A Psychiatrist at Large

The brain, behavior, and everything in between.

Johnny Cash and Mental Hurt

Neurotically creative and the works

Last weekend I saw a wonderful musical about Johnny Cash's life: Ring of Fire. The show is put together by a cast of eight actors illustrating different aspects of JC's multi-faced personality, as it unfolded over a life time. Amazing voices, beautiful music, an overflow of creative juices - a spectacle of sound and light well worth seeing.

But this is not the reason for this post. I've been a Johnny Cash fan for as long as I can remember but till this last Sunday I haven't really paused to ask myself what is it, the secret ingredient that makes me love his music. While watching the show, mesmerized, lost in JC's life story, all of a sudden it hit me: it is so much more than just the music, it is the person that comes through the lyrics and almost painful musical tones, that gets to me. Johnny Cash has been an immensely open person. Not afraid to reveal his "Hurt", spontaneously engaging with his fellow beings, not thinking twice about putting himself in someone's else shoes ("Folsom Prison Blues", "Delia's Gone"), the man in black has shown himself to be a deeply tender man.

In modern psychological parlor we would have described him as "emotionally reactive", with a full range of affect, and clearly open to new experiences. Now these are some of the essential characteristics that made Johnny Cash in the cultural icon that he is. If someone were to ask you if these are qualities that someone should aspire toward, what would you say? Are these strengths or weaknesses, positive or negative personality traits?

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Certainly, people who score high on this "emotional reactiveness" trait are not cool headed (those would be the "emotionally stable") but sensitive people. Arguably most of the greatest artists would score high on this trait. As what is good art if not the ability to experience the world as it is, with not only the good, but also the bad and the ugly? So, maybe it is a strength?

Well, before you make up your mind, did you know that "emotional reactiveness" also goes under the name of "neuroticism"? Neuroticism is seen as being at the opposite end of the spectrum from emotional stability and tends to be seen as a negative personality trait as it seems to indicate a predisposition towards experiencing negative emotions such as anger, guilt, and, well, hurt. Add to this that neuroticism has been consistently associated with affective disorders in general, and depression and anxiety more specifically (Farmer et al., 2002), and the chance is that now your view of neuroticism already took a U-turn on the path toward a desirable character trait.

And of course, in common parlor, "neuroticism" almost sounds like "neurotic", a label with rather negative connotations. Imagine a parent proclaiming loudly: "I am so proud. The teacher just told me that my little Jane is just so neurotic". Really? Certainly, not seen as a strength by most people.

But remember? The discussion was started based on the hypothesis the JC, a well respected, beloved, and talented individual, and also not known to have had any mental illness, would in all likelihood have scored rather high on this personality trait scale. A personality trait that seems to have played a major role in JC's success as an artist and human being. Add to this that there is an increasing body of evidence link between neuroticism and creativity (Strong et al., 2006) and you will agree that from this angle neuroticism can justifiably be understood as "being sensitive", or simply feeling the feelings. Then, "I am so proud. The teacher just told me that my little Jane is just so sensitive." becomes a sensible observation and a desirable personality trait.

Positive or negative? Strength or weakness? This is the question.

The point here is that neuroticism, as any other personality trait or psychological - psychiatrical symptom, needs to be considered as part of a bigger context. Further, that a proposition of value, in the words of William James, should be an essential part of any psychiatric/psychologic assessment.

Any specific personality trait, taken outside of context, can be seen as "negative", implying illness and justfiying an intervention geared towards eradication, or "positive" implying mental health and justfiying unconditional support.

Judging quickly, which might be a positive when it comes to simple survival decisions in the wilderness, easily becomes judging too quickly, clearly a negative when it comes to complex decisions about who people are.

© Copyright Adrian Preda, M.D.

(Ring of Fire is playing at the Fred Kavil Theatre, Thousand Oak Civic Arts Center in Thousand Oaks, CA)

Adrian Preda, M.D., is an Associate Professor of Psychiatry and Human Behavior at the UC Irvine School of Medicine.

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