Doctor's Review: Medicine on the Move

October 23, 2021

Vincent van Gogh’s creative drive spilled out in his need to write as well as paint.

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Hypergraphia: a two-sided affliction

The joys and sorrows of the incurable writing disease

Give me a condor’s quill! Give me Vesuvius’ crater for an inkstand! Friends, hold my arms! – Herman Melville, Moby Dick

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. – Alice W. Flaherty, The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain

That’s not writing, that’s just typewriting. – Truman Capote, about the Beats

What writer wouldn’t consider exchanging their soul for the ability to churn out page after page of brilliant prose at any time of the day or night? To be seized by inspiration so strong that not to write was impossible? Such an affliction seems like the ideal antidote to writer’s block but it is not without a dark side. Dostoyevsky, Flaubert, Stephen King, Joyce Carol Oates and other prolific writers are considered by many health experts to be not merely gifted, but also cursed with an illness. The diagnosis? Acute hypergraphia.

The “incurable writing disease” was described as long ago as the first century by Roman poet Juvenal. Even before that, Hippocrates had labelled it the “sacred disease.” For Edgar Allan Poe, another of the afflicted, it was the “midnight disease.” Not until the 20th century did neurologists begin to explore the brain chemistry behind the compulsion to write.

Biochemically speaking, the condition appears to arise from an abnormal interaction between the temporal lobes and frontal lobe of the brain, wherein activity in the temporal lobes is reduced, boosting activity in the frontal lobe, which regulates speech. The staunching of the writer’s inner critic results in a florid outpouring, which may or may not be pleasurable to read — not surprisingly, it depends on the quality of the writing before hypergraphia strikes.

The term “hypergraphia” — not to be confused with hypergraphy, which refers to the combining of text with visual material — was first coined in the 1970s by behavioral neurologists Waxman and Geschwind. The team observed hypergraphia as part of a cluster of personality traits that are associated with some cases of temporal lobe epilepsy. The behaviors seen in Geschwind syndrome, as it’s known, include a deepened emotional life, sometimes described as hyper-philosophical or hyper-religious, emotional volatility which manifests as aggressive outbursts, and altered sexuality. Another trait is over-inclusiveness, the tendency to engage in extreme chatting with excessive attention paid to detail. One logical alternative to talking your loved-ones ears off, especially at night when everyone’s asleep, is, naturally, writing.

Russian writer Dostoyevsky’s episodes of epilepsy began when he was 25. He was ruled by pronounced mood swings, compulsive gambling, and attacks of rage — all the while being deeply thoughtful and religious, often mystical. He was apparently asexual until his mid-30s, but then married twice and had extramarital affairs. Writing seemed to worsen his medical condition, but this didn’t stop him from churning out 19 novels and novellas as well as extensive notebooks, diaries and letters.

In Notes From Underground, the unnamed main character voices Dostoyevsky’s own hypergraphic experience saying, “Again, what is my object precisely in writing? If it is not for the benefit of the public, why should I not simply recall these incidents in my own mind without putting them on paper? Quite so; but yet it is more imposing on paper… Besides, I shall perhaps obtain actual relief from writing.”

The catalyst of grief

Indeed, many of those with hypergraphia describe the pleasure that writing gives them. Alice Flaherty, a Harvard medical school neurologist and author of The Midnight Disease: The Drive to Write, Writer’s Block, and the Creative Brain, first experienced hypergraphia after the death of her premature twin boys. She was swallowed by an ocean of grief, but 10 days after their birth, she awoke with an overwhelming desire to write and was unable to do much else for four months.

The sequence repeated itself a year later, though in happier circumstances, when twin girls were born prematurely, but lived. A passionate reader and writer before the loss of the boys, her drive to write was possibly magnified and altered by her bipolar illness, but the act of writing, though abnormal in its excess, remained pleasurable unless she felt it blocked. “I feel joy when I’m writing well. I have my bad days, and I’m terrified of writer’s block. But in the end, the joy of finding even one good verb makes in all worthwhile,” she says.

Dr Flaherty’s hypergraphia was triggered not by epilepsy, but by her depression and its ensuing mania. It seems that mood disorder-related hypergraphia may be more common than the research reflects. One blogger who is himself gripped by hypergraphia notes that contemporary psychiatrists seem disinterested in wan papers about the frenzied writing habits of their patients, while neurologists, who are more apt to study conditions like epilepsy, have shown greater interest in the subject. He points out that there are thousands of bipolar bloggers and Tweeters, many of whom incorporate the term “hypergraphia” into their blog titles, though as someone made miserable by his fits of compulsive writing, he takes umbrage at their tongue-in-cheek use of the term. Another similarly afflicted bipolar blogger sums up this frustration, writing, “I cannot see why anyone would want to have the condition. Everything else more or less ceased to exist during (the 20 days I was writing); friends and family became cardboard cutouts, chores got ignored.”

Alcohol and the creative process

Statistically, there is a distinct correlation between bipolar illness and writers and poets. Is the disease part and parcel of being prolific? Perhaps not. Stephen King, author of 63 novels and nearly 200 short stories, has written in defense of prolific writers. As a child, he says he had “a thousand ideas, but only 10 fingers and one typewriter,” but this was, he thinks, a good thing. Though he struggled with alcoholism for years, and did experience depression briefly after he quit the drink, he has since written some of his best works, and his production has not slowed.

Joyce Carol Oates, similarly prolific, disparages the idea that one can write “too much” and says “I assure you, there is very little that is compulsive about my life, either in writing or otherwise. [One] is behaving normally and instinctively and healthily when one is creating […]. I am disturbed that a natural human inclination would, by some Freudian turn of phrase, be considered compulsive — perhaps even pathological. To me this is a complete misreading of the human enterprise.”

Aside from illness or sheer inspiration, there is another way to invite the symptoms of hypergraphia, one that Truman Capote, the author of Breakfast at Tiffany’s and In Cold Blood may have had in mind when he referred to the writings of Jack Kerouac and his beatnik cohorts: intoxication. Kerouac famously typed On the Road onto a 37-metre-long scroll in 20 days, though it was hardly a spontaneous act — he had been preparing to write his version of the “Great American Novel” for years. Still, the compressed rush of words was brought on by Benzedrine, his drug of choice, and endless cups of coffee, cigarettes and bowls of pea soup supplied by his wife.

Robert Louis Stevenson, author of Treasure Island and other classics, was a lifelong invalid whose sad state of health inspired one doctor to prescribe cocaine for his afflictions. In a fit of coke-fuelled inspiration, he wrote non-stop for three days, then asked for his wife Fanny’s opinion. When she suggested that his new work was “too allegorical,” he chucked it in the fire and began again, completing The Strange Case of Dr Jekyll and Mr Hyde just three days later. “That an invalid in my husband’s condition of health should have been able to perform the manual labour alone of putting 60,000 words to paper in six days seems incredible,” remarked Fanny.

Dr Flaherty, who, as a neurologist, continues to study the impact of experiments involving creativity and brain stimulation at Harvard, is riveted by the paradox of examining a phenomenon as elusive and esteemed as creativity. She writes, “My belief that I write because I love to is not inconsistent with my belief that I do it because my brain is in a particular state. […] I went into science because I thought it would help me solve the mind-body problem. Instead, it seems to have made me unable to forget it.”

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