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The Catalyst

When comedy becomes no laughing matter

By Dawn Brazell
Public Relations

Actor and MUSC psychiatrist Dr. A. Lee Lewis (center) performs improv at Theatre 99 with Greg Tavares, the theatre’s co-founder. photo by Dawn Brazell, Public Relations

An expectant stillness settles on a standing–room–only crowd at Theatre 99.

A. Lee Lewis, M.D., stands jabbing his finger into thin air, trying to play “Born in the USA” on an imaginary jukebox that’s broken. Fellow actor Greg Tavares, the theatre’s co–founder, watches him, and then breaks out in song that soon unravels because he doesn’t know the words.

The crowd laughs at the improv moment being created by the duo in their ensemble act called “Moral Fixation.” Lewis, who has traveled the nation performing improv, has been acting with the group for 14 years.

One of the lessons he’s learned from doing improv is to forget about trying to make people laugh. “It’s about investing in the scene and letting ‘funny’ happen naturally. That is what Robin Williams was so good at. It’s one reason news of his death has been so difficult for people to comprehend.”

A former fulltime actor who opted to go to medical school, Lewis said he loves keeping acting as part of his life. One reason is that it’s a tight, caring community.  “You make a friend in the theater, you make a friend for life.”

This may seem like an oxymoron, given the news of Williams’ death, but it’s really not, said Lewis, who also holds the title of assistant professor in the Department of Psychiatry and Behavioral Sciences at MUSC. Often famous, creative people suffer from such issues as depression or bipolar disorder or substance abuse and these can predispose them to suicidal impulses despite a strong social network and great career success.

There have been studies linking creativity and mental illness, such as the one by Arnold Ludwig (1995) that found many highly creative people have suffered from major depression. Depression in the general population runs eight to 20 percent in any given time, Lewis said. Ludwig’s study found the lifetime rate of depression was 77 percent for poets, followed by 59 percent for fiction writers, 50 percent for artists, and 46 percent for composers.

What Can You Do to Help?
Read tips on suicide prevention on MUSC’s News Center. Dr. Lewis shares his tips at Read tips from Dr. Mark George at

Another common issue that can affect creative types is substance abuse. Sixty percent of actors meet criteria to have an alcohol use disorder, he said.  “When alcohol is part of their pathology as well, it’s even more likely that depression creeps in with consistent use.”

Certain mental illnesses can predispose certain people to depression and suicidal impulses. Writers have a higher rate of suicide than the general population and also a higher rate of bipolar disorder.  It explains why some writers had periods of high output during their manic stages and then periods of depression when they hit their lows and are more susceptible to criticism and vulnerable to depression, he said.

With more evidence showing how much of a biological basis there is to mental disorders, more people are realizing that it’s not just a state of mind. “Here at MUSC, we’re lucky to be spearheading research looking at how physical and biological stimuli to certain areas of the brain can have a dramatic and almost immediate effect in treating disorders, just like radiation can shrink a tumor in cancer over time,” he said, referring to such treatments as transcranial magnetic stimulation, electroconvulsive therapy and deep brain stimulation.
Creativity runs through the prefrontal cortex, the amygdala and the limbic system.

“Depression also runs through the limbic system and the amygdala — that’s the emotional areas of the brain. It’s where our emotions are attached to our memories. So it’s easy to see how creative people who are very good at evoking emotion, evoking memory in their work are also prone to having their emotions go a little haywire because they are tapping into that on such an intense basis to do the work they are so good at.”

Creative types also can face external, circumstantial challenges. Performers may have five shows in a row, where they are awash in positive feedback and then go through a dry spell. Creative jobs also can come and go and the people who do them are subject to rejection.

“Whether you get work or not is not just about your talent, which is important, but it’s based on luck and timing too. Also the ultimate decision about whether you work or how good you are is based on what other people think about you. That’s not really the case in a lot of work places where you are judged by your productivity or your bottom line.”

In music, theater, writing and poetry, and other such creative pursuits, people often are judged by whether others find them to be good or not. Those interactions increase stress and can lead to a more depressed worldview if people are saying negative things.

This is not to say creativity is a gateway to mental illness, which is not true at all, he said. An analogy is that you can get hurt doing fitness or sport activities, but those activities aren’t unhealthy to pursue.

Lewis so believes that creative outlets can be therapeutic that he has submitted a grant to use an improv curriculum to treat people suffering from social and performance anxiety. The proposed study also will measure the treatment’s effects on depression and anxiety. He and Tavares also are putting together an interdisciplinary training seminar using improv to help health professionals in developing trust, empathy and decision-making.

“What I love about improvisation and acting is the same thing I love about psychotherapy. It’s all about character study and learning how people think and why they think what they think. The ultimate expression of that is improvisation — the ability to become someone in a moment and do what you think that character would do. It’s the ultimate character study.”
Improvisation as a discipline combines many of the elements that appear to be therapeutic in treatment curricula for anxiety, including the concept of exposure, mindfulness, cognitive r
restructuring, role–play, insight into motivation, and social skills training, he said.

Likewise, creative outlets, such as music, comedy and writing can be beneficial. Studies show that people who have creative outlets tend to be overall healthier, with boosted immune systems that make them more resistant to coronary and cancer risks.

The caveat is that creative outlets are not a cure–all.

In psychology the term “defense mechanism” is used to describe actions used to self–protect. Acting out can be a defensive mechanism where instead of feeling sad or shameful, you get mad and lash out at people.

“Utilizing humor to deal with problems and issues is considered one of the highest orders of defense mechanisms. I think what we forget is that it still is a defense mechanism. It still is an attempt to defend yourself against something that is hurting you. I think what happens a lot of times with comedians is that they are using their humor to deal with their demons and most do it incredibly successfully. But to think you can use your humor to always deal with your demons might not be true.”

Lewis said he gets writers who keep journals to bring them in so that he can help them process their emotions in a therapeutic setting. “You see that in some creative people. If you’re depressed, and you’re a storyteller, your story is likely to be even more depressing than it is in reality. Creative people are good at taking reality and making it bigger than reality.”

Sometimes people, creative or not, just get caught in a rut where they are unable to see a solution. There are ebbs and flows for people who suffer from depression. “Cancer is the same way. You get treated, and it can go into remission for a long time, and come back. Or you can be cancer free. I think mental illness and cancer have a lot of parallels to one another.”

A positive effect of Williams’ death is the conversation it is generating about how depression is more of a silent killer than society admits and how there needs to be more funding for mental health treatment and awareness of how it is a brain disorder that people are fighting, he said.

“I never assumed Robin Williams was fighting demons every day of his life.  I think the vast majority of his life was brilliant and fun and happy. But when those demons come, much like cancer relapses, it can become overwhelming and even possibly take our lives.”

What Can You Do to Help?

1. Reach out.
It’s difficult to recognize depression in yourself. Your cognitive schema becomes altered. Break the silence if you see someone struggling. If they isolate themselves and are getting more irritable, reach out to help. Notice if you see someone who is creative shy away from his or her creative outlets. That can be a “loss of the lust of life” or anhedonia, which is a key sign of depression.
2. Break privacy.
If you’re hesitant to reach out to someone, Lewis recommends considering: “What’s the best that can happen? What’s the worst that can happen?” Even if you share your concern and they get mad, it may plant the seed for future action. It’s better to reach out.
3. Mobilize on a community level.
Find ways to mobilize to get more funding for mental health care, which has much lower funding than many other health conditions despite having a higher prevalence rate in the general population. “I hope as a society that we are moving to a place where everyone who needs and wants mental health treatment can get it and that we will be empowered and mobilized to make a difference on a community level – not just on Facebook,” according to Lewis.
4. Take advantage of new treatments.
If you’re suffering from depression or suicidal impulses know there are new treatments and that traditional ones can work as well. Lewis also recommends behavioral activation – to make yourself do things you enjoy doing even if you’re not feeling it. “Fake it until you make it.”

If you don’t have the energy to fake it, then at least call to get another perspective. (National suicide hotline: 1-800-784-2433).



September 5, 2014



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