speculation. Although recent biographies of the aviator have been consulted, none of them presented new information about his mental illness. However, based on the available reports on the life and behavior of ASD, it is possible to carry out a semiological and nosological exercise on his mental illness. This exercise, despite being merely speculative, would have a didactic or, at least, playful character.
Previously, it had been hypothesized that ASD have presented episodes of depression with psychotic symptoms.[1] In fact, it seems clear that he had, since he was 36 years old, several depressive symptoms. Prostration, discouragement, sadness, hopelessness, social isolation, mutism, anorexia, extreme weight loss, feeling of guilt and suicide attempts, all typical of depression, are mentioned.[2] From a clinical point of view, it makes no sense to attribute this picture to the use of the airplane as a weapon. ASD fell ill in 1910, therefore, four years before the beginning of the First World War. Guilt ideas, sometimes delusional ones, are common in depression.[2] Thus, the regrets he felt for inventing the airplane are probably symptoms of his illness and not its cause. In addition, as we have seen, the primacy of ASD over the first flight of a machine heavier than air was no longer widely accepted in 1910.
ASD’s depression apparently had an episodic course. According to current classificatory systems in psychiatry, given the occurrence of recurrent depressive episodes, the doubt as to the nosological diagnosis lies between bipolar disorder, when there were also manic or hypomanic episodes, and major depressive disorder, when manic or hypomanic episodes are absent.[3]
There are several indications that ASD suffered from bipolar disorder. As already mentioned, on several occasions he experienced euphoria, irritability, increased motor activity, disinhibition and inappropriate behavior, which are typical symptoms of manic syndrome.[4] The risks in which he placed himself flying at great heights aboard his inventions may well be the expression of the courage and heroism of ASD. However, it must not be forgotten that the absence of fear and excessive self-confidence are clinical manifestations observed in mania. Finally, his latest inventions, considered bizarre, could be explained by a loss of critical ability, which also occurs in manic syndrome.[2]
DSM-5[3] subdivides bipolar disorder into two types: in type 1, there was at least one episode of mania; and, in type 2, there were episodes of hypomania and depression. Since episodes of depression may be absent in type 1, in practice the occurrence of episodes of mania or hypomania is what defines bipolar disorder in DSM-5. The symptoms of mania and hypomania are the same, the distinction between the two syndromes is made based on the intensity of symptoms and the severity of psychosocial impairment. It is unclear whether ASD would have suffered from type 1 or type 2 bipolar disorder, but he would likely meet the diagnostic criteria of a manic or hypomanic episode. Surely, he presented the two mandatory changes according to DSM-5: elevation of mood and increase in motor activity. In addition, other symptoms listed in the classification were described: grandiosity, pressure to speak, agitation and excessive involvement in potentially dangerous activities.
Regarding the diagnosis of multiple sclerosis, it can be said that it is quite doubtful.[1] In this autoimmune inflammatory disease of the central nervous system,[5] in fact, double vision and vertigo may occur.[6] However, these were the only two symptoms of multiple sclerosis that ASD would have presented, which, in addition, are nonspecific. On the other hand, this neurological disease is associated with high rates of comorbidity with mental disorders: for example, 23.7% have depression; and 5.83%, bipolar disorder.[7]
ASD’s mental illness had a tragic outcome: he killed himself at 59. Among mental disorders, bipolar disorder is the one that is most associated with suicide, especially during depressive and mixed episodes.[8] Family history of suicide is among the risk factors for suicide,[2] and, as mentioned, the aviator’s mother had also taken her own life.
ASD, like all inventors, had a high creative capacity. There seems to be a relationship between bipolar disorder and creativity. In the study of the biographies of great artists, descriptions of what appear to be depressive and manic episodes, as well as suicides, are often found. When modern diagnostic criteria are applied in interviews with living artists, high rates of bipolar disorder are detected. In the evaluation of individuals with bipolar disorder, high levels of creativity are observed, higher than in those with other mental disorders. Finally, there are many similarities between creative behavior and manic or hypomanic states, which include increased activity, self-confidence, impulsiveness, excitement and accelerated thinking.[9]
CONCLUSIONS
In the biographies about ASD, very typical depressive episodes were described. In addition, reports of increased mood and increased energy indicate that he also had manic symptoms. So it seems likely that he suffered from bipolar disorder.
INDIVIDUAL CONTRIBUTIONS
EC is the only author.
CONFLICTS OF INTEREST
The author declares no competing interests. The author did not receive funding for this work.
- ↑ 1.0 1.1 Barros REM. Did the “Father of Aviation” have his wings clipped by depression? Rev Bras Psiquiatr. 2013;35(2):208-9.
- ↑ 2.0 2.1 2.2 2.3 Goodwin FK, Jamison KR. Doença maníaco-depressiva: transtorno bipolar e depressão recorrente. 2ª ed. Porto Alegre: Artmed; 2010.
- ↑ 3.0 3.1 American Psychiatric Association. DSM-5: Manual Diagnóstico e Estatístico de Transtornos Mentais. 5ª ed. Porto Alegre: Artmed; 2014.
- ↑ Cheniaux E, Filgueiras A, Silva RDAD, Silveira LAS, Nunes ALS, Landeira-Fernandez J. Increased energy/activity, not mood changes, is the core feature of mania. J Affect Disord. 2014;152-154:256-61.
- ↑ Silveira C, Guedes R, Maia D, Curral R, Coelho R. Neuropsychiatric symptoms of multiple sclerosis: State of the art. Psychiatry Investig. 2019;16(12):877-88.
- ↑ Politte LC, Huffman JC, Stern TA. Rounds in the General Hospital: Neuropsychiatric Manifestations of Multiple Sclerosis. Prim Care Companion J Clin Psychiatry. 2008;10(4):318-24.
- ↑ Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, et al. The incidence and prevalence of psychiatric disorders in multiple sclerosis: A systematic review. Mult Scler J. 2015;21(3):305-17.
- ↑ Lage RR, Santana CMT, Nardi AE, Cheniaux E. Mixed states and suicidal behavior: a systematic review. Trends Psychiatry Psychother. 2019;41(2):191-200.
- ↑ Johnson SL, Murray G, Fredrickson B, Youngstrom EA, Hinshaw S, Bass JM, et al. Creativity and bipolar disorder: Touched by fire or burning with questions? Clin Psychol Rev. 2012;32(1):1-12.
