Creativity and mental illness - do you have to be mad to be creative?
Professor Raj Persaud
Introduction: Professor Frank Cox, Fellow of Gresham College When one says there is no need to introduce the speaker, one tends to go on for ages and ages. I’m not going to do that. Tonight, your speaker
is in fact very well known to everybody. It is Raj Persaud, who is consultant psychiatrist at the Institute of Psychiatry. He is in fact also the Visiting Gresham Professor for the Public Understanding of Psychiatry, and this is the third series of lectures that he has done. Without any further ado, I will ask Raj to give his first lecture on creativity and mental illness.
Thank you very much. I’m really pleased to have been invited yet again to give another series of lectures here at Gresham College. We live in an ancient city, with ancient traditions, and often we can forget that. This College and the lectures that are being given here are part of a tradition that goes back to the 16th Century, and I always feel very moved by that thought, how lucky we are in London to be able to avail ourselves of these magnificent traditions.
Some of you will know that I’m a consultant psychiatrist, and I work in the NHS at a hospital in South London called the Bethlem Royal & Maudsley Hospitals. The Bethlem Royal is the second oldest public hospital in Britain. It was founded in the 13th Century here in London, not very far away from here, in Bishopsgate. It has moved several times in its history and now it is out in Beckenham in Kent. When it was in Bishopsgate, back in the 13th Century, those were the suburbs of London then, and whenever London has grown it has moved; for example, it moved to the current site of Moorfields Hospital, where my wife is an eye surgeon, and then it moved to the Imperial War Museum, where that is now. That building actually is the original Bedlam building. It keeps having to move because as London expands it becomes not so acceptable to have a large psychiatric hospital right in the middle of the City, so it always has to move out yet again to the suburbs, where it is now in Beckenham. My ward is Gresham 1 Ward at the Bethlem, and I suspect Thomas Gresham may have had something to do with endowing that ward a long time in the past, so there is a kind of circularity to some of the traditions.
I am going to talk a little bit today about the psychology of creativity, a very important subject I think, and very neglected by the world in
general and by those in my subject, psychologists and psychiatrists. You hear a lot about the mystery of consciousness and how consciousness is a really deep and fascinating problem, but you hear much less about the mystery of creativity. I want to contend that creativity is a much better mystery, a much more fascinating puzzle, than that of consciousness. I suspect that consciousness as a problem will definitely be solved at some point in the future, with the right brain scanning technology - and we are constantly making advances. I am confident it is going to be solved. One of the things that makes creativity such a fascinating, and a deeper, more wonderful puzzle, is the fact that I am not convinced that it might ever be solved, even with the magnificent brain scanning technology we have now, and I will tell you why. What we would have to do if we were going to solve the puzzle of creativity is, to take an example from history, we would have to get someone like Newton, at the moment the apple falls on his head and he discovers gravity - his ‘Eureka’ moment – we would
have to have him in the brain scanner at that moment, and be able to scan his brain, to see the brain activity patterns at that moment of magnificent inspiration. What are the chances that we are ever going to be able to do that? What the chances of ever being able to get a Mozart, stick him in the brain scanner, or stick a wonderful lady composer or writer in the brain scanner at the moment of inspiration and scan the brain at that moment, and therefore develop the insight into where in the brain creativity comes from? For that reason, I think creativity remains a much more magnificent and deeper and more wonderful mystery.
But to start off with, one of the things that people forget about creativity is creativity, at its heart, is about being different. I want to tell you a little story about one of the most different people who ever taught me at medical school. At medical school – I trained at University
College in Gower Street, again not very far away from here – they had
a tradition back then, way back when I was a medical student, of when you went and did general practice, you did two kinds of general practice. You went and attached yourself to an urban general practice and saw what inner city medicine was like, and then the medical school sent you out to the rural countryside to live with a countryside GP for a couple of weeks to see what countryside medicine was like, the idea being you would see that there was a very big difference.
Now, because you had to go and live with this GP for two weeks, there was a system whereby the GPs had a Rolodex file in the Dean’s Office at the medical school, listing their interests, where they were, etc. You went to go and look in this little box with the cards, and picked out the GP that most attracted you or interested you in terms of going to live with them, and rang them up, from their details on that card, and made the
arrangements to go out there. Now, being a very disorganised medical student, I was the very last person to go and look in the Rolodex box, and as a result, when I got there, there was only one card left in the box, so I got the guy that everyone else had rejected. Now, most of these cards, as I said, had the GP’s name, address, some details about their family life – you know, we have a couple of pets, we have three children, we love golf, that kind of thing. This card had just one sentence on it. It said: ‘No wimpy lettuce eaters!’ That was a bit ominous!
I rang the number on the card. The ’phone rang for an awfully long time
before eventually it was picked up, and it became apparent to me that I was talking to someone with a very slurred voice at the other end. We made arrangements to meet – he was going to pick me up from the train
station – and right at the end of the conversation, he said, with a very slurred voice, ‘What do you drink?’! I was actually practically
teetotal at the time, but I had to think of something quickly, so I said, ‘Whisky.’ Then the voice came on the phone, said, ‘Right, I’ll get a crate of that in!’ I had a sense I was dealing with someone with a few substance misuse problems…
I arrived at the train station, got off the train, and looked up and down the platform. It was deserted, and I thought, ‘Oh my God, there’s been a problem, a mix-up. He’s not made the train. I’m going to have to
So I walked towards the exit, and I try and find him some other way.’
fell over someone…and it was him! He’d passed out on the platform. I
helped him up and we staggered over to his car. This was obviously in less enlightened times, when people had less of a problem over drink driving. We set off.
I was very nervous, but he seemed to sober up very quickly in the car. We are driving through the rural countryside, middle of nowhere, he suddenly pulls the car over and stops, and I wonder what the hell is going on now. So he gets out the car, and he strides purposefully across one field, and I run after him. We go across another field, then another field, then another field, and then we come to a field where there is a solitary horse, in the middle of the field, quietly chewing the grass. He said to me, ‘You see that horse over there?’ I said, ‘Yes.’ He said, ‘I bought
that horse for my wife, and as a result of me buying that horse for my wife, she had horse riding lessons, and then she ran off with the horse riding instructor. That horse is the reason for my divorce!’ And then
he proceeded to swear at the horse for about half an hour!
When we got back in the car and we drove off, it began to dawn on me that I was dealing with someone probably in the middle of a bit of a nervous
breakdown as a result of his divorce. He kept saying to me in the car, ‘I’m going to show you what British general practice is all about!’
And so we drove into the little village where his practice was, and we drove right past the surgery, and I thought ‘U-oh.’ Then we kept
driving, and then we came to a hotel with a sauna in it, and he said, ‘We’re going to go to the sauna for the afternoon.’ I was a bit
nonplussed by this, but we went to the sauna. Then I discovered that, in the sauna, you had to be naked. I’ve got to tell you right now, I
don’t do public nudity, particularly when I’m with a guy who I’ve only just met 20 minutes ago and who is in the middle of a divorce! I was getting very nervous by this time. I was afraid, ‘any port in a storm’
may be what he is thinking.
we’re sitting there in the sauna, and I’m very nervous, and then two So
naked women came in, which came as more of a shock – I had no idea it
was a mixed sauna. And then it turned out of course that what this guy was doing – because he was in the middle of this divorce, he’d split up from his wife – he was out trying to meet women. He started chatting them up straightaway, and this obviously was his favourite haunt to meet women, and he told them that he was a test pilot for the RAF, which again came as a shocker to me! But you know, it seemed to work, it seemed to be very successful…and I’ll be talking some more about some of those tactics in my lecture on seduction in a few weeks’ time.
Then, we were on call that night. In those days, you’re on call from
home, and we got a call in the middle of the night and he arranged to see the patient in his surgery. So it’s about midnight, we’re driving out
to his surgery, he leans over to me and says, ‘This is a patient who is a bit depressed, and I think she has got an eating disorder as well. Do you know anything about eating disorders? Because I don’t know anything
about them at all!’ he said. So I racked my brains and I said, ‘Well,
I only know one thing about eating disorders. I seem to remember reading somewhere that some women who’ve got an eating disorder have sometimes been sexually abused when they were children and there may possibly be a link, but you know, it’s only a tentative memory in my mind.’ He said,
So we got to the surgery, we parked the car, went in, and we’re waiting for the woman, and it’s quite a big reception area that we’re waiting in. Then the woman arrives, and she is halfway through the front door, and about to take off her coat, but she’s still halfway through the front door, taking off her coat, when he suddenly shouts out to her, 50 yards across the reception area, ‘I say, were you ever sexually abused as a child?’! I thought to myself, ‘Oh my god! Whatever happened to
building rapport, that kind of thing?!’ She suddenly stopped, taking
off her coat halfway, and said, ‘Actually, yes I was, and I’ve never told anyone before.’ He turned to me and he said, ‘You’re a genius! I’m giving you an A!’
The next day, we were in the clinic for the very first time, and I thought it was going to be interesting to see him in action.
The first patient came in, and I’m sitting there with him, and the patient relates a set of symptoms. He thought hard after the symptoms were related, and then he said, ‘I hardly ever do this because the drug I’m thinking of prescribing for you is incredibly powerful and very expensive, so we hardly ever prescribe it on the NHS. So I hardly ever do this, but on this one occasion, I think I’ll make an exception and I’ll prescribe this drug.’ So having given this drug this magnificent big build-up, the patient left, clutching the prescription as if it was the Holy Grail. The next patient came in, related a completely different set of symptoms. He paused for a moment, sat back and thought for a second, and he said, ‘I hardly ever do this…’ and then he gave exactly the same spiel about this drug! He prescribed the drug, patient leaves, clutching the prescription as if it’s the Holy Grail. And he does this
with practically every single patient that we see that morning. I bumped into the local pharmacist a few days later in the high street, and he said, ‘Are you a medical student with that GP?’ I said, ‘Yes,
I am.’ He said, ‘Would you please try and get him to stop prescribing Penbritin – (Penbriten is a very old form of penicillin) – because they
don’t make it any more?’ he said, ‘and it’s getting incredibly difficult to get hold of, and he’s prescribing it for everything!’
So you could say this was a very different GP, a very different doctor, and some people would say actually he had some of the key elements of the creative individual… He didn’t really care what people thought about him. I only met him for a short while, and already he was saying stuff that was a bit outrageous to me. Creative people have to not care about what others think about them, because in the creative process, when you come up with a new idea, a creative idea, what is really fascinating is that all the best, most wonderful creative ideas have always met with a huge amount of resistance when someone first came up with them. And what we understand from the psychology of creativity is not just that you have to come up with new and original ideas, you have got to be able to put up with resistance and fight to get your idea accepted. So there’s a
kind of fighting bit that is important as well.
You often have to be a bit of a risk-taker, because if you are going to come up with new ideas, people are going to think of you as being a bit odd, and you will have to not care what people think about you, but you also have to be able to take risks.
You have to look at the world – and here’s a key point – in a different
way, and we’ll come back to this shortly in terms of how we measure creativity.
It was clear to me that this GP was looking at the world in terms of his practice in a very different way to the way I had been taught at medical
Up until that moment, what I had been taught at medical school school.
was that medicine is about the patient comes in, you make a diagnosis, you give them the treatment, and if there isn’t a diagnosis for which there’s a treatment, you let the patient know that. His view of medicine
was very different. His view was you tried to let the patient feel special and you let the patient leave feeling very happy. So we had a very different view of practising medicine, and a different way of looking at the world.
Now, we’ll come to that in a moment in terms of the thorny problem of
how we measure creativity. To have a science of the subject, in order to study a subject, you have to start with measurement – how do we measure