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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 I

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.

Mark Gorkin, LICSW, the Stress Doc, a psychotherapist and nationally recognized speaker, trainer, consultant and author, is also known as AOL's and the internet's "Online Psychohumorist" ™. Check out his USA Today Online "Hot Site" website - www.stressdoc.com or <A HREF="www.stressdoc.com">STRESSDOC HOMEPAGE</A> and his page on AOL/Online Psych, Keyword: Stress Doc or <A HREF="aol://4344:972.doc.1264535.556723207">The Stress Doc @ Online Psych </A>.

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