Bipolar Disorder and Creativity

Introduction

Society will always welcome the eccentric and the almost romanticised notion of the ‘mad genius’, with incomprehensible ramblings, fiery thoughts and feelings, who bears a startling capacity for novel thought. The heralded about notion of the ‘mad genius’ has become so typecast that the author of one review wrote ‘Creativity is not a kind of psychopathology!’ This piece of work will explore the link between creativity and bipolar disorder. The famous and exuberant poet Lord Byron was one of those few ‘touched’ by the troublesome, cyclic and contrasting nature of manic-depressive illness (bipolar disorder) This is a frightening affliction of disturbed gaieties, melancholy and chaotic temperament. The idea that fervent moods, illogical reasoning and an artistic temperament can be categorised together into a ‘fine madness’ is a controversial one. Most people would find the notion that an often psychotic, destructive and dangerous disease to convey certain ‘advantages’ such as powerful imagination, stronger emotional responses and an increase in energy, incomprehensible and counterintuitive.

This essay will try to explore the connection between bipolar disorder and creativity and deem whether it is creditable or not.

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What is Bipolar Disorder?

Bipolar disorder is a disease of manic symptoms of varying severity. There are two types of bipolar disorder. Bipolar 1 affecting approximately 1% of the population is characterised by episodes of fully blown mania that can be accompanied by depression or not (mixed). This receives more concern and attention that it’s milder and more frequent form, type 2 bipolar prevalent in about 2.9% of the population. This is marked by less severe hypomanic and depressive episodes and ‘cyclothymia’, which is a swing between depressive and hypomanic states (hence the term ‘bipolar’ to highlight the contrast in mood and temperament). Cyclothymia affects about 4.2% of the population. Examples of manic symptoms include elevated and sometimes irritable moods, an increased amount of energy, less need for sleep and bouts of insomnia, reckless and impaired judgement, an uncontrolled increase in promiscuity (which may lead to a disruption of the family unit) and thoughtless and foolish behaviours. When a person is going through a manic episode, they may feel more irascible and on edge and feel pressurized to keep talking or talk very fast with often-disconnected thought patterns. They may become more aware of their body and not be sure what to do with their hands when conversing so fidget more with them and wring them unnecessarily. During a manic episode, the person may also indulge in more extravagant behaviours that may cause regret later on such as spending a lot of money and drinking and eating in excess which may cause them to put on a bit of weight. Usually, the extent of manic or depressive episodes varies from person to person. Some people may not even suffer from the typical manic symptoms or suffer from milder forms (hypomania). In contrast to mania, an example of depressive episodes are characterized by intense feelings of despair that can turn into feelings of desperation and hopelessness, memory impairment and episodes of amnesia, feelings of worthlessness, guilt, difficulty thinking and indecision. Other symptoms of a depressive episode include anhedonia (a loss of pleasure in acts that normally give pleasure), sleep and appetite disturbances, psychomotor retardation, loss of energy, recurrent and preoccupying thoughts of death. A crippling fatigue can take over that can last in duration from weeks to months and leave the person incapacitated to carry out even small tasks in a daily routine such as getting up to eat. On top of all this, the sufferer may be clueless as to why this is happening to them. Other things that affect the daily routine are daytime sleepiness making it hard for the person to socially interact and hold down a job – particularly one that requires good concentration.

As has been shown, this is a frightening and dangerous disease. The remainder of the essay after a brief look into the meaning of ‘creativity’ will explore whether studies have confirmed the link between bipolar disorder and creativity and if the disease confers a special ‘gift’ to those who are unfortunate to suffer from it, try to explain any associated link and then determine whether any association is tenuous or strong.

What is creativity?

Having established what bipolar is, we need to have a brief definition as to what is creativityVery simply creativity can be described as ‘a collection of behaviours/thoughts that are both adaptive/useful and novel/original’. There are many different types and classifications of creativity, too numerous to relate here but for the purpose of demonstrating an association here, the majority of the studies have measured creativity subjectively as an individual attribute and has been demonstrated by occupation.

Evidence for an association between creativity and bipolar disorder

There is actually quite a lot of evidence for elevated rates of creativity within bipolar disorder sufferers. Reviews of biographical material have suggested that the disorder is significantly prevalent amongst samples of authors, visual artists and poets (2, 8-10).

One of the very first studies to investigate bipolar disorder and creativity was in 1949. A study of 113 German architects, writers, composers and musicians was undertaken along with relatives. The study reported an increase in the number of suicides and individuals characterised as “insane and neurotic” in the artistic group compared to the general population. The higher rates of deviance from the norm were discovered in poets (50%) and then the musicians (38%).

In Ludwig’s 1994 study (9), biographical material was looked at from 1005 eminent individuals. Approximately 8.2% of those in creative professions (e.g. architecture/design, composing and performing music, writing, theatre) had reported experiences of mania. This is in comparison with the general population 1%. There are numerous other studies that show that some 10% of artists (loosely defined) had symptoms of Bipolar Disorder (11-12).

It is important to note that as well as in eminent samples of poets and musicians and other creative artisans, a strong link has been shown between creativity and bipolar disorder in the general population. Santosa et al. (2007) found people with the disorder had Baron–Welsh Art Scale scores higher than healthy controls and comparable to graduate students in creative fields (13-15). In support of this, Richards et al found bipolar patients to have greater lifetime creative accomplishment than healthy controls on the Lifetime Creativity Scales

In a recent very large study of a cross sectional representative study of thirteen thousand people ordinary people in the USA, those with bipolar disorder were found more often in the most creative occupations (e.g. painting, writing, and lighting design).

As well as demonstrating a strong link between those suffering from bipolar disorder and an outward manifestation of creativity, there has also been research carried out into healthy controls that suffer from hypomanic traits. Healthy samples have been found to have higher self-rated creativity, fluency, everyday creative achievement and divergent thinking (18-20)

Interestingly, there is not a directly linear relationship between the severity of bipolar disorder and creativity. On the contrary, Richards et al (1988) found that those with hypomanic traits (milder form of bipolar disorder) had higher rates of creative accomplishment than those with bipolar 1 disorder and remarkably genetically related unaffected individuals in the family had higher rates of creativity than those affected with type 1 disorder. (21-23). Andreasen in 1987 also showed that in a study of accomplished authors, more authors met the diagnostic criteria for bipolar 2 disorder than bipolar 1.

This may give some indication that the severe type 1 disorder is too destructive and may interfere with accomplishment whereas the milder type 2 variety does confer some benefits to the sufferer and that a vulnerability to mania may be associated with creativity rather than mania itself. This is known as ‘The Inverted U hypothesis’.

Evidence against a link between bipolar disorder and creativity

Rothenberg (2001) did some fairly rigorous research into the methodological flaws into some of the most prominent research demonstrating a link between bipolar disease and creativity. For example Andreason (1987) reported a 43% prevalence of bipolar disorder in a writing group compared to controls (10%). However what is interesting is that the writer group were matched with controls in age, sex, and educational status but not in occupation with the controls coming predominantly from very non-artistic occupations such as ‘business men, social workers medics, lawyers and computer science students’ and the bipolar group being all being writers! Obviously matching occupations in the controls would have been vital to the design of this study. On top of this, the investigator herself carried out the interviews and there was no independent assessment of the subjects.

As shown previously, in Ludwig’s 1994 study, biographical material was looked at from 1005 eminent individuals. Approximately 8.2% of those in creative professions (e.g. architecture/design, composing and performing music, writing, theatre) had reported experiences of mania. This is in comparison with the general population 1%

However, despite the large number of studies highlighted, material was only drawn from biographical resources. This limits the validity of the findings. Biographies may indeed provide reliable information but they are a very non-professional source. A lot of the evidence is anecdotal and whilst fascinating and irreplaceable cannot always be credited as being wholly reliable. The reason for this is that in the view of self-assessment and romanticising the past, the letters and self-analysis is often blinded by bias. The reliability of letters, memoirs, journals and anecdotes can be fraught with bias and over-exaggerations in light of writing for a future generation. Indeed major biographers refused to write the biography of Jack Benny because he had such an ‘uninteresting, happy, boring life’!!!. Also, only 6% of Nobel Laureates ranging from the sciences have been written in comparison to 100% of Nobel Laureates in Literature! This shows that the biographies of famous writers are very popular especially when exaggerating eccentric behaviour and dark moods and temperaments and idealising the stereotyped melancholic poet or drunken writer. Hence they definitely cannot be relied upon as a wholly reliable source of information.

Richards et al (1988)  showed that there was a link between hypomanic traits in an individual and creativity. However, further analysis into the designs of the study shows some very dubious definitions of creativity that are almost comical! The following example presented of the vocational category for high peak creativity:

“An entrepreneur who advanced from chemist’s apprentice to independent researcher of new products before starting a major paint manufacturing company, and whose operation surreptitiously manufactured and smuggled explosives for the Danish Resistance during World War II”

This definition of so called creativity was then matched with hypomanic symptoms but as you can see is rather dubious and seems to be clutching on straws when occupations in the creative disciplines are more commonly used in other studies!

I have picked out three key studies that I used in my evidence for demonstrating a link between bipolar disorder and creativity and scrutinized the methodology. When put under the spotlight, it seems that based on these three studies, there is weak and dubious evidence for an association between bipolar disorder and creativity. However, there are other studies that have ALSO demonstrated the association and if we had more time, would allow us to evaluate and review their methodology too.

What could explain the link between bipolar disorder and creativity?

A way to investigate the apparent link between creativity and bipolar disorder is to consider personality traits (7, 24). There seems to be a significant overlap between personality traits associated with both creativity and bipolar disorder.

One of the personality traits of creative people is an ‘openess to experience’ . This has been found to be significantly higher in those people labelled as creative e.g. in a comparison of creative versus less creative scientists. This ‘openess to experience trait’ has interestingly also been associated with an increased appreciation and willingness to engage in novel ideas and experiences  and an increase in intellect and correlates with an increase in creative accomplishment. Interestingly, there is also evidence for this trait ‘an openness to experience’ (O) to be elevated in bipolar disorder too. The trait of neuroticism (N) has also been linked with more specific forms of creativity and this may be due to the link between neuroticism and emotional sensitivity. Furthermore, elevated levels of neuroticism are also more prevalent in those suffering from bipolar disorder compared to the general population.

Another personality trait associated with an increase in creativity is extraversion (E). Those in the performance arts such as musicians, singers and actors are significantly shown to have higher levels of extraversion. Moreover, some studies have found that elevated extraversion differentiates bipolar disorder from unipolar depression. The strongest correlation between the trait of extraversion and bipolar disorder may be in individuals prone to mania and may be more evident in bipolar disorders who interestingly have the strongest links with creativity (see above).

Finally, another personality trait elevated in bipolar disorder is impulsivity and this appears to be evident even during well states . The trait of impulsivity is more marked during episodes of mania. Creativity has been demonstrated to be related to impulsivity too (6). Theoretically perhaps, impulsivity may induce expressiveness and the ability to produce more novel and unique work.

Thus there is a link between the traits expressed in creative people and those of the bipolar sufferer. The final section will conclude on whether I think based on all the evidence I have reviewed if there is a connection or not and then try to explain my rationale.

An association between bipolar disorder and two key components of creativity: Generativity and Consolidation

Figure 1: There is an overlap between bipolar disorder and two key elements of creativity. In the box are variables in the three areas of overlap and direction of association.

This essay has attempted to demonstrate the link between bipolar disorder and creativity. In summary, there are some good grounds for the widely held assumption that creativity and bipolar disorder are associated in some way. There has been a series of studies that have demonstrated that those with bipolar disorder can be highly creative. However, for future work into answering this question, the researcher should note that it is absolutely essential to look and critique the methodologies of these studies and try to look at the source of the participants, whether they are matched with the controls, what information is used to assign creativity (e.g. definitions of creativity, biographical sources etc.) and whether there are any non-biased independent experimenters taking part in the study. I selected three specific studies and exposed their methodological flaws that could most definitely have introduced an element of bias and skewed results. Despite this, there still does definitely seem to be a link between bipolar disorder and creativity that is not all due to coincidence or dubious study design. An explanation for this seems to be that traits that are elevated in creative people are also elevated in the bipolar sufferer, which would explain some of the overlap between bipolar disorder and creativity. Furthermore, those with hypomanic traits (milder form of bipolar disorder) had higher rates of creative accomplishment than those with bipolar 1 disorder suggesting that creative accomplishment is limited in severe type 1 disorder due to the destructive nature of the disease and it’s impact on life. . (22-23)

Finally, it is important to note that much of the evidence between the link between bipolar disorder and creativity stems from biographical reports and case report studies. There has not actually been a direct test in epidemiological research – a proper epidemiological study has not yet tested the link between an increased prevalence of bipolar disorder in creative populations and vica versa. I look forward to such a study design in the future.

BIBLIOGRAPHY

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8. Andreasen, C. N. (1987). Creativity and mental illness: Prevalence rates in writers and their first-degree relative. The American Journal of Psychiatry, 144(10), 1288-1292
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13. Santosa, C. M., Strong, C. M., Nowakowska, C., Wang, P. W., Rennicke, C. M., &Ketter, T. A. (2007). Enhanced creativity in bipolar disorder patients: Acontrolled study. Journal of Affective Disorders, 100(1–3), 31-39
14. Barron, F. (1963). Barron–Welsh Art Scale, a portion of the Welsh Figure Preference Test. Palo Alto, CA: Consulting Psyc

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