Saturday, August 02, 2014

The Creative Brain : Links to Mental Illness?

If you're a psychiatrist, you likely know who Nancy Andreasen is.  For as long as I've been around, she's been one of those big names in psychiatry and someone who leaves you to wonder if she ever sleeps, or if she has a clone, because it's hard to imagine that one human being can accomplish so much.  She has a Ph.D in English literature, and she's a psychiatric researcher who studies schizophrenia, neuroimaging, genomics and schizophrenia, and she directs every organization she belongs to and has won more prizes than I care to mention. She's a former editor of The American Journal of Psychiatry, the Chair of the University of Iowa's department of psychiatry.  In addition, she writes books, and scuba dives.  And yes, she's married with children.  I've heard her speak, and I enjoyed her recent article in The Atlantic, "The Secrets of the Creative Brain" enough that I read it twice so I could share the highlights with Shrink Rap readers. 

First, Dr. Andreasen talks about Kurt Vonnegut -- his depression and his strong family history of mental illness.  You may recall that I reviewed his son's book on Shrink Rap, "Just like someone with mental illness only more so."  Vonnegut's mother committed suicide, other family members suffered from mental illness, but they are also a very creative family.  Andreasen notes:

For many of my subjects from that first study—all writers associated with the Iowa Writers’ Workshop—mental illness and creativity went hand in hand. This link is not surprising. The archetype of the mad genius dates back to at least classical times, when Aristotle noted, “Those who have been eminent in philosophy, politics, poetry, and the arts have all had tendencies toward melancholia.”

She mingles talk about the course of her work and her dual career (literature, then psychiatry) with a discussion of her interest in mental illness and creativity.  Andreasen goes on to talk about the work of Stanford research Lewis Terman who identified and followed people with notably high IQ's over time.  She writes:
  For example, they were generally physically superior to a comparison group—taller, healthier, more athletic. Myopia (no surprise) was the only physical deficit. They were also more socially mature and generally better adjusted. And these positive patterns persisted as the children grew into adulthood. They tended to have happy marriages and high salaries. So much for the concept of “early ripe and early rotten,” a common assumption when Terman was growing up.
 Andreasen notes that 'creative geniuses' are generally smart, but don't have to be all that smart.  She seems to indicate that an IQ of 120 will do.  She talks about how to measure creativity with a test -- and defines convergent and divergent thinking, but then notes that this may not really be a way to measure creative genius.  Instead she settles on the Duck Test, and here at Shrink Rap, we like all things ducky, so I'll quote her on this one: 
A second approach to defining creativity is the “duck test”: if it walks like a duck and quacks like a duck, it must be a duck. This approach usually involves selecting a group of people—writers, visual artists, musicians, inventors, business innovators, scientists—who have been recognized for some kind of creative achievement, usually through the awarding of major prizes (the Nobel, the Pulitzer, and so forth). Because this approach focuses on people whose widely recognized creativity sets them apart from the general population, it is sometimes referred to as the study of “big C.” The problem with this approach is its inherent subjectivity. What does it mean, for example, to have “created” something? Can creativity in the arts be equated with creativity in the sciences or in business, or should such groups be studied separately? For that matter, should science or business innovation be considered creative at all?
Andreasen began to study people from the Iowa writer's workshop and people she deemed to be creative geniuses.  At first, she hypothesized that they would have more relatives with schizophrenia than the average person and she based this on her observation that some geniuses (e.g. Einstein) had relatives with schizophrenia.  
As I began interviewing my subjects, I soon realized that I would not be confirming my schizophrenia hypothesis. If I had paid more attention to Sylvia Plath and Robert Lowell, who both suffered from what we today call mood disorder, and less to James Joyce and Bertrand Russell, I might have foreseen this. One after another, my writer subjects came to my office and spent three or four hours pouring out the stories of their struggles with mood disorder—mostly depression, but occasionally bipolar disorder. A full 80 percent of them had had some kind of mood disturbance at some time in their lives, compared with just 30 percent of the control group—only slightly less than an age-matched group in the general population. (At first I had been surprised that nearly all the writers I approached would so eagerly agree to participate in a study with a young and unknown assistant professor—but I quickly came to understand why they were so interested in talking to a psychiatrist.) The Vonneguts turned out to be representative of the writers’ families, in which both mood disorder and creativity were overrepresented—as with the Vonneguts, some of the creative relatives were writers, but others were dancers, visual artists, chemists, architects, or mathematicians. This is consistent with what some other studies have found.
Andreasen became interested in using MRI to study the brain structure of people with schizophrenia (she is a pioneer in this field).  She began to wonder what imagining studies might reveal about the brains of the very creative.  
Designing neuroimaging studies, however, is exceedingly tricky. Capturing human mental processes can be like capturing quicksilver. The brain has as many neurons as there are stars in the Milky Way, each connected to other neurons by billions of spines, which contain synapses that change continuously depending on what the neurons have recently learned. Capturing brain activity using imaging technology inevitably leads to oversimplifications, as sometimes evidenced by news reports that an investigator has found the location of something—love, guilt, decision making—in a single region of the brain.
And what are we even looking for when we search for evidence of “creativity” in the brain? Although we have a definition of creativity that many people accept—the ability to produce something that is novel or original and useful or adaptive—achieving that “something” is part of a complex process, one often depicted as an “aha” or “eureka” experience.
She then goes on to talk about using PET scans to look at the workings of the brain when people are asked to think about specific "episodic" events versus free-associating or REST (random episodic silent thought).
Based on my interviews with the creative subjects in my workshop study, and from additional conversations with artists, I knew that such unconscious processes are an important component of creativity....In my own version of a eureka moment, the answer finally came to me: creative people are better at recognizing relationships, making associations and connections, and seeing things in an original way—seeing things that others cannot see. To test this capacity, I needed to study the regions of the brain that go crazy when you let your thoughts wander.
Her subjects spend 3 days in Iowa.  During this time, Dr. Andreasen has them to dinner at her house, drives them around her 40 acre nature retreat, then she interviews them (in-depth inquiries about their childhood, interests, families and more) and she scans their brains.  It sounds like fun.  I don't know if the control group gets dinner and the estate tour or not, but I'll assume so. She's studied 13 creative people and 13 controls.  Of the 13 creative types, 2 had parents who died of suicide (an exceedingly high number).
The creative subjects and their relatives have a higher rate of mental illness than the controls and their relatives do (though not as high a rate as I found in the first study), with the frequency being fairly even across the artists and the scientists. The most-common diagnoses include bipolar disorder, depression, anxiety or panic disorder, and alcoholism. I’ve also found some evidence supporting my early hypothesis that exceptionally creative people are more likely than control subjects to have one or more first-degree relatives with schizophrenia.
 Andreasen speculates about why the creative geniuses may have a higher incidence of mental illness:

One possible contributory factor is a personality style shared by many of my creative subjects. These subjects are adventuresome and exploratory. They take risks. Particularly in science, the best work tends to occur in new frontiers. (As a popular saying among scientists goes: “When you work at the cutting edge, you are likely to bleed.”) They have to confront doubt and rejection. And yet they have to persist in spite of that, because they believe strongly in the value of what they do. This can lead to psychic pain, which may manifest itself as depression or anxiety, or lead people to attempt to reduce their discomfort by turning to pain relievers such as alcohol.
Her subjects talk about the joy they get from creating, and she notes that they work much harder than other people, because they love their work.   Finally, in linking creative genius to mental illness, Andreasen ends with a mind-boggling thought:
Some people see things others cannot, and they are right, and we call them creative geniuses. Some people see things others cannot, and they are wrong, and we call them mentally ill.



Anonymous said...

Very interesting article!

Even though I work in a school by day, creative writing and painting are my passions.

And, yes, I have struggled with major depression. I was first treated eight years ago, and continue to check in with my therapist monthly because I find it helpful for me and my close relationships.

I suspect I was drawn to creative pursuits in part because of the depression, but who knows? Maybe it's all just the way I'm wired...

Anonymous said...

Yes I love this research! Great article.

Anonymous said...

The post mentioned a "duck test" so maybe this won't be considered off topic. But, I had to share with you that my sister's chicken just became the proud new mother of two little ducklings. She must wonder why her children turned out so strange.