Creativity and Mental IllnessPublished on Psychiatric Times(http://www.psychiatrictimes.com)

Creativity and Mental IllnessNews [1] | April 17, 2014 | Neuropsychiatry [2]By Arline Kaplan [3]

Since the terms “genius” and “creativity” have different definitions, Psychiatric Times asked aneuropsychologist and creativity expert to clarify how the terms are being used in scientific studies.

Recent large-scale registry and brain imaging studies are exploring the validity of this ancientobservation, which linked creativity/genius and psychopathology. The results are mixed. Since theterms “genius” and “creativity” have different definitions, Psychiatric Times asked neuropsychologistand creativity expert Rex Jung, PhD, Assistant Professor in the Department of Neurosurgery,University of New Mexico, to clarify how the terms are being used in scientific studies.

According to Jung, the best definition of creativity is found in a 1953 article1: creativity is defined asthe production of something novel and useful. “This dynamic tension between novelty andusefulness likely has important neural correlates that we are attempting to explore withneuroimaging techniques,” said Jung.“Genius,” he added, “is achievement at the far margins of human expression (eg, creative,intellectual, leadership). It involves production of extraordinary accomplishment and creativecapacity that is exceedingly novel and breathtakingly useful. This capacity is, by definition, rare inspite of the tendency to sprinkle the term liberally throughout our daily endeavors. It is hypothesizedto occur at the exceedingly rare rate of 1 per 1 million individuals, which implies that there are fewerthan 7000 geniuses on the entire planet.”ControversyThe idea that creativity and psychopathology are inextricably linked is widespread but highlycontroversial. R. Keith Sawyer, PhD, Morgan Distinguished Professor in Educational Innovations atthe University of North Carolina at Chapel Hill, cited several studies that examined creativeindividuals.2 “None of these studies found an elevated degree of mental illness in creative people.”Simon Kyaga, MD, a senior consultant in psychiatry and PhD student in the Department for MedicalEpidemiology and Biostatistics at the Karolinska Institute in Stockholm, contends that early studiesby Andreasen,3 Jamison,4 and Karlsson,5 which focused on schizophrenia and bipolar disorder, haveprovided limited empirical evidence for the relationship between creativity and psychopathology.The problem may be that many earlier studies have been small and/or were done retrospectively.Kyaga has been lead investigator on 2 Swedish studies on the association between creativity andpsychopathology. “The main strengths of our studies are that they involve a lot of people, and whilethe analysis is retrospective, the collection of data is prospective.”The researchers undertook a nested case-control study using longitudinal Swedish total populationregistries.6 Individuals who had received inpatient treatment for schizophrenia, bipolar disorder, andunipolar disorder and their relatives without the disorders were compared with controls. As a proxyfor creativity, the researchers used occupational codes and census information. Artistic and scientificoccupations were defined as “creative” and included university teachers, authors, visual artists,photographers, composers and musicians, designers, and performing artists.The researchers found an increase in creative occupations among individuals with bipolar disorderand among relatives of patients with schizophrenia and bipolar disorder. No association was foundfor unipolar depression.The second study involved 1.2 million patients and their relatives without psychiatric diagnosescompared with controls.7 The earlier study was expanded by adding other psychiatric disorders andincluding discharge diagnoses for inpatient treatment between 1973 and 2009 as well as someoutpatient episodes from 2001 to 2009.With the exception of bipolar disorder, no association between psychopathology and overallcreativity was found. On the contrary, creative professionals had a reduced likelihood of havingschizophrenia, schizoaffective disorder, unipolar depression, anxiety disorders, alcohol or drugabuse, autism, or ADHD. However, the team observed that the siblings of patients with autism andfirst-degree relatives of patients with schizophrenia, bipolar disorder, and anorexia nervosa wereover-represented in the creative professions.

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Creativity and Mental IllnessPublished on Psychiatric Times(http://www.psychiatrictimes.com)

“I would say our findings on autism are a bit shaky, although there is some literature suggesting anassociation between scientific occupations and autism,” Kyaga said. “There is no literaturesuggesting an association between anorexia and creativity, and I have to say we really didn’t knowwhat to do with that.”Aware that findings from earlier studies suggest a higher prevalence of psychopathology amongprofessional authors, Kyaga and colleagues looked at that group separately. They found that authorssuffered from schizophrenia and bipolar disorder more than twice as often as controls. In addition,compared with controls, authors were more likely to have unipolar depression, anxiety disorders,and alcohol or drug abuse disorders, and to commit suicide.NeuroscienceThe study of creativity is a “growth industry” for cognitive neuroscientists, according to Jung. Forexample, Fink and colleagues8 from the University of Graz in Austria, investigated functional patternsof brain activity using functional MRI (fMRI) during creative cognition in groups with low versus highpsychometrically determined schizotypy. They found an association between the originalitycomponent of creativity and reduced deactivation of right parietal brain regions and the precuneusduring creative cognition, congruent with the idea that people who are more creative may includemany more events/stimuli in their mental processes than do less creative people. Similarly, thehigh-schizotypy group showed weaker deactivation of the right precuneus during creative cognition.According to these researchers, the fact that originality and schizotypy show similar functional brainactivity patterns during creative ideation (ie, reduced deactivation of the right precuneus) supportsthe contention that similar mental processes may be implicated in creativity and in psychosis risk.The neuroimaging techniques Jung finds most helpful in assessing brain traits include structuralmagnetic resonance imaging (sMRI), diffusion tensor imaging (DTI), and proton magnetic resonancespectroscopy (1H-MRS).9 Jung explained, “sMRI informs us mostly about the cortical mantle,including the volume of neuronal cell bodies. . . . DTI gives information regarding the fidelity of themyelin/axonal fibers connecting such processing nodes, while 1H-MRS gives us information regardingunderlying biochemical fidelity of both neurons (via N-acetylaspartate) and axons (via choline andmyoinositol), as well as neurotransmitters including glutamate and glutamine.”Asked about his team’s brain imaging studies, Jung said that funding by the John TempletonFoundation “has allowed us to explore all the major measures of creativity (eg, divergent thinking,creative achievement, insight, and openness) and correlate these with our various neuroimagingtechniques in rather large cohorts of normal human subjects. If creativity exists, it should bedetectable across the entire range of human endeavors.”10 His team has produced 3 reportshighlighting the first biochemical, white matter, and structural correlates of creative cognition inhuman subjects.11-13

Jung and his team are now focused on less studied scientific creativity (science, technology,engineering, math). “Our first results have been submitted and are consistent with our findings in amore general population: lower measures of brain fidelity, particularly within the frontal lobe, arepredictive of higher performance on measures of creative capacity, creative personality andachievement. . . . This is different than what we found in terms of intelligence correlates, wherehigher measures of brain fidelity were invariably associated with higher intelligence. Creativity andintelligence are different constructs and manifest differently within networks of the brain.”With respect to creativity and mental illness, their study on white matter integrity, creativity, andpsychopathology provides some guidance. Jung and colleagues used DTI to examine whether whitematter integrity, assessed by fractional anisotropy (FA), is related to 2 measures ofcreativity—divergent thinking and openness to experience. They found that a composite creativityindex was inversely related to FA within the left inferior frontal white matter and openness wasinversely related to FA within the right inferior frontal white matter.Jung and his team recommend that measures of creative cognition and personality should beadministered in tandem with DTI measures to patients with psychotic disorders and to theirunaffected relatives to better understand the mechanisms underlying lower FA, creativity, andpsychosis within frontal white matter.In an ongoing study, Andreasen14 is using neuroimaging to examine the neural basis of the creativeprocess. The psychological and neural basis of the creative process is being examined: half of thesubjects represent the arts and the other half, the sciences. The subjects are being interviewed,given standard neurocognitive tests, and sMRI and fMRI brain scans are taken.Jung believes that to his knowledge “no well-known creative output was produced in the thrall ofovert psychosis, mania, or other mental state that could be pointed to as critical to the process. . . .Perhaps the time between overt episodes is a time worth discussing as critical to creative cognition

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Creativity and Mental IllnessPublished on Psychiatric Times(http://www.psychiatrictimes.com)

for such individuals, and the possibility of medications dampening or hindering such innovation oroutput should be explored. The risk of severe mental illness would appear to outweigh any potentialbenefit at the current time.” References: 1. Stein MI. Creativity and culture. J Psychol. 1953;36:311-322.

2. Sawyer RK. Creativity and mental illness: is there a link? November 2, 2012. http://www.huffingtonpost.com/dr-r-keith-sawyer/creativity-and-mental-il.... Accessed March 4, 2014.

3. Andreasen NC. Creativity and mental illness: prevalence rates in writers and their first-degreerelatives. Am J Psychiatry. 1987;144:1288-1292.

4. Jamison KR. Mood disorders and patterns of creativity in British writers and artists. Psychiatry.1989;52:125-134.

5. Karlsson J. Genetic association of giftedness and creativity with schizophrenia. Hereditas. 1970;65:177-182.

6. Kyaga S, Lichtenstein P, Boman M, et al. Creativity and mental disorder: family study of 300,000people with severe mental disorder. Br J Psychiatry. 2011;199:373-379.

7. Kyaga S, Landén M, Boman M, et al. Mental illness, suicide and creativity: 40-year prospectivetotal population study. J Psychiatr Res. 2013;47: 83-90.

8. Fink A, Weber B, Koschutnig K, et al. Creativity and schizotypy from the neuroscience perspective.Cogn Affect Behav Neurosci. 2013 Sep 11; [Epub ahead of print].

9. Jung RE, Mead BS, Carrasco J, Flores RA. The structure of creative cognition in the human brain. Front Hum Neurosci. 2013;7:330.

10. Rex Jung. How are intelligence and creativity related to brain structure and function? http://www.rexjung.com. Accessed March 5, 2014.

11. Jung RE, Gasparovic C, Chavez RS, et al. Biochemical support for the “threshold” theory ofcreativity: a magnetic resonance spectroscopy study. J Neurosci. 2009;29:5319-5325.

12. Jung RE, Segall JM, Jeremy Bockholt H, et al. Neuroanatomy of creativity. Hum Brain Mapp.2010;31:398-409.

13. Jung RE, Grazioplene R, Caprihan A, et al. White matter integrity, creativity, andpsychopathology: disentangling constructs with diffusion tensor imaging. PLoS One. 2010;5:e9818.

14. Meet Dr Nancy Andreasen. http://www. nancyandreasen.com. Accessed March 5, 2014. Source URL: http://www.psychiatrictimes.com/neuropsychiatry/creativity-and-mental-illness

Links:[1] http://www.psychiatrictimes.com/news[2] http://www.psychiatrictimes.com/neuropsychiatry[3] http://www.psychiatrictimes.com/authors/arline-kaplan

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