Blog | Friday, November 18, 2011

QD: News Every Day--Mental illness sparks creativity among sufferers and their families

People with schizophrenia or bipolar disorder and their first-degree relatives more frequently work in creative professions, suggesting some truth to the long-mythologized link between artists and madness. The way the link plays out along family lines suggests a genetic cause, researchers reported.

While smaller studies have looked specifically at small groups of creative populations such as artist's workshops and their rates of mental illness, researchers in Sweden conducted a population-based study of how often mental illness occurs among people and their relatives, and its association with creative and non-creative professions.

The researchers performed a nested, case- control study using longitudinal Swedish total population registers and compared it with occupational census data. Creative professions included visual artists such as photographers and non-visual artists such as performers and writers, as well as members of the scientific professions among university academics. Accountants and auditors acted as a control group.

Results appeared in The British Journal of Psychiatry. Overall, the registries reported 54,042 people (29,479 men and 24,563 women) with schizophrenia, 29,644 people (11,910 men and 17,734 women) with bipolar disorder and 217,771 people (84,352 men and 133,419 women) with unipolar depression.

Compared with the control group, those with schizophrenia demonstrated no difference in having a creative profession (odds ratio [OR]=0.98; 95% confidence interval [CI], 0.88 to 1.08) but were significantly less likely to be scientists (OR=0.63; 95% CI, 0.51 to 0.79), researchers reported. They were significantly more likely to be an artist, (OR=1.14; 95% CI, 1.01 to 1.28), mainly because of a trend in the visual arts (OR=1.30; 95% CI, 1.13 to 1.49).

Parents and siblings of people with schizophrenia were significantly more likely to hold a creative profession across all domains compared with the control group (parents OR=1.55; 95% CI, 1.43 to 1.67; siblings OR=1.36; 95% CI 1.26 to 1.48). Offspring were not more likely to be in a creative profession overall, but were more likely to be in the visual arts (OR=1.38; 95% CI 1.18 to 1.62), a finding that is in line with the individuals with schizophrenia, the authors noted.

Those with bipolar disorder were significantly overrepresented in creative professions compared with the control group (OR=1.35; 95% CI 1.22 to 1.48). There was an increased likelihood of both visual (OR=1.42; 95% CI 1.23 to 1.64) and non-visual (OR=1.44; 95% CI 1.20 to 1.73) artistic occupations, researchers reported. First-degree relatives of those with bipolar disorder were more likely than those in the control group to hold a creative profession in general, with higher odds ratios for scientific than artistic occupations.

Individuals with unipolar depression were not more likely to be involved in creative professions (OR=0.94; 95% CI, 0.90 to 0.99). Those with bipolar disorder and their first-degree relatives were not more likely to become auditors or accountants, and those with schizophrenia or unipolar depression and their first-degree relatives were significantly less likely to do so.

"This Swedish total population case-control study is several magnitudes larger than previous studies and demonstrates an increased likelihood for both people with schizophrenia and bipolar disorder, as well as for their respective relatives, to work in a creative occupation, compared with controls," the authors wrote.

They continued, "Even though the present study does not explain what mechanisms may underlie the observed association between mental disorder and creative occupations, it is noteworthy that the likelihood of creative occupations in relatives of those in the case group was highest among healthy first-degree relatives and this gradually decreased with increasing familial distance to these individuals. Additionally, there were no significant differences between the maternal and paternal half-siblings. These results hence suggest a genetic rather than environmental explanation."

The study did not control for the more open environment found in many creative professions, which might allow those with mental illnesses to function successfully, compared to the more structured, 9-to-5 atmosphere found in auditing and accounting careers. The study's lead author, Simon Kyaga, told ACP Internist "Generally traits associated with creative behavior are openness, non-conformity, contrarianism, sensitivity, etc. that are unlikely to go hand in hand with 9-to-5 atmosphere."

He continued, "Two important aspects of creativity are divergent thinking and motivation. It is likely that these aspects will be present to a differing degree in patients with different psychiatric disorders. Studies have for instance shown patients with schizophrenia being able to 'think outside of the box' or actually less restrained by common sense, while patients with bipolar disorder have been shown to be more ambitious than the general population."

An editorial commented that mental illness is counterintuitive to be linked with creative success because of symptoms, including impaired concentration, short-term memory deficits and impaired executive function.

But, the editorial noted, other symptoms boost the creative mind. Elevated mood and rapidity of thought often facilitate creativity. Mania and hypomania increase the types of thought important in creativity. Bipolar illness can lead to risk-taking, grandiosity, restlessness and discontent. Illness-induced introspection and a need to make meaning of or ameliorate suffering inspire imagination and creativity as well, the editorialist wrote.