It began when Alice¹ lost her prematurely-born twin boys. As with all mothers who have suffered this trauma of death, she was overtaken by almost paralysing grief. However, the pain then metamorphosed into a bizarre condition – an uncontrollable urge to write. Ideas would sometimes send her tumbling to a computer screen or sheet of paper at four in the morning. The condition went away after four months; a year later she gave birth to another set of (healthy) twins and the obsession began anew.

Alice is a typical victim of hypergraphia.

What is hypergraphia?

For those who have never had first-hand experience, it may be hard to imagine a condition where a person is driven into a creative frenzy, being propelled by an unknown force to scribble away furiously on whatever is available – notebooks, toilet paper, walls, skin. But that is just exactly what hypergraphia is – the uncontrollable need to write.

What causes hypergraphia?

Several different regions of the brain govern the act of writing. The ability to write is conferred in part by the cerebral cortex which comprises the outer layer of the brain. The drive to write is controlled by the limbic system, a ring-shaped cluster of cells deeply buried in the cortex which governs emotion, affiliated instincts and inspiration and is said to regulate the human being's need for communication. The understanding of words and the source of ideas comes from the temporal lobes behind the ears, which are connected to the limbic system via nerve fibres. The organising and editing of ideas is controlled by the frontal lobe behind the forehead.

Hypergraphia is triggered by changes in brainwave activity in the temporal lobe. It's akin to the limbic system which governs the human need for contact, kicking the speech area of the temporal lobe into overdrive. The leading cause seems to be lesions on the temporal lobe which causes temporal lobe epilepsy² (TLE). Like other forms of epilepsy, TLE³ is the neural equivalent of a lightning storm: a frenzied firing of neurons in the brain, characterised by repetitive, automatic movements. Unlike most forms of epilepsy however, it causes only impairment – not complete cessation – of consciousness and involves only parts of the brain and body; this is described in medical terms as a complex partial seizure disorder.

In a study carried out by a Japanese research team led by T Okamura, it was found the number of Washington Psychosocial Seizure Inventory (WPSI) items indicating emotional maladjustment and CT scan anomalies were significantly higher in patients with epilepsy and hypergraphia than in patients who suffered from non-hypergraphia epilepsy. It was concluded that hypergraphia reflected changes in emotional responsiveness secondary to organic temporal lobe lesions. Another study carried out by HS Sachdev revealed that TLE patients who were presented with a standard questionnaire tended to reply more frequently and were inclined to write extensively (average: 1301 words) as compared to those who did not suffer from TLE (average: 106 words). Furthermore, of the patients who exhibited hypergraphia, a total of 73% were sufferers of TLE, suggesting that hypergraphia and TLE were closely related. A variation of this condition was also reported in conjunction with lesions in the right brain hemisphere which seemed to cause patients, when subtly prompted, to produce linguistically correct but semantically loose writing.

Aside from temporal lobe lesions, other major causes of hypergraphia include bipolar disorder (which shares several personality characteristics with TLE – among them, alteration of temporal lobe activity during manic episodes), schizophrenia and frontotemporal dementia. Also, people with Asperger's Syndrome have reported experiencing hypergraphia, suggesting that the two conditions may also be linked.

What is the frequency of hypergraphia?

The frequency of hypergraphia on its own has not been established, but its frequency in conjunction with temporal lobe epilepsy may be estimated from TLE statistics. It is believed that TLE affects between 600,000 and a million Americans, although if properly diagnosed the rate might be as high as one in a hundred adults, which would make it a common affliction. It is estimated that 73% of the hypergraphic population are sufferers of TLE. There is, however, not enough demographic data to determine if these numbers are uniform throughout the world.

What famous people suffer from hypergraphia?

Some of the world's most prolific authors and artists have been known to exhibit signs of hypergraphia. Among them are Fyodor Dostoyevsky (likely a temporal lobe epileptic) who, inbetween seizures, wrote in a hypergraphic frenzy, often attempting to reconcile the fact that the periods when he experienced his 'ecstatic or religious aura in which the world was flooded with meaning' were the result of his seizures. In his hypergraphic fits, Vincent van Gogh wrote as many as three painfully detailed six-paged letters to his brother Theo daily and produced a canvas every 36 hours. Samuel Taylor Coleridge spewed torrents of metaphysical treatise. Other suspected temporal lobe epileptics include Franz Kafka, Lord Tennyson, Edgar Allan Poe, Lord Byron and Petrarch. It is even suspected that the great Master of Science Fiction, Isaac Asimov, who published more than 300 books during his lifetime, may have been hypergraphic and not graphomanic (driven to write for fame) as some have believed.

Does hypergraphia affect the quality of creative output?

'All poets are mad.'
– Robert Burton.

There seems to be two schools of thought regarding the matter of creativity going hand-in-hand with hypergraphia. Dr Peter Whybrow, Director of the Neuropsychiatric Institute of UCLA argues 'It's not hypergraphia that makes one creative. In van Gogh's case, hypergraphia affected and changed his way of painting...but it didn't spur him to paint', pointing out that in contrast to van Gogh's meticulous method of planning and sketching his canvases on 'normal' days, his periods of hypergraphic fever were spent painting frenetically and spontaneously. According to him, this is the manifestation of mania where all behaviour is rushed and acted out in excess and that the quality of work is independent of these surges of activity. Indeed, manic depressives who are diarists or who have an inclination towards composing poetry are found to engage in such activities mostly during their bleakest periods of despair.

Dr Kay Jamison, a professor of psychiatry at John Hopkins University disagrees, arguing that 'Two aspects of thinking are pronounced in both creative and hypomanic thought: fluency, rapidity and flexibility...and the ability to combine ideas or categories of thought in order to form new and original connections.'

There does seem to be a significantly higher proportion of sufferers of depression in the creative field, be it visual, audio or literary arts, as compared to those in non-creative professions, suggesting that a certain element of instability may be a key to creativity. Dr Alice Flaherty, a neurologist at Massachusetts General Hospital and a hypergraphic writer herself, argues that creative writers in general are more profoundly affected – and presumably inspired – by suffering, which serves as a trigger for their limbic system and temporal lobe activity, thus enhancing their need to write and communicate. Yet a sizeable number of successful artists suffer no such affliction. And there are plenty more who are driven by hypergraphia but produce little or nothing of quality.

Doctors do agree that in psychological terms drive is more important than talent. Although many successful writers and composers are simply the ones with the highest amount of output, it has also been demonstrated that intrinsic motivation – for example, enjoyment – is more likely to produce fruitful work; in contrast, extrinsic motivation (including money) seems to hamper creativity. And temporal lobe epilepsy certainly does seem to create writers with incredible motivation.

Dr Flaherty, however, cautions against pathologising creativity: 'It makes more sense to go in the opposite direction and notice that in certain cases mental illness can also bring strengths and that all of us share traits with the mentally ill.'

What other conditions are associated with hypergraphia?

Hypergraphia has in some – but not all – cases been associated with other neurological disorders. A percentage of people with temporal lobe epilepsy have a group of five personality traits called the Geschwind syndrome. The five traits are:

• Hypergraphia
• Hyperreligiosity⁴ - a heightened degree of concern with morality, philosophy and mysticism
• 'Clinginess' – characterised by a reluctance to end conversation
• Altered or decreased interest in sex
• Aggressiveness – usually transient and seldom leading to actual violence

And as mentioned earlier, hypergraphia is sometimes linked to manic depression and schizophrenia.

Wait...writer's block is linked to hypergraphia?

One would have thought that writer's block, the bane of authors, could not possibly be further removed from the frenetic activity of hypergraphia – and yet it would seem that the two conditions are related. The inability to communicate one's ideas causes depression and anxiety, which in turn causes an inability to communicate and decreased activity in the frontal lobe where ideas are organised and edited – which is what writer's block is all about. However, writer's block is often genre-specific and the people who suffer from this condition often turn to other outlets for release – be it pouring one's soul into poetry, chronicling one's life in painful detail, writing lengthy letters or, in the age of electronics, marathon emails. Indeed, it has become a technique employed by writers in the rut – escaping from the block by writing about it, which is apparently what Coleridge and Wordsworth were famous for.

How is hypergraphia treated?

Hypergraphia is seldom, if ever, treated on its own; rather, when treatment is given at all it is directed at the conditions that cause hypergraphia. This may involve the use of anticonvulsant drugs for TLE, antipsychotic medication for schizophrenia antidepressants and anticonvulsants for manic depression, supportive psychotherapy and – for severe cases of TLE – surgical removal of the part of the brain containing the seizure focus.

In cases where hypergraphia results as a consequence of genre-specific writer's block, there are educational and psychotherapeutic treatments available. Alice Flaherty and Harvard psychologist Shelly Carson are now experimenting with ways to break writing blocks using light to relieve Seasonal Affective Disorder (SAD)-related blocks (SAD is a form of depression that affects people when the days get darker and colder). The University of Adelaide in Australia has also been having some success in preliminary studies of a technique called transcranial magnetic stimulation (TMS) involving passing a magnetic wand over the heads of people, which seems to enhance creativity. More often than not, however, the person suffering from writer's block seeks self-medication, usually in the form of stimulants, antidepressants and alcohol, as history has clearly demonstrated many times.

The irony is that many people suffering from hypergraphia do not want treatment. For them, writing and the creative urge to write is an important part of their lives. As Dr Flaherty puts it, 'It felt like a disease: I could not stop. It also felt like one of the best things that has ever happened to me. It still does'; there are many who liken the affliction to a rush not unlike the sort a junkie experiences from taking recreational drugs.

Dr. Peter Whybrow disagrees. 'People do not benefit from severe mental illness', he says. 'Mental illness is not a spur to creativity.'

If only the line dividing surges of creativity and mental illness were that clearly defined.

Endnote: Stimulating hypergraphia to boost creativity?

In a bleak world where the inability to communicate or create is a crippling plague, drugs have been the main choice of blocked artists seeking to release the floodgate of words welled within them. Robert Louis Stevenson's The Strange Case of Dr Jekyll and Mr Hyde was purportedly a six-day, 6,000-word cocaine spree. Unfortunately, many other practitioners of 'traditional remedies' (eg, alcohol, caffeine) have not always been as successful in breaking the proverbial block.

Although hypergraphia is regarded by many medical professionals as an illness, in the future it may be that the triggering of hypergraphia may someday be used to enhance creativity. One 37-year-old woman with Tourette's Syndrome who had wires surgically implanted into her frontal lobes to control the tics reported experiencing increased creativity and productivity in her work and personal activities at certain current settings; an accidental side-effect of her treatment, but one that hinted at future prospects of using electrical stimulus to get in touch with one's muse.

Hook me up to those electrodes, Scotty.

Bibliography

Dupree, C, January-February, 2004: Authorial synapses Harvard Magazine, January-February Issue.

LaPlante, E, November, 1988: 'The Riddle of TLE' The Atlantic Magazine.

Martineau, C, 18 March, 2004: 'Telling a tale with too many words' The Guardian, 18 March.

Okamura T, M Fukai, A Yamadori, M Hidari, H Asaba and T Sakai, 1993: 'A clinical study of hypergraphia in epilepsy' Journal of Neurology, Neurosurgery and Psychiatry Vol 56(5):556-9

Sachdev, HS and SG Waxman, 1981: 'Frequency of hypergraphia in temporal lobe epilepsy: an index of interictal behaviour syndrome' Journal of Neurology, Neurosurgery, and Psychiatry Vol 44:358-360

Yamadori, A, E Mori, M Tabuchi, Y Kudo and Y Mitani, 1986: Hypergraphia: a right hemisphere syndrome Journal of Neurology, Neurosurgery, and Psychiatry Vol 49:1160-1164