Bipolar Disorder & Creativity:

Tiffany Rudin

Introduction

• Numerous studies have shown a correlation between mood disorders and creativity

• Some studies have been retrospective, taken from biographical case studies and other posthumous information (Manic-Depressive Illness pg. 381)

• There have, however, also been more recent studies of living writers and artists that support this phenomenon (pg. 389)

• The research is not suggesting that all people with Bipolar disorder are artistically creative.

• Nor is it suggesting that all artistically creative people suffer from Bipolar disorder or other affective disorders.

• What the research does support is that there is a disproportionate amount of artistically creative people who have Bipolar or other mood disorders when compared to the population of control or non-creative people.

Bipolar Disorder

What is Bipolar Disorder?

• There are 3 major Bipolar spectrum disorders: bipolar I, bipolar II, and cyclothymia

• The bipolar disorders are characterized by cyclical moods with extreme phases of depression alternating with episodes of mania (Castillo 215)

Depression

• A major depressive episode is one of the diagnostic requirements for both bipolar I and bipolar II disorder

• “Characterized by at least two weeks of depressed mood with at least four additional symptoms of depression” (Castillo 202)

Symptoms of Depression

• Changes in appetite, weight, sleep, or psychomotor activity

• Fatigue• Feelings of worthlessness or guilt• Difficulty thinking• Recurrent thoughts of suicide or suicide attempts• Somatic complaints such as bodily aches & pains• Loss of interest in pleasure• Loss of interest in sexual activity (Castillo

202-203)

Mania:

• A manic episode is “characterized by an abnormally elevated, euphoric, or irritable mood lasting at least one week, or less if hospitalization is required” (Castillo 208)

• Need at least 3 additional manic symptoms to classify as a “manic episode” (208)

• Hypomania is a milder version of mania that doesn’t cause impairment to social or work life (210)

Symptoms of Mania

• Grandiosity/inflated self-esteem• Decreased need for sleep• Pressure of speech• Flight of ideas• Distractibility• Increased goal-directed activity• Excessive involvement in pleasurable activity

with a high potential for painful consequences (Castillo 208)

Symptoms of Mania cont…

• Certainty of conviction about the correctness and importance of their ideas

• Excessive spending sprees• Reckless driving• Extreme impatience• Intense/impulsive romantic or sexual liaisons• Volatility (Jamison, “Touched” 13)

Creativity

Defining Creativity:

• Creativity has been given a variety of definitions and there seems to be no “universal or psychometrically standardized definition of creativity” (Lauronen 82)

• One definition of creativity given by Rybakowski et al, is “the generation of ideas and behaviors, both original and useful, and implementing them in life” (37)

Characteristics of Creative People

• Broad interests• Fascination with complex problems• Great vigour• Independent views• Autonomy• Intuition• Self-confidence• Capacity to resolve contradictions (Rybakowski

37)

Historical Beliefs about “Madness” and Creativity

• In popular folklore, we tend to find a correlation between creativity and insanity

• Stereotypes such as “suicidal poets, raving artists, and mad scientists” may come to mind (Shapiro 742)

These Historical Stereotypes may have Scientific Basis:

• It has been repeatedly shown that these stereotypes may have scientific support. Although many of these studies have their limitations and some of them are less reliable than others, the recurrent and persistent pattern found throughout all of them is undeniable

• It seems if we combined all these studies together, the majority of the result would point toward the same conclusion:

• For whatever reason, the presence of mood extremes and mood disorder has a higher prevalence in artistic populations (Goodwin & Jamison, “Manic” 381)

How Bipolar Disorder Facilitates Creativity

• “Hypomania and mania often generate ideas and associations, propel contact with life and other people, induce frenzied energies and enthusiasm, and cast an ecstatic, rather cosmic hue over life” (Goodwin & Jamison, “Manic” 402)

• “Melancholy, on the other hand, tends to force a slower pace; cools the ardor; and puts into perspective the thoughts, observations, and feelings generated during more enthusiastic moments” (402)

• When depression isn’t too extreme, it can be utilized as an editorial period during which to revise things which were produced during the manic state

• Something that seemed fabulous during the manic state when someone feels completely grandiose and invincible is given a reality check during the depressive episode when a person is much more sober-minded

• “Depression prunes and sculpts; it also ruminates and ponders and, ultimately, subdues and focuses thought. It allows structuring, at a detailed level, of the more expansive patterns generated during hypomania” (Goodwin & Jamison, “Manic” 402)

• It’s important NOT to romanticize about the creative tendencies of mental illness

• Madness as Muse:• http://www.youtube.com/watch?v=Nl1fv5AIqnQ

What the Brain is Doing during Creativity

• In order for a person to be exceptionally creative they must at least have “a high level of general intelligence” as well as special skills or knowledge in a specific domain

• Some creative people may also have structural variances in particular areas in the posterior neocortex (Chakravarty, 606)

• The frontal lobes play a huge part in promoting divergent thinking (Chakravarty 608)

• “Creative innovation often occurs during low arousal states and creative people often manifest features of affective disorders” (606

• “This suggests a role of neurotransmitters in creative innovation” (606)

Posterior Neocortex

• A person can have particular cognitive disorders such as dyslexia or autism but can still have exceptional talent in a creative field “even to the level of a creative genius” (Chakravarty 607)

• If a person has the capacity for that domain specific knowledge, they can still be extraordinarily creative despite their cognitive deficits or abnormalities

• In the human brain this “domain-specific” type of knowledge is generally located in the posterior neocortex (607-608)

The Neocortex (also known as the cerebral cortex or the neomammalian brain) is what we learned about in chapter 3 that is “responsible for language, including speech and writing. Handles problem solving, memory, and planning for the future. Controls voluntary movement. Processes sensory information” (Sweeney 69). It is located in the cerebrum.

Frontal Lobes

• It has been shown that major frontal lobe dysfunction prevents creative thinking

• “In order to find a creative solution to a problem that has remained unsolved, a person must alter the way by which people have previously attempted to solve the problem” (Chakravarty 608)

• This type of divergent thinking, in which disengagement from the typical solutions used by most people occurs, happens in the frontal lobes (608)

The frontal lobes, which, as we learned in our layers and lobes power point is responsible for higher level thinking. Part of that higher thinking is involved in the process of creativity.

Neurotransmitters in Creativity

• “Dopaminergic pathways are involved in the novelty seeking attitudes of creative people while norepinephrine levels are depressed during discovery of novel orderly relationships” (Chakravarty 606)

• This is where we can really see how Bipolar Disorder can sometimes give people a creative edge.

Low Arousal State

• “High cortical arousal induced by stress is often associated with conscious attempts at problem solving” (Chakravarty 610)

• However, when this occurs it suppresses the brain’s ability to make unusual associations involved in creativity

• When a lower level of cortical arousal is present, this allows the unusual associations to take place, leading to a more creative thinking process (610)

How does this low arousal state relate to creativity?

• The answer appears to be related to a change in the level of neurotransmitters (610)

Dopamine (609)

Norepinephrine (611)

Dopamine

• Research has shown that “exposure to novelty activates the mesolimbic dopamine (DA) system of the brain” (Chakravarty 609)

• As we learned in our power point on Neurotransmitters, dopamine heightens awareness, increases ability to focus senses, and aids in learning

• Each of these functions would definitely contribute to being artistic and productive

Dopamine cont…

• “There is arguably the strongest pharmacological support for the dopaminergic system among all the neurotransmitter systems with regard to potential involvement in the switch process to hypomania/mania” (Goodwin & Jamison, “Manic” 484)

• Therefore the neurotransmitter dopamine appears to be involved in both the novel-thinking of the creative process as well as the alternation of the depression to mania phase of Bipolar disorder

• http://www.youtube.com/watch?v=0rGK3zj5B10

Norepinephrine

• Norepinephrine (NE) “is reduced both during sleep, relaxation and depression” (Chakravarty 611)

• “Sleep and relaxation being associated with a low NE state enhances creativity”

• Decreased NE=Increased Creativity (611)

Norepinephrine cont…

• “The locus coeruleus (LC) is the richest source which provides NE output to the cortex”

• “Low levels of LC activity would enhance creative cognition and outputs” (Chakravarty 611)

NE cont…

• “The frontal lobes [which, we said earlier, is involved in the divergent thinking process] appear to exert an inhibitory influence on the LC” (Chakravarty 611)

• Therefore, the same neurotransmitter, when inhibited by the frontal lobes increase both a depressive affective state as well as the novel-thinking involved in creativity

• This is how norepinephrine is negatively correlated with creativity and depression

Case Studies and Research Support

• According to a study done by Ludwig (1995)—which studied 1,004 renowned people in a variety of different occupational fields—when compared with regular non-artistic occupations, the group containing the artistic professions “had 2-3 times the rate of psychosis, suicide attempts, mood disorders, and substance abuse” (Goodwin & Jamison, “Manic” 385)

(Goodwin & Jamison, “Manic” 389 “Table 12-3—Source: Adapted from Ludwig, 1992”)

Rates of Suicide, Depression, Mania, and Psychosis in a Sample of Writers, Artists, and Composers

LIFETIME RATES (%)

Sample Size Depression Mania Psychosis Suicide

Poets 53 77 13 17 20

Fiction writers

180 59 9 7 4

Nonfiction writers

64 47 11 8 1

Artists 70 50 9 4 6

Composers 48 46 6 10 0

• In a research study done of writers at the University of Iowa, “fully 80 percent of the study sample met standardized (RDC) diagnostic criteria for a major affective disorder”

• “In contrast, 30 percent of the control sample (individuals outside the arts who were matched for age, education, and gender) met the same criteria (p<.001)” (Goodwin & Jamison, “Manic” 390)

(Goodwin & Jamison, “Manic” 391 “Table 12-4—Source: Adapted from Andreasen, 1987. Reprinted with permission from the American Journal of Psychiatry, American Psychiatric Association”)

Table 12-4. Lifetime Prevalence of Mental Illness in Writers and Control Subjects

Diagnosis (Research Diagnostic Criteria)

Writers(n=30)

(%)

Controls(n=30)

(%) p

Any affective disorder

80 30 .001

Any bipolar disorder

43 10 .01

Bipolar-I 13 0 NS

Bipolar-II 30 10 NS

Major depression 37 17 NS

Schizophrenia 0 0 NS

Alcoholism 30 7 .05

Drug abuse 7 7 NS

Suicide 7 0 NS

• In 1993, Jamison did a study of the incidence of mood disorders and suicide in a group of British and Irish poets who lived within a 100-year time period

• She examined a variety of documents including autobiographies, contemporary accounts, and medical records when they were available in order to see if there was some sort of pattern within the data (Goodwin & Jamison, “Manic” 385)

• “She examined the available letters, journals, and medical records for symptoms of depression, mania, and mixed states; seasonal or other patterns in moods, behavior, and productivity; the nature of the course of the illness…;and evidence of other psychiatric or medical illness…that might confound the diagnostic picture” (Goodwin & Jamison, “Manic” 385)

• “She placed strong emphasis on both the severity and the recurrence of symptoms. In all cases it was the patterning of mood, cognitive, energy, sleep and behavior symptoms that formed the focus of the study” (385)

Jamison found a disproportionate occurrence of psychosis, manic-depression, admission to asylum, and suicide within the group of

poets she studied when compared to the normal population (“Touched” 385)

Recurrent Depression

Manic-Depressive Illness

Psychotic Features

Confined to Asylum

Suicide

Samuel Johnson

X

Thomas Gray

X

William Collins

possibly X X

Christopher Smart

X X X

Joseph Warton

Oliver Goldsmith

Probably Bipolar II or Cyclothymia

Recurrent Depression

Manic-Depressive Illness

Psychotic Features

Confined to Asylum

Suicide

William Cowper

X X X

James Macpherson

Robert Fergusson

X X X

Thomas Chatterton

X X

John Bampfylde

X

George Crabbe

X

Recurrent Depression

Manic-Depressive Illness

Psychotic Features

Confined to Asylum

Suicide

William Blake

X X

Robert Burns

Probable Bipolar II or Cyclothymia

Joanna Bailie

William Lisle Bowles

Samuel Rogers

William Wordsworth

possibly

Recurrent Depression

Manic-Depressive Illness

Psychotic Features

Confined to Asylum

Suicide

Sir Walter Scott

Possibly

Samuel Taylor Coleridge

X

Robert Southey

Walter Savage Landor

Probable Bipolar II or Cyclothymia

Thomas Campbell

Probably Bipolar II or Cyclothymia

Thomas Moore

Recurrent Depression

Manic-Depressive Illness

Psychotic Features

Confined to Asylum

Suicide

Leigh Hunt X

Thomas Love Peacock

George Gordon, Lord Byron

X

Percy Bysshe Shelley

X X

John Clare X X X

John Keats Probable Bipolar II or Cyclothymia

(Jamison, “Touched” 63-71)

Recurrent Depression

Manic-Depressive Illness

Psychotic Features

Confined to Asylum

Suicide

George Darley

X

Hartley Coleridge

X Possibly

Thomas Hood

Thomas Lovell Beddoes

X X

Robert Stephen Hawker

Probable Bipolar II or Cyclothymia

James Clarence Mangan

X X

Conclusion

What’s Left?

• As you have seen, the evidence is overwhelming that there is some association between Bipolar Disorder and creativity

• What is still left to be determined is whether there is a causal relationship

• And IF there is a causal relationship, which variable is the cause and which is the result (Shapiro 743)

Ethical Issues

• Scientists have been trying to pinpoint a gene that predisposes people to Bipolar disorder

• If/when it is found, the question still stands, what is the ethical thing to do?

• Is it ethical to allow the continued gene of a disorder that has led to the agonizing suffering and eventual loss of so many lives?

• Is it ethical to eliminate a gene that may have played a huge part in so many people’s personal identities as well as artistic contributions to our world? Artistic genius that has literally helped to shape culture and society? (Jamison, “Touched” 257-259)

Annotated Bibliography

Castillo, Richard J. "Mood Disorders." Culture and Mental Illness: a Client-centered Approach. Pacific Grove: Brooks/Cole Company, 1997. Print.

This book talks about mental illness and the cultural constructs that creates them. I mainly used it in my presentation to lay down the basic DSM-IV definitions for bipolar disorder and other terminology related to mood disorders. I cited from the chapter on mood disorders to explain what bipolar disorder is.

Chakravarty, Ambar. "The Creative Brain--Revisiting Concepts." Medical Hypotheses (2009): 606-11. Print.

This article talks about what is going on in the brain during the process of creative thinking and production. It also talks about the differences in the brain between people with exceptional creativity when compared to the average person. It also discusses the parts and chemistry of the brain that perhaps cause the correlation

between mood disorders and creativity.

Goodwin, Frederick K., Kay R. Jamison, and S. Nassir. Ghaemi. Manic-depressive Illness: Bipolar Disorders and Recurrent Depression. New York, NY: Oxford UP, 2007. Print.

This book details all of the research done to-date on manic-depressive illness and other illnesses related, such as recurrent depression. It includes past research and history as wellas more current studies and summaries of what still needs to be researched.

Jamison, Kay R. Touched with Fire: Manic-depressive Illness and the Artistic Temperament. New York: Free, 1993. Print.

This book is an examination of manic depressive illness and the "artistic temperament". The author goes through and

examines the research as well as the past lives of many renowned artists, writers, and poets and explains the link

between extreme moods and artistic creativity. Although a bit older, the claims made in this book are still supported

by more current research.Lauronen, Erika, Juha Veijola, Irene Isohanni, Peter B. Jones, Pentti Nieminen, and Matti Isohanni.

"Links Between Creativity and Mental Disorder." Psychiatry 67.1 (2004): 81-82. Print.

This article was basically an examination of all the current research concerning links between creativity and mental disorder. It included a lot of information from many of the other sources I was using and seemed to tie all the current research together.

Rybakowski, Janusz, Paulina Klonowska, Amelia Patrzala, and Jan Jaracz. "Psychopathology and Creativity.“ Archives of Psychiatry and Psychotherapy (2008). Print.

This article talked about the connection between psychopathology involved with mood disorders and the creativity process. It talked about the similarities in personality and behavior between patients of bipolar disorder and members of creative families and the potential neurobiological similarities between the two phenomena.

Shapiro, Pamela J., and Robert W. Weisenberg. "Creativity and Bipolar Diathesis: Common Behavioural and Cognitive Components." Cognition and Emotion 13.6 (1999): 741-47. Print.

This article talked about creativity and the diagnosis of bipolar disorder and the similar cognitive and behavioral components involved. It brought up the question of whether the relationship between the two is causative or simply involved in similar cognitive and behavioral processes. The author notes that we ought to really examine each process individually before we start making conjectures about the relationship between the two phenomena.