Some highly creative people have suffered from schizophrenia, including Syd Barrett (1946–2006), the early driving force behind the rock band Pink Floyd; John Nash (born 1928), the father of ‘game theory’; and Vaclav Nijinsky (1889–1950), the legendary choreographer and dancer. The cases of Barrett, Nash, and Nijinsky are exceptional, and most people with schizophrenia are intensely disabled by the disorder. Even highly creative people with schizophrenia such as Barrett, Nash, and Nijinsky tend to be at their most creative not during active phases of the disorder, but before its onset and during later phases of remission.

Many more highly creative people, whilst not suffering from schizophrenia themselves, have or have had close relatives who do. This was, for example, the case for the physicist Albert Einstein (his son had schizophrenia), the philosopher Bertrand Russell (also his son), and the novelist James Joyce (his daughter). This is unlikely to be simple coincidence, and a number of studies have suggested that the relatives of people with schizophrenia do indeed have above average creative intelligence.

According to one theory, both people with schizophrenia and their non-schizophrenic relatives lack lateralisation of function in the brain. Whilst this tends to be a disadvantage for the former, it tends to be an advantage for the latter who gain in creativity from increased use of the right hemisphere and thus from increased communication between the right and left hemispheres. This increased communication between the right and left hemispheres also occurs in people with schizophrenia, but their thought and language processes tend to be too disorganised for them to make creative use of it.

Schizophrenia affects about 1% of the population; the idea that the genes that predispose to schizophrenia also predispose to creativity – and thus confer an adaptive or evolutionary advantage – may help to explain why such a debilitating illness remains so common.

Adapted from The Meaning of Madness.

Diogenes of Sinope or Diogenes the Cynic was a contemporary of Socrates’ pupil Plato, whom Plato described as ‘a Socrates gone mad’. Like Socrates and, to a lesser extent, Plato, Diogenes favoured direct verbal interaction over the written account. When a man called Hegesias asked to be lent one of his writing tablets, he replied, ‘You are a simpleton, Hegesias; you do not choose painted figs, but real ones; and yet you pass over the true training and would apply yourself to written rules.’ After being exiled from his native Sinope for having defaced its coinage, Diogenes moved to Athens, took up the life of a beggar, and made it his mission to metaphorically deface the coinage of custom and convention, which, he maintained, was the false coin of morality. He disdained the need for conventional shelter or any other such ‘dainties’ and elected to live in a tub and survive on a diet of onions. He proved to the later satisfaction of the Stoics that happiness has nothing whatever to do with a person’s material circumstances, and held that human beings had much to learn from studying the simplicity and artlessness of dogs, which, unlike human beings, had not ‘complicated every simple gift of the gods’. The terms ‘cynic’ and ‘cynical’ derive from the Greek kynikos, which is the adjective of kyon or ‘dog’.

Diogenes placed reason and nature firmly above custom and convention, which he held to be incompatible with happiness. It is natural for a human being to act in accord with reason, and reason dictates that a human being should live in accord with nature. Accordingly, he taught that, if an act is not shameful in private, then it should not be shameful in public either. Upon being challenged for masturbating in the marketplace, he replied, ‘If only it were so easy to soothe hunger by rubbing an empty belly’. Upon being asked, on another occasion, where he came from, he replied, ‘I am a citizen of the world’ (cosmopolites), a radical claim at the time and the first recorded use of the term ‘cosmopolitan’. Although Diogenes privileged reason, he despised the sort of abstract philosophy that was being practiced elsewhere and in particular at Plato’s Academy. When, to great acclaim, Plato defined a human being as an animal, biped, and featherless, Diogenes plucked a fowl and brought it to the Academy with the words, ‘Behold! I have brought you Plato’s man.’ Plato consequently revised his definition, adding to it ‘with broad nails’.

Diogenes was not impressed with his fellow men, not even with Alexander the Great, who came to meet him one morning while he was lying in the sunlight. When Alexander asked him whether there was any favour he might do for him, he replied, ‘Yes, stand out of my sunlight.’ Much to his credit, Alexander still declared, ‘If I were not Alexander, then I should wish to be Diogenes.’ In another account of the conversation, Alexander found Diogenes looking attentively at a pile of human bones. Diogenes explained, ‘I am searching for the bones of your father (King Philip of Macedon), but cannot distinguish them from those of a slave.’ Diogenes used to stroll about in broad daylight with a lamp. Whenever curious people asked him what he was doing, he would reply, ‘I am just looking for a human being.’ Much to his chagrin, all he ever found were rascals and scoundrels. When asked how he wished to be buried, he left instructions to be thrown outside the city wall so that wild animals could feast upon his body. After his death in the city of Corinth, the Corinthians erected to his memory a pillar upon which they rested a dog of Parian marble. Diogenes taught by living example that wisdom and happiness belong to the person who is independent of society. He was, I think, a shining example of the art of failure.

In my experience, most medical students enjoy learning about mental illness and talking to mentally ill people, who often have a refreshing knack for saying things exactly how they are. In a fit of inspiration, some medical students tell me that psychiatry is the only specialty that enables them to think about themselves, about other people, and about life in general. They also like the lifestyle (in the UK): an hour for each patient, ‘special interest’ days, protected time for teaching, light on calls from home, and guaranteed career progression. In medicine they might treat yet another anonymous case of asthma, chest pain, or pulmonary oedema. In surgery they might do one knee replacement after another, up until the day they retire or collapse. But in psychiatry there can be no factory line, no standard procedure, and no mindless protocol: each patient is unique, and each patient has something unique to return to the psychiatrist. I often come across those same students again, months or sometimes years later. After the smiles and the niceties, it transpires that they are no longer so interested in psychiatry. So what happened?

The students are never too sure, but I think I have an idea. When I was a medical student in London, an American firm offered me a highly paid job as a strategy consultant in their Paris office. So I glady left medicine, and the many inconveniences of working in (and increasingly ‘for’) the National Health Service. I had a great time in Paris, but the job itself turned out to be more about dealing with personality disorders than about having brilliant ideas. I quit after six months and freelanced as an English tutor to high-flying executives, bankers, venture capitalists, and such like. As my clients already spoke good English and merely wanted to improve their fluency, all I had to do was to make conversation with them. My lessons often turned into something akin to psychotherapy, as I realised that I could make my clients open their hearts and minds simply by listening to them speak. Although they seemed to have everything in life, they were actually deeply unhappy, and had rarely stopped to ask themselves why. I wanted to find out why, so I decided to go back to the UK, do my house jobs (internships), and specialise in psychiatry. I had always been far too ‘ambitious’ to consider psychiatry, but by then it had become clear that I didn’t want to pursue a career that didn’t allow me to think and feel, and to relate to others and to the world in a genuine and meaningful way. There are not many such jobs, but psychiatry—along with general practice, teaching, academia, and the clergy—is certainly one of them, and even, arguably, their archetypal form.

The following year while going about my house jobs I put up with all sorts of abuse from my colleagues in medicine and surgery. One of the other house officers (interns), by then a good buddy, took me aside one day and said with an alcoholic mixture of concern and disdain: ‘Why do you want to go into psychiatry? You’re a good doctor. Can’t you see you’re wasting your talents?’ It became very clear, first, that the stigma that people with a mental disorder are made to feel also extends to the doctors who look after them; and, second, that this stigma emanates most strongly from the medical profession itself, mired as it is in middle class preoccupations and prejudices and, as a whole, far too grounded in neurosis not to be terrified of psychosis.

Of course, it is simply not true that psychiatry is ‘a waste of talent’. The term ‘psychiatry’ was first used 200 years ago in 1808, in a 188-page paper by Johann Christian Reil. In this paper, Reil argued for the urgent creation of a medical specialty to be called ‘psychiatry’, and contended that only the very best physicians had the skills to join it. These physicians needed to have not only an understanding of the body, but also a much broader range of skills than standard physicians. Indeed, a psychiatrist can change a person’s entire outlook with a single sentence, so long as he can find the right words at the right time. No protocols, no high-tech equipment or expensive drugs, no pain or side-effects, and no complications or follow-up. Now that is talent, and one so great that I can only ever aim at it. And each time I fail, I always have medicine to fall back upon.