Thursday, May 07, 2009

Creativity and Mental Illness - Two Articles

Two different posts on the topic of mental illness and creativity - one from this week, and one from a year ago. There has long been a connection between creativity and mental illness, mostly anecdotal but not so much anymore - researchers are not starting to figure it out.

This first article is from The Independent UK. This article also looks at depression and comedians.

Creative minds: the links between mental illness and creativity

All too often, creativity goes hand in hand with mental illness. Now we're starting to understand why. Roger Dobson reports

Tuesday, 5 May 2009


Seneca: "There is no great genius without a tincture of madness."

At first glance, Einstein, Salvador Dali, Tony Hancock, and Beach Boy Brian Wilson would seem to have little in common. Their areas of physics, modern art, comedy, and rock music, are light years apart. So what, if anything, could possibly link minds that gave the world the theory of relativity, great surreal art, iconic comedy, and songs about surfing?

According to new research, psychosis could be the answer. Creative minds in all kinds of areas, from science to poetry, and mathematics to humour, may have traits associated with psychosis. Such traits may allow the unusual and sometimes bizarre thought processes associated with mental illness to fuel creativity. The theory is based on the idea that there is no clear dividing line between the healthy and the mentally ill. Rather, there is a continuum, with some people having psychotic traits without having the debilitating symptoms.

Mental illnesses have been around for thousands of years. Evolutionary theory suggests that in order for them to be still here, there must be some kind of survival advantage to them. If they were wholly bad, it's argued, natural selection would have seen them off long ago. In some cases the advantage is clear. Anxiety, for example, can be a mental illness with severe symptoms and consequences, but it is also a trait that at a non-clinical level has survival advantages. In healthy proportions, it keeps us alert and on our toes when threats are sensed.

It's now increasingly being argued that there are survival advantages to others forms of illness, too, because of the links between the traits associated with them and creativity. "It can be difficult for people to reconcile mental illness with the idea that traits may not be disabling. While people accept that there are health benefits to anxiety, they are more wary of schizophrenia and manic depression," says Professor Gordon Claridge, emeritus professor of abnormal psychology at Oxford University, who has edited a special edition of the journal Personality and Individual Differences, looking at the links between mental illness and creativity. "There is now a feeling that these traits have survived because they have some adaptive value. To be mildly manic depressive or mildly schizophrenic brings a flexibility of thought, an openness, and risk-taking behaviour, which does have some adaptive value in creativity. The price paid for having those traits is that some will have mental illness."

Research is providing support for the idea that creative people are more likely to have traits associated with mental illness. One study found that the incidence of mood disorders, suicide and institutionalisation to be 20 times higher among major British and Irish poets in the 200 years up to 1800. Other studies have shown that psychiatric patients perform better in tests of abstract thinking. Another study, based on 291 eminent and creative men in different fields, found that 69 per cent had a mental disorder of some kind. Scientists were the least affected, while artists and writers had increased diagnoses of psychosis.

"Most theorists agree that it is not the full-blown illness itself, but the milder forms of psychosis that are at the root of the association between creativity and madness," says Emilie Glazer, experimental psychologist and author of one of the Oxford journal papers. "The underlying traits linked with mild psychopathology enhance creative ability. In severe form, they are debilitating."

Research is also showing that traits associated with different mental illnesses have different effects on creativity. The creativity needed to develop the theory of relativity, is, for example, very different from that required for producing surreal paintings, or poetry.

Research is now homing in on whether the psychosis that is linked to different types of creativity comes through schizophrenia and schizotypy traits, through manic-depressive or cyclothymic traits, or traits associated with the autism and Asperger's disorders. A study at the University of Newcastle found significant differences between artistically creative people and mathematicians. While the artists showed schizotypy traits, mathematicians did not, and that fits in with the idea that mathematics and engineering, which require attention to detail, are closer to the autistic traits than to psychosis.

"Affective disorder perpetuates creativity limited to the normal," says Glazer, "while the schizoid person is predisposed to a sense of detachment from the world, free from social boundaries and able to consider alternative frameworks, producing creativity within the revolutionary sphere. Newton and Einstein's schizotypal orientation, for instance, enabled their revolutionary stamp in the sciences."

The stereotypical images of mad scientists working alone and preferring foaming beakers to friends, abound in literature, and reflect a popular perception of the aloof, detached and obsessive genius. But the idea goes back even further. 2000 years ago in Rome, the philosopher Seneca was obviously already on the case when he wrote: "There is no great genius without a tincture of madness."

It's no joke: Comedians and depression

Heard the one about the man who went to the doctor to get help for his depression? He's told to go and see a show with a well known comedian who would make him laugh and lift his spirits. "But that's me," says the patient. "I'm the comedian."

The joke, related by Rod Martin, author of 'The Psychology of Humor – An Integrative Approach', is apparently something of a favourite among comedians, who are known to be prone to depression, from the late Tony Hancock and Spike Milligan, to Stephen Fry and Paul Merton.

One theory is that humour is developed in response to depression, and that it works as a coping mechanism. One study, reported by Martin, looked at 55 male and 14 female comedians, all famous and successful. It found that comedians tended to be superior in intelligence, angry, suspicious, and depressed.

In addition, their early lives were characterised by suffering, isolation, and feelings of deprivation, and, he says, they used humour as a defence against anxiety, converting their feel ings of suppressed rage from physical to verbal aggression. "The comedic skills required for a successful career may well be developed as a means of compensating for earlier psychological losses and difficulties," says Martin. A second study did not find higher levels, although comedians had significantly greater preoccupation with themes of good and evil, unworthiness, self-deprecation, and duty and responsibility.

"A significant proportion of comedians do seem to suffer more with depression," says Professor Gordon Claridge, emeritus professor of abnormal psychology at Oxford University. "Comedy seems to act as a way of dealing with depression. I think there is an emotionality and cognitive style that goes along with these depressive disorders which seems to feed creativity."

Salvador Dali was not just a great artist. He also met the criteria for several psychosis diagnoses, a mixture of schizophrenic and depressive. He may also have been paranoid, as well having antisocial, histrionic, and narcissistic disorders. "Dalí and his contribution to the history of art highlights that abnormality is not necessarily disagreeable – or to be so readily dismissed as a sign of neurological disease. For without his instability, Dalí may not have created the great art that he did," says Caroline Murphy of Oxford.

This article is from last year in Cosmos Magazine. This is a longer and more developed article.

Do you have to be nuts to be a genius?

To see, hear and imagine what others cannot. But at a cost: mood swings and difficulty comprehending social norms and expressing emotions. Is this what it takes to be a genius?

Einstein pokes his tongue out

Had Sir Isaac Newton been alive today, he would have been a Harry Potter fan. He was fascinated by alchemy and the existence of a philosopher's stone that could turn any metal into gold.

Despite being grounded in the pure sciences and best known for devising the law of gravitation, Newton devoted a great deal of his time to alchemy and theology. His genius is unquestionable and his influence vast, but at school he was initially a poor student.

Newton was introverted, insecure, depressive and as an adult became embroiled in vicious quarrels with several of his scientific peers. Could he have had a mental illness, and could this have contributed to his genius?

Genius comes in all shapes and forms, from those with a creative bent in the arts – writers, painters and musicians – to those grounded in the sciences – physicists, mathematicians and philosophers.

Geniuses are defined as individuals of high intellect who possess exceptional creativity and are capable of original thought. But they are also often obsessive, depressive, compulsive, introverted or manic.

And are these behaviours within the normal spectrum – albeit occasionally at the extreme end – or do they indicate an underlying neurological malfunction that might be a factor in their genius?

The perceived link between genius and mental illness isn't just coincidence: it extends from observations made centuries ago. The ancient Greek philosopher Aristotle asked, "Why is it that all men who are outstanding in philosophy, poetry or the arts are melancholic?"

More recently, 19th century Italian psychiatrist Cesare Lombroso theorised that a man of genius was essentially a degenerate whose madness was a form of evolutionary compensation for excessive intellectual development.

Mental illness, by the very phrasing of the term, has long had negative connotations, and can be very destructive for the sufferer and for those around them. But things are not always black and white: having a mental illness can actually prove a boon.

Affective disorders, including bipolar disorder – also known as manic depressive illness – are believed to have contributed to the creation of some of history's most lauded poems, novels, artworks, discoveries and original ideas.

More recently, a number of history's most brilliant minds have been retrospectively diagnosed with Asperger's syndrome – a high functioning form of autism characterised by narrow interests and 'workaholism'. In fact, some researchers believe that these two types of mental illness might confer traits that are conducive to genius.

Academics and historians have trawled through diaries and biographies written about geniuses looking for 'red flags' – traits that allow them to diagnose a mental illness according to current criteria outlined in the psychiatrist's bible, the Diagnostic and Statistical Manual of Mental Disorders.

But diagnosing someone who is no longer alive is difficult since the evidence for one disorder or another may not be clear-cut. To augment their data, researchers look for biographical information about family members. On occasion this can reveal patterns of inherited traits or disorders that helps with the diagnosis.

Nineteenth century British poets Lord Byron, and Alfred, Lord Tennyson both produced works of timeless genius – and both have a clear family history of mental health problems. Tennyson suffered from recurrent depression, as did four of his siblings.

A particularly bad time for Tennyson occurred in his early twenties, when the sudden and unexpected death of a good friend sent him into a deep depression.

The condition profoundly influenced his work; for the next nine years he didn't publish, but wrote a number of poems expressing his grief. Tennyson also had a brother who spent most of his life in an asylum and it was this inherited madness he feared the most.

Several of Byron's relatives had violent tempers and mood swings, and some committed suicide – a tragically common outcome in those who suffer from bipolar disorder.

Byron first wrote about his melancholy as a schoolboy and as an adult spoke about suicide often enough to worry his wife and friends. He also experienced periods of frenzied behaviour during which he would spend money compulsively.

Byron's mathematically talented daughter, Ada Lovelace (best remembered for her descriptions of Charles Babbage's analytical engine, one of the first mechanical computers, and for being the first to write a computer programme) appears to have inherited his 'genius genes', but also behavioural extremes.

Convinced she had a sure-fire way of choosing the winners in a horse race, she once lost so much money that she had to pawn the family jewels.

BORN IN WARSAW in 1867 as Maria Sklodowska, Marie Curie is the only woman ever to have received two Nobel prizes. The first, in 1903, was jointly awarded to her husband for their work on radiation; the second was awarded in 1911 for her discovery of the elements radium and polonium, and for her isolation and study of radium.

In 1935 Curie's eldest daughter Irène, was also jointly awarded a Nobel Prize with her husband, in recognition of their "synthesis of new radioactive elements".

The elder Curie first suffered from a "nervous illness" at the age of 15, after graduating with honours, and as Valedictorian of her class, from high school. The illness left her feeling extremely lethargic and she spent a year recuperating in the Polish countryside. Some believe this bout of tiredness was the first sign of a depressive illness that was to re-emerge in adulthood.

Russian authorities of the time did not allow women to attend university, so Curie was unable to pursue tertiary education in Warsaw. But by the age of 23, she had saved enough money to move to Paris to attend Sorbonne University.

Marie's single-minded determination to succeed meant she became completely absorbed in her studies and had little time for anything else. Three years later she not only had Masters degrees in both physics and maths, but she had graduated first and second respectively in her class of almost 2,000 students.

A physics research scholarship enabled her to pursue a research career, and she moved to the Paris Municipal School of Industrial Physics and Chemistry to join the lab of Pierre Curie, whom she subsequently married.

Marie's autobiographical notes reveal that she and her husband spent long days toiling in a makeshift laboratory in an old shed trying to isolate radium. Marie would lock herself in the lab to work for weeks on end until she collapsed from physical and mental exhaustion.

The Curies had two daughters, but according to American writer and historian Barbara Goldsmith, author of Obsessive Genius: the Inner world of Marie Curie, such was Marie's devotion to her research, that there were periods when she wouldn't see her children for up to a year.

In Marie's autobiographical works she writes: "It can be easily understood that there was no place in our life for worldly relations".

The Curies' Nobel Prize and subsequent fame was also a cause for lament: "The overturn of our voluntary isolation was a cause of real suffering for us and had all the effect of disaster. It was serious trouble brought into the organisation of our life."

Goldsmith was one of the first members of the public to obtain access to Marie's workbooks and diaries, sixty years after they were sealed in the National Library of France. She consulted a number of psychiatrists to arrive at a diagnosis of bipolar disorder for Curie.

Michael Fitzgerald, an eminent psychiatrist at Trinity College in Dublin, Ireland, believes Curie's personality traits could also be indicative of Asperger's syndrome. He says Curie's excessive drive and obsession with her research, as well as her aversion to socialising, are key signs of the disorder.

Albert Einstein has also been subject to scrutiny. Einstein was a loner as a child and didn't speak until he was three, then he repeated sentences obsessively for several years. In adulthood he lacked grooming (note the wild crop of hair) and was reportedly lax about hygiene.

These characteristics, among others, lead Fitzgerald to believe that Einstein had Asperger's – a diagnosis also suggested by Oxford University's Ioan James and the director of Cambridge University's Autism Research Centre, Simon Baron-Cohen. However, others have suggested that Einstein had schizophrenia or dyslexia.

Isaac Newton may also have suffered from Asperger's. In his latest book, Genius Genes, Fitzgerald discusses Newton's genius and "definitive" autistic characteristics, alluding to the autistic aggression Newton exhibited when he worked at the Royal Mint.

Newton was in charge of sending counterfeiters to their death by hanging, which he apparently relished. Another sign of his Asperger's, says Fitzgerald, was Newton's belief in alchemy: his inability to separate fact from fiction. This contrasts sharply with his single-minded pursuit of mathematical proofs, at which he would work continuously, without eating, for several days.

Total immersion in one's work is another key sign of Asperger's, but again the case is not straightforward: other researchers think Newton's symptoms were more indicative of bipolar disorder.

The intense focus and desire for routine associated with Asperger's doesn't only suit academic or scientific professions, however. Fitzgerald also names a number of writers, philosophers, musicians and painters (including Beethoven and van Gogh) as probable Asperger's sufferers. But again, things get complicated.

Vincent van Gogh suffered from bouts of depression, a wild temper, spasms (possibly brought on by overindulging in absinthe) and psychotic episodes before committing suicide at the age of 37. Widely thought to have had bipolar, it has also been suggested he had schizophrenia or epilepsy. Similarly, Beethoven meets the diagnostic criteria for Asperger's, but his traits are also compatible with a schizoid personality disorder or depression.

In fact, a number of mental illnesses have overlapping symptoms and associated behaviours, and some conditions could coexist with others. Schizoaffective disorder, for example, is characterised by mania and depression as well as psychosis (delusions, incoherent speech, hallucinations) or other attributes of schizophrenia. This overlap, combined with the difficulties in interpreting available data, makes a definitive retrospective diagnosis extremely difficult.

THE DANGER IN ALL this speculation is that people will be labelled as mentally ill simply because of their talent and dedication.

In his autobiography, The Double Helix, for example, the increasingly outspoken James Watson makes disparaging remarks about Rosalind Franklin – a researcher who made important, and often poorly acknowledged, contributions to our understanding of the structure of DNA.

Watson suggests she suffered from Asperger's syndrome, and insists the disorder is common among women who are talented at science.

Clearly not all geniuses have a mental illness, and not all with a mental illness are geniuses.

"Most manic depressives do not possess extraordinary imagination, and most accomplished artists do not suffer from recurring mood swings," says Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins University in Baltimore, U.S., and an expert on bipolar affective disorder.

However, over the past few decades, numerous studies, including Jamison's own, have suggested that creative and intelligent individuals are more likely to suffer from mental illness. Most have investigated the incidence of mood disorders in living artists who have achieved a certain degree of recognition.

Collectively, the studies show that artists experience eight to 10 times the rate of depression, and 10 to 20 times the rate of manic depression and its milder form, cyclothymia, than the general population.

But does this observed phenomenon extend to geniuses from other disciplines?

One of the few studies to consider the psychopathology of scientists was carried out by the late Felix Post, a London hospital physician. Published in 1994 in the British Journal of Psychiatry, Post's decade-long investigation "sought to determine the prevalence of various psychopathologies in outstandingly creative individuals".

Using data extracted from their biographies, he assessed the mental health of scientists and inventors, thinkers and scholars, statesmen and national leaders, painters and sculptors, composers, novelists and playwrights.

Among the 45 male scientists included in the study (women were "regretfully" excluded because of a dearth of data and knowledge that disease prevalence varies between the sexes), were such eminent names as Charles Darwin, Albert Einstein, Ernest Rutherford, Erwin Schrödinger, and Gregor Mendel – all of whom were found to have mild, marked or severe psychopathology.

The paper revealed that approximately one third of scientists, composers and artists had no psychopathology, whereas the same could only be said for a sixth of the artists and politicians. By far the most commonly affected were the writers: 88 per cent had a marked or severe psychopathology, with 72 per cent suffering from a depressive condition.

A follow-up study of writers confirmed the finding, but went a step further by analysing the diagnoses assigned to particular sub-groups of writers: poets, prose fiction writers, and playwrights. It found a greater frequency of affective illnesses and alcoholism among prose writers and playwrights. Poets, however, had a higher incidence of bipolar disorder.

The study makes fascinating reading, but as Raj Persaud, a professor for the public understanding of psychiatry and consultant psychiatrist at the Maudsley Hospital in London points out, the data set is biased. It includes only acknowledged geniuses, which he likens to an analysis of reported crime versus actual crime.

"The other problem is that when biographers write about the characteristics of history's intelligencia, there's a tendency to unearth eccentricities because they are interesting and this can lead to an over diagnosis of mental illness."

"It's also possible that people who are geniuses or who are highly creative deploy mental illness as an excuse for bad behaviour, when in fact they are just badly behaved," he says. It may also be the case that in some literature pertaining to history's brilliant minds, potential psychoses are overlooked.

WHILE MENTAL ILLNESS can be devastatingly destructive, the questions remain: would cancer radiotherapy have existed if not for the Curies' obsessive research habits, would some of the most oft quoted prose of our time have been written if great poets like Tennyson and Byron were not affected by extreme moods, and would our current understanding of motion and gravity exist if not for Newton's neurotic drive to understand the universe around us? How is mental illness linked with genius?

Could it be the X-factor? Many suspect it is. Socrates believed a mental illness gave an already talented individual an edge.

In Plato's Phaedrus, Socrates' second speech contains the phrase: "If a man comes to the door of poetry untouched by the madness of the muses, believing that technique alone will make him a good poet, he and his sane compositions never reach perfection, but are utterly eclipsed by the inspired madman".

And 19th century American poet Edgar Allan Poe, who is said to have had bipolar disorder, certainly believed his condition had a positive effect on his art: "Men have called me mad, but the question is not yet settled, whether madness is or is not the loftiest intelligence… [and] whether all that is profound, does not spring from disease of thought"

Neil Cole of the Alfred Psychiatric Research Centre in Melbourne says that having a mental illness – in particular bipolar – affects creativity as well as the speed of work.

A bipolar sufferer himself, Cole has found that: "the word associations, puns, flight of ideas, that are an intrinsic part of bipolar disorder in its manic phase, and the reflective thoughts, ruminations and the stripping of life away to the bare essentials that are experienced during the depressive phase, in my view, considerably enhance the artist's armoury of ideas."

In fact, Cole believes that genius hinges on eccentricity – that mental illness is the X-factor.

He's not alone. The late Hans Asperger, an Austrian paediatrician after whom Asperger's syndrome is named, said that "it seems for success in science or art, a dash of autism is essential". But how could this be beneficial?

Baron-Cohen argues that people with autism spectrum disorders favour systems that change in predictable ways, and that they have problems with ambiguity or fiction and are strongly driven to discover the truth.

Fitzgerald even believes that the genes that give rise to genius are the same as those that give rise to high-functioning autism. "Asperger's might be a necessary ingredient of human creativity," he says. "Perhaps even the crucial ingredient."

Others aren't so sure. Persaud points out that to be recognised as genius an individual's work has to be acknowledged and accepted by their peers, so geniuses aren't just high-functioning intellectuals.

"Recognised geniuses are those who have to interact in a positive way with society and therefore have to have a certain number of social skills." These skills are often lacking in people with mental illnesses such as Asperger's. Persaud also asks: if Asperger's is linked to genius, how do we account for the large number of people with Asperger's who aren't geniuses?

He's reluctant to totally dismiss the argument, however: "Mental health is a continuum – everyone lies somewhere within the spectrum – and there is a loose association between the capacity for original thought and mental health". People at the extreme end are unlikely to produce work that is accepted as of genius nature, he explains.

No doubt Sylvia Plath, who is believed to have had bipolar, would agree with him. She said: "When you are insane, you are busy being insane – all the time...When I was crazy, that's all I was".

So, do you have to be nuts to be a genius? The answer is no, but it could help. As the late Harvard University psychologist William James noted, "When a superior intellect and a psychopathic temperament coalesce – as in the endless permutations and combinations of the human faculty, they are bound to coalesce often enough – in the same individual, we have the best possible condition for the kind of effective genius that gets into the biographical dictionaries."

Branwen Morgan is a Sydney-based medical science writer and communications specialist with a PhD in neuroscience.

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