The Midnight Disease — A Book Review

The Midnight Disease: The Drive to Write, Writer’s Block, and the Creative Brain, by Alice W. Flaherty, Houghton Mifflin Company, 2005.


My feeling about this book on writing, and not-writing, is ambivalent. This reflects the ambivalence of its author, a neurologist at Massachusetts General Hospital, who teaches at Harvard Medical School, who has received a prestigious fellowship to study the biology of creativity, and who once had to be hospitalized as a mental patient.

I was drawn to the book by the promised discussion of writer’s block and creativity, I suppose. Although my problem with buckling down to write is more laziness than some fugue state, I thought I might perhaps get more insight into my usual procrastination.


The first chapter begins with a discussion of the opposite of writer’s block, the condition called hypergraphia which I had never come across before: she calls it “the incurable disease of writing.” “Hypergraphia” as Flaherty describes it is akin to Dr. Oliver Sack’s tales of people who can’t recognize their face in the mirror or Dr. Francis Galton, known for his pioneering studies of human intelligence, who developed the odd desire to taste everything in the hospital pharmacy in alphabetical order. Something may have gone awry in the brain.

She starts with this syndrome, for lack of a better word, of hypergraphia because it happened to her. After she gave birth prematurely to twin boys who died, she became deeply agitated and filled with ideas, all pressing to be written down. She began to suffer a complicated mixture of mania and depression. But often, she says, “The world was flooded with meaning.”

Flaherty recognizes the dangers of medicalizing the intense desire to write with a term wearing a white coat like “hypergraphia.” But at the same time:

“My writing felt like a disease: I could not stop, and it sucked me away from family and friends. Sensations outside of language dried up: music became irritating discord, the visual world grew faint. … While my hypergraphia felt like a disease, it also felt like one of the best things that has ever happened to me. It still does.”

She became pregnant again and gave birth prematurely, this time successfully, to twin girls, and again began to experience wild swings of moods and an overwhelming desire to write. In an effort to stabilize her moods, she began taking a drug which blocked most uncomfortably this desire. And then tried other medications which let her write again.

Somewhere in all that she was hospitalized for depression.

This experience informs the entire book, even the drier passages examining brain anatomy and the possible localizations of our capacity for writing. It gives the writing a personal quality that in the end becomes moving. She is not just an academic or a doctor trying to tell us the facts and what we should think about them. This is a human being speaking to us of what she has experienced, and of her effort to approach the impossible mystery of trying to say what she feels.

dostoI find the book states its intent in almost a misleading way. She says at the start that the book is intended to lay out what neuroscience is beginning to tell us about the drive to write and create. And she does do that, especially in the first half of the book, discussing temporal lobe epileptics, biochemical explanations and treatments of writer’s block, manic-depressive tendencies towards hypergraphia, the function of the limbic system. But the impression left by the end of the book is not that at all, but of a personal journey.

I find that I’m not too concerned whether brain structures like my amygdala or my hippocampus are more involved with creative writing. The detailed explication of the brain’s role in writing are sometimes intriguing but it more often I think displays the intensity of the author’s own interests, at least when she began her career, rather than shedding much useful light on writer’s block or the Muse.

A wrinkled organ and the universe

Of course there are aspects of our biological nature, the functioning of the brain and writing that are essential to the task at hand. Flaherty does make the point that all our ideas, and indeed, the representation of the world itself, “comes from a wrinkled organ that at its healthiest has the color and consistency of toothpaste.”

Several great writers have had temporal lobe epilepsy. Dostoevsky is a prime example with his free-floating mood swings of doom and ecstasy, his overpowering desire to write, his seizures as “holy experience.”

Lewis2bLewis Carroll is also thought to have had temporal lobe epilepsy and exhibited hypergraphia: he wrote 98,721 letters from his twenties until his death at 65. In purple ink.

Gustave Flaubert was famously epileptic, as Flaherty puts it. His seizures began with a sense of doom followed by a feeling that the boundaries of his self were dissolving.

It is speculated that Tennyson, Lear, Poe, Byron and de Maupassant may all have been subject to some form of epilepsy.

Many writers have been manic-depressive. There’s psychological research which suggests that writers are ten times more likely to be manic-depressive than the rest of the population, and poets… well, they’re 40 times more likely.

So many writers have written about their depression that as Flaherty comments, it has become a sub-genre with its own anthologies.

Compulsive memoirism

“Perhaps the compulsive memoirism of the mentally ill can help to explain an age so memoir-mad that most young novelists present their thinly veiled autobiographies as fiction. (I, for variety, present mine as neuroscience.) Thanks to the Internet, there is even a new variety of continuously updated on-line memoir sometimes called the blog….”

The novelist Milan Kundera coined the term “graphomania” which is not a desire to write letters or diaries but to write for unknown readers. It is the desire to be published, in some form, but most usually to write a book: “The reason we write books is that our kids don’t give a damn. We turn to an anonymous world because our wife stops up her ears when we talk to her… .”

This is all very well, but that’s not really the portion of the writing spectrum, the end that actually does a lot of writing, that concerns me. I have rarely if ever felt compelled to write. It is almost always an act of will to start, although once begun I do often become intent on uncovering the words that peek out at me.

I have envied those who write brilliantly around their epileptic seizures. I have wished for the hallucinatory driven work of those fortunate enough to feel an unfettered compulsion to write. I have wanted to write like a fevered combination of Jack Kerouac and Charles Dickens. But perhaps it is well, especially after reading this book, that I don’t. Beware what you wish for…

Writer’s block

I’m more interested in the writer’s block end of things. Flaherty has two chapters, Writer’s Block as State of Mind and Writer’s Block as Brain State.

In the State of Mind chapter, she begins by defining what she means by a blocked writer: “…they do not write despite being intellectually capable of doing so, and they suffer because they are not writing.”

conrad signature picShe describes Joseph Conrad (who happens to be one of my literary heroes) as being sometimes both hypergraphic and blocked. Conrad describes at one time sitting down for eight hours of writing every day, and perhaps coming up with three sentences which he would erase at the end. “Everything is there: descriptions, dialogue, reflection, everything, everything but the belief, the conviction, the only thing needed to make me put pen to paper.”

Flaherty points out that much popular psychology is aimed at curing writer’s block by blunting internal critics, and yet some internal criticism is necessary for good writing.

She notes that “writer’s block” may be culturally determined: it’s a North American thing. J.D. Salinger for instance fashioned an entire career out of it.

Inspiration finite?

Many writers, including some of the most talented, like F. Scott Fitzgerald, believe there is a finite amount of inspiration available to any writer, and there’s no accounting when it may run out. Most psychologists and writing teachers tend to dismiss this, but as Flaherty says, one can’t discount the experience of professional writers themselves.

There are as many theories of the reason for writer’s block as there are schools of psychology. But most of them divide between an account of a cognitive process, how the writer thinks about what he is doing, and an affective, emotional process, where what matters is how the writer feels.

Freudianism lends itself well to how writers themselves think about writing, because of its emphasis on unconscious desires and fears, which itself is a very writerly perspective.

As most writers or those who wish to write know, there is an entire industry of self-help books on writer’s block. Most provide instructions to be confident, brainstorm and prioritize, and throw in some more or less disguised Freudian notions of the id, ego and superego. For instance, brainstorming in one form or another is obviously related to the Freudian technique of free association. (It’s amusing, as Flaherty points out, that Freud appears to have borrowed this idea from an 1823 essay called “The Art of Becoming An Original Writer in Three Days.”)

Flaherty does a good job of distinguishing what the self-help books say about writer’s block from what writers themselves often say. Writers tend to be very specific about the problems of time and inspiration.

But she also looks at the opinions of literary critics. “For literary critics, the most significant past is the literary past, the vast weight of talented writers.” Those who aspire to literary greatness may be blocked by this ocean of those who have gone on before.

In writer’s block as a brain state, Flaherty recognizes the danger of moving from writer’s block as a literary phenomenon to writer’s block as a neurological response to stress or a brain chemical imbalance.

The importance of biochemistry

But then all the events we participate in necessarily include our bodies and biochemistry inevitably enters into the stress of inviting your mother-in-law over for tea as it does being moved to write a haiku.

Most people are wary, rightly so, of reduction of the complex reality of their lives to some medically approved terminology. But there is some fruitful discussion here.

writer's brainFor instance, I realized that procrastination, although similar to writer’s block, and which fits biological and behaviorist models fairly well, is different than block. I think I am more of a procrastinator, for whatever reasons. A blocked writer has the discipline to stay at the desk but cannot write. “A procrastinator, on the other hand, cannot bring himself to sit down at the desk; yet if something forces him to sit down, he may write quite fluently.”

She explores the links between block and depression, block and anxiety, block and hormonal fluctuations in considerable detail which I won’t outline here.

In the end, she recommends a guarded self-experimentation to see what helps, especially when medication or some technique is involved. For instance, perhaps a light-box during winter months may help for cases of Seasonal Affective Disorder .

Her chapter on Metaphor, the Inner Voice, and the Muse at the end of the book I found the most meaningful. She quotes Aristotle: “Ordinary words convey only what we know already; it is from metaphor that we can best get hold of something fresh.”

What is metaphor like?

Metaphor, using a word for one thing to describe another, is one of the most magical aspects of language, Flaherty points out. According to her, one study found that English speakers produced an average of three thousand novel metaphors a week. And if you look at it closely enough, nearly everything is a metaphor: we’re constantly explaining aspects of the world around us in terms of something else.

In fact, for some researchers, creativity itself is the formation of metaphors.

Flaherty describes how during her post-partum hypergraphia, metaphors preoccupied her, not quite delusions, not quite hallucinations but with the flavor of both. That breakdown after the death of her sons changed her from believing that metaphors and heightened imagery were only for poets, and from believing in the completeness of the scientific method. “The deliberate bloodlessness of scientific writing now seems less a necessary imperfection in the search for objectivity than a crime against humanity.”

Flaherty, as she wryly notes, feels compelled to list off the names of the nine Greek Muses. A few psychologists have begun, though, to begin study of the mental sensation of being visited by the Muse.

“Their work suggests that personifying inspiration as an external being is an attempt to say something about what inspiration actually feels like, about the way it seems to come from the outside just as the air you breathe does during respiratory inspiration.”

I regret to say that I have never been inspired to make such a personification… unless occasionally getting lost and thrilled by what I’m trying to say counts as something I could personify if I wanted to.

She raises the interesting question of why artists attribute their best ideas to something outside themselves. Octavio Paz said, “Whatever name we give this voice — inspiration, the unconscious, chance, accident, revelation — it is always the voice of otherness .”

She argues that the experience of the otherness of the Muse, these creative states, are extreme variants of the inner voice, or voices, that have been with us since we learned our mother tongue as toddlers. One form of the inner voice may be easily intoxicated with song, so much so that we must listen all day to that sappy tune we heard on the radio in the morning.

Of course, if one is totally alienated from the inner voice, then we are at psychosis. The author tread the edge of this during her own breakdown. And yet, that was where the germ of the idea of this book first arose.

Trusting in a favorable outcome

If we want to write, we must trust in a favorable outcome. Flaherty points out that many writers prefer quiet, inflexible writing schedules that do not depend on inspiration so that they may prepare the soil for whatever seed may land.

This process, not unlike the strict schedules of contemplatives like certain monks and nuns, shows similarities to mystical religious experience.  Writing can become an act of prayer….

At the end of the book, Flaherty writes: “The scientist in me worries that my happiness [in writing] is nothing more than a symptom of bipolar disease, hypergraphia from a postpartum disorder. The rest of me thinks that artificially splitting off the scientist in me from the writer in me is actually a kind of cultural bipolar disorder, one that too many of us have.”

She goes on: “I write because when I don’t, it is suffocating. I write because something much larger than myself comes into me that suffuses the page, the world, with meaning. Although I constantly fear that what I am writing teeters at the edge of being false, this force that drives me cannot be anything but real, or nothing will ever be real for me again.”

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Notes on images, from the top:

The first is Dostoevsky’s notes for chapter 5 of The Brothers Karamazov.

The second is some whimsical writing from Lewis Carroll.

The third is from the Joseph Conrad Society.

The fourth is from this home decor site. The labels for the different lobes of the writer’s brain can be seen more clearly there.

Explore posts in the same categories: Art, Awareness, Book Review, Culture, Writing

13 Comments on “The Midnight Disease — A Book Review”

  1. Wow. I write because it is fun and it makes me feel good. But you never know: maybe I write because I am crazy, man, crazy.

    I think mostly people do the things they like to do because they are fun and it makes them feel good. I always figured that depressive/creatives were at least partially drawn to write for the same reason. The same reasons people do all sorts of stuff. Why we do the things we do not like to do is another story.

    Think I’ll take my dog for a walk in the sun.

  2. fencer Says:

    Hi Mr. Beer,

    I tend to agree with you, about writing simply because it is fun and rewarding…

    And too many words, and thinking about words, can be suffocating.

    But writers tend to be moody, more than the general population probably, and it seems like some people are fiercely driven to write, often in emotional outpourings, whether fun or not. I wouldn’t mind experiencing that once or twice to see what it was like.

    I think we’re all a little crazy if we look close enough, although eccentric might be my preferred word…

    Thanks for coming by!


  3. Rick Matz Says:

    Struggling to find
    Just one cohesive though.
    At a blank piece of paper
    I stare.

  4. fencer Says:

    Hi Rick

    There you have it… it’s a bear when it happens.

    Thanks for coming by…


  5. Hi Fencer,

    This was really interesting. I tend to write in manic phases–in one now. Get a little misanthropic, stay in my house, produce pages and pages and pages and then spend the months after revising. I’m not sure I believe in writer’s block. I tell my students to park their behinds in the chair every day, even if they write the word shi* five hundred times, then they can walk away for that day without guilt. But for me, it’s kind of like that car you don’t drive in the yard? You have to turn it over to keep all the valves and fluids from freezing, so when the day comes to drive it, you’re there and it’s ready :-)


  6. Very innnnteresting …
    I enjoyed this read. Am not sure I’d go for a whole book’s worth of it.
    In another creative vein, artist’s block is closely related. When I’m painting, that first brush stroke is sometimes daunting. During a long (and recent) period that has lasted a good 6 years now, with little time to paint, I’ve done what I call “keeping my hand in” or “keeping my skills up”. The images are mundane landscapes, vases of flowers or a singleton, etc. At least my hands keep using the brush and my eye/hand coordination is forced to work.
    Even so, when I was working almost full time at my more thoughtful, experimental imagery, I had times when nothing flowed, inspiration had gone on holiday. It’s the time between series – the “what next?” time.
    It used to produce a large amount of uncomfortable frustration. Eventually, though, I saw a pattern in my way of working.
    It was akin to the seeding/growing/harvesting/laying fallow progression of agriculture; only here the “seeding” was the researching, reading, gathering imagery, and thinking about it all to come by a worthy idea. The “growing” part used that material to explore possibilities, fooling around with sketches and minor works to grapple with the ideas.
    The “harvesting” was the period of putting some mature imagery to canvas – a series of valid images that work together and that have some meaningful, coherent shape. This stage usually just hums along; I’m eager to get stuff down on paper or on canvas. I can’t work fast enough for the contingent ideas bombarding me. All the previous stages are bearing fruit. And then whammo! it stops. There is nothing more to be said in that vein, or it reduces to a trickle. A work or two may generate later, but I don’t inhale without exhaling.
    I’ve learned to respect the “laying fallow” time of creativity. I still feel the frustration, but I remind myself that, like fields, the mind has to regain the substance that it consumed in the making of the previous spurt of creative activity.
    I can change the crop I’m trying to get out of it . For instance, I can switch to writing or music. I can recharge the nutrients with music, reading, gallery going, taking a course from a colleague who will seed a new idea, or go walking on the Eastside, the docks, construction sites or down to the shoreline .
    Eventually, one day, the thought processes start focusing on one general area of interest, and then, it’s back to the “Seeding” stage of things.
    It works for me. It keeps me off Prozac.

  7. fencer Says:

    Hi Mary,

    Thanks for your comments… I appreciate that discipline you try to inculcate in your students. You can’t expect to write without putting in the time, although I know I always wanted magic to appear without much effort, foolishly.


  8. fencer Says:

    Hi lookingforbeauty,

    One can be blocked in other creative endeavours… funny that we focus on writing so much.

    Flaherty writes about cycles of productivity related to sleep, the seasons, and hormonal cycles. The latter not just for women, but also the role of testosterone in male creativity and mood.

    It sounds like you’ve figured out your creative rhythm. You can’t push the river, but it certainly helps to be ready in your boat.

    Thanks for describing how it works for you… That seeding time is important. Although for me, it seems like my whole life is one long seeding, and I may have forgotten where the crop was supposed to come up… (whoa, those metaphors get carried away, sometimes).


  9. forestrat Says:

    “Thanks to the Internet, there is even a new variety of continuously updated on-line memoir sometimes called the blog….”

    Stinking Internet! I’ve known for a long time that computers are the evil seed of Satan. They have been chewing away at my brain for a long time now.

    It’s too late for me – save yourself – arrggggh…


  10. fencer Says:

    That damn Internet. It’s insidious, isn’t it?

    (Pretty funny, by the way!)


  11. […] – bookmarked by 6 members originally found by ozpete2111 on 2008-10-08 The Midnight Disease — A Book Review – bookmarked by 3 […]

  12. As a creativity blogger and also an author of (yet another) book about writing, Writing in Flow, I wanted to pop in and say Be patient with authors of books about writing. I like to think of mine as living in the bathroom or on the kitchen table, something to dip into when you need reminders of how other writers cope with blocks and neurotic anxieties. Reading my or Flaherty’s book all the way through, especially at once, may be too much. But when we get a contract for a book about writing, we have to fill up a whole book, so don’t blame the author for including too much. Some readers said I didn’t include enough brain stuff. Some say SHE included too much! Choose what you like and can use. As for the personal journey aspect, some readers love it and some don’t. I plan to interview Flaherty for a blog post of my own soon. “Blogging: The Procrastinator’s New Best Friend.”

  13. fencer Says:

    Hi Susan,

    Thanks for your comments…

    I appreciate what you say, how sampling certain books now and again is the way to go. I find that for me though, I like to comprehend the entire book in context. I tend to read through once I get going, for better or for worse. And authors need to expect that… I found with Flaherty’s book that the inconsistencies in approach were sometimes confusing. I did enjoy her writing as it became more personal and less didactic, though.


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