerto at the Royal School of Music in London. Helfgott returns to Australia where he is institutionalized.Eventually, he recovers enough of his musical prowess to be able to give a recital.
In reality, Helfgott had his breakdown in Australia after returning from London and, according to his publicist, "spent many years under treatment." What type of treatment, and whether inpatient or outpatient, was not specified.As to the nature of Helfgott's illness, his handlers have at various times declared him to be schizophrenic, schizoaffective (i.e., suffering from a combination of schiz- ophrenia and manic-depressive disorder), or suffering from nothing more than a "nerve disorder."
In her book, Love You to Bits, Helfgott's wife, Gillian, documents his inco- herence, agitation, extreme mood swings, self-hatred, sadness, fear, whimsical word games, alliterations, and "mercurial metaphors." She describes Helfgott's "near permanent state of elation" and his "slight" manic tendencies, his rapid speech and his distractibility.She notes that he was quieter and calmer on lithi- um, but when he became "flat" and stopped playing in the middle of a concert, his psychiatrist switched him to a combination of the major tranquilizer Serenace® and the mood-stabilizing anticonvulsant Tegretol®. In an appendix at the end of her book she lists some of the "special words" her husband uses liber- ally.Some are based on French, Russian, Polish, or Yiddish, while "others appear to be entirely of his own making." Such neologisms are numbered among the symptoms of schizophrenia and manic-depressive disorder, and are generally associated with chronic, severe illness.
In playing the role of David Helfgott in Shine, Jeffrey Rush imitates a the- saurus of manic symptoms: racing thoughts, flight of ideas, clang association (i.e., association of words by sound rather than meaning), pressured speech, excitabili- ty, gregariousness, familiarity, charm, witty remarks, hyperactivity, playfulness, mischievousness, lack of inhibition, restlessness, punning, rhyming, and infectious gaiety.When the real David Helfgott was interviewed by a cable TV channel, much of what we saw was a repeat of the psychopathology we observed in Shine. Helfgott's manic, infectious gaiety had the interviewer in stitches.His speech was pressured, his ideas took flight, he rambled, he echoed the interviewer's words, and his mood was merry. He was excitable and restless, childish, and had the "vivacious movements of expression" referred to by Emil Kraepelin, including floods of words, joking, and muttering.Frequently he closed his eyes and assumed what Kraepelin referred to as a "posture of exaltation."
To the seasoned eye, Helfgott suffers from manic-depressive disorder, and of a severity seldom seen today.We are left wondering whether he has failed to respond to medication or whether the treatment he has received is adequate. And one won- ders, if Helfgott's symptoms were less severe or his response to treatment optimal, whether he would have reached the virtuosity which has thus far eluded him.
The prevalence of manic-depressive disorder is a mystery. Epidemiologists cite a figure of 1 percent, a figure which I cannot reconcile with my twenty-nine years of experience of treating the disorder.Many people do not know that they or their close ones are manic-depressives, and many people obscure the disorder by drug or alcohol abuse, gambling, or violence. Many manic-depressives are offended when told that some people with their disorder are predisposed to violence; the fact remains that our prisons are filled with nonviolent and violent depressives and manic-depressives who are not included in epidemiological studies.
Manic-depressive disorder has been a recognized entity for the past 6,500 years. Over the past three decades Freudian psychiatrists have developed new diag- nostic entities, such as borderline personality disorder and narcissistic personality disorder.The borderline concept includes fluctuations in self-image, fears, mood swings, self-mutilating or suicidal behavior, fear of abandonment, anger, impulsivity, unstable relationships, and transient paranoid thoughts. The narcissistic person- ality is said to have grandiose self-importance, is preoccupied with fantasies of unlimited success, believes that he is special, is arrogant and haughty, takes advan- tage of others, requires admiration, lacks empathy, and is envious.
All the symptoms of borderline and narcissistic personality disorders occur in manic-depression. And Freudian psychiatrists, with few exceptions, have never offered a cogent argument as to why these entities should be regarded as separate from manic-depressive disorder.To the skeptic, borderline and narcissistic disor- ders were spun off from manic-depressive disorder to create entities to be regard- ed as personality disorders, and thus amenable to treatment with intensive, long‐ term psychotherapy rather than with mood stabilizers or antidepressants.
In the United States many people suffering from the severer forms of manic‐ depressive disorder are diagnosed as schizophrenic. Paranoia occurs in both phas- es of manic-depression, yet the presence of paranoia is automatically associated, by many psychiatrists, with schizophrenia. Violence may occur in depression and in mania, yet the association of violence and psychosis will, in the United States, generally earn a patient the diagnosis of schizophrenia.
In the July 1978 issue of the Archives of General Psychiatry, Harrison Pope, M.D., and Joseph Lipinsky, M.D., of the Harvard Medical School, published a study examining the specificity of "schizophrenic symptoms." Pope and Lipinsky reviewed studies on the phenomenology of psychotic illness, outcome, family his- tory, response to treatment with lithium carbonate, and cross-national and historic diagnostic comparisons.They found that most so-called schizophrenic symptoms, taken alone and collectively, have remarkably little, if any, demonstrated validity in determining diagnosis, prognosis, or treatment response in psychosis. They con- cluded that the result is an overdiagnosis of schizophrenia, and an underdiagnosis of mood disorders. These findings, however, have had little impact on American psychiatry, and it is not difficult to find reasons why: Unlike the treatment for schiz- ophrenia, American psychiatrists have never developed a rationale for treating manic-depressive disorder with psychotherapy; there is a tendency throughout medicine to ignore research which challenges prevailing dogmas; and all too few clinicians have read Eil Krapelin's epic Manic-Depressive Insanity and Paranoia.
Creative people often worry that taking an antimanic-drug such as lithium will strip them of their creativity. Mogens Schou, the researcher who pioneered the use of lithium in manic-depressive disorder, once did a study in which he interviewed twenty-four highly creative people on maintenance lithium therapy. Twelve felt that lithium had not influenced their creativity; six reported that their creativity had been diminished; and six felt that their creativity had been enhanced.Assuming that this study is valid, it can be said that one cannot predict with confidence the effect of long-term lithium therapy on an individual's cre- ativity. In one person lithium therapy may slow mental processes so that he can- not write or compose, while in another reduction of restlessness, excitability, and irritability may enhance the ability to create. Today, as when this book was first published, we do not have all the facts to explain the relationship of manic-depressive disorder to creativity and genius. Daniel Goleman's Emotional Intelligence explores the role of emotion in learn- ing and achieving, and Kay Jamison's Touched by Fire: Manic Depression and the Artistic Temperament examines, as does this volume, the relationship between manic-depressive disorder and creativity.Other workers in this field who have done important work include Nancy Andreasen, M.D., Ph.D.; Hagop Akiskal, M.D.; Arnold Ludwig, M.D.; and Ruth Richards, M.D. Between us we have forged a new understanding of the relationship of creativity and genius to manic‐ depressive disorder.
But there is much that none of us can fully explain, notably the outer limits of creativity plumbed by manic-depressives, such as the invention of calculus by Newton, the discovery of natural selection by Darwin, Beethoven's Fifth Symphony, Verdi's Aida, and Michelangelo's David.
It remains a challenge to explain, with known physiological principles, the experiences of Nikola Tesla, the Yugoslavian genius of electricity.He was a sci- entific genius of the first rank, and belongs in the company of Newton and other immortals.A brilliant innovator in the laboratory, Tesla was no match in the boardroom for the likes of Thomas Edison, George Westinghouse, and other inventor/entrepreneurs, and died in obscurity and poverty.According to his biog- rapher, Margaret Cheney,
Tesla's senses had always been abnormally acute.He claimed that several times in boyhood he had saved neighbors from fires in their own homes when he was awakened by the crackling of flames. When he was past forty and carrying on his lightning research in Colorado, he would claim to hear thunderclaps at a dis- tance of 550 miles....
But what happened during his breakdown was astonishing even by Tesla standards.He could hear the ticking of a watch from three rooms away. A fly landing on a table in his room caused a dull thud in his ear. A carriage passing a few miles away seemed to shake his whole body. A train whistle twenty miles distant made the chair on which he sat vibrate so strongly that the pain became unbearable. The ground under his feet was constantly trembling.
"The roaring noises from near and far," he wrote, "often produced the effects of spoken words which would have frightened me had I not been able to resolve them into their accidental components." During this period Tesla's pulse fluctuated from subnormal to 240.
Later in his life, Tesla learned to tame electricity as if it were a living organism. Nightly, after his highly ritualistic dinner at the Waldorf, he compulsively walked the identical route to his laboratory, where he performed the most amazing elec- trical experiments, accompanied by his assistant and often witnessed by Mark Twain. Tesla, who invented alternating and direct current and contributed to the development of the radio and radar, played with electricity as a snake charmer does with a hooded cobra.The electricity generated by many of his experiments would have felled a team of oxen, but in his hands it was harmless.
The intellectual/emotional depths necessary to perform the feats of a Tesla may be reserved for people with mood disorders. Michael Faraday, who suffered from recurrent depression, defined the nature of light and electromagnetic forces while in a state of intuitive visions, and thereby developed one of the foundations of physics although lacking any formal training in mathematics.Such altered states may be a prerequisite for great creative advances, and limited to the states of elation and exaltation only manics experience.
The collective work on the relationship of manic-depressive disorder to creativi- ty and genius has attracted interest in the media. However, it has not penetrated the area where it is most needed, and that is education. Manic-depressive disor- der can have damaging effects on learning, and it can strike people of all ages, even children. Depressed children don't learn. They don't learn because they can't concentrate; they lack initiative; they are too timid to ask questions or vol- unteer; they are easily discouraged; they are distracted by anxiety, phobias, or compulsions; they cannot organize their activities; and they may be chronically fatigued. In extreme cases they may be so phobic that they refuse to go to school. For many of these children, school is hell. For such children who respond to an antidepressant, school becomes a pleasant, rewarding, and affirming experience.
Over the past decade some psychiatrists have remained unconvinced about the validity of the broad concept of "attention-deficit hyperactivity disorder," viewing it as often the cognitive and behavioral expression of manic-depressive disorder or major depression in childhood.Preliminary research by Dr. Joseph Biederman at Harvard now suggests that between one-fifth and one-quarter of children with ADHD have manic-depressive disorder, or will go on to develop it. It falls on educators at all levels to consider depression and manic-depressive dis- order in students who are failing or underachieving.
The signs and symptoms of syphilis can imitate so many diseases that, earli- er this century, it was named the "great masquerader." When the objective phe- nomena of mood disorders overtake the romance with Sigmund Freud, depres- sion and manic-depressive disorder will take their place as the masqueraders of the twentieth century, the invisible force behind humankind's greatest achieve- ments and failures.