Mad GEnius: is there a link between creativity & mental illness?

A Literature Review

November 5, 2020

Cultural Background

Plato was quoted to say that creativity is “divine madness” in a poet. This isn’t a unique belief. Stories about mad geniuses and tormented artists all seem to suggest some sort of psychopathology that underlie their creativity. Consider the greats in poetry such as Edgar Allen Poe, Emily Dickinson, John Keats, Robert Frost, and Virginia Woolf. There was speculation that Poe bipolar and anxious, that Woolf was bipolar, Dickinson depressed, Keats depressed, Frost depressed, and the list goes on. It begs the question; is there really a link between mental illness and creativity or is this just a perpetuating stereotype? 

Some studies suggest that there may be a correlation. Post (1994) studied 291 world-famous men, evaluating several attributes, and determined that “severe personality deviations were unduly frequent only in the case of visual artists and writers.” Preti and Vellante (2007) studied 160 people, 80 creative professionals and 80 non-creative professionals, and found that the more creative scored higher on a standard test of psychopathology. However, the discussion still remains inconclusive. Schlesinger (2009) criticized studies like these for being too subjective and anecdotal, calling them “Creative Mythconceptions.” Also, a Swedish study (Kyaga 2012) took a 40 year look at the entire registered population of Sweden to find that there was no correlation between creativity and psychiatric disorders at all. Though the findings on this topic seem to be contradictory, it is intriguing to analyze the possible truths or fallacies that underlie this pervasive belief. 

A Review of the Academic Literature

Psychiatric Perspectives

  Anecdotes of famous cases, such as the shocking and violent stories of Vincent Van Gogh and Sylvia Plath, drew several psychologists into studying this supposed phenomenon. One of the most well-cited researchers in this topic, Nancy C. Andreasen, began her research in the 1970s with a case study on James Joyce, but developed her more scientific inquiries in a 1974 publication comparing 15 successful creative writers and 15 non-creative people, using structured interviews and diagnosis from the DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised). 73% of the writers reported some psychiatric disorders whereas only 20% of the control group did. In the families of the writers, 21.4% had psychiatric illnesses compared to the 4.4% in the families of non-creative people. The study claims to show a correlation between creativity and familial associations but Andreasen would go on to discuss the limitations of her findings. In 2008, Andreasen published an article on the approaches to research in this area, stressing the use of empirical data over anecdotal findings. Citing several studies, she determines that there is a direction of correlation in prior research, but states that, "the overall literature supporting this association is relatively weak. A great deal of the work reported suffers from inadequate definitions of both creativity and mood disorders, reliance on anecdotal and autobiographical or biographical sources, and a lack of control groups.” Her discussion provided grounds for more objective investigations into this association. 

One of the studies cited by Andreasen in her 2008 article was conducted by Ludwig (1994) in which he took 59 women writers from the National Women Writers' Conference and 59 women from the general population as the control group. He evaluated them using screening questionnaires such as the Sensation-Seeking Scale, the Rotter I-E Scale, the Personal Reaction Inventory, the Maudsley Personality Inventory, and the Ways of Coping Checklist. He then conducted personal interviews and used the DSM-lll-R to diagnose them. The women of the two groups were significantly different in their diagnosis with higher rates of psychiatric variance in the writers, specifically in depression and mania. However, Ludwig also mentioned “difficulties in generalization” saying that there are all kinds of creative artists and people engage in all kinds of creativity that may not be defined as so. He limited his subjects to female writers to control for other variables but his study can easily be challenged for misrepresenting the creative population.   

  In 1989, Jamison focused specifically on moods as a measure of psychopathology. She gathered a group of British people, mostly men, all awarded with prestigious prizes for their literature or art; poets, playwrights, novelists, biographers, and artists. She then surveyed them for their history and treatment of mood disorders and any patterns of mood in relation to their creative work. “A very high percentage of the total sample, 38%, had been treated for an affective illness… one-third of the writers and artists reported histories of severe mood swings.” Interestingly, they found that biographers seem to show very little indication of any mood disorder or patterns, with Jamison stating that biographers may be less creative of the group. Because no analysis was made in comparison to the general population, this study did show any statistical significance in its findings but it provided some investigation into the mood patterns of creative-minded individuals. Together, the works of Andreasen, Ludwig, and Jamison provide an interesting foundation for the analysis of creative people but their work relied heavily on retrospective experiences that may be affected by hindsight bias or subjectivity. 

Neuroscience Investigations

  In attempt to find other variables that creative individuals might be predisposed with, Preti and Vellante (2007) gave 80 artists and 80 non-creative people the Annett Hand Preference Questionnaire (HPQ), as well as the Peters et al. Delusions Inventory and the General Health Questionnaire. The results showed that artists used their left hand more, which was hypothesized to show higher right-brain activation, and had a higher level of delusion and psychopathology. As a note, the creative group also had higher counts of licit and illicit drug use. They analyzed their data through SPSS to find that the result did show a statistical difference in both psychopathology and handedness in order to conclude that creativity is linked to cases of delusion, along with a third variable of left-handedness. Discussion in this area alludes to a more neuroscientific perspective, with the use of handedness as an indication of cortical activation.

  Folley (2005) conducted another neuroscience study, looking at the “neural substrates of creative thinking.” He gathered 17 schizophrenic people, 17 healthy controls, and 17 schizotypal people. From each group, he took a subset and measured their hemispheric prefrontal activation using infrared spectroscopy while they performed creative tasks such as the Remote Associates Test (RAT) and a new Divergent Thinking Task (DTT). The task was to come up with ‘uses’ for different items. Schizotypy was found to have increased measures of divergent thinking compared to the other groups, with preference to activation on the right side of the prefrontal cortex even though divergent thinking is associated with bilateral activation. In this study, Folley eliminated profession as a creative factor as well as subjective methods to determine psychopathology. Although this is a more substantial study to draw conclusions from, creativity is limited to the tasks of divergent thinking which may not be reflected in all artists and creative people. In other words, not all artists may display divergent thinking as the sole mechanism to their creativity. This finding was also restricted to schizophrenia, excluding other psychiatric disorders that are discussed in association with creativity. 

Genetic Explorations

  Later studies focus more on a genetic link; polygenic risk scores for schizophrenia and bipolar disorder were measured for individuals associated with artistic society membership or creative profession (Power et al. 2015). The authors described a creative person to be “most often considered one who takes novel approaches requiring cognitive processes that are different from prevailing modes of thought or expression.” Polygenic risk scores, which are“cumulative genetic risk profiles from across the genome,” found that schizophrenia and bipolar disorder explained some variance of creativity. Interestingly, they also found that both also predicted higher educational attainment. To look at more representative data, the study took longitudinal data from the population of the Netherlands and Sweden, comparing artistic profession, Creative Achievement Questionnaire (CAQ), and the polygenic risk scores, excluding those that were presently diagnosed with either conditions. A higher number of people in the creative group had higher polygenic risk scores, determining some genetic basis in the argument.

  Some genetics-focused studies fully contradict this creativity-psychopathology association, including a full population study conducted by Kyaga (2012). He set out to test the association and determine whether the results were due to environmental factors or genetic factors. His case-control study used the Swedish registry to conduct a longitudinal study on the entire Swedish population. To determine mental health, diagnosis were made using the 8th, 9th, and 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), and to determine creative occupations, they used records from the Nordic Classification of Occupations. They then compared individuals in the creative occupations who were treated for mental illness (schizophrenia, bipolar disorder, depression) and their families to those of non-creative individuals. The findings show that schizophrenia depression was the same rate in creative people, their families, and non-creative people. However, the study did find something surprising in the relatives of the affected individuals; “the non-affected first-degree relatives of people with schizophrenia or bipolar disorder demonstrated increased creativity compared with a control group, whereas the individuals in the case group themselves showed only modest increases in creativity.”

Kinney (2001) decided to take up this direction and gathered 36 adult adoptees of biological parents with schizophrenia and 36 adoptees with no family history of mental illness. In a blind study, he used the DSM-III to diagnose all of them. Their creativity was assessed based on interviews. The study hypothesized that the individuals had “genetic liability for schizophrenia” but not schizophrenia itself so they would exhibit more creative thinking. They found just that, “Nonschizophrenics with either schizotypal or schizoid personality disorder or multiple schizotypal signs had significantly higher creativity than other participants.” So family risk or schizoidal personalities actually did show more creativity. However, despite these prospective results, the shortcomings of previous studies also apply here. Although the study was blind and the “reliable” measures were used, the subjectivity in defining creativity also limits this study from being generalized for the population. A study of the larger population with controlled variety would further support this correlation. With several suggestions on how to improve this exploring further this association, it is likely that this investigation will continue indefinitely.

Criticisms

Dietrich (2014) made widespread critiques on all previous literature on this topic, saying, “there does not seem to be any scientific data on the matter,” and that they were all based on “an unholy marriage of case reports and anecdotal storytelling.” Some of his points were based on fallacies commonly found in psychological studies such as the ones discussed before. He looks at base rate neglect, which is basically ignoring baseline information for comparison and concluding based on only specific information. For example, he brings up that the rate of incidences of mental illness in a lifetime is over 50%, so most of the data claiming a higher rate in creative individuals is false. The data produced in previous studies also claim great underestimation of “geniuses” that are not afflicted by mental illness and overestimation of those that are. He also looks at another fallacy, availability heuristic, in his paper. The correlations are “illusionary” because the information regarding creative individuals who happen to have a history with psychopathology is much more available, creating a false relationship between the two just because they occur so often in conjunction when telling anecdotal stories of mad geniuses. Dietrich concludes by saying that he would like to consider a humanist standpoint of creativity, that “creative imagination and expression is the hallmark of a well-adjusted, self-actualizing, fully functioning person.”

Schesinger (2009) seems to agree with Dietrich, saying that the theory of mad geniuses is long-standing and defended because it is a “cherished cultural icon.” He criticized the psychologists further by noting that some of them, such as Andreasen and Jamison, worked alone. This increases the likelihood of subjectivity and experimenter bias. Most studies looking at famous creative individuals from the past and even groups of creative individuals today lack a comparison group to determine the significance of the studies’ findings. He cites the writings and interview with psychiatrist Albert Rothenberg, a Harvard professor, who says that “the need to believe in a connection between creativity and madness appears to be so strong that affirmations are welcomed and treated rather uncritically.” Rothenberg continues to say that the only characteristic that should be associated with creativity is the motivation to create and to be creative. Schlesinger ends his paper by stating that the anecdotes and speculations presented as scientific data “devalues not only the traditional standards of research but the credibility of the profession itself.” Because the nature of diagnosis is so subjective when based on only qualitative data, even the honest studies of mental illness and creativity is skeptical. However, despite all the problems, the general public will continue to believe in this notion, “because madness sells… the ‘mad genius’ idea is embedded so deeply in our collective imagination that it hardly matters whether it stands on science or not.”

A Quick Investigation

Background: To dive into these hypotheses with a little bit more focus and control, famous American poets will be investigated for signs of mental illness. But why poets? Kaufman (2002) decided to distinguish writing styles and study why poets, namely females, are more prone to illnesses like depression and bipolar disorder. In his discussion, he stated that poetry attracted the “more likely to be unstable,” was less likely to be therapeutic in the cases of mental illness, and carried a stereotype for the profession that might be self-fulfilling. He also mentions that most poets are younger at the height of their profession, which is common age for the development of mental illness. The style of poetry also lends a hand in attracting the more psychopathological, with it being “more expressive, emotional, and introspective than fiction.”  (Szajnberg, 1992). Poetry is just more abstract. Furthermore, the ruminations of a depressed individual may manifest into poetic writing. For his study, Kaufman took four types of writers for a total sample of 1629 and looked at their “setback” measure based on mental illness, physical illness, and personal tragedy.  The statistics showed a significant difference in mental illness and personal tragedy for the writers, but “female poets were significantly more likely to be mentally ill than any other type of writer.” Overall, “poets were significantly more likely to be mentally ill than were the fiction writers and playwrights.” A second study focused on 520 eminent women throughout American history and came out with the same results, with significant results in tragedy and mental illness for females, but more so in the female poets. The Sylvia Plath effect was coined from this study. 

Methods: To look at the psychopathology behind poetry among females compared to males, 30 of the most famous American poets were assessed, with 15 females and 15 males. “Setback” measures (Kaufman 2001), including individual mental illnesses and records of mental illness within first-degree family members ,will be taken from biographical data. From the collected information, the male poets and female poets will be separated to determine their number of incidence in each category.

Results: From the data, the male poets had higher incidences of mental illness compared to female poets, with 60% of male poets and 40% of female poets indicating some psychopathology. The male poets also had higher incidences in the family history category. Depression was the highest illness in both genders and schizophrenia was not evident in either. Overall, 50% of the top 30 American poets were affected by mental illness.

Discussion: This study does show prevalence of psychopathology in poets that may be correlated to creativity but despite the results, the methods were still very limited by the incomplete information. For example, the biographies of the male poets seem to show much more information on their background whereas the information on female poets focused solely on their work alone. Also, some exclusion criteria should be applied if possible. All of the poets were very diverse in lifestyle, writing education, and experiences. Although this may indicate that poets still showed high rates of psychophathology despite the variety in backgrounds, it should be noted that only the most prolific poets were investigated in this study. Moving forward, a more conclusive answer should be based on more objective empirical data. It would also be beneficial to first provide a clear and comprehensive definition of psychopathology and of creativity as well. 

References 

Folley, B.S. & Park, S. (2005). Verbal creativity and schizotypal personality in relation to prefrontal hemispheric laterality: a behavioural and near-infrared optical imaging study. Schizophrenia Research 80(2-3):271-82.

Jamison, K. (1993). Touched with fire: Manic-depressive illness and the artistic temperament. New York: Free Press.

Kaufman, J.C. (2002). I bask in dreams of suicide: Mental illness, poetry, and women. Review of General Psychology, 6(3).

Kaufman, J.C. (2001). The Sylvia Plath effect: Mental illness in eminent creative writers. The Journal of Creative Behavior, 35(1).

Kyaga S et al. (2011). Creativity and mental disorder: family study of 300,000 people with severe mental disorder. British Journal of Psychiatry 199:373-379.

Ludwig, A.M. (1995). The price of greatness: Resolving the creativity and madness controversy. New York: Guilford.

Rothenberg, A. (1990). Creativity and madness: New findings and old stereotypes. Baltimore: Johns Hopkins University Press.

Sass, L.A., & Sculdberg, D. (Eds.). (2000-2001). Creativity and the schizophrenia spectrum [Special issue].Creativity Research Journal, 13(1).

Waddell, C. (1998). Creativity and mental illness: Is there a link? Canadian Journal of Psychiatry, 43(2).