"We of the craft are all crazy"

I hope that you don't think I am making light of mental illness with the title of this post which originally comes from Lord Byron but I got from this article by Hankir* on bipolar disorder and poetic genius. The reason for it stems from this paper by Simon Kyaga and colleagues** which, in quite a large population group, asked the eternal question about whether those in the creative professions are more likely to be treated for mental illness compared with the general population.

Nevermore, nevermore @ Wikipedia 

This latest work follows on from a previous study from the same group*** who talked about a "familial cosegregation of both schizophrenia and bipolar disorder with creativity". I had to look it up but cosegregation apparently is a genetics term relating to "the transmission of two or more linked genes on a chromosome to the same daughter cell leading to the inheritance by the offspring of these genes together".

Going back to the most recent work by Kyaga and colleagues, a few important points are worth mentioning:

• A sample size which was positively eye-watering at 1,173,763 participants based on a nested case-control methodology, looked at cases diagnosed with one or more of psychiatric diagnoses and compared them with asymptomatic cases to ascertain the rate of creative (scientific and artistic) occupations. 
• Psychiatric diagnoses included: schizophrenia, bipolar disorder, anxiety disorders, alcohol abuse, drug abuse, autism, ADHD, and completed suicide, to name some.
• The study was not just confined to patient cases but also their non-diagnosed relatives.
• Results: although some of the headlines are a little misleading (see here), outside of bipolar disorder, there was no significant trend towards creative occupations = more psychiatric disorder. Unless that is, you were an author which "was specifically associated with increased likelihood of schizophrenia, bipolar disorder, unipolar depression, anxiety disorders, substance abuse, and suicide".
• A look at the relatives of those diagnosed with a psychiatric disorder however did suggest an association with the creative occupations.

I've perhaps been a little harsh in translating these results which have already received some media attention. The connection between being diagnosed with bipolar disorder and also being in a creative occupation is not to be sniffed at, as per the Hankir paper and some quite high profile cases such as Twitter royalty Stephen Fry. Indeed seemingly everyday now, one or more of the creative geniuses in public life seem to 'come out' and talk about their experiences of bipolar disorder as per the Wikipedia page titled: List of people with bipolar disorder. Obviously I'm going to have to be careful here not to make too much of the link based on comparatively few names set against the hundreds of thousands of people involved in the creative arts who do not seemingly present with the features of bipolar disorder (or at least don't tell the public). Things are never so cut-and-dried. 

Indeed I was also interested in the other links that have been made between diagnoses such as bipolar disorder and cognitive styles. So, this research from Gales and colleagues**** who asked whether bipolar disorder was more commonly present in highly intelligent people. Their conclusion was very possibly but generally seen more in men and without the interference of other comorbidity. Indeed I hope Mr Fry does not mind me using him again as an example, but one would speculate that his IQ score (or should that be QI?) would be 'up there somewhere'. 

Looking at the occupations listed under creative careers, I also noted 'scientific' to be listed. I have to say that I did a bit of double-take at this given that I never really looked at science as sharing the same creativity as say a writer or an artist. Having said that, if we take the literal meaning of creativity to mean invention and originality, I can see how even boring old researchers talking about study design and p-values might have reason for some creative flair at times. One might ask whether the most creative scientists, such as those Nobel Prize winners for example, might also be more prone to mental ill-health like bipolar disorder? The subsequent questions are: which came first (creativity or bipolar disorder) and whether the propensity and/or actuality of bipolar disorder might drive someone to make certain creative career choices.

I cannot leave this post without also making further mention of the author - mental illness link reported by Kyaga et al. Reading between the lines it seems that the notion of a tormented writer - like for example Edgar Allan Poe - might actually have more truth than fiction. Noting for example, that authors were significantly more likely to commit suicide is an important observation and something which could potentially inform strategies to reduce suicide. That being said, suicide is a complicated thing. Based on the wealth of other literature on occupation and suicide, as per the high rates of suicide in medical physicians for example, one has to be cautious at making such correlations set against the bigger picture.

This is an interesting area of research and discussion, not just in terms of cognitive styles and mental health, but also as to how aspects of creativity may very well overlap with the perceptions of mental health and ill-health. I draw back from making too much of such data however (despite the current study sample size) given the multitude of other factors potentially at work and the seemingly increasing tide of labelling the extraordinary with some kind of diagnosis.

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* Hankir A. Review: bipolar disorder and poetic genius. Psychiatr Danub. 2011; 23 Suppl 1: S62-S68.

** Kyaga S. et al. Mental illness, suicide and creativity: 40-Year prospective total population study. J Psychiatr Res. 2012. pii: S0022-3956(12)00280-4.

*** Kyaga S. et al. Creativity and mental disorder: family study of 300,000 people with severe mental disorder. Br J Psychiatry. 2011; 199: 373-379.

**** Gales CR. et al. Is bipolar disorder more common in highly intelligent people? A cohort study of a million men. Mol Psychiatry. April 2012.

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Kyaga S, Landén M, Boman M, Hultman CM, Långström N, & Lichtenstein P (2012). Mental illness, suicide and creativity: 40-Year prospective total population study. Journal of psychiatric research PMID: 23063328