Mind of the 'Maestro': Inside the Head of Leonard Bernstein

In the new Netflix movie "Maestro," the 20th-century composer and conductor Leonard Bernstein comes alive as a high-energy force of nature -- a genius who transforms the world but is tortured by his desires.

What was going on inside Bernstein's head? For perspective, MedPage Today turned to New York City psychiatrist and concert pianist Richard Kogan, MD, artistic director of the Weill Cornell Music and Medicine Program in New York City.

Kogan, who has lectured on Bernstein's mind and music, spoke in an interview about the master musician's complex inner life, the interactions between mental illness and genius, and the ways medicine could have helped him.

What was Leonard Bernstein like?

He was born with what mental health professionals call a hyperthymic temperament -- exuberant, energetic, extroverted, indefatigably sociable.

This temperament was a mixed blessing in his musical career. As a conductor, it was an asset: He could reliably access ecstatic states whenever he performed, and his personal magnetism was thrilling to audiences.

But as a composer, it was a hardship. Composing a symphony is fundamentally a solitary activity, and Bernstein had trouble tolerating being alone. He also grappled with feelings of despondency, particularly in the last decade of his life when he struggled to compose and coped with the death of his wife.

Was he bipolar?

Hyperthymia is akin to a chronic low-level mania. While hyperthymia may in some cases evolve into bipolar disorder, I would not apply the bipolar diagnosis to Bernstein without an appropriate psychiatric history and evaluation.

Did he have any other psychiatric conditions?

He had a variety of substance-abuse problems. He smoked three to four packs of cigarettes daily and was such an addicted smoker that he would have pre-lit cigarettes waiting for him in the wings backstage so he could take puffs when he was walking on and off stage between bows.

Bernstein also had traits associated with histrionic personality disorder -- theatricality, exaggerated expressions of emotion, and a compulsion to be the center of attention. At social gatherings, he would plant sloppy kisses and give forceful hugs to everyone around him. His response to anyone that resisted was to hug that person even harder.

Did he have narcissistic personality disorder too?

Bernstein once said, "Of course I'm a narcissist -- why else would I perform?" But his need for admiration and attention was overwhelming, even by the lofty standards of performers.

He had the most grandiose ambitions imaginable: He wanted to be the greatest composer, the greatest conductor who ever lived, the teacher of all mankind. And he wanted to solve all global problems.

Did being a narcissist make his life more difficult?

Many narcissists have trouble adjusting to the limits imposed by the aging process, and Bernstein was no exception. As a young man, he had dreams of unlimited glory, and he was convinced that the ordinary rules did not apply to him. His struggles with composing in middle age shattered his feelings of invincibility and led to depression.

But Bernstein was different in significant ways from typical narcissists, many of whom lack empathy. Bernstein was a loving father, a loyal friend, and a generous mentor.

What else was going on in him psychologically?

Bernstein was an enormously complex man. A bisexual with a primarily homosexual orientation, he felt considerable self-loathing with regard to his sexual impulses. He sought treatment with numerous psychiatrists, some of whom practiced conversion therapy.

He did not publicly acknowledge his homosexuality until he was in his 50s, not long after the American Psychiatric Association [in 1973] made the decision to stop classifying homosexuality as an illness.

How would a Freudian look at him?

In the Freudian topography of the mind, the id represents the instincts, drives, and desires, while the superego contains the values and constraints imposed by family and society.

You can make a case that Bernstein's id was urging him to be a gay man and a flamboyant performer beloved by the masses, whereas his superego was insisting that he be a heterosexual family man and a composer of serious classical symphonies.

Part of the reason he was so supremely successful as a teacher -- with his Young People's Concerts, his Omnibus TV series, and his Norton Lectures -- is that teaching was an activity that satisfied his superego and id simultaneously. For Bernstein, teaching was both a sacred obligation and an unadulterated pleasure.

How did he work out his inner conflicts?

Many people are immobilized or even paralyzed by the competing demands of their superego and id. What's fascinating about Bernstein is that for much of his life he seemed energized by contradictions -- the tension between tradition and innovation, between appeal to the intellect and appeal to the emotions.

What do we know about the connections between mental illness and genius?

There has been some epidemiological data that confirms what we intuitively sense, that the incidence of mental illness, particularly the disorders of mood, is greater in populations of writers, poets, artists, and musicians than in the general population.

The 19th century German composer Robert Schumann is a classic case of an artist with bipolar disorder. He used his racing thoughts, increased energy, sharpened imagination, and decreased need for sleep to compose prolifically during his manic episodes. But he shut down creatively whenever he was depressed. He spent the final years of his life in the nightmarish conditions of an insane asylum and died of self-starvation.

The Russian composer Sergei Rachmaninoff, in response to bad reviews for his Symphony No. 1, plunged into a devastating depression that resulted in writer's block that lasted for years. He was cured in a hypnotherapy treatment by psychiatrist Nikolai Dahl and in gratitude dedicated his beloved Piano Concerto No. 2 to him.

It is important not to overromanticize mental illness in the creative process. Most artists who are depressed are too immobilized to be at their creative peak, and most artists who are psychotic are unable to create in a coherent way.

How could today's medications have fit into Bernstein's treatment?

Medication could have helped him with smoking cessation. Bernstein had chronic emphysema and pleural mesothelioma. His health was impaired and his life shortened by his smoking addiction.

I'm not sure that psychotropic medication would be central to the treatment of Bernstein, although a careful evaluation could have revealed the potential benefit of mood-stabilizing drugs.

Could psychotherapy have helped?

Dynamic therapy could have helped him with unresolved anger toward his father, who actively attempted to block his interest in music as a youngster. And cognitive therapy could have helped resolve some of his distorted thinking that resulted in intense guilt, as he was plagued by a sense that he squandered his potential as a composer and that his extramarital dalliances led to his wife's early death.

Unfortunately, psychiatric treatment has evolved toward a model of shorter sessions, where psychiatrists are encouraged to make a rapid diagnosis and solve the clinical problem by prescribing medication. Patients like Bernstein are better served by a more nuanced approach that is increasingly endangered by the pressures of time.

You've talked to Bernstein's family members. What did they tell you?

Bernstein's three children -- Jamie, Nina, and Alex, who was a classmate of mine in college -- were all extremely helpful in providing insight into this fascinating man whom they adored. I remember his younger brother Burton, who passed away a few years ago, telling me, "My brother Lenny was just like everyone else, only more so."

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