There is something in bipolar disorder that lends itself to music. The New Zealand band Crowded House allude to it in their songs Black and White Boy and Four Seasons in One Day, while songwriters Neil and Tim Finn include the tune Mood Swinging Man in their eponymous album. More historically, Jimi Hendrix’s song Manic Depression appeared on his 1967 album Are You Experienced. Of course, the more classical connoisseur of mood related music might reasonably cite anything by Ludwig van Beethoven.
What might have inspired him? Beethoven had a notoriously difficult personality, and was prone to both fluctuating mood and intense bouts of impatience, anger and even paranoia. After meeting him in 1812, Goethe famously wrote, “His talent amazed me; unfortunately he is an utterly untamed personality, who is not altogether in the wrong in holding the world to be detestable but surely does not make it any more enjoyable for himself or for others by his attitude”. Some critics have suggested Beethoven may have had bipolar disorder, although there appears to be little firm evidence of this.
Not so with his fellow German composer Robert Schumann. Born in Zwickau, Saxony on 8 June 1810, Schumann was taught the piano first by his mother, second by the local church organist in Zwickau, and last by the distinguished music teacher Friedrich Wieck. Later, he would marry Wieck’s daughter Clara, boldly defying his former teacher’s stern objections. In 1832, Schumann broke the third finger of his right hand and partially paralysed the neighbouring index finger, thus dashing his hopes of becoming a career performer, and turned his attention instead to composing symphonies. Schumann also studied law at the University of Leipzig and received an honorary doctorate from Jena University in 1840. He was a professor at Mendelssohn’s Leipzig Conservatorium by 1843.
Schumann began to worry about his mental health from his early twenties. He once wrote to Clara that, “This fear drove me from place to place – my breath stopped at the thought: ‘What if you are no longer able to think?’ …anyone who has once been crushed like that knows no worse suffering, or illness, or despair, that could possibly happen to him”. From 1833, Schumann suffered from melancholia (depression) alternating with periods of excessive “exhalation”. As he became gradually more unwell, he increasingly heard voices, strange noises and musical notes for which he could not account, and developed an increasing paranoia of medication, metal instruments and certain types of music. In 1854, he jumped from a bridge into the Rhine and had to be rescued by a boatman. The same year, he retired to a private asylum in Endenich near Bonn, where he died just two years later.
Accounts therefore suggest Schumann experienced both mania and depression. Symptoms of the latter typically include a pervasively low mood, a diminished sense of enjoyment, enduring fatigue, disrupted sleep, loss of appetite and poor concentration. Meanwhile, mania involves an unusually elated or irritable mood lasting a minimum of seven days, combined with increased creativity, accelerated thinking, excessive energy, marked difficulty sleeping, over-talkativeness, grandiosity, over-familiarity with others and reckless behaviour such as overspending. As with Schumann, up to twenty percent of manic individuals experience psychotic symptoms such as delusions (firmly believing things that are neither true nor the cultural norm) and auditory hallucinations (hearing things that are not there). A less severe form of mania lasting a minimum of four days is termed hypomania.
What, then, is bipolar disorder? Perhaps more popularly termed manic depression, it is a relapsing and remitting illness marked by distinct episodes of mania, hypomania and depression, each usually lasting weeks or months and interfering with the ability to lead a normal life while unwell. Bipolar disorder affects around one percent of the population and tends to emerge first between the ages of fifteen and forty. Its causes are a matter of well-researched theory, but studies on genetics and twins suggest having a family member with bipolar disorder significantly increases the risk of an individual developing the illness. Meanwhile, stresses that may precipitate mania include prolonged sleep deprivation, bereavement, childbirth and physical illness.
While few individuals with bipolar disorder manage to avoid hospital completely, modern management yields a far better prognosis than in Schumann’s time. Medication is usually essential for both recovery and relapse prevention, while cognitive behavioural therapy (CBT), rehabilitation and carer information courses have increasingly been shown to facilitate a return to normal living. Knowledge of the early signs of relapse is essential so that the psychiatric team can be alerted if they occur. Finally, important lifestyle strategies include avoiding alcohol and street drugs, a healthy diet, regular exercise and a well-structured daily routine.Mindfulness may also help, perhaps accompanied by a gentle tune. There is, after all, something in bipolar disorder that lends itself to music.
Dr Stephen McWilliams is a consultant psychiatrist and author. His latest book, Psychopath? Why We are Charmed by the Anti-hero, is published by Mercier Press.
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