INTRODUCTION
“I spent so many years wanting him to succeed and wanting him to be happy,”1 Noah, the father of Ethan, a sixteen-year-old who had been diagnosed as a young child with ADD and Asperger’s, said to me once. With those words he was articulating the desires all parents have for their children: to be happy and to succeed. Those goals, while so simple sounding, can be difficult to achieve—for anyone. But for children and adults with diagnosed brain differences, the path can be even more perilous and uneven.
In the early years of Ethan’s schooling, his personal challenges emerged as behavioral difficulties. There seemed to be a disconnect between Ethan’s intellectual brightness and his inability to control himself physically and to engage socially in appropriate ways. Ethan himself remembers “jumping around in classes. I might throw tantrums. The usual not knowing when to be quiet, basically behavioral issues that made it hard for me to work with teachers. Teachers would have to take too much time to deal with me, and sometimes I would crawl under the table and read and ignore them.”2 Noah describes Ethan as having “lacked a filter.”
This disconnect within Ethan is one that parents and educators are often forced to grapple with: what to do with a child who has intellectual gifts but behavioral challenges. Often these are children who lack what is called “executive function”—that is, the ability to contain their emotional and behavioral impulses. A special education environment can eliminate the stress of having to conform to the standards of a crowded mainstream classroom, but it can be educationally uninspiring for a bright child. Noah chose to place Ethan in a special environment to deal with the behavioral aspects of his difficulties—after all, if a child can’t sit still and pay attention, a child can’t exercise his or her intellectual gifts.
Eventually, via a combination of maturing communication skills, his own remarkable perseverance, and judiciously prescribed Adderall (for his ADD), Ethan decided that he was ready to get out of the protected environment of his special school and put himself in the much more academically rigorous environment of one of Manhattan’s most competitive public schools. This was not the recommendation of the special school that he attended. Educators there believed that once a student was categorized as having a particular problem, then he or she would always need extra help for that problem; they felt Ethan would flounder if he didn’t receive that special attention. It’s not that they didn’t think well of Ethan as a student—they did. But they failed to see that their labeling of Ethan had also become limiting. They did not recognize he’d developed the strengths, skills, and tenacity to succeed elsewhere.
Noah says, “There’s something [in Ethan’s] nature to be very curious and inquisitive, very friendly, bright, and creative. And when the conditions are right, extremely hardworking and very generous. A lot of those aspects of him must have helped him to become more self-aware.” Entirely of his own volition, Ethan applied himself to studying for the New York City specialized high school exam. Noah says, “For a couple of summers he would take the train every day out to Flushing for test prep classes. It totally came from him.” It’s remarkable to consider that this level of discipline existed in the same child who had once been considered a disruption in mainstream classes. Ethan describes his drive to enter a mainstream high school as coming from a “fear for my future and wanting to do more.” His father says, “Ethan became extremely focused on proving everyone wrong, by not only getting into a specialized high school, but getting into exactly the one he wanted to attend. He sought some advice from us, but really he only wanted support, which we gave him absolutely. He wanted to prove to himself he could do it and be successful. My role was as encourager.” The challenge of adjusting academically to a New York City specialized high school would be daunting for any student, but Ethan’s family was also concerned about how he would transition socially. But while it hasn’t always been easy, Ethan has excelled and thrived.
Now that Ethan has learned how to manage the impulsiveness of his younger years, the positive flipside of his ADD has emerged more clearly, and Ethan has flourished creatively. He’s transfixed by technology and shows enormous ingenuity in using technology to solve problems. One feature of ADD is what is called “hyperfocus” (single-minded attention) on a task of particular interest. In Ethan’s case, what particularly interests him is programming. His ability to hunker down and lose himself in a particular task—which is a direct offshoot of his ADD, as I will go on to describe in chapter 2—contributes greatly to his ability to creatively problem-solve. He wanted to build his own computer, so for his sixteenth birthday he received the parts as gifts. Then he not only built the computer, but also created a remote desktop on his iPad, so that no matter where he was he’d never have to worry that he was missing something he needed for his studies. Noah says, “He’ll go on and on about this forever—he’s so into technology and turned on by problem-solving.” Ethan began coding at the age of ten using the MIT program Scratch, but soon exceeded its limits and has been writing his own computer code ever since. In high school, Ethan has found that he’s been able to connect with other bright kids with their own quirks. “My school has a bunch of weird students, which is great for me. There’s very little judgment. Almost my entire school is this quirky cast.”
Ethan’s story is one of ultimate success, and certainly Ethan comes across as being as close to happy as one expects an adolescent boy to be. But his success story was hard won—both by him and by his devoted father. The key to success for Ethan was not simply to mitigate his weakness, however. If that had been his and his father’s approach, he might have remained in special education throughout his schooling. Rather, in Ethan’s case—and for so many others with brain differences—the key was to mitigate the weakness and thereby provide an opportunity to magnify the strengths. The flipsides of Ethan’s challenges are also his brightest sparks of genius. This is the mystery and wonder of how the human brain works—a mystery that we are at the very beginning stages of unlocking.
* * *
WHAT IS GENIUS, and how can it coexist with what we would consider a mental flaw in the form of a brain difference? For that matter, what is a brain difference? For many of us, Einstein comes to mind as the quintessential genius. Even without the benefit of IQ testing, we can empirically observe that he, like Leonardo da Vinci or Isaac Newton, clearly had intellectual gifts several standard deviations above the person with average intelligence. There are also many high achievers among us who might not be geniuses of this order—geniuses with a capital G, if you will—but who have accomplished above-average things in all fields. It’s these high achievers, who have performed in arguably genius ways, on whom I’m most focused in this book.
Oxford Dictionaries defines genius as “exceptional intellectual or creative power or other natural ability.”3 The purity and simplicity of this definition help to clarify the coexistence of gifts and weaknesses within these high achievers. Most of us intuitively understand that while we are exceptionally good at one thing, we might be exceptionally poor at another. The absentminded professor stereotype exists for a reason—as does that of the tortured artist. This book explores the ways in which the unique wiring—some aspects of which might be considered weakness in certain contexts—of many high achievers has directly contributed to their abilities and achievements.
In order to apply names—or diagnoses—to the wide variety of brain differences that exist in humans, clinicians and medical insurers have relied on the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. The newest edition of this manual—the DSM-5, as it’s popularly known—lists 157 diagnoses.4 These classifications range from various forms of learning differences, such as dyslexia, to more severe mental illnesses, such as schizophrenia. While the manual isn’t what anyone would call scintillating reading, the launch of the DSM-5 at the American Psychiatric Association’s annual meeting in May 2013 incited a firestorm of criticism. The diagnostic manual has always been an imperfect tool. Its neat categorizations of constellations of symptoms into discrete psychiatric disorders are often arbitrary, and the human brain defies such black-and-white definitions. But the manual is a necessary evil for practitioners as well as patients—insurance companies require such categorization in order to cover the costs of treatment.
One of the most vocal critics of the DSM-5 was psychiatrist Allen Frances, who had been chair of the DSM-IV task force. In an article he wrote for Psychology Today, he called the APA’s approval of the new set of guidelines “the saddest moment” of his long professional career.5 He felt that the DSM-5’s continued expansion of the number of diagnoses served to pathologize too much of human behavior, and he argued the research criteria didn’t exist to validate each one of those diagnoses. Thomas Insel, director of the National Institute of Mental Health (NIMH) from 2002 to 2015, also questioned the validity of the DSM-5’s diagnostic criteria and objected to its combining of disorders that he felt deserved their own designations. He wrote, “While DSM has been described as a ‘bible’ for the field, it is, at best, a dictionary, creating a set of labels and defining each.” 6 And he concluded, “Patients with mental disorders deserve better.”
Indeed, they do, and the labeling of disorders is itself a source of significant pain and suffering. The heated debate surrounding the DSM-5 reveals just how sensitive an issue labels can be, and not just in the medical and scientific communities. Labels are, by definition, limiting, and if they are suggestive of mental illness, they can be downright terrifying. Such was certainly the case for parents of children with Asperger’s, who learned that the DSM-5 folded Asperger’s into the autism classification. Those whose children had been diagnosed with the softer-sounding disorder of Asperger’s were dismayed to find out that medical experts now placed their children in the same category as people whose symptoms seemed far more extreme and potentially devastating. Such is the power of labels.
While medical professionals, health advocates, and concerned parents have been debating the language we use to diagnose people with brain differences, new initiatives in neuroscience might soon render these arguments moot. Nearly simultaneous with the launch of the DSM-5, President Obama announced the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, which will create a map of the human brain. Far beyond a purely intellectual exercise, the initiative is a first step in discovering new ways to treat, prevent, and eventually cure brain disorders ranging from Alzheimer’s to schizophrenia. We can’t begin to solve problems that we can’t see, and it’s astounding—and arguably tragic—that medical science has thus far been attempting to navigate diseases and disorders of the brain while lacking something as fundamental as a map. For centuries, prior to the discovery of psychotherapy and psychopharmaceuticals, treatment of the mentally ill largely consisted of chaining up patients in institutions that were more like prisons than hospitals, submerging them in freezing water, inciting diabetic shock, and performing lobotomies. Thankfully, we are past such horrors, but nonetheless medical professionals have been operating much like the blind men and the elephant, each of us desperately trying to understand our portion of the larger mystery.
At this writing, the Obama administration has announced that more than three hundred million dollars in public and private financing is pledged to the BRAIN Initiative’s efforts. While he was at the helm, Thomas Insel indicated that the initiative would break entirely free of the DSM’s labels, his theory being that a pioneering effort shouldn’t be constrained by potentially wrong and archaic assumptions. Insel believed it was important to take the old rubric entirely off the table and start from scratch, and all indications are that the BRAIN Initiative will continue in that direction.
The idea of a clean slate is enormously appealing. A new vocabulary would be helpful as well. Advances in our understanding of brain science and the spectrum of conditions have caused an evolution in popular attitudes toward mental illness. But the terms we use are just one hint of the degree to which we have a long way to go in overcoming shame and stigma. Think how often the word nuts is used with derision to describe someone with a diagnosed mental condition. The word retarded is finally being driven out of our vocabularies, but it’s still relatively commonplace to hear someone with a mental illness referred to as crazy. While those with mental illness are far more likely to be the victims of crime than the perpetrators, the very few crimes that are committed by those with diagnosed mental illness are too often sensationalized and heralded as exemplary of all of those with mental illness.7
It was therefore refreshing when President Obama announced in his introduction of the BRAIN Initiative, “There should be no shame in discussing or seeking help for treatable illnesses that affect too many people that we love.” The emphasis in that sentence should be placed on the word many. It’s estimated that nearly half of all Americans will experience a mental disorder at some point in their lives.8 Given that statistic, it’s arguable that what we call mental disorder—as if it were an aberration—is in fact a natural part of our diversity as a species. And it is entirely possible that the more we come to understand about the brain, the more we will come to realize that there is no such thing as a normal brain. In his blog for Scientific American, Scott Barry Kaufman, scientific director of the Imagination Institute in the Positive Psychology Center at the University of Pennsylvania, writes, “Every single healthy human being lies somewhere on every psychopathology spectrum (e.g., schizophrenia, autism, mood disorders). What’s more, we each show substantial fluctuations on each of these dimensions each day, and across our lifespan.”9
Mental disorders are not only prevalent, they’re overlapping. There is no such thing as a single, neat diagnosis. In the past, we have lumped individuals into tidy buckets—this one has anxiety, that one has depression; this one has autism, that one has dyslexia. However we are becoming increasingly aware that brain differences and the symptoms associated with them are not discrete. Many, if not all, of us fall into multiple categories of brain differences. A full quarter of American children have been diagnosed with anxiety, and anxiety itself can be a symptom of other brain differences, from attention deficit disorder (ADD) to dyslexia to depression.10 The narrow labels that we try to apply can be simplistic at best and erroneous at worst.
A fog of negativity often settles in around a diagnosis of mental disorder. We understand very little about brain differences and what causes them, and we fear what we don’t understand. We dread the stigma, the judgment, the sense of failure and loss of normalcy. Parents are terrified for their children, mournful that a diagnosis is a sentence that will inhibit their future success and potentially doom them to unhappiness. Many adults have spent much of their lives suspecting that their brains don’t work quite the same way as other people’s, and have suffered terrible blows to their self-esteem—and their relationships—as a result. Often, it’s not until their children are struggling that parents are forced to confront their own issues. It’s now a cliché of ADD treatment that the father of the child who has been diagnosed will at some point have a lightbulb moment and say, “I think I have that, too.”
The negativity that surrounds brain differences creates an atmosphere in which our approach is either to ignore symptoms or to attempt to make them go away. Certainly, judiciously prescribed medication can be a genuine salvation for many individuals with more severe forms of mental disorder. However, medicine’s overwhelming focus on alleviating symptoms has distracted from an equally important cultural discussion about the unique abilities, strengths, and insights that are a part of these same constellations of symptoms.
There is now ample clinical evidence that brain differences do not solely present us with challenges to be overcome—and this book offers an overview of these studies as well as what this kind of delicate balance between strength and hardship looks like in individual lives. The subject of genius and mental illness has been discussed and debated on a scientific level for decades. Our cultural awareness of the link between mental disorder and genius is as old as philosophy. Plato wrote of what he called “divine madness,” and Aristotle recognized that creative people tended toward melancholia. It is no coincidence that such a high percentage of American Nobel and Pulitzer Prize–winning writers are also alcoholics.11 We’re perhaps less aware but not surprised to learn that the most creative individuals are at higher risk for mental illness than are the less creative.12
Nancy Andreasen, neuroscientist and neuropsychiatrist at the University of Iowa, conducted a decade-long, highly influential study of thirty writers at the renowned University of Iowa Writers’ Workshop,13 famous for attracting highly creative and talented individuals like Ann Patchett and John Irving. Andreasen compared the writers from the Iowa workshop with a control group of thirty individuals of similar age and IQ who worked in fields that are not overtly creative. She found that 80 percent of writers reported some incidence of mental illness, compared to 30 percent of the control group. While Andreasen’s findings are based upon individual case studies as opposed to the kind of randomized controlled study that is typically considered the gold standard for scientific rigor, her work has subsequently been backed up clinically and scientifically by many of the researchers cited throughout this book.
The world is full of fascinating people who didn’t achieve such success despite their brain differences, but rather in large part because of their brain differences. Researchers Darya L. Zabelina, David Condon, and Mark Beeman of the Department of Psychology at Northwestern University reported in Frontiers in Psychology that real-world creative achievement—that is, among healthy individuals without clinical diagnoses—was significantly more likely among those who exhibited greater tendencies toward psychoticism (particularly associated with impulsivity and sensation seeking) and hypomania (an elevated mood state that results in rapid thought processes).14
But what does acknowledging the link between brain difference and genius get us? As parents, as educators, even as people who might have been diagnosed with a brain difference ourselves, what are we supposed to do with the evidence that shows that the very things that can cause our lives to be difficult (our inability to relate easily to others, or learning differences, or mood disorders, for example) often come with unique skills and aptitudes (artistic abilities, creativity, a knack for remembering numbers or names, or an ability to visualize data in a unique way)? And is it possible that if we focused not on the diagnoses or labels, but on all the potential—the spark—that comes with our brain differences, we could access our unique abilities to contribute to our families, communities, and the world in a new way?
For this book I conducted over fifty interviews with experts in the fields of psychiatry, education, creativity, and child development, as well as exceptionally high-achieving individuals who have openly struggled with symptoms of brain differences. I spoke with several schools to identify children who exhibited great intellectual and artistic gifts while also struggling with psychiatric diagnoses and/or learning differences. I spoke with many of their parents to identify the constellation of factors that goes into nurturing a child with brain differences. I also spoke with the recent head of the National Institute of Mental Health and other leaders who are guiding the future of the fields of adult and child psychiatry and neuroscience. And I performed an exhaustive review of scientific literature and current studies as they relate to the science of understanding the correlations between symptoms of brain differences and particular strengths. The goal of this book is to cast a light on this correlation between genius and brain difference, and to help both individuals with brain differences and their families and communities to foster and support the exceptional abilities that accompany difference. This isn’t to say that all of those with brain differences are or have the potential to be geniuses with a capital G. Not everyone with obsessive-compulsive disorder will turn creation on its head like Charles Darwin did. However, anyone who seems to experience a heightened attention to detail can be encouraged to channel that ability to create their own highly successful outcomes and to exhibit their own sparks of genius. Similarly, not all children with ADD can grow up to become revolutionary thinkers like Albert Einstein. However, it is nonetheless true that ADD is strongly associated with flights of fancy and ingenuity, and Einstein could not have made his historic scientific breakthroughs were it not for his daydreamy, distractible mind. Once parents release some of their anxiety about their children’s diagnoses dooming them to failure, they can invest more of their energy into identifying what will grab their child’s imagination and create opportunities for them to shine in their own areas of strength. In the words of psychologist Scott Barry Kaufman, “I don’t think everyone [with a brain difference] has the potential to achieve greatness in every field, but I think everyone has the potential to achieve greatness in some field.”15
There is, of course, more to achievement than an atypical brain. And there are extremes of illness that are deleterious to any expression of creativity. It’s as important to note, however, that in the absence of any brain difference, there is also a comparatively lower frequency of above-average creativity. This phenomenon is referred to as the inverted U-shaped curve, and it applies across the brain differences discussed in this book. This means that there is in fact a sweet spot for expressions of the special strengths and abilities, or spark, associated with any brain difference. This ideal range exists between the extremes of average brain function and acute illness. Therefore, the person with mild to moderate bipolar disorder is likelier to be creatively productive than is either someone without bipolar disorder or someone with severe bipolar disorder.16 This also means that individuals with brain differences are far more capable of displaying their spark productively when their symptoms are moderated via appropriate treatment.
In addition to the neurology of individual brain differences, this book will explore the other special qualities that distinguish high achievers with brain differences from those who haven’t been able to cope as well. It will address how those positive qualities can be fostered within us, and also tended by parents and educators. A complex host of factors that contribute to success—from support networks, to proper treatment, to sheer grit and determination—can enable people with brain differences to harness their unique skills and points of view to contribute invaluably to our culture. Through stories of individuals, families, and educators who have contributed invaluably to the success of people with all sorts of brain differences, we will see what it is that can make the difference between a diagnosis dooming one to a life of insecurity and unhappiness or a diagnosis that helps someone access their unique gifts and opens up a world of opportunity.
In my twenty-three years in private practice as a psychiatrist and on the faculty of Weill Cornell Medical College and New York–Presbyterian Hospital, I have always paid particular attention to the ways in which successful people manage to incorporate their shortcomings with their gifts. The irony is that while my patients are focused on getting past the obstacles that exist between them and their larger goals, it is very often the case that there is great strength to be mined from those obstacles, and brilliance to be observed in how my patients both utilize their struggles and maneuver around them. This was the inspiration behind my development of the Strength of Mind series at the 92nd Street Y, which delved into the impact of psychological makeup on personal achievement, and the Psychobiography series, which examined the correlation between mental disorder and brilliance in renowned artists, authors, and historical figures. As a practicing psychiatrist, I have seen firsthand the wells of emotional intelligence and insight exhibited by my patients with brain differences. Treated properly, with the right therapy or medication, the positive aspects of depression, for example, do not go away, but can be drawn upon. Even one of our country’s leading intellectuals, Andrew Solomon, the National Book Award–winning author of Far from the Tree and The Noonday Demon, among other highly regarded books, attributes his acute sensitivity to the empathy he has gained via his own experience with severe clinical depression. His awareness of an arguably beneficial side to what might otherwise be considered a purely negative diagnosis was echoed among the many experts and high-performing individuals whom I interviewed for this book.
I have interviewed multiple successful and supremely creative individuals with brain differences for this book, and in each case I have asked them if, given the choice, they would eliminate their brain difference. To a person—and no matter how much pain their difference has caused them—they said that they would not. Each of my interviewees couldn’t imagine separating their strengths from their weaknesses.
Science bears out their instincts. Medical experts used to conceive of a sort of phrenology of the brain—that you could segment it into parts in which each piece of the brain is responsible for a highly specific function. But that old-fashioned view has now been debunked. Our brains are not filing cabinets. We can’t pluck out what doesn’t serve us or identify exactly what does. Rather, our brains are more like coral reefs in which even the most seemingly distinct species (or parts of the brain) are highly interconnected and interdependent.
Brain function isn’t tidy. There is a tidal flow back and forth between parts of the brain, and deficiencies in certain areas allow for acuities in others. For example, in the case of the ADD brain, there is a dysregulation in what is now known as “executive function.” Contrary to popular belief, the person with ADD isn’t incapable of paying attention, rather the individual can’t always control when they focus and what they focus on. Yet it is this very dysregulation that lessens thought inhibition, encourages daydreaming, and yields creative thought.
It is the tension and interplay between order and disorder in the brain that create the ideal conditions for genius. According to neuropsychologist and brain imaging researcher Rex Jung, genius can be directly attributed to the nature of the dynamic flow between the two networks in the brain—the cognitive control network and the default network. The cognitive control network is in charge of solving problems in the external world (also called convergent thinking), and the default network is responsible for internally generated thoughts (also called divergent thinking). In the neurotypical brain, these networks are in balance with each other and there is a less pronounced ebb and flow. In the atypical brain, there is more dramatic, rapid, less hindered ebb and flow.17 It’s important to note that in high-performing individuals with brain differences, there is still some degree of balance between the two networks. The person with bipolar disorder, for example, may experience flights of creative thought while swinging into a more manic phase; however, without proper treatment—for example, the regulating influence of medication—the thinking becomes too disordered to be productive. Creativity may originate to some degree in the default network, but it needs the orderly influence of the cognitive network in order to be expressed well.
This interplay of inhibition and disinhibition—the way that some parts of the brain suppress others, and the way that a deficit in one part of the brain can create an amplification in another—is a new and rapidly emerging field of discovery. We’re also just beginning to get a glimpse of the sophistication of this interplay. For example, while less gray matter in the left lateral orbital frontal region is associated with higher creative achievement, a higher volume of gray matter in the right angular gyrus is also associated with greater creative output. In other words, a deficit in one area of the brain is as responsible for genius as is a pronounced asset in another part of the brain. This is a powerful and inspiring discovery: strength cannot exist without weakness.18
But this discovery only takes us so far. The goal of this book is to explore this fascinating link from the perspective of real people and what that connection has meant in their lives. We will examine the science behind this remarkable correlation, and we will delve into the lives of adults and children from all walks of life who have contended with some degree of mental disorder yet who have thrived and achieved extraordinary things.
When the new DSM-5 launched to such a hue and cry, many of my colleagues and I just shrugged our shoulders. As Tom Insel noted, the DSM-5 is, quite simply, a list of labels. It is helpful in that it allows doctors to assign names to conditions so that insurance companies can classify them and cover the patients’ treatments and prescriptions. But labels aren’t the way that those of us in the mental health field actually treat our patients. We treat symptoms, not diagnoses. For example, melancholy is a constellation of feelings, and can be an aspect of numerous conditions—if, for instance, you have suffered from untreated anxiety for many years, it’s very likely that you will go through depressed periods. When exploring an individual’s potential, the label is less important than the way the brain actually expresses itself.
For this reason, The Power of Different is organized according to major symptoms as opposed to conditions. Beyond diagnoses and classifications, the most important questions this book asks and answers are: What are the traits—learning differences, distractibility, anxiety, eccentric thinking, melancholy, cycling mood, and lack of relatedness—associated with the most common brain differences? What are the potential gifts, talents, tendencies, and particular sparks of brilliance or insight that often accompany those traits? How have others with those same brain differences applied their own sparks of brilliance and made the most of traits that might otherwise have caused real difficulty in their lives? What can we as individuals, parents, spouses, family members, and educators do to help people with brain differences access their own unique potential?
I chose these seven constellations of traits because they encompass the vast majority of people with brain differences while also being the most strongly associated with creativity. Readers will potentially find themselves and loved ones in multiple chapters. The parent of the child with ADD might recognize her son in the chapter on distractibility, but she might also find some interesting common ground in the chapter on learning differences. Similarly, the person who experiences episodes of melancholy will likely recognize their own bouts of obsessional thinking in the chapter on anxiety. It is the symptoms—not the labels—that impact how we engage with the world and how the world engages with us.
I will reveal—to the degree that current scientific knowledge allows—not only the mechanics of these correlations, but also the inspiring stories of real people with remarkable, atypical brains. These are people just like you and me, just like our children, spouses, parents, colleagues, and friends, who have struck a delicate balance among their seeming flaws and their apparent gifts. I will address exactly how these individuals—from award-winning scientists to celebrated artists and performers, to children and adults with less fame but no less drive—have learned to fully utilize their exceptional minds. And they will illuminate how all of us can learn to do the same.
Copyright © 2017 by Gail Saltz
