Dr. ISMAIL SADEKASS. Lecture of Psychiatry

Al- Azher university

Creativity and mental illness

Robin Williams

عبقريمطلقا يوجد اللمسة جنونالمن دون

Creativity has long been associated with mental disorder, epitomized by Aristotle’s claim that ‘no great genius has ever existed without a strain of

madness’

Introduction and overviewDefinitionsEvidence for an association between

creativity and mental disordersmechanisms of creativity processNeurobiology of relation between

creativity and mental disordersCreativity and engagement with

treatment

Vincent van Gogh battled severe depression, and famously cut off his own ear. In spite -- or perhaps because -- of his troubles, he created legendary masterpieces, such as his "Sunflowers" series, pictured here.

There are several possibilities explaining the possible association between creativity and mental disorders.

The link can be incidental or causal. Creative ability may influence a person to be vulnerable to mental disorders, and mental disorders may help one to be creative.

Asking if creativity is linked to mental illness is like asking if there is a dog breed that fits your personality

or if there is a journal that will publish your

dissertation study

the sheer number of possibilities makes us reluctant to simply say no.

Both creativity and mental illness are vast, abstract concepts. There are many disorders and many domains of creativity: crossing the different disorders with the different creative domains yields a massive Disorder by Creativity matrix.

This huge matrix can be multiplied if researchers believe that both mental illness and creativity can vary in amount, not just in kind.

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Introduction and overviewDefinitionsEvidence for an association between

creativity and mental disordersmechanisms of creativity processNeurobiology of relation between

creativity and mental disordersCreativity and engagement with

treatment

In the past, creativity tended to be equated with intelligence.

It is now known that the two factors are independent, though most creative people appear to have an IQ of 120 and above.

Creativity

This often involves a combination of an operational definition (what the person has produced) and the use of psychological markers that are said to be characteristic of creative persons (nonconforming, adventurous, sensitive, introspective, independent).

Creativity is typically defined as behaviors or thoughts that are both novel/original and adaptive /useful.

A related distinction is between generativity (inspiration) and consolidation

Creativity refers to any idea, act, or product that significantly changes an existing domain, or transforms an existing domain into a new one in a meaningful and useful way.

Creativity

According to Adler creative self represents “the dynamic aspects of human development”, and is “the active principle of life”,

Creative thinking, critical thinking and reflective practice are interrelated and complementary processes.

Isaac Newton

Bipolar disorder I II Depression ScezophreniaAnxietySubstance misuse

Mental illness

Bipolar disorder is defined on the basis of manic symptoms of varying severity.

Bipolar I disorder, defined by a full-blown episode of mania (either without a concomitant episode of depression or with a concomitant depression, labeled a ‘mixed’ episode),.

Nonetheless, increasing attention has been given to bipolar II disorder, defined by hypomanic episodes and depressive episodes,

and cyclothymia, defined by frequent swings between subsyndromal depressive and manic symptoms that do not develop into full-blown episodes.

Whereas bipolar I disorder affects approximately 1% of the population, another 2.9% appears to develop bipolar II disorder , and perhaps 4.2% of the population are affected by cyclothymia .

Bipolar disorder

Introduction and overviewDefinitionsEvidence for an association between creativity and mental disorders

mechanisms of creativity processNeurobiology of relation between

creativity and mental disordersCreativity and engagement with treatment

Albert Einstein had a son with schizophrenia and was also somewhat schizotypal and eccentric

The study of the association between creativity and psychiatric disorders has primarily been addressed in two types of studies.

Some studies assess psychiatric disorders in eminent, creative individuals using structured diagnostic interviews or retrospective analysis of written biographies.

The other type is to assess creativity in psychiatric pt.

) ( بعنوان لودفيج والمرض ) دراسة اإلبداعي اإلنجازعام – ( . في نشرت المهن بين مقارنة م . 1992النفسي

بدراسة قام خالل 1005وقد مجال من أكثر في مبدع حالةعام من عام قسم 1990-1960ثالثين لعمله وتسهيال م

إلى : العينة إبداعي طابع لها بالضرورة هي التي الحرف مجموعة

: ، الرسامون ، المصممون ، المعماريون مثل وخالقوالشعراء النقاد ، المسرحيون ، العازفون ، الموسيقيون

الروايات . وكتاب إبداعية ليست التي الحرف تضم ثانية مجموعة

: ، الرياضيون ، المستكشفون ، األعمال رجال بالضرورةالطبيعة . علماء ، العموميون الموظفون ، العسكريون

عالقة هناك أن أكدت مثيرة لنتائج الدراسة توصلت وقد ، النفسية واألمراض اإلبداعية المهن بين

المبدعين عند الكحول تعاطي وعند% 32ر6نسبة%12ر02غيرهم

المبدعين عند اإلكتئاب غيرهم% 41ر2حاالت وعند% 18ر8

بنسبة المبدعين عند الهوس عند% 8ر8حاالت بينما%2ر8غيرهم

المبدعين عند االنتحارية غيرهم% 7ر6الميول وعند %2ر8

المبدعين عند بالذهان غيرهم% 6ر8اإلصابة وعند%2ر8

اإلبداعية المهن حسب المشاكل :تصنيف�

كحولية – 1 النقاد: – – – مشروبات الروائيون الشعراءالعازفون – – . الرسامون الموسيقيون

الذهان – 2 الشعراء: نوباتالرسامون : لقلقا – 3والمسرحيون: .النتحار ا – 4 الشعراء

One of the earliest attempts to use this approach was Lange-Eichbaum’s study of over 800 people regarded as geniuses published in 1931.

He argues that it is within the group of individuals with exceptional gifts and a concomitant psychopathology that history’s greatest geniuses are found;

exemplified by Michelangelo, Luther, Napoleon, Beethoven, Schopenhauer and Strindberg, among others

For example, Ludwig (1992) reviewed biographical material from 1005 eminent individuals.

Compared with the general population prevalence of about 1%, multiple studies suggest that some 10% of artists (broadly defined) endorse symptoms of BD

A few studies have evaluated creativity in people with manifest psychopathology.

Santosa et al compared individuals with bipolar disorder, unipolar disorder, healthy creative, and non-creative controls using the Barron–Welsh Art Scale. They found that people with bipolar disorder and healthy creative controls scored higher than those with unipolar depression and non-creative controls.

Another study reported increased creativity in 40 American adults with bipolar disorder compared with healthy controls using the Lifetime Creativity Scales .

In the ECA study of a representative sample of 13,700 people living in the United States, BD was over-represented in the most creative occupations, such as painting, writing, and lighting design.

It has been estimated that approximately 8% of people diagnosed with bipolar spectrum disorder might be considered creative ( Akiskal & Akiskal, 2007).

It is useful to note some qualifications on the association between creativity and BD.

Firstly, the putative link is yet to be directly tested in epidemiological research, and existing evidence derives primarily from large case report studies.

Secondry , therelationship between creativity and B D appears to be non-linear.

For example, using ratings of lifetime creative accomplishments, (Richards, Kinney, Lunde, et al). found those with milder forms of B D to have greater accomplishments than those with bipolar I disorder, and unaffected family members of bipolar persons had higher creative output than those with the disorder

Thirdly, the majority of evidence cited above concerns artistic creativity, and there are grounds for concluding that BD is primarily linked to artistic rather than scientific creative achievement.

Performance lifestyle as a precipitating or perpetuating factor for mood dysregulation

Some features of the creative professions, particularly artistic performance, may be counterproductive for people with BD.

Although not universal components of these careers, five features warrant attention —

reinforcement of emotionality,

occupational stress ,

substance misuse,

irregular sleep and activity schedules, and

challenges to goal regulation

Abnormal regulation of goal pursuit is common in BD.

بيكهام ديفيد عام منذ بذلك واعترف القهري، الوسواس من بيكهام ديفيد اإلنجليزي الالعب عانى

مثالية 2006 لتبقى مرة من أكثر غرف�ته ترتيب إعادة على أحيانا يجبره مرض وهو ،

Introduction and overviewDefinitionsEvidence for an association between

creativity and mental disordersmechanisms of creativity process

Neurobiology of relation between creativity and mental disorders

Creativity and engagement with treatment

Creativity has been conceptualized as forming of associative elements into new and useful combinations

Creativity as a process

A testable deduction from the associational theory is that creativity might involve the use of information previously coded as irrelevant.

Similarly, decreased latent inhibition (a measure of the tendency to filter “irrelevant details”) has been demonstrated in more creative individuals.

Decreased latent inhibition may manifest pathologically in the cognitive symptom “overinclusiveness”, seen in both mania and schizophrenia

Neuroscientific research has elevated cognitive, or perceptual imagery rather than linguistic processing in creativity .

Indeed, a small positive relationship between use of mental imagery and divergent thinking was found in a recent meta-analysis ( LeBoutillier & Marks, 2003).

Mood is probably the least disputed predictor of creative behaviour. A large number of studies affirm that, compared with neutral mood, positive affect (exemplified in happiness) is associated with increased fluency and originality.

Although it has been suggested that both positively and negatively valenced states might enhance creativity if accompanied by high levels of arousal

Bipolar disorder and the mechanisms of creativity process

Three core features of the creative process:

fluency of association,

use of cognitive imagery and

positive affect are commonly reported in BD.

Legendary artist Pablo Picasso, pictured here in his atelier in Mougins in the 1960s, is said to have struggled with depression. That didn't stop him from producing canvasses of vivid and explosive color, such as "Homme et Femme au Bouquet", shown here (detail).

Introduction and overviewDefinitionsEvidence for an association between

creativity and mental disordersmechanisms of creativity processNeurobiology of relation between creativity and mental disorders

Creativity and engagement with treatment

An association was also found between the dimension of “psychoticism”, schizotypal features and the measures of creativity.

A neurobiological model of generating ideas and creative drive assumes a dominant role of the frontal lobes, temporal lobes and the mesolimbic system.

Neurobiology

The dopaminergic system

neurotransmission, especially its

mesolimbic and cortical pathways

are mostly connected with

elevated mood and psychotic

thinking.

Neurobiological, molecular, genetic and pharmacological evidence has been accumulated pointing to an involvement of these pathways in motivational, emotional and cognitive processes, and indirectly, in the processes of creativity.

Dopamine causes the diminishing of the habituation processes and influences the sense of increased perception and salience of external stimuli .

It may also reduce the latent inhibition mechanism . The increase in the dopaminergic activity may, thus, predispose to psychotic thinking on the one hand, and to increased creativity on the other.

Dorsolateral prefrontal cortex (DLPC)manages complex operations of information processing, such as working memory and executive functions.

Ventromedial prefrontal cortex is involved in the coordination of emotional and motivational processes, concerned mainly with decision making.

Prefrontal cortex functions depend to a large degree on the optimal activity of the dopaminergic system and activation of dopamine receptors DRD1

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أيضا آخر عقلي� مرض من يعاني� إنه وقال القطب�؛ ثنائي� االضطراب

Introduction and overviewDefinitionsEvidence for an association between

creativity and mental disordersmechanisms of creativity processNeurobiology of relation between

creativity and mental disordersCreativity and engagement with treatment

In general, treatments can be roughly divided into ones that are creativity-promoting and creativity-killing.

Creativity-promoting treatment involves stimulating patients to learn and use creative modes of thought and behavior and redirecting their interests into creative fields. It is a well known fact that creative expression can make a powerful contribution to the healing process.

Medication remains the first line treatment for BD I, but there is growing support for augmenting pharmacotherapy with psychosocial treatments .

(Goodwin, 2009; Yatham et al., 2006).

psychoeducation, cognitive behaviour therapy (CBT), family focussed therapy (FFT), and interpersonal and social rhythm

therapy (IPSRT).

Patients with bipolar disorders and schizophrenia commonly discontinue medication due to complaints of creativity diminution and cognitive impairments caused by drug treatment

James Joyce had a daughter with schizophrenia and had many schizotypal traits. Albert Einstein had a

son with schizophrenia and was also somewhat schizotypal and eccentric.[4] Bertrand Russell had

many family members with schizophrenia or psychosis: his aunt, uncle, son and grand-daughter.

Winston Churchill, Vincent van Gogh and Edgar Allan Poe are believed to have had

bipolar disorder.

Notable individuals

Joanne Greenberg's novel I Never Promised You a Rose Garden is an autobiographical account of her teenage years in Chestnut Lodge working with Dr. Frieda Fromm-Reichmann. At the time she was diagnosed with schizophrenia, although two psychiatrists who examined Greenberg's self-description in the book in 1981 concluded that she was not schizophrenic, but had extreme depression and somatization disorder.The narrative constantly puts difference between the protagonist's mental illness and her artistic ability. Greenberg is adamant that her creative skills flourished in spite of, not because of, her condition.

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