Mozart and Bipolar Disorderby Dr Ahmed El-Medany
Wolfgang Amadeus Mozart (1756-1791) is one of the most renowned figures in Western classical music. A child prodigy, Mozart composed over 600 works in a variety of musical genres before his death at age 35. Along with this recognised status, Mozart has also been depicted as one of the more eccentric composers of his or any other time. It has been hypothesised that Mozart also lived with several possible psychiatric disorders, including mood disorders, depression, and borderline personality disorder (BPD) (Huguelet and Perroud, 2005). It has also been proposed that Mozart lived with bipolar disorder; although Huguelet and Perroud (2005) ultimately concluded that Mozart was unlikely to have met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for classic bipolar disorder, they did concede that Mozart probably did have a cyclothymic disorder and that he could qualify for a ‘soft diagnosis’ along the bipolar spectrum. Other interpretations of the same data, however, could be used to support a stronger argument for bipolar disorder.
Posthumous diagnosis, by definition, relies on forensic evidence and does not have the benefit of direct observation of the individual in question. This evidence in the case of Mozart, whose life was that of the 18th century equivalent of a celebrity, includes extensive biographical research by music historians and personal correspondence between Mozart and his family and friends. Mozart’s correspondence is especially useful in providing insight that might strengthen the credibility of a posthumous diagnosis. As preeminent Mozart biographer Alfred Einstein (1965, p. 3) noted, ‘Thanks to these letters—the liveliest, least dressed-up, most genuine letters ever written by a musician—we really know Mozart the man.’ Mozart’s widow, Constanze, destroyed all letters that Mozart received after 1782 because of their Masonic references, although there remained four volumes of five hundred pages each of correspondence between Leopold Mozart and his son for biographers to examine (Sitwell, 1932).
While this evidence does not compensate entirely for the lack of firsthand observations of Mozart by a qualified diagnostician, the historic record does provide sufficient evidence from which reasonable assumptions about the status of Mozart’s mental health may be made. Posthumous diagnoses of famous historical figures, for all of their weaknesses, may be beneficial when they are used to educate or to encourage patients who are currently living with similar disorders. Posthumous diagnoses also provide a possible frame through which the lives and behaviours of influential individuals may be better understood.
Mozart’s early years may have had significant implications for his mental health. Mozart’s father, Leopold Mozart, a court musician for the archbishop of Salzburg, wrote an internationally recognised treatise on violin playing. He recognised his son’s talent and became his mentor. Despite his success as a teacher, Leopold was frustrated with his career as a musician, which may explain why he pushed his son to develop his own talent. Wolfgang Mozart’s musical abilities were first noted at age 3, when he showed an interest in the clavier, a keyboard instrument that was the forerunner of the modern piano. As a child, Mozart was a model student who was ‘extraordinarily jolly, but a bit of a scamp’, according to his father (Einstein, 1965, p. 28). By age 6, Mozart had already written several musical compositions, some of which he dictated to his father and some of which were written in his own childlike handwriting. It was also around age 6 when Leopold took his son to Munich to perform for the Court of the Elector Maximilian III (Einstein, 1965). This would be the first of many performances that required the young Mozart to travel great distances.
In 1762, while traveling and performing, Mozart contracted scarlet fever. Einstein (1965, p. 16) speculated that scarlet fever as a child may have contributed to Mozart’s early death. Furthermore, Mozart was scarred from smallpox at a young age, and suffered recurrent upper respiratory tract infections (Huguelet and Perroud, 2005). Later in life, Mozart often consumed excess amounts of alcohol, although Huguelet and Perroud (2005) did not indicate that they believed Mozart was a chronic alcoholic. They did, however, speculate that alcohol consumption may have contributed to a fall and subsequent traumatic brain injury.
Leopold had high expectations of his son and has been accused of trying to exploit his talent. The significance of Leopold in the life of his son cannot be overstated. Einstein (1965) concluded that without Leopold’s influence, for better and for worse, the younger Mozart would not have developed into the man he became. Leopold’s strict control over virtually all aspects of his son’s life created a backlash effect that had negative consequences once the younger Mozart finally broke free of his father’s control.
Throughout his adult life, Mozart continued to display a childlike or even adolescent sense of humour, struggled to manage his finances, tended to overindulge in whatever happened to catch his attention at the time, and needed someone to provide a guiding hand and organisation for his life (Einstein, 1965). Until Mozart was 25, it was Leopold who provided that guidance, but this all dwindled after the break with his father.
Based on a review of Mozart biographies, Huguelet and Perroud (2005) noted that there was no evidence of any psychiatric disorders during Mozart’s childhood or adolescence. After the break with his father at age 25, however, Mozart exhibited signs of what might be considered adolescent rebellion. Leopold addressed this change in behaviour in one of many letters he sent to his son after their separation, “My son! You are hot-tempered and impulsive in all your ways!” (Einstein, 1965, p. 27). Leopold became quite distressed by his son’s behaviour as an independent adult, and especially with his son’s choice of a wife. Beginning in 1777 and following, Leopold’s letters often included advice for his son and comments about Mozart’s impulsiveness, and flight of ideas (Dimond, 1997).
OVERVIEW OF BIPOLAR DISORDER
All people experience fluctuations in mood due to normal life experiences. For individuals with bipolar disorder, these fluctuations are much more intense and may become debilitating. These mood swings and the behaviours that are associated with them affect the individual’s ability to form relationships, to remain in employment, and to otherwise function on a normal basis.
The DSM-IV indicates four categories of bipolar disorder. Bipolar I is characterised by at least one complete full manic episode and one full major depressive episode. Bipolar II is marked by at least one full major depressive episode, but with at least one hypomanic episode rather than a full manic episode. During hypomania, the individual experiences elevated mood, increased activity, decreased need for sleep, and other symptoms that are similar to those of a manic episode, but to a lesser degree. Although hypomania is generally a pleasant state of mind, the sense of grandiosity and invulnerability that may lead to adverse consequences due to poor decision making. Cyclothymia is a mild form of bipolar disorder that is generally characterised by emotional ups and downs that are less extreme than the fluctuations that are associated with bipolar I and bipolar II, but still affect the individual’s ability to function. Bipolar Disorder NOS (Not Otherwise Specified) is characterised by mood changes that do not fit the criteria for bipolar I or bipolar II diagnosis. This may include rapid cycling between manic and depressive states, manic episodes with no accompanying depressive episodes, or bipolar behaviours that are part of another diagnosis, such as schizophrenic disorder or a psychotic disorder (American Psychiatric Association [APA], 2000).
To qualify for bipolar diagnosis, the mood shifts must not be associated with normal grieving or elation or another medical condition, such as brain injury, stroke, substance abuse disorders, or other disorders that might affect the patient’s mood. Evidence that Mozart may have suffered a brain injury due to a fall (Huguelet & Perroud, 2005) may have implications for an accurate diagnosis.
DSM-IV Criteria for Major Depressive Episodes
Depressive episodes are characterised by a generally depressed mood with feelings of sadness or emptiness, worthlessness, or inappropriate guilt; a marked loss of interest in pleasurable activities – anhedonia; significant and unintentional weight loss or weight gain; and dramatic changes in sleep patterns resulting in daily bouts of insomnia or hypersomnia. The individual experiences a diminished ability to think or concentrate, and may appear to be indecisive. Depressed individuals are often preoccupied with inappropriate thoughts of death, including recurrent thoughts of suicide with or without a specific plan for ending their life. To qualify for diagnosis, symptoms should last for no less than 2 months and/or be characterised by severe functional impairment (APA, 2000).
DSM-IV Criteria for Manic Episodes
Manic episodes are characterised by inappropriately elevated mood, including inflated self-esteem, grandiosity, or grandiose delusions. During a manic phase, the patient experiences a decreased need for sleep, is more talkative than usual, and may report racing ideas. There is an increase in goal-directed activity (either socially, at work or school, or sexually) which is usually accompanied by increased distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli). Finally, the manic patient becomes overly focused on the pursuit of what he or she perceives to be pleasurable activities, often with painful consequences. Examples of these include extreme overspending, hypersexuality, or foolish business investments that may damage the individual’s relationships, financial status, or career (APA, 2000). It is unlikely that the individual who is experiencing a manic episode would recognise that his or her behaviour is inappropriate; however, the changes in behaviour are noticeable to others. Hypomania has characteristics that are similar to a manic episode but not as extreme.
DIAGNOSTIC CRITERIA AS APPLIED TO MOZART
Huguelet and Perroud (2005) provided a very insightful analysis of Mozart’s behaviours and his potential psychopathologies and ultimately concluded that Mozart was unlikely to have been bipolar. Other writers have also provided perspectives on Mozart that lead to equally compelling, although different conclusions. A running theme through all of the biographies about the personal life of Mozart is his bouts with depression. In his biography of Mozart, Sitwell (1932) discussed Mozart’s impulsiveness with money and with women. Sitwell also concluded that Mozart was lazy, although another interpretation of what Sitwell describes could be that Mozart was easily distracted. All of these symptoms point to possible manic episodes or hypomania.
In his description of Mozart’s character, Sitwell also focused on the composers financial worries, which Sitwell believed were the source of his depression. Other biographers have also noted that Mozart appeared to waver ‘between depression and hope, longing, and uncertainty’ (Schenk, 1959, p. 253). However, these fluctuations do not appear to have affected Mozart’s creativity or his ability to compose (Gardner, 1997).
Mozart’s depressive episodes and his known bouts with insomnia, impulsive spending, and other symptoms of mania support a diagnosis along the bipolar spectrum. Whether this is full-blown bipolar I or bipolar II or, as Huguelet and Perroud suggest, cyclothymia, is unclear. Although the voluminous correspondence between Mozart and his father, along with other letters, provides a great deal of insight into the mind of Mozart, it is highly possible that the authors of these letters omitted details that might be embarrassing or cause what they felt was undue concern. For example, after his mother’s death while she was with Mozart in Paris, Mozart wrote a letter to his father in which he stated that his mother was ill (Sitwell, 1932). If this understatement is any indication of Mozart’s way of protecting his father from bad news, then it is possible that Mozart would also minimise his mood shifts and other problems.
Under normal circumstances, it could also be said that Mozart displayed the grandiosity and ego of an individual in a manic state. However, as a man who was arguably the greatest composer of his time and who was aware of his status among his peers, this is not necessarily inappropriate. Nevertheless, Mozart’s lifestyle seem to indicate a personality that is consistent with a manic mindset. While the work of Huguelet and Perroud should not be dismissed, the evidence supports a diagnosis of bipolar disorder.
• American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th ed: DSM-IV. Washington, D.C. American Psychiatric Association Press.
• Dimond, P. A Mozart Diary: A Chronological Reconstruction of the Composer’s Life, 1761-1791. Westport, CT: Greenwood Press.
• Einstein, A. (1965). Mozart, His Character His Work. Translated by Mendel, A., and Broder, N. New York: Oxford University Press.
• Gardner, H. (1997). Extraordinary Minds: Portraits of Exceptional Individuals and an Examination of Our Extraordinariness. New York: Basic Books.
• Huguelet, P. and Perroud, P. (2005). Wolfgang Amadeus Mozart’s psychopathology in light of the current conceptualization of psychiatric disorders. Psychiatry: Interpersonal & Biological Processes,68 (2), p130-139. Retrieved April 29, 2008, from Academic Search Premier.
• Schenk, E. (1959). Mozart and His Times. Translated and edited by Winston, R. and Winston, C. New York: Alfred A. Knopf.
• Sitwell, S. (1932). Mozart. New York: D. Appleton.