Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain

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Overview

What Underlies the human ability, desire, and even compulsion to write? Alice Flaherty first explores the brain state called hypergraphia -- the overwhelming desire to write -- and then the science behind its antithesis, writer's block. As a leading neurologist at a major research hospital, Flaherty writes from the front lines of brain research. Her voice, driven and surprisingly original, has its roots in her own experiences of hypergraphia, triggered by a postpartum mood disorder. Both qualifications lend power...
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Overview

What Underlies the human ability, desire, and even compulsion to write? Alice Flaherty first explores the brain state called hypergraphia -- the overwhelming desire to write -- and then the science behind its antithesis, writer's block. As a leading neurologist at a major research hospital, Flaherty writes from the front lines of brain research. Her voice, driven and surprisingly original, has its roots in her own experiences of hypergraphia, triggered by a postpartum mood disorder. Both qualifications lend power to Flaherty's vibrant connections between the biology of human longing and the drive to communicate, between drugs and productivity, between metaphor and emotion. The Midnight Disease charts exciting new territory in the relationship between the creative mind and the body. Flaherty -- whose engagement with her patients and passion for literature enrich each page -- argues for the importance of emotion in writing, illuminates the role that mood disorders play in the lives of many writers, and explores with profound insight the experience of being "visited by the muse." Her understanding of the role of the brain's temporal lobes and limbic system in the drive to write challenges the popular idea that creativity emerges solely from the right side of the brain. Finally, The Midnight Disease casts light on the brain functions and dysfunctions of writers past and present, from Dostoevsky to Conrad, from Sylvia Plath to Stephen King. The Midnight Disease brings the very latest brain science and a lively literary voice to bear on the most compelling questions surrounding human creativity.
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Editorial Reviews

The Washington Post
This is a learned book. It's chock-full of information on drug use and alcohol, hallucination and vision, advice and caveats from writers of every stamp. Some of the information is poignantly practical: Hot showers and clean clothes may sometimes help writer's block, and stay away from the snooze button on your alarm because it won't help your mental state! There is the story of a child who tried, literally, to climb into a book and broke down sobbing because he couldn't. And a marvelous chapter on metaphor and inspiration, dealing with use of language and the connections between the muses who speak to writers and the divinities who have spoken (or is it our own inner voices that speak?) to our visionaries and saints. — Carolyn See
Publishers Weekly
Flaherty (The Massachusetts General Handbook of Neurology) mixes memoir, meditation, compendium and scholarly reportage in an odd but absorbing look at the neurological basis of writing and its pathologies. Like Oliver Sacks, Flaherty has her own story to tell a postpartum episode involving hypergraphia and depression that eventually hospitalized her. But what holds this great variety of material together is not the medical authority of a doctor, the personal authority of the patient or even the technical authority of the writer, but the author's deep ambivalence about the proper approach to her subject. Where Sacks uses his stylistic gifts to transform illness into literature, Flaherty wrestles openly with the problem of equating them, putting her own identity as a scientist and as a writer on the line as she explores the possibility of describing writing in medical terms. She details the physiological sources of the impulse to write, and of the creative drive, metaphorical construction and the various modes of stalled or evaded productivity called block. She also includes accounts of what it feels like to write (or fail to write) by Coleridge and Joan Didion as well as by aphasiacs and psychotics. But while science may help one to understand or create literature, "it may not fairly tell you that you should." To a student of literature, Flaherty's struggle between scientific rationalism and literary exuberance is familiar romantic territory. What's moving about this book is how deeply unresolved, in an age of mood pills and weblogs, that old schism remains. Writers will delight in the way information and lore are interspersed; scientists are more likely to be divided. (Jan. 6) Copyright 2003 Reed Business Information.
From the Publisher
"[Flaherty] is the real thing . . . and her writing magically transforms her own tragedies into something strange and whimsical almost, almost funny.
The Washington Post

"This is interesting, heated stuff." The San Francisco Chronicle

"Brilliant . . . [a] precious jewel of a book . . . that sparkles with some fresh insight or intriguing fact on practically every page." Seattle Post-Intelligencer

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Product Details

  • ISBN-13: 9780641974588
  • Publisher: Houghton Mifflin Company
  • Publication date: 1/6/2004
  • Pages: 320
  • Product dimensions: 5.70 (w) x 8.30 (h) x 1.10 (d)

Meet the Author

A. W. Flaherty is a neurologist at Massachusetts General Hospital who also teaches at Harvard Medical School. She is the author of The Midnight Disease: The Drive to Write, Writer’s Block, and the Creative Brain. A. W. lives with her husband and twin daughters near Boston.

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Read an Excerpt

Introduction

Writing is one of the supreme human achievements. No, why should I be
reasonable? Writing is the supreme achievement. It is by turns exhilarating
and arduous, and trying to write obsesses and distresses students,
professional writers, and diarists alike. Writers explain why they write (and
have trouble writing) one way; freshman composition teachers, another;
literary critics and psychiatrists and neurologists have increasingly foreign
explanations. These modes of thinking about the emotions that surround
writing do not easily translate into one another. But one fact is always true:
the mind that writes is also the brain that writes. And the existence of brain
states that affect our creativity raises questions that make us uneasy. What
is the relation between mind and body? What are the sources of imagination?

How can both neuroscience and literature bear on the question of
what makes writers not only able to, but want to, even need to, write? How
can we understand the outpouring of authors such as Joyce Carol Oates or
Stephen King? Why does John Updike see a blank sheet of paper as radiant,
the sun rising in the morning? (As William Pritchard said of him, "He must
have had an unpublished thought, but you couldn't tell it.") This compulsion
seems—and is—an unbelievably complex psychological trait.
Yet it is not so complex that it cannot be studied. Neurologists
have found that changes in a specific area of the brain can produce
hypergraphia—the medical term for an overpowering desire to write. Thinking
in a counterintuitive, neurological way aboutwhat drives and frustrates literary
creation can suggest new treatments for hypergraphia's more common and
tormenting opposite, writer's block. Both conditions arise from complicated
abnormalities of the basic biological drive to communicate. Whereas linguists
and most scientists have focused primarily on writing's cognitive aspects,
this book spends more time exploring the complex relationship between
writing and emotion. It draws examples from literature, from my patients, and
from some of my own experiences.
Evidence that ranges from Nabokov to neurochemistry, Faulkner
to functional brain imaging, shows that thinking about excesses and dearths
of writing can also clarify normal literary output and the mechanisms of
creativity. The few current books on creativity that include a neuroscientific
perspective have neglected crucial brain regions such as the temporal lobe
and limbic system in favor of a still popular —but arguably oversimplified—
emphasis on the role of the right side of the brain.
Focusing on the importance of the brain in the drive to write helps
suggest treatments for disorders of creativity that are sometimes medical. It
should do so, though, without ignoring the fact that most innovative people,
and most people struggling with blocks, are not mentally ill. Concentrating on
the brain structures underlying creativity provides surprising answers to such
diverse questions as how we learn to write, the nature of metaphor, and even
what causes the strange sensation of being visited by the muse.
Although The Midnight Disease attempts to be a scientifically
accurate book, it is far from a dispassionate one. How could I speak dryly on
a subject as charged as the origin of literature? I am infatuated with writing,
and this emotional engagement shapes the book. Writing can do
extraordinary things. One night when I was a child, I read a passage in C. S.
Lewis's autobiography, Surprised by Joy, which described one of his own
reading experiences as a child. He had been reading Longfellow's
poem "Tegner's Drapa," when a line jumped out at him: "I heard a voice that
cried / Balder the beautiful / Is dead, is dead. . . ."The beauty of that line, the
way it tore at him, drove him to become permanently addicted to reading and
writing. Strangely, even out of context, the line stirred me as well. Something
swept me out of his book high into the cold air above the northern wastes.
What was it that was transmitted from the writer of "Tegner's Drapa" to the
writer of The Allegory of Love to me, possibly even to you?
In her book On Beauty and Being Just, Elaine Scarry imagines
Leonardo da Vinci seeing a woman with a face so beautiful that he tries over
and over to capture it in different drawings. Later artists are moved by his
copies, which they then try to copy themselves. Eventually the critic Walter
Pater writes his famous essay on Leonardo, and the copies of the woman's
face spread from one art form into another. Beauty drives copies of itself,
whether in art, or when we want to make children with someone we love.
Great scientific ideas drive their own transmission in the same way—it is not
a metaphor when researchers refer to an elegant theorem as beautiful.
In another sense, though, it is the brain, not beauty, that drives
those copies. Many parts of the brain play a role: Leonardo's exquisite motor
cortical control of his pen, the way his visual cortex perceived shape from
shadow, his face recognition area. Yet some parts of the brain may be more
crucial than others for the emotional aspect of the drive toward beauty or
meaning.
One of these regions is the pair of temporal lobes, located in the
cerebral cortex roughly behind the ears. The temporal lobes have been
somewhat neglected by neurologists, in part because damage to them does
not produce glaring motor or cognitive problems. Still, the temporal lobes are
important for producing literature, in part because they are necessary for
understanding word meaning—and also Meaning in its philosophical senses.
In addition, changes in the temporal lobes can produce hypergraphia.
A second region of the brain that is surprisingly relevant to
creative writing is the limbic system, the seat of emotion and drive and, I'll
argue, some aspects of the feeling of being inspired (a feeling, alas, that
does not always coincide with producing great work). It gets its name from
the fact that it forms a limbus, or ring, deep under the cortex. The limbic
system connects more strongly to the temporal lobes than to any other
region of the cortex. This strong link underlies the importance of emotion and
drive to creativity—factors that are anatomically as well as conceptually
distinct from the cognitive contributions of the rest of the cerebral cortex. The
limbic system also reflects the way mood swings can drive creativity.
The temporal lobes and the limbic system appear to underlie the
drive to seek beauty and meaning in nonliterary forms of artistic achievement
as well. The temporal lobes' role in hypergraphia, for instance, may parallel
their role in intense drives to paint and to compose music. The same brain
changes that drove Vincent van Gogh's frenzied painting (at his peak he
produced a new canvas every thirty-six hours) seem to have driven his
hypergraphic letters to his brother, Theo. Further, to the extent that
hypergraphia and frenetic artistic achievement are special cases of the more
general phenomenon of a sense of vocation, or of workaholism, they can
shed light on how or whether to control these double-edged states. Nearly all
of us, artists or not, feel the terror of work as well as the joy of work.
Along with my fascination with writing, my work as a physician
shapes the book. I am obsessed with illness and how it changes my
patients. Moreover, like many doctors, I have acquired the occupational
illness of seeing disease everywhere. During dull conferences, my colleagues
and I amuse ourselves by diagnosing one another: Horner's syndrome, swan-
neck deformity, congenital toe-walking, frontal release signs.
Can any good come from casting such a medicalized eye on the
world of writing? Medicalization tends to lead to pathographies of artists: El
Greco's elongated figures are explained away as mere astigmatism,
Dostoevsky's writing as nothing but epilepsy. Pathologizing the process of
writing could make us see creativity as abnormal or even dangerous. Yet
affliction is everywhere, perhaps especially in writing. Suffering has driven
great writing, and problems with writing, notably writer's block, have caused
great suffering.
One of the most moving, and most readily helped, groups of
patients I see is college students admitted for their first psychiatric break.
Often what finally brings them to their university's attention is that they can
no longer write and are beginning to get incompletes in their courses. These
are students with biologically based psychiatric problems that affect their
creativity and their ability to express themselves. Their treatment often
underestimates their problems with work as side effects of family issues.
Indeed, the two are hard to separate. But work—how we make things of and
do things to the external world—is nearly as basic, and primeval, a factor in
human happiness as family relations. The inability to write reflects the
sufferer's feeling that he or she cannot contribute to the world, cannot
communicate with others in any meaningful way.
The medical model for fighting suffering, although it has distinct
limitations, is also immensely powerful. Bringing a doctor's eye to writers'
own accounts of their creative process can lead to startling and useful
conclusions—ones that don't necessarily involve prescribing pills. To give a
simple instance, many writers who hate themselves every winter for their
sluggishness and lack of productivity could be aided not by "more
motivation," but by bright full-spectrum light for a half an hour every morning
to treat their brain's seasonal response to the shortened days.
Problems of motivation are not, of course, restricted to writers.
Some of my patients have severe movement disorders and, despite the best
intentions, from day to day their willpower is no longer enough to drive their
limbs. Yet someone with, say, Parkinson's disease who has spent months in
a wheelchair will, if there is a fire, be able to leap from her chair and run. This
confusing inconsistency often convinces family members that their mother or
husband isn't ill, but simply isn't trying hard enough. Sometimes not even the
patient wants to give up that belief. To admit that your will is sometimes
ineffective is terrifying.
In place of the will, what do I offer my Parkinsonian patients? Pills,
of course, or permanently implanted electrodes in their brains to stimulate
them to move. I began to wonder if similar medical treatments might help
people with disorders of motivation not just in movement initiation abilities,
but also in cognitive skills such as writing. Motor-cognitive tasks are not
perfectly analogous. In simple movements, stronger motivation—the fire
under the wheelchair— is generally better. But in complicated tasks, if the
motivation is too strong, the adrenaline that usually helps movements can
cause the performer to freeze. This "stage fright" aspect to writer's block is
often neglected. Another difference between "psychological states" such as
block and "neurological" states such as Parkinson's disease is that relatively
subtle behavioral interventions (psychotherapy, for instance) can be
immensely helpful in the former, but not in the latter. Because of my biology-
based training, and because so many others have described the ways that
therapy can help writing problems, I sometimes neglect therapy and other
behavioral interventions in this book. Yet they are important, ultimately
biological, treatments. They work, in the end, by altering one's brain
chemistry and neuroanatomy.
As a doctor, I hope I do not simply see normal problems as
illness; I want also to see that illness is often nearly normal. If we are all a
little bit sick, it is not all that sick to be sick. Illness is even sometimes
useful. It is easy to forget that whether a behavior is a disease or a gift may
depend on its context. The fallow periods that some writers call block are, for
others, a fermentation stage in the creative process.
Take the famous "little man with a perfect memory" so movingly
described by the Russian psychologist A. R. Luria in The Mind of a
Mnemonist. Although the man Luria studied had a photographic memory, he
was cursed rather than blessed by it. Reading and writing were among the
many activities his too-good memory made hard for him. Every word, even
every letter within a word, called up so many associations that it was nearly
impossible for him to concentrate on a chain of thought. His distracting
memory ended his writing career as a journalist, and he finished his life as a
circus performer doing memory tricks. (Or would only a writer say that this
career change was unfortunate?)
Other people who have near-perfect memories, but different social
and intellectual resources, have used them to great advantage in successful
writing careers. One instance is the prodigious memory of the prolific literary
scholar Harold Bloom, who has reportedly recited Paradise Lost backward.
The Midnight Disease is shaped not only by my work as a doctor
with people, but also by my work as a neuroscientist with brain imaging to
study neural activity. Is it therefore my goal to reduce the composition of
marvels like Dante's Inferno to nothing more than electrical and
neurochemical patterns? Emphatically not. Do I want to say that talking of
the chemical states of our brains is more important than talking of experience
or the will? Emphatically not. We will always be talking about mental states,
too, because they are powerful, subtle, indispensable concepts. But when
Dante describes his writer's block ("It seemed to me that I had undertaken
too lofty a theme for my powers, so much so that I was afraid to enter upon
it; and so I remained for several days desiring to write and afraid to begin"),
he is describing a brain state as well as a mental state.
Many readers, while granting that our minds are the products of
our brains, believe that there are some aspects of our thoughts—especially
during creative inspiration—that come from outside us. It would be a mistake
to dismiss this emotionally resonant position. In fact, I will show in the last
chapter that this position supports current scientific hypotheses of how our
brains handle creative, moral, and religious impulses.
While doctors care about disease because they want to cure it,
many neuroscientists care about disease as a scalpel with which to dissect
health. When something falls apart, you can see its pieces more clearly. In
this way, for instance, researchers learned about the role of the left and right
sides of the brain from split-brain patients. As a neuroscientist, I am
fascinated by hypergraphia and writer's block because of what they tell us
about normal creativity. Most writing about creativity squares its shoulders
pluckily and stares the phenomenon in the face. The result is countless
biographies of uniquely Great Men, or statistical studies of one hundred
Nobel laureates. But staring creativity in the face has turned many writers to
stone. The Midnight Disease sneaks up on creativity from behind, by
considering its disorders.
As a researcher, I am obsessed with the powerful notion of
testability, which is the foundation of the scientific method. Single examples
often mislead ("A friend of a friend lost sixty pounds on this new diet!"); most
explanations and treatments for writing problems still need rigorous testing
by what scientists consider the gold-standard method: the double-blind,
prospective, randomized clinical trial. Indeed, neuroscientists have been
squeamish about the difficulty of testing theories about creativity and its
problems and sometimes dismiss the field as intellectually unhygienic.
Nonetheless, despite the complexity of problems such as writer's block and
treatments such as psychotherapy, despite the fact that every individual is
different, the effectiveness of these techniques is still ultimately testable. In
this book I try to spell out some ways to evaluate their worth. Fascinating
new techniques will in the near future make such tests easier. In the interest
of keeping the text readable, I have exiled much information about research
methodology, replication, and contradictory studies to the notes at the back
of the book; readers who are interested in pursuing a topic further can do so
there.
The application of science and medicine to problems such as
writing well disturbs many people specifically because of the notion of
testability, of cold human experimentation. Experimentation is not
necessarily something that is done to you, however. Cautious self-
experimentation can be crucial to taking control of your own problem. If
writing at night doesn't work, try writing in the morning. If you try
medications, do so with a clinician willing to help you evaluate the results
and not just prescribe according to a protocol. If medications don't work, try
psychotherapy, or vice versa. A new approach may be especially important in
writer's block, which can stem from rigidity that makes the sufferer use the
same failing approach over and over. This rigidity has some features in
common with known syndromes of frontal lobe malfunction. People who do
try new techniques often make readily correctable mistakes in the way they
go about their self-experiments. I hope that by pointing them out I can make
those mistakes easier to avoid.
Presenting my biases as a scientist might seem to be
inconsistent —scientists are supposed to be objective. But I argue in this
book, as many before me have done, that all scientists have biases; it is
merely that most fail to admit them. Scientific diction can be as deceptive as
oratory; its mind-numbing passive constructions and jargon often bring only
the appearance of neutrality.
Why, if I am a scientist, have I written a book? Scientists should
write scientific papers. A melancholy fact is that in the sciences, the book
has become as marginal a literary form as the sestina or the villanelle. With
the rise of the Internet, books may soon be obsolete even for general readers.
(I should confess that often while writing this work, I would check a reference
on the Internet rather than stand up and walk to the bookshelf five feet away.)
Perhaps writing this book is my eulogy for the book, or a wistful hope that
people will always be crazy enough to write books. In the end, though,
because of an unusual personal experience, writing this book was something
I could not stop myself from doing.
I always wrote a little more than was normal, but I was able to
keep my tendencies discreet. When occasionally a friend would ask if I ever
considered publishing what I wrote, I was puzzled; it seemed such a private
pleasure that it was as if someone who thought I was good in bed asked if I
had considered doing it in public. (Thus I still lacked a key aspect of being a
writer. Who was it who said that an artist is someone who gets pleasure from
the praise of complete strangers?) In medical school when I first heard about
the existence of hypergraphia, I began to wonder whether my own writing
were hypergraphic —partly because suggestible medical students tend to
believe they have whatever disorder they are currently studying, and partly
because my writing was indeed becoming more driven. When I wrote my first
book, a handbook of neurology, I was a hospital resident working 80 to 110
hours a week. Without any plan to start a book, I found that some notes I
was taking to help me on the wards crept up on me and took over. Soon I
was skipping meals and waking early to work on them. As a joke, I told
people that the book was an attempt to make my hypergraphia useful. Then I
got pregnant and had a postpartum mood disorder during which my writing
truly exploded. After that, it was no longer witty to describe my writing as a
medical symptom.
My postpartum mood disorder, which had several manic as well
as the more typical depressed features, came after I had given birth
prematurely to twin boys who died. They were so small—one grasped my
finger before he died, and his hand hardly fit around it. For ten days I was
filled with sorrow. Then suddenly, as if someone had thrown a switch, I was
wildly agitated, full of ideas, all of them pressing to be written down. The
world was flooded with meaning. I believed I had unique access to the
secrets of the Kingdom of Sorrow, about which I had an obligation to
enlighten my—very tolerant— friends and colleagues through essays and
letters.
While postpartum major depression occurs after one in ten
deliveries, postpartum mania occurs after one in a thousand. Mania and
depression can come in complicated mixtures. As I found out, one manic
feature is hypergraphia. Not all mania is the textbook mania of flamboyant
dressing, risk taking, and barroom fights. Its principal effect on me was to
make me hole up in my office and write. Why pathologize this and call it a
disease? I could still do my normal job. But my writing felt like a disease: I
could not stop, and it sucked me away from family and friends. Sensations
outside of language dried up: music became irritating discord, the visual
world grew faint. Cramming the inclinations of a writer into a skull already
filled with many years of training as a scientist created extraordinary
pressure. While my hypergraphia felt like a disease, it also felt like one of the
best things that has ever happened to me. It still does.
For the next four months I ricocheted daily between euphoria and
terror. On good days, ideas would wake me at four in the morning, tendrils of
words coiling around me like some heady perfume. It was as if a door had
opened onto a hot wind from the tropics, the sort of wind that propels ships
carrying peacock feathers and rubies and apes and incense. On bad days,
the words were like a charnel house through which I had to search for the
bodies of people I loved. In either case, the desire to write was overpowering.
I wrote during department meetings, when I should have been doing
experiments, when I could have been with friends. The sight of a computer
keyboard or a blank page gave me the same rush that drug addicts get from
seeing their freebasing paraphernalia.
Although the inevitable depression followed, it lasted only a month
or so and its apathy was in some ways almost a relief. When the world went
dead, words lost their meaning; there was no pressure to write. I was not
really a blocked writer, I was no longer a writer at all. It was peaceful—unless
I tried to speak or write. Then it was as if my lungs were full of water,
suffocating.
I became pregnant again. In a strange symmetry I delivered
premature but healthy twin girls, Katerina and Elizabeth. A similar excited
postpartum state started eleven days after delivery, eventually followed by a
similar torpor. This time, though, I tried a mood stabilizer. Although the drug
slightly decreased my periods of agitation, it gave me an excruciating writer's
block. My head again filled with ideas, but this time I could not articulate
them. The pressure in my head continued to build until it was a throbbing
abscess that I was frantic to drain.
Before I started taking the mood stabilizer, I had never
experienced what I would have called writer's block. Although it is still hard
for me to believe that a pill could cause block, I know I felt that mute pressure
only while on that drug, and that the block increased as the dose did. I tried
several other medications—doctors' faith in pills dies hard. Eventually I found
ones that helped. Would they help everyone with writing problems? Probably
not. But general rules pointed out drugs that were likely to help.
As my writing calmed, the world and the words oscillated less
violently between supreme Meaning and nonsense, and my hypergraphia
turned back into normal writing. More or less. Some researchers believe
one's brain is never quite the same after a manic episode, however mild.
Even now, when I am writing well, my pulse speeds up, I feel gripped by
something stronger than my will, and I have some of the delicious feeling I
had at my most hypergraphic. When I can't find an idea, I now much more
quickly begin to think that I am blocked.
The sudden change in my writing was in one respect a "natural
response to bereavement," as my friends kept reassuring me when I started
throwing around words like "hypergraphia." Nonetheless, it was also an
unusual brain state. It wasn't just bereavement: not only my first, unhappy
pregnancy, but my second, happy one triggered the change. It is likely that
pregnancy-induced mood disorders and hypergraphia are linked to the wild
hormonal fluctuations that happen at birth (a similar change may explain
premenstrual syndrome, and estrogen can treat depression even in men).
Hormones are not the only way, or even a major way, to induce
hypergraphia. But it disturbed me that writing, which seems one of the most
refined, even transcendent talents, should be so influenced by biology. I
wanted to understand how my brain was different when it started writing
obsessively and when it became blocked. Like many patients with a problem,
I began reading everything I could find on the subject—ranging from
Hippocrates' descriptions of the "sacred disease" through what Edgar Allan
Poe and later Michael Chabon have called the "midnight disease" that causes
writing. I wrote this book to try to explain to myself what had erupted in (or
into) my brain to turn me, almost against my will, into a writer.
You may well ask what my experience has to do with the writing
of normal people. The answer is that although my brain may have a screw
loose, everyone has the same screw. (That is not to say that drugs are
necessarily the way to treat most writing problems.) Mental illness is not
completely separable from sanity. There is a sense in which mental illness is
awfully like sanity—only much, much more so.
Because my drive to write has been so magnified and altered by
illness, I think I see more clearly how important are the emotions that
underlie periods of writing well and periods of block. The pleasure of writing
and the pain of its absence tells something crucial about the motivation to
write and the way it springs from our instinct to communicate. It is a feeling
that is essential both for our ability as writers and for our potential to interact
as human beings.

This book lays out what neuroscience is beginning to tell us about the drive
to write and to create, about creative block and its treatment, about the
cortical and limbic underpinnings of these drives and blocks, and finally about
neurological aspects of the relation between metaphor, the inner voice, and
inspiration. Many of these ideas are preliminary—not meant to be the final
word on these complex subjects, but to spur further debate.
Chapter 1 describes several relatively well defined brain conditions
that increase the desire to write. Some patients with temporal lobe epilepsy,
manic-depression (bipolar disorder), and other disorders experience florid
hypergraphia. Yet their hypergraphia is usually a trait they value in
themselves. It can be something others value too, for their writings can range
from the simple (one epileptic patient's copious journal was endless
repetition of "Thank god, no seizures" in variously colored inks) to the sublime
(the novels of Gustave Flaubert, also a temporal lobe epileptic).
The odd behavior of temporal lobe epileptics can tell us about the
odd behavior of some professional creative writers. Chapter 2 describes how
the temporal lobes may help drive "normal" emotionally engaged writing just
as they drive "abnormal" hypergraphia. Moreover, the existence of people with
temporal lobe changes who begin to paint or compose music provides
evidence that the temporal lobes' role in creativity applies also to nonliterary
creativity. The frontal lobes may help judge and edit the somewhat
indiscriminate ideas whose generation was driven by the temporal lobes.
Temporal lobe explanations of creativity shed new light on more traditional
theories of creativity; for instance, the hypothesis that creativity resides
primarily in the right side of the brain.
Hypergraphia is neither painful nor common. Writer's block is
both. The paradoxically eloquent literature on writer's block, from famous
sufferers such as Flaubert and Franz Kafka, and from clinicians, explains
block as everything from an oppressed inner child to penis envy. What we
know about the psychological mechanisms of writer's block, described in
Chapter 3, can also help us to understand block in relation to another
agonizing problem, procrastination.
A neuroscientific, as opposed to a psychological, perspective on
block (Chapter 4) allows biochemical explanations and treatments of block.
In the frequent case of block related to mood swings, a medical model of
block can clarify why writers such as Samuel Taylor Coleridge, who were
made miserable by writer's block, were also able in bursts of creativity to
write hypergraphically. I explore the origins of such cycles from multiple
perspectives, including behavioral, neurochemical, and evolutionary. The
close relationship between productivity and mood is complex, as when mood
disorders both spark and hinder the drive to write, or when alcohol abuse
eases the anxiety of writer's block but decreases the ability to write well.
It turns out that the drive and the ability to write are to a significant
extent controlled by different areas of the brain. The cerebral cortex has more
of a role in the ability than in the drive to write. Chapter 5 describes how
recent advances in neuroscience, including brain imaging technology, have
made it possible to study the ability to write in normal people, as well as in
language-impaired people. The advances have brought an explosion of new
information. Even high-level literary phenomena, such as metaphor and
metonymy, are turning out to have defined brain substrates. Writing also
requires reading, as is apparent in dyslexia. The odd phenomenon of
hyperlexia (compulsive reading) and the even odder experience of
synesthesia or colored reading (a cortically based experience that may
underlie some poets' use of metaphor) also cast new light on brain
mechanisms for literature.
The limbic system, in contrast to the cortex, has a greater role in
basic drives and how they are influenced by drugs such as antidepressants
or opiates. One limbic drive described in Chapter 6, one almost strong
enough to be an instinct, is the drive to communicate. Powerful neural and
emotional changes result when the drive to communicate is blocked, as
when a social monkey is made mute, when an American with limited
knowledge of French moves to Paris, or—a somewhat more complicated
phenomenon—when a writer's great success with a first novel makes writing
the second one harder. Limbic dynamics underlie the close relationship
between suffering and the drive to write, and have implications for determining
who becomes a writer and why. It turns out that problems such as
procrastination are usually better treated by putting the writer in the
appropriate limbic or motivational state than by cognitive strategies such as
making To Do lists. Most procrastinators are very aware of exactly what they
are not doing.
Reading and writing give us not only an intellectual, cortical
apprehension of word meaning but also an emotional or limbic sensation of
meaningfulness or importance. In Chapter 7 I argue that metaphoric thinking,
important for science as well as literature, can link these types of meaning.
Metaphoric thinking is largely a temporal lobe function. So, it is likely, is the
inner voice we hear in our heads every day. Temporal lobe changes occur
during states in which the inner voice starts to feel alien, as in the auditory
hallucinations of psychotics. Temporal changes may also occur during the
very different processes of religious and creative inspiration. The sensation of
receiving dictation from an external force or muse, felt by some writers at
their most inspired, may share with psychosis a neurologically based
projection of the inner voice onto the external world. Such biological origins
do not strip bare the mystery of creativity. Rather, the fact that such a
transcendent process could also be an embodied one shows that it is even
more mysterious than we thought.

Copyright © 2004 by Alice Weaver Flaherty. Reprinted by permission of
Houghton Mifflin Company.
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Table of Contents

Acknowledgments
Introduction 1
1 Hypergraphia: The Incurable Disease of Writing 17
2 Literary Creativity and Drive 49
3 Writer's Block as State of Mind 79
4 Writer's Block as Brain State 108
5 How We Write: The Cortex 149
6 Why We Write: The Limbic System 183
7 Metaphor, the Inner Voice, and the Muse 224
References 267
Illustration Credits 284
Index 285
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First Chapter

Introduction

Writing is one of the supreme human achievements. No, why should I be
reasonable? Writing is the supreme achievement. It is by turns exhilarating
and arduous, and trying to write obsesses and distresses students,
professional writers, and diarists alike. Writers explain why they write (and
have trouble writing) one way; freshman composition teachers, another;
literary critics and psychiatrists and neurologists have increasingly foreign
explanations. These modes of thinking about the emotions that surround
writing do not easily translate into one another. But one fact is always true:
the mind that writes is also the brain that writes. And the existence of brain
states that affect our creativity raises questions that make us uneasy. What
is the relation between mind and body? What are the sources of imagination?
How can both neuroscience and literature bear on the question of
what makes writers not only able to, but want to, even need to, write? How
can we understand the outpouring of authors such as Joyce Carol Oates or
Stephen King? Why does John Updike see a blank sheet of paper as radiant,
the sun rising in the morning? (As William Pritchard said of him, 'He must
have had an unpublished thought, but you couldn't tell it.') This compulsion
seems—and is—an unbelievably complex psychological trait.
Yet it is not so complex that it cannot be studied. Neurologists
have found that changes in a specific area of the brain can produce
hypergraphia—the medical term for an overpowering desire to write. Thinking
in a counterintuitive, neurological way about what drives andfrustrates literary
creation can suggest new treatments for hypergraphia's more common and
tormenting opposite, writer's block. Both conditions arise from complicated
abnormalities of the basic biological drive to communicate. Whereas linguists
and most scientists have focused primarily on writing's cognitive aspects,
this book spends more time exploring the complex relationship between
writing and emotion. It draws examples from literature, from my patients, and
from some of my own experiences.
Evidence that ranges from Nabokov to neurochemistry, Faulkner
to functional brain imaging, shows that thinking about excesses and dearths
of writing can also clarify normal literary output and the mechanisms of
creativity. The few current books on creativity that include a neuroscientific
perspective have neglected crucial brain regions such as the temporal lobe
and limbic system in favor of a still popular —but arguably oversimplified—
emphasis on the role of the right side of the brain.
Focusing on the importance of the brain in the drive to write helps
suggest treatments for disorders of creativity that are sometimes medical. It
should do so, though, without ignoring the fact that most innovative people,
and most people struggling with blocks, are not mentally ill. Concentrating on
the brain structures underlying creativity provides surprising answers to such
diverse questions as how we learn to write, the nature of metaphor, and even
what causes the strange sensation of being visited by the muse.
Although The Midnight Disease attempts to be a scientifically
accurate book, it is far from a dispas one. How could I speak dryly on
a subject as charged as the origin of literature? I am infatuated with writing,
and this emotional engagement shapes the book. Writing can do
extraordinary things. One night when I was a child, I read a passage in C. S.
Lewis's autobiography, Surprised by Joy, which described one of his own
reading experiences as a child. He had been reading Longfellow's
poem 'Tegner's Drapa,' when a line jumped out at him: 'I heard a voice that
cried / Balder the beautiful / Is dead, is dead. . . .'The beauty of that line, the
way it tore at him, drove him to become permanently addicted to reading and
writing. Strangely, even out of context, the line stirred me as well. Something
swept me out of his book high into the cold air above the northern wastes.
What was it that was transmitted from the writer of 'Tegner's Drapa' to the
writer of The Allegory of Love to me, possibly even to you?
In her book On Beauty and Being Just, Elaine Scarry imagines
Leonardo da Vinci seeing a woman with a face so beautiful that he tries over
and over to capture it in different drawings. Later artists are moved by his
copies, which they then try to copy themselves. Eventually the critic Walter
Pater writes his famous essay on Leonardo, and the copies of the woman's
face spread from one art form into another. Beauty drives copies of itself,
whether in art, or when we want to make children with someone we love.
Great scientific ideas drive their own transmission in the same way—it is not
a metaphor when researchers refer to an elegant theorem as beautiful.
In another sense, though, it is the brain, not beauty, that drives
those copies. Many parts of the brain play a role: Leonardo's exquisite motor
cortical control of his pen, the way his visual cortex perceived shape from
shadow, his face recognition area. Yet some parts of the brain may be more
crucial than others for the emotional aspect of the drive toward beauty or
meaning.
One of these regions is the pair of temporal lobes, located in the
cerebral cortex roughly behind the ears. The temporal lobes have been
somewhat neglected by neurologists, in part because damage to them does
not produce glaring motor or cognitive problems. Still, the temporal lobes are
important for producing literature, in part because they are necessary for
understanding word meaning—and also Meaning in its philosophical senses.
In addition, changes in the temporal lobes can produce hypergraphia.
A second region of the brain that is surprisingly relevant to
creative writing is the limbic system, the seat of emotion and drive and, I'll
argue, some aspects of the feeling of being inspired (a feeling, alas, that
does not always coincide with producing great work). It gets its name from
the fact that it forms a limbus, or ring, deep under the cortex. The limbic
system connects more strongly to the temporal lobes than to any other
region of the cortex. This strong link underlies the importance of emotion and
drive to creativity—factors that are anatomically as well as conceptually
distinct from the cognitive contributions of the rest of the cerebral cortex. The
limbic system also reflects the way mood swings can drive creativity.
The temporal lobes and the limbic system underlie the
drive to seek beauty and meaning in nonliterary forms of artistic achievement
as well. The temporal lobes' role in hypergraphia, for instance, may parallel
their role in intense drives to paint and to compose music. The same brain
changes that drove Vincent van Gogh's frenzied painting (at his peak he
produced a new canvas every thirty-six hours) seem to have driven his
hypergraphic letters to his brother, Theo. Further, to the extent that
hypergraphia and frenetic artistic achievement are special cases of the more
general phenomenon of a sense of vocation, or of workaholism, they can
shed light on how or whether to control these double-edged states. Nearly all
of us, artists or not, feel the terror of work as well as the joy of work.
Along with my fascination with writing, my work as a physician
shapes the book. I am obsessed with illness and how it changes my
patients. Moreover, like many doctors, I have acquired the occupational
illness of seeing disease everywhere. During dull conferences, my colleagues
and I amuse ourselves by diagnosing one another: Horner's syndrome, swan-
neck deformity, congenital toe-walking, frontal release signs.
Can any good come from casting such a medicalized eye on the
world of writing? Medicalization tends to lead to pathographies of artists: El
Greco's elongated figures are explained away as mere astigmatism,
Dostoevsky's writing as nothing but epilepsy. Pathologizing the process of
writing could make us see creativity as abnormal or even dangerous. Yet
affliction is everywhere, perhaps especially in writing. Suffering has driven
great writing, and proble writing, notably writer's block, have caused
great suffering.
One of the most moving, and most readily helped, groups of
patients I see is college students admitted for their first psychiatric break.
Often what finally brings them to their university's attention is that they can
no longer write and are beginning to get incompletes in their courses. These
are students with biologically based psychiatric problems that affect their
creativity and their ability to express themselves. Their treatment often
underestimates their problems with work as side effects of family issues.
Indeed, the two are hard to separate. But work—how we make things of and
do things to the external world—is nearly as basic, and primeval, a factor in
human happiness as family relations. The inability to write reflects the
sufferer's feeling that he or she cannot contribute to the world, cannot
communicate with others in any meaningful way.
The medical model for fighting suffering, although it has distinct
limitations, is also immensely powerful. Bringing a doctor's eye to writers'
own accounts of their creative process can lead to startling and useful
conclusions—ones that don't necessarily involve prescribing pills. To give a
simple instance, many writers who hate themselves every winter for their
sluggishness and lack of productivity could be aided not by 'more
motivation,' but by bright full-spectrum light for a half an hour every morning
to treat their brain's seasonal response to the shortened days.
Problems of motivation are not, of course, restricted to writers.
Some of my patients have severe movement d and, despite the best
intentions, from day to day their willpower is no longer enough to drive their
limbs. Yet someone with, say, Parkinson's disease who has spent months in
a wheelchair will, if there is a fire, be able to leap from her chair and run. This
confusing inconsistency often convinces family members that their mother or
husband isn't ill, but simply isn't trying hard enough. Sometimes not even the
patient wants to give up that belief. To admit that your will is sometimes
ineffective is terrifying.
In place of the will, what do I offer my Parkinsonian patients? Pills,
of course, or permanently implanted electrodes in their brains to stimulate
them to move. I began to wonder if similar medical treatments might help
people with disorders of motivation not just in movement initiation abilities,
but also in cognitive skills such as writing. Motor-cognitive tasks are not
perfectly analogous. In simple movements, stronger motivation—the fire
under the wheelchair— is generally better. But in complicated tasks, if the
motivation is too strong, the adrenaline that usually helps movements can
cause the performer to freeze. This 'stage fright' aspect to writer's block is
often neglected. Another difference between 'psychological states' such as
block and 'neurological' states such as Parkinson's disease is that relatively
subtle behavioral interventions (psychotherapy, for instance) can be
immensely helpful in the former, but not in the latter. Because of my biology-
based training, and because so many others have described the ways that
therapy can help writing problems, I sometimes neglect thera and other
behavioral interventions in this book. Yet they are important, ultimately
biological, treatments. They work, in the end, by altering one's brain
chemistry and neuroanatomy.
As a doctor, I hope I do not simply see normal problems as
illness; I want also to see that illness is often nearly normal. If we are all a
little bit sick, it is not all that sick to be sick. Illness is even sometimes
useful. It is easy to forget that whether a behavior is a disease or a gift may
depend on its context. The fallow periods that some writers call block are, for
others, a fermentation stage in the creative process.
Take the famous 'little man with a perfect memory' so movingly
described by the Russian psychologist A. R. Luria in The Mind of a
Mnemonist. Although the man Luria studied had a photographic memory, he
was cursed rather than blessed by it. Reading and writing were among the
many activities his too-good memory made hard for him. Every word, even
every letter within a word, called up so many associations that it was nearly
impossible for him to concentrate on a chain of thought. His distracting
memory ended his writing career as a journalist, and he finished his life as a
circus performer doing memory tricks. (Or would only a writer say that this
career change was unfortunate?)
Other people who have near-perfect memories, but different social
and intellectual resources, have used them to great advantage in successful
writing careers. One instance is the prodigious memory of the prolific literary
scholar Harold Bloom, who has reportedly recited Paradise Lost backward.
The Midnight Disease is only by my work as a doctor
with people, but also by my work as a neuroscientist with brain imaging to
study neural activity. Is it therefore my goal to reduce the composition of
marvels like Dante's Inferno to nothing more than electrical and
neurochemical patterns? Emphatically not. Do I want to say that talking of
the chemical states of our brains is more important than talking of experience
or the will? Emphatically not. We will always be talking about mental states,
too, because they are powerful, subtle, indispensable concepts. But when
Dante describes his writer's block ('It seemed to me that I had undertaken
too lofty a theme for my powers, so much so that I was afraid to enter upon
it; and so I remained for several days desiring to write and afraid to begin'),
he is describing a brain state as well as a mental state.
Many readers, while granting that our minds are the products of
our brains, believe that there are some aspects of our thoughts—especially
during creative inspiration—that come from outside us. It would be a mistake
to dismiss this emotionally resonant position. In fact, I will show in the last
chapter that this position supports current scientific hypotheses of how our
brains handle creative, moral, and religious impulses.
While doctors care about disease because they want to cure it,
many neuroscientists care about disease as a scalpel with which to dissect
health. When something falls apart, you can see its pieces more clearly. In
this way, for instance, researchers learned about the role of the left and right
sides of the brain from split-brain patients. As a neuroscientist I am
fascinated by hypergraphia and writer's block because of what they tell us
about normal creativity. Most writing about creativity squares its shoulders
pluckily and stares the phenomenon in the face. The result is countless
biographies of uniquely Great Men, or statistical studies of one hundred
Nobel laureates. But staring creativity in the face has turned many writers to
stone. The Midnight Disease sneaks up on creativity from behind, by
considering its disorders.
As a researcher, I am obsessed with the powerful notion of
testability, which is the foundation of the scientific method. Single examples
often mislead ('A friend of a friend lost sixty pounds on this new diet!'); most
explanations and treatments for writing problems still need rigorous testing
by what scientists consider the gold-standard method: the double-blind,
prospective, randomized clinical trial. Indeed, neuroscientists have been
squeamish about the difficulty of testing theories about creativity and its
problems and sometimes dismiss the field as intellectually unhygienic.
Nonetheless, despite the complexity of problems such as writer's block and
treatments such as psychotherapy, despite the fact that every individual is
different, the effectiveness of these techniques is still ultimately testable. In
this book I try to spell out some ways to evaluate their worth. Fascinating
new techniques will in the near future make such tests easier. In the interest
of keeping the text readable, I have exiled much information about research
methodology, replication, and contradictory studies to the notes at the back
of the book; readers who a interested in pursuing a topic further can do so
there.
The application of science and medicine to problems such as
writing well disturbs many people specifically because of the notion of
testability, of cold human experimentation. Experimentation is not
necessarily something that is done to you, however. Cautious self-
experimentation can be crucial to taking control of your own problem. If
writing at night doesn't work, try writing in the morning. If you try
medications, do so with a clinician willing to help you evaluate the results
and not just prescribe according to a protocol. If medications don't work, try
psychotherapy, or vice versa. A new approach may be especially important in
writer's block, which can stem from rigidity that makes the sufferer use the
same failing approach over and over. This rigidity has some features in
common with known syndromes of frontal lobe malfunction. People who do
try new techniques often make readily correctable mistakes in the way they
go about their self-experiments. I hope that by pointing them out I can make
those mistakes easier to avoid.
Presenting my biases as a scientist might seem to be
inconsistent —scientists are supposed to be objective. But I argue in this
book, as many before me have done, that all scientists have biases; it is
merely that most fail to admit them. Scientific diction can be as deceptive as
oratory; its mind-numbing passive constructions and jargon often bring only
the appearance of neutrality.
Why, if I am a scientist, have I written a book? Scientists should
write scientific papers. A melancholy fact is that in the science book
has become as marginal a literary form as the sestina or the villanelle. With
the rise of the Internet, books may soon be obsolete even for general readers.
(I should confess that often while writing this work, I would check a reference
on the Internet rather than stand up and walk to the bookshelf five feet away.)
Perhaps writing this book is my eulogy for the book, or a wistful hope that
people will always be crazy enough to write books. In the end, though,
because of an unusual personal experience, writing this book was something
I could not stop myself from doing.
I always wrote a little more than was normal, but I was able to
keep my tendencies discreet. When occasionally a friend would ask if I ever
considered publishing what I wrote, I was puzzled; it seemed such a private
pleasure that it was as if someone who thought I was good in bed asked if I
had considered doing it in public. (Thus I still lacked a key aspect of being a
writer. Who was it who said that an artist is someone who gets pleasure from
the praise of complete strangers?) In medical school when I first heard about
the existence of hypergraphia, I began to wonder whether my own writing
were hypergraphic —partly because suggestible medical students tend to
believe they have whatever disorder they are currently studying, and partly
because my writing was indeed becoming more driven. When I wrote my first
book, a handbook of neurology, I was a hospital resident working 80 to 110
hours a week. Without any plan to start a book, I found that some notes I
was taking to help me on the wards crept up on me and took over. Soon I
was skipping meals and waking early to work on them. As a joke, I told
people that the book was an attempt to make my hypergraphia useful. Then I
got pregnant and had a postpartum mood disorder during which my writing
truly exploded. After that, it was no longer witty to describe my writing as a
medical symptom.
My postpartum mood disorder, which had several manic as well
as the more typical depressed features, came after I had given birth
prematurely to twin boys who died. They were so small—one grasped my
finger before he died, and his hand hardly fit around it. For ten days I was
filled with sorrow. Then suddenly, as if someone had thrown a switch, I was
wildly agitated, full of ideas, all of them pressing to be written down. The
world was flooded with meaning. I believed I had unique access to the
secrets of the Kingdom of Sorrow, about which I had an obligation to
enlighten my—very tolerant— friends and colleagues through essays and
letters.
While postpartum major depression occurs after one in ten
deliveries, postpartum mania occurs after one in a thousand. Mania and
depression can come in complicated mixtures. As I found out, one manic
feature is hypergraphia. Not all mania is the textbook mania of flamboyant
dressing, risk taking, and barroom fights. Its principal effect on me was to
make me hole up in my office and write. Why pathologize this and call it a
disease? I could still do my normal job. But my writing felt like a disease: I
could not stop, and it sucked me away from family and friends. Sensations
outside of language dried up: music became irritating discord, the v
world grew faint. Cramming the inclinations of a writer into a skull already
filled with many years of training as a scientist created extraordinary
pressure. While my hypergraphia felt like a disease, it also felt like one of the
best things that has ever happened to me. It still does.
For the next four months I ricocheted daily between euphoria and
terror. On good days, ideas would wake me at four in the morning, tendrils of
words coiling around me like some heady perfume. It was as if a door had
opened onto a hot wind from the tropics, the sort of wind that propels ships
carrying peacock feathers and rubies and apes and incense. On bad days,
the words were like a charnel house through which I had to search for the
bodies of people I loved. In either case, the desire to write was overpowering.
I wrote during department meetings, when I should have been doing
experiments, when I could have been with friends. The sight of a computer
keyboard or a blank page gave me the same rush that drug addicts get from
seeing their freebasing paraphernalia.
Although the inevitable depression followed, it lasted only a month
or so and its apathy was in some ways almost a relief. When the world went
dead, words lost their meaning; there was no pressure to write. I was not
really a blocked writer, I was no longer a writer at all. It was peaceful—unless
I tried to speak or write. Then it was as if my lungs were full of water,
suffocating.
I became pregnant again. In a strange symmetry I delivered
premature but healthy twin girls, Katerina and Elizabeth. A similar excited
postpartum state started eleven days afte delivery, eventually followed by a
similar torpor. This time, though, I tried a mood stabilizer. Although the drug
slightly decreased my periods of agitation, it gave me an excruciating writer's
block. My head again filled with ideas, but this time I could not articulate
them. The pressure in my head continued to build until it was a throbbing
abscess that I was frantic to drain.
Before I started taking the mood stabilizer, I had never
experienced what I would have called writer's block. Although it is still hard
for me to believe that a pill could cause block, I know I felt that mute pressure
only while on that drug, and that the block increased as the dose did. I tried
several other medications—doctors' faith in pills dies hard. Eventually I found
ones that helped. Would they help everyone with writing problems? Probably
not. But general rules pointed out drugs that were likely to help.
As my writing calmed, the world and the words oscillated less
violently between supreme Meaning and nonsense, and my hypergraphia
turned back into normal writing. More or less. Some researchers believe
one's brain is never quite the same after a manic episode, however mild.
Even now, when I am writing well, my pulse speeds up, I feel gripped by
something stronger than my will, and I have some of the delicious feeling I
had at my most hypergraphic. When I can't find an idea, I now much more
quickly begin to think that I am blocked.
The sudden change in my writing was in one respect a 'natural
response to bereavement,' as my friends kept reassuring me when I started
throwing around words like 'hypergraphia Nonetheless, it was also an
unusual brain state. It wasn't just bereavement: not only my first, unhappy
pregnancy, but my second, happy one triggered the change. It is likely that
pregnancy-induced mood disorders and hypergraphia are linked to the wild
hormonal fluctuations that happen at birth (a similar change may explain
premenstrual syndrome, and estrogen can treat depression even in men).
Hormones are not the only way, or even a major way, to induce
hypergraphia. But it disturbed me that writing, which seems one of the most
refined, even transcendent talents, should be so influenced by biology. I
wanted to understand how my brain was different when it started writing
obsessively and when it became blocked. Like many patients with a problem,
I began reading everything I could find on the subject—ranging from
Hippocrates' descriptions of the 'sacred disease' through what Edgar Allan
Poe and later Michael Chabon have called the 'midnight disease' that causes
writing. I wrote this book to try to explain to myself what had erupted in (or
into) my brain to turn me, almost against my will, into a writer.
You may well ask what my experience has to do with the writing
of normal people. The answer is that although my brain may have a screw
loose, everyone has the same screw. (That is not to say that drugs are
necessarily the way to treat most writing problems.) Mental illness is not
completely separable from sanity. There is a sense in which mental illness is
awfully like sanity—only much, much more so.
Because my drive to write has been so magnified and altered by
illness, I think I se how important are the emotions that
underlie periods of writing well and periods of block. The pleasure of writing
and the pain of its absence tells something crucial about the motivation to
write and the way it springs from our instinct to communicate. It is a feeling
that is essential both for our ability as writers and for our potential to interact
as human beings.

This book lays out what neuroscience is beginning to tell us about the drive
to write and to create, about creative block and its treatment, about the
cortical and limbic underpinnings of these drives and blocks, and finally about
neurological aspects of the relation between metaphor, the inner voice, and
inspiration. Many of these ideas are preliminary—not meant to be the final
word on these complex subjects, but to spur further debate.
Chapter 1 describes several relatively well defined brain conditions
that increase the desire to write. Some patients with temporal lobe epilepsy,
manic-depression (bipolar disorder), and other disorders experience florid
hypergraphia. Yet their hypergraphia is usually a trait they value in
themselves. It can be something others value too, for their writings can range
from the simple (one epileptic patient's copious journal was endless
repetition of 'Thank god, no seizures' in variously colored inks) to the sublime
(the novels of Gustave Flaubert, also a temporal lobe epileptic).
The odd behavior of temporal lobe epileptics can tell us about the
odd behavior of some professional creative writers. Chapter 2 describes how
the temporal lobes may help drive 'normal' emotionally engaged writing just
a drive 'abnormal' hypergraphia. Moreover, the existence of people with
temporal lobe changes who begin to paint or compose music provides
evidence that the temporal lobes' role in creativity applies also to nonliterary
creativity. The frontal lobes may help judge and edit the somewhat
indiscriminate ideas whose generation was driven by the temporal lobes.
Temporal lobe explanations of creativity shed new light on more traditional
theories of creativity; for instance, the hypothesis that creativity resides
primarily in the right side of the brain.
Hypergraphia is neither painful nor common. Writer's block is
both. The paradoxically eloquent literature on writer's block, from famous
sufferers such as Flaubert and Franz Kafka, and from clinicians, explains
block as everything from an oppressed inner child to penis envy. What we
know about the psychological mechanisms of writer's block, described in
Chapter 3, can also help us to understand block in relation to another
agonizing problem, procrastination.
A neuroscientific, as opposed to a psychological, perspective on
block (Chapter 4) allows biochemical explanations and treatments of block.
In the frequent case of block related to mood swings, a medical model of
block can clarify why writers such as Samuel Taylor Coleridge, who were
made miserable by writer's block, were also able in bursts of creativity to
write hypergraphically. I explore the origins of such cycles from multiple
perspectives, including behavioral, neurochemical, and evolutionary. The
close relationship between productivity and mood is complex, as when mood
disorders both spark and hinder t drive to write, or when alcohol abuse
eases the anxiety of writer's block but decreases the ability to write well.
It turns out that the drive and the ability to write are to a significant
extent controlled by different areas of the brain. The cerebral cortex has more
of a role in the ability than in the drive to write. Chapter 5 describes how
recent advances in neuroscience, including brain imaging technology, have
made it possible to study the ability to write in normal people, as well as in
language-impaired people. The advances have brought an explosion of new
information. Even high-level literary phenomena, such as metaphor and
metonymy, are turning out to have defined brain substrates. Writing also
requires reading, as is apparent in dyslexia. The odd phenomenon of
hyperlexia (compulsive reading) and the even odder experience of
synesthesia or colored reading (a cortically based experience that may
underlie some poets' use of metaphor) also cast new light on brain
mechanisms for literature.
The limbic system, in contrast to the cortex, has a greater role in
basic drives and how they are influenced by drugs such as antidepressants
or opiates. One limbic drive described in Chapter 6, one almost strong
enough to be an instinct, is the drive to communicate. Powerful neural and
emotional changes result when the drive to communicate is blocked, as
when a social monkey is made mute, when an American with limited
knowledge of French moves to Paris, or—a somewhat more complicated
phenomenon—when a writer's great success with a first novel makes writing
the second one harder. Limbic dynamics u the close relationship
between suffering and the drive to write, and have implications for determining
who becomes a writer and why. It turns out that problems such as
procrastination are usually better treated by putting the writer in the
appropriate limbic or motivational state than by cognitive strategies such as
making To Do lists. Most procrastinators are very aware of exactly what they
are not doing.
Reading and writing give us not only an intellectual, cortical
apprehension of word meaning but also an emotional or limbic sensation of
meaningfulness or importance. In Chapter 7 I argue that metaphoric thinking,
important for science as well as literature, can link these types of meaning.
Metaphoric thinking is largely a temporal lobe function. So, it is likely, is the
inner voice we hear in our heads every day. Temporal lobe changes occur
during states in which the inner voice starts to feel alien, as in the auditory
hallucinations of psychotics. Temporal changes may also occur during the
very different processes of religious and creative inspiration. The sensation of
receiving dictation from an external force or muse, felt by some writers at
their most inspired, may share with psychosis a neurologically based
projection of the inner voice onto the external world. Such biological origins
do not strip bare the mystery of creativity. Rather, the fact that such a
transcendent process could also be an embodied one shows that it is even
more mysterious than we thought.

Copyright © 2004 by Alice Weaver Flaherty. Reprinted by permission of
Houghton Mifflin Company.
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