Brainstorm: occupational choice, bipolar illness and creativity

The role of bipolar disorder and family wealth in choosing creative occupations

Research in psychology and medicine has linked mental health disorders, and particularly bipolar disorder (BD), to employment in creative professions. Little is known, however, about the mechanisms for this link, which could be due to biology (primarily through a person's genes) or environmental (through socioeconomic status). Using administrative data on mental health diagnoses and occupations for the population of Denmark, we find that people with BD are more likely to be musicians than the population, but less likely to hold other creative jobs. Yet, we also show that healthy siblings of people with BD are significantly more likely to work in creative professions. Notably, people from wealthy families are consistently more likely to work in creative professions, and access to family wealth amplifies the likelihood that siblings of people with BD pursue creative occupations. Nevertheless, family wealth explains only a small share of the correlation between BD and creative employment.

Bipolar spectrum traits and the space between Madness and Genius: The Muse is in the Dose

Creativity has long been associated with the bipolar spectrum, particularly among unaffected first-degree relatives and those with milder expressions of bipolar traits, suggesting that some aspects of the bipolar spectrum may confer advantages for creativity. Here we took a multifaceted approach to better define the shared vulnerability between creativity and bipolar disorder. We recruited 135 individuals with bipolar disorder, 102 creative controls, and 103 non-creative controls for a total of 340 participants. All participants completed a comprehensive assessment battery that included several self-report temperament and personality questionnaires, a computerized test of cognitive function across multiple domains, and an evaluation of creative performance and achievement. Significant group differences were observed for the hypothesized shared vulnerability traits of hypomanic personality, cyclothymic temperament, impulsivity, and positive schizotypy. While both the creative and bipolar groups demonstrated superior creative ability, the creative group alone revealed enhanced cognitive performance. Accounting for intercorrelations between traits, a combination of openness, hypomanic personality, divergent thinking, and reasoning ability emerged as the strongest predictors of creativity, collectively explaining 34% of the variance in creative achievement and correctly classifying 85% of individuals with high achievement irrespective of diagnosis. These results confirm and extend earlier observations of a shared vulnerability between creativity and bipolar disorder and suggest that mild to moderate expressions of bipolar spectrum traits are associated with enhanced cognitive functioning and creative expression. Further investigation of these traits is needed to clarify the nature of this shared vulnerability and suggest individualized treatment strategies to improve clinical outcomes in bipolar disorder.

Creativity and Bipolar Disorder: A Shared Genetic Vulnerability

Bipolar disorder is a lifelong mood disorder characterized by extreme mood swings between mania and depression. Despite fitness costs associated with increased mortality and significant impairment, bipolar disorder has persisted in the population with a high heritability and a stable prevalence. Creativity and other positive traits have repeatedly been associated with the bipolar spectrum, particularly among unaffected first-degree relatives and those with milder expressions of bipolar traits. This suggests a model in which large doses of risk variants cause illness, but mild to moderate doses confer advantages, which serve to maintain bipolar disorder in the population. Bipolar disorder may thus be better conceptualized as a dimensional trait existing at the extreme of normal population variation in positive temperament, personality, and cognitive traits, aspects of which may reflect a shared vulnerability with creativity. Investigations of this shared vulnerability may provide insight into the genetic mechanisms underlying illness and suggest novel treatments.

Creativity in persons at-risk for bipolar disorder-A pilot study

AIM

The association between bipolar disorder and creativity may be related to symptoms of the disorder itself or personality traits present before the onset. To further explore the relationship between creativity and clinical risk for bipolar disorder, creativity among individuals with a history of depressive disorder and varying risk for future (hypo-)manic episodes was assessed and compared.

METHODS

Thirty-eight participants completed the diagnostic process, including Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Diagnosis, Hamilton Depression Scale and Young Mania Rating Scale. The early detection tools Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P), Early Phase Inventory for Bipolar Disorders (EPIbipolar) and bipolar-at-risk-(BAR) criteria were used to assign participants into different at-risk groups. Assessment of creativity included Barron-Welsh Art Scale (BWAS) and Creative Achievement Questionnaire (CAQ). Scores were compared between low- and high-risk groups for the development of bipolar disorder.

RESULTS

Participants meeting BAR criteria scored significantly higher on the BWAS than the non-BAR group (P = 0.03). EPIbipolar groups did not differ significantly in creativity scores. Participants with mood swings, especially when associated with increased activity and euphoric features, had significantly higher BWAS scores compared to individuals without mood swings (P = 0.04). Sleep disturbances, substance abuse, anxiety, ADHD and behavioural disturbances in childhood or adolescence had no effect on creativity level or achievement scores. Generalisability was reduced by small sample size and inclusion of depressive participants only considered at-risk for bipolar disorder.

CONCLUSIONS

There is evidence of increased creativity, but not of higher creative achievements, in persons at-risk of bipolar disorder. Mood swings are strongly associated with creativity.

Prefrontal Activity Measured by Functional Near Infrared Spectroscopy During Divergent and Convergent Thinking in Bipolar Disorder

Introduction

Biographical research as well as some controlled studies point out to a relationship between bipolar disorder (BD) and creativity. Neurobiological underpinnings of this relationship are unclear. Although there is no consensus on the definition of creativity, Alternative uses Test (AuT) and Remote Association Test (RAT) are frequently used to measure convergent and divergent creativity. We aimed to examine prefrontal cortex (PFC) activity with functional near-infrared spectroscopy (fNIRS) during the RAT and AuT tests in subjects with BD.

Methods

We measured PFC activity in subjects with remitted BD (N=31) and healthy control subjects (N=27) with fNIRS during divergent and convergent thinking tasks (AuT and RAT respectively). We were particularly interested in the antero-posterior dissociation of the activity within the PFC according to the two task domains.

Results

We found that the index subjects displayed lower performance than healthy controls during the AuT and the RAT. AuT and RAT were associated with different activities in the two groups. Anterior PFC (aPFC) activity was higher than posterior PFC (pPFC) activity during the RAT in the index group, and during the AuT in the control group. aPFC activity was negatively correlated with the RAT performance in the index group.

Conclusion

Higher activity in the aPFC may be the functional neuro-anatomical correlate of low convergent creativity performance in BD.

Creativity and Mood Disorder: A Systematic Review and Meta-Analysis

Although the belief that creativity is related to psychopathology is prevalent, empirical evidence is limited. Research findings relating to mood disorder in particular are mixed, possibly as a result of differing research approaches (e.g., assessing the creativity of individuals with versus without mood disorder opposed to the prevalence of mood disorder in creative versus noncreative individuals). Therefore, a systematic review and meta-analysis were conducted to investigate prior research examining the link between mood disorder and creativity from three distinct research approaches. Multilevel random effects models were used to calculate the overall effect size for studies that assessed (a) creativity in a clinical versus nonclinical sample ( k = 13), (b) mood disorder in a creative versus noncreative sample ( k = 10), and (c) the correlation between dimensional measures of creativity and mood disorder symptoms ( k = 15). Potential moderators were examined using meta-regression and subgroup analyses, as significant heterogeneity was detected among the effects in all three analyses. Results reveal a differential strength and pattern of effects across the three analyses, suggesting that the relationship between creativity and mood disorder differs according to the research approach. The theoretical implications of results and potential mechanisms responsible for the relationship between creativity and mood disorder are discussed.

The link between hypomania risk and creativity: The role of heightened behavioral activation system (BAS) sensitivity

BACKGROUND

The relationship between bipolar disorder (BD) and creativity is well-known; however, relatively little is known about its potential mechanism. We investigated whether heightened behavioral activation system (BAS) sensitivity may mediate such relationship.

METHODS

Korean young adults (N=543) completed self-report questionnaires that included the Hypomanic Personality Scale (HPS), the Behavioral Activation System(BAS) Scale, the Everyday Creativity Scale (ECS), the Positive Affect and Negative Affect Schedule (PANAS), and the Altman Self-Rating Mania Scale (ASRM). Correlational, hierarchical regression and mediation analyses using bootstrap confidence intervals were conducted.

RESULTS

As predicted, BAS sensitivity was associated with self-reported creativity as well as hypomania risk and symptoms. Even when positive affect was controlled, BAS sensitivity predicted incrementally significant variance in explaining creativity. In mediation analysis, BAS sensitivity partially mediated the relation between hypomania risk and creativity.

LIMITATIONS

Reliance on self-report measures in assessing creativity and usage of non-clinical sample.

CONCLUSIONS

BAS sensitivity was related not only to mood pathology but also to creativity. As a basic affective temperament, BAS sensitivity may help explain incompatible sides of adaptation associated with BD.

Positive Traits in the Bipolar Spectrum: The Space between Madness and Genius

Bipolar disorder is a severe, lifelong mood disorder for which little is currently understood of the genetic mechanisms underlying risk. By examining related dimensional phenotypes, we may further our understanding of the disorder. Creativity has a historical connection with the bipolar spectrum and is particularly enhanced among unaffected first-degree relatives and those with bipolar spectrum traits. This suggests that some aspects of the bipolar spectrum may confer advantages, while more severe expressions of symptoms negatively influence creative accomplishment. Creativity is a complex, multidimensional construct with both cognitive and affective components, many of which appear to reflect a shared genetic vulnerability with bipolar disorder. It is suggested that a subset of bipolar risk variants confer advantages as positive traits according to an inverted-U-shaped curve with clinically unaffected allele carriers benefitting from the positive traits and serving to maintain the risk alleles in the population. The association of risk genes with creativity in healthy individuals (e.g., NRG1), as well as an overall sharing of common genetic variation between bipolar patients and creative individuals, provides support for this model. Current findings are summarized from a multidisciplinary perspective to demonstrate the feasibility of research in this area to reveal the mechanisms underlying illness.

Creativity and Bipolar Disorder: Igniting a Dialogue

Bipolar disorder (BD) has been related to heightened creativity, yet core questions remain unaddressed about this association. We used qualitative methods to investigate how highly creative individuals with BD understand the role of symptoms and treatment in their creativity, and possible mechanisms underpinning this link. Twenty-two individuals self-identified as highly creative and living with BD took part in focus groups and completed quantitative measures of symptoms, quality of life (QoL), and creativity. Using thematic analysis, five themes emerged: the pros and cons of mania for creativity, benefits of altered thinking, the relationship between creativity and medication, creativity as central to one's identity, and creativity's importance in stigma reduction and treatment. Despite reliance on a small sample who self-identified as having BD, findings shed light on previously mixed results regarding the influence of mania and treatment and suggest new directions for the study of mechanisms driving the creative advantage in BD.

Retirement and cognitive development in the Netherlands: Are the retired really inactive?

This paper uses longitudinal data to analyze the relation between retirement and cognitive development in the Netherlands. Controlling for individual fixed effects and lagged cognition, we find that retirees face lower declines in their cognitive flexibility than those who remain employed, which appears to be persistent 6 years after retirement. However, the information processing speed of low-educated retirees declines faster. The magnitude of both changes in cognition is such that retirees appear 5-6 years younger in terms of cognitive flexibility, and older in terms of information processing speed. We show that these relationships between retirement and cognitive development cannot be explained by (1) feeling relieved from routine work, (2) changes in mood, (3) changes in lifestyle, and (4) changes in blood pressure. The decline in information processing speed after retirement particularly holds for the low educated. This could increase the social costs of an aging society.

Creativity is linked to ambition across the bipolar spectrum

OBJECTIVE

Beyond evidence for an association, little is known about the mechanism linking creativity bipolar spectrum conditions. Theory suggests that ambition, which is heightened in bipolar disorder (BD) and associated with creativity in the general population, might be an important variable. The overarching aim of this project was to evaluate whether ambition is related to creativity among those with bipolar spectrum conditions.

METHOD

Across two studies, we examined correlations between a validated self-report measure of ambition, the WASSUP, and creativity. In Study One, 22 individuals diagnosed with BD who self-identified as highly creative completed the WASSUP and a measure of lifetime creative accomplishment. In Study Two, 221 undergraduates completed the WASSUP, a measure of mania risk (the Hypomanic Personality Scale, HPS) and a measure designed to assess creativity in business projects and tasks.

RESULTS

In Study One, WASSUP scores were significantly elevated compared to normative levels in BD, and WASSUP scores were correlated with lifetime creative accomplishment within the artistic sample. In Study Two, mania risk was related to greater ambition and creativity, and ambition was also directly related to greater creativity.

LIMITATIONS

Both studies were limited by the reliance on self-reported ambition.

CONCLUSION

Ambition could be one important component of creative success across the bipolar spectrum.

Exploring the links between the phenomenology of creativity and bipolar disorder

BACKGROUND

The links between bipolar disorder (BD) and creativity have historically attracted academic and public interest. Previous research highlights common characteristics of people considered to be highly creative, and those diagnosed with BD, including extraversion, impulsivity, divergent thinking and high motivation (Ma, 2009).

METHOD

In the first phenomenological study focussing on the links between creativity and extreme mood, an Interpretative Phenomenological Analysis (IPA) approach was used to collect and analyse in-depth interview data from seven people diagnosed with BD in the UK.

RESULTS

Four key themes were constructed to reflect and convey the collective accounts: 1. High mood leads to an expanding mind; 2. Full steam ahead; 3. A reciprocal relationship between mood and creativity 4. Reframing bipolar experiences through creative activity.

LIMITATIONS

Participants were a small sample of people who were identified as having BD on the basis of a clinical diagnosis and Mood Disorders screening Questionnaire (MDQ), and who defined themselves as creative without further corroboration.

CONCLUSIONS

Among this sample, creativity was recognised as a valued aspect of BD. Clinical services may usefully draw on creative resources to aid assessment and formulation, and even utilise the effects of creativity on the management of mood. Research demonstrates a high prevalence of non-adherence to medication among persons with BD and this ambivalence might be better understood when the links between extreme mood and creativity are considered.

Manic tendencies are not related to being an entrepreneur, intending to become an entrepreneur, or succeeding as an entrepreneur

BACKGROUND

Popular literature suggests a relationship between entrepreneurship and manic tendencies, yet little scientific research has evaluated whether manic tendencies foster entrance into entrepreneurial roles, intent to become an entrepreneur, or success as an entrepreneur.

METHODS

In study 1, 225 undergraduates and business school students/affiliates took an online survey to assess engagement and intent as entrepreneurs, as well as manic tendencies, including family diagnoses as reported on the Family Index of Risk for Mania, subsyndromal manic tendencies as assessed with the Hypomanic Personality Scale, and self-reported diagnoses. In study 2, the sample of entrepreneurs identified in study 1 was enriched by recruiting a larger group of established entrepreneurs from the community. Entrepreneurs (n=210) completed items concerning their success in entrepreneurship, and we examined whether the three measures of manic tendencies were related to success.

RESULTS

There was no evidence that those vulnerable to mania, regardless of definition, were more likely to be entrepreneurs, to intend to become entrepreneurs, or to succeed as entrepreneurs.

LIMITATIONS

The studies were limited by self-report measures and relatively small samples.

CONCLUSIONS

More nuanced models may explain the frequent clinical observations of manic traits among entrepreneurs.

The assessment of creativity in creativity/psychopathology research - a systematic review

INTRODUCTION

The possible link between creativity and psychopathology has been a long time focus of research up to the present day. However, this research is hampered by methodological problems, especially the definition and assessment of creativity. This makes interpretation and comparison of studies difficult and possibly accounts for the contradictory results of this research.

METHODS

In this systematic review of the literature, research articles in the field of creativity and psychopathology were searched for creativity assessment tools. The tools used in the collected articles are presented and discussed.

RESULTS

The results indicate that a multitude of creativity assessment tools were used, that many studies only used one tool to assess creativity and that most of these tools were only used in a limited number of studies. A few assessment tools stand out by a more frequent use, also outside psychopathological research, and more solid psychometric properties.

CONCLUSION

Most scales used to evaluate creativity have poor psychometric properties. The scattered methodology to assess creativity compromises the generalizability and validity of this research. The field should creatively develop new validated instruments.

Mental health and employment: The SAD story

This paper explores the relationship between health-related quality of life (HRQOL) measures and employment status in light of a constructed index related to Seasonal Affective Disorder that depends only on latitude and day of year. In models including demographic covariates and indicators for state, year, and quarter, more hours of darkness is associated with poorer HRQOL, which in turn is associated with a lower likelihood of employment. The relationships between the darkness index and HRQOL measures are stronger overall for women than for men. Inclusion of both the darkness index and the HRQOL measures in models of employment status determinants provides some evidence that the former operates through the latter in predicting a lower likelihood of employment. When specifying the darkness index as an instrument for HRQOL, each additional day of poor mental health per month leads to a 0.76 percentage point increase in the probability of unemployment among women.

Creativity and affective temperaments in non-clinical professional artists: an empirical psychometric investigation

OBJECTIVE

Manic-depression/bipolar disorder was linked to creativity, with affective temperaments allegedly favoring creative expression and achievement, but a few studies only empirically tested the link.

METHODS

152 undergraduate students attending preparatory courses for creative artistic professions and 152 students in areas expected to lead to a profession mostly requiring the application of the learned rules were invited to fill in the TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego - Autoquestionnaire), the General Health Questionnaire (GHQ) and the Creative Achievement Questionnaire (CAQ). Latent class analysis (LCA) was used to investigate the links between creativity scores and measures of psychopathology.

RESULTS

Creative participants and controls did not differ in terms of sex (males=47%), age (24.5 years, SD=3.8), or socioeconomic status. Creative people scored higher than controls on the CAQ and on the cyclothymic, hyperthymic and irritable subscales of the TEMPS-A, but not on the GHQ. Greater involvement in creative activities rather than being a creative achiever best differentiated those into the "risk for bipolar spectrum" class from the other two classes extracted by the LCA from the TEMPS-A.

LIMITATIONS

The use of self-report measures to evaluate both creative involvement and the risk of psychopathology, and the exclusive focus on artistic creativity limit the generalizability of the findings.

CONCLUSIONS

This study confirms that the cyclothymic dimension of the bipolar spectrum is linked to creativity, and this link is likely to result from increased involvement into pleasurable activities, including creative ones.

Creativity and mental disorder: family study of 300,000 people with severe mental disorder

BACKGROUND

There is a long-standing belief that creativity is coupled with psychopathology.

AIMS

To test this alleged association and to investigate whether any such association is the result of environmental or genetic factors.

METHOD

We performed a nested case-control study based on Swedish registries. The likelihood of holding a creative occupation in individuals who had received in-patient treatment for schizophrenia, bipolar disorder or unipolar depression between 1973 and 2003 and their relatives without such a diagnosis was compared with that of controls.

RESULTS

Individuals with bipolar disorder and healthy siblings of people with schizophrenia or bipolar disorder were overrepresented in creative professions. People with schizophrenia had no increased rate of overall creative professions compared with controls, but an increased rate in the subgroup of artistic occupations. Neither individuals with unipolar depression nor their siblings differed from controls regarding creative professions.

CONCLUSIONS

A familial cosegregation of both schizophrenia and bipolar disorder with creativity is suggested.

Great wits and madness: more near allied?

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.

Creativity and bipolar disorder: touched by fire or burning with questions?

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.

The link between bipolar disorders and creativity: evidence from personality and temperament studies

Although extensive literature supports connections between bipolar disorder and creativity, possible mechanisms underlying such relationships are only beginning to emerge. Herein we review evidence supporting one such possible mechanism, namely that personality/temperament contribute to enhanced creativity in individuals with bipolar disorder, a theory supported by studies showing that certain personality/temperamental traits are not only common to bipolar disorder patients and creative individuals but also correlate with measures of creativity. Thus, we suggest based on studies using three important personality/temperament measures-the Neuroticism, Extraversion, and Openness Personality Inventory (NEO); the Myers-Briggs Type Indicator (MBTI); and the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A)-that changeable (increased TEMPS-A-cyclothymia) and at times negative (increased NEO-neuroticism) affect and open-minded (increased NEO-openness) and intuitive (increased MBTI-intuition) cognition may contribute importantly to enhanced creativity in individuals with bipolar disorder.

The clinical significance of creativity in bipolar disorder

Clinical implications of the high rates of creativity within bipolar disorder (BD) have not been explored. The aim of this review is to outline these implications by (i) reviewing evidence for the link between creativity and BD, (ii) developing a provisional model of mechanisms underpinning the creativity-BD link, (iii) describing unique challenges faced by creative-BD populations, and (iv) systematically considering evidence-based psychosocial treatments in the light of this review. While more research into the creativity-BD nexus is urgently required, treatment outcomes will benefit from consideration of this commonly occurring phenotype.