SXSW Final: Daniel Johnston had a Psychotic Illness, And Lived His Dreams

Reflections on human dignity and the point of helping someone

Daniel Johnston authored more songs than most people will… anything. He was a remarkable visual artist and a remarkable musician. You have probably heard his music—the theme song for Friday Night Lights (“Devil Town”) or from Built to Spill, who did a whole cover album.

He was born on January 22, 1961. He is among the most revered songwriters in indie rock.

Daniel was a relentlessly generative person and started his career in art in the city of Austin:

In 1984, Johnston took a job at McDonald's and passed out tapes in the store.^[7] When Johnston moved to Austin, Texas, he began to attract the attention of the local press and gained a following augmented in numbers by his habit of handing out tapes to people he met.^[12] Live performances were well-attended and hotly anticipated.^[13]

His music and art were compelling, but as a founder of SXSW reminded us, he both made moving music and regularly chose to stop taking his psychiatric medications. He had an illness, either schizophrenia or bipolar disorder, with severe delusions at times. He was, in words, of his long-time photographer, crazy. He looked like this at the time he was starting his career:

Daniel in his youth.

With “grandiose crazy” people—and I say this as a fan, physician, and co-traveler—it can be hard to tell what is real. What is the risk for those looking from the ouside in? We get distracted by the craziness. We risk missing the person and their motivations in the process. The difficulties in Daniel’s mind were evident and unsettling to his fans:

“We knew when we needed to get him to a doctor and load him up with meds before he did harm to himself or other people. Crazy people are really crazy. We fell in love with his music before we knew he was crazy.”

—Louis Black

Daniel was involuntarily admitted to psychiatric hospitals repeatedly and would often stop taking his medications. He wrote more songs and albums than you can imagine writing:

A discography, visually:

Albums By Daniel Johnston

His music was so beautiful that David Bowie said, “…[his] songs made me fall in love with music again.”

According to Jung Kim and Louis Black—a founder of SXSW—his story wasn't one of tragedy in their panel discussion.

The panel of two.

Daniel wanted, more than anything, to be an influential artist. He did exactly that. Not only in music but also in visual art. A tiny sample:

Daniel Johnston Visual Art

“The fact that he was crazy helped his. art.”

—Louis Black

Daniel was sick. The man crashed a plane while psychotic and didn’t die. The attempts to treat his psychotic illness were often unsuccessful, as measured by Daniel stopping them so he could create.

He was much more than crazy. He was innocent, manipulative, playful, nasty, and driven. All of those traits interacted with his illness. But the illness wasn’t the story. You can tell the story without even referencing his psychiatric illness, but you will miss a piece:

Daniel Johnston was one of the greatest artists anyone ever saw. He was a wildly successful artist and musician. The thing that killed him was a heart attack. And this was, I suspect, due to the adverse effects of medicines and the poisoning from sugar. Sugar was the center of his enthusiasm (Mountain Dew and Candy Bars). He was someone who craved the sweetness of all things.

Briliant, obese and a smoker.

Mental illness didn’t stop him from being a brilliant human. It may have been necessary for the work that he created. Metabolic consequences of antipsychotic medications took a tremendous toll:

He was a compelling artist.

Daniel Johnston was an artist, a complex person, and mentally ill. The two things that shine out from his story to me, as a Psychiatrist, are these:

Worrying if Daniel Johnston was crazy is pointless—he was bonkers and brilliant as a package deal. You can't “treat” only part of someone; Daniel lived that truth.

The treatments we offer have benefits and consequences. They, along with sugar and nicotine, took Daniel from us early.

If we decide to accept illness that must be cured as the frame of reference, we will not succeed as healers. Should we instead choose to understand suffering should be relieved, absent judgment about its causes? This is uncomfortable. It is perhaps more humane than a treatment-over-objection philosophy. These often often collide with a person’s understandable reasons that exist with unreasonable symptoms. There is a tension in help that isn’t understood as helpful, and this tension might be unavoidable, but is worth accepting as real.

As the physician for Lady Macbeth, in her troubles discussed with her husband:

Macbeth: How does your patient, doctor?

Doctor. Not so sick, my lord,
As she is troubled with thick coming fancies,
That keep her from her rest.

Macbeth. Cure her of that.
Canst thou not minister to a mind diseased,
Pluck from the memory a rooted sorrow,
Raze out the written troubles of the brain
And with some sweet oblivious antidote
Cleanse the stuff'd bosom of that perilous stuff
Which weighs upon the heart?

Doctor. Therein the patient
Must minister to himself.

This advice, from an era long past, Daniel took to heart and made his world available to us all with breathtaking honesty:

I was livin' in a devil town
Didn't know it was a devil town
Oh lord it really brings me down
About the devil town
And all my friends were vampires
Didn't know they were vampires

Loving Daniel Johnston’s art asks us to drop the pretense that crazy is only and always a bad thing to be eradicated. It’s part of our humanity, and denying its role is denying what moves us. Just ask this Wilco performance of one of his songs:

The most important thing I heard about healthcare at SXSW was this:

True love will find you in the end
You'll find out just who was your friend
Don't be sad, I know you will
But don't give up until

True love will find you in the end
This is a promise with a catch
Only if you're looking can it find you
'Cause true love is searching too

But how can it recognize you
If you don't step out into the light, the light
Don't be sad I know you will
Don't give up until
True love will find you in the end

—Daniel Johnston

To Daniel’s mind, we can be vampires and find love, all at once. Our human hearts and psychiatric treatments share this duality. Benefits and risks, perhaps, are born of the same substrate—potent treatments, axiomatically, do something potent. Potency is the stuff of great art, and great medicine. This reality was present in talks about AI, and in talks about surgical robots, and is still left out of many talks about treatments in psychiatry. Psychedelic medicine may have been all the rage this year at SXSW, but balancing the risks and the benefits inherent in the potent wasn’t at the forefront. Daniel’s art suggests that being timid about the realities of mental illness and the compromises in all treatments should be part of the conversation. As one healthcare panelist put it confidentially afterward:

“Private equity vampires shouldn’t be running panels. Involuntary psychiatric hospitals are not the answer. Our system of care is f&*cked. We did Daniel dirty. And until people understand that, get the f- off the stage.”

A poorly attended panel about an indie rock genius had more actual “industry insights” than the rest of the entire conference. We need to reflect as a healthcare industry and as a society as to how we can offer help that is actually helpful. As Daniel sung:

Turns out I was a vampire myself
In the devil town
I was livin' in a devil town
Didn't know it was a devil town
Oh lord it really brings me down
About the devil town

—Owen Scott Muir, M.D.