The link between Creativity and Bipolar Disorder:

A Systematic Review

Silvia Zarraluqui López

MSc: Mental Health. Psychological Therapies

Barts and the London Institute of Psychiatry Queen Mary University

London August 2012

(10035 words)

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AKNOWLEDGEMENT ...................................................................... 3

ABSTRACT ........................................................................................... 4

INTRODUCTION ................................................................................ 6

RESEARCH QUESTIONS: AIMS, OBJETIVES: ......................... 18

METHODOLOGY ............................................................................. 20

QUALITY ASSESSMENT ................................................................ 30

RESULTS ............................................................................................ 35

MAIN FINDINGS ............................................................................... 53

DISCUSSION ...................................................................................... 61

BIBLIOGRAPHY ............................................................................... 68

 

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AKNOWLEDGEMENT

I wish to acknowledge my tutor Nassir Warfa for guide me

through the world of the systematics reviews, with patience and

professionalism.

I would like to thanks also the professor Gella Richards for

motivating and encouraging me to do a systematic review about

creativity, and finally to my family for their patience and

support.

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ABSTRACT

There is a common consensus about the existence of a link

between creativity and madness, and this unanimity is empirically

supported. During the last 30 years a high number of studies have

investigated the nature of the relationship between bipolar

disorder and creativity. One of the main questions that are

creating disagreements in the scientific community is the

definition of creativity. The aim of this study is to provide a

detailed synthesis of the mayor findings obtained in this field and

present a converging summary of the mechanisms that underline

the relation between creativity and bipolar disorder. Thirteen

papers were selected using electronic databases like MEDLINE,

CENTRAL (Cochrane Central Register of Controlled Trials),

PsycINFO, ELSEVIER SD, SCIVERSE science direct and APA

PSYCnet. Case-control studies were used due to the nature of the

variables. Only participants suffering some kind of mood disorder

were included, excluding those ones that had any kind of

psychotic disorder or schizophrenia. The age inclusion criterion

comprehends children on the range between nine and eighteen

years old, and adults in between eighteen and sixty four years old.

The results suggested that bipolar disease in linked with

creativity, and that this relationship is related to a hyperthymic

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affective pattern. Bipolar descendants have higher creativity than

healthy control offspring. Some temperamental variables as

neuroticism, cyclothymia, dysthymia, openness and intuition

were significantly positive correlated with creativity. The overlap

between bipolar disorder subject’s results and creative control

subject’s results on the measure tools of creativity suggest that

there could be some neurobiological commonalities. There were

some limitations, like the restriction of sources used, the use of

case –control studies, the risk of “over-matching” and the sample

selection. Clearly future studies are needed to clarify the

correlation between mania and creativity in Bipolar Disorder.

Keywords : Creativity. Bipolar Disorder. Temperament.

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Introduction

 If we analyzed almost all the human history, creativity was

assumed to be a privilege of supreme existences. A lot of

religions are based on mythologies in which Gods molded the

firmament and the earth. It was only very recently that the

situation overturned: Men and women started being the creators

and the Gods the inventions of their imagination.

(Csikszentmihalyi, M.1996). Although we cannot predict the

ultimate results of creativity, at least we can try to understand this

potency and how it works. Creativity is a product of the

interaction of a structure constituted of three components: A

culture that contains figurative guidelines, an individual who

brings innovation into the symbolic area, and a group of

specialists who identify and authenticate the invention.

(Csikszentmihalyi, M. 1996) Creativity is the cultural

corresponding of the process of genetic changes that generates

consequences in genetic evolution. On creativity there are not

procedures equivalent to the ones that follow the DNAs since a

idea or discovery is not automatically delivered to the next

generation, the analogy is that creative ideas are elements of

evidence that we must study if we want culture to continue. These

components of knowledge are the ones that a creative person

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modifies, and if sufficient persons understand the alteration as

one advance, it will start being part on our culture background.

(Csikszentmihalyi, M.1996). Creative discoveries are unthinkable

without having a previous comprehension of what is happening in

the field, without the academically networks that inspires to

meditate and think, and without the social institutions that

accepted and spread the novelties. (Csikszentmihalyi, M. 1996) A

creative person if wants to create anything, they must first started

to dedicate their attention to the material that has to be studied,

and attention is a limited ability, since a great amount of our

limited forces are focused on surviving day by day. There are

some considerable effects that appeared if we followed these

ideas: to be a creative person in an existing domain; this person

must have extra capacity of attention available.

(Csikszentmihalyi, M. 1996) .As cultures progress, it becomes

progressively more and more difficult to control more than one

area of knowledge; therefore creative subjects with specialized

knowledge in one field will have more opportunities of creating

new ideas over people with generalized knowledge. An important

consequence that appears when they limited their attention is that

creative individuals could be viewed as egotistical, self-centered,

and cold, but in fact creative people are just focused and

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dedicated. (Csikszentmihalyi, M.1996). Considering these

temperamental differences the idea about a connection between

creativity and a mental disease is been considered during

hundreds of years, but until the last century questions about the

nature of this association have not been considered in the

scientific world.

Nowadays there is a common consensus about the existence of a

link between creativity and madness, and this unanimity is

empirically supported. The unresolved questions are about what

exactly type of mental illness, psychosis, schizophrenia or

affective disorder, is related with the creative behavior. One of

the main questions that are creating disagreements in the

scientific community is the definition of creativity. Creativity is

conceptualized in many different ways, as a single construct, as a

continuum and in different forms. Each way to describe the

creativity it is also influenced by the implication creativeness

with some mental pathologies. Creative genius conceptualizes

creativity as a performance that involves effortless and the

unconscious, it appears in moments where the cognitive functions

were disinherited and not guided by a goal. (Martindale 2007)

Other authors like (Amabile, 2010), described creativity as a

characteristically human ability to generate new ideas, new

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attitudes and new explanations”. However, other approaches

consider that the current concept of creativity is poor and

inappropriate, because it only takes into account the operational

level of the activity: creation. Kaufmann (2003) distinguishes

between six types of novelty: The one, which comes from the

stimulus, the one that comes from the response, proactive,

reactive, “Big C” or eminent creativity and “mini C”. Kaufmann

gave us a new dimension to explore, the “eminent or “Big C”

creativity”, following this line Nora Madjar (2011) published an

article proposing that creativity is based on ideas that conform a

continuum. This continuum goes from radical ideas that create

revolutions to routine performance, considering the existence in

between of other options like incremental creativity, radical

ideas… being all this concepts potentially positive. She created

the new term of “radical or divergent” creativity, being that

activity, which generates ideas, that are substantially different

from the existing ones, and did not fit into the current

organizations and practices. These ideas form new frames and

processes. Nora Madjar (2011) showed that inclination to take

risks and have resources and dedication are related to radical

creativity. According to this position, when individuals are

challenged with a new situation, they tried to understand and

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handle it by creating their own explanation and significance of it.

This behavior provides new aims and incentives for the next

accomplishment (Nora Madjar, 2011). She underlined as

especially important is the “sense making theoretical

framework”, which is based on Ford’s (1996) interpretation of

creativity. This theoretical framework believes that creative

activities are the opposing behavior that appears when the options

available are restricted or does not answer our requirements.

(Nora Madjar, 2011). Individuals use the creativity to negotiate

between conflicting structures of reference assumed by the

different groups they are subordinate with. This model suggest

that when a creative person made the choice to be involved in a

creative task, apart on the personal and circumstantial issues,

involves complex cognitive processes. Following this approach,

“the sense making” assessment of creativity, offers a valuable

structure to understand the causes of how individuals understand

and perceive a setting and how and how they perceive the to

create something new. Furthermore, this perspective contributes

to prevailing models of creativity by recognizing the role of the

person´s interpretation of the context. (Nora Madjar, 2011).

However those are only some theoretical approaches, creativity is

not an isolated concept, is strongly correlated to the

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environmental forces. Hennessey and Amabile in 2010

represented these forces in concentric circles (figure 1) in which

“creativity forces perform”.

Figure 1 (Hennessey, Amabile, 2010)

As Csikszentmihalyi, (1996) said, creativity does not happen

exclusively inside people´s mind, but in the interaction between a

person´s opinions and feelings and a socio-cultural environment.

It is a general rather than an individual phenomenon. Adding to

that creative expressions are universal phenomenon that appears

in all cultures. Rudowicz (2003) argued that the relationship

between creativity and culture is complex and historically,

socially and individually biased.

As we could see there is multitude of approaches to assess the

definition of creativity. The majority of then generally have

restrained correlations. Because the multiple forms to define the

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paradigm, researches have also considered the abilities that

conform the creativity as paradigms. Jonshon in 2012 published a

small sample of the different test that was made to measure the

abilities linked with creativity. Many of them are founded on

conceptual models. For example the Remote Associates Task

(RAT), (Mednick, 1967), measure the creativity trough the study

of the ability to generate associations, therefore considering

creativity as the capacity of produce a broad series of

associations. Other tests provide measures of originality, fluency

and flexibility like the Unusual Uses Task (Guilford, 1967), in

this test creativity is conceptualized as the ability to propose no

redundant uses for things, the capacity of generate new categories

inhibiting the prior responses. Jonshon (2012) finally

distinguished two kinds of processes that we use to solve the

creativity difficulties: The logical, systematic, conscious way and

the insight, unaware process. This last one refers to the state were

the person is not consciously aware of the process that he or she

is using to solve a problem, doing new combinations, relating

distant concepts. In sum, the literature about creativity is broad

and full of different paradigms trying to reach the definition of

the concept. This is one of the mayor troubles of the field.

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It was only recently centuries Bipolarity and Creativity have been

linked. In general it is considered that many artists suffered mood

disorders, and their creativity increased especially during the

manic periods. During the last 30 years a high number of studies

have investigated the nature of this relationship. Some of them

have considered that creativity is a risk factor to developing a

bipolar disorder; others cite creativity as a consequence of the

mood disturbance.

Bipolarity is an illness that encompasses a wide variety of manic

and suppressive symptoms with different severity and variations.

The main symptoms are: “vivaciousness and touchiness, reduced

need for rest, speeding thoughts, extreme self-assurance,

augmented vigor, psychomotor tension, and inclination to engage

in reward-oriented comportments without respect of possible

negative costs (American Psychiatric Association, 2000).

Generally the illness is classified into three subtypes: Bipolar

Disorder I, Bipolar Disorder II and Cyclothymic disorder. The

RDC (Spitzer et al.1978) divided the Mood disorders into Maniac

disorders characterized by elevated, expansive or irritable mood.

Hypomanic disorder categorizes the nonpsychotic manic-like

states that do not have enough intensity or impairment to meet

manic criteria. Bipolar Depression with Mania (Bipolar I) is a

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category that refers to the subjects who met the standards of a

manic syndrome and depressive syndrome, which could be major,

insignificant or sporadic depressive disorder. Bipolar Depression

with Hypomania (Bipolar II) is diagnosed when any patient has

congregated the conditions for hypomanic and depressive

disorder together, but has never suffered a full manic disorder.

This variation is included because some evidence indicates that

the people suffering Bipolar II disorder has a nearer relationship

to Bipolar I than to a Unipolar Depressive Disorder. Akiskal and

Pinto (1999) said that Bipolar Disorder I and Cyclotimyc disorder

meet all the criteria in the “bipolar spectrum”, while patients with

Bipolar II Disorder sometimes have “only” one manic episode.

Patients with Bipolar Disorder II usually present also less severe

hypomanic episodes. Finally, Cyclothymic Disorder draws

situations of chronic changes between low and high mood states

that are not strong enough to be classified as manic or depressive

episodes.

There is a long history of investigation into the relationship

between creativity and bipolarity. Initially a scientist called

Nancy Andreasen undertook what we used to consider the “the

landmark” study in 1987;subsequently Kay Jamison published a

very influential work in 1989, after in 1993 wrote “Touched With

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Fire: Manic Depression and the Artistic Temperament”(Jamison,

993), which is one of the most important works ever published in

this field. Later in 1995 Arnold Ludwig write “The Price of

Greatness: Resolving the Creativity and Madness Controversy”,

another important piece of research. As an example of studies

that support the correlation between mood disorders and

creativity, some Vellante et al. (2011) founded that in a sample of

non-clinical professional artist, creative people had higher scores

comparing to the control group, on the “CAQ and on the

cyclothymic, hyperthymic and irritable sub-scales of the TEMPS-

A, however not on the GHQ”. They had found as well that those

people on the risk for bipolar spectrum (Vellante et al. (2011)

specially trough the cyclothymic aspects. Creativity is mainly

related to mania episodes as described by the tools to measure the

sub-syndromal manic symptoms like as the General Behavior

Inventory (GBI), ( Depue, Krauss, Spoont et al. 1989), and

measured by the Hypomanic Personality Scale (HPS);( Eckblad,

Chapman, 1986). For instance Ma (2009) or Ludwig (1992)

demonstrate a high level of prevalence of this disorder on a

creative population, specially linked with the mania episodes.

(Goodwin, Jamison 2007; Rothenbergm 2001). Carlson and

Goodwin defined the stages of mania in 1973 as: Stage 1:A Slight

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distressed speech, divergent, hyperactive, and joyful. Stage 2:

Paranoid, hyper-religious, hyper verbal, patrolling and feelings of

grandiosity. Stage 3:Hyper verbal, delusional, terrified, labile,

suspicious, sexually preoccupied, disoriented and angry. Stage 2:

Still paranoid but more cooperative, agitated, hypersexual,

manipulative and angry. Stage1: Calmer, more organized, over

conversational, seductive, and depressed.

In the following graphic we could see how Jonshon in 2012,

represented the relationship between Bipolar Disorder and

Creativity, being the “Risk of Mania” one of the fourth main

factors that contributes to reinforce this correlation.

Figure 2. (Jonshon et al. 2012)

Bipolar  Disorder   Creativity  

 

Diagnosis   Risk  for  Mania  

Family  History  

Related  traits  

Activity  Preference  

Divergent  thinking  Related  

traits  

Eminence  achievement  

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However there are some limitations on the studies that have been

done about creativity and bipolar disorder. First most of the

researchers were concentrate in one part of the field, being

sometimes unaware about the advances in other disciplines

related to the psychology of creativity. (B.A. Hennessey. M.

Amabile (2010)). Others have used small sample size, becoming

their findings insignificants, for instance Vellante et al. 2011)

founded that a significant number of studies that show a

connection between Bipolarity and creativity were founded on

insignificant, non-randomly selected samples, considered

retroactive explanations on psychopathology. Finally there are

some researches that have founded these results inconsistent. For

instance De Dreu et al. (2008), or Friedman et al. (2007) showed

that how affect the bipolar disorder the creativity is not yet

settled. Chavez-Eakle and colleagues (2001) discovered trough a

sample of highly creative population that they punctuated low

scores on bipolarity, concluding that mood disorders are more

related with personality instead of creativity.

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RESEARCH QUESTIONS: AIMS, OBJETIVES:

As explained in the introduction, theories of a relationship

between creativity and bipolar disorder date back fifty years.

Even recent work exposed a strong association between bipolarity

and creativity. However, questions still remain regarding what

mechanisms underline such associations, and how an illness that

potentially threatens and constrains life could be advantageous to

becoming an artist. The research undertaken juggled with

different reasons that could explain this link; it involves affective

and cognitive components, talent, motivation, neurobiological,

and environmental factors. Since explanations of the mechanism

that underline such relation are beginning to emerge and more

investigation is needed, this study is going to conduct an

exhaustive review of the most representative literature relevant to

our research question: How is creativity related to bipolarity?

The aim of this study is to provide a detailed synthesis of the

major findings obtained in this field, selecting a small but

representative division of studies, and presenting a converging

summary of the mechanisms that underline the relationship

between creativity and bipolar disorder.

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The objectives are to investigate

• Whether bipolar disease is linked to creativity.

• The genetic basis of the relationship between bipolarity and

creativity through familial studies.

• How some temperamental features influence the

development of creativity.

• The neurobiological link between creative behavior and

bipolar disease

• Gaps in current research that need to be investigated

• Provide useful recommendations for future research

   

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METHODOLOGY

The Systematic review is a valuable and an extremely useful

scientific tool, considering that researchers and health

professionals are generally overwhelmed with a large amount of

information. There is a necessity to integrate all this information

in order to identify the most significant data for policymaking. A

good systematic review presents the most consistent findings that

could be generalized across population and the methodology used

instills confidence in professionals about the accuracy of the

results obtained. (Mulrow, 1994).The first reason for the

necessity of this tool is the vast amount of articles published

every year, making it impossible for the investigator to read all of

them and be up-to-date in the field. (Mulrow, 1994). The second

reason that justifies the use of this instrument is the necessity of

providing a summary of the most important and critical results

obtained to the analysts that create health policies. This assists in

the formulation of new strategies and legislation concerning

diagnosis and treatment approaches. The third reason is that it

aids researchers in avoiding possible setbacks or difficulties and

refines their objectives and research questions. (Mulrow, 1994) A

systematic review prevents any deviations or new research in

previously explored fields, and enables a faster implementation of

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the diagnostic/treatment strategies. This tool is also one of the

search strategies that allow more generalization of the results,

since it reviewed very diverse studies. It also provided a more

realistic context of the field, sometimes not available in any

randomized controlled trials, quasi-experimental studies or

observational designs. (Mulrow, 1994) Finally, linked with the

capacity of generalization that the systematic reviews gave us,

another strength of this methodology is the information regarding

the consistency of the relationships between variables, and vice

versa the systematic reviews explain data deviation and disparity,

and whether findings are effective.

Search Strategy

Following PICOS strategy the data extracted for this review is in

this summary:

Population Patients suffering any mood disorder (BD, MDD,

Cyclothymia )

Intervention Measure their creativity through different tools.

Comparator Creative and Healthy people without any mood disorder

Outcome Creativity performance

Study design Randomized controlled trials and quasi-experimental studies

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The databases used for this research were the ones linked with

the catalogues of Queen Mary Library, the British Library and

The Senate House Library. The electronic databases were

MEDLINE, CENTRAL (Cochrane Central Register of

Controlled Trials), PsycINFO, ELSEVIER SD, SCIVERSE

science direct and APA PSYCnet. Another important way of

obtaining the articles was searching through the Journal of

affective Disorders.

The terms used during the research were:

Independent Variable dependent variable

Bipolar Disorder Creativity

Mood Disorder Art

Bipolarity Artist

Mania Genius

The process of data extraction ended with a large number of

potentially interesting papers, but only a few of these studies were

selected. A designed protocol was followed in order to minimize

mistakes and bias that could appear during the selection process.

The first selection was made based on titles and abstracts. The

majority of the papers were rejected because the paper was not

focused on the research question, for instance papers where the

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concept of creativity was linked to other mental health problems

such as schizophrenia. Other papers were excluded due to the

methodological approach; for example, some papers were

observational case- studies that specified a large amount of

research about individuals like the composer Schuman or the

writer Virginia Woolf.

In the second stage papers where the full text was unavailable

were excluded, as were duplicate papers.

In the third and final stage some papers were removed due to

their unsuitability with the exclusion criteria. For instance, in this

stage papers such as “The Link Between Bipolar Disorders and

Creativity: Evidence from Personality and Temperament Studies”

(Srivastava, Ketter 2010), and “Art, alpha-1-atitrypsin

polymorphisms and intense creative energy: Blessing or

curse?”(Everett, 2007) were excluded. The former due to the

methodological approach, and the latter paper because the

biological content was not suitable to compare to other papers.

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Each paper of this review has been selected following clear

criteria regarding the study strategy. Certain study designs are

methodologically stronger than others, while other designs are

comprised of more detailed information even they are less robust,

(for example the observational studies). In this area of study an

assortment of study strategies is needed in order to adopt diverse

variables in the same review.

Inclusion and exclusion criteria

Study characteristics

Only studies whose aims were to find a relationship between

creativity and mood disorders were incorporated. Also considered

were those who studied the nature of the association. Prospective

cohort studies were excluded since the purpose of the review is to

find a correlation between the variables at the present time. To

study the consequences of the link between creativity and

bipolarity across time is an objective excluded and postponed for

future investigations. Case-control studies were included due to

the nature of the variables, it being necessary to compare groups

from the same population (creative people, members of the same

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family) with and without a mental disorder, therefore the risk of

“over-matching” has been considered when the groups were

made to make them comparable for possible confounding

features. One cross sectional study is included (Soeiro de Souza

et al. 2011), because of the nature of the study and the useful

information it provides.

Participants

Only participants suffering some kind of mood disorder were

included, excluding those that had any kind of psychotic disorder

or schizophrenia. This criterion involved subjects that suffered

from Bipolar Disorder I or II, Cyclothymia and Major Depressive

Disorder. Patients with a comorbid illness were also included

especially the bipolar progenies see (Simeonova et al. 2005), pg.

626. For example, Oppositional Defiant Disorder (ODD),

Conduct Disorder (CD) and other anxiety disorders like a general

anxiety disorder, separation anxiety disorder, obsessive-

compulsive disorder, social phobia, and post-traumatic stress

disorder. In the case of the control group, healthy creative

participants have been included.

The age inclusion criterion consists of children between the ages

of nine and eighteen, and adults between eighteen and sixty four

years old. College students have also been included; even though

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the age was not specified. Finally, the Forgeard (2008) study does

not indicate the overall age of the participants, but it has been

included as an exception in this case due to the nature of the study

Intervention and setting

All the settings where the intervention was delivered were

enclosed. Considering the nature of the study, it is consider that

where the test administration was applied did not influence the

outcomes. (This sentence is confused) Studies where the data

measuring and preparation to assess the relationship between

creative behavior and mood disorders was applied in different

settings such as hospitals or universities were included. Only the

researchers that included a pharmacological or therapeutically co-

intervention were excluded.

Outcomes

Only psychometric tools were considered to measure the

correlation, but excluding those ones without methodological

internal consistency. Meaning that all of the tools used had to

have been previously approved and tested. For example, the text

analysis software program “Linguistic Inquiry and Word Count”

used by Forgeard (2008), has been continuously positively tested

by Pennebaker et al. (1998).

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The definition of creativity used for each study is not an

exclusion criteria, since this paper underlines in the introduction

that there is not a general consensus about the definition of this

paradigm.

Finally, regarding the results, only studies with significant

positive or negative correlations between the independent and the

dependent variable were included.

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INCLUSION EXCLUSION

Study Characteristics

Link between creativity and Mood Disorders.

Links between creativity and other mental illness .

Case-Control studies Crossectional studies.

Prospective cohort-studies.

Participants

Bipolar Disorder II, Cyclothymia and Major Depressive Disorder patients or I. Comorbid illness (ODD, CDD, Anxiety Disorders)

Psychotic disorder or schizophrenia patients.

All ages included X

Intervention Setting

All settings included X Intervention focused on assess the relationship between creative behavior and mood disorders

Pharmacological or therapeutically co-intervention

Outcomes

Measurement: Psychometric tools Non methodologically tested tools

All definitions about the concept of creativity

Non consider to define the concept of creativity

Significant correlations on the results between the variables

Non significant correlations on the results

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Quality assessment

There were two types of studies used in this systematic review to

assess the correlation between creativity and bipolar. Twelve case-

controls and one cross-sectional study, all of them are observational

studies, for this reason it is particularly important to consider the

individual aspects of the designs in order to avoid possible bias.

The Centre for Reviews and Dissemination of the University of

York, described in the publication “Systematic Reviews” (2009), a

bias as a “systematic deviation from the true underlying effect

brought about by poor study design or conduct in the collection,

analysis, interpretation, publication or review of data”. Therefore,

assessing the quality of these studies was difficult due to the varied

range of data provided per analysis. A procedural research has been

carried out trying to recognize the characteristics of each paper

most connected with predispositions or prejudices. One of the main

problems was that the participants were not blinded. (They knew

they were being tested because they were creative or bipolar). The

control groups, especially the ones formed by creative controls

were another source of difficulty because they could be

“contaminated” by the stereotypes of “creative genius”. Armstrong

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et al. (2007) provided a checklist that compiles the criteria for

assessing quality on qualitative studies. This study followed those

guidelines:

1. Method applicable to research inquiry

2. An clear link to the model

3. Distinctly specified aims and objectives

4. A well-defined explanation of setting

5. A clear description of sample

6. A clear description of research methods

7. Validation of the data analyzed

8. Inclusion of enough data to funding the explanations

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All the studies followed an appropriate methodology to measure

the variables with the exception of Soeiro de Souza et al. (2011)

who used a cross-sectional methodology to measure the

correlations, losing the prospect of having a control group that

provides a deeper point of view. Forgeard et al. (2008) does not

include information regarding the diagnosis methodology that it

used to assess whether the subjects suffered from bipolar or

unipolar disorder. The main weakness of this review appears on

the description of the context used and the sample

characteristics because ten of the thirteen studies used

population non-randomly selected from the same environment.

Is worth noting that six of the studies samples were collected at

the Stanford Clinic (USA), and the other three studies used

college students. However, Richars et al. (1988),Kyaga et

al.(2011) and Soeiro de Souza et al .(2012) used a less uniform

sample. Finally, it is important to underline the descriptive

nature of these studies since they are measuring a subjective

construct such as creativity, and almost all of them manage to

choose the correct methodology to measure the creative

behavior. The exceptions being Kiaga et al.(2011) and

Nowakowska et al.(2005) that have some limitations, and

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Fodor,Laird(2004) and Forgeard (2008) that were focused on

creative writing and probably did not have access to more

sources of data measurement.

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RESULTS

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These thirteen papers were written following generally the same

purpose: To find a relationship between Mood Disorders and

creativity. However, all of them followed different inclusion and

exclusion criteria in order to select the sample and the

methodology. Specifically, two included family as an

independent variable; others added neurological and

pharmacological variables, whilst another two papers purpose

was to study the non-eminent creativity excluding other types of

creativity. Finally, two researches focused their hypothesis solely

on the creativity related to the writing process.

Richard et al. (1988) centered their research on the possibility of

a familial compensatory advantage to bipolar illness involving

creativity, and Simeonova et al. (2005) attempted to find if

children with a bipolar parent would display higher creativity

scores than healthy control children. Kyaga et al. (2011) also

includes the family variable, however, this study gave more

importance to another systemic variable: The professional

occupations of the participants. The aim of this study was to find

the occurrence of creative occupations among individuals with

schizophrenia, unipolar depression, bipolar disorder, and their

families. Soeiro de Souza et al. (2011) assessed conceivable

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differences in creativity marks among manic, mixed, and

depressive episodes of bipolar disorder, the impact of the

executive function, and the effect on medication-free bipolar I

Patients, they therefore included the use of medication and how

the neurocognitive functioning of their patients, giving another

perspective into the problem. Following the neurocognitive

approach Soeiro de Souza et al. (2012) investigated whether there

was a neurocognitive relationship between the BDNF genotype

(Brain-derived neurotropic factor) and creativity. BDNF is the

one of the most extensive and practiced neurotropic and it is

related to the pathophysiology of Bipolar Disorder. Santosa et al.

(2007) investigated the non-eminent creativity in bipolar disorder

patients compared to healthy controlled group patients. With non-

eminent or “everyday creativity” these authors confined their

research to a more specific concept. This concept was also used

in the study of Shapiro, Weisberg (1999) when they tried to

determine if the association between bipolar disorder and

creativity would generalize to creative individuals “beyond the

circle of eminence”. The Srivastava et al. (2010) paper focused

the research on creativity related to intuitive thinking in order to

find if Bipolar Disorder is not just linked with negative and

changeable feelings but also positive skills. Rybakowski,

39  

Klonowska (2011) restricted their research to the effects of an

acute affective episode (depressed or manic) and the descriptions

of how an schizotipy state influences the measurements of

creativity. Strong et al. (2007) goal was to investigate the

temperament-creativity relationships, understanding those

temperamental behaviors most strongly related to creativity.

Nowakowska et al. (2005), purpose was to examine

consistencies and variances between euthymic mood disorder

subjects, creative or healthy controls. Finally, Fodor, Laird (2004)

and Forgeard excluded in there research the creativity unrelated

to the writing process. They tried to demonstrate that persons

with a bipolar inclination would achieve the highest creativity

ratings in their writing style than healthy control group

participants.

40  

41  

Twelve of the articles in the review used a control group, only the

Soeiro de Souza et al. (2011) research did not employ this tool,

testing 67 individuals with Bipolar Disorder I. Regarding the size

of the sample, it is remarkable the study of Kyaga et al. (2011),

54042 patients with Schizophrenia, 29644 patients with Bipolar

Disorder and 217771 patients with Unipolar depression were

tested. The information concerning the number of siblings tested

in the control group is not provided in the research; nonetheless

the sample size is one of the strongest points of this research.

Conversely, Simeonova et al. (2005) had the smallest sample size

with who belonged to families where at least one member had

bipolar disorder, and 18 healthy control subjects.

Another interesting methodology tool is the use of Creative

Controls in the sample. This offers the perspective of seeing if

merely being creative makes you more susceptible to having a

mood disorder. Santosa et al. (2007) evaluated 49 bipolar

disorder, 25 manic-depressive disorder and 32 creative controls

comparing them to 47 healthy control subjects. Srivastava et al.

(2010) tested 32 bipolar disorder patients, 21 with a major

depressive disorder, 22 creative controls and 42 healthy controls.

Strong et al (2007) also utilized a group of 32 creative control

subjects, comparing them with 49 bipolar, 25 major depressives

42  

and 47 healthy controls. Finally Nowakowska el al. (2005)

utilized as well a sample of 32 creative controls, relating them

with 49 bipolar disorder patients, 25 with major depression, and

47 healthy controls.

Finally, another interesting characteristic of the sample is the

selection criteria. Forgeard (2008) selected 30 deceased writers,

10 Unipolar, 10 Bipolar and 10 healthy. However, Fodor, Laird

(2004) randomly chose 22 living writers with an inclination

towards bipolar disorder. Therefore, both studies, despite the fact

they were focused on the same field, had completely different

sample characteristics.

43  

44  

All of the studies employed different psychometric tools to

diagnose the euthymic disorders in the sample. Two of the studies

concerned have accessed patient data. This is interesting

considering that each doctor would have to follow different

criteria due to their varying psychological approaches. The

weakness is that it is difficult to control that variable and we

could deal with different concepts of bipolarity, on the other hand

this diagnosis data follow test results, and referees- doctor

opinion as well, so the profile is much more complete. The study

developed by Richards et al. (1988) utilized the clinical records

gathered together by Wender et al. (1986), also adding the

Centralized Danish registers, always following the DSM IV

diagnosis group criteria. Kiaga et al. (2011) employed the

Swedish Hospital Discharge Register (National Board of Heath

and Welfare), but there was no clarification as to which

Diagnosis Criteria System the register follows. The other two

pieces of research found the patients through recognized

psychometric tools, the positive point is that the result would be

more homogeneous and the variables more controlled, however,

this meant they lost the opportunity to have a biopsicosocial view

of the person, which is how the illness functions in a family, and

45  

how it affects society and also the biological system of the

individual. Soeiro de Souza et al. (2011) utilized the LICAVAL

Clinical trial, the Structured clinical interview (SCID-I/P), The

Young Mania Rating Scale, the Montgomery-Asberg Depression

Rating scale and the Clinical Global Impression. The SCID:

Structured-semi-structured clinical interview is one of the tools

more widely used, namely by Soeiro de Souza et al. (2012),

Santosa et al. (2007),Simeonova el al.(2005) and Nowakowska et

al.(2005). The SCID is a semi-structured interview to assess the

major Axis I DSM-III-R diagnoses. It contains a preliminary

overview followed by nine modules, seven of which represent the

major axis I. Using a “decision tree approach” Ref Inc. (Spitzer el

al.1992). The SCID helps the clinician examining diagnostic

theories during the dialog. The output of the SCID is a register of

the incidence of each of the disorders being considered currently

and during a period of time.

The Beck Depression Inventory is also frequently utilized.

Santosa et al. (2007), Srivastava et al. (2010), Strong et al. (2007)

and Nowakowska et al. (2005) applied it so as to determine the

appearance of a mood disorder on the subjects of the sample. As

by Ref Inc. Beck in 1961, The Beck Depression Inventory (BDI)

is a scale that measures 21 feelings or thoughts: sadness,

46  

pessimism about the future, feelings of failure, lack of

satisfaction feeling of guilt, grief, hatred of self, reproachful

towards himself; suicidal Ideation; fits of tears, irritability, social

interest, indecision, body image work, sleep disturbances, fatigue,

appetite, weight loss, attention towards their health and libido.

Each category describes a specific behavioral manifestation of

depression and consists of a series of 4 to 5 states. The proposals

were ranked by degree of severity ranging from 'no symptoms' to

extremely severe. Beck (1961) in his original report on the BDI

states that the internal consistency using the split-half method

shows high reliability: the Pearson correlation between odd and

even categories reached r = 0.86. Correction with the Spearman-

Brown coefficient of 0.93 is even reached. An agreement exists

with the findings by psychiatrists in 97% of cases, with a point of

difference for the four-point scale. Finally, is important to

underline the fact that the Forgeard (2008) paper that classified

eminent deceased writers by their mood disorder, followed the

“Diagnosis of mental illness by Jamison (1993). This was

necessary due to the retrospective nature of the study. Forgeard et

al. (2008) justified this decision by explaining that the Jamison

classification was based on “documentation from different

sources.”

47  

48  

Each study measured the creativity term in different ways.

Subsequently, in the data analysis, Richards et al. (1988) and

Kyaga et al. (2011) did not apply an elongated battery of tests.

Kyaga et al. (2011) (researchers) employed an uncommon

methodology to investigate creative subjects. They referred to the

Nordic Classification of Occupations for Creative professions so

they determine the creativity of the subjects only under

productivity or professionally characteristics, disregarding the

“unproductive” and creative behavior, (unproductive as in

engaged in an unpaid activity or an amateur). Another problem is

that there could be creative people, especially bipolar patients that

did not feature on that list, as they perhaps lived in an inpatient

clinic and they not registered as having a particular occupation.

Richards et al. (1988) also utilized the interview as a tool to

distinguish creative people, the question is what kind of

interview, questions, and measures they have employed.

Alternatively, they use the Lifetime Creativity Scales, which is

validated, and helps to assess “everyday creativity”. Soeiro de

Souza et al. (2011) and Santosa et al. (2007) based their

investigation on a long battery of tests. Firstly, they employed the

BWAS, the Neurocognitive: WCST, the WCST-CONC, the

WCST-PR, the WCST-FMS, the WCST-CC, the WCST-E, the

49  

WCST-NP, the WCST-P and the Intelligence Scale: WASI.

Santosa et al. (2007) also utilized the Barron-Welsh Art Scale

(BWAS) , annexing the Adjective Check list Creative Personality

Scale (ACL-CPS), and the Torrance Test of Creative Thinking on

Figural (TTCT-F) and verbal versions (TTCT-V).

It is important to underline The Barron-Welsh Art Scale (BWAS)

utilization, owing to the fact that it is used in several studies of

this systematic review with the exception of the two named

above. Srivastava et al (2010), Soeiro de Souza et al. (2012),

Strong et al. (2007), and the Simeonova et al. (2005) papers also

employed this method. Santosa et al. (2007) described the Barron

–Welsh Art Scale (BWAS) as an empirically derived metric

created by Barron in 1963, formed by 86 black or white images

that the subject could rate as like or dislike. Higher scores are

given for the subjects that show preference for asymmetrical and

complex images. Generally creative people choose those figures

more frequently. BWAS involves not only visual processing of

the images, it also involves an affective process that appears

when the subject expresses there like or dislike of the images.

The second most frequently employed instrument is the ACL-

CPS scale. It is utilized in Srivastava et al. (2010),Santosa et

al.(2007),Strong et al.(2007), and finally the Shapiro and

50  

Weissberg (1999) papers. Santosa et al. (2007) described it as a

derivation of the Adjective Checklist created by Gough in 1979.

This scale reflects any supposed personality constituent of

creativeness. The participants have to designate adjectives

recognized by experimental studies to distinct groups of creative

and non-creative individuals. Some of the adjectives like

ingenious, hilarious, inventive, and original, are frequently

ascribed to creative people, while others like conservative,

commonplace, honest, or submissive are rarely linked with

creative people. Rybakowski and Klonowska (2011) used two

uncommon tests, the Revised Art Scale (RAS) and the Berlin

Intelligence Structured Test (BIS). The first one measures

creativity from a psychoanalytic perspective, and it assumes,

similar to the BWAS scale that creative people have preferences

for irregular and complex figures. The BIS however, define

creativity as a subcomponent of intelligence. Finally, is important

to point out that the Fodor, Laird (2004) and Forgeard (2008)

papers utilized completely different measures for their studies.

The reason being that they focused their papers solely on the

creativity linked with the activity of writing. Fodor and Laird

(2004) used Play Therapy to interpret Children´s Stories and

compose Haiku Style poems. The use of Haikus is an interesting

51  

tactic since Blasko and Merski in 2010 stated that the unity of

simplicity of form and profundity of connotation makes the haiku

a perfect subject for the interdisciplinary analysis of creativeness.

52  

53  

Main findings

 This review will analyze outputs following a criteria based on an

independent variable, which means that firstly the results

concerning to correlations between creativity and a mood

disorder (including the creative controls) will be analyzed and

secondly, the correlations between creativity and temperament

features. Finally, a more in-depth analysis of the correlation

between creativity and the bipolar stages: manic or depressive.

Only the positive or negative correlations represented by a

significant statistic result will be considered. There is a strong

positive correlation between having a Bipolar Disorder and being

creative. Santosa et al. (2007) found that Bipolar patients, had a

45% higher mean BWAS-Total score than the healthy control

group, but no more than the creative people control group and

similar to scores previously observed in architects (29.4 ± 10.6)

and creative writers (32.9 ± 11.1) It is realistic that

temperamental/ character variances could contribute to

heightened creativity in Bipolar disorder, with medication, and a

history of drug misuse also influencing it. Santosa et al. (2007)

encouraged further investigation concerning this point and

54  

stressed the necessity for more studies regarding age differences.

Srivastava et al. (2010) presented BWAS- total scores

significantly higher compared to HC patients in BP and in CC

patients. The same happened with the BWAS-dislike scores.

TEMPS-A-Ciclothymia/NEO-Neuroticism scores were

significantly upper in BP, MDD and CC. Myers-Brigg Type

Inventory: MBTI-Intuition: Had significantly upper scores with

the BD group compared to MDD, CC and HC. The authors

suggested that Affective (NEO-Neuroticism and TEMPS-A-

Cyclothymia) and cognitive (NEO-Openness and MBTI-

Intuition) factors contributed to components of the creativity

measured by the BWAS-Dislike and the BWAS-Like.

Rybakowski and Knlonowska in 2011 discovered that in the BIS:

Berlin Intelligence Structure Test scores, BP subjects had

significantly better results compared to HC on the total creativity

BIS scale, and especially in the section related to verbal

creativity. Simeonova et al. (2005) in their paper concerning the

sample size of patients with bipolar disorder, showed that 100%

had a comorbid illness such a ADHD, Oppositant defiant

disorder, and Conduct Disorder…Regarding the results in

creativity, parents on the BWAS Dislike subscale scores graded

significantly higher than the control group. Children related to

55  

patients with mood disorders, that also suffered BD or ADHD

themselves, had high punctuations particularly on the BWAS

Dislike subscales compared to the control group. Elevated/great

punctuations on the BWAS Dislike subscale indicate that patients

dislike simple and symmetrical figures). This shows that bipolar

descendants with psychopathology may have more eminent

creativity than healthy control children. Limitations to this study

included the small simple size, and the use of BWAS as the only

assessment test, where only one aspect of creativity is measured.

Furthermore, it is still not validated on children so some of the

results may not be reliable. Finally, bipolar descendants might be

more creative due to the family environment, being influenced by

their parents’ projects and views. Nowakowska et al. (2005)

presented that patients with mood disorders and creative controls

punctuated higher on Cyclothymic, Irritability and Dysthymia

than the healthy control subjects on the TEMPS-A Scores:

Measure of Cyclothymia /Irritability/Dysthymia/ Hyperthymia.

Surprisingly on irritability, Creative Controls did not grade

significantly higher than bipolar and depressive disorder patients.

The most significant percentage is the one that showed that

Bipolar Disorder patients had significantly more cyclothymic

symptoms than the others (Major depressive disorder, creative

56  

and healthy controls). Neuroticism had a similarly high grade in

BP, MDD, and CC compared to HC. In contrast,

conscientiousness was decreased for MDD, BD and CC again

compared to HC on the NEO-PI-R:

Neuroticism/Conscientiousness/openness. Finally, openness had

significantly elevated scores for BD than for CC, and CC

obtained significantly higher scores than HC and MDD. On the

TCI there was significant group differences for harm avoidance,

self-directedness, novelty seeking and self-transcendence.

Particularly BP, MDD and CC scored much higher than the HC

group on harm avoidance and novelty seeking punctuations.

These three groups a significantly lower grade that was almost

identical on self-directedness compared to HC. Only for self-

transcendence did BP score higher than the other groups. Fodor

and Laird (2004) showed participants with a bipolar inclination

who received exposure to the play therapy procedure were the

group who subsequently exhibited the highest levels of literary

creativity. DB patients achieved higher creativity scores in their

writing of haiku –style poems than CC, and they also achieved

insignificantly higher scores interpreting children’s stories. Manic

patients produced highly creative poems. Finally, only Forgeard

(2008) did not support a positive correlation between creativity

57  

and mood disorders, in his first study 30 works were analysed

using Pennebakes et al. (2011) Linguistic Inquiry and Word

Count, 74 lexical groups referring to sensitive, intellectual,

bodily, and societal processes were considered. Comparing

bipolar, unipolar and control writers, non-significant differences

between unipolar, bipolar and healthy writers uses of words

connected to emotions during creative process were found. In his

second study again employing Pennebaker et al. Linguistic

Inquiry and Word Count (2001), he showed that the kind of mood

disorder (unipolar or bipolar) that a writer suffers is related with

some linguistic characteristics. Writers with unipolar depression

explicit more interest in others intellectual processes, while

writers with bipolar disorder use more lyrics related to mortality.

However, those results were not directly related to creativity. In

Kiaga et al. (2011) research indicated the number of individuals

with bipolar disorder significantly increased in creative

professions, especially in visual artistic professions. The

difference is well defined if compared with the control group.

The first-degree relatives were also revealed as having more

creative occupations, for example, scientific or creative

professions.

58  

Regarding temperament features related to creativity, Soeiro de

Souza et al. (2011) research results were divided between three

groups formed by twenty patients experiencing manic episodes,

twenty-one mixed states and twenty-six depressive episodes.

Concerning neurocognitive functions and executive function

scores, as rated by the WCST; the manic group had higher scores

than the mixed group in the neurocognitive tests. The final scores

on the BWAS test were more elevated in the mania group than in

the mixed or depression episode groups, however, IQ scores did

not differ between them. Kiaga et al. (2011) found that IQ (only

in males) was commonly superior in people with creative

occupations, but lower in those persons with bipolar disorder and

respective siblings, always comparing them with people without

any diagnosis. Mood changes and cognitive functions only affect

the BWAS scores of the mania group. Richards et al. (1988)

found the highest correlation among creativity and Bipolar

Disorder on cyclothymic patients than in manic-depressives and

their relatives. Indeed, the level of creativity was higher in manic-

depressives, cyclothymic, and normal first-degree relatives

combined, but cyclothymiacs had a stronger correspondence.

Richard et al. (1988) added information about vocational peak

creativity (arts, sciences, humanities and social sciences),

59  

showing that cyclothymic people punctuated significantly higher

creativity than the other two index groups. Rybakowski and

Klonowska (2011) study results presented non-relevant effects of

a manic episode on creativity, however, depression had a

detrimental effect on the creativity measured by the BIS scale.

(Depression-creative block) Schizotipy symptoms correlated with

RAS-like, RAS-dislike, and RAS-total. Shapiro and Weisberg

(1999) results were about the “continuous affective patterns”,

Creativity scores measured by the ACL-CPS, are higher when

hypomania-plus-biphasic scores are high and depression scores

low. With regards to the “criteria affective patterns” individuals

displaying a hyperthymic pattern measured significantly higher

on ACL-CPS creativity scores than those at risk for either

cyclothymic or depression. In conclusion, Shapiro and Weisberg

(1999) study gave insignificantly different ACL-CPS creativity

scores for individuals meeting GBI criteria for hyperthimic from

those least symptomatic, or euthymic individuals. (Those results

differ from the results obtained by Richards (1988). Finally,

Strong et al. (2007) measuring the temperament –creativity

relationship found that BWAS-Total scores correlated

significantly with the Neuroticism / Cyclothymia /Dysthymia

Factor. BWAS-Dislike scores also correlated significantly with

60  

the Neuroticism /Cyclothymia /Dysthymia Factor. Specifically

correlated with NEO-PI-R-Neuroticism and TEMPS-A

Cyclothymia. Finally, openness correlated significantly with

BWAS-like and ACL-CPS.

61  

DISCUSSION

This review found answers for the objectives previously fixed.

The results suggested that bipolar disease is linked to creativity,

and that this relationship is related to a hyperthymic affective

pattern. (Shapiro, Weisberg1999). This means that there is a peak

of creative behavior in bipolar patients compared to healthy

control participants. However, this positive correlation is almost

the same for creative control participants. (Santosa et al.2007).

This relationship is especially strong in the inventiveness part of

the test, particularly in the verbal domain. (Rybakowski,

Klonowska 2011). For instance, Fodor, Laird (2004), found that

Barnes´s (1996) play therapy technique could intensify literacy

creativity in bipolar patients, therefore a person with a bipolar

predisposition who had a significantly enhanced temperament

practicing play therapy, wrote more creative poems. However,

not all the papers reached the same conclusion; creativity is

stronger in subjects that have sub-clinical expressions of

bipolarity (for instance, cyclothymes), compared to the subjects

suffering more severe manifestations of the illness like manic-

depressives. (Richards et al.1988). Other results showed a

significant impairment of creativity performance during

depressive states, the degree of this impairment directly

62  

correlated to the severity of the depression, especially those

“active” aspects of creativity that were the ones more affected by

a “creative block” (Rybakowski, Klonowska 2011). Conversely,

one paper´s results revealed no differences between unipolar and

bipolar writers when using emotional words, consequently, there

may not be any differences in emotional states between writers

with a mood disorder and healthy writers during the creative

process. (Forgeard 2008). So, even though the relationship

between creativity and bipolar disorder appeared clearly, there

are still some gaps in our knowledge that remain unresolved.

There is clearly a necessity to investigate exactly which phases of

the disorder increase creative behavior, and which impairs it.

Regarding the genetic bases of this relationship, this review

showed that bipolar descendants have higher creativity than

healthy control offspring. (See Simeonova et al. 2005). That

relationship also affects the tendencies of choosing a creative

occupation, bipolar disorder patients and their relatives used to

choose more creative occupations than subjects from the healthy

control group and their relatives. On the contrary, individuals

with a major depressive disorder and their relatives did not show

any consistent pattern of association with creative occupations.

(Kyaga et al. 2011)

63  

Studying the relationship between bipolar disorder and creativity

in depth we can see there are some temperamental features that

specifically influenced the development of creativity. Once again

there is a difference between bipolarity and other mood disorders,

(Santosa et al. 2007) underlined that those personality differences

are constrained to the bipolar disorder, and do not appear in a

major depressive disorder. Concretely the personality differences

that this review has found were temperamental-affective

variances such as neuroticism, cyclothymia and dysthymia, and

temperamental- cognitive variances for example, openness and

intuition. This means that these components contribute

significantly in increasing the features of creativity. (Srivastava et

al 2010), (Strong et al. (2007). The first mentioned (neuroticism,

cyclothymia and dysthymia) could provide access to the

changeability of the affects, and the others (openness and

intuition) to flexibility. Differences among different mood bipolar

states were also reported; manic patients were found to have

greater creativity results on the psychometric tools, especially on

the task related to executive functions (Soeiro de Souza et al.

(2011).

Another important link found between creative behavior and

bipolar disease is the neurological one. The overlap between

64  

bipolar disorder subject results and creative control subject results

on the measure of tools of creativity suggest that there could be

some neurobiological commonalities between people suffering

bipolarity and individuals that exhibited creative behavior.

(Nowakowska et al. (2005). Furthermore, this review showed that

the proBDNF (Met-) monoaminergic is linked with a better

performance on creative task in individuals suffering bipolar

disorder, but only during the manic phase. (Soeiro de Souza et al.

(2012)

There are clearly some limitations of this review. Firstly, we can

see there are a multitude of approaches to assess the definition of

creativity, and the majority of them generally have restrained

correlations. The general use of artistic and scientific

occupations, or specific behaviors defined by the test, as a

representation for creativity is clearly a limitation. Secondly, the

databases used for this research were restricted to the ones linked

to the catalogues of the Queen Mary Library, the British Library

and the Senate House Library, being necessary for future research

add other sources, and also include studies written in other

languages since due to the personal characteristics of the

investigator this study in limited to English written papers.

Thirdly, only case-control studies were included it being

65  

necessary to compare groups from the same population (creative

people, members of the same family) with and without a mental

disorder, therefore there was a risk of “over-matching” when the

groups were made to make them comparable for possible

cofounding features, therefore, further research including

randomized controlled trials is necessary. Fourthly, the sample

characteristics created very important limitations. For instance

some of the participants were college students, and they have

been included even the age was not specified, and due to their

characteristics the investigation was restricted to a highly-

educated sample. Other studies included a mixture of un-

medicated and medicated patients in the same sample, which

created some uncontrolled bias. Ten of the thirteen studies used

population non-randomly selected from the same environment.

Another of the sample problems was the difficulty presented by

the fact that the participants were not blinded. (They knew they

were tested because they were creative or bipolar). The control

groups, especially the ones formed by creative control

participants were another source of difficulty because they could

be “contaminated” by the stereotypes of “creative genius”, this

means that the idea of a “genius” has created an image about how

a creative person should be, and during the test many participants

66  

could exaggerate their behaviour patterns according to that idea.

Steve Allen called that “the Bohemian excuse” (Allen, 1998). In

The Mad Genius Controversy, the sociologist George Becker

(1978) notes that: “The aura of madness served the function of

differentiating genius from the mean, the mediocre, or the

bourgeois . . . the man of genius could claim some of the powers

and privileges granted the ‘fool’ and the ‘possessed’ prophet”.

Finally, the majority of the papers used the BWAS, as an

assessment tool to measure creativity and this is a restraint since

the kind of exact creativity notions underlying the BWAS

remains to be recognized. Due to the instruments nonverbal

measures and its perceptual tendency, it could be viewed as a

measure that assesses only one aspect of creativity.

Considering that a systematic review should help researchers to

avoid possible drawbacks or difficulties and refine their

objectives and research questions, there are some important

future recommendations that would allow the generalization to

have a more realistic context. (Mulrow, 1994). Clearly future

studies are needed to clarify the correlation between mania and

creativity in Bipolar Disorder; exploratory analysis using multiple

tests replicating these results was necessary. Further studies are

needed to determine what increases creativity and how these

67  

mechanisms are related to temperament, mood, and medication

status. It would also be important to distinguish genotype-

environment exchanges that stimulate creativity, the descendants

and relatives of subjects suffering any mood disorder, could be

influenced by family atmosphere, parents aesthetic opinions and

artistic endeavours. (Simeonova et al. 2005). Finally, more

longitudinal studies should be conducted to observe if creativity

would continue in the participants who attended therapy for a

sustained period of time.

68  

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