Publisher: Robinson (2017)
Gail Saltz is a psychiatrist and member of faculty at Weill Cornell Medical College in New York who has a particular interest in the relationship between mental illness and extraordinary achievement.
In this book, which is highly accessible to a lay audience, she explores the challenges of living with conditions such as dyslexia, attention deficit hyperactivity disorder (ADHD), depression, anxiety, bipolar disorder and schizophrenia; however, her primary aim to to highlight the conditions in which people who have these diagnoses can flourish and indeed excel.
Interestingly, while the many individuals interviewed for this book have been given such diagnostic labels (and the experts to whom she has spoken and whose work she has drawn on tend to use them too), Dr Saltz personally shies away from the conventional terminology of psychiatry, preferring to discuss ‘brain differences’ rather than mental illnesses, explaining that these often co-exist, overlap, or have criteria which exclude certain individuals whose struggles are still real.
Thus, she writes about ‘learning differences’, ‘distractibility’, ‘cycling mood’, and ‘divergent thinking’, for example, observing that we may all exhibit some of these traits or tendencies to a greater or lesser degree (and conceding in her final chapter that even the term ‘brain difference’ is in effect redundant given that all of our brains are in actual fact different).
The basic tenet of this book is that every person, regardless of challenges or diagnoses, has the potential to succeed in some area of life, provided the conditions are right for them to do so. For example, a child with dyslexia may come to dread school and rebel against formal education if they are forced to do exercises to help them distinguish b from d all day when their brain is simply not wired to do this, whereas if they are allowed to tell stories aloud, or draw, or build bridges out of straws – whatever catches their imagination, they may find that they can achieve and become excited about learning.
Saltz cites the example of Harvard Professor of Radiology, Beryl Benacerraf, who is profoundly dyslexic but whose ability to recognise patterns and pinpoint tiny differences in images has taken her to the forefront of her field. She highlights the fact that people with learning differences tend to be natural problem-solvers and their capacity to develop work-arounds for their disability, if cultivated, can make them some of the world’s greatest overcomers.
Whether a person’s brain difference is debilitating anxiety with obsessive-compulsive traits or whether their episodes of elevated and depressed mood have led to a diagnosis of bipolar disorder, Saltz describes an inverted U-shaped curve in relation to their capacity to achieve. Put simply, a person who is not anxious may under-perform in a maths test, whereas a person who is anxious but who can channel that anxiety may show such attention to detail that they score in the top percentile, and someone who is so uncontrollably anxious that they draw a complete blank and run out of the exam hall (falling off the end of the U-shaped curve).
Someone who suffers from cycling mood and who is mildly hypomanic may have disinhibited thinking which can lead to remarkable idea generation, feats of design or exceptionally creative writing (Saltz offers a long list of examples of visual artists, authors and entrepreneurs who are bipolar); however, if this hypomania is left completely unchecked, full blown, chaotic mania will result. The balance between flight of thought and the organising higher cognitive processes – which allow the best ideas to be selected out – is tipped over, leading to complete dysfunction and an end to creative output. The only way to remedy this is with appropriate medication or behavioural therapy, which many patients may resist until they recognise that steady creative output is preferable to sudden bursts of ideas interspersed with long fallow periods. Kay Redfield-Jamison, prominent clinical psychologist and author of the memoir, ‘An Unquiet Mind’, is one such example.
What interested me most, as someone who has been diagnosed with psychotic illness, was Saltz’s approach to the ‘gift’ of what she calls divergent thinking – thinking that diverts from that which most people perceive as ‘normal’, and, when it disturbs people or causes others to become concerned about them, may be diagnosed as symptomatic of schizophrenia or schizoaffective disorder, for example. Here again, the writer describes a curve in which a certain degree of divergent thinking, tempered by a recognition of what unusual thoughts are ingenious and useful and what are simply bizarre, can lead to remarkable achievements, whilst untreated psychosis can cause people to lose touch with reality to a degree which leaves them on the margins of society.
One person whose experience Saltz draws on in this regard is Elyn Saks, a well-known Professor of Law at the University of Califonia, Los Angeles. Saks has schizophrenia and struggled to function for some years, but is now a leader in the field of mental health law, having – with the aid of a drug called clozapine – been able to gain mastery over her ability to think differently rather than allowing her thought processes to master her. Saltz notes that psychiatrists often fail to recognise that people with schizophrenia (John Nash is another example) can achieve academic heights, and that many of the drugs currently used to treat psychosis are blunt instruments which sedate and limit dexterity of thought – something which resonated with my own experience.
I feel that Saltz has really hit on something with this book which will speak to any of us who have brain differences – whether self-diagnosed or clinically recognised – and will offer a hope which can sometimes evade us. The fact that she deals so sensitively with the extreme distress which these conditions most often cause as well as addressing the potential which people who suffer can achieve gives the book balance and authenticity.
It is clear that a lot of careful thought and research has gone into this project, and in my opinion it is definitely worth reading. Interesting, enjoyable and – above all – optimistic, I hope that teachers, clinicians, parents, and those who feel all too strongly that they are ‘different’, will take note of the evidence which Dr Saltz presents and be encouraged by the many examples of the genius to be found amidst psychological adversity.