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Medicine and the Arts


Fusar-Poli, Paolo MD; Madini, Lorenzo MD

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doi: 10.1097/ACM.0b013e31817ec740
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No great genius has ever existed without some touch of madness.

Aristotle (384–322 BC)

Recorded at Abbey Road Studios between June 1972 and January 1973, The Dark Side of the Moon, thanks to its use of avant-garde techniques and its philosophical lyrics, has become a worldwide symbol of the British psychedelic era and a legendary landmark between “classic” blues rock and the newer progressive electronic music. The iconic refracting prism on its cover and the subtly textured music, which evolves from ponderous, neopsychedelic art rock to jazz fusion and blues rock, resulted in a leisurely paced album that creates a dark, haunting world. Its core leitmotif is the exploration of human irrationality. The year prior to The Dark Side of the Moon’s release (March 17, 1973), the band decided to change the album’s title to Eclipse: A Piece for Assorted Lunatics. The term “lunatic” evolved from the Latin word luna (moon), reflecting the ancient belief that insanity varied with or was caused by the phase of the moon. The symbolic conceptual connection between the moon and madness helps to understand the penultimate song of the album, “Brain damage,” with its startlingly eccentric and haunting lyrics.

The first verse clearly depicts childhood. The desire to keep “the loonies on the path” represents trying to maintain order, staying sane. The “lunatic on the grass” (the square in between the River Cam and Kings College chapel in Cambridge) was no doubt Roger Keith “Syd” Barrett, the founder of the band that would become Pink Floyd in 1965. Newspapers have called him “the golden boy of the mind-melting late-60s psychedelic era, its brightest star and ultimately its most tragic victim.”1 In fact, after the release of the band’s first album—inspired by LSD2 and driven by Barrett’s song-writing and singing—and two haunting solo albums, his eccentric and creative personality drifted into a psychotic reclusive state, forcing him to withdraw from public view.1,3 However, Pink Floyd would pay tribute to Barrett and would include madness as an ongoing theme on their best and most successful albums. Thus, “the dam break[ing] open many years to soon,” “no room upon the hill,” “head explod[ing] with dark forebodings,” “cloud burst[ing] thunder in your ear,” and “shout[ing] but no one seems to hear,” may all be metaphors for psychotic phenomena. Then comes the line that gives the album its title, “I’ll see you on the dark side of the moon.” What does this represent?

Roger Waters, the lyrics’ author, seems to relate the dark side of the moon to madness, implying that it is always there, but invisible, waiting to be exposed. We may liken it to the dark side of ourselves, which in Freud’s words would be the unconscious mind. Through this song, the dark side of the moon became one of the most famous music metaphors of human irrationality, even psychosis; prompting the question: what is the link between psychosis and artistic creativity?

Since the time of the Greek philosophers, creativity was believed to require a regression to more primitive mental processes and a dipping into irrationality in order to access unconscious symbols and thoughts. Some authors identified particular, specific thought processes used by creative people during the process of creation.4 This translogical thinking is a type of conceptualizing in which the thinking processes transcend the common modes of ordinary logical thinking; to a certain extent it seems to characterize both psychotic and highly creative persons. We could question whether, as for Barrett, there is something about the creative psychotic process itself that, over time, contributes to disintegration. Clinical experience indicates that psychotic thinking rarely turns into creative production without some abatement of the psychosis, but there is evidence that creative processes sometimes turn into psychotic ones. In other word, as Foucault would suggest, psychosis can create art, but in the end it destroys it. Thus, creativity and catastrophic self-destruction seem intimately linked, as testified to by the personal accounts of Holderin, Nietzsche, Artaud, Poe, Van Gogh, and many other artists. What, then, is the ethical and therapeutic role of psychiatrists, psychologists, nurses, and all people who are in the “bright” side of the moon?

The album closes, after “Eclipse,” the same way it opens in “Speak to me,” with the heartbeat, renewing the heraclitean cyclic recurrence of the phases of the human life. This reminds us that madness, even in its darkest sides such as psychosis and schizophrenia, is always a possibility of the human experience and, as the phenomenological accounts of Husserl and the existentialist account of Heidegger would argue, a way of “being-in-the-world”. In this context, the simple rationalistic objectification of such an articulated subjective experience within the medical paradigm is not free from dangerous consequences, as the history of psychiatry has shown. In fact, the song gives a detached description of a lobotomy—“you raise the blade, you make the change, you rearrange me ‘til I’m sane”—performed in order get the “lunatic” out, sealing off madness and stigmatizing—“lock the door and throw away the key”—psychotic creativity. The consequences are described in the penultimate line, “the band you’re in playing different tunes,” clearly applicable to Barrett, who did “play different tunes” from the rest of the band at several concerts until he was kicked out and isolated from society. Stigma around mental illness can be overcome provided psychiatrists and mental health workers avoid the persistent temptation of limiting their work to providing abstract classifications and easy-to-prescribe psychopharmacological treatments. To be able to play “different tunes,” psychiatry still requires art and music to sound out different notes of human irrationality, as psychiatrists still require sharing, through the emotional resonance of their heartbeats, the obscurity of their dark sides with that of their patients.

Paolo Fusar-Poli, MD

Lorenzo Madini, MD

Dr. Fusar-Poli is a consultant psychiatrist and researcher at the Neuroimaging Section of the Institute of Psychiatry, King’s College London, London, UK. e-mail: ([email protected]).

Dr. Madini is a dentist and researcher at the Department of Restorative Dentistry, University of Brescia, Brescia.


1 Fusar-Poli P. Roger Keith “Syd” Barrett (1946–2006). Am J Psychiatry. 2007;164:1028.
2 Vardy MM, Kay SR. LSD psychosis or LSD-induced schizophrenia? A multimethod inquiry. Arch Gen Psychiatry. 1983;40:877–883.
3 Ferrari L. Syd Barrett: A Fish Out of the Water. Viterbo, Italy: Stampa Alternativa-Nuovi Equilibri; 1996.
4 Rothenberg A. Creativity and madness: New findings and old stereotypes. Baltimore: Johns Hopkins University Press, 1990.
© 2008 Association of American Medical Colleges