Femi Olugbile:
“It is natural to expect that people who create beautiful things, and who bring pleasure to other people and enhance the culture of humanity by their works should be held in high esteem by society, and should generally live happy secure fulfilled lives, based on the value of their outputs. Indeed many creative people are able to make huge incomes from their works, and many have all through time enjoyed celebrity status. However, on casual inspection an even larger number appear to have lived or to be living troubled lives ravaged by penury, social dislocation, broken relationships, and isolation and illness, especially mental illness. Many have committed suicide or various acts of deliberate self-harm.”

By Femi Olugbile.

A ‘double-barreled’ assignment. One barrel is for the lecturer, representing an area of abiding interest. One is for Professor Adeoye Lambo, distinguished Psychiatrist, and erstwhile Deputy Director General of the World Health Organisation, whose life we are celebrating through this annual activity.

Arts (‘The Arts’)
Antonyms: craft, profession, dexterity, artistry, knowledge, adroitness, ingenuity, mastery, imagination, know-how, aptitude, inventiveness. Wordweb (based on latest edition of Chambers dictionary) ‘The products of human creativity; works of art collectively. The creation of beautiful, significant things.

From ancient times, Arts, and the people with ‘artistic’ talents, have played a prominent role in the lives of society. The importance of the Arts transcends the life of the artist (there has been more money paid on Picasso’s works since he died than in all the years of his life).It transcends the life of society itself. When societies, cultures and civilisations die, such as ancient Pompeii, the Roman Empire, or ancient Egypt, the Arts – in the form of architecture, artifacts, paintings, sculptures and implements are taken as the evidence of the quality of life and level of attainment of the society.

‘The creation of beautiful significant things’ can cover a very wide area in different cultures. It covers oral and written literature, drama, poetry, music, drawing, painting, and sculpture. It covers design, which in the present day has been interwoven into virtually every aspect of life, including electronic and mechanical devices that functionally would not normally be related to ‘Art’. One of the prime selling points of the Apple brand is the ‘minimalist’ art design that is reflected in every item it produces. It is reflective of the importance and ubiquity of ‘Art’ in modern life, that ‘smart phones’ are now no longer ‘just’ phones, but works of art that in some future age will provide information to curious generations yet to come about the lives and times of the present generation.

The connection between all creators of Art – whether it is a Picasso and his giant paintings, or an Achebe and his literature, is the possession and expression of ‘Creativity’. We may seek to explain the concept of ‘Creativity’ as a situation involving the possession and display of a quantity that may be described as talent, inventiveness, ingenuity, genius, originality, inspiration. It is easy to mistake the concept for ‘brilliance’ – a factor which is reflected scientifically by the measurement of ‘Intelligence’. And yet they are not quite the same. While most people with strong creative talent have Intelligence Quotients of 120 and above), the ‘superior’ performance of the writers tends to be in the WAIS vocabulary subtest. (Andreasen et al, 1988).

“Prof Lambo was not only socially conscious. He was socially involved. The repeated political failings of his country, Nigeria, was a thing that got him hot under his elegant collar. He was normally loath to criticize people, but towards the end of his life, his criticisms of the Nigerian political class became a recurrent strident theme in his conversation, to the point where it received very wide press coverage. He began to advocate that politicians should undergo mental state examination before they could be eligible to hold public office.”

It is natural to expect that people who create beautiful things, and who bring pleasure to other people and enhance the culture of humanity by their works should be held in high esteem by society, and should generally live happy secure fulfilled lives, based on the value of their outputs. Indeed many creative people are able to make huge incomes from their works, and many have all through time enjoyed celebrity status. However, on casual inspection an even larger number appear to have lived or to be living troubled lives ravaged by penury, social dislocation, broken relationships, and isolation and illness, especially mental illness. Many have committed suicide or various acts of deliberate self-harm. School children, learning Art, are mystified when they are told the story of Vincent Van Gogh, who cut off his own left ear and handed it to a prostitute with an instruction to ‘preserve this package carefully’, before returning home to collapse from the attendant haemorrhage. The famous writers Ernest Hemingway and Virginia Wolf committed suicide in what are assumed to have been states of disturbed mental functioning.

Such observations have led some scientific enquirers to look for evidence of a putative relationship between creativity and mental illness. There are depictions in the media about famous individuals who had evidence of formal mental illness. An example is‘A Beautiful Mind’ – a major Hollywood movie, based on a biography of John Forbes Nash, a mathematical genius who won the Nobel Prize in Economics even as he battled with Schizophrenia. The book is written by Sylvia Nasar, and the film stars Russell Crowe. Such works have tended to imprint in the popular perception the notion that there is an association between innovative, creative talent and Schizophrenia. For some time there were romantic notions – especially in anti-Psychiatry circles, that Schizophrenia, far from being an illness, could be a ‘cool’ condition – a higher state of perception and experience that ordinary mortals disparaged because they failed to understand it.

Is there any Science at all to this line of thinking?

Much of the early research interest was actually focused on exploring a putative relationship between Creativity and Schizophrenia. In a study published in 1926, Ellis (Ellis, 1926) selected 1,020 eminent people in the UK. They included politicians, scientists and artists. They were actually selected more for their fame than any proven creative talent. He found that 4.2% of his sample were ‘insane’, 8% were ‘melancholic’, 5% had ‘personality disorder’.
Brain (Brain, 1948) observed that ‘geniuses’ were more ‘nervous’ than other people. When they broke down, the diagnosis was often ‘cyclothymia’.
Juda (Juda, 1949) in a paper titled ‘The relationship between high mental capacity and abnormalities’ examined the medical records of 113 artists and 18 scientists. He found personality disorder as the commonest diagnosis. Artists who had abnormalities tended to show alcoholism and schizophrenia, while scientists appeared to suffer more from affective disorder.
Lumbroso (Lumbroso, 1981) introduced the idea of ‘hereditary taint’ to describe the relatively frequent appearance of ‘genius’ (defined as exceptional talent) along with ‘madness’ (psychotic illness).

More recent work
It is an exciting area of research.
A Danish adoption study (McNeil, 1971) measured psychopathology in some creative people who had been adopted away from home at an early age, and in their biological and adoptive relatives. It found that 3% of the creative sample had psychiatric diagnosis. 28% of the biological parents had a diagnosis of some kind of mental illness, while only 5% of the adoptive parents were ill. The commonest diagnosis was ‘Reactive Psychosis’)
Rust (Rust et al, 1988) found a relationship between creative originality and the positive cognitive aspects of schizotypal thinking. However their findings have not been reproduced since.
In a study reported in 1988, Richard (Richard, 1988) in Harvard set out to discover if there was a compensatory advantage in ‘Manic Depressive Illness’. His model was Sickle Cell anaemia, where the heterozygote is supposed to enjoy relative immunity from Malaria.
He selected a sample of people with diagnoses of Manic Depressive illness, Cyclothymia, as well as normal first degree relatives, along with matched controls. He measured their Creativity, using a ‘Lifetime Creativity Scale’.

His finding was that creativity was higher among the test sample than the controls. Remarkably, there was more Creativity among normal first degree relatives than even among the ill patients themselves. Those with diagnosis of ‘Cyclothymia’ came in between.
Andreasen in Iowa (Andreasen,1987) carried out a survey of 30 writers from all over who came to work in the University faculty. (famous African writers have been on the Iowa programme), and compared them with matched controls.She also studied their first degree relatives. Her finding was startling. 80% of the writers had had an episode of Affective Illness at some time. This was compared to 30% in the controls. 43% of the writers had Bipolar disease. There was also a higher incidence of illness and creativity in the writers’ first degree relatives.

The same researcher has gone a step further to establish from neuro-imaging studies that highly creative individuals have more intense activity in association cortices when performing ‘creative’ functions (Andreasen, 2011).

A British researcher (Jamison, 1989) took a sample of 47 famous British writers and artists who had won major awards such as the Booker Prize, or who were distinguished members of the Royal Academy of Arts. She found that 38% of them had received treatment for Affective Disorder (antidepressant, Lithium and/or hospitalization). Poets and novelists were particularly prone to mood swings, whereas visual artists were apparently less vulnerable.
More recently, a team working in Lagos (Olugbile et al, 2011) compared samples of patients in two Psychiatric Units (Lagos State University Teaching Hospital and Federal Neuro-Psycbiatric Hospital Yaba) who had diagnoses of Affective Disorder and Schizophrenia on the basis of their ‘Creativity’. No significant difference was found between the two populations, although the study was confounded by a number of factors, including small sample size.

Musolini.
“A review article by Hugh Freeman in the British Journal of Psychiatry (Freeman, 1991) speculated that Kemal Ataturk (founder of modern Turkey), as well as Benito Mussolini suffered from neurosyphilis, which was at that time a debilitating condition with neuropsychiatric complications. Woodrow Wilson, Winston Churchill, General Eisenhower, Leonid Brezhnev are known to have suffered from cerebrovascular incidents during their active public lives. General Franco and Adolf Hitler are said to have shown evidence of Parkinson’s disease.”

Let us leave the discussion of the Arts for a moment, and focus on the other ‘barrel’ of our agenda. As I said earlier, this is The Lambo Lecture – created in honour of Professor Adeoye Lambo – founding father of Nigerian Psychiatry, and mentor and inspiration to not one but several generations of African Psychiatrists, among which I count my own. I had the privilege of enjoying some proximity to Prof Lambo in the days after his return from his assignment with the WHO. He was a man with an impeccable sense of dress, and unflappably gracious manners. I was a young man who often wore his emotions on his sleeves. Sometimes I could not understand why he was so cool. I once tried to draw him out on the subtle racism of some European psychiatrists of his generation who implied, for instance, that Africans could not experience depression.To my mind, they were similar to writers such as Joseph Conrad and the Oxford-Cambridge historians of the ilk of Hugh Trevor Roper who saw Africa as ‘the dark continent’ where there was nothing before the advent of the European. It was the work of people like Lambo that subsequently opened up the eyes of the world to the mental experience of the African, and situated his illness in pretty much the same diagnostic context as the rest of humanity, in a similar fashion to what Chinua Achebe did in Literature by writing ‘Things Fall Apart’.

Prof Lambo was an exceptionally brilliant man, the scion of a privileged Egba family, married to a very beautiful English wife Diane. He was perfectly comfortable in his skin. Those who knew Prof Lambo would remember that he was virtually always dressed in formal suit, complete with pocket square. The only time I remember seeing him in agbada (of course complete with elegantly tilted cap) was the day he graciously accepted to be chairman at the public presentation of one of my novels – BATOLICA.

He had insisted on getting a copy of the book a week before the event, and, thorough man that he was, he had read it with close interest. He told me he liked it. The plot of the book centred around a group of idealistic but naïve students and lecturers in a university, disgruntled with their corrupt society, locking the gates of their University and declaring it an independent Republic. This was in a country under military rule. Predictably, dire consequences would follow. Prof Lambo directed the book presentation from the podium at NIIA in Victoria Island that morning with practiced elegance, talking familiarly about the idealism of youth and the need for people, including Psychiatrists, to be socially conscious.

Which leads me to the crux of the reference. Prof Lambo was not only socially conscious. He was socially involved. The repeated political failings of his country – Nigeria was a thing that got him hot under his elegant collar. He was normally loath to criticize people, but towards the end of his life, his criticisms of the Nigerian political class became a recurrent strident theme in his conversation, to the point where it received very wide press coverage. He began to advocate that politicians should undergo mental state examination before they could be eligible to hold public office. I had the privilege of discussing this matter with him on a couple of occasions.
He of course was a Professor of Psychiatry, a leader in his generation. He knew all the pitfalls attached to the position, beyond the emotional desire to have a cleaner politics in his country. He wanted psychiatrists to champion the cause. I therefore took it upon myself to explore the precedence and seek evidence for his position.

The Evidence
Mapping a relationship between the holding of political office and the existence of mental illness is a scantily explored field, even now. And yet convincing evidence of such a link would be the minimum requirement to commence a discussion of the utility value of carrying out mental state evaluation of politicians.

Davidson (Davidson et al, 2006) published a review that showed that of the 37 Presidents of the USA who served between 1776 and 1974, 18 (49%) met DSM IV criteria for different diagnoses. Of these, 24% suffered from Depressive syndromes, 8% Bipolar Affective Disorder, 8% suffered from Anxiety, and 8% met criteria for Alcohol abuse/dependence. Somewhat alarmingly, 27% of the cases started while the President was actually in office, raising the possibility that they might have affected their on-the-job performance, including major decisions such as taking the country to war!

A review article by Hugh Freeman in the British Journal of Psychiatry (Freeman, 1991) speculated that Kemal Ataturk (founder of modern Turkey), as well as Benito Mussolini suffered from neurosyphilis, which was at that time a debilitating condition with neuropsychiatric complications. Woodrow Wilson, Winston Churchill, General Eisenhower, Leonid Brezhnev are known to have suffered from cerebrovascular incidents during their active public lives. General Franco and Adolf Hitler are said to have shown evidence of Parkinson’s disease. The extrapolation can be extended back to biblical times. King Nebuchadnezzar of Babylon suffered from what was obviously a psychotic condition.‘Emperor’ Jean Bedel Bokassa of the Central African Republic who declared his impoverished African country an ‘Empire’ with himself as ‘Emperor’ over it was the subject of much speculation about what seemed to be grandiose and paranoid symptoms he exhibited in office.

What Value – the ‘Evidence’
Much of the ‘evidence’ is not based on definitive clinical information but is anecdotal. There is no implication, for instance, that the rate of various mental disorders is higher in people in political office than it is in the general population.
There is a subjectivity to speculation about other people’s mental health based on their public image or behaviour. The observation may be coloured by the attitude and political sympathy of the observer. A writer (Vertzberger, 1990) described how some ‘experts’ speculated, based on his behavior and pronouncements in office, that Kwame Nkrumah suffered from a paranoid condition. Obviously, many Africans with a pan-African passion, including psychiatrists, would have disagreed with such people.

This ‘psychological speculation’ in fact has become a genre of literature, with the advent of the ‘psycho-biography’. Interestingly it was Sigmund Freud who started the trend, working with a collaborator to write a psycho-biography of President Woodrow Wilson. In like manner, a British psychiatrist, tried to explain the enigma of Winston Churchill (Storr, 1989). What the psychobiography does is try to use the principles of Psychology, including formal Psychoanalysis to explain retrospectively the life and actions of a public figure. It is meant to provide a depth of insight that the ordinary biography cannot match. However it has become controversial in the recent past. The fundamental assumption that the psychiatrist who is writing the script is himself without bias is not always a correct assumption. The biased opinion of a writer, even one who is a psychiatrist or a psychoanalyst, may camouflage as ‘scientific’ fact.