Archetype Writing Blog

This time I was responsible for choosing the blog chain topic. Kate (who comes before me in the chain) just did a great wrap up of our last chain , on confidence. Michelle  (who comes after me in the chain) will be the next to tackle the questions I've chosen:

Angst (n.) (ängkst)
Everyone talks about angst-ridden creative people, so I looked up the definition of the word “angst” to get myself going. (I normally hate when people include definitions — hello, I can use a dictionary — but I’m making an exception so you and I both know what the heck we mean when we say “angst.”) The word is German and refers to an “A feeling of anxiety or apprehension often accompanied by depression .” Fanfic writers use the word to help categorize some forms of fanfic: “Putting the characters and by extension the readers through deep emotional and possibly physical pain .”

Mental Illness
Some people take the angst idea a step farther. They believe that writers need to be at least a little touched by madness. Interestingly, there is a strong positive correlation between bipolar disorder (aka manic depression) and creativity . According to Frederick Goodwin and Kay Redfield Jamison, both giants in the study of bipolar disorder:

It is counterintuitive that such a destructive illness could be associated with imagination or great works of art. Yet the perceived association is a persistent cultural belief and one that is backed by data from many studies… The argument is not that manic-depressive illness and its related temperaments are essential to creative work; clearly they are not. Nor do we argue that most people who have bipolar or recurrent depressive illness are creative; they are not. The argument is, rather, that a disproportionate number of eminent writers and artists have suffered from bipolar spectrum disorders and that, under some circumstances, creativity can be facilitated by such disorders.

From Michelangelo and Jackson Pollock to Samuel Taylor Coleridge and Percy Bysshe Shelley, from Kurt Cobain and Billy Corgan to Ernest Hemingway and Stephen King, depression or bipolar illness is disproportionately common in creative geniuses.

Is Angst Necessary?
Now, if bipolar disorder and depression are common in creative geniuses, and angst is a description of how people with those disorders often feel, does that mean angst is necessary to the creative process?

Well…let’s see what the others in the blog chain think.

Looking at the psychological research…no. Interestingly, people who are creative have more in common with people who are bipolar than they do with “normal” people, but the commonalities lie not necessarily in mood disturbances, but rather in idiosyncratic thinking patterns, in enthusiasm and passion for their art, in how easily they can produce new and strange ideas. In many cases, people who are bipolar and creative are better able to express themselves creatively when they are being appropriately treated for their disorders.

Part of what makes being creative with a mental illness so difficult is the behaviors that result. Alcoholism is found in over 50% of the people with bipolar disorder. Drug abuse is also extremely high. Periods of despair can be so intense that the individual can hardly get out of bed, let alone create something. And of course the rate of suicide and suicide attempts is much higher than in creative people who aren’t also struggling with a mental illness.

The way I think of it is like this — there is an overlap between “creative” genes and “bipolar/depressive” genes. And while some people, like Kurt Cobain, feel much more creative when they’re in the manic phase of bipolar disorder, they may also be less coherent (“Smells Like Teen Spirit” lyrics, anyone?), and they also have to deal with the crash of depression (Cobain committed suicide). Research also suggests that over time depressive/bipolar illnesses gnaw away at creativity. In a study done with children , “we found a negative correlation of illness duration with…creativity ; the longer the children were sick, the less creative they were.” So overall, the illness becomes a hindrance to creativity, rather than a help.

Angst vs. Soul
An ex of mine was an amazing artist, technically. He could reproduce anything he saw, often without ever lifting the pencil. I’ve never seen someone who could draw like he could without ever needing to erase. He didn’t need to work the image over and over from rough to smooth — he just produced an immaculate image the first time.

He spoke at one point to some galleries about displaying his work, but he was turned down. One director was kind enough to give him some feedback. She told him something was “missing” from his work.

He thought it was angst. But it wasn’t. (He got to share mine, and it didn’t affect his art at all. I checked.) What he was missing was soul.

So I don’t think it’s angst that we all need to produce good stuff. It’s soul.

My Angst
So that brings us to me. Do I need angst to produce good work? I honestly don’t know, because precocious creative works started around the same time my angst found me. So I’m really curious about what the others in the blog chain are going to say.

I do have an emotional state that I think I write in better than any other (besides flow, of course). I call it “melancholy.” It’s a calm, quiet state that for some reason makes it easier to sink into a creative state. But maybe the reason that’s helpful is that I enjoy writing fiction with “angst” in it.

I have met people who become extremely distraught about putting their characters through a tale of angst. Some cry, some sink into a depression, some feel guilty. I’m not sure why they write it if they feel that way. (The only time I sink into a depression as a result of writing is when I finish a novel — I always worry I won’t be able to write another one!) For me, writing angst is like an outlet for my own. If I’ve got it, why not plumb it for material?

Even if you avoid tabloid rumors like the plague, you probably know all about Britney's latest troubles.

The front of People magazine has a picture of her from better years, and below the looming headline that you can't miss from anywhere in the supermarket: MENTAL ILLNESS.

As is usually the case, though, the terms are all tossed together into a hodgepodge that makes little sense, and none of it is flattering.

On January 3rd, Britney was taken from her home on a gurney after a disagreement with police about returning her children to her ex-husband.

A "Psycho Psychotic Mental Patient"

According to US Weekly:

"She went completely psycho," says an eyewitness. "They had to strap her down like a mental patient. She was going between laughing and crying hysterically. A total psychotic breakdown."

First, what exactly does "psycho" mean? Nothing except "bizarre." Which, you have to admit, kind of fits the situation, even if it is a bit of a slur. And "mental patient"? Means the same thing, and my issue is not that the speaker is suggesting Britney is out of control and needed to be strapped down, it's the suggestion that everyone with a psychological problem is and does.

And "psychotic" means a complete disconnection from reality as other people experience it. That may also be the case with Britney, but there's no real evidence from news reports that she was, for example, hearing voices or seeing things (ie having hallucinations) and it's not clear whether she was having ideas not based at all in shared ideas of reality (ie delusions).

It really bothers me when people toss around such loaded words without thinking about it. Why? Because, for example, if someone takes an "antipsychotic," everyone thinks things like "psycho killer" and "crazy psycho Britney" without understanding that some people take them as antidepressants and have never had a psychotic episode in their lives! And even if they have, it's because something is wrong with their brain chemistry, not because they chose to have problems, anymore than someone chooses to have cancer.

An Ambulance to the Hospital

And the fact that she was taken in an ambulance -- let me explain what happens when someone needs to be taken to the hospital for a psychological assessment. If the emergency folks on the scene determine that someone is an immediate danger to herself (ie suicidal) or to someone else (ie homicidal), they can mandate a trip to the hospital for an assessment. Typically the person gets plenty of chances to say "ok," including being told that they can be forced to go in handcuffs if they choose to really make a scene.

In most cases, people choose to go. After all, there's no guarantee they're going to be admitted, they're just going to be checked out so someone can make an informed decision about whether they're dangerous. (When doctors have admitting privileges, that makes the process quicker, partly because it's darn hard to commit someone in the US, especially against their will. Sometimes the hospital will say "Sorry, we have no place to put them. You're going to have to deal with it or find another hospital." But this is Britney. I'm sure they had no problems finding someone to assess her.)

Since there were fire and ambulance rescue personnel on site, it's not uncommon to use an ambulance to transport, especially when most of the media on the Western seaboard are flying over taking pictures. The goal is to stigmatize as little as possible. And you have to admit, going in an ambulance is less stigmatizing than going in the back of a police car.

According to the article in US, "Police offered her a choice of leaving in a cop car or an ambulance."

Britney might have issues, but she knew what to do when offered that choice!

It does sound like they pink-slipped to keep an eye on her, but the time she was kept for was so brief that in spite of all the reports that they had her on suicide watch, that's highly unlikely. She would never have been allowed to leave the hospital the next morning if anyone truly believed she was likely to walk out and kill herself. Emergency personnel have explained this to the media, but I guess that doesn't make such a good story. (US says, "LAPD officer Sara Faden explains the medical stay, which can be as long as 72 hours, to Us: 'Medical professionals attend the person and determind that they are not going to harm themselves or others. The person may be released earlier if it is determined they are no longer a danger." Or never were a suicide risk to start, no matter how much more exciting the story might have been if they were.)

Let me also note there that no matter how bizarre or erratic someone's behavior is, if they're an adult, in the United States they cannot be kept in a hospital against their will unless they are an immediate danger to themselves or someone else. (You can read more about suicide assessments on the Archetype site.) So if you're wondering why someone doesn't just get Britney some help...they literally can't, unless she does become suicidal, and nothing except rumor suggests that; the fact that she was kept for less than 12 hours in the hospital says she's not even hinting at suicidality.

Then, as everyone knows, Dr. Phil showed up. This just makes me want to bang my head on the wall, because everything I see suggests that he's making the most of a media situation to get himself publicity. That opinion went from tentative to very firm when I saw that Dr. Phil was forced to "cancel a hoped-for Spears family reunion for his Dr. Phil Now show, stating that the situation was 'too intense at this time.'" In other words, she didn't want nothin' to do with it. Or him. Neither would I if I had even an inkling that someone who's supposedly in the helping profession might exploit me and my family.

Dr. Phil Arrives

Dr. Phil apparently told Entertainment Tonight that "I've been working with this family behind the scenes for a long time."

Going well, ain't it? Keep up the good work, Phil.

Dr. Phil, and I'll try to keep this brief, got thrown out of psychology by our governing body, the APA, for misrepresenting psychology to the world. They asked him to note that what he does on TV is entertainment, because it's nothing like therapy. He refused, and they had to throw him out for what amounts to fraud. So whatever "work" he's doing isn't kosher by psychology's handbook.

And that's the problem. What most people believe to be psychology...isn't. At all. The client/patient comes first, and therapists listen rather than boss you around. Don't we all get bossed around enough at work and at home and by people we don't even know? Why would we pay someone to do more of it? I have my students do an exercise where they imagine Dr. Phil giving them advice for a problem they haven't been able to solve. After having over 100 students do it, only one has come out of the exercise with a fix. Granted, that's 1 person who's life is better, but it's also 1%, and that's a rotten success rate for anything. In fact, it's far less than the rate of improvement left to time or chance alone.

So What's Wrong with Britney?

Anyhow. So what's wrong with Britney? There's been a lot of talk of bipolar disorder, and I've seen some suggestions that she has borderline personality disorder. The fact that her erratic behavior doesn't seem to be caused (for the most part) by drugs, one does have to wonder about mania. Here are the critieria for mania (from the DSM-IV-TR):

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
(1) inflated self-esteem or grandiosity
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas [ideas jumping from one thing to the next very quickly, or thoughts are moving very fast] or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation [jitteriness or fidgetiness]
(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

And here are the criteria for Borderline Personality Disorder (also from the DSM-IV-TR), which is often comorbid with Bipolar disorder (some say in about 1/3 of cases):

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment.
(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self-image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating).
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria [sadness or sad mood], irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
(7) chronic feelings of emptiness
(8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe dissociative symptoms

So what's actually wrong with Britney? I'm not sure. Some of it may be the fact that she has a lot of money and her star status gives her a lot of freedoms. But yes, it does look like maybe some of the things listed above fit her situation.

New Article: Diagnosing Anakin Skywalker
Summary: A group of French researchers have proposed that Anakin Skywalker had Borderline Personality Disorder. This article looks at why, along with the evidence for and against such a diagnosis.

A new study suggests that all the hubbub about drugs like Prozac "causing" suicide -- which led to the FDA's "black box" warning on them -- led physicians to be more conservativew about prescribing the meds. And that appears to have caused the suicide rate to go up in children and teens.

Now, the first caution is that this is correlational data. That means we know that as the emphasis on the "dangerousness" of antidepressants went up, so did the suicide rate. That doesn't necessarily mean that one caused the other. It just looks pretty darn suspicious.

But there's a bigger problem here, and that is that we're still focusing on the wrong thing: the drugs.

Healthy, psychologically sound people who feel like there's hope don't commit suicide. People who feel there is no other option commit suicide, and teens tend to be more impulsive, so their suicide rate is a little higher than average. (The teen suicide rate is not the highest, by any means. The elderly population, especially elderly white males, are far more likely than any other group to commit suicide.)

Research shows that most antidepressant prescriptions are written by general practitioners, not psychiatrists. Now, GPs are writing them because they want to help, and that's what they can do to help -- they see people briefly, write a prescription or provide some other specific advice, and send the person out the door. In some cases they recommend therapy, but with a scrip in hand, the average person ignores the therapist's name.

And the average person doesn't realize that each antidepressant works differently (that's why there are so many of them -- gasp!) and that figuring out which is the best can be a trial-and-error process that may involve different dosages and different combinations of drugs.

So people go home, pop their Prozac, and by day 2 or 3 they feel great! They don't realize, of course, that it takes 2-6 weeks for Prozac to start working, and that they're getting a placebo effect. So at the end of week 1 they're not feeling so great and by the end of week 2 they quit taking the med becuase it's "stopped working." And they feel hopeless.

Or they feel a little better, but not a lot better, but they assume Zoloft is like penicillin -- it works or it doesn't, and there's not a lot of in between. They begin to think that feeling this bad is normal, and they're just not handling it well. Nor do they want to. And they feel hopeless.

Or the drug causes side effects they don't like, so they figure that the whole drug class is useless to them. And they feel hopeless.

See how this works?

Plus, in a lot of cases, even if the drug works great, it can't rout out the cause of the problem like an antibiotic. An antibiotic kills the infection and gets rid of the symptoms, too. With mental illness you may eliminate the symptoms and even get the brain chemistry working better, but if the psychological problem, or the bad living situation, or the learning disability, or whatever is still there, you haven't dealt with the true "infection," and you're still going to struggle with depression. That's exhausting. So you feel hopeless.

My point is, it's not as simple as a drug causing or not causing suicide rates. It has a lot to do with understanding that a drug is a tool, and an important tool, but only a tool. We shouldn't put it on a pedestal or blame it for the world's ills.

SSRIs (the class of antidepressants that includes Prozac, Zoloft, Wellbutrin, etc.) were one of the most important chemical revolutions in psychiatry. They help a lot of people who couldn't otherwise live normal lives live very normal lives. But they're drugs, not magic in a bottle.

You know how they say, "Guns don't kill people, people kill people"? Well, antidepressants don't cause suicide, but they also don't usually cause miracles. It's not that simple, and until we stop trying to make it that simple, we're not using the tools as effectively as we should be.

Here's TheLastPsychiatrist's latest post on Hui (Cho Seung Hui: It's The Movies, Stupid); his approach is exactly the opposite of mine, and while I disagree that we should focus exclusively on the media rather than Hui's mental health history, he makes some excellent points, including:

• People look to the media for models of how to do things
• Hui was looking for an identity
• People with mental illnesses are not statistically more likely than anyone else to act violently (though those with severe mental illnesses are eleven times more likely than others to be the victims of violence) and focusing only on the mental health aspects of things villifies people who don't even begin to deserve it.

As I said in a recent post, I love this guy's blog. Part of the reason I note it here is that it's important to consider different points of view on any issue; in many cases, even people with completely opposite ideas are "right" (or at least worth listening to) at the same time. (Not that he'd necessarily say I'm right, but I bet he's the sort to enjoy a healthy debate and would agree that tolerance and discussion is a far better approach to disagreement than going all Warcraft on someone's a**.) Appreciating different viewpoints doesn't mean you're ambivalent, it means you're wise enough to be able to hold and appreciate opposing views.

The test of a first-rate intelligence is the ability to hold two opposing ideas in mind at the same time and still retain the ability to function. -F. Scott Fitzgerald.

Now is a particulary important time to recognize that we can disagree and still appreciate and respect and even admire the people we disagree with. A lot of people are threatened by views that differ from theirs (the uncomfortable feeling that causes that is called cognitive dissonance), which in most cases is ridiculous. Tolerance is respecting and appreciating the other person and his/her ideas without disrespecting or wanting to hurt that person.

A number of people have remarked that Hui doesn't deserve the attention; it's what he wanted. They insist that we focus on the lives of the survivors and all the positive things they did and gave to the world. In this spirit, CNN.com is currently running photos, biographies, and loved ones' stories about the lives of each of them.

I'm writing this two days after the Virginia Tech tragedy, the worst "shooting rampage" in US history. Cho Seung Hui, a 23-year-old creative writing major who was just about to graduate from the Virginia Polytechnic Institute and State University in Blacksburg, Virginia, shot and killed a student and an RA in a dormitory and then walked across campus to an academic building, chained the doors shut, and shot and killed 31 other people in classrooms, including himself. A number of his victims are still in the hospital, some of them in critical condition.

In the United States, at least, one of the things that has made this unique is how much information was available immediately from people who were in the classrooms via blogs as well as cell phone text messages, videos, and photos. I find myself wondering if things might have been worse--both in terms of how many people were hurt or killed and in terms of psychological fallout--if people hadn't been able to communicate that way.

People are going to scramble to figure out why this happened. The most tempting thing to do will be to write Hui off as "crazy" or "evil." To make him Other. One of my students asked me today if Hui was "psycho;" someone else told me a profiler on an evening news program repeatedly referred to him as a "psychopath." (Neither term is used clinically, and the evidence seems to be pointing at a disorder like depression, not sociopathy, so it's just irresponsible to be throwing terms like that around on television.)

Rock music and violent video games and movies will get some blame. Some people will blame the "narcissism" they believe this generation of children has grown up with. There will be a lot of sensationalistic emphasis on the gory details. And in the end we'll have some kind of profile of the person who did this.

But try not to forget that it was a person who did this, and writing someone off as an anomalous monster keeps us from truly understanding how he felt and thought--and that is the most important why. If we truly understand how depressed or angry or sick he was, we can try to do a better job of intervening so this doesn't happen again. As one person wrote me this morning, so many people are now saying, "I wondered if [Hui] would show up in the newspaper some day morning for killing people," but they didn't really do anything. Or maybe they did do something and those they talked with didn't do enough in response.

Dylan Harris and Eric Klebold, responsible for the Columbine tragedy, gave every indication that they were dangerous. They were even in trouble for the kind of behavior that later led to the death of 13 people, but nobody did enough to prevent what happened. Hui did the same; he gave every indication that he intended to do something horrible, but nobody took him seriously enough, or acted strongly enough, to prevent what happened. Why aren't we learning when things like this happen? Sometimes I think it's because we demonize these people, so when we see or hear a perfectly real human being going down the same path, we minimize the reality that a perfectly real human being is always who does this sort of thing.

Now, no matter what illness someone who hurts other people might have (if they do have one), and no matter what their motivations, that neither excuses their behavior nor provides any type of consolation to those whose lives were affected, particularly those who knew and loved the victims. And just about anyone who hears about what happened is affected by how awful it was.

No matter how much pain someone is in, and no matter how distorted their perceptions of the world might be, taking someone else's life is inexcusable. Hurting others doesn't make your pain better; it makes it worse, because now others are suffering at least as much as you were, even if they're suffering in a different way. One of the things that bothers me most about our health-care system here in the States is that those perpetrators who do receive rehabilitation of some kind are often given more psychological care than those who are affected by what they did. No matter what happens to the perpetrator, survivors almost always have to pay for their own therapy, if they can even afford it. Those who were affected by what happened at Virginia Tech have access to free therapy right now, which is as it should be, but they can't be completely healed in a month, or six months, or a year. And how many people, who have experienced so many other tragedies, never receive any help at all?

And no amount of therapy in the world can "undo" what others have done to us. It's so excruciatingly unfair that survivors are left to pick up the pieces of their lives when they should never have been involved in the first place.The psychological fallout from human-orchestrated trauma is extraordinary. The idea that another thinking, conscious being would do something so awful overloads the brain. Human cruelty is more likely to cause Post-traumatic stress than anything else, no matter how bad. And the alcoholism and suicide rate for people who have PTSD is extremely high. The firefighter who appeared on the front of Time magazine carrying an infant out of the rubble of the Oklahoma City bombing later killed himself.

The survivors should always be who we think of first. But we should also think about Hui. We don't want to take away someone's freedoms because they might possibly be dangerous, but we also can't ignore or minimize someone's behavior when they're sending strong messages that they are.

It's okay to tell someone in authority you're worried that someone you know might hurt someone else. In therapy, we do a very thorough assessment when we hear those things. When we get indications that someone is dangerous, we act, and we'd rather overreact a bit than underreact a lot. There's even something in place in the US we refer to as the Tarasoff law, which means that if you hear someone talk serious about hurting someone else, you have a duty to warn that person s/he's in danger.

It's better to feel a little embarrassed or to have a friend or acquaintance never speak to you again than to let behavior like Hui's go. The guilt some people will feel for not acting will haunt them for the rest of their lives. And my experience with authorities, even before I became a psychologist, was that they want to know so they can intervene if necessary. You can also walk into any emergency room in this country with someone you believe is dangerous to himself or someone else and they will intervene.

There's concern that people will "copycat" what happened, which makes vigilance right now even more important. You don't need to jump every time someone says they'd rather shoot someone than go to another staff meeting, but when you hear it over and over, or when you see other disturbed behaviors with those remarks, it's best to act.

If you'd like more information or would like to do something to help, you can visit Virginia Tech's website or contribute to the Hokie Memorial Fund, which will be used to provide grief counseling, memorials, communication expenses, comfort expenses, and incidental needs to survivors.

If you've been affected profoundly in some way, for example because this brings back memories of something you've experienced, seek some support or counseling for yourself as well.