By Colette Inaba
Schizophrenia and Creativity
“The truly creative person is
one who can think crazy”
-Frank Goble
“There was never a genius without
a tincture of madness”
-Aristotle
“The distance between insanity and
genius is measured only by success” -Bruce Feirstein
Outline
Illness and Creativity
Traits Shared by
Schizophrenic and Creative Individuals
Common Pathophysiology
Clinical Implications
Creativity
• Generation of unique
activities or ideas that are novel and useful or meaningful (vs. bizarre) to a community, as determined by cultural context
• Creation of a new concept
from unrelated existing ones
•
• Abstraction from conventional
thinking
Illness and Creativity
More Time
Fewer responsibilities (e.g. work)
during illness = more time
More Motivation
Suffering may motivate patients to
find creative solutions to cure or treat their illness
Mental Illness Linked to Creativity
•
• Schizotypy
• Hypomania
• History of Depression
• Temporal Lobe Epilepsy
• Parkinson’s Drugs
• Frontotemporal dementia
Contradictory evidence
for association between schizophrenia and creativity
Schizophrenia:
Review
Positive Symptoms
•
• Hallucinations
• Delusions
• Disorganized thought
• Disorganized/catatonic
behavior
Negative Symptoms
•
• Affective flattening
• Alogia
• Avolition
Famous
People with Schizophrenia
•
• John Nash—mathematician
• Tom Harrell—jazz trumpeter
and composer
• Andy Goram—soccer player
• Lionel Aldridge—football
player
• Peter Green—guitarist
and composer
• Syd Barrett—singer-songwriter,
guitarist, painter
• Alexander “Skip” Spence—singer-songwriter,
guitarist
• Bob Mosley—songwriter,
bassist
• Roger Kynard “Roky”
Erickson—singer-songwriter, guitarist
• Joe Meek—songwriter,
record producer
• Jim Gordon—songwriter,
drummer
• Charles “Buddy” Bolden—jazz
cornetist
• Antoin Artaud—playwright,
poet, actor
• Vaclav Nijinsky—ballet
dancer and choreographer
• John Kerouac—novelist
and poet
The Arts: the imaginative, creative, and nonscientific branches of knowledge
•
• John Nash—mathematician
• Tom Harrell—jazz
trumpeter and composer
• Andy Goram—soccer
player
• Lionel
Aldridge—football player
• Peter Green—guitarist
and composer
• Syd Barrett—singer-songwriter,
guitarist, painter
• Alexander
“Skip” Spence—singer-songwriter, guitarist
• Bob Mosley—songwriter,
bassist
• Roger Kynard
“Roky” Erickson—singer-songwriter, guitarist
• Joe Meek—songwriter,
record producer
• Jim Gordon—songwriter,
drummer
• Charles
“Buddy” Bolden—jazz cornetist
• Antoin
Artaud—playwright, poet, actor
• Vaclav
Nijinsky—ballet dancer and choreographer
• John Kerouac—novelist
and poet
Schizophrenia and Creativity
•
• Schizophrenic individuals
are more likely to:
• Think of uncommon uses
for common objects
• Be overly inclusive in
word-association tests
•
•
• Individuals with schizotypic
or psychotic traits show:
• Reduced latent inhibition
• Increased openness to unusual
ideas
• Increased loose associational
thinking
• Increased bilateral cerebral
activation
•
• Neuroregulin 1 gene is
associated with both high creativity and increased risk of psychosis
and schizophrenia
Greater bilateral activation in creative people: approach + novelty
Frontal
Action
Right
Avoidance and withdrawal
Recognizes novel stimuli
Ignores familiar stimuli
Left
Curiosity and pursuit
Recognizes familiar stimuli
Ignores novel stimuli
Schizophrenia and Creativity
Cerebral
Functional Asymmetry
•
• Increased bilateral activation
in creative people:
curiosity & pursuit (left) + novelty (right)
•
• Correlation between reduced
asymmetry and severity of positive symptoms in schizophrenic individuals
• family members of schizophrenics
have intermediate asymmetry
•
• Schizophrenic individuals
are more likely to be left-handed or mixed-handed compared to healthy
controls
• mixed-handedness is correlated
with increased magical thinking
• creative artists are also
more likely to report nonright-handedness
Cerebral
Functional Asymmetry
•
• Severe schizophrenic symptoms
are associated with diminished creativity
• poor cognitive and executive
function
•
• There is an association
between creativity and schizotypy or close relatives of schizophrenic
patients
• higher schizotypy scores
in creative and artistic people
• higher creative achievement
in families of mentally ill individuals
• higher incidence of mental
illness in families of creative individuals
Pathophysiology
of Schizophrenia
Leading hypotheses:
•
• Dopamine dysregulation
•
• Serotonin dysregulation
•
• Deficient glutamate neurotransmission
via NMDA receptor
•
• Altered GABA neurotransmission—reduced
GABA synthesis and reuptake
Dopamine and Schizophrenia
•
• Positive symptoms result
from subcortical dopaminergic hyperactivity
• severity of positive symptoms
correlated with concentration of dopamine
• increased release of dopamine
in striatum in response to amphetamines
• secondary to increased
ventral hippocampal activity?
•
• Efficacy of D2 receptor
antagonists in reducing psychotic symptoms
Dopamine Pathways
Negative Symptoms
Positive Symptoms
Ventral
Tegmental Area
•
• Creativity is also correlated
with subcortical dopamine hyperactivity
•
• Dopamine is associated with
• motivation, imagination, curiosity
• excessive goal-directed activity
• enhanced mental imagery:
hallucinations, metaphors, scientific insight
• improved working memory, mental associations
• decreased latent inhibition
• increased associative thinking
Dopamine and Creativity
Before treatment
levadopa +
cabergoline
Clinical Implications
•
• Consider potential loss
of creativity in schizophrenic patients secondary to treatment with
dopamine antagonists
• e.g. businessman who loses
his job due to fewer marketing ideas
•
• Consider increased creative
motivation secondary to treatment with dopamine agonists
• association with impulse-control
problems, hallucinations
•
• All else being equal, to
minimize loss of creativity use:
• stimulating > sedating medications
• atypical > typical antipsychotics
•
Summary
•
• Overlap between schizophrenia
and creativity:
• loosening of associations
and low latent inhibition
• reduced cerebral asymmetry
• dopamine hyperactivity
•
• Severe symptoms may be
associated with decreased creativity due to poor cognitive/executive functioning
•
• Consider effects of medications on patients whose livelihood depends on creativity
References
•
• Abraham A, Windmann S,
McKenna P, Gunturkun O (2007) Creative thinking in schizophrenia: the
role of executive dysfunction and symptom severity. Cog
Neuropsych. 12:235-258.
• Carey RJ, Pinheiro-Carrera
M, Dai H, Tomaz C, Huston JP (1995) L-DOPA and psychosis: evidence for
L-DOPA-induced increases in prefrontal cortex dopamine and in serum
corticosterone. Biol Psychiatry. 1995;38:669.
• Flaherty AW (2011) Brain
illness and creativity: mechanisms and treatment risks. Can J
Psych. 56:132-143.
• The Huxley Institute for
Biosocial Research. What Schizophrenia Does.http://www.schizophrenia.org/artist.html
(Aug. 8, 2011)
• The Internet Mental Health
Initiative (2010) Famous People with Schizophrenia.http://www.schizophrenia.com/famous.htm
(July 27, 2011)
• Keri S (2009) Genes for
psychosis and creativity. Psychol Sci. 20:1070-1073.
• Kulisevsky J, Pagonabarraga
J, Martinez-Corral M (2009) Changes in artistic style and behavior in
Parkinson’s Disease: dopamine and creativity. J Neurol. 256:816-819.
• Lewis DA, Gonzalez-Burgos
G (2006) Pathophysiologically based treatment interventions in schizophrenia.
Nat Med. 12:1016-1022.
• Lodge DJ, Grace AA
(2011) Hippocampal dysregulation of dopamine system function and the
pathophysiology of schizophrenia. Trends
Pharm Sci. doi:10.1016/j.tips.2011.05.001.
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DEJ (2011) Cerebral asymmetry in schizophrenia. The Neuroscientist.
April 25, 2011. DOI: 10.1177/1073858410386493
• Preti A, Vellante M (2007)
Creativity and psychopathology: higher rates of psychosis proneness
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