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Artistic Creativity and Mental Illness

Researchers have believed an association between vulnerability to certain mental

illness and artistic creativity. Prevalence rates for mental illness in artists, is dependant

on the type or style of mental illness, artist, and research design. For example, although

within the general population prevalence rates for bi-polar and/or schizophrenia ranges

from 1% to 3% [1], among poetry and visual artists the range is from 20% to 75% [2, 20].

While the array of studies on the relationship is wide and the research approaches

diverse, it’s worthy to note that to date, large scale prospective studies have not been

conducted. A review of existing literature reveals at least six different types of studies on

the topic.

1) Biographical and Survey Data reveal high levels of depression and bipolar

disorder, in eminent people in literature and the arts [2, 3].

2) Family studies among psychiatric patients and families suggest the personality or

cognitive trait of creativity hereditary. Studies reveal creative interests and

aptitudes in close relatives of psychiatric patients, including those separated by

adoption [4]. Interestingly, the healthy relatives show higher levels of creativity

than their mentally ill counterparts.

3) Studies among schizophrenic patients show higher performance on divergent

thinking when compared to non-schizophrenic patients [5]. Divergent thinking

involves the ability to generate multiple solutions to a problem by recognizing

links among remote associations and/or transforming information into unexpected

forms. It’s sometimes used as a measure of creativity. Divergent thinking is very

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similar in definition to thought disorder, prominent in psychosis and psychotic

episodes [6, 7].

4) Correlation studies among the general population show a relationship between

performances on tests of creative performance or self-rated creativity with results

on scales that measure risk for mental illness. Additional correlations are

uncovered as those who score high on tests for positive psychotic symptoms also

score high on a divergent thinking battery [8].

5) Biological Studies have shed light to a biological basis for the association

between mental illness and creativity. Creative groups tend to have much lower

levels of latent inhibition (measurement of one’s ability to ignore stimulus in the

external environment that experience has shown is not relevant) than the general

population. Low levels of latent inhibition are also seen in acute schizophrenia

patients [9, 10,11] Whether an individual’s low level of latent inhibition results in

psychosis or heightened levels of creativity is hypothesized as dependent on the

individual’s level of intelligence [10,11].

"During the early stages of diseases such as schizophrenia, which are often
accompanied by feelings of deep insight, mystical knowledge and religious
experience, chemical changes take place in which latent inhibition disappears. It
appears that we have not only identified one of the biological bases of creativity
but have moved towards cracking an age-old mystery: the relationship between
genius, madness and the doors of perception." (Jordan Peterson, a psychologist
at the University of Toronto, Canada)[10]

6) Psychometric assessments show creative people, especially those in creative

occupations and pursuits, and bipolar patients sharing high levels of the

personality traits, particularly neuroticism and openness to experience [12]. These

two traits are similar to people at risk for affective disorders.

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Other psychometric assessments use the concept of schizotypy, measured using

the O-LIFE schizotpy scales of 104 items (see Appendix) which are from traits

associated with schizophrenia [13]. Schizotypy includes four factors:

• Unusual Experiences which includes magical thinking (shown to be a

predictor of the onset of psychosis), hallucinations, delusions and thought

disorder; however, just because one scores high on the unusual experience

dimension doesn’t mean they’re mentally ill.

• Cognitive Disorganization which includes difficulty of attention and

concentration along with a sense of purposelessness and moodiness.

• Introvertive Anhedonia or lack of enjoyment.

• Impulsive Nonconformity which is described behaviors of violence,

recklessness, and self-abusiveness [13]

A recent study by psychologist Daniel Nettle measuring the relationship between

these four O-LIFE traits among artists (i.e., poets and visual artists) and

psychiatric patients reveal that artists and psychiatric patients (i.e., bi-polar and

schizophrenia) share divergent thought (their thought processes are unusual and

sometimes chaotic) but that psychiatric patients have significantly lower levels of

introvertive anhedonia than artists [7]. So in essence, artists and psychiatric

patient scores of creativity correlate on positive psychotic symptoms and

negatively on negative psychotic symptoms [7]. What we don’t know is what

triggers and feeds the development of introvertive anhedonia in artists? And can

introvertive anhedonia be lowered in the life of the mentally ill artist? Once we

know this, we may be able to use preventive measure to stave off the suffering
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caused by the mental illness, while encouraging and enhancing the artists’

creativity.

Another interesting finding from the Nettle study is that those making their living

in creative artistic professions of poetry or visual arts had the lowest scores on

introvertive anhedonia when compared to mathematicians, non-artists, and psychiatric

patients. Are professional artists knowingly avoiding the debilitating aspect of mental

illness (anhedonia) in order to be successful in their occupations? If so, how are they able

to do so? What strength do they have that enables them to resist the debilitating

anhedonia? Interestingly, a study by Frank Barron, a pioneer in psychological studies of

creative writers [14] strongly indicates the factor “ego strength” determines whether an

artist is mentally healthy or mentally ill. The factor “ego strength” includes resilience

and ability to cope with stress. What factors enhance the development of “ego strength”

in artists? Can artists at risk for mental illness modulate this strength for their own mental

wellness?

A few studies bring understanding of the types of creative expressions or styles

that may be at greater risk for certain mental illnesses. For example, a survey of writers at

the University of Iowa's famed Writers' Workshop in 1987 by Nancy Andreason found 80

% of the faculty with mood disorders, 43% bipolar, 30 % addicted to drugs,, and 12%

eventually killed themselves [2].

But are other styles of creative expressions at equal risk for certain types of

mental illness? It seems that whether visual art or written art, the more expressive the

style, the higher the correlation with mental illness [15, 16]. Examination of the different

types of writers found poets to have the highest rates of mental illness (specifically
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psychosis and depression), highest rates of bipolar disorder, and the highest levels of

suicide (3, 17). Mortality studies also reveal a shorter life span for writers as compared to

other occupations, including artistic type occupations. Female poets have been found

more likely to suffer from mental illness than female writers of other forms like

nonfiction/fiction/playwright and all male writers regardless of the writing form/style

[18]. Research suggests that when poets experience depression, if poetry therapy is used

in the treatment protocol, emphasis should be on narrative based poetry. Without a

narrative approach (in other words a story approach, with a beginning, middle and end) in

the poetry therapy, the poetry may make the patient’s situation worse [19].

Visual artists whose style is more emotive (such as abstract expressionalism) were

observed to suffer from mental illness more than their visual artist counterparts whose

style was more formal and less emotive. Abstract art was rated as formal because of its

compositional emphasis, pop art was symbolic, and abstract expressionism was

predominantly emotive. In the Ludwig study (1998), on nearly every measure of

psychopathology, visual artists with emotive styles had a 75 percent lifetime prevalence

of alcoholism, drug use and depression; symbolic artists a 52 percent lifetime rate and

those with the most formal styles a 22 percent rate [20].

So what help is there for the artist that is affected with a disabling mental illness?

In a 2005 Cannes Film Festival winning documentary, The Devil and Daniel Johnston,

outsider visual and musical artist Daniel Johnston’s life was filled with high levels of

artistic creativity and accompanying struggles with mental illness were beautifully

depicted. Daniel’s initial disabling episode was diagnosed as manic depression. He’s

currently diagnosed as bi-polar. For years he was vexed by delusions of demons. What
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help is available to the many Daniel Johnstons to help them turn off the disabling aspects

of the particular mental illness while maintaining and/or increasing their creativity? As

with any illness, proper diagnosis is certainly necessary to effective treatment. But then

some mentally ill creative individuals that are offered medical treatment say the delusions

and sufferings are a part of them and their art and they are afraid that medication will

negatively impact their creativity, causing them to no longer be motivated to create [21].

It seems that these fears may be justified.

Kay Redfield Jamison, a professor of psychiatry, author and internationally

acclaimed authority on mental illness, when addressing the issue said, the psychotic drugs

can "dampen a person's general intellect and limit his or her emotional and perceptual

range" [21]. In a recent interview, Jamison related that many treatment cocktails don’t

pay enough attention “to the fleeting benefits that bipolar disorder can bestow among

certain people,” like the windstorm of ideas and creative intensity that often comes with

manic disorders. “Lithium and other mood stabilizers are extremely effective for

controlling mania and depression, but in some patients these drugs can limit emotional

range,” Jamison explained. Effective treatment should seek to find a balance preserving

crucial human emotions and experiences while alleviating destructive extremes. With the

right amount of lower doses, she believes its “possible to maximize intensity by choosing

the lowest possible dosage” without negatively impacting the artist’s mental health [22].

According to Jamison, too much creative intensity is an unhealthy state of mind. This is

evidenced when looking at brain studies of structural differences among individuals who

have experienced one psychotic episode and those who have experienced multiple

psychotic episodes [22]. Dr. Peter Jamison, seasoned psychiatrist who has devoted much
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of his professional career advancing the field of psychiatry, especially as it relates to over

medication and abusive clinical practices, believes, “Mental health professionals need

to reclaim their professional knowledge and skills. They should strive to help their clients

and patients to reclaim their faith in fundamental values, including personal

responsibility, empathy and love, and principled living.” [23].

Comments and Considerations:

Current research, though provocative, is limited in methodology. It seems that

large-scale prospective studies among mentally healthy, undiagnosed groups with

inclusion of monitoring for psychopathology over a long period of time is warranted.

Participants could be randomly selected with matched controls. Identifiers should be

removed from research evaluators to control for rater bias.

In the meantime, case-control data suggests prevalence rates of mental illness

(particularly bipolar and schizophrenia) as significantly higher among certain artist

groups as compared to the general population. If we appreciate the gifts these creative

people have given us, they deserve our understanding and careful consideration.

As of this writing, specific solutions aimed specially at this target group are not

included in the mental health protocol (DSM). Voices from clinical experts in the field

chime the importance of achieving a balance of maintenance of human

emotion/experiences while alleviating the debilitating extremes, when drug therapy is

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prescribed. Others stress the importance of proper diagnosis for effective treatment. As a

result of this writing and personal discussions with artistic family/friends, consideration

should be given to increasing client awareness of the importance of and assistance with

taking care of themselves. Learning from one another techniques to better manage stress,

increase resilience, and reduce anhedonia might prove useful. What about a Viagra for

anhedonia in at risk groups?

Since professional artists fare better than their hobbyist counterparts, perhaps

another potentially useful tool for artists would be increased networking opportunities for

the interested hobbyist to work diligently on their art. Hopefully, pharmaceutical firms

and medical researchers will continue to search for treatments and advances to help the

mentally ill artist reduce the high levels of sometimes disabling creative intensity.

Currently, the U.S. Preventive Services Task Force (USPSTF) recommends that

adults be screened for depression at any clinical practices that have systems in place for

proper diagnosis, effective treatment and follow-up [24]. How effective or not on patient

outcome, would it be to make self-diagnostic tests and/or family-diagnostic tests (with

pertinent follow-up recommendations based on score) available for the disabling

symptoms of the types of mental illness that artists are most vulnerable for --depression,

bi-polar or schizophrenia? Would this type screening be beneficial or harmful to the

individual and/or family?

Finally, discussion and investigation surrounding the benefits or not of the CDC

tracking the health of adult artists with mental illness, the same way they track the health

of other at risk groups, in attempts to better identify the problem(s) and seek for
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appropriate solutions is suggested. After years of research and discussion and the

possibility of high prevalence rates of mental illness among certain artists groups, it

seems cruel to do any less.

Until then, the situation a mentally ill artist might experience is expressed by an

old joke: A man is driving past a mental hospital when one of the wheels falls off his car.

He stops and recovers the wheel but can't find the lug nuts to secure it back in place. Just

then he notices a man sitting on the curb carefully removing small pebbles from the grass

and piling them neatly on the sidewalk. "What am I going to do?" the man asks aloud.

The fellow piling the pebbles looks up, and says, "Take one of the lug nuts from each of

the other wheels and use them to put the wheel back on." The driver is amazed. "Wow!"

he exclaims. "What a brilliant idea. What are you doing in a place like this?" he asks,

nodding toward the mental institution. "Well," the man answers, "I'm crazy, not stupid."

[11].
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References

1. http://www.nimh.nih.gov/publicat/numbers.cfm#Bipolar

2. Andreasen, N.C. (1987). Creativity and mental illness: Prevalence rates in writers and
their first-degree relatives. American Journal of Psychiatry, 144:1288-1292.

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

4. Heston, J.J. (1966). Psychiatric disorders in foster home reared children of

schizophrenic mothers. British Journal of Psychiatry, 112, 819-825.

5. Andreasen, N.C., & Powers, P.S. [1975]. Creativity and psychosis: An examination of
conceptual style. Archives of General Psychiatry, 32, 70-73.

6. Guilford, J.P. (1967). The nature of human intelligence. New York: McGraw-Hill.

7. Nettle, D. (2006). Schizotypy and mental health amongst poets, visual artists, and
mathematicians. Journal of Research in Personality, 40(6), 876-890

8. Green, M.J., & Williams, L.M. (1999). Schizotypy and creativity as effects of reduced
cognitive inhibition. Personality and Individual Differences, 27, 263-276.

9. Swerdlow, N.R., Braff, D.L., Hartston, H., Perry, W., & Geyer, M.A. (1996). Latent
inhibition in schizophrenia. Schizophrenia Research, 20(1-2), 91-103.

10. http://www.news.utoronto.ca/bin5/030930b.asp

11. http://www.hno.harvard.edu/gazette/2003/10.23/01-creativity.html

12. Nowakowska, C., Strong, C.M., Santosa, S., Want, P.W., & Ketter, T.A. (2004)
Temperamental commonalities and differences in euthymic mood disorder patients,
creative controls, and healthy controls. Journal of Affective Disorders, 87, 207-215.

13. Mason, O., Claridge, G., & Jackson, M. (1995). New scales for the assessment of
schizotypy. Personality and Individual Differences, 1, 7-13.

14. Barron, R. (1972). Artists in the making. New York: Seminar Press.

15. Silverman, M.A., & Will, N.P. (1986). Sylvia Plath and the failure of emotional self-
repair through poetry. Psychoanalytic Quarterly, 55, 99-129.
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16. Ludwig, A.M. (1998). Method and madness in the arts and sciences. Creativity
Research Journal, 11, 93-101.

17. Jamison, K.R. (1989). Mood disorders and patterns of creativity in British writers
and artists. Psychiatry, 52, 125-134.

18. Kaufman, J.C. (2001). Genius, lunatics, and poets: Mental illness in prize-winning
authors. Imagination, Cognition, and Personality, 10, 305-314.

19. Kaufman, J. C., & Sexton, J.D. (2006). Why doesn’t the writing cure help poets?
Review of General Psychology, 10(3), 268-282.
http://www.uky.edu/PR/News/MCPRNews/1998/mental.htm

20. http://www.uky.edu/PR/News/MCPRNews/1998/mental.htm}

21. Jamison, K.R. (1993). Touched with fire. New York: Free Press.
University of Victoria citation: http://home.vs.moe.edu.sg/whitenoise/AE_PA.html

22. Bender, E. (2007). Do Psychiatric Drugs Dampen Artists’ Creativity? Psychiatric

News, 42(1), 9

23. Breggin, P. R., (2003). Psychopharmacology and Human Values, Journal of

Humanistic Psychology, 43(2), 34-49.

24. http://www.ahrq.gov/clinic/uspstf/uspsdrin.htm
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APPENDIX
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The Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE)

Unusual Experiences

Do you believe in telepathy?

Do you ever feel sure that something is about to happen, even though there does not seem to be any reason
for you thinking that?

Do you ever suddenly feel distracted by distant sounds that you are not normally aware of?

Do you often have days when indoor lights seem so bright that they bother your eyes?

Does your sense of smell sometimes become unusually strong?

Have you felt as though your head or limbs were somehow not your own?

Have you sometimes sensed an evil presence around you, even though you could not see it?

Have you wondered whether the spirits of the dead can influence the living?

On occasions, have you seen a person's face in front of you when no one was in fact there?

When in the dark do you often see shapes and forms even though there's nothing there?

When you look in the mirror does your face sometimes seem quite different from usual?

Are your thoughts sometimes so strong that you can almost hear them?

Can some people make you aware of them just by thinking about you?

Do ideas and insights sometimes come to you so fast that you cannot express them all?

Do the people in your daydreams seem so true to life that you sometimes think they are real?

Do you sometimes feel that your accidents are caused by mysterious forces?

Do you think you could learn to read other's minds if you wanted to?

Does it often happen that nearly every thought immediately and automatically suggests an enormous
number of ideas?

Does a passing thought ever seem so real it frightens you?

Does your voice ever seem distant or faraway?

Have you ever felt that you have special, almost magical powers?

Is your hearing sometimes so sensitive that ordinary sounds become uncomfortable?

Do you ever have a sense of vague danger or sudden dread for reasons that you do not understand?

Do you feel so good at controlling others that it sometimes scares you?

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Have you ever thought you heard people talking only to discover that it was in fact some nondescript
noise?

Have you felt that you might cause something to happen just by thinking too much about it?

Have you occasionally felt as though your body did not exist?

Have you sometimes had the feeling of gaining or losing energy when certain people look at you or touch
you?

Are the sounds you hear in your daydreams really clear and distinct?

Do your thoughts sometimes seem as real as actual events in your life?

Cognitive Disorganization

Are you easily distracted when you read or talk to someone?

Do you ever feel that your speech is difficult to understand because the words are all mixed up and don't
make sense?

Do you often experience an overwhelming sense of emptiness?

Do you often feel lonely?

Is it hard for you to make decisions?

Are you a person whose mood goes up and down easily?

Are you easily hurt when people find fault with you or the work you do?

Are you sometimes so nervous that you are ‘blocked’?

Do you dread going into a room by yourself where other people have already gathered and are talking?

Do you easily lose your courage when criticised or failing in something?

Do you find it difficult to keep interested in the same thing for a long time?

Do you frequently have difficulty in starting to do things?

Do you often feel that there is no purpose to life?

Do you often have difficulties in controlling your thoughts?

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Do you often worry about things you should not have done or said?

Do you worry about awful things that might happen?

No matter how hard you try to concentrate do unrelated thoughts creep into your mind?

When in a crowded room, do you often have difficulty in following a conversation?

Are you easily confused if too much happens at the same time?

Are you easily distracted from work by daydreams?

Do you often feel ‘fed up’?

Do you worry too long after an embarrassing experience?

Would you call yourself a nervous person?

Do you often hesitate when you are going to say something in a group of people whom you more or less
know?

Introvertive Anhedonia (lack of enjoyment)

Can you usually let yourself go and enjoy yourself at a lively party? negative

Do people who try to get to know you better usually give up after a while?

Do you feel that making new friends isn't worth the energy it takes?

Do you find the bright lights of a city exciting to look at? negative
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Do you like going out a lot? negative

Do you prefer watching television to going out with other people?

Do you usually have very little desire to buy new kinds of food?

Is it fun to sing with other people? negative

Are people usually better off if they stay aloof from emotional involvements with people?

Are there very few things that you have ever really enjoyed doing?

Are you much too independent to really get involved with other people?

Are you rather lively? negative

Can just being with friends make you feel really good? negative

Do you have many friends? negative

Do you like mixing with people? negative

Do you think having close friends is not as important as some people say?

Does it often feel good to massage your muscles when they are tired or sore? negative

Has dancing or the idea of it always seemed dull to you?

Have you often felt uncomfortable when your friends touch you?

Is trying new foods something you have always enjoyed? negative

On seeing a soft thick carpet have you sometimes had the impulse to take off your shoes and walk barefoot
on it? negative

When things are bothering you do you like to talk to other people about it? negative

Do you feel very close to your friends? negative

Do you love having your back massaged? negative

Have you had very little fun from physical activities like walking, swimming, or sports?

Do you enjoy many different kinds of play and recreation? negative

Is it true that your relationships with other people never get very intense?
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Impulsive Nonconformity

Do people who drive carefully annoy you?

Do you often feel like doing the opposite of what other people suggest, even though you know they are
right?

Do you often feel the impulse to spend money which you know you can't afford?

Do you often have an urge to hit someone?

Do you sometimes talk about things you know nothing about?

Are you usually in an average sort of mood, not too high and not too low? negative

Do you at times have an urge to do something harmful or shocking?

Do you ever have the urge to break or smash things?

Do you often change between intense liking and disliking of the same person?

Do you stop to think things over before doing anything? negative

Do you think people spend too much time safeguarding their future with savings and insurance?

Have you ever blamed someone for doing something you know was really your fault?

Have you ever cheated at a game?

Have you ever felt the urge to injure yourself?

When in a group of people do you usually prefer to let someone else be the centre of attention? negative

When you catch a train do you often arrive at the last minute?

Would being in debt worry you? negative

Would you take drugs which may have strange or dangerous effects?

Do you consider yourself to be pretty much an average kind of person? negative

Have you ever taken advantage of someone?

Would you like other people to be afraid of you?

Do you often overindulge in alcohol or food?

Would it make you nervous to play the clown in front of other people? negative

All items scored + 1 for ‘yes’, 0 for ‘no’ except negative items for which + 1 for ‘no’, 0 for ‘yes’.
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Interesting and relevant web-reading:

1. Reminder of the bout of creative intensity leading the way to Van Gogh’s final
days.

http://www.azcentral.com/ent/arts/articles/0613vangoghslastdays0613.html

2. Upcoming neural level study of the relationship between mental illness and
creativity.
http://www.medicalnewstoday.com/medicalnews.php?newsid=71677

3. New technology for diagnosing mental illness.

http://www.technologyreview.com/Biotech/18803/