Creativity and Bipolar Disorder

Neus Barrantes-Vidal from Barcelona and Gloria Calderon from Oxford, discuss the issue of creative advantage associated in families with bipolar disorder and other related illnesses.

Creativity and Bipolar Disorders Revisited from Current Psychological Perspectives.

“One of the practically useful implications of increased understanding of this area is that it may help destigmatise bipolar disorder and also echo the experience of some people with bipolar disorder. These are the individuals who describe experiencing a degree of positivity of some of the advantageous traits during periods when they are mildly ‘hypomanic’ or in complete remission from severe and disabling episodes. Acknowledging this experience is an important factor in helping people come to terms with the need for long term treatment to reduce the frequency and severity of episodes of illness while not impairing or trivialising their experience of creativity during periods of remission. This is currently easy in some but a considerable challenge in others.”

The original article is an in depth review of the lines of evidence which suggests an intriguing association between bipolarity, and creativity by Neus Barrantes-Vidal from Barcelona. What follows is a summary of the key points covered in her paper, which was published by the Journal of Consciousness Studies.

Rather than taking a simplistic view, the authors explain how both bipolarity and creativity may stem from a shared pool of personality traits and dispositions.

Introduction.

The belief that ‘lunacy’ and creativity go hand in hand is centuries old and found in most cultures. In fact, the history of the ‘creativity-madness’ hypothesis can be traced back to classic antiquity. Socrates used the word “demon” to refer to a creative spark, which he viewed as a divine gift granted to a few individuals and which enabled them to communicate with the gods. It was Aristotle however who first pointed to a distinct relationship between creativity and a propensity to mental illness. “Those who have become eminent in philosophy, politics, poetry, and the arts have all had tendencies toward melancholia.”

In the medical literature, the relationship with creativity only started to be systematically analysed one century ago. Cesare Lombroso, the great Italian psychiatrist, carefully studied biographies of creative individuals such as Julius Cesar, Newton and Schopenhauer, and reached the conclusion that “between the physiology of the man of genius and the pathology of the insane, there are many points of coincidence; there is even actual continuity.” Such intriguing anecdotal observations were followed during the 20th century by several systematic studies, which, with a couple of exceptions, corroborated the view of an existing relationship between mental illness and creativity. For example, one influential study found that “geniuses show a much higher incidence of ‘psychosis and psychoneurosis’ than the average population, manic-depressive insanity (bipolar disorder) only in the scientists, in a frequency 10 times the incidence of the average population. Schizophrenia, however, occurred only in the artists”. Another study made the important observation that creativity peaks in mentally ill people do not usually happen during active periods of illness, but in periods of remission.

“creativity peaks in mentally ill people do not usually happen during active periods of illness, but in periods of remission”

What is Creativity?

Creativity has been defined as “the ability to produce work that is both novel (i.e., original, unexpected) and appropriate (i.e., useful, adaptive concerning task constraints)”. Thus, “a key point in differentiating …(the results of) …true creativity from odd and ‘eccentric’ products is that creative output must not be idiosyncratic and only understandable by the creative individual, but meaningful for those belonging to the particular field of the creative endeavour”.

As the author states, rather than being a unitary concept, it is likely that creativity is composed of several dimensions. In other words, a creative act can be seen as something that comes into existence only when a number of different conditions come together.

Conditions favouring this may range from biological predisposition, personality traits, as well as the right environmental and sociocultural settings.

What sort of biological predisposition would allow an individual to display the kind of ‘out of the box’ thinking, which characterises a creative act? Interestingly, a recent neurobiological model proposed that creative thinking involves what has been called as a “cognitive disinhibition syndrome” characterised by low arousal of parts of the cortex (out layer) of the brain. Such reduced arousal could lead to disinhibition of thought process which would allow a mental state of defocused attention and greatly expanded capacity to associate ideas in a productive, non-conventional way. In this regard, it has been suggested that creativity results from a tendency to oscillate back and forth along two ends of a spectrum. One end is characterised by ‘lateral, free-associative, irrational and alogical thinking’ as in the cognitive disinhibition described above. The other end, in turn, is characterised by logical, abstract, reality-oriented thinking, focused attention and higher levels of cortical arousal.

Several studies suggest that although there is an overlapping area between intelligence and creativity, they are clearly two distinct cognitive domains. In short, intelligence seems a necessary but not sufficient condition for creativity.

How can mental illness and madness be related to creativity? How is it possible that the different symptoms of mental illness (the main types considered here are manic-depressive illness schizophrenia and paranoia), such as chaotic thinking, disconnection from reality, bizarre affect, perceptual anomalies, and erratic behaviour, could be related to creative thinking?

Rather than thinking as clear-cut ‘diseases’, sharply distinct from normalcy (the categorical view), an alternative view suggests that there is not a clear separation between ‘sanity’ and mental illness. According to this view ‘mental illness’ would just be an extreme expression of thoughts and behaviours that are present in different degrees in the general population (the dimensional view).

It has been suggested that such a dimensional view would make it possible to understand the relationship with creativity. Indeed, it is not that mental illness causes creativity or vice versa, but rather that there are cognitive and personality traits at the illness end of the spectrum which share biological, emotional and cognitive features with creativity when expressed at a less extreme level.

As suggested above, however, being in possession of those elements would not automatically confer creative talent, given that other necessary conditions such as intelligence, persistence, stimulating environment and favourable socio-cultural context, need to be present for the creative process to happen. In addition, the very extreme expression of these traits may itself predispose to the characteristics of ‘illness.’

Is there a particular form of illness, which is associated with creativity?

Before we consider this question in some depth, it is relevant to first mention the main clinical distinctions between the two main forms of severe mental illness; namely, bipolar disorder (manic depressive illness) and schizophrenia.

People with bipolar disorder tend to experience alternating episodes of depression and mania or milder ‘hypomania’. Mania is characterised by elated and often irritable mood, racing thoughts, hyperactivity, and grandiose ideas. In severe cases, patients experience psychotic symptoms such hallucinations and delusions. Typically, those affected with the condition experience symptom-free periods between episodes of depression or mania. Schizophrenia is usually a more pervasive disorder causing impairment of a wide range of mental functions like perception, thought, language, emotion and motivation. While the outcome can be variable, schizophrenia tends to have a chronic course characterized by recurring episodes of psychosis, with some recovery of functioning between episodes.

Recent researchers have drawn attention to the remarkable similarity between hypomania and creativity in terms of motivational and emotional features. For example, one study looked into the role of emotional states on the creative process in 47 renowned living British writers and artists. It was found that more than one third had being diagnosed as suffering from an affective disorder and offered psychiatric treatment. Whilst, artists and writers had only received treatment during depressive episodes, poets had also required treatment during hypomanic (mild form of mania) or manic phases. Interestingly, it has been found that mood elation usually precedes the creative period rather than being a product of it, and most subjects considered this emotional state fundamental for their creative work.

“One study looked into the role of emotional states on the creative process in 47 renowned living British writers and artists. It was found that more than one third had being diagnosed as suffering from an affective disorder and offered psychiatric treatment. Whilst, artists and writers had only received treatment during depressive episodes, poets had also required treatment during hypomanic (mild form of mania) or manic phases.”

Earlier in the 20th century views favoured a connection between creativity and schizophrenia. In recent years, however, a consensus is emerging which suggests an almost exclusive relationship between bipolar disorder (manic depressive illness) and creativity. Two main factors may be relevant to explain this dramatic shift. First, it is now clear that bipolar disorder was greatly underdiagnosed during the first half of the 20th century, and no doubt many patients diagnosed with schizophrenia suffered in fact from bipolar disorder. Second, given that the concept of creativity seems to emphasise cognitive rather than emotional components. It is likely that this assumption biased psychiatrists to seek a connection with schizophrenia given the predominance of cognitive symptoms in its definition.

In addition to the emotional links between mania and creativity, recent studies also show that patients with bipolar disorder display distinct cognitive profiles. Some of these have recently been shown in several studies to persist between episodes of illness when the patent is in clinical remission.

For example, it has been suggested that patients with bipolar disorder show distinctive features in their thinking and associative processes which resemble attributes of creative cognition. These common elements seem to be an increase of ideational fluency, high mental speed, cognitive flexibility, and an enhanced capacity to associate ideas in new and original ways. Although depression in itself is not thought to be directly linked to creativity, some authors argue that the cyclic and sometimes even juxtaposed experience of manic and depressive moods and their associated cognitive and biological features may give rise to a more complex mental organisation, facilitating the usage of certain forms of creative cognition. Thus, the abrupt replacement of the melancholic experience by intense manic states of elation and expansiveness would give the individual with a special capacity for introspection and a heightened need to express himself/herself in a creative, mainly artistic, way.

Interestingly enough, there is evidence indicating that people falling into the bipolar spectrum exhibit greater work-related than leisure-related everyday creativity, whereas the opposite is the case for schizophrenia-spectrum subjects.

It may well be that the extraverted, competitive, driven, gregarious personality roots of bipolarity allow these subjects to display this creative advantage in the social contexts where professional activities take place, whereas the traits of introversion, social anxiety, or awkwardness, more common in the schizophrenia spectrum, may make it easier for these subjects to display their creative potential in more relaxed, less socially pressured and judged environments such as leisure and vocational activities. (See “The Hypomanic Edge,” a book by John T Gartner.)

From a different angle, it has been argued that artistic creativity is probably much more likely to result from the psychological characteristics that predispose to bipolar spectrum, thus causing an overrepresentation of affective disorders in artistic fields, especially literature.

The dimensional view of psychopathology that states that some forms of mental illness are continuous with normal personality dimensions, has led to the development of psychometric instruments, which in the form of questionnaires measure the presence and degree of creativity traits in both normal and disordered individuals. The use of such instruments has allowed researchers to identify which personality features are particularly associated with high creative capacity. In this regard it has been found that a set of normal personality traits including individualism, originality, rebelliousness, independence, persistence, tolerance to ambiguity, motivation guided by internal rewards, and risk taking are highly associated with creativity.

A related issue tackled by psychometric studies has been to examine whether creativity in normal individuals is related to the personality traits that predispose to schizophrenia (schizotypic personality) and bipolar disorder (hypomanic and depressive traits). The results from such studies show a stronger, although not exclusive, link between creativity and the emotional/motivational sphere than with ‘schizotypy’.

“The fact that some of these traits are likely to be biologically and genetically determined may partly explain the observation of above average and exception creativity in family members of some individuals affected severely by both disorders who may have inherited a ‘useful’ degree of these traits which may confer the blessing of the traits without the curse of experiencing severe illness.”

Studies carried out in recent years have found associations between creativity and new personality dimensions such as ‘Openness to Experience’ and ‘Sensation Seeking’ (need for new and varied experiences through dangerous and non-conventional activities). The former seems to encompass many of the ‘normal’ personality traits that have been linked to creativity such as intellectual curiosity, aesthetic sensitivity, liberal values, and emotional differentiation.

Another personality dimension that has shown a compelling association with creativity is that of ‘psychoticism’. The latter was proposed by the famous German psychologist Hans Eysenck, along two other dimensions: extraversion and neuroticism. According to Eysenck, psychoticism is genetically transmitted and reflects a general predisposition to all psychoses. Although the notion of ‘psychoticism’ remains controversial, substantial size of studies have shown a positive and significant association between the Eysenck’s Psychoticism Scale and trait-creativity. In short, individuals who score high on psychoticism and creativity tests show a common cognitive profile characterised by unusual patterns of word-sorting, more divergent thinking, and less degree of cognitive inhibition. Interesting recent studies suggest that psychoticism and novelty seeking have neurochemical correlates, which suggest that the search for a common factor between creative cognition and vulnerability to psychosis may be at least partially neurobiologically determined.

Conclusion

To conclude, it is clear that we have come a long way in our understanding of the relationship between creativity and mental illness. What started as anecdotal observations suggesting an intimate relationship between creativity and ‘madness’, have led to more complex views which emphasise a dimensional rather than a categorical perspective on mental illness. In turn, attempts to uncover selective links with bipolar disorder and schizophrenia, have led to a richer understanding of creativity itself, which underlines both its cognitive and emotional components.The fact that some of these traits are likely to be biologically and genetically determined may partly explain the observation of above average and exception creativity in family members of some individuals affected severely by both disorders who may have inherited a ‘useful’ degree of these traits which may confer the blessing of the traits without the curse of experiencing severe illness.

The fact that some of these traits are likely to be biologically and genetically determined may partly explain the observation of above average and exception creativity in family members of some individuals affected severely by both disorders who may have inherited a ‘useful’ degree of these traits which may confer the blessing of the traits without the curse of experiencing severe illness.

One of the practically useful implications of increased understanding of this area is that it may assist in destigmatisation of bipolar disorder and also resonate harmoniously with the experience of some people with bipolar disorder. These are the individuals who describe experiencing a degree of positivity of some of the advantageous traits during periods when they are in complete remission from severe and disabling episodes. Acknowledging this experience is arguably an important factor in helping people come to terms with the need for long term treatment to reduce the frequency and severity of episodes of illness while not impairing or trivialising their experience of creativity during periods of remission. This is currently easy in some, but a considerable challenge in others.

Further Reading:

Touched with Fire by Kay Redfield Jamison and
The Hypomanic Edge by John T Gartner

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