We tend to think that the great figures of history—those who changed the world through their inventions or art or books—were free of the kind of self-doubts and neuroses that can hold back the rest of us. But as Claudia Kalb discovered when researching Andy Warhol Was a Hoarder: Inside the Minds of History’s Great Personalities (published by National Geographic), famous people also can suffer from chronic psychological or physiological disorders, which deeply affect their lives and the lives of those around them. New advances in neurological science are now enabling us to better understand their challenges—and our own. (Find out why your brain is hardwired to snap.)
Talking from her home in Alexandria, Virginia, Kalb takes us inside the brain of Fyodor Dostoyevsky, explains how Howard Hughes had a grilled cheese sandwich problem, and why Charles Darwin is her hero.
A recent study diagnosed that paragon of Victorian virtue, Florence Nightingale, with “bipolar disorder with psychotic features.” Is it really fair to judge historically remote figures by today’s psychiatric norms?
That is such an important and controversial question. It’s a rule among psychiatrists that you don’t diagnose or discuss patients that you don’t treat in your office. But in some cases, especially with well-known figures whose conditions have been discussed either by themselves, in the case of Princess Diana and Betty Ford, or by others, it can help us better understand their behavior. The reports that have been published about historic figures in medical journals—and there are many of them—raise awareness of the condition and chip away at the stigma by presenting information through a well-known person rather than a dry, scientific report.
I did eliminate people, though, if I felt there was not enough biographical or scientific evidence. For instance, I came across a reference to Babe Ruth having ADHD [attention deficit hyperactivity disorder]. The story came from his granddaughter, who described behavioral issues Ruth had as a kid. But no medical experts had weighed in on this. So I felt it was a conclusion that didn’t have a lot of weight behind it.
The takeaway seems to be that history’s movers and shakers are just as neurotic as the rest of us. Or am I being harsh on myself?
[Laughs] That’s true. And I hope readers can find connections with these famous people whom we all know at a superficial level. By going behind the scenes and exploring what made and motivated them, or held them back, bothered them, or made them succeed, we can see that those challenges are things we all deal with.
For instance, with Marilyn Monroe, I did not realize the extent to which she suffered. I knew her as the Hollywood actress with that beautiful, glamorous look. But I did not know the internal chaos that she struggled with throughout her life, or the extent to which she sought help and craved answers and wished she could make her life better. She had such a difficult early childhood. She was given up early to a foster family and lived in an orphanage for some time. That explains her lifelong quest for security, love, and family. The other fascinating question her case raises is whether today’s psychotherapies, rather than medications, could have helped and maybe saved her.
Since it was first published in 1952, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has increased its list of mental disorders from 80 to 157. Are we crazier than people used to be?
[Laughs] No, I don’t think so. The number of conditions has increased greatly as the experts have started to sort out the differences between conditions and fine tune treatment. For example, hoarding was originally conceived to be a sub-category of OCD [obsessive-compulsive disorder]. But after researchers discovered that some of the characteristics of hoarding are dissimilar to OCD, it has now been isolated out as its own disorder.
Gambling disorder is another interesting example. It is the first behavioral addiction to appear in the DSM, which up to now has focused exclusively on substance use. But having looked at brain scans of patients who have gambling addictions, they’ve been able to match similarities in the reward pathway of the brain to other substance abuse disorders.
How can you perform as president, get up every day and do your job, and yet be clinically depressed?
The example I describe is Russian writer Fyodor Dostoyevsky. He was fairly irresponsible around money and at some point turned to gambling. As it took hold of him, he became a chronic and compulsive gambler for a decade. He came up with all sorts of methods he thought could beat the system and would chase his losses, convincing himself that he would win the money back. He begged and pleaded with friends to borrow money so he could continue gambling and had all the characteristics of what is now known as gambling disorder. It’s fascinating to think of running a scan on Dostoyevsky to see what was actually going on in his brain.
You say, “A number of these profiles were inspired by long-standing debates about what the person’s ailment was.” This applies particularly to Abraham Lincoln, doesn’t it?
The debate with Lincoln is whether he was clinically depressed or not. It’s obvious he was often a melancholy and morose man. There were descriptions by contemporaries and you can see it in photographs. There seemed to be this weight hanging off his shoulders. It’s well known that he lived a very troubled life. He lost his mother and sister very young, did not have a great relationship with his father, endured the loss of two young sons, and struggled over the Civil War.
Mental health experts who have looked at him have concluded that there appears to be clinical depression. He had bouts of identifiable depression in his 20s, which were severe enough for people to think he might kill himself. The question that comes up is how can you perform as president, get up every day and do your job, and yet be clinically depressed? What became clear in the research is that you can function because depression can come in waves. It’s not always that you’re lying in bed for days with the covers pulled up. It moves; it changes.
Charles Darwin solved the mystery of evolution and produced an extraordinary volume of work—but he was a very sick man, wasn’t he?
Darwin was really sick, and I did not know the extent of that during the 20 year period he was writing On the Origin of Species. He complained of all sorts of symptoms and kept a very meticulous health journal. He had chills and trembling, headaches and stomachaches. He was very honest and forthright about what he was feeling. He talked about feeling extreme levels of anxiety. Yet he still managed to accomplish this great work.
One of the big debates is whether he picked up a tropical bug during his journey on The Beagle, which might have triggered his terrible stomachaches and gastrointestinal stress. In the course of looking at these symptoms, experts have diagnosed everything from anxiety to agoraphobia, appendicitis, hepatitis, irritable bowel syndrome, lactose intolerance, malaria, OCD, and peptic ulcer.
My sense is that underlying all this was a state of anxiety. He had hypochondria about himself and his children’s health. He worried about his wife when she was pregnant. There is a lot of evidence—in his own words—that there was this underlying strain and anxiety running through his system.
In recent years, neurological research has greatly increased our knowledge of the brain. What is the role of genes? Are mental disorders inherited—or acquired?
In most cases there is a combination of influences of genes and experiences. There are genes that clearly play a role in many mental health conditions, like depression or autism. A number of experts in autism have hypothesized, for instance, that Albert Einstein may have had Asperger’s. They have found new evidence about the way the brain is supposed to “prune” itself. The healthy brain prunes synapses, which are the way the brain communicates, to allow other areas to mature and excel. But they have found in children with autism that the synapses that are supposed to be pruned grow out of control.
Howard Hughes wrote memos about all sorts of things. One of them was a grilled cheese sandwich report.
The condition also seems to be heritable because of the links that are being discovered between family members. And our understanding will continue to evolve from the days when it was considered that autism was the fault of a “refrigerator mother,” that a cold, distant parent was responsible for this condition.
Howard Hughes had a grilled cheese sandwich problem, didn’t he?
[Laughs] Howard Hughes had very persnickety tastes, and this was all about his OCD. He was a perfectionist about how things were handled and prepared, so food was a big issue. At some point, he found a grilled cheese sandwich that he really liked from a restaurant in L.A. From then on, he demanded that his staff prepare it exactly the same way. He wrote memos about all sorts of things. One of them was a grilled cheese sandwich report. [Laughs] The bread had to be heavily buttered, placed a certain way on the grill, then the two slices had to be put together to make the sandwich.
You say that narcissism is on the rise partly because of the emphasis on self-esteem as early as preschool. Are parents and teachers raising a generation of egomaniacs?
I think it is a concern. There is such a heightened emphasis on self-esteem and making children feel good about themselves that it is leaving them unprepared for weathering the storm of everyday life. Frank Lloyd Wright had a mother who not only decided he was going to be an architect from a very early age but also indulged him in a way that contributed to his narcissism. He felt entitled and that he could do anything he wanted because that was the way his early life was framed. As a result, his narcissism became overwhelming in the way he treated other people, whether business clients or his own son. He had such a sense of superiority and entitlement and it played out in his life in very negative ways.
What was the biggest surprise for you writing this book?
There were so many surprises! From the smallest detail, like Princess Diana’s waist being the size of an 8-year-old’s when she walked down the aisle to marry Prince Charles, to the items in Warhol’s “time capsules”: old wigs and pizza dough, toothbrush containers or discarded wrappers. I found all that incredibly surprising.
Darwin’s story captivated me the most, though, because he struggled so much internally. I have such admiration for him, after discovering what he went through, and what he achieved despite of it. He seems so real—and so much like the rest of us.
This interview was edited for length and clarity.