bipolar disorder and creativity


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(Updated 8/25/04)

Rothenberg A.
Bipolar illness, creativity, and treatment.
Psychiatr Q 2001 Summer;72(2):131-47
"There have been in recent years increasing claims in both popular and professional literature for a connection between bipolar illness and creativity. A review of studies supporting this claim reveals serious flaws in sampling, methodology, presentation of results, and conclusions. Although there is therefore no evidence for etiological or genetic linkages, it is still necessary to explain interrelationships in those creative persons suffering from the illness. Examples of the work in progress of artists with bipolar disorder, Jackson Pollock and Edvard Munch, illustrate the use of healthy and adaptive creative cognition--janusian and homospatial processes--in the former's breakthrough conception during an improvement phase in treatment leading to the development of the Abstract Expressionist Movement and in the latter's transformation of an hallucination into his famous artwork "The Scream." Treatment options that do not produce cognitive effects are important for creative persons with bipolar disorder." [Abstract]

Andreasen NC.
Creativity and mental illness: prevalence rates in writers and their first-degree relatives.
Am J Psychiatry 1987 Oct;144(10):1288-92
"Rates of mental illness were examined in 30 creative writers, 30 matched control subjects, and the first-degree relatives of both groups. The writers had a substantially higher rate of mental illness, predominantly affective disorder, with a tendency toward the bipolar subtype. There was also a higher prevalence of affective disorder and creativity in the writers' first-degree relatives, suggesting that these traits run together in families and could be genetically mediated. Both writers and control subjects had IQs in the superior range; the writers excelled only on the WAIS vocabulary subtest, confirming previous observations that intelligence and creativity are independent mental abilities." [Abstract]

Shaw ED, Mann JJ, Stokes PE, Manevitz AZ.
Effects of lithium carbonate on associative productivity and idiosyncrasy in bipolar outpatients.
Am J Psychiatry 1986 Sep;143(9):1166-9
"To determine the effect of lithium carbonate on the productivity and idiosyncrasy of written associations of euthymic outpatients with affective disorder, the authors assessed 22 patients at weekly intervals during lithium treatment, 2 consecutive weeks of placebo, and 2 consecutive weeks after lithium was resumed. Lithium discontinuation produced a significant increase in associational productivity and a demonstrable increase in associative idiosyncrasy, and restoration of lithium dose significantly reversed both effects. The results suggest that lithium may affect the underlying neuropsychological functions critical to the ability to generate associations and indicate the need for further study of lithium's effects on these and other functions that may relate to neuropsychological and creative processes." [Abstract]

Schou M.
Artistic productivity and lithium prophylaxis in manic-depressive illness.
Br J Psychiatry 1979 Aug;135:97-103
"Twenty-four manic-depressive artists, in whom prophylactic lithium treatment had attenuated or prevented recurrences to a significant degree, were questioned about their creative power during the treatment. Twelve artists reported increased artistic productivity, six unaltered productivity, and six lowered productivity. The effect of lithium treatment on artistic productivity may depend on the severity and type of the illness, on individual sensitivity, and on habits of utilizing manic episodes productively." [Abstract]

Andreasen NC, Glick ID.
Bipolar affective disorder and creativity: implications and clinical management.
Compr Psychiatry 1988 May-Jun;29(3):207-17
"Research on the relationship between creativity and mental illness is summarized, and studies documenting a relationship in writers between creativity and affective illness (particularly bipolar illness) are described. Writers have a high prevalence of affective illness, and both affective illness and creativity have increased frequency in their first-degree relatives. The clinical management of the creative individual is challenging. In general, creative individuals are most productive when their affective symptoms are under good control." [Abstract]

McDermott JF.
Emily Dickinson revisited: a study of periodicity in her work.
Am J Psychiatry 2001 May;158(5):686-90
"OBJECTIVE: Emily Dickinson, arguably one of America's foremost poets, is characterized by critics as able to capture extreme emotional states in her greatest work. Recent dating of her poems offers the periodicity of her writing as a behavior that can be examined for patterns of affective illness that may relate to these states. METHOD: The bulk of Dickinson's work was written during a clearly defined 8-year period when she was age 28-35. Poems written during that period, 1858-1865, were grouped by year and examined for annual and seasonal distribution. RESULTS: Her 8-year period of productivity was marked by two 4-year phases. The first shows a seasonal pattern characterized by greater creative output in spring and summer and a lesser output during the fall and winter. This pattern was interrupted by an emotional crisis that marked the beginning of the second phase, a 4-year sustained period of greatly heightened productivity and the emergence of a revolutionary poetic style. CONCLUSIONS: These data, supported by excerpts from letters to friends during this period of Dickinson's life, demonstrate seasonal changes in mood during the first four years of major productivity, followed by a sustained elevation of creative energy, mood, and cognition during the second. They suggest, as supported by family history, a bipolar pattern previously described in creative artists." [Abstract]

Blumer D.
The illness of Vincent van Gogh.
Am J Psychiatry 2002 Apr;159(4):519-26
"Vincent van Gogh (1853-1890) had an eccentric personality and unstable moods, suffered from recurrent psychotic episodes during the last 2 years of his extraordinary life, and committed suicide at the age of 37. Despite limited evidence, well over 150 physicians have ventured a perplexing variety of diagnoses of his illness. Henri Gastaut, in a study of the artist's life and medical history published in 1956, identified van Gogh's major illness during the last 2 years of his life as temporal lobe epilepsy precipitated by the use of absinthe in the presence of an early limbic lesion. In essence, Gastaut confirmed the diagnosis originally made by the French physicians who had treated van Gogh. However, van Gogh had earlier suffered two distinct episodes of reactive depression, and there are clearly bipolar aspects to his history. Both episodes of depression were followed by sustained periods of increasingly high energy and enthusiasm, first as an evangelist and then as an artist. The highlights of van Gogh's life and letters are reviewed and discussed in an effort toward better understanding of the complexity of his illness." [Abstract]

Lederman RJ.
Robert Schumann.
Semin Neurol 1999;19 Suppl 1:17-24
"Robert Schumann, one of the giants of early romantic music, was born in Saxony in 1810 and died in an asylum shortly after his 46th birthday. Early in life, he demonstrated extraordinary skills in both music and journalism; he remained active in both areas until his final illness. His marriage to the remarkable pianist, Clara Wieck, provided him with both much-needed emotional support and a highly effective champion of his music throughout her lengthy career. Schumann's plans to be a concert pianist were thwarted at least partially by an injury to his right hand, the nature of which has been the subject of much speculation. After considering what few facts are available, the author concludes that this may have represented focal dystonia. His compositional output waxed and waned dramatically over his professional life, reflecting to some degree his emotional state. It is considered most likely that he suffered from a major affective disorder, bipolar type. This ultimately led to a suicide attempt in February 1854, and to his eventual death in July 1856. Despite wide-spread and reasonable suspicion that he may have died from neurosyphilis, severe malnutrition from self-starvation seems more likely." [Abstract

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Recent Bipolar Disorder and Creativity Research

1) Thys E, Sabbe B, De Hert M
[Creativity and psychiatric disorders: exploring a marginal area].
Tijdschr Psychiatr. 2012;54(7):603-15.
background Creativity is an important human quality on which many of man’s achievements are based. aim To give a historical and cultural context, to facilitate meaningful scientific research into the link between creativity and psychiatric disorders. method Review of relevant literature. results The possibility of a link between creativity and psychiatric vulnerability was first discussed in antiquity. Modern interest in the subject stems from the romantic era and acquired a scientific aura in the 19th century. In the 20th century creativity and psychopathology became still further entangled as a result of the influence that mentally disturbed artists exerted on art. The history of the Prinzhorn collection illustrates many aspects of this interaction. Psychometric, psychodiagnostic and genetic research supports a link between creativity and psychiatric illness within the bipolar-psychotic continuum, with schizotypy/thymotypy as prototypes of creativity-related disorders. Evolutionary hypotheses connect the schizophrenia paradox to a survival advantage obtained as a result of enhanced creative ability. Neuro-aesthetics explains the neurologic correlates of the aesthetic experience on the basis of the features of the visual system. conclusion A specific challenge for scientific research in this complex and heterogeneous area is appropriate operationalisation of creativity and psychiatric illness within an truly artistic context. There is a continuing need for meaningful definitions and measurement instruments and for a multidisciplinary collaboration. [PubMed Citation] [Order full text from Infotrieve]

2) Gitlin M, Frye MA
Maintenance therapies in bipolar disorders.
Bipolar Disord. 2012 May;14 Suppl 2:51-65.
[PubMed Citation] [Order full text from Infotrieve]

3) Soeiro-de-Souza MG, Post RM, de Sousa ML, Missio G, do Prado CM, Gattaz WF, Moreno RA, Machado-Vieira R
Does BDNF genotype influence creative output in bipolar I manic patients?
J Affect Disord. 2012 Jul;139(2):181-6.
[PubMed Citation] [Order full text from Infotrieve]

4) Gale CR, Batty GD, McIntosh AM, Porteous DJ, Deary IJ, Rasmussen F
Is bipolar disorder more common in highly intelligent people? A cohort study of a million men.
Mol Psychiatry. 2012 Apr 3;
Anecdotal and biographical reports have long suggested that bipolar disorder is more common in people with exceptional cognitive or creative ability. Epidemiological evidence for such a link is sparse. We investigated the relationship between intelligence and subsequent risk of hospitalisation for bipolar disorder in a prospective cohort study of 1?049?607 Swedish men. Intelligence was measured on conscription for military service at a mean age of 18.3 years and data on psychiatric hospital admissions over a mean follow-up period of 22.6 years was obtained from national records. Risk of hospitalisation with any form of bipolar disorder fell in a stepwise manner as intelligence increased (P for linear trend <0.0001). However, when we restricted analyses to men with no psychiatric comorbidity, there was a 'reversed-J' shaped association: men with the lowest intelligence had the greatest risk of being admitted with pure bipolar disorder, but risk was also elevated among men with the highest intelligence (P for quadratic trend=0.03), primarily in those with the highest verbal (P for quadratic trend=0.009) or technical ability (P for quadratic trend <0.0001). At least in men, high intelligence may indeed be a risk factor for bipolar disorder, but only in the minority of cases who have the disorder in a pure form with no psychiatric comorbidity.Molecular Psychiatry advance online publication, 3 April 2012; doi:10.1038/mp.2012.26. [PubMed Citation] [Order full text from Infotrieve]

5) Schmechel DE, Edwards CL
Fibromyalgia, mood disorders, and intense creative energy: A1AT polymorphisms are not always silent.
Neurotoxicology. 2012 Mar 10;
Persons with single copies of common alpha-1-antitrypsin polymorphisms such as S and Z are often considered "silent carriers". Published evidence however supports a complex behavioral phenotype or trait - intense creative energy ("ICE")-associated with A1AT polymorphisms. We now confirm that phenotype and present an association of fibromyalgia syndrome (FMS) and A1AT in a consecutive series of neurological patients. This is a retrospective case control series of 3176 consecutive patients presenting to Duke University Memory Clinic (747 patients) and to regional community-based Caldwell Hospital Neurology and Memory center (2429 patients). Work-up included medical history and examination, psychological evaluation, and genetic analysis. Chronic widespread pain (CWP) or FMS were diagnosed according to clinical guidelines, mostly as secondary diagnoses. Neurological patients carrying A1AT polymorphisms were common (ca 16% prevalence) and carriers had significantly higher use of inhaler and anxiolytic medications. Patients with ICE phenotype had a significantly higher proportion of A1AT polymorphisms (42%) compared to non-ICE patients (13%). Presence of CWP or FMS was common (14-22%) with average age at presentation of 56 years old and mostly female gender (82%). Patients with CWP/FMS had again significantly higher proportion of A1AT polymorphisms (38%) compared to other neurological patients (13%). Patients with anxiety disorders, bipolar I or bipolar II disorders or PTSD also had increased proportion of A1AT polymorphisms and significant overlap with ICE and FMS phenotype. Significant reductions in CWP/FMS prevalence are seen in apolipoprotein E4 carriers and methylene tetrahydrofolate reductase (MTHFR) mutation homozygotes. Since ICE phenotype is reported as a lifelong behavioral attribute, the presumption is that A1AT carriers have fundamental differences in brain development and inflammatory response. In support of this concept is finding those persons reporting a diagnosis of juvenile rheumatoid or idiopathic arthritis (JRA, JIA) had a significantly high proportion of A1AT polymorphisms (63%), suggesting a spectrum for JRA to later FMS presentations. Likewise, persons reporting a history of attention deficit disorder (ADD) had an increased proportion of A1AT polymorphisms (26%) compared to non-ADD persons (13%). Toxic environmental exposures are common (23%) and associated with diagnoses of PSP, PPA, FTD, FTD-PD, PD and ADVD. A1AT carriers were increased in cases of toxic exposure and PSP, PPA and FTD-PD. Our findings support the ICE behavioral phenotype for A1AT polymorphism carriers and the reported association with anxiety and bipolar spectrum disorders. We now extend that phenotype to apparent vulnerability to inflammatory muscle disease in a spectrum from JRA to fibromyalgia (FMS) and specific behavioral subsets of ADD, PTSD, and specific late onset neurological syndromes (FTD-PD and PPA). High and low risk FMS subsets can be defined using A1AT, MTHFR and APOE genotyping. Clinical diagnoses associated with A1AT polymorphisms included fibromyalgia, JRA/JIA, bipolar disorder, PTSD, primary progressive aphasia and FTDPD, but not most Alzheimer Disease subtypes. These results support an extended phenotype for A1AT mutation carriers beyond liver and lung vulnerability to selective advantages: ICE phenotype and disadvantages: fibromyalgia, affective disorders, and selected late onset neurological syndromes. [PubMed Citation] [Order full text from Infotrieve]

6) Koutsantoni K
Manic depression in literature: the case of Virginia Woolf.
Med Humanit. 2012 Jun;38(1):7-14.
The steady growth of the discipline of medical humanities has facilitated better understanding of the symptoms and signs of mental health conditions and the feelings of the humans experiencing them. In this project, the arts have been seen as enabling re-engagement of the practitioner with the patient's own perceptions and feelings. With respect to the association between creativity and bipolar disorder in particular, work within medical humanities has meant that mentally ill creative individuals have been subject to scientific scrutiny and investigation, rather than continuing to be viewed as naively romanticised cases of mental illness. This paper is an attempt to supplement traditional literary criticism by examining Virginia Woolf's history of bipolar disorder through a medical humanities lens. I will provide an overview of Woolf's history of manic-depressive episodes, their symptoms and manifestation, look back on her circumstances during their occurrence, and observe the author's losing battle to salvage her identity in the throes of the disease. The aim is to offer further insight into Woolf's psychopathology and to gain some understanding of the causes and progression of the condition that led to her death by suicide. [PubMed Citation] [Order full text from Infotrieve]

7) Thys E, Sabbe B, de Hert M
[Creativity and psychiatric disorders: recent neuroscientific insights].
Tijdschr Psychiatr. 2011;53(12):905-15.
[PubMed Citation] [Order full text from Infotrieve]

8) Parker G, Paterson A, Fletcher K, Blanch B, Graham R
The 'magic button question' for those with a mood disorder--would they wish to re-live their condition?
J Affect Disord. 2012 Feb;136(3):419-24.
[PubMed Citation] [Order full text from Infotrieve]

9) Tremblay CH
Workplace accommodations and job success for persons with bipolar disorder.
Work. 2011;40(4):479-87.
[PubMed Citation] [Order full text from Infotrieve]

10) Johnson SL, Murray G, Fredrickson B, Youngstrom EA, Hinshaw S, Bass JM, Deckersbach T, Schooler J, Salloum I
Creativity and bipolar disorder: touched by fire or burning with questions?
Clin Psychol Rev. 2012 Feb;32(1):1-12.
Substantial literature has linked bipolar disorder with creative accomplishment. Much of the thinking in this area has been inspired by biographical accounts of poets, musicians, and other highly accomplished groups, which frequently document signs of bipolar disorder in these samples. A smaller literature has examined quantitative measures of creativity among people with bipolar disorder or at risk for the disorder. In this paper, we provide a critical review of such evidence. We then consider putative mechanisms related to the link of bipolar disorder with creativity, by drawing on literature outside of bipolar disorder on personality, motivational, and affective predictors of creativity. Because so little research has directly evaluated whether these factors could help explain the elevations of creativity in bipolar disorder, we conclude with an agenda for future research on the theoretically and clinically compelling topic of creativity in bipolar disorder. [PubMed Citation] [Order full text from Infotrieve]

11) Jamison KR
Great wits and madness: more near allied?
Br J Psychiatry. 2011 Nov;199(5):351-2.
A purported association between creativity and psychopathology is ancient, persistent and controversial. Biographical research, studies of living artists and writers, and investigations into the cognitive and temperamental factors linked to both creativity and mood disorders suggest a more specific link to bipolar illness. A new, large and well-designed population-based study adds further support to this connection. [PubMed Citation] [Order full text from Infotrieve]

12) Hankir A
Review: bipolar disorder and poetic genius.
Psychiatr Danub. 2011 Sep;23 Suppl 1:S62-8.
[PubMed Citation] [Order full text from Infotrieve]

13) Monaghan D
Creating an open mind.
Australas Psychiatry. 2011 Jul;19 Suppl 1:S73-5.
Duncan Monaghan is 33 years old and in his second year of an Arts degree in Creative Writing. He is a published poet and is currently producing a music CD. Duncan has a history of bipolar disorder which was diagnosed when he was nineteen: "It worried me at first a lot. It played on my mind constantly. I felt different from everybody else--I did not understand what was happening to me." Drawing on his life experiences, Duncan has been enhancing his recovery through creativity--in poetry, lyrics, music and story. "Life for me was a constant battle of relying on medication and appointments with my case manager...until I realized I could combine my recovery with my passions as a tool to use as an outlet to many of the "mind traps" I so often found hindering my own recovery." Duncan is Aboriginal and has experience of the mental health systems in most states and territories and now lives in Brisbane. This is a shortened version of his presentation at Creating Futures 2010. [PubMed Citation] [Order full text from Infotrieve]

14) O'Donovan R
How the creative spirit saved me from a fate worse than hospitalization.
Australas Psychiatry. 2011 Jul;19 Suppl 1:S65-8.
Ross is a mental health patient representative based in Cairns and has been a member of the Cairns CAG for the past eight years. He has played a significant role in the development of consumer participation in Cairns and at a state level. Ross has sat on a range of committees as a consumer representative and has worked as an accreditor with the Institute of Healthy Communities Australia. Currently he sits on the management committee of the Queensland Voice for Mental Health. Ross was a founding member of the Irukandji Pens writers group, based at the Cairns Mental Health Resource Service. [PubMed Citation] [Order full text from Infotrieve]

15) Vellante M, Zucca G, Preti A, Sisti D, Rocchi MB, Akiskal KK, Akiskal HS
Creativity and affective temperaments in non-clinical professional artists: an empirical psychometric investigation.
J Affect Disord. 2011 Dec;135(1-3):28-36.
[PubMed Citation] [Order full text from Infotrieve]

16) Barale A, Emanuele E, Politi P
Aby Warburg, 1866-1929.
Am J Psychiatry. 2011 Aug;168(8):782.
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17) Leopold K, Ritter P, Correll CU, Marx C, Özgürdal S, Juckel G, Bauer M, Pfennig A
Risk constellations prior to the development of bipolar disorders: rationale of a new risk assessment tool.
J Affect Disord. 2012 Feb;136(3):1000-10.
[PubMed Citation] [Order full text from Infotrieve]

18) Soeiro-de-Souza MG, Dias VV, Bio DS, Post RM, Moreno RA
Creativity and executive function across manic, mixed and depressive episodes in bipolar I disorder.
J Affect Disord. 2011 Dec;135(1-3):292-7.
[PubMed Citation] [Order full text from Infotrieve]

19) Olugbile O, Zachariah MP
The Relationship between Creativity and Mental Disorder in an African Setting.
Mens Sana Monogr. 2011 Jan;9(1):225-37.
[PubMed Citation] [Order full text from Infotrieve]

20) Rybakowski JK, Klonowska P
Bipolar mood disorder, creativity and schizotypy: an experimental study.
Psychopathology. 2011;44(5):296-302.
[PubMed Citation] [Order full text from Infotrieve]