The Problems of Pathography
In Studies Dedicated to Erik Essen-Möller, Acta Psychiatrica Scandinavica 46, 1970
Affectionately dedicated to Erik Essen‑Möller.
Pathography and psychiatry are sister sciences approaching a common subject matter from opposing sides. In the ordinary psychiatric case history we consider the story of the patient's life for clues which will enable us to understand his illness. Pathography, also, relies for its data on the biographies of individuals, but seeks for data about his illnesses which will help us to understand his life story. Psychiatry eventually emerges with generalisations about mental illnesses, which have to be based on some system of classification. The generalizations for which the pathographer will seek will relate to human beings; and they too will have to be grouped or classified in some systematic way.
Past contributions to pathography have been of a largely anecdotal kind. Medical men have applied their special knowledge to the study of single outstanding individuals, noteworthy for their ability and achievement, or the notoriety of their crimes, or their historical significance. They have thereby contributed what might be called specialists' reports for the use of professional biographers, or historians, or for the general reader. The significance of the pathography relates only to the individual who is its subject. The pathographic weapon, however, can be applied in a systematic way, to individuals grouped by possessing some highly important common characteristic, and chosen so as to be representative of them. It is possible that much might be learned (no one has tried it yet) by investigating the illnesses, physical and mental, and the deviations of personality which have afflicted the millionaires or statesmen, libertines or chess‑masters, red‑head men or men two metres tall.
To my knowledge the only people who have been thought worthy of any sustained and extensive work have been the (so‑called) geniuses. The word "genius" is a question‑begging one, which seems to provide an answer to a whole range of problems before they can even be properly formulated. For example, one of the great mysteries of the world is how it came about that William Shakespeare of Stratford upon Avon, who is not known for sure to have had any school education, was the author of the plays and poems ascribed to "William Shakespeare", who had a vocabulary of some 15,000 words at his disposal. The answer which is invariably given and thought to be wholly sufficient is that, of course, he was a genius.
In the popular mind, genius is tantamount to mental power of a qualitatively different order from that of the generality of mankind. Of course, this is not the view of serious investigators; and many have pointed out that there is no ground for believing that those who are universally acclaimed as geniuses differed from those who were merely highly talented in other than a quantitative degree. We see here the operation of a natural principle by which a quantitative change in the variable A may produce a qualitative change in variable B. One little touch more of insight or application may solve the problem, or create the synthesis, which, till that moment, had been unattainable. The superiority of the achievements of the man of the highest talent over those of his near rivals may be disproportionately greater than is his mental superiority to them. If we find in his work something that is breath‑taking, it does not follow that the awe and wonder with which we view it are at all appropriate emotions in regarding the author.
Lange‑Eichbaum has provided us with the beginnings of an analysis of the special emotions which have to be aroused, if we are going to say that the work is one of genius. From the work we have to obtain certain impressions, impressions which are cognate with those imposed on us by nature herself. These are: das Überlegene (majestas), the quality of greatness, superiority to ourselves, seen less often in the works of man than in those of nature, in high mountains and great seas; das Zwingende (energicum), the outflow of energy, action which seems to carry us with it and imparts a feeling of dynamism even to the passive participant; das Lockende (fascinans), the quality that is desirable, delicious, alluring through its sensory, sensuous and sensual appeal; das Herrschende (sanctum), the sanctified, the universally acknowledged and respected; das Unheimliche (tremendum), the strange and otherworldly, the eerie; das Besondere (mirum), the wonderful and marvellous, transcending normal experience. In the contemplation of any one work of the human mind a mixture of emotions will be aroused, and the work will be experienced as having more than one of the qualities so listed. The particular mixture of emotions aroused, in their varying degrees, will come as a total complex to have an individuality, a specific quality, but one which carries with it always an essence, which Lange‑Eichbaum calls the numinous, the appearance of the quasi‑divine or more than unaidedly human.
These qualities in the work throw their reflected light onto its creator, and he in his repertoire will be found to have the capacity to arouse emotions over a particular range of the whole gamut. Behind this individuality lie different combinations of personality traits, which differ not only from man to man but also from group to group, such as those of statesmen, men of war, inventors, discoverers, philosophers, scientists, prophets, disciples, artists. But genius lies still more in the eye of the beholder, and the fame of genius has its own natural history. Many who are eventually called genius were not so regarded in their lifetime; and many who soon or late attain that state sink subsequently in repute. There is, in fact, a general tendency to decline. When our culture has endured for a few ten thousands of years we may perhaps be in a position to review this birth, maturation, retrogression and death in a sufficient number of instances to understand it. From what we can at present see, it appears that a certain sort of impression has to be formed on a community of sufficient size, with such strength that it persists in traditional memory, for "genius" to be attained.
Lange‑Eichbaum writes: "A genius is a man whose person, whose work, whose fate and whose fame unite to form a composite structure which excites the feeling of the numinous in the minds of a large community. It is a valuation of a number of sorts of greatness, any one of which may be exchanged for another... The fame of genius has only a social existence, with its life epochs of arising, growing, ripening, ageing and death. Genius is nothing absolute and nothing objective, but rather a constantly fluctuating function." In a single phrase, we might say that genius is not a thing in itself, but a relationship between a man and the community that knows him. The historical man and the popular image always differ, and the latter is not only a simplified but also a transformed version of the former.
Lange‑Eichbaum rejected the view that greatness of mind or personality were absolute pre‑requisites for recognition as a genius. On the other hand some form of mental abnormality, psychosis or psychopathy were great advantages in this sense. The qualities of tremendum and mirum, the uncanny and the wonderful, were both strongly suggested by mental abnormality. Geniuses, he found, could be classified into a two by two table: those who had greater than average ability and those who were only average; and those who were mentally normal and those who were abnormal. As greatness of mind and abnormality of mind were both advantages, the largest number of geniuses would be found in the cell containing those who were both able and psychopathic. There were however considerable numbers of geniuses in two of the other cells, but they are geniuses of a somewhat specialized kind. Thus those who are able and mentally normal have to be absolute giants in talent to receive the accolade, such men as Rembrandt, Titian, Van Dyck, Rubens, Bach, Verdi, Ibsen, Gauss and Leibniz. Those who were mentally abnormal but not endowed with any high talent are typified by the prophets and religious teachers, such as Mahomed, Swedenborg, the Mormon Smith, Joan of Are, etc. In the fourth of the groups, those who have neither advantage, and are both of average ability and of normal mentality, are the great numbers of those whom Lange‑Eichbalm calls "concentration‑geniuses", namely those people whose names have become the labels to be applied to some discovery, or successful course of policy, the achievement of which has been the work of many minds.
Lange‑Eichbaum, however, goes much further than merely to assert that mental abnormality, or speaking more precisely the biologically negative factor, enters the picture only at the point where great achievement receives the laurels of genius. It is, he maintains, an aid in the achievement itself. He defines the bionegative factor as all those dynamic processes which are in any way harmful or disadvantageous to life, including therefore psychotic illnesses, neurotic disturbances and psychopathic constitutions. He supports, then, in a sophisticated form a theory which is practically as old as civilization itself; for which authority can be found in Democritus, Socrates, Plato, Aristotle:"nullum magnum ingenium nisi insania quadam mixtum" (there is no great feat of mind without insanity mixed therein); a theory which was propagated with enormous energy, success and abiding influence by Lombroso; a theory which is found quite exceptionally palatable by the litterati of today.
With this we are offered a hypothesis which can be subjected to the test of observation. Is it true that creative workers have more mental abnormality than the generality of mankind? Lange‑Eichbaum has proved that the concept of "genius" is too much contaminated by subjective ideas to provide a useful principle of classification of the men we should study. To avoid a questionbegging definition, we must go in the first place to the created works, the achievements, which arouse our admiration, for these may be judged by a relatively objective standard; from them we can go to consider the men who made them.
This was the approach used by Adele Juda (1953), in an investigation carried out in the Genealogical Department of the Forschungsanstalt für Psychiatrie in Munich in the years before and during the last war. What she asked for was the names of persons, speaking the German tongue, who had been in their own field the most gifted and creative of all born since the year 1650; and to get them she went to juries of specialists, chemists to choose ohemists, mathematicians to choose mathematicians, musicologists to choose composers, etc. The assessors were asked to make their choice on a basis of achievement only. From the lists she obtained in each field she could mark off the names which had been notified unamimously by every one of her assessors, the names which were notified by a majority only, and those which did not receive even a majority vote; these last were excluded and were not further investigated.
Juda has described the results of her great work in a monograph, so that there is no need to discuss them in detail. She had 294 names to work with, which she divided into 113 artists and 181 men of science, an admittedly much over‑simplified division. She investigated the personal histories of her subjects, and also their ancestry, their families and their descendants. She reached conclusions on the subject of maternal age, birth order, marriage and fertility, and the more than average gifts of both blood‑relatives and wives. Frequencies of psychosis, psychopathy, etc., were calculated for the probands and their relatives; and among the latter there was very little in the way of a shift towards any increased tendency to mental abnormality.
For us the crucial question is whether the subjects themselves were mentally abnormal in undue proportion. The incidence of schizophrenia in the artists was calculated as 2.8%, in the scientists nil. Manic‑depressive psychosis was found in none of the artists, in 4.0% of the scientists. The incidence of unclear endogenous psychosis in the artists was 2.0%, in the scientists nil. The total incidence of endogenous psychosis was accordingly about the same in the two groups at 4.8% and 4.0%. This is compared with an expectation of endogenous psychosis in the general population of 1.2%; so that both artists and scientists were from three to four times as heavily predisposed to endogenous psychosis as might have been expected on a chance basis.
The raised expectations of psychosis were paralleled by an incidence of psychopathy; 27% of the artists and 19% of the scientists were diagnosed as psychopathic, by a standard which would give an incidence in the general population of 10 to 12%. Psychopathy, in the sense of Kurt Schneider, was accordingly between 1 ½ and 2 ½ times as frequent in Juda's probands as one would have expected.
Both the positive and the negative aspects of these results are important to us. The more important lesson is that the great majority of these distinguished figures were mentally normal, and suffered neither from mental illness nor from any morbid or antisocial deviation of personality make‑up. The ancient superstition, derived through Lombroso from the Greeks, that genius is to madness near allied, can be dismissed. The lesson is one which should be taken to heart by the creative artists and the critics of today, who, as it seems to me, are fascinated so much by the breaking of conventional restrictions, by the chaotic and disorderly, by the neurotic and the deviant, even by phenomena which are directly evil, that they can find little interest or merit in the products of an energetic and healthy normality.
The other aspects of these results is the more intriguing one. Why was it that Juda found a raised incidence of endogenous psychosis and of psychopathy in her probands? Are we to suppose that her finding is a reliable one, and that other observers, perhaps working on different selective principles, would be able to confirm it? Is it true of all kinds of artists, alternatively of all kinds of scientists? Is there any change between the relationship between great achievement and mental abnormality which shows itself over the course of centuries?
Some years ago Alfred Meyer and I were kindly put in possession of Juda's biographical material on her probands, and made an intensive study of the group of musicians (1959, 1960). On the basis of that work I should like he to put forward some tentative suggestions, which might be regarded as working hypotheses and subjected to further test.
It seems probable that the series taken by Juda was a fairly representative one, and that the phenomenon she observed ‑an increased liability to mental disorder among men of high achievement ‑ is a general one. The extent which it holds good appears to vary over the course of time. In the days when musicians were a kind of craft‑worker, having their natural place in a feudal society, their careers would be chosen for them by their families more than themselves. The deviant personality and the social misfit would be less rather than more than normally likely to find himself, after a testing apprenticeship, in a highly skilled professional occupation in which creative work was call for. As society gradually changes, two factors, both of them unfavourable, begin to make their effects felt. In an increasingly free society the position the creative artists becomes less protected and less happy as a career; and the element of self‑selection increasingly operates, electing for the work those who find dissatisfaction and frustration along the conventionally approved pathways. It seems quite possible that, while things have been going this way in the wos of the artists, a reverse process has been occurring in the world of the scientist. Scientific research is now an approved and reasonably well remunerated life-work. The part played in it by the deviant and the eccentric is probably already no more than what random expectation would imply.
Are there then no traits of personality which for high achievement are needed in more than average degree, and which when present in more than average degree may cause some disharmony of personality or difficulties adjustment? It is hoped to examine this question in detail in work still to be published; but a few provisional observations may be made here. One thing seems to stand out in the life histories of Juda's musical composers, the suggestion that the capacity for a massive energy output is of central importance.
The general model of development which the creative process follows stat with the nascent idea. Through a period of latency and incubation there is gradual building up of tension which breaks, with the onset of effective expression, into a sustained flow of outpoured energy, frequently in a high and sweating excitement that goes on hour after hour. "I work at a thousand horse power", said Hugo Wolf, and an equivalent observation could have been made by many of the others. For such a process to occur, the personality must have a capacity to accumulate reserves, and availability of resources of energy seems to be a necessity for work of any magnitude. If we look only at the amount the work which has been produced by Juda's composers, regardless of its quality, we find that it is larger among the great than among the less grea and Handel, Bach, Haydn, Mozart, etc., had a larger output than, say, Bruckner, Cornelius, Liszt, Mahler and Wolf.
There are two rather curious findings which may, perhaps, be associated with this capacity for output of mental energy at high tension. One of them is the fact that by and large the composers tended to be men of small stature, and in Juda's list only Gluck and Schumann seem to have been men of more than average height. The other is that a surprising number of the most dynamic and masculine never developed any permanent relationship with women. This may have been on their side merely a method of self‑protection, to spare their energies for the work of composition.
If now we look for the conditions in which higher than average levels of energy output are associated with psychiatric disorder, we at once think of the cyclothymic personality and manic‑depressive illness. Both Schumann and Wolf were liable to profound endogenous mood changes which are reflected in a marked rhythmicity in their output of work. Other composers noteworthy for their cyclothymic traits include Handel, Max Reger, Schubert and Johann Strauss.
However, the principal conclusion to which one finds oneself forced by the study of these life histories is that creative work is done out of the vigorous and healthy elements of the personality. Psychopathic features may give a slant to the work; neurotic fixations may lead to the selection of material of a particular kind for elaboration; griefs and sorrows may compel the artists to find some creative way of catharsis. But the creative work itself proceeds from strength and not weakness.
Juda, A. (1953): Höchstbegabung: ihre Erbverhältnisse sowie ihre Beziehungen zu psychischen Anomalien. Munich and Berlin (Urban u. Schwarzenberg).
Lange‑Eichbaum, W. (1956): Genie, Irrsinn und Ruhm; 4th edition. Ed. by W. Kurth. Munich and Basle (Reinhardt).
Slater, E. and Meyer, A. (1959): Contributions to a pathography of the musicians: 1. Robert Schumann. Confin. psychiat. 2, 65‑94.
Slater, E. and Meyer, A. (1960): Contributions to a pathography of the musicians: 2. Organic and psychotic disorders. Confin. psychiat. 3, 129‑145.