November 10, 2011 — Creative individuals have a disproportionately higher rate of mental illness, including schizophrenia and bipolar disorder, and they and their relatives are more likely to work in artistic and scientific occupations, according to new research published in the November 2011 issue of the British Journal of Psychiatry.
"Creativity has long been associated with mental disorder, epitomized by Aristotle's claim that 'no great genius has ever existed without a strain of madness,' " lead author Simon Kyaga, MD, from the Karolinska Institute, Stockholm, Sweden, told Medscape Medical News.
"Working as a psychiatrist, I have many times encountered patients who, despite severe psychiatric disorder, were able to create in artistic and scientific areas, as well as being successful entrepreneurs," Dr. Kyaga said. "I was therefore intrigued by the idea of a connection between creativity and madness, and together with my supervisors, we initiated the study, trying to provide answers to this old question."
Dr. Kyaga and colleagues performed a nested case-control study using a variety of sources to obtain information on the association between creativity and mental illness.
These data sources included the Hospital Discharge Register, which provided discharge diagnoses for all in-patient treatment episodes for schizophrenia, bipolar disorder, and unipolar depression in Sweden between 1973 and 2003; the Multi-Generation Register, which identified biological relatives of patients; and national censuses for 1960, 1970, 1980, and 1990, which provided information on professions in the entire Swedish population.
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Subjects' professions were categorized using the Nordic Classification of Occupations. Creative professions included both scientific jobs, such as university teachers, and artistic jobs, including designers, performing artists, musicians, and authors.
Accountants and auditors were defined as less-creative professions.
The researchers compared 300,000 patients who had received inpatient treatment for schizophrenia, bipolar disorder, or depression and their relatives who did not have a diagnosis of mental disorder with a control group.
They found that those patients with bipolar disorder were significantly overrepresented in creative professions compared with control patients (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.22 - 1.48), mainly as a result of their presence in visual (OR, 1.42; 95% CI, 1.23 - 1.64) and nonvisual (OR, 1.44; 95% CI, 1.20 - 1.73) artistic occupations.
In addition, first-degree relatives of people with bipolar disorder were more likely than those in the control group to have a creative profession, especially scientific professions.
People with schizophrenia had no increased rate of overall creative professions compared with control patients, but they did have an increased rate of visual artistic occupations (OR, 1.30; 95% CI, 1.13 - 1.49).
Unipolar depression was not associated with an increased likelihood of having a creative profession.
"I think the study stresses the importance of treating all patients individually, and with the aim of finding the optimal treatment with regards to effectiveness, while minimizing the adverse effects that medication can have on positive aspects of psychiatric disorders," Dr. Kyaga said.
"We often encounter the suggestion that lithium reduces creativity in patients with bipolar disorder and that adherence therefore is difficult. Now we can say that it is true that bipolar disorder is in fact associated with increased creativity, but we also know from previous research that terminating treatment with lithium in bipolar disorder will, in the long run, disrupt creative behavior," he continued.
"We therefore need to pay close attention to what patients tell us while being treated, so that we can find a regimen that will work for them to prevent the disastrous consequences of severe psychiatric disorder, while providing them opportunities to uphold their creative behaviors in the long run," Dr. Kyaga said.
In an accompanying editorial, Kay Redfield Jamison, PhD, the Dalio Family Professor in Mood Disorders and professor of psychiatry at the Johns Hopkins University School of Medicine in Baltimore, Maryland, writes that Dr. Kyaga and colleagues give support to accumulating evidence showing a disproportionately high rate of mental illness among creative individuals.
She agrees that it is essential to develop treatments that minimize the adverse effects of medication on the positive effects of mood disorders.
"Bipolar illness is devastating and this should remain the central focus of our scientific and clinical work," Dr. Jamison writes. "But while doing so, we need to keep in mind the anciently observed thin partition between disease and imagination."
Dr. Kyaga and Dr. Jameson have disclosed no relevant financial relationships.
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