AS A GENIUS COMPOSER and a cutting-edge music critic, Robert Schumann (8 June 1810–29 July 1856) has long been attracting interest as to the correlations between his creativity and mental condition.1,2 Although still debated, his progressively deteriorating bipolar disorder was the most likely cause of his mysterious suicide attempt in 1854, which tragically resulted in his incarceration in a psychiatric hospital in Endenich, Germany, where he died 2 years later. In order to pay tribute to the great composer on the 200th anniversary of his birth, we reviewed the biographical and historical literature in order to generate his admission report based on the modern concepts of the psychiatric diagnostic system and psychopathological descriptions. The correlation between musical creativity and mood bipolarity in the master is discussed.
Mr S, a 43-year-old composer and music critic, had suffered from devastating auditory hallucinations for more than 2 years. On 4 March 1854, he was admitted to a psychiatric hospital due to a suicide attempt (jumping into the river on 27 February) followed by repeated suicidal ideations.
Mr S had experienced continuous mood bipolarity throughout his life. During manic episodes, he exhibited impetuous behaviors with destructive consequences (including having his right hand injured after over-practising on piano and having syphilis infection due to hypersexuality).2 In his early adulthood, these episodes of manic excitement often resulted in overactive creativity. For example, he would need very little sleep, he would be alert to his musical inspiration, which would emerge from musical hallucinations of tremendous speed and intensity, and he would compose incessantly for several days. But there would soon be mood swings in the opposite direction. During major depressive episodes, he had difficulty maintaining his social or occupational functions and the symptoms consisted of feelings of extreme sadness and irritability, lethargy, sleep disturbance, poor concentration, mood-congruent auditory and visual hallucinations, thoughts of hopelessness, guilt and death, and self-destructive behaviors. He used to self-medicate with alcohol, nicotine and caffeine for his comorbid anxiety, hypochondriasis and panic disorders.
Mr S's recent psychotic exacerbation was precipitated by the stress of fierce criticism over his conducting career and long-distance travel. In February, he became extremely depressed, irritable, and psychotic. He heard ‘music that is so glorious, and with instruments sounding more wonderful than one ever hears on earth’. However, he could no longer organize his mind to transform these inner voices into musical compositions. As Mr S's psychosis worsened, so did his fear of harming his wife and he asked to be taken to a hospital because he could no longer control his mind and behaviors. On 27 February, he escaped from his daughter's watch and jumped into the Rhine River to drown himself, but was rescued by two witnesses.
According to his history, Mr S had experienced the early life traumatic events of his sister's suicide (jumping into the river too) and the sudden death of his father when his mother was away in a sanatorium for mental illness. He had a significant family history of psychiatric disorders, including major depressive disorder (his parents), suicide (his sister and cousin), psychosis (his second son who was confined to an asylum for 31 years) and morphine addiction (his third son).
The ethical and philosophical issues related to treating a patient like Schumann have been debated. Indeed, his mood states and his creative output were remarkably correlated, as he composed less when he was depressed, and he composed more when he was hypomanic.1 However, in his last 2 years of his life, both the quality and quantity of Schumann's music works, as well as his psychological health, deteriorated substantially in the asylum. With modern psychiatry guidelines, Mr S, the great composer Schumann, should be assessed soon after admission with comprehensive physical and laboratory examinations for any correctable organic causes. He should then be treated with a second-generation antipsychotic agent (e.g. olanzapine and quetiapine) for acute psychotic bipolar depression, with or without a mood stabilizer. Regarding his good pre-morbid functioning, the prognosis should be satisfactory. Hopefully, modern bipolar patients like Schumann can be relieved from their suffering with proper treatment, and compose their own beautiful movement of life.