(Author's Note: This article may be a source of inspiration for all who grapple with the pressures, frustrations, depressions and elations surrounding emotional vulnerability, authenticity and the drive to be one's personal/professional best.)

A provocative lunchtime question concerning the impact of psychotropic medication on creative genius triggers a thought-provoking esay on medication and mood disorder, artistic personality and productivity. The Stress Doc ebbs and flows between his study of Van Gogh and personal reflection on depression- driven creativity -- pre-and post-Prozac.

Van Gogh, Prozac and Creativity:
A Mere Pigment of the Imagination? Part 2

Two recent communications - one real, the other virtual - have been hyperactively percolating in my primal wellspring. The first occurred over lunch with a soulful and insightful seventy-year-old grandmother and friend. I mentioned seeing the movie, Vincent and Theo, about the Van Gogh brothers. Just before or after my statement, I also shared a recent discovery: a series on my own depressive condition and medication trial-transformation has been indexed by the Yahoo Search Directory under "Rapid Responders" (to Prozac). (Email stressdoc@aol.com for the series.)

Ernestine, who has a daughter taking medication for manic-depression, raised a provocatively poignant question, highlighted by the recent National Gallery Van Gogh exhibit. (An exhibition that had allowed both DC residents and tourists some distraction from the insufferable and omnipresent Clinton Impeachment process.) As for Ernie's enigma: "Would Van Gogh have been as creative if he had taken Prozac?" Actually, a number of psychohistorians suspect the artistic giant of having a bipolar condition. So, more accurately, Lithium would be the damnable drug in question. (For a thought- provoking work on a link between creativity and moderate to serious mental illness, try Kay Redfield Jamison's, Touched with Fire: Manic-Depressive Illness and the Artistic Temperament.

The second communicational catalyst was an email in 18 point bold type: "What if you're taking 150mgs of Zoloft (an antidepressant first cousin of Prozac) and you're still not happy?" (My instinctive response here is get a second psychiatric opinion, find a good psychotherapist and start a regular exercise regimen, for starters.)

And both queries raise two fundamental issues: what are the purposes for and outcomes of psychotropic mood medication? Actually, we have a mirror image conundrum. Ernestine asks about the potential negative consequences of too much happiness through chemistry. The emailer's question laments her lack thereof despite chemical intervention.

Stress Doc's Van Gogh Mania

This has been "My Fall of Van Gogh's Genius and Discontent." In addition to catching the awe-inspiring exhibit, I've seen two movies about Vincent Van Gogh, (the other, the compelling Lust for Life, with a youthful-looking Kirk Douglas). Also, I'm currently reading a collection of the voluminous, impassioned letters to his brother titled, Dear Theo.

Now I must declare a number of people have commented on a likeness with Van Gogh, especially when wearing my New Orleans brim. (For the pic, check out my homepage: www.stressdoc.com .) It's probably the shape and rust coloring of my trimmed beard. But I will recognize some affinities: a passion for creative expression and a predisposition to depression. Though not manic- depressive, some cyclothymia (a tendency toward moderate mood swinging) is a diagnostic possibility. (And certainly, various depressive/psychiatric labels, like Christmas ornaments, have been strewn on the family tree.)

While Van Gogh committed suicide at 37 years of age, my self-destructive musings remained mostly hypothetical. Though I did commit academic suicide -- self-immolating and burning out of a doctoral program over a wildly creative and off the academic wall dissertation project at age 33. Twelve years later, after a rapid series of personal and professional upheavals (and a history of overt and covert depression denied), I reluctantly started taking a clinical baseline dosage - 20 mgs - of Prozac. Over a two-year period, I've reduced my intake to 1/3 of a 10mg capsule, twice/day. Basically, it's my daily serotonin supplement. ;-)

So dispassionate lunchtime listening was hardly possible. When Ernie pondered about Van Gogh and Prozac, as a patient, therapist, writer and performer, a heartfelt protest jumped from my guts and throat. The issue of medication drying up or blocking a creative wellspring defies simplistic speculation.

Has being on Prozac affected my creative process and product? Surely there's been an impact. (Which I will reflect upon shortly.) Still, I do know agitated depression and emptiness. It just doesn't take as long to mourn, crawl around, reach out for support or to massage the obsessive thoughts and piercing emotions, and to muster, finally, the energy to get back on my feet. And I still grapple with my creative muse and self-doubts on a near daily basis.

But now let me conjure up Van Gogh's response to biochemical intervention. This mind game may not be possible if a person has been medicated for a lengthy duration in early childhood. Such intervention in the formative years may well change a person's biochemistry and subsequent maturational development. It may also impede an uncommon biological and psychological sensitivity to and acuity with certain types of information processing and experience. So I will not ponder a hyperactive Baby Van Gogh getting Ritalin. Though I do agree this is a legitimate area of professional and ethical concern.

The Van Gogh/Prozac Hypothetical

So which scenario are we contemplating? Van Gogh, struggling with a career identity in his 20's, not fitting in as an art seller or as a "man of the pulpit," seeking therapy and medication instead of following his love of art and his intuitive sense of himself as an artist? Or Van Gogh the struggling artist, almost always on the financial edge (despite his brother's support), with little recognition, few friends, fewer sales. Would he have short- circuited a full-blown psychotic break along with his full development as an artist by opting for some peace through Prozac or lightness with Lithium?

Drawing on my various explorations of Van Gogh, along with personal and professional experience, here are my premises along with hypotheses about the interaction effects between this manic-depressive artist and medication usage on his creative processing.

1. The Essence of the Man. Van Gogh's biochemical imbalance is definitely an intrinsic part of his being and likely a family predisposition. It's a component that would predictably and, at times, scarily and uncontrollably, excite, exhaust or flatten mood and energy levels and cognitive processing abilities. However, his essence was also forged by overall genetic predisposition, family dynamics, including being raised in a clerical family, and an upbringing that placed high value on the beauty and aesthetic appreciation of nature. And he was fortunate to have the financial and emotional backing of a brother with both an aesthetic sensibility and a capacity for resonating with a family predisposition for psychiatric instability.

Clearly, he also had creative genius: a compelling need and ability to look behind and beyond the superficial, to capture, unmask and transform the obvious. He was driven to distill and achieve both a universal and an uncommon synthesis - an elegant simplicity - in his understanding and representation of humanity. Van Gogh was compelled to experiment with varying modes of seeing, methods of applying color and, in general, designing new relationships among the flora and fauna of his artistic world.

2. Impact and Use of Medication. I will allow myself the conceit of contemplating how Van Gogh would use medication. A bias may be present. Based on my readings of his letters he would take the least amount of medication possible and would experiment with lowering the dosage. Or, he would obsessively study the impact of medication on his perceptual faculties. He'd probably do the same sketch multiple times at different dosages. In other words, medication would as likely be subsumed by art as art by medication. Important to Van Gogh would not be emotional equilibrium or contentment, but the incessant drive to develop his mind and his heart, his eye and his hand…to strive endlessly to absorb and depict the essentials of nature and human nature in a fresh and idiosyncratic manner.

Medication would not have changed a tenaciously reflective student of his own history and the work of other artists. In addition to his paintings, he wrote unceasingly, poignantly and analytically to Theo on all facets - high and low - of his art, philosophy and life -- sixteen hundred pages worth of letters. Van Gogh's genius was a mix of gifts combined with a personal quest to find difficult and wonderful artistic problems to work on rather than "saleable" solutions to gain favor with family, other artists or the marketplace.

Whether on medication or not, the reality of limited sales would have been a perennial source of frustration, isolation and disappointment. And what makes him a personal and powerful role model, stronger than Prozac, is a conviction that he would always revere and pursue the most demanding aesthetic -- not commercial -- standard. Medication might smooth out some of the mood swings, but it would not change the basically precarious and heroic course of history for an individual who was destined to be cutting edge!

Of course, one may ask whether he would have rejecteded medication even if it was available. Van Gogh often noted that his work, and it's contribution to society, was more important than his life which he believed, because of exhaustion and his enigmatic medical condition, was likely to be short-lived. Nonetheless, if only to appease his brother, I believe Van Gogh would have done a meds trial. (He did voluntarily commit himself to a sanitarium and, as a patient, produced some major works.) Medication may well have extended both his longevity and his productivity.

3. The Essence of a Work-Life. Van Gogh never fit into the bourgeois world of his upbringing. He was not suited for the logical or conventional career choices that appeared along his path. Certainly, a depressive or bipolar condition when combined with an artistic temperament heightens the sensitivity to and sense of a poor fit between the environment and the individual. It's why depressive-creative people can appear inflexible; they have great difficulty accommodating an environment that leaves little room for individual expression, the workings of their inner clock or the passionate pursuit of their mission. (Of course, some folks shroud themselves in this tortured mantle and are basically just spoiled prima donnas or narcissistic legends in their own minds.)

Gradually, then steadily -- by his late 20s -- Van Gogh knew he would wholeheartedly pursue the artistic life. And he pursued his calling despite a life of much deprivation and near poverty. Actually, Van Gogh often noted that losing himself in his work was a valuable distraction from material deprivation and melancholia. So would Lithium have detracted from painting as a distracting and refocusing agent? While there is commonly a period of adjustment to medication, and balance is more pronounced with effective chemical intervention, the fire of compassion and vision, alienation and inspiration still rages within. In other words, medication would not have motivated Van Gogh to take a day job. He would have continued to accept financial support and live on the financial edge because of his beliefs in a higher quest. Van Gogh would continue to empathize with and paint those living a marginal existence. This man would not have become mainstream.

4. The Essence of a Mind and Soul. Clearly, Van Gogh's not just out of the mainstream because of non-traditional work and spare living conditions, or even by his rejecting most superficial trappings and escapes of middle-class existence. Van Gogh is at the far sides of the bell curve because his mind- psyche ranges from intense moodiness and psychopathology to uncommon visual- spatial intelligence and ego strength. He also had to create a unique bridge between his inner and outer worlds. This artist had to seize things by the root and had to be touched by the heart. Now this doesn't make Van Gogh a saint. He could be explosive, at times extremely sensitive to criticism, and infuriatingly demanding, especially when others could not see the breadth and depth of his position.

That which Van Gogh found compelling was often overlooked or downplayed by others. That which others found impressive, was often found wanting by this unusual man of conscience and consciousness. In a letter to his brother, he imagines another artist's disparaging and dismissive attitude toward himself for not producing saleable art: "You are a mediocrity, and you are arrogant because you don't give in and make little mediocre things: you are making yourself ridiculous with your so-called 'seeking.'"

In general, I believe only improper medication or the misuse or abuse of the same would have profoundly contaminated his genius and persistently honed gifts. Actually, the stress and exhaustion from hunger and poverty often triggered his lows. At the same time, to escape the melancholy he could work himself into manic exhaustion. And still, drawing and painting was not just a diversion from pain. This relentless activity was a way of purposefully and imaginatively structuring exciting, dark and chaotic thoughts and feelings. Melancholia may even induce reflective restraint, giving "on the edge" perspective to "off the wall" mania. The creative "aha" not only yields a triumphant or, even, a transcendent moment but also a fertile field of meaning waiting to be explored and plowed.

If anything, I believe medication would have allowed just a bit more respite between mood cycles. He might have grappled with visionary highs and despairing lows without such extreme psychosomatic wear and tear. There's often a price to pay as a lonely, sometimes hungry, frequently misunderstood and psychiatrically vulnerable pioneer. However, the extreme sensitivity and obsessional quality of his mind, the tenacious yet humble search for mastery, the passion in his soul, and the edginess of his lifestyle would not and could not be denied or hormonally harmonized.

5. The Memory of a Man. If you accept my working hypothesis, then Van Gogh would have had at least two, if not three, decades without supervised medication. What this means is that he has both a treasure trove and a Pandora's box of memories and emotional associations that will not be erased or obliterated by biochemical intervention. (Now I must admit, even with low dose Prozac, sometimes my short-term memory is a figment of my imagination. Did I pick up the keys? Did I turn off the toaster-oven? On the other hand, having five decades under my belt may also be a factor.)

For Van Gogh, a highly introspective and analytic individual, his memory pool would be a primal wellspring even without quite as much hormonal "sturm und drang." In fact, mild-moderate melancholic states often induce subdued introspection, hence clearer access, to the psychic interior. In contrast, the symbolic meaning, psychological source and creative potential of subconcious material is often initially obscured by the hurly burly of manic eruption. It's the ebb and flow or flow and ebb - from melancholia to mania and back again - that often provides the unusual breadth and depth of the work of such an artist. Not surprisingly, the uncommon synthesis of contradictory elements is also a hallmark of such emotionally charged art.

Van Gogh on medication would still dip into past and present pain and passions to infuse his perceptions and projections. Memory, intuition and the practice of undivided attention to self and to other yields a capacity for profound empathy. His original and groundbreaking art springs from a historical connection and resonance with his own vital yet vulnerable self, his subjects and his surroundings.

6. The Realm and Process of Creativity. Still, the use of medication can have important impact on the primal wellspring; on how one's creative energy, sensitivity and flow is channeled and expressed. Let me draw on a variety of personal and experiential sources and styles. Before taking Prozac, my writings poured from emotional, inner world conflicts and acute, early childhood and adolescent memories. At the same time, especially when sketching contemporary clients or girl friends for the mass media, there was almost an obsessive need to use puns, to be so clever. (In fact, one woman broke off a relationship fearing her debut in a future standup routine.)

Though in some ways playful, even, liberating, too often writing was a forced process well into my '30s. Still smarting from self-destructing as a doctoral student and still lacking sufficient self-assurance regarding my writing abilities and creative status, I was trying too hard to prove my worthiness. At times I had difficulty appreciating and capturing absurdity or poignancy outside of myself. A capacity for subtly weaving my voice and persona into an inner-outer world tapestry often remained elusive.

Yet, there was a raw power in this witty, alliterative and on the edgy excavation and construction. Darkly humorous concepts such as the "Burnout Boogie," "Practice Safe Stress," "The Intimate FOE: Fear of Exposure," "Are You a Blameaholic?," "Creative Risk-Taking: The Art of Designing Disorder" and "Emancipation Procrastination" were brought to life. There was a not so shiny knight allegory about "romantasy" and addictive tendencies -- "The Dark Knight of the Soul or Letting Go Can Be a Knightmare." Or a theatre monologue based on a passionate, ill-fated romance that personified roguishly aggressive ways -- "His Moans, Her Moans, Hormones."

Pre-Prozac prose poetry and clever media sayings were a primary means of conveying pain and passion and, often, playfully transforming the charged primary process lode. For example, mid-80s radio script titles were an oft- used transformative vehicle, such as one on the defensive consequences of burnout: "Breaking Out of a Hell of a Shell or Don't Feel Too Sorry for Humpty Dumpty…He Needed to Hit Bottom!" Or another favorite: "Don't Clock the Writer's Block: Premature Impatience Will Sow Creative Impotence." Consider this prose poetry on the perils of production vs. procrastination:

Why can't writing be a race, ideas blasting from inner space with bursts of brilliance and subtle grace? Ha! For me, that starting block is a mental block building to a wall of frustration. It's the test of time. Will banging my head against the wall sooner produce a breakdown than a breakthrough?…Fortunately, I'm hard-headed.

And in the early '90s, the "Burnout Boogie" and "The Electrifying Lady" (a lyrical anthem for an African-American beauty contest) got some attention. Then, in an altered, daydream state before waking, while pondering the inanity of a therapist and university professor writing rap lyrics, the "aha" jumped out as if shaken by an unexpected morning alarm. The performance concept of psychologically humorous rap music had percolated from my subconscious - Shrink Rap Productions! And lyrics started pouring off the pen. So too the evolution of a stage costume: Blues Brothers hat, black sunglasses and black tambourine. One quasi-rap number, in particular, captured the ebb and flow of depression and mania - "Double-Edged Depression."

Waves of sadness, raging river of fear Whirlpooling madness till I disappear Into the depths of primal pain Then again, no pain, no gain…

Climbing icy spires, dancing at the ledge The phoenix only rises on the jagged edge. In a world of highs and lows Hey, the cosmos ebbs and flows…

Well I'm pumping iron and Prozac, too What else can a real man do? In a life of muted dreams How about a Primal Scream? AHHHH…

(For the entire piece, send an email.)

7. Primary Process and Practice on Prozac. To my surprise, six months after writing this lyric, which spoofed taking medication, I was on Prozac. I'm still not sure when the full impact kicked in. With hindsight, both in writing and public performance, my post-Prozac process reveals a less self- centered connection between my inner depths and individual voice. I'm more attruned to the reader's or audience's ear, psyche, heart and soul. Building on talents for witticism and poetry, I've matured into a psychohumorist, essayist and storyteller. (A friend also swears Prozac has done wonders for my rap singing.)

How much of this shift is due to the Prozac shrinking (certainly not eliminating) my primal pool of emptiness and depression or impacting confidence and energy levels? Taking medication is often a balancing act, trading off a symptom for a side effect. Though with the right medication there's a favorable balance of trade. Now I choose a very low dosage. I prefer some emptiness with a heightened sensitivity -- greater alertness, consciousness and obsessiveness -- over less emptiness, more drowsiness and reduced agitation.

Today, with biochemical support and some psychological maturation, I don't have the same compelling desire to pour out my pain in a country codependency number, as I did in this chorus from "The Love Trade":

The Love Trade, The Love Trade Why must love be so hard? The Love Trade, The Love Trade, Whose turn to play De Sade? The Love Trade, The Love Trade Why must love be so hard? The Love Trade, The Love Trade Who will be left scarred?

Also, as an individual and an artist, eventually a feeling arises of "been there, done that" -- from creative work to dysfunctional relationships; it's time for a new direction. As the Stress Doc says: Fireproof your life with variety!

Medication may well be a catalyst for developing a new balance (not better or worse than pre-meds daze) between: a) my emotional and analytical processing, or b) between using inner and outer worlds as the source for artistic conception and expression. Feeling more confident - both because of Prozac and progress in my path - my work has a less raw quality. I'm stretching more than straining. I'm not TRYING SO HARD TO BE CREATIVE! There may be some tradeoffs in terms of quality and merit. At times I wonder if I'm as wildly creative as I was in my "American in Cajun Paris" years. Now, it's true…New Orleans is the personification of the primal swamp and creative breeding ground! Then again, some of my most outrageously satirical essays on organizational dysfunction have been written in my DC and AP (After Prozac) years.

Finally, Prozac has allowed me to become more prolific; I have greater energy, overall. My obsessive drive has not been tempered. More specifically, the ebbs are shorter and the flows are steadier, along with greater patience and discipline. And as Van Gogh preached and lived, with incessant practice and reflection startling harmony and wholeness is possible despite the maddening and exhausting forces within and without. Of course, being able to grapple with and strikingly transform such warring elements for as long as he did is a tribute both to his unswerving devotion and to a vastly imaginative and powerfully analytical mind.

Along with genius, Van Gogh had an inordinate curiosity and exploratory drive in all facets of drawing and painting that left him ever hungry for self- betterment. I can only express humble awe for such a tenacious and thirsting mind-heart-soul.

Clearly, there are profound dangers in having an uncommonly balanced, if not imbalanced, biochemical/psychological apparatus. However, for the complex and committed artist, this acute sensitivity and vulnerability, while engendering risk also affords rare opportunity. To quote the aformentioned Dr. Jamison: "The integration of these deeper, truly irrational sources with more logical processes can be a tortuous task but, if successful, the resulting work often bears a unique stamp, a 'touch of fire,' for what it has been through."

Perhaps the discriminating use of medication may strengthen a gifted yet psychiatrically vulnerable, creative risk-taker's ability to navigate and, ultimately, to sustain a productive life "on the edge."

Conclusion. As I've tried to illustrate, definition and evolution as an individual and an artist is the byproduct of many factors, including biochemistry, family history, gifts, drive, discipline, support, frustration tolerance…Also, of technological innovation and opportunities, for example, the recent availability of a more precise acting and cleaner generation of antidepressant medications. Another profound technological development that has personally presented new creative doors is, of course, the Internet. The roles and literary/virtual-public performance persona of "Online Psychohumorist"™ and "The Stress Doc"™ has further expanded and sharpened my voice and sensibility.

And this is really the critical point. While depression or a bipolar state is a necessary condition for understanding many an artist (though certainly not all artists are tortured) it is not sufficient. The panoply of life - loss and love, longing and liberation must be reckoned with. A medical condition was certainly a driving force in Van Gogh's idiosyncratic way of being, suffering and expressing his inner dynamics, demons and worldview. However, as I've argued, if provided a sound and self-manageable medical option, perhaps final tragedy, though surely not trauma and drama, would have been averted. And creative genius would have burned bright longer in that starry, starry night.

Just as painting in the South of France, with the stronger sunlight, led to experimenting with bolder and brighter color, as previously mentioned, so too would medication be accommodated by Van Gogh's modus operandi. Prozac, Lithium or whatever the drug therapy would be incorporated and, ultimately, transcended by his integrity, blazing passion, intelligence, obsession and harmoniously tortured essence and existence. I choose this hopeful stance because the man himself embraced and embodied so much of life experience less as a blessing or a curse but as wondrous puzzle and creative challenge.

Van Gogh, of course, has the final word -- a poignantly affirming message in an 1882 letter to his brother. Such words if taken to heart may help cultivate a determined, if not defiant, spirit of self-acceptance and empathy, of courage and purpose in us all, including our previously referenced and discouraged emailer:

What am I in the eyes of most people -- a nonentity, an eccentric, or an unpleasant person -- somebody who has no position in society and never will have, in short, the lowest of the low. All right then--even if that were absolutely true, then I should like to show by my work what such an eccentric, such a nobody, has in his heart.