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For most of its history, neuroscience has been uneasy in its attempts to investigate elusive aspects of the mind, such as imagination, inspiration, and creativity. Most neuroscientists, and even many neurologists, have avoided formal study of these concepts out of respect for their imposing complexity, all the while surely recognizing that no science of the brain can be complete without grappling with all the wondrous mental phenomena that seem so clearly to be a cerebral product. This reluctance mirrors a larger gap between the sciences and the humanities in general, a dichotomy famously articulated – and lamented – by the scientist and novelist C.P. Snow in his 1959 lecture The Two Cultures.

For decades thereafter this chasm persisted, but the last 10 or 20 years have witnessed a gratifying effort to understand mental activity as a direct result of the operations of the brain. It is now commonplace to encounter sophisticated neuroscientific studies of the highest brain functions that contribute to understanding the mind, functions previously approachable only by introspection and speculation.

The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Mind, by Massachusetts General Hospital neurologist Alice W. Flaherty, fits squarely into this modern framework, bravely leaping into the turbid waters of literary creativity from the perspective of a clinical neuroscientist with a vivid personal history of what it means to be a writer.


The inspiration for this book was the author's experience of hypergraphia associated with the manic phase of her own postpartum mood disorder, and then an episode of writer's block induced by a mood stabilizer prescribed by her physician. She had already been inclined to write more than most people, but with her hypergraphia, she was consumed by the prospect of putting pen to paper: “… ideas would wake me at four in the morning, tendrils of words coiling around me like some heady perfume.”

After taking the prescribed drug, just the opposite was true: “My head again filled with ideas, but this time I could not articulate them. The pressure in my head continued to build until it was a throbbing abscess that I was frantic to drain,” she writes. From this dramatic background emerges a detailed, ambitious, and engrossing account of the neurology of writing.

At its core, this book is about creativity, one of the most enticing yet vexing topics in the pantheon of higher mental capacities. But this is no ordinary book on the topic. Not surprisingly, the familiar popular psychology teaching that creativity arises from the right side of the brain is readily challenged as overly simplistic.

Dr. Flaherty directs us to the left hemisphere as the usual repository of language, creative and otherwise, and has much more to say about the temporal lobes and other brain areas that contribute to creative productivity. Also dealt with in a sensible manner is the romantic claim that mental illness and creativity are closely linked; even if degrees of mania seem to affect a substantial number of artists, she argues, “… almost without exception no one is seriously ill and still creative.” Exploration of much new and exciting territory awaits readers for whom these ideas are all too familiar.


The book is an impressive blend of neuroscience and the humanities that has something for most any reader who picks it up. Dr. Flaherty's neuroscientific scholarship is abundantly evident, reflecting intimate familiarity with the care of neurologic patients and research on their diseases. Although aware that too many literature citations can be deadening to an otherwise lively text, she provides 17 pages of well-focused references that will satisfy the curiosity of those who want to read more.

At the same time, her prose is peppered with illuminating comments on notable figures in the humanities, among whom Fyodor Dostoevsky and Samuel Taylor Coleridge figure prominently. The final chapter, “Metaphor, the Imagination, and the Muse,” makes relevant connections to many humanistic concerns.

Particularly important to Dr. Flaherty are the subjects of hypergraphia, the compulsion to write, and its opposite, writer's block. The curious phenomenon of hypergraphia – known to many neurologists who have received page after page of emotionally charged writings from some patients – is discussed as one component of the Geschwind syndrome, in which temporal lobe epilepsy appears to be the origin of an irresistible urge to write. Other features of this syndrome include hyper-religiosity, emotional volatility, altered sexuality, and a tendency for overinclusiveness often called viscosity.

An interesting parallel is then drawn with Wernicke aphasia, another temporal lobe disorder, in which patients display a similar increase in the production of spoken language. In contrast, writer's block is portrayed as an agonizing obstacle to creative output, the analogy being with those patients who suffer from frontal lobe dysfunction, most notably Broca aphasia and its notoriously frustrating nonfluency. None of these disorders can be held accountable for the author's experiences with her own altered writing states, but the theoretical associations of temporal and frontal lobe dysfunction to postpartum mania and mood stabilizing drugs are intriguing. These ideas invite investigation with techniques such as functional MRI that may clarify the neuroanatomy of literary creativity.

In stylistic terms, the author's writing consistently appeals, happily so in view of the often rather dense propositions being considered. Her prose sparkles with engaging metaphor and imagery, and her love of writing – whether or not one chooses to call it hypergraphia – is obvious. She is also enamored of neurology, and her attempt to bridge the gap between science and the arts is bold and generally successful. Although in the end there is still enormous ambiguity about how the biology of the brain influences the creations of the mind, this book is a valuable extended memoir from one who has an intimate knowledge of both sides of this complex equation.


The inspiration for this book was the authors experience of hypergraphia associated with the manic phase of her own postpartum mood disorder, and then an episode of writers block induced by a mood stabilizer prescribed by her physician.


On another level, Dr. Flaherty is worth reading when discussing her own mental illness, especially as she approaches this sensitive subject from the perspective of an experienced academic neurologist. She decides that, for her, hypergraphia is not a disease, echoing Geschwind's opinion that the personality changes of people with temporal lobe epilepsy are best considered traits and not disorders; that is, a change in personality, even if produced by a neurologic disease, can be viewed as a positive development if it leads to enhanced creativity. Consistent with this view is her contention that treatment of a mood disorder may actually be less desirable than enduring the illness so as not to suppress the drive to create. Thus “illness” as determined by physicians may not be nearly as painful as the inability to satisfy the fundamental human need to communicate. Seen in this light, noncompliance in the name of creativity may not be inappropriate.

In short, The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Mind is simply a marvelous work of neurology and humanism. Based on the author's own story of mental illness, her professional involvement with her patients and research, and her abiding commitment to the humanities, the book is a beautifully written, cogent, and provocative discourse on how it is that the brain participates in the creative process. While acknowledging that objective data on the subject are only beginning to appear, this unusually satisfying synthesis manages at once to explore, and exemplify, the extraordinary capacity we call creativity. For neuroscientists and humanists alike, time spent with this book will be handsomely rewarded. C.P. Snow would indeed be proud.