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Creativity and the Troubled Mind

by Constance Holden

"The mind is its own place, and of itself
Can make a Heaven of Hell, a Hell of Heaven.":

So wrote John Milton in PARADISE LOST. Whether or not he suffered from an emotional disorder, Milton sounds like a man who knew firsthand the torments and elations of severe mood swings. If so, he was not unusual. Speculation on a connection between art and madness has gone on since the ancient Greeks. Now, a small handful of modern studies indicates there may be something to it. In particular, they indicate a striking association between creativity and manic depression, or bipolar illness. The phenomenon appears especially pronounced among writers, particularly poets.

Twentieth-century American poets have supplied poignant evidence for this. Some of the best known -- Robert Lowell, Delmore Schwartz, Randall Jarrell and Theodore Roethke -- were diagnosed as manic- depressive or had histories of such behavior. Quite a few, including John Berryman, Sylvia Plath and Anne Sexton, committed suicide.

Full-blown cases of manic-depression are characterized by episodes of uncontrollable hyperactivity, often accompanied by grandiose delusions, and longer periods of incapacitating, and often suicidal depression. The genetic component is strong: Among identical twins, whether or not they were raised together, if one twin has the illness, the other is 80 percent likely to suffer from it. Manic depression afflicts at least 1 percent of the population, and, in contrast to most mental illnesses, the rate is considerably higher in the upper social and economic classes.

Psychiatrist Nancy C. Andreasen of the University of Iowa College of Medicine is the first investigator to have used modern psychiatric diagnostic criteria to explore the relationship between mental illness and creativity. In the early 1970s, Andreasen completed a study of 15 topflight American writers at the prestigious University of Iowa Writers' Workshop and compared them with others matched for age, education and sex. Ten of the writers had histories of mood disorders, compared with only two from the comparison group. Two of the 10 were diagnosed as manic-depressive, and almost all reported mood swings, including manic or hypomanic (mildly manic) states.

Andreasen has continued the study during the past 15 years, expanding the sample of writers to 30. According to a recent report, the proportion of writers treated for mood disorders has increased to 80 percent, compared to 30 percent of the comparison group. Forty- three percent of the writers had some degree of manic-depressive illness, as compared with 10 percent of the others. Alcoholism, which is very high among sufferers of manic-depression, afflicted 30 percent of the writers and 7 percent of the comparison group. Two of the 30 committed suicide during the 15 years of the study. ":Issues of statistical significance pale before the clinical implications of this fact,": Andreasen says.

The data on the writers lend weight to the finding of a 1983 investigation conducted in England by psychologist Kay R. Jamison of the University of California, Los Angeles. Jamison surveyed 47 of the top British artists and writers, questioning them about their mood states and their treatment history.

Thirty-eight percent of the total had sought treatment for mood disorders -- a rate of about 30 times that of the general population. Writers experienced the most problems, and of these, poets topped the list -- with half od them reporting psychiatric intervention (drugs and/or hospitalization) for depression and/or mania. Almost two-thirds of the playwrights had been treated for mood disorders, mainly with psychotherapy. The rate for biographers was 20 percent, and for artists the incidence was 13 percent.

One-third of the 47 reported that they suffered from severe mood swings, particularly the poets and novelists. Jamison reports that the biographers, the least likely to be associated with ":creative fire,": reported no history of mood swings or elated states.

More data on contemporary artists may be forthcoming from a study being conducted in Paris involving exhaustive personal interviews with about 50 artists, writers and musicians.

Psychiatrist Hagop S. Akiskal of the University of Tennessee is collaborating in this study, which will compare information from recognized creative individuals with that from a comparison group matched for age, sex, background and achievement in nonartistic areas.

Akiskal has already looked at 750 of his patients in the U.S. who are diagnosed with depression, manic-depression and schizophrenia to see if any subgroups showed different levels of creativity. He found those with sever manic-depression showed high rates of antisocial behavior, including violent crimes. But among those with more moderate versions of the illness, he found that 9 to 10 percent were creative artists and writers.

Although most investigators believe that creative achievement occurs despite, not because of, emotional illness, Jamison says that ":intense creative episodes are, in many instances, indistinguishable from hypomania.": The similarities suggest that mild mania can supply intense energy as well as a way of seeing reality that, filtered through a creative mind and a discerning intellect, can be highly conducive to artistic productivity.

There are many elements that mood states have in common, sometimes including a sense of spiritual enlightenment that is reminiscent of certain mystical states. Some other commonalities are:

• Emotional Reactivity. Both artists and manic-depressives tend to be highly sensitive to stimuli both from the outside and from within. Andreasen calls this an ":extremely fine-tuned": nervous system, sensitive to a wide range of stimuli, including pain. She has speculated that this results from ":input dysfunction": or ":a defect in the cognitive mechanisms which filter stimuli.":
• Disihibition. Psychologist Ralph Tarter of the University of Pittsburgh says a ":fundamental breakdown in inhibitory mechanisms": is characteristic of most psychopathological conditions. This breakdown, which can also be stimulated by alcohol or drugs, leads to farfetched connections, and -- as is true in many artists -- easier access to unconscious material. Manic thinking flows freely, and includes man loose and novel associations.
• Absorption. Hypomania is associated with superior powers of concentration. Harvard neurologist G. Robert DeLong, who studies children with early signs of manic-depression, says that these children have significantly richer imaginations than most. They show an ":unusual intensity of focus": when engaged in creative tasks, which results in impressive feats of memory and highly detailed drawings. They can become lost in fantasies for hours on end.

What of the emotionally ill -- are they more creative than average? There is only one modern study that explores this connection, conducted in Denmark by psychiatrist Ruth L. Richards and psychologist Dennis R. Kinney of Harvard Medical School's McLean Hospital. Richard's and Kinney's subjects were 17 manic-depressives, 16 cyclothymics (who suffer from milder forms of the illness) and 11 of their relatives with no psychiatric history. Of 33 people studied for comparison, 15 were illness-free, while the other carried other psychiatric diagnoses. Creativity was assessed by evaluating individuals' jobs and avocational activities.

The researchers found that creativity was significantly higher among the study subjects -- manic-depressives, cyclothymics and their relatives -- than among the comparison group. Cyclothymics and relatives of manic-depressives showed the highest levels of creativity. The researchers' conclusion: "Creativity can be enhanced, on the average, in subjects showing milder and perhaps 'subclinical' expressions of potential bipolar liability."

Reprinted from Psychology Today, April, 1987
©1987 Psychology Today

Modified December 25, 2002