Isabella Blow arguably suffered manic depression, and in the end she passed away as many of those suffering this disorder do – by her own hand. It is a sad reminder of the consequences of a severe condition present since the very beginning of human civilisation. Hippocrates tells of melancholia in a woman from Thasos, who 'as a result of justified grief became morose, and although she did not take to her bed, she suffered from insomnia, loss of appetite … she complained of fears and talked much; she showed despondency and …talked at random and used foul language … many intense and continuous pains … she leapt up and could not be restrained.'
Today the World Health Organisation (WHO) considers this disorder as the sixth leading contributor to the global burden of disease in age rank 15 to 44. While I refuse to make diagnoses on persons I have never met, Hippocrates’ description of a woman suffering melancholia is in many ways similar to the image of Blow painted by Lauren Goldstein Crowe in Isabella Blow – A Life in Fashion. Crow vividly writes about Blow’s constant fears, bouts of low mood, and despair. Of course the main characteristics of Blow was not these traits but rather her passion for glamour, and great nose for talent. She made herself into a representation of this by dressing in an exceptional and striking way, not least evidenced by her choice of headwear.
The question put forward here is if Blow’s talent and eccentric behaviour can be seen as a consequence of her suffering manic depressive disorder, or what we today call bipolar disorder? Bipolar disorder is characterised by intermittent episodes of depression and mania. It is present in the general population at a rate of 1-5% depending on severity. In the classic manic depressive illness coined by Emil Kraepelin (1856-1927), the patient intermittently has severe melancholic depressions and extreme manic episodes with delusions of grandeur. While these delusions are often the most dramatic symptoms in patients, it is the recurrent depressions that harbour the life threatening dangers. With bipolar disorder the risk of suicide is twenty folded compared to the general population.
In any case, it seems clear that Blow increasingly became occupied by her own death; in Lauren Goldstein Crowe’s words: 'The problem, Isabella said, was life. She just didn’t see the point of going on anymore … on May 5, a sunny Saturday morning at Hilles, Isabella went outside with a bottle of Paraquat – the same poison her father in-law used to kill himself thirty years earlier – put the bottle to her mouth, and drank.'
Blow’s personal reasons for her sadness and increasing suicide ideation reflects those of many other patients: 'sadness over her inability to have a child, fear of winding up destitute … and confusion over the fact that others had become so financially successful while she had not.' These general human ruminations were entangled with her 'frustration with the commercial turn the fashion industry had taken.'
In the end, Blow became yet another story of the suffering artist that the world has come to now so well. While it is true that her way of life and tragic end reflects this image well, it seems that what really defined Blow was not her apparent struggle with bipolar disorder. It was the care and impact she provided for the many people that knew her, paired with her relentless desire for beauty.
However, bipolar disorder has historically also been linked to great cultural achievements. Plato argued that: 'Madness, provided it comes as a gift from heaven, is the channel by which we receive the greatest blessings … [It] is a nobler thing than sober sense … madness comes from God, whereas sober sense is merely human.' Madness was seen as a divine gift. Similarly, Aristotle asked: 'Why is it that all those who have become eminent in philosophy or politics or poetry or the arts are clearly melancholics and some of them to such an extent as to be affected by diseases caused by black bile?' Some two thousand years later Dryden aptly concluded: 'Great wits are sure to madness near allied / And thin partitions do their bounds divide.'
History is painted with quotes like these above. Might this be the reason why researchers who are otherwise stringent and subjected to rational thought sometimes are carried away when discussing creativity and mental illness? The field is characterised by authors taking contradictory positions arguing everything from mental illness having nothing to do with creativity to other authors arguing for it being deeply entwined. Often these arguments are passionate and less founded in empirical studies.
Nevertheless, a consensus seems to have arisen with the prevailing view proposing a link, regardless of time and place, between creativity and mental illness most often manifested in bipolar disorder. We recently investigated this question on a national level in more than one million Swedish patients and their relatives. Results were published in the British Journal of Psychiatry in 2011 and the Journal of Psychiatric Research in 2013 demonstrating an increased occurrence of creative professions, such as visual artists, musicians, designers, and scientists in patients with bipolar disorder and their relatives. In these articles we argue that a certain temperament may be associated with both increased risk of bipolar disorder and inclination towards great achievements. Essentially, people with bipolar traits seem to want more intensively than do others, continue to want even after attaining a reward, and consequently endorse highly ambitious life goals. Hence, they are best characterised by their high degree of motivation.
Another way to understand Blow’s fate can be found in the psychoanalyst Elliot Jacques’ description of the Midlife crisis. In this theory put forward in 1965, great creators only have one of three prospects after reaching about 35 years of age. The first is that their creativity develops into a more mature and pensive state, the second is that the creative career ends, while the third, more drastically, sees the creator dead; evidenced throughout history by countless artists such as Mozart, Gauguin, and Chopin. The ignition to the Midlife crisis is according to Jacques the realisation of 'death and human destructiveness - that is, when both death and the death instinct is taken into account.'