Creativity and Touch of Madness

By Arline Kaplan ©2014 (All Rights Reserved)

No great genius has ever existed without some touch of madness.–Aristotle or Seneca1

Recent large-scale Swedish registry studies and brain imaging studies are exploring the validity of this ancient observation linking creativity/genius and psychopathology, and the results are mixed.

Since the terms, genius, and creativity have received multiple definitions, we asked Rex Jung, Ph.D., neuropsychologist and creativity expert, to clarify how the terms are being used in scientific studies.

Stein, he said, gave the best definition of creativity, in his 1953 article.2

It is defined “as the production of something novel and useful. This dynamic tension between novelty (on the one hand) and usefulness (on the other) likely has important neural correlates that we are attempting to explore with neuroimaging techniques,” said Jung, Assistant Professor in the Department of Neurosurgery, University of New Mexico.

Genius,” he added, “is achievement at the far margins of human expression (creative, intellectual, leadership, etc.). It involves production of extraordinary accomplishment and creative capacity that is exceedingly novel and breathtakingly useful. This capacity is, by definition, rare in spite of the tendency to sprinkle the term liberally throughout our daily endeavors. It is hypothesized to occur at the exceedingly rare rate of 1/1,000,000 individuals, which would imply that there are fewer than 7,000 geniuses on the entire planet. “


That creativity and psychopathology are inextricably linked is a widespread but highly controversial idea among researchers. In a Huffington Post article, R. Keith Sawyer, PhD, cited four major past studies that examined large numbers of creative and eminent individuals.3

“None of these studies found an elevated degree of mental illness in creative people,” said Sawyer, Morgan Distinguished Professor in Educational Innovations at the University of North Carolina at Chapel Hill and author of the 2012 book, Explaining Creativity: The Science of Human Innovation.

Last year, psychologist Judith Schlesinger, PhD, critiqued what she called “the sacred scrolls of the mad genius movement”—the 1989 study by psychiatrist Nancy Andreasen, MD, PhD; the 1989 study by psychologist Kay Redfield Jamison, PhD; and the 1995 book by psychiatrist Arnold Ludwig MD. 4-7

However, Simon Kyaga MD, a senior consultant in psychiatry and PhD student in the Department for Medical Epidemiology and Biostatistics at the Karolinska Institute in Stockholm, contends that the early studies by Andreasen, Jamison and Karlson,8 primarily focused on schizophrenia and bipolar disorder, have provided limited empirical evidence for the relationship between creativity and psychopathology.

The main problem with some earlier studies is that they have been small and of a retrospective design, Kyaga said.

Kyaga has been lead investigator on two recently published Swedish studies seeking to validate the association between creativity and psychopathology.9 ,10

“The main strengths of our studies [published in 2011 and 2013] are that they involve a lot of people, and while the analysis is retrospective, the collection of data is prospective,” he said.

For their 2011 study, Kyaga and his team performed a nested case-control study using longitudinal Swedish total population registers. They had data on anyone who received inpatient treatment for schizophrenia, bipolar disorder and unipolar disorder between 1973 and 2003 and on their non-diagnosed relatives. The groups of patients and relatives were compared with that of controls.

As a proxy for creativity, the researchers used occupational codes and census information. Artistic and scientific occupations were defined as “creative” professions and included university teachers, authors, visual artists, photographers, composers and musicians, designers and performing artists, among others.

We found an increase in creative occupations among individuals with bipolar disorder and among relatives ( e.g., parents and siblings) of patients with schizophrenia and bipolar disorder, Kyaga said. The association was not found for unipolar depression.

The second study involved 1.2 million patients and their non-diagnosed relatives (identified down to the third-cousin level.

Since all were matched with healthy controls, Kyaga said, the study encompassed “basically the entire Swedish population.” The team expanded upon the 2011 study by adding other psychiatric disorders and by including discharge diagnoses for inpatient treatment between 1973 and 2009 as well as some outpatient episodes from 2001 to 2009.

With the exception of bipolar disorder, the researchers did not find a positive association between psychopathology and overall creative professions. Rather, individuals holding creative professions had a significantly reduced likelihood of being diagnosed with schizophrenia, schizoaffective disorder, unipolar depression, anxiety disorders, alcohol abuse, drug abuse, autism and attention-deficit hyperactivity disorder.

But the team also observed that the siblings of patients with autism and the first-degree relatives of patients with schizophrenia, bipolar disorder and anorexia nervosa were significantly over-represented in creative professions.

“I would say our findings on autism are a bit shaky, although there is some literature suggesting an association exists between scientific occupations and autism.,” Kyaga said in the interview.   “There is no literature suggesting there is an association between anorexia and creativity, and I have to say we really didn’t know what to do with that.”

Aware that prior studies suggested a higher prevalence of psychopathology specifically among professional authors, Kyaga and the team looked at that group separately. They found that authors suffered from schizophrenia and bipolar disorder more than twice as often as controls,. Additionally, compared to controls, authors were more likely to be diagnosed with unipolar depression, anxiety disorders, alcohol or drug abuse disorders and to commit suicide.

Asked about current and future research, Kyaga said they have a study underway in which they are using more standardized creative assessments to investigate possible associations between creativity and psychopathology.

They also want to look at personality characteristics and creativity and such positive traits as leadership or entrepreneurship, that have been associated with psychiatric disorders as well as treatment issues.

Neuroscience studies

The study of creativity is now a “growth industry” for cognitive neuroscientists, according to Jung.

Key researchers in the field, Jung said, include Andreas Fink, PhD, University of Graz; Anna Abraham, PhD, Kuwait University; Oshin Vartanian, PhD, University of Toronto, Scarborough; Charles Limb, MD, Johns Hopkins School of Medicine; Scott Barry Kaufman, PhD, New York University; Mark Beeman, PhD, and Darya Zabelina (PhD candidate), Northwestern University; Hikaru Takeuchi, PhD, Tohoku University; and Qinglin Zhang, PhD, Southwest University (China).

Fink and colleagues, for example, addressed the potential link between creativity and schizotypy by investigating functional patterns of brain activity (using functional magnetic resonance imaging [fMRI]) during creative cognition in preselected groups with low versus high psychometrically determined schizotypy.11

They found an association between the originality component of creativity and reduced deactivation of right parietal brain regions and the precuneus during creative cognition, congruent with the idea that more-creative people may include many more events/stimuli in their mental processes than do less-creative people. Similarly, the high-schizotypy group showed weaker deactivation of the right precuneus during creative cognition.

According to Fink et al., the fact that originality and schizotypy show similar functional brain activity patterns during creative ideation (i.e., reduced deactivation of the right precuneus) strongly supports the contention that similar mental processes may be implicated in creativity and in psychosis proneness.

The neuroimaging techniques Jung finds most helpful in assessing brain traits include structural magnetic resonance imaging (sMRI), diffusion tensor imaging (DTI) and proton magnetic resonance spectroscopy (1-H-MRS).12

“sMRI informs us mostly about the cortical mantle, including the volume of neuronal cell bodies,” Jung told said.  “DTI gives information regarding the fidelity of the myelin/axonal fibers connecting such processing nodes, while 1H-MRS gives us information regarding underlying biochemical fidelity of both neurons (via N-acetylaspartiate) and axons (via choline and myoinositol), as well as neurotransmitters including glutamate and glutamine. “

Asked about his team’s brain imaging studies of creativity, Jung explained that the John Templeton Foundation for several years has been funding his work on the neuroscience of creativity.

“This has allowed us to explore all the major measures of creativity (e.g., divergent thinking, creative achievement, insight and openness) and correlate these with our various neuroimaging techniques in rather large cohorts of normal human subjects. If creativity exists, it should be detectable across the entire range of human endeavors (as well as non-human animals if it is of evolutionary import),” he said.

The team, he said, has produced three foundational research reports highlighting the first biochemical, white matter and structural correlates of creative cognition in normal human subjects. 13-15          

In the second phase of funding, Jung and the team are focused on the less-studied scientific creativity (science, technology, engineering, math).

“Our first results have been submitted and are consistent with our findings in a more general population: lower measures of brain fidelity, particularly within the frontal lobe, are predictive of higher performance on measures of creative capacity, creative personality and achievement,” he said. “This is different than what we found in terms of intelligence correlates, where higher measures of brain fidelity were invariably associated with higher intelligence. Creativity and intelligence are different constructs and manifest differently within networks of the brain.”

With respect to creativity and mental illness, Jung and colleagues’ study on white matter integrity, creativity and psychopathology provided some guidance.

They used diffusion tensor imaging to examine whether white matter integrity, assessed by fractional anisotropy (FA), is related to two measures of creativity (divergent thinking and openness to experience.) The researchers found that a composite creativity index (CCI) was significantly inversely related to FA within the left inferior frontal white matter and that openness was inversely related to FA within the right inferior frontal white matter. Other researchers have found lower FA in the inferior frontal lobes in patients with schizophrenia or bipolar disorder.

Jung and his team recommended that measures of creative cognition and personality should be administered in tandem with DTI measures, both to patients diagnosed with psychotic disorders and to their unaffected relatives to better understand the causal mechanisms underlying lower FA, creativity and psychosis within frontal white matter.

Another researcher using neuroimaging to examine the neural basis of the creative process is Andreasen, The ongoing study funded by the Brain & Behavioral Research Foundation (formerly NARSAD) seeks to examine the psychological and neural basis of the creative process in a group of “creative geniuses” with half representing the arts and the other half, the sciences. They are undergoing structural and functional magnetic resonance scans of their brains, taking standard neurocognitive tests and being interviewed by Andreasen.

“ I have been actively recruiting, but the study is very labor-intensive, and I do not as yet have enough subjects to produce a publication,” Andreasen said.

Treatment implications

In discussing the clinical implications of the various study findings, Kyaga said he is not advocating stopping medications in, for example, bipolar patients, who are highly creative.

With regard to creativity, the few studies that have investigated the issue, he said, suggest that it is beneficial to treat bipolar disorder with lithium or other medications, because in the long run, it is such a destructive psychiatric disorder.

Jung said, “no well known creative output (to my knowledge) was produced in the thrall of overt psychosis, mania or other mental state that could be pointed to as critical to the process….Perhaps the time between overt “episodes” is a time worth discussing as critical to creative cognition for such individuals, and the possibility of medications dampening or hindering such innovation or output should be explored. The risk of severe mental illness would appear to outweigh any potential benefit at the current time.”


  1. Aristotle (394-322 BC. Problemata 50:1 and Seneca the Younger 50 BC –AD 65) “On Tranquility of the Mind” (17.10). Moral Essays, tr. John Basore, 1952.
  2. Stein, MI. Creativity and culture. J Psychol. 1953;36:311-322.
  3. Sawyer, RK. Creativity and mental illness: Is there a link? Huffington Post. November 2, 2012. Accessed February 10, 2014.
  4. Schlesinger J. Stardust, smoke, and mirrors: The myth of the mad genius. Skeptical Inquirer. September/October 2013. Accessed February 26.
  5. Andreasen NC. Creativity and mental illness: prevalence rates in writers and their first-degree relatives. Am J Psychiatry. 1987;144(10):1288-1292.
  6. Jamison KR. Mood disorders and patterns of creativity in British writers and artists. Psychiatry. 1989;52:125-134.
  7. Ludwig, AM. The Price of Greatness: Resolving the Creativity and Madness Controversy. New York: The Guilford Press, 1995.
  8. Karlsson J. Genetic association of giftedness and creativity with schizophrenia. Hereditas. 1970:65:177-182.
  9. Kyaga S, Lichtenstein P, Boman M, et al. Creativity and mental disorder: family study of 300,000 people with severe mental disorder. Br J Psychiatry. 2011;199(5):373-379.
  10. Kyaga S, Landén M, Boman M, et al. Mental illness, suicide and creativity: 40-year prospective total population study. J Psychiatr Res. 2013;47(1):83-90.
  11. Fink A, Weber B, Koschutnig K, et al. Creativity and schizotypy from the neuroscience perspective. Cogn Affect Behav Neurosci. 2013; Sep 11. [Epub ahead of print.  Jung RE, Mead BS, Carrasco J, Flores RA. The structure of creative cognition in the human brain. Front Hum Neurosci. 2013;7:330
  1. Jung RE, Segall JM, Jeremy Bockholt, et al. Neuroanatomy of creativity. Hum Brain Mapp. 2010;31(3):398-409
  2. Jung RE, Grazioplene R, Caprihan A, et al. White matter integrity, creativity, and psychopathology: disentangling constructs with diffusion tensor imaging. PLoS One. 2010;5(3):e9818.

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