Creativity & Insanity - Friends or Foes?

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Last Modified: 02/28/07

Summary: How are creativity and insanity related.

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El arte de la demencia - Thu, 01 Mar 2007 06:00:18 GMT

El arte de la demencia

Obra de una pintora con demencia

A D E M Á S ...

NOTICIAS RELACIONADAS

De acuerdo a la ley del Tao, todo acontecimiento o realidad negativa tiene su equivalente positivo. La demencia parece seguir el postulado de esta filosofía oriental porque a medida que progresa la degeneración neurológica propia de la enfermedad aumenta la creatividad del paciente. El talento artístico del individuo crece con la pérdida de facultades puramente racionales, como el lenguaje.

«La habilidad de trascender la restricciones sociales, físicas y cognitivas es una capacidad de los grandes artistas» afirman los autores de un artículo publicado en Neurology. Las personas que sufren demencia acceden al olimpo de los genios a través de su enfermedad. «La liberación de los patrones de pensamiento dominados por el lenguaje parece ser un factor clave en la aparición de habilidades artísticas en estos pacientes», explica estos investigadores.

En la publicación se describe el caso de una paciente de 52 años que desarrolló una forma poco frecuente de demencia denominada frontotemporal. Esta mujer tenía una formación artística y era profesora de arte, pero sus cuadros comenzaron a evolucionar espectacularmente con la progresión de la enfermedad. A medida que la pintora perdía su capacidad para comunicarse verbalmente y para recordar los nombres de sus alumnos, «sus pinturas se volvieron más salvajes y más libres» afirman los investigadores.

La paciente era de origen asiático, aunque había crecido en EEUU y antes de la aparición de la demencia, sus obras eran figurativas y paisajes. Algunas de ellas representaban los estilos occidentales y otras seguían las pautas clásicas del folclore chino. Con el tiempo comenzó a mezclar ambas culturas, a añadir color y formas complejas. «Estaba claro que se había liberado de las restricciones de su formación. Sus últimas piezas ya no eran realistas, sino que tenían un estilo intensamente emocional e impresionista», asegura Bruce Miller de la Universidad de California (EEUU), autor principal del artículo.

La pintora ha abandonado recientemente la producción artística, pero recuerda perfectamente sus obras y las técnicas que empleó para crearlas. «Cuando habla de sus cuadros, su lenguaje es más libre y más espontáneo que cuando conversa de otros temas», explica el investigador.

Miller lleva años estudiando el comportamiento y la evolución de los pacientes con demencia y ha observado que muchos de ellos, incluso cuando nunca han tenido interés por el arte, desarrollan habilidades creativas a medida que progresa su enfermedad. Entre estos sujetos ha encontrado una pauta común, la afectación neurológica se sitúa exclusivamente en el hemisferio izquierdo. Esta región del cerebro se asocia a los procesos ‘racionales’ como el lenguaje o el cálculo. El hemisferio derecho, por el contrario, es la residencia de la intuición, de la creatividad y de todas aquellas aptitudes consideradas ‘no racionales’.

Los investigadores sugieren que cuando el área racional del cerebro domina el comportamiento suprime las habilidades creativas y cuando se ‘desconecta’ por alguna razón, éstas salen a la luz. Sin embargo, no es necesario enfermar para explorar los dones ocultos. Desde hace algunos años se están empleando algunas técnicas orientales de meditación y otras desarrolladas en Occidente como la visualización cuyo objetivo es estimular el hemisferio derecho para recuperar las capacidades ocultas por el poder de la mente racional.

From: http://www.elmundo.es/elmundosalud/2003/05/27/medicina/1054047291.html

Bipolar Disorder and the Creative Mind - Thu, 01 Mar 2007 05:54:35 GMT

Bipolar Disorder and the Creative Mind

Liz Paterek

There is an old stereotype that artists are moody individuals prone to fits of depression and madness. Is this little more than an old wives tale? Many artists and writers speak of periods of increased mental fluidity and lifted mood ((4) ). Poets such as Edgar Allan Poe and Emily Dickinson, novelists such as Mary Shelley and Leo Tolstoy and artists such as Michelangelo and Vincent Van Gogh have all be reported to show signs mental instability ((2) ). How common is depression in artists compared to other creative professions? If there is a trend, is it because this bipolar nature generates a new way to see the world? Are the arts a refuge for mentally unstable? Is artistic genius linked with madness?

Major depression strikes as many as 5% of the general population, often later in life and is more common in women. Bipolar affective disorder, which involves phases of mania and depression, is known to strike 1% of the population, with the numbers of men and women being similar ((1b) ). Mania is expressed by periods of extreme productivity, grandiosity, hyperactivity and irritability lasting for at least a week. Hypomania is a less severe form of this disorder also involved in manic depression. Major depression must last for periods of at least 4 weeks and is characterized by inability to concentrate, feelings of worthlessness and fatigue ((5) , (3) ).

Memory and creativity are related to mania. Clinical studies have shown that those in a manic state will rhyme, find synonyms and use alliteration more than controls. This mental fluidity could contribute to an increase in creativity. Moreover mania creates increases in productivity and energy. Those in a manic state are more emotionally sensitive and show less inhibition about attitudes, which could create greater expression ((3) ). Studies performed at Harvard looked into the amount of original thinking in solving creative tasks. Bipolar individuals, whose disorder was not severe, tended to show greater degrees of creativity ((5) ).

Bipolar disorder is not the first to be linked to creativity. During the 1960's, it was alcoholism. Before that, many artists, including Keats, Shelley, and Poe were thought to have fatal diseases such as tuberculosis. However, these diseases all are linked by symptoms. Tuberculosis has manic and depressive phases, which gives credence to the idea that artists experience mood swings ((2) ). Alcoholism is linked to mania and depression ((3) ).

There have been studies pointing to a link between manic-depression and left-brained talents. When Nancy C. Andreasen of the University of Iowa questioned 30 writers, she found that at least 80% had had at least one episode of major depression, mania or hypomania compared to 30% of controls ((2) , (5) ). Another researcher, Rothenburg, who has spent 30 years studying creative individuals, objects to her control groups and her methods ((2) ). Later when Kay Redfield Jamison studied 47 writers, painters, and sculptors, she found that 30% had been treated for bipolar disorder ((2) , (5) ). Half of the poets studied were treated for bipolar disorder ((5) ).

While these samples are small and it is difficult to judge prominence of many living individuals, there is a trend. Some diagnosis of the past has been performed to help confirm this data. This is based on second hand information and has its flaws ((2) ). The way individuals are portrayed by others will be scattered, because they do not know all aspects of a person's life. All people have quirks, if one wanted to see insanity, it would be easy to exaggerate them. However, if this data is supportive, it will cement the trend.

Artists in generations past have been shown to have suicide rates 10-20 times higher than the general population and higher than average rates of hospitalization for depression ((1b) ). Another researcher, Ludwig, delved into depression in prominent 20th century individuals based on 2,200 biographies of 1,004 individuals. He showed that while 11% of creative individuals suffered from mania; only 1% of the general population did. He also showed 46 to 77% suffered from depression, almost twice the rate in the general population ((1c) ). He found that accomplished individuals in other fields, including science, had only a 3% rate of depression. He believed the biographers were less likely than psychiatrists to believe that a person had a mental disorder and that clinical stories are autobiographies which are the most inaccurate understanding of a person ((2) ). Despite any flaws in how these experiments have been performed, the trend persists. Therefore it is important to ask why this trend exists.

While Jamison and Andreasen argued that bipolar disorder enhances creativity, Ludwig argued that individuals who are creative but manic are more likely to find a home in art rather than other fields ((2) ). According the Ludwig, the sciences require organization, preparedness and levelheadedness. An artist could draw on the lack of these traits for inspiration; a scientist could not ((2) ).
There is the question of different forms of intelligence. A scientist may not be an outstanding poet nor is an outstanding poet likely to be great at physics. At an elite level, talents are often focused in specific field. This is at least somewhat suggestive that there may be different brain connections that create different talents. Therefore a genius may not be able to choose to go between fields because of personality as Ludwig suggests.

The Jamison and Andreasen argument is shaken by the fact that around half of all great creative minds have not been bipolar; therefore manic phases could not cause their creativity. They have no data to suggest directionality of this link. It could just as likely be that artistic talents generate a predisposition for bipolar symptoms as it could be that being bipolar generates artistic abilities. The latter makes less sense because fewer bipolar individuals are artistic than artists are bipolar, as well as that those with severe mania are less creative than those with mild forms. While drug studies would seem to support the link that without manic phases creativity decreases, it would be better to realize that these drugs have broad effects and all effects may not be directly related ((2) , (5) ).

It is clear that being bipolar does not mean that one will necessarily be creative. It is also clear that being bipolar is not a requisite for genius. However, Hagop S. Akiskal found that 9-10 percent of those bipolar patients he studied with less severe symptoms were artists and writers ((1a) ). The mind of a left-brained genius could be more vulnerable to mood swings, which manifest similarly to normal bipolar symptoms. Therefore the symptoms would not exist in all geniuses but in many. The connections in the brain that cause this genius may be different from those who express right brained talents. This would explain why geniuses in other fields do not show the same symptoms. It would also keep the link between mania and creativity that Ludwig's argument does not.

Left brained creativity could be a vulnerability factor to developing symptoms of bipolar disorder. Studies present a seemingly clear link between bipolar disorder and artistic creativity. This would account for the reason other individuals in creative fields, such as science, do not show the same results. Because talent is often focused, it is unlikely that a manic individual chooses art. Because not all bipolar minds are creative but many creative minds are bipolar, it seems likely that bipolar disorder generates vulnerability for bipolar symptoms. Because it is only a vulnerability factor, many people will not suffer from it while still having talent.

From: http://serendip.brynmawr.edu/bb/neuro/neuro06/web2/lpaterek.html

Creativity and Psychopathology - Thu, 01 Mar 2007 05:54:52 GMT

Creativity and Psychopathology

by Rachel Friedman

"For me, insanity is super sanity. The normal is psychotic. Normal means lack of imagination, lack of creativity."

- Jean Dubuffet (1901-1985) French painter, sculptor, printmaker in "New Yorker," 16 Jun 1973

Creativity and Psychopathology: An Introduction

What do Vincent van Gogh, Tchaikovsky, Picasso, and Rachmaninoff all have in common? Besides sharing historical fame as musical or visual artists, these four men also share the distinction of having been known as both intensely creative and severely psychologically disturbed individuals during their lifetimes (Post, 1994). But they are by no means alone in this category: Jamison writes in the introduction to her study on this subject that "extremes in mood, thought and behavior�including psychos is�have been linked with artistic creativity for as long as man has observed and written about those who write, paint, sculpt or compose" (1989). Indeed, Gauguin, Colette, Tolstoy, Charlotte Bronte, and Kafka are just a few of countless other world-renowned artists with historically documented psychopathologies (Post, 1994). It�s enough to make one wonder: What is the physiological or psychological source of human creativity? Are the seemingly high incidences of certain mood disorders and other psychiatric illnesses in these creative geniuses just coincidence? Or, as several studies have attempted to prove, is there an underlying correlation or even causal relationship between the two?

Two Lines of Inquiry Are Better Than One

In my research on this subject, I found what seemed to be two different experimental approaches to the issue of creativity and psychopathology. The first type, employed by both Jamison and Felix Post, uses up-to-date psychiatric diagnostic criteria to identify psychopathologies in already established artists and other prominent creative individuals. This strand of investigation attempts to confirm stereotypes of the "mad genius" by showing high correlation among prevalence of creativity and certain mood disorders, while raising important ethical issues about the implications of diagnosis and drug treatment of affective disorders in creative individuals. Despite convincing results, neither approach is sufficient itself in either proving a causal relationship between creativity and psychopathology or offering conclusive scientific insight into where creativity stems from in the brain and how it develops in humans.

I will therefore also examine a relatively new line of inquiry into the intriguing notion of a causal relationship between mental illness, or abnormality, and creativity. Thanks to recent advances in neuroimaging technology that have allowed more precise diagnoses of mental illnesses in living individuals, neurologists have discovered a small population of remarkable individuals who seem to open the door to a whole new arena of investigations into the physiological correlation between visual artistry and damaged brains. In direct contrast to individuals with Alzheimer�s Disease, who seem to overwhelmingly undergo dramatic deterioration in all previously held artistic ability (Cummings & Zarit, 1987), Miller, the pioneer on this subject, has published several articles about the actual appearance of artistic talent in previously uncreative or unartistic people. As I will discuss in my review of his investigations, all five of these individuals were found through SPECT brain imaging scans to have a newly identified form of dementia called frontotemporal dementia, FTD. After briefly discussing the difficulty of defining and confining creativity as stemming from a certain part or function of the brain, I will present Miller�s findings and conclude by addressing the possible philosophical and ethical issues raised by this topic.

Madness and Genius: Just a Coincidence?

In the last twenty years, an increasing volume of literature has amassed with critical support that provides evidence of a strong link between creativity and a tendency to affective (mood) disorders (Hare, 1997; Jamison, 1993; Post, 1994). In spite of the difficulty in classifying and measuring a characteristic as nebulous as creativity, these studies are groundbreaking in their systematic investigation of the topic. In Post�s study, two hundred ninety-one already deceased world-famous people were chosen as examples of creative individuals, each falling into one of six field categories: scientist, composer, politician, artist, thinker, or writer. Subjects were chosen on the basis of the availability, quantity, and reliability of relevant material about their lives and personal characteristics in factual (i.e., non-autobiographically subjective) biographies written about them (Post, 1994). Extracted data on each subject was then transformed into psychiatric diagnosis when appropriate, using the latest standard of diagnosis available at the time, the DSM-III-R (American Psychiatric Association, 1987).

The results of this massive effort suggested a much higher prevalence of psychological abnormalities in the groups of more creative professionals like artists and writers than in the less creative scientists or intellectuals. As a result, Post concluded that certain pathological personality characteristics are causally linked to some kinds of valuable creativity (1994). While I agree that this study raised some excellent points in addressing the philosophical controversy about whether creativity and genius are ultimately indications of the highest possible expression of humanity, or conversely, just evidence of abnormality; even a high correlation between the two characteristics does not necessarily indicate a causal relationship. Indeed, a high proportion of the subjects under review were also Protestant, yet this does not imply a causal relationship between Protestantism and creativity.

Creativity and Lithium: Not Perfect Together

Jamison, while undertaking a project with similar methodology as Post, provides a more cogent argument in many respects because she attempted to answer a question that was both more quantifiable and more limited in its scope. Jumping off the springboard planted by DeLong and Aldershof, who found an unusually high incidence of special abilities like artistic talent in a sample of children with manic-depressive illness (1983), Jamison designed a study to test the hypothesis that extremes in mood, thought, and behavior specifically are linked with artistic creativity (1989). She accomplished this by investigating rates of treatment for affective illness in a sample of eminent British writers and artists, and studied differences�if any�in subgroups of each profession (poets, novelists, playwrights, biographers, artists). Results included a much higher prevalence of reported histories of severe mood swings among artists and writers than in the general population. Virtually all subjects reported having intense, highly productive and creative episodes, and a full 90% even stated that such moods and feelings were integral and necessary or at least very important in the development and execution of their work (1989). In addition, Jamison noted that "interestingly, the biographers�who provided a comparison group by being outstanding but perhaps less creative writers�reported no history of mood swings or elated states" (1989).

The Issues

Jamison also discussed some of the theoretical, clinical, literary and societal-ethical implications of this investigation. She considers such issues as the understanding of cognitive, perceptual, mood and behavioral changes common to manic, depressive and creative states; the potential ability to lessen the stigma of mental illness; effects of psychiatric treatment (for example, lithium) on creativity; and concerns raised about genetic research on mood disorders. (Jamison, 1989). Thus, even if it does not provide conclusive scientific evidence on a causal relationship between creativity ad psychopathology, her research nevertheless opens a forum for the discussion of these important implicative issues.

Cummings and Zarit raise similar issues crucial to this topic in their article on "Probable Alzheimer�s Disease in an Artist" (1987). They report the case of a 75-year-old male painter whose painting skills drastically deteriorated over a two and a half year course of behavioral and neuropsychological assessments of his probable Alzheimer�s Disease. In observing these dramatic effects of brain damage on artistic creativity, the authors speculate on the nature of creative talent, a characteristic they claim is "innate and reflects the unique structural-functional organization of the artist�s brain." This would seem to imply that creativity is not a consciously cultivated phenomenon, and is instead just the physiological result of a certain neurological structure. An interesting twist to this story came in the form of responses to the article. Apparently numerous art critics saw the series of paintings done by the patient, which Cummings and Zarit used as evidence of an obvious and drastic deterioration in the patient�s artistic and creative talents, and vehemently disagreed. One letter writer argues that the second painting in the series, completed seven years after the onset of Alzheimer�s disease, is "a stunning painting," "the work of a genius, recalling the best of Van Gogh." (JAMA 1988). Such a response highlights the subjective nature of this notion of creativity, and therefore might remind us of the complex and often ambiguous nature of these aspects of human thought and behavior.

Looking at Dementia

But while these three studies raise intriguing questions and a possible correlation between psychological abnormality and creativity�including the very question of what defines abnormality, in all of these studies the evidence has been gathered in one direction only. That is, the researchers have identified certifiably "creative" individuals, and then explored the prevalence of psychopathology. In the case study of the man with Alzheimer�s Disease, a certain neurological formation was linked to creativity only because the patient�s creativity and artistic talent arguably diminished with the cortical deterioration characteristic of the disease. But the reader responses seem to suggest that perhaps the patient developed an increase in creativity even as his objective artistic skills declined. This may seem ridiculous at first glance, but as we will see, there is growing evidence that a certain subset of non-Alzheimer�s dementia, called the temporal variant of frontotemporal dementia (FTD) after the brain regions it affects, may actually induce creativity and visual artistry in some individuals. In one of the leading recent reports that cite spontaneous creativity in the setting of dementia, Miller (1988) details the case histories of a handful of patients who acquired new artistic skills while diagnosed specifically with FTD.

Frontotemporal Dementia: The New Creative Frontier?

Frontotemporal dementia, or FTD, is a diagnosis used to describe individuals with a certain category of cortical degeneration (i.e., in which cells in certain regions or lobes of the brain�s cerebral cortex become atrophied or swollen). Similar in nature to Alzheimer�s Disease, another type of dementia, FTD is nevertheless anatomically and chemically distinguished in two ways. While in Alzheimer�s Disease the early atrophy of cell bodies and cortical lobes occurs in the posterior parietal and medial temporal areas of the brain, FTD effects are restricted to the frontal and temporal lobes. In addition, FTD degeneration tends to be more assymetric than in Alzheimer�s, where the atrophy is more general.

It should be noted that all of these distinctions in still living patients are made possible by SPECT (single photon emission computed tomography). Certain radiopharmaceuticals (proteins or organic molecules with attached radioactive atoms) are selected for use based on their known absorption properties within the brain. A healthy brain will, when its cells are functioning normally, uptake a certain amount of radiopharmaceutical�this can be observed as a bright area in a SPECT image. Unusually bright or dim areas on the scan, therefore, suggest an abnormal metabolic functioning of those cells and may represent an atrophied or diseased state.

Miller used SPECT imaging to diagnose the five patients in his report as having FTD. In fact, four of the five were shown to exhibit a temporal lobe variant of FTD, in which the anterior temporal lobes (related to language and social skills) become atrophied while the dorsolateral frontal cortex (related to visual skills) is largely spared. As Miller hypothesizes, this unique selective loss of function in the anterior temporal lobes may have a causal effect on the sudden facilitation of artistic skills.

Meet the Patients

In direct contrast to the Alzheimer�s patient mentioned previously, who apparently lost his existing creativity and artistic talents, Miller�s patients seemed to develop skills they had never before possessed. Patient 1, for example, had had "no prior interest in art but started taking art courses with the onset of dementia." Despite acting disinhibited and irritable, hallmark characteristics of patients suffering from FTD, Patient 1 began painting pictures of remembered places with remarkable clarity (Miller et al. , 1998). Patient 2 also began taking art classes rather suddenly, and shortly thereafter became uncomfortable in social situations, incontinent, and verbally disinhibited. Probably most striking, however, is a patient described as RTLV 4 in a study by Edwards-Lee et al. on the temporal lobe variant of FTD (1997).

A 68-year old retired stock broker when first seen for dementia, Patient RTLV 4 had had no previous interest in art when he first started painting 13 years before. This new hobby erupted spontaneously with a phenomenological event the patient described as "open" and "closed" periods. During "open" periods, light and sound produced feelings of pleasure in the patient which, he claimed, allowed him to think creatively (Miller et al. , 1998). During "closed" periods, however, normal sensory stimuli felt uncomfortable, even intensely painful, to the patient (Edwards-Lee et al. , 1997). Despite increasing disinhibition along with severe language and memory deterioration, the patient continued to paint images experienced during both his open and his closed periods. Moreover, as Miller describes, his precision and detail actually improved over the course of his illness and he even won awards at several art shows (1998).

Conclusion

Goldman-Rakic observed that "visuospatial processes engaged in humans by activities such as�painting and drawing from memory�rely on the dorsolateral prefrontal convexity." As Miller describes, this is the primary region of the brain that was spared in all five of these patients with FTD, and all of the observed enhancements in creativity were visual, never verbal. Miller hypothesizes a possible mechanism for the observed phenomena, called paradoxical functional facilitation. Hypothetically, the observed loss of social skills and inhibitions may have been more than just coincident symptoms of FTD: according to Miller, "selective degeneration of the anterior temporal and orbital frontal cortex [thought to correspond to social skills] decreased inhibition of the more posteriorly located visual systems involved with perception, thereby enhancing these patients� artistic interests and abilities" (1998).

FTD therefore may lend some insight into the physiological basis of the artistic process. Nevertheless, it should be clear that none of the studies mentioned are in any way a final word on the topic. SPECT imaging has not yet been developed that can actually pinpoint a "creativity center," even though it has proved to be a remarkable window into the nature of brain functioning. If anything, these observations and patient samplings may be seen as first steps in a biological exploration of the mystery of creativity. They might be used to inspire discussions about the relationship of creativity to mental illness of different sorts, or even of creativity to artistic talent. For although the two terms were used almost interchangeably throughout this discussion, it is not yet clear whether they are indeed one and the same. Additionally, this discussion might include a speculation about possible evolutionary bases of creativity. Finally, we might tackle the issue of mental illness as abnormality, in terms of assessing our own social stigmas and potential future eugenic measures surrounding those with mental illness, and how this might change if creativity and psychopathology are causally linked at some point in the future.

References

Cummings, J. L. & Zarit J. M. (1987). Probable Alzheimer�s disease in an artist. Journal of the American Medical Association, 258, 2731-4.

Edwards-Lee, T., Miller, B. L., Benson, D. F., Cummings, J. L., Russell, G. L., Boone, K., & Mena, I. (1997). The temporal variant of frontotemporal dementia. Brain, 120, 1027-40.

Goldman-Rakic, P. S. (1996). Regional and cellular fractionation of working memory. Proceedings of the National Academy of Science, 93, 13473-13480.

Jamison, K. R. (1989). Mood disorders and patterns of creativity in British writers and artists. Psychiatry, 52, 125-34.

Keynes, M. (1995). Creativity and Psychopathology. Lancet, 345, 138-9.

Miller, B. L., Cummings, J. L., Mishkin, F., Boone, K., Prince, F., Ponton, M., & Cotman, C. (1998). Emergence of artistic talent in frontotemporal dementia. Neurology, 51, 978-82.

Miller, B. L., Ponton M., Benson D. F., Cummings J. L., & Mena I. (1996). Enhanced artistic creativity with temporal lobe degeneration. Lancet, 348, 1744-5.

Post, F. (1994). Creativity and psychopathology: A study of 291 world-famous men. British Journal of Psychiatry, 165, 22-4.

Stokes, P. (1994). Creativity and psychopathology. British Journal of Psychiatry, 165, 555-6.

From: http://www.hcs.harvard.edu/~husn/BRAIN/vol7-spring2000/creativity.htm

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