A Conversation With Dr Richard Kogan

Editor’s note: If you have any questions for Dr Kogan, you can e-mail him at Richardkogan@aol.com. Following this interview are videos of Dr Kogan playing piano and talking about some of the composers he mentions. To order the dvd Music and the Mind, Volume 1 go to http://www.touchstarpro.com/p-96-music-the-mind-volume-1.aspx. In this first in a series, Dr Kogan discusses the life of Robert Schumann and performs his works.

Richard Kogan, MD, always draws a crowd, whether he is presenting one of his hugely popular lectures at the annual meeting of the American Psychiatric Association (APA) or performing brilliantly on the concert stage. His insight into the psychopathology behind creative genius has resulted in a series of lectures on the great musical masters, including Beethoven, Tchaikovsky, Bernstein and, most recently, Chopin.

Dr Kogan’s musical talent was recognized at an early age by his mother-a music teacher-and he started piano lessons at age 4. He went on to study piano at the Julliard School until age 18. However, rather than going on to a music conservatory for further study, Dr Kogan decided to attend Harvard College and later Harvard Medical School and become a physician. But his love of music never ebbed and he continued to develop as a musician.

Today, Dr Kogan is both a psychiatrist and a concert pianist and he often combines the two in very interesting ways. We recently sat down with Dr Kogan to try to understand more about the association between the creative process and psychopathology.

Q: There seems to be a disproportionately high incidence of mental illness in creative people. To what do you attribute this association between psychopathology and creative genius?

A: Creative people tend to see the world in novel and unconventional ways, and they often seek out intense and destabilizing experiences. Creative ideas are frequently generated during chaotic mental states characterized by loosening of associations that resemble the psychosis of mania or schizophrenia.

Q: Is madness a prerequisite for creativity?

A: While studies by psychiatrist Nancy Andreasen, psychologist Kay Jamison, and others demonstrate that writers and artists have mood disorders in greater proportion than the general population, mental illness is not a prerequisite for creativity. There have been examples of great composers, such as Bach, Haydn, and Mendelssohn, who seem to have been relatively free of significant psychopathology.

Q: Could part of the brain comprise, in essence, a sixth sense?

A: The mystery of creative genius has long been one the most fascinating problems for those who seek to understand the mind. Freud once remarked that the essence of artistic genius was beyond the comprehension of psychoanalysts. Neuroscientists and brain researchers today are striving to unlock the mystery and complexity of the creative process.

Q: Can you give us some exam-ples of creative geniuses with psychopathology?

A: The painter Vincent Van Gogh, the poet Sylvia Plath, and the mathematician John Nash (who was depicted in the movie A Beautiful Mind), are examples of creative geniuses who grappled with mental illness. One of the best examples in the world of music is the 19th century German composer Robert Schumann, who had mood swings and intermittent bouts of psychosis and spent the last years of his life in an insane asylum, where he eventually died of self-starvation.

Q: Are there creative advantages for composers with mental illness?

A: Schumann demonstrated both the creative advantages and disadvantages of mental illness. During his episodic depressive periods, he composed virtually nothing because he had difficulty in concentrating and was seized by the delusional conviction that he was a worthless composer. But when he cycled into hypomanic states, he was prolific. He made use of the increased energy, sharpened imagination, and decreased need for sleep to create original musical masterpieces. The arc of his career reveals episodic bouts of staggering creativity. He composed 3 string quartets in a 2-week period and completed 140 songs in 1 year. Many clinicians have noted that bipolar individuals can be resistant to compliance with treatment regimens because many of them do not want to give up the creative “highs” associated with their mania.

Q: How does Schumann’s psychiatric illness inform his work?

A: In the opening of Schumann’s G Minor Sonata, he writes in the score the instruction for the performer to play “as fast as possible.” Later, in the coda of this movement, he marks “now faster” and then “even faster.” I believe that this was an attempt to translate his racing thoughts into musical language. His music is full of abrupt, unprepared transitions, which made his music nearly incomprehensible to his contemporaries, and I believe that this was a reflection of his disjointed and fragmented thought processes. Schumann invented 2 imaginary companions to comfort him during times of stress-Eusebius, a melancholic, poetic dreamer, and Florestan, a hyperkinetic, aggressive individual. Eusebius, representing Schumann’s depressive self, and Florestan representing his manic self, make regular appearances throughout Schumann’s music.

Q: How does psychiatry address the question of what an artist truly sees-or a composer hears-and, if that artist is “mad” (or visa versa, the psychopath is an artist), does modern psychiatry attempt to squelch creativity? Could the solution be to exercise a patient’s creativity and thereby understand his or her experience through his or her creative medium? Would music therapy be an option?

A: I believe that music is an underutilized modality in healing and that it is essential for all clinicians not to lose sight of music’s unparalleled capacity to lift spirits, to soothe anxiety, and to reduce pain. And, I believe that psychiatrists need to keep in mind the potential in vulnerable individuals for creative pursuits to provide temporary inner harmony and ward off the worst manifestations of mental illness. The Russian composer Tchaikovsky, who was chronically dysthymic and plagued by suicidal thoughts, resisted instruction from his internist to compose less in order to preserve his energy. He once wrote, “I need work like I need air to breathe. As soon as I am idle, despondency overcomes me. I am dissatisfied with myself and even hate my-self. Only work saves me. Without music I would go insane.”

Q: One assumes that treatment with a psychotropic medication would blunt the creative process. How do you feel about treating a creative genius with a drug?

A: In spite of the noted association between creative genius and psychiatric illness it is important not to overromanticize the impact of mental illness on the creative process. Many creative individuals insist that depression, mania, and psychosis are incompatible with their creative lives, and that they can only produce works of art when their psychiatric symptoms are reduced or eliminated.

Psychiatrists in the 21st century have tools that are more powerful than those that were available in the past to fight against mental illness. For example, Schumann’s psychiatrist prescribed phlebotomy and hydrotherapy-modern mood-stabilizing drugs probably would have been more effective.

A clinician must balance the le-gitimate concern about blunting the creative process through the use of psychotropic medication against the concern that withholding medica-tion could result in symptoms that interfere with the creative process. And psychiatric illnesses, like the mood disorders in schizophrenia, carry a high risk of suicide. Artistic careers like those of Van Gogh and Sylvia Plath might have been prolonged with appropriate and effective treatment.

Q: If it’s not already happening, it won’t be too far off in the future that tests are available that predict whether a baby will be born with a mental disorder, giving parents the option of not conceiving. Will this mean the end of creative genius?

A: I don’t believe that reducing and/or eliminating the incidence of mental illness will lead to the end of creative genius.

Q: You’ve lectured on a number of composers. Who is your favorite, both as an interesting psychiatric case study and musically?

A: Ludwig van Beethoven suffered from a variety of psychiatric symptoms, including persecutory delusions, volatile moods, ex-plosive rages, and suicidal ideation. But I believe that he is most compelling as the quintessential example of a characteristic of mental health, specifically, resilience or the capacity to cope with adversity. Deafness, a hardship for anyone, is a catastrophe for a musician. But Beethoven ultimately embraced the loss of his hearing as an opportunity to fulfill his artistic destiny. Locked in the silent world of his imagination, Beethoven created a musical language that was different from anything that had previously existed. He anticipated the sonorities of the modern piano, writing sonatas such as the Appassionata and the Hammerklavier, which vastly exceeded the capacity for resonance of the instruments of his era. And he wrote works such as his renowned fifth and ninth symphonies, which begin with dramatic conflict and end in triumph and transcendence, paralleling the narrative arc of his own life story.

Q: It’s hard to diagnose any illness, and even a tentative diagnosis would seem particularly hard to do with a historical figure. How have you arrived at the diagnoses for the composers that you’ve studied?

A: It is indeed challenging to do a retrospective diagnosis on any historical figure. I have enough difficulty with establishing an accurate diagnosis in the living patients that I see in my office. But there fortunately exists a wide range of primary source material for many of the deceased composers whom I have studied. Tchaikovsky, for example, exchanged approximately 1200 letters with his patron Madame von Meck, and he kept meticulous diaries. So we have information about his men-tal state for nearly every day of his adult life.

Q: Has the study of a composer’s music ever helped in making a diagnosis?

A: There are numerous examples of musical compositions offering valuable diagnostic clues. The French composer Maurice Ravel suffered in his last several years from frontotemporal dementia. One can make the case that his symphonic work Bolro, in which he uses a seemingly unending repetition of the same thematic material, is an example of perseveration and evidence that Ravel, when he wrote the piece, was in the early stages of dementia.

Q: How do you go about chosing a composer as the subject for your lectures at the APA?

A: Essentially, I have 2 requirements: I always try to select composers who had intrapsychic conflict that had an impact on their creative process. And, I also choose composers who wrote for the piano so that I can illustrate my points with musical examples.

I’ve often used an anniversary as a pretext to explore a certain composer. This year I presented Chopin on the bicentennial of his birthday. In 2006, I explored Mozart’s mind and music during his 250th anniversary year, and in 2007, I presented Leonard Bernstein on the occasion of the 50th anniversary of the world premiere of West Side Story.

Q: You’ve lectured on composers as diverse as Mozart and Gershwin. What is your favorite musical style?

A: While I am trained as a classical musician and have primarily investigated classical composers, I have a deep appreciation for a wide variety of musical genres. I love the music of George Gershwin, who forged an inimitable style by combining elements of the classical, jazz, and pop traditions. I am generally opposed to arbitrary stylistic distinctions. I agree with the viewpoint of Duke Ellington, who once said, “There are only two kinds of music-good music and bad music. I like both kinds.”

Q: Who is your favorite composer? And why?

A: Over the years, I’ve had at least a dozen different favorite composers, including Bach, Mozart, Beethoven, Schubert, Chopin, Brahms, Debussy, Stravinsky, Bartk, and Shostakovich. My favorite composer seems to be the one whose musical world I’ve been immersed in most deeply at any given time. Right now I am absorbed in the musical universe of Sergei Rachmaninoff, who was a master of translating melancholy and nostalgia into a musical language. He was cured of a profound writer’s block through hypnosis, and he dedicated his beloved Second Piano Concerto to his psychiatrist, Dr Nikolai Dahl. I am considering presenting him at an upcoming APA annual meeting.

Q: Taking a cue from the Proust questionnaire, if you could have dinner with any composer (living or dead), who would you invite and why?

A: It is unimaginatively exciting to contemplate a meeting with any of the composers that I’ve studied. Last month, I had dinner with all 3 of Leonard Bernstein’s children. They regaled me with stories and observations about their brilliantly creative father, and I’ve been contemplating how I might incorporate these insights into my next Bernstein presentation.