Bipolar Disorder and the Creative Genius
Bipolar Disorder and the Creative Genius
HimaBindu K Krishna
Bipolar disorder, also known as manic depression, is a psychopathology that affects approximately 1% of the population. (1) Unlike unipolar disorder, also known as major affective disorder or depression, bipolar disorder is characterized by vacillating between periods of elation (either mania or hypomania) and depression. (1, 2) Bipolar disorder is also not an illness that remedies itself over time; people affected with manic depression are manic-depressives for their entire lives. (2, 3) For this reason, researchers have been struggling to, first, more quickly diagnose the onset of bipolar disorder in a patient and, second, to more effectively treat it. (4) As more and more studies have been performed on this disease, the peculiar occurrence between extreme creativity and manic depression have been uncovered, leaving scientists to deal with yet another puzzling aspect of the psychopathology. (5)
Patients with bipolar disorder swing between major depressive, mixed, hypomanic, and manic episodes. (1-9) A major depressive episode is when the patient has either a depressed mood or a loss of interest/pleasure in normal activities for a minimum of two weeks. Specifically, the patient should have (mostly): depressed mood for most of the day, nearly every day; diminished interest or pleasure in activities; weight loss or gain (a difference of 5% either way in the period of a month); insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; diminished ability to think or concentrate; feelings of worthlessness; recurrent thoughts of death or suicidal ideation or attempt. It is important to note that, except for the last symptom, all of these symptoms must be present nearly every day. (2, 7) In addition to major depressive episodes, patients with manic depression also feel periods of hypomania. A hypomanic episode must be a period of at least four days, during which the affected person feels elevated or irritated--a marked difference from the depressed period. (2, 7) The symptoms are: inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual, flight of ideas or racing thoughts, distractibility, psychomotor agitation or an increase in goal-directed activity, excessive involvement in pleasurable activities that may have negative consequences. (2, 7) This change in mood is observable by others and medications, substance abuse, or another medical condition does not cause the symptoms. (7)
In contrast to hypomania is mania, which is a more extreme case of hypomania. A manic episode is a period of an elevated or irritable mood for at least one week. (2, 7) The symptoms must cause problems in daily functioning and cannot be caused by a medical condition or drugs. (7) Manic symptoms are: inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual, flight of ideas or racing thoughts, attention easily drawn to unimportant or irrelevant items, increase in goal-directed activity or psychomotor agitation, and excessive involvement in pleasurable activities which may have negative consequences. (2, 7) Lastly, bipolar disorder patients may also go through mixed episodes, which are periods when the patient meets the criteria for both a manic episode and a major depressive episode every day for at least one week. (2,7)
Due to the different mood phases, which the patient may experience, the DSM-IV (diagnostic manual of American Psychologists) has categorized two different types of bipolar disorder, I and II.
Bipolar I is characterized as any one of the following variations:
1. The patient having a manic episode without precedence of a depressive episode
2. Most recently in a hypomanic episode with at least one previous manic or mixed episode
3. Most recently in a manic episode with at least one previous major depressive episode, manic episode, or mixed episode
4. Most recently a mixed episode with at least one previous major depressive episode, manic episode, or mixed episode. (7)
Subsequently, Bipolar II is characterized as the presence or history of one or more major depressive episodes and at least one hypomanic episode, without a precedence of a manic or mixed episode. (7, 1) One of the problems with diagnosing bipolar disorder is that the symptoms may not be incredibly noticeable until the disease has progressed to a dangerous point. (4) The disorder is such that a manic phase may only last a few hours at a time. (4) That is, the episode can proceed as a few hours of mania every day for at least one week. The affected person may not mind the mania or may be in denial of the disease, and since it only lasts a few hours, no one else may even notice. (4) By the time people actually begin to notice the manic-depressive cycle (or just the mania) it has already reached a point where the patient is barely able to function normally. (4) In addition, many clinicians have difficulty first differentiating between bipolar I and bipolar II. Since the types of patients, lengths of episodes, and age of onset are very similar, the only diagnostic tool is the difference between mania and hypomania. Since the symptoms are basically the same, except for the understanding that mania is one step more severe than hypomania, many clinicians fluctuate between the two subsets before diagnosing the patient. (4) Studies are still being conducted to more accurately and quickly distinguish bipolar I patients from bipolar II patients.
Researchers are still questioning the cause of manic depression. The most popular theory is that the disorder is caused by an imbalance of norepinephrine and serotonin. (1) During manic periods there are unusually high levels of norepinephrine and serotonin while, during depressed periods, there are unusually low levels. (1) The biological explanation is also supported by strong genetic inheritance. Many twin studies have been performed which have shown a predominance of bipolar disorder among monozygotic (identical) and dizygotic (fraternal) twins, with a greater chance of inheritance in monozygotic twins. Other studies have shown that bipolar patients often have a family history of both bipolar and unipolar disorder. (2) In addition to these studies, the fact that the most common method of treatment for bipolar disorder is medication testifies to the validity of the biological theory of causation.
Treatment for manic depression consists of mood stabilizers, medications that balance the manic and depressive states experienced by patients with bipolar disorder. (6) The most common treatment, or the first medication attempted, is Lithium. Lithium increases the serotonin and norepinephrine reuptake, this causes its counterbalancing effects of mania and depression. (6, 8) Research shows that Lithium alters NA transport and may interfere with ion exchange and nerve conduction. (8) Another effect of Lithium is its ability to inhibit second-messenger systems. These systems regulate cell cycling and circadian rhythms. Cell cycling and circadian rhythms, in turn, dictate the frequency and duration of the manic-depressive moods. (6, 9) However, many patients do not respond to Lithium. Some say that this is due to the drug, while others maintain that it is due to lack of consistency in taking the drug. (6) It has been shown that Lithium in not effective for all types of bipolar disorder, so other medications have been produced to help Lithium resistant individuals. (6, 8)
Anticonvulsants are the second attempted medications to alleviate the symptoms of bipolar disorder. Valproate (VPA) and Carbamazepine (CBZ) are the two most commonly prescribed. VPA has the same efficacy as Lithium for decreasing mania as well as acting faster, which is important to some patients. (6) However, the exact mechanism of action is still unclear. Research indicates that VPA may be involved with gamma-aminobutyric acid (GABA). VPA may either enhance GABA receptor activity and/or inhibit its metabolism. (6) CBZ has similar effects as VPA. That is, CBZ is also an anticonvulsant that alleviates the symptoms of mania, and possibly depression. Unlike VPA, more is known on the mechanism of CBZ. CBZ has been associated with neurotransmitter and ion-channel systems. (6) It binds to voltage-sensitive sodium channels, decreasing the sodium influx. It promotes potassium conductance and may block dopamine receptor-mediated currents. (6) Medication seems to be the best treatment to date for bipolar disorder. Psychotherapy is also helpful, particularly cognitive-behavioral therapy, which focuses on readjusting patient's perceptions of life. (2, 3) However, patients still experience symptoms to one degree or another.
Though this psychopathology is not for one to wish, one interesting association with bipolar disorder is the creativity of those afflicted. (2, 3, 5, 7) This is not the normal creativity experienced by the above-average people (on the scale of creativity). This creativity is the creative genius, which is so rare, yet an inordinate percentage of the well-known creative people were/are afflicted with manic depression. (2, 3) Among the lengthy list are: (writers) F. Scott Fitzgerald, Ernest Hemingway, Sylvia Plath; (poets) William Blake, Sara Teasdale, Walt Whitman, Ralph Waldo Emerson; (composers) Rachmaninoff, Tchaikovsky. (10) Psychiatrists, realizing a connection greater than coincidence, have performed studies all over the world in an attempt to establish a link between bipolar disorder and creativity. (5) In the 1970s, Nancy C. Andreasen of the University of Iowa examined 30 creative writers and found 80% had experienced at least one episode of major depression, hypomania, or mania. (5) A few years later Kay Redfield Jamison studied 47 British writers, painters, and sculptors from the Royal Academy. She found that 38% had been treated for bipolar disorder. In particular, half of the poets (the largest group with manic depression) had needed medication or hospitalization. (5) Researchers at Harvard University set up a study to assess the degree of original thinking to perform creative tasks. They were going to rate creativity in a sample of manic-depressive patients. Their results showed that manic-depressives have a greater percentage of creativity than the controls. (5) There have been biographical studies of earlier generations of artists and writers which show that they have 18 times the rate of suicide (as compared to the general population), 8-10 times the rate of unipolar depression, and 10-20 times the rate of bipolar depression. (5) The additive results of these studies provide ample evidence that there is a link between bipolar disorder and creative genius. The question now is not whether or not there exists a connection between the two, but why it exists.
One common feature in mania or hypomania is the increase in unusually creative thinking and productivity. (2, 3, 5, 7) The manic factor contributes to an increased frequency and fluency of thoughts due to the cognitive difference between normalcy and mania. (2, 5) Manic people often speak and think in rhyme or alliteration more than non-manic people. (2, 5) In addition, the lifestyles of manic-depressives in their manic phase is comparable to those of creative people. Both groups function on very little sleep, restless attitudes, and they both exhibit depth and emotion beyond the norm. (2, 5) Biologically speaking, the manic state is physically alert. That is, it can respond quickly and intellectually with a range of changes (i.e. emotional, perceptual, behavioral). (5) The manic perception of life is one without bounds. This allows for creativity because the person feels capable of anything. It is as if the walls, which inhibit the general population, do not exist in manic people, allowing them to become creative geniuses. They understand a part of art, music, and literature which normal people do not attempt. The manic state is in sharp contrast to the depressive phase of bipolar patients. In their depressed phase, patients only see gloom and boundaries. They feel helpless, and out of this helplessness comes the creativity. (5) The only way bipolar patients can survive their depressed phases, oftentimes, is to unleash their despondency through some creative work. (5, 3)
Since the states of mania and depression are so different, the adjustment between the two ends up being chaotic. Looking at some works of literature or music, it can be noticed which phase the creator was in at the time of composition. In works by Sylvia Plath, for example, the readers may take notice of the sharp contrast among chapters. Some chapters she is full of hope and life, while other chapters read loneliness and desolation. Another example can be found in Tchaikovsky's music; there is a great variation among his compositions concerning their tone, tempo, rhythm, etc. In fact, some say that most actual compositions result from this in-between period because this is the only time when the patient can physically deliver something worthwhile. (3) Because the phases are so chaotic, the ideas float during the manic and depressive states, but the final, developed products are formed during the patients' "normal" phases.
However, the problem with bipolar disorder in present time is that drug treatment often vanquishes the creativity in the patient. (5) In earlier days when drug therapy was not implemented, the creativity would be free. Yet, through the attempt for affected people to cope with day to day living, their creativity must be sacrificed. It is remarkable how these "afflicted" persons exude extraordinary creativity. Therapists and researchers are on the constant search to provide treatment for the debilitating symptoms. In the case of bipolar disorder, the world benefits from the mood swings endured by a large percentage of these patients. Though their ability to function properly is of utmost concern, since the cycling between manic and depressive phases is so traumatic and energy depleting, the unusual existence of creativity of such caliber in these people is something to conserve. As more effective drug treatment is being sought after, hopefully there will be medication that will permit the creative genius of the patients and allow them to function in society as well.
12/21/2005, from a Reader on the Web
Just glanced at your bipolar/creativity article. I'm afraid that mis-conceptions like symptom remision interfering with creativity is cited as reasons for people with bipolar disorder to discontinue any form of treatment. Although I don't have the references with me, a survey of the literature now (look for Richard's work with the Lifetime Creativity Scales) would suggest that it isn't people with full-blown mental illness that are creative (as behaviours such as apathy and psycho-motor retardation or grandiosity and poor impulse control would impede production of creative works), it is actually those with sub-syndromal mental illness (a partial expression of a genetic pheontype perhaps identifiable in family members or muted psychiatric symptoms) that are more creative. That research lab has also found that creativity actually goes down in people with full blown mental illness. I think this speaks to the importance of managing one's symptoms so that one can use the gifts that this style of thinking can afford. While this discussion needs greater space than comments can afford, I would caution people from making medical decisions based off of the few emminent people that do come to our attention with mental illness, rather than research conducted on everyday people. I would also make the caution that if a person with bipolar disorder does feel they are finally comming around and they suddenly have a tonne of creative ideas, please pace yourself and take steps to limit what could be another manic episode. Other creativity research will tell you that creative endeavour for MOST people is much like a marathon....if you sprint for the first half the race, you'll hit the wall in the second half. However, if you pace yourself (perhaps by keeping a book of creative ideas that can be explored later), you are much more likely to have a better overall performance and finish the race. David Armstrong
The trouble was, whatever I was writing, I believed afterwards anyways, was a sort of prophesy - such that when you are writing, you don\'t know what the prophecy is at the time - you are not sure what the thoughts mean or where they came from. So it is just a very intense experience. I was able to hike with more strength as well I remember, it isn't just your brain that is operating at a very high "RPM."
So I agree with HimaBindu that an organized creative bipolar type would harness the creativity while they were fully manic, and save it, then fine tune it later after getting through the months of nasty depression which is the price of full blown mania (what goes up must come down.)
I also agree somewhat to Armstrong's comment, that ideas might be more useable, down to earth, less prophetic in nature, and less grandiose (if you listen to a lot of the classical music from famous composers - you could almost define the great ones as grandiose.) An exception might be art, music, and certain writings. So that really depends on what is being created. Creating a concept for an advertisement would probably be better done while hypomanic than manic, as this is a not so grandiose creation. While classical music might require a grandiose mood to come up with a great composition in the first place.
It is interesting to note, that I can turn on the creativity anytime I want, just by shorting myself with sleep. I don't know why this is the case. All people I think get a little "silly" and creative when they lack sleep don't they? This is more pronounced when you have bipolar. It seems as if the logical part of your mind gets exhausted and is not used much, while the creative side becomes dominant and does not get exhausted, rather it seems to get energized.
One possibility would be to look at bipolar and mania, rather than as a genetic flaw, it may be it is the opposite end of the envelope - that bipolars are pushing the envelope of creativity as an evolutionary stretch - that perhaps the human species mind is evolving to become more creative. That one day you could be fully manic your entire life, without crashing into depression, and live a richer life as a result. The "Kingdom of God" that Jesus spoke of (who some people think was bipolar by the way) could actually be a mental heaven that our species is progressing towards. Towards enlightenment I guess you could say. I realize I am getting a bit grandiose with this evolutionary possibility, but anything is possible, so I wouldn't write it entirely off as out of touch with reality. Some authors seem to also think there is a link between mania and spirituality, and I think that is along the same lines of what I just mentioned ... Jim, 16 June 2006
From my knowledge of manic-depression, and as a type I manic-depressive myself, I agree with Armstrong ... Douglas Lucas, 19 July 2006
I finally found a clue that might help me and others about the Bipolar Disorder Creative Genius. I have severe chronic back pain and have to take strong pain killers and muscle relaxants. I have been detoxed twice in a hospital ward for drug addiction. I made the decision to enter on my own. I hate taking the meds and the way they make me feel but each time I have had to go back and get the meds for pain. That's my history but the first time I detoxed and the place that I was in there was some really weird things going on and others thought so too. Anyway they were jacking with my thyroid. The Doctor said my test showed borderline and then he said "I'm going to give you some thyroid medicine;sometimes you can jumpstart a thyroid.Each time the Nurse would bring my meds I would look at them and ask her what they were even though I had it all memorized. I knew them by their shape and color. So rather wait till after a group therapy session to give me some meds she just comes over where I am sitting and tells me here is another med for you. It was like nothing I had ever seen before but she tells me it was thyroid medicine. I was so wired I felt like I was going for the moon. Iwas a total nervous wreck but I had to fight the horrible nervousness constantly. And for some reason (how about in the name of science!)they started giving us intelligence tests. The therapist giving the test said it was a test that they gave Marines and that seldom does anyone score 1 and extremely rare for anyone to score 2. Another part of the test was to score your answers by how close they came to being right or something like that. Anyway I was already sailing in outer space a bit,soI sailed right through this test never thinking twice about my choices because we were being timed also. All I know is I am no genius and my scores were off the charts you might say. I had the two answers that were rarely answered correctly and I scored 37 points. In comparison to everyone else in the room and their being on the low end, No one even got 1 on the first part of the tests and the scores on the other part were like 12 to 17. What was going on in my brain I haven't a clue. Everyone that was in this ward of only 16 people felt like we were being used like lab rats. It is a very long and complicated story that I won't get into any further ... Linda Rivers, 22 May 2007