In the 1970s, Nancy Andreasen carried out the first empirical study of bipolar disorder and creativity at the University of Iowa. Andreasen studied the mental histories of a group of 30 prominent authors, expecting to find a strong correlation between creativity and schizophrenia.
Although she found no history of schizophrenia amongst the authors, she did find an unexpectedly strong history of mood disorders: 80 per cent of her sample of authors had experienced at least one episode of major depression, hypomania, or mania, compared to only 30 per cent of a matched control group. Andreasen followed-up the authors for the next 15 years and found that 43 per cent of them had bipolar disorder compared to only 10 per cent of the control group and 1 per cent of the general population. During the 15 years of the follow-up study, two of the authors committed suicide. For Andreasen, ‘Issues of statistical significance pale before the clinical implications of this fact.’
The Royal Academy Study
In 1989 the psychiatrist Kay Redfield Jamison (who herself suffers from bipolar disorder) surveyed 47 British authors and visual artists from the British Royal Academy and found that 38 per cent had been treated for a mood disorder. In particular, half of the poets in her sample had needed medication or hospitalization. Responding to questions about the role of very intense moods in the creative process, many participants in the study reported changes in mood, cognition (thinking), and behaviour either preceding or coinciding with creative episodes. The most common such changes were ‘increases in enthusiasm, energy, self-confidence, speed of mental association, fluency of thoughts and elevated mood, and a strong sense of well-being’. Participants also reported a noticeably decreased need for sleep and feelings of elation, excitement, and anticipation. These features overlap closely with the clinical features of hypomania.
The Evolutionary Argument
Genes for potentially debilitating disorders such as bipolar disorder usually pass out of the population over time because affected people have fewer children. The fact that this has not happened for bipolar disorder suggests that the responsible genes are being maintained despite their potentially debilitating effects on a significant proportion of the population, and thus that they must be conferring an important adaptive or evolutionary advantage. Unusually amongst mental or indeed physical illnesses, bipolar disorder is more common in higher socioeconomic groups, suggesting that the genes that predispose to bipolar disorder also predispose to greater achievement and success in the relatives of people with bipolar disorder and sometimes even in people with bipolar disorder themselves. A prime example is Kay Redfield Jamison (quoted above), who is not only a Professor of Psychiatry but also an Honorary Professor of English. Jamison has written a number of critically acclaimed books including one called An Unquiet Mind on her experience of suffering with bipolar disorder.
Whilst the genes responsible for bipolar disorder may lead to adaptive advantages at the individual level, they may also lead to adaptive advantages at the level of the population group. Compared to neighbouring population groups, population groups with a high proportion of creative individuals are likely to be more artistically and culturally developed, lending them a stronger sense of identity and purpose and tighter social cohesion. They are also likely to be more scientifically and technologically advanced, and so more economically and militarily successful. As a result of these important adaptive advantages, such population groups are more likely to survive and the genes for bipolar disorder to be maintained and propagated.
Some Possible Explanations
For Andreasen, a creative person may be different from other people in that he is more open to experience, exploratory, risk tasking, and tolerant of ambiguity. Such traits make him see and feel and understand more, but they also make him hurt more easily and so more prone to experience suffering and dark moods. A creative person experiences the order and structure that others find comforting as inhibiting and even suffocating. For this reason, he feels the need to confront norms and conventions, discard the certitudes of black and white definition, and escape into a richer and more nuanced ‘borderless grey’. The freedom that he finds in this limbo enables him to enter into periods of intense concentration and focus akin to a trance or hypomanic episode. Such periods are characterized by heightened consciousness, frenzied activity, and intense productivity and are the hallmark of the creative process.
After carrying out a detailed study of some of the most eminent personalities of the twentieth century, the psychiatrist Felix Post (1913–2001) postulated that the psychological discomfort that accompanies a mental disorder is in itself the principal driver of creative expression, and many artists have asserted that the creative act enables them both to stave off and to sublime their depressive anguish. As the psychiatrist Anthony Storr (1920-2001) remarked,
The creative process can be a way of protecting the individual against being overwhelmed by depression, a means of regaining a sense of mastery in those who have lost it, and, to a varying extent, a way of repairing the self damaged by bereavement or by the loss of confidence in human relationships which accompanies depression from whatever cause.
A recent study carried out at Stanford University by Santosa and colleagues found that people with bipolar disorder and creative discipline controls scored significantly more highly than healthy controls on a measure of creativity called the Barron-Welsh Art Scale. In a related study the same authors sought to identify temperamental traits that people with bipolar disorder and creative people have in common. They found that both shared tendencies for mild elation and depression with gradual shifts from one to the other, openness, irritability, and neuroticism (roughly speaking, a combination of anxiety and perfectionism).
It is interesting to note that, according to this study, one of the temperamental traits that people with bipolar disorder and creative people have in common is a tendency for mild elation and depression with gradual shifts from one to the other. During periods of mild depression people with bipolar disorder and creative people may be able to retreat inside themselves, introspect, put thoughts and feelings into perspective, eliminate irrelevant ideas, and focus on the bare essentials. Then during periods of mild elation they may be able to gather the vision, confidence, and stamina for creative expression and realization.
Notes Of Caution
Shifts in mood may be evidenced in the acts of creation of people with bipolar disorder. This is particularly the case, for example, in the poems of Sylvia Plath or in the musical compositions of Peter Tchaikovsky (perhaps most of all in the crypto-biographical Swan Lake). Yet it must be stressed, first, that not all people with bipolar disorder are creative and, second, that even those who are creative tend to be at their most creative during periods of remission when symptoms are either mild or absent. Most people with bipolar disorder who are creative say that they cannot create when they are depressed, but use depression as a source of inspiration for whatever it is that they are next going to produce; nor can they create when they are manic or psychotic because their concentration is too poor and their thinking too disorganised and chaotic to produce anything coherent.
Episodes of depression and mania are very difficult to live through, and in some cases can even lead to death through suicide, self-neglect, or accident. Even highly creative and successful people with bipolar disorder such as Sylvia Plath or Virginia Woolf committed suicide in the end. For these reasons mental disorder should not be romanticized, sought out, or left untreated simply because it might or might not increase insight and creativity. All mental disorders are drab and intensely painful, and most people who suffer from one would never wish it on anyone, least of all themselves.
It is also important to highlight that many creative geniuses do not have bipolar disorder and most people with bipolar disorder are not creative geniuses; thus, in logical terms, bipolar disorder is neither necessary nor sufficient for creative genius. As there are fewer people with bipolar disorder who are artists than there are artists with bipolar disorder, it seems more plausible to argue that creative genius predisposes to bipolar disorder rather than vice versa. And whilst people with bipolar disorder may be more creative than average, this may result from the fact that they are better suited and thus more attracted to careers in the arts rather than, say, in the sciences. Thus, whilst there can be little doubt that bipolar disorder and creative genius are associated, evidence of causation and of the direction of causation is still lacking.
Neel Burton, M.D., is a psychiatrist, philosopher, writer, and wine lover who lives and teaches in Oxford, England.
He is a Fellow of Green-Templeton College, Oxford, and the recipient of the Society of Authors’ Richard Asher Prize, the British Medical Association’s Young Authors’ Award, the Medical Journalists’ Association Open Book Award, and a Best in the World Gourmand Award.