Health: Writers of insight and insanity: Inspiration and mental illness sometimes go together, and can run in families. Rob Stepney on a link that may bring hope

Gwen Watkins's youngest son, Tristan, suffered for 20 years from manic depression and died two years ago. Her husband, the poet Vernon Watkins, who died in 1967, experienced a severe schizophrenic breakdown when he was a young man.

Vernon Watkins was ill for 18 months. During that period, in addition to completing about 2,000 poems, he slapped the face of a future Archbishop of Canterbury. Tristan was also amazingly productive during his manic phases. 'He simply could not type fast enough to get his ideas on to the page,' Mrs Watkins recalls.

Mrs Watkins, who lectures on English literature, felt that even such a short family history as hers pointed to two things: that mental instability and creative energy were closely linked; and that a tendency to both could be inherited. She decided to delve more deeply into the apparent connections suggested by the experiences of her husband and son, by carrying out a more general study.

The belief that great imagination involves at least a dash of madness can be traced as far back as the Romans. More recently a study by a geneticist, J L Karlsson, found that a third of the giants of literature experienced episodes of at least borderline insanity, compared with the one-in-20 risk of mental illness in the general population.

But although this indicates a strong association between instability and creativity, it does not explain it. To explore why inspiration and madness should span the generations, Mrs Watkins joined forces with Ruth Pryor, also an authority on English literature, and Dr Gordon Claridge, lecturer in abnormal psychology at Oxford University. Their research has provided new insights into the links between creativity and mental illness, and may modify our attitudes towards the mentally ill.

'Tragic though insanity is, the closeness of the link with creativity signals some hope for those likely to suffer from it,' Dr Claridge says. 'Since psychosis contains within itself the occasional capacity for superlative functioning and high achievement, we suggest at the very least that those who are mentally ill should not be dismissed as 'merely insane'.'

Mrs Watkins has taught English literature in universities from Swansea to Washington, and was a friend of Dylan Thomas. Her book Sounds from the Bell Jar, written with Dr Claridge and Ms Pryor (Macmillan, pounds 14), explores the links between psychosis and creativity in 10 literary figures. But she does not wish to imply that madness is the same as creativity. To paraphrase the poet and novelist Sylvia Plath, when you are insane you are too busy being crazy to be anything else.

'Nor would I argue that all creative authors must be mad or carry the propensity to madness,' she adds. 'There are people like Chaucer and Jane Austen who were inescapably sane, as were their families, as far as we know. However, periods of madness clearly do not preclude great originality of thought. And the overall closeness of association suggests that we might do well to modify our views about the social acceptability of insanity.'

Geneticists have investigated the close relatives of psychiatric patients and found that they are more than twice as likely to be authors as the close relatives of a control population. The picture is similar when the association is studied in reverse, by taking a population of writers and looking for psychosis in their families. One such study - of participants in the University of Iowa Writers' Workshop, which spawned such authors as Kurt Vonnegut and Philip Roth - found that the families of the writers were 'riddled' with mental illness as well as creativity.

Families share environments as well as genes. However studies of adoption cases show that both creativity and mental illness follow the line of the natural parents and not that of the adoptive families. What is it that is being inherited? Evidence suggests that it is both a tendency to particular patterns of thought and a set of characteristic emotional responses.

Dr Claridge is struck by the similarities in cognitive style between creative and psychotic thought. These include emphasis on fantasy, divergent thinking and loosely associated ideas. The imagination has been described as having an accelerator but no brake. In a classic American study, psychiatrists were presented with the writings of James Joyce and a number of psychotic patients. Almost half thought that the Joyce excerpts had come from a schizophrenic.

Dr Claridge says: 'In schizophrenia, patients cannot limit the contents of consciousness. They are overwhelmed by thoughts which would normally be selected out. One stimulus sets off an uncontrolled series of associations, many bizarre. Creative people are perhaps those who can surrender themselves to that and yet come back.'

Studies of the backgrounds of prolific writers such as Virginia Woolf, Sylvia Plath and John Ruskin have revealed threads of madness and creativity running through their family histories. Certain members of the family, it seems, are greatly gifted; others are mad; and many are both. The most likely explanation is that the genes coding for creativity also code for madness, and that the tendency to one is inherited along with the other.

Dr Claridge believes that there is some gateway through which the raw material of creativity must pass from the unconscious to the conscious mind. He suggests that this may be related to anatomical connections between the intuitive right hemisphere of the brain and the language-using, logical left hemisphere.

A resemblance in cognitive style characterises psychotic and imaginative thought. There is also a similarity between the creative and the mad in the intensity of emotional response. Virginia Woolf's father, Leslie Stephen, talked about his 'skinlessness', meaning an almost painful hypersensitivity.

Along with this may go a paradoxical lack of empathy for the feelings of others, perhaps as a means of coping, or perhaps because such people are preoccupied with their own feelings. 'This swinging between hypersensitivity and coldness is seen in clinical psychosis,' says Dr Claridge.

If inspiration and mental illness are so closely allied, can society do anything to protect those vulnerable individuals endowed with exceptional creativity against the potentially dark side of their gift?

One suggestion is that children who show an unusual degree of imagination might benefit from counselling to enable them to channel their creativity and harden them against clinical psychosis. Another possibility is that ultrasensitive children might be given help in minimising stress or limiting its effects.

Mrs Watkins also believes that the stigma of mental illness may lead us to underestimate its prevalence in literary figures: 'The wild and drunken writer is tolerated, especially if a poet, whereas a psychotic would not be. Dylan Thomas was an alcoholic, but many people use alcohol to mask the symptoms of schizophrenia. He was probably a borderline schizoid personality. And an interpretation of Dylan Thomas's terminal hallucinations as undiagnosed psychosis, rather than as DTs, is now being prepared,' she says.

The author John Fowles has talked about writers as those who suffer and go mad for society's sake. Is it of any comfort to Mrs Watkins to think that her son's illness reflects the dark side of a process responsible for creativity?

She has little sympathy for the view that artists exist so that we can stay

sane. 'What you see is only the ex-

treme suffering. What you see is the waste,' she says. 'But it seems that people do go mad so that society can have great creative minds. For many, literature is a salvation; for others, a crucifixion.'

(Photographs omitted)