What Is the Connection between Bipolar Disorder and Creativity?

For centuries, insanity and creativity have been linked in the popular imagination. In the modern era, biographical studies of accomplished artists, as well as psychological studies of both creative individuals and psychiatric patients, have documented a correlation of bipolar disorder with creativity.

What accounts for this association? The U.C. Berkeley psychologist Sheri Johnson and a group of colleagues have looked at the psychological literature to understand what features of bipolar disorder account for creativity and what aspects of creativity are heightened in people with bipolar disorder. Their review is a good starting place to understand this fascinating connection.

The authors wisely distinguish bipolar I disorder on the one hand from bipolar II disorder and cyclothymia on the other, which they call “bipolar spectrum” disorders. (Hagop Akiskil and others have written about a much broader bipolar spectrum which includes milder tendencies toward intense or variable moods.) Johnson and colleagues also look at subsyndromal manic symptoms as measured by psychological inventories.

The largest literature linking bipolar disorder with creativity comes from biographical studies of famous creative individuals. In addition, researchers have looked at groups who have achieved recognition for creativity, such as participants in the Iowa Writers’ Workshop and individuals whose biographies were reviewed in the New York Times. Others have studied the prevalence of bipolar disorder in creative occupations. The picture is fairly consistent: creative individuals are more likely to have milder forms of bipolar disorder than the general population, but more disabling mental illness, such as bipolar I disorder, is less common than the milder forms in creative individuals.

If bipolar spectrum disorders are more common in creative individuals, how common is creativity in people diagnosed with bipolar disorders? Johnson and colleagues reference a sample of 750 psychiatric patients which found that high creativity ratings were more common in those with bipolar spectrum disorders (8%) than in those with bipolar I disorder, schizophrenia, or major depression (1%). It is noteworthy that most patients were not seen as highly creative. In epidemiological samples, patients with bipolar disorders are more likely to work in creative occupations and engage in creative hobbies.

Turning to the psychological literature, the authors describe several components of creativity. Divergent thinking is the capacity to generate unique and diverse solutions by combining conceptually distinct elements in novel ways. It encompasses fluency, the ability to generate multiple responses to a prompt; flexibility, the number of different kinds of responses, and originality, the number of unusual responses. Flexibility may depend on inhibiting prior responses and shifting sets.

The authors note that some creative solutions emerge from conscious analytical problem solving, while others depend on “insight,” when a solution emerges suddenly without prior conscious awareness. This can involve using atypical or distantly related concepts in unusual ways. They also note that achieving recognition for creativity also requires drive, motivation, opportunities, and social resources. These components of creativity turn out to be only modestly correlated with each other, with ratings by others of creativity, and with achieving eminence in a creative field.

Johnson and colleagues move from the psychology of creativity to consider creative psychological patterns in individuals with bipolar disorder. In one study, divergent thinking was correlated with risk for mania as measured by a Hypomanic Personality Scale, but studies in patients with diagnosed bipolar disorder have not found high levels of divergent thinking—in contrast, such patients have shown deficits in set shifting.

In sum, Johnson and colleagues find high levels of bipolar spectrum disorders in people with creative accomplishments but limited evidence of divergent thinking and set shifting, especially in those with diagnosed bipolar I disorder. It seems possible that a tendency toward divergent thinking facilitates creativity, but too much can interfere with creative productivity and recognition. It is also possible that other symptoms of bipolar disorder, such as increased energy, drive, and social interactions facilitate creative accomplishment. A third possibility is that creativity ebbs and flows with changes in mood state or for other reasons.

Reviewing personality factors, Johnson and colleagues find evidence of high levels of impulsivity in both creative individuals and people with bipolar disorders. Another trait high in both groups is openness to experience, which they define as motivation to pursue novel ideas and experiences. Commitment and effort are also associated with creative accomplishment. People with bipolar disorder tend to have very high lifetime ambitions, which appears to be a trait independent of mood state, but during times of elevated mood, confidence can rise to extraordinary heights. In sum, the personality traits of impulsivity, openness to experience, ambition, and the confidence associated with elevated moods may contribute to success in creative endeavors.

In the area of affect, despite much romantic theorizing about depression and other negative emotions contributing to creativity, and the elevated rates of depression found in creative individuals, negative emotions and depression themselves do not appear to be associated with creativity.

In normal individuals, positive emotional states broaden attention and increase the range of percepts, thoughts, and images that reach awareness. They relax inhibitory control and increase the ability to process information at a global level. Particularly when combined with high arousal, these positive emotional states are associated with creativity. The association, however, is primarily with generation of new ideas rather than with problem solving, and the effect is strongest at moderate rather than very high levels of positivity.

Patients diagnosed with bipolar disorder as well as accomplished writers and artists tend to believe their positive moods and manic symptoms enhance creativity, and there is concern that mood-stabilizing mediation might diminish creativity. Biographical studies have confirmed that some, but not all, creative individuals are more productive during hypomanic and manic periods—examples include Emily Dickinson and Robert Schumann, but not Virginia Woolf.

Looking at cognitive features of elevated mood, the authors found that increased fluency was associated with manic states. Eminent writers and artists reported that elevated moods, high energy, and decreased need for sleep benefited their creativity, but more destructive symptoms such as hypersexuality and overspending did not.

Summarizing their findings from the literature, Johnson and colleagues note that while a fairly small minority of people with bipolar disorder are highly creative, bipolar symptoms and bipolar spectrum diagnoses are common in creative individuals. Different aspects of creativity are associated with different cognitive, affective, motivational, and personality characteristics. Choosing a creative occupation is associated with impulsivity and openness to experience. Divergent thinking and insight correlate with moderate levels of positive affect. There is little support for the idea that depression enhances creativity.

The authors conclude that while bipolar disorder is associated with elements of creativity, including impulsivity, openness to experience, ambition, confidence, and positive mood states, little is known about which of these actually mediate creativity in people with bipolar disorder: few studies have evaluated affect, personality, and cognition along with indices of creativity. They go on to propose an agenda for more refined psychological research.

This review both expands and focuses the conceptualization of creativity’s relationship to bipolar disorder. It appears that milder elevated mood states such as hypomania facilitate creativity by increasing confidence, cognitive fluency and flexibility. Personality traits more common on people with bipolar disorder, such as impulsivity and ambition, may also play a role. While depression itself does not foster creativity, mood shifts might, though this has received little study. The authors do not discuss effects of heightened mood on the content of artistic productions, such as the intensity, vividness and sense of wonder found in many of their productions. In addition, artists such as Virginia Woolf have drawn on their experiences of mood disorder for narrative purposes. The review does also does not address the effects of today’s widespread public awareness, diagnosis, and treatment of bipolar on artistic creativity. While Johnson and colleagues shed much light on the relationship of bipolar disorder to creativity, many interesting questions remain.

Further Reading:

Johnson SL, Murray G, Fredrickson B, et al. Creativity and bipolar disorder: touched with fire or burning with questions? Clin Psychol Rev. 2012; 32:1-12.

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