Creativity and Mental Illness: Is There a Link?
Charlotte Waddell, MSc, MD, CCFP, FRCPC1
Objective: To critically assess the scientific evidence for associating creativity with mental illness.
Method: MEDLINE and secondary literature searches identified 29 studies and 34 review articles on creativity and mental illness. All studies were critically evaluated. Reviews were also assessed.
Results: Of 29 studies that evaluated possible associations between creativity and mental illness, 15 found no evidence to link creativity and mental illness, 9 found positive evidence, and 5 had unclear findings. Most studies used flawed methodologies with weak (case series or case control) designs. There were no randomized or prospective cohort studies. Adequate criteria for determining causal association were not met. In 34 selective reviews, despite mixed evidence, many authors asserted that creativity and mental illness were positively or causally associated.
Conclusions: There is limited scientific evidence to associate creativity with mental illness. Despite this, many authors promoted a connection. Explanations for this contradiction are explored, and social and research implications are discussed.
(Can J Psychiatry 1998;43:166–172)
Key Words: creativity, mental illness
Creativity and mental illness have long been popularly associated. Until recently, few studies have examined this purported association using scientific methods. A spate of recent review articles, as well as memoirs of mental illness by prominent, creative individuals, have coincided with scientific interest in possible associations between creativity and mental illness. These studies, reviews, and memoirs have garnered media attention and reinforced popular views that creativity and mental illness are positively associated.
Despite the interest in linking creativity and mental illness, there have been no recent comprehensive, critical reviews of the literature. This review examines the studies on creativity and mental illness and critically assesses the scientific evidence for an association. Reviews are also assessed, and methodological problems as well as social and research implications are discussed.
What Is Creativity?
In the diverse literature on creativity, many authors have suggested definitions of creativity. Becker equated creativity with genius or intellectual giftedness (1). Richards suggested that intelligence was necessary but not sufficient for creativity (2). Storr defined creativity as a dynamic of normal drives to play (3). Independence was mentioned by Andreasen and Glick (4), and fluency and flexibility were cited by Jamison as essential to creativity (5).
Rothenberg defined creativity as the ability to simultaneously conceive opposites or antitheses (6). Ludwig commented that creativity required both unconventionality and a drive to communicate (7–9). Both Richards and Ludwig noted that evaluations of novel or creative products were always embedded in social and political contexts (2,7–9). Weisberg stressed that creativity required hard work and collaboration (10).
In the recent scientific literature, most authors have defined creativity as either processes or products that are both original and worthwhile, as denoted by public recognition or awards. Creativity in the arts, science, and public leadership have all been studied, but no universal or psychometrically standardized definitions of creativity have been accepted.
What is Mental Illness?
There is copious literature on the nature of mental illness, and many authors have critiqued psychiatric concepts and definitions. Foucault, a French philosopher and sociologist, suggested that “madness” was socially constructed to scapegoat and control people whom society found deviant (11). Foucault’s thought was echoed in many later feminist, sociological, and philosophical critiques of psychiatry, including critiques that suggested “madness” did not exist apart from social constructs (12–15).
Most recent authors studying creativity and mental illness have not debated philosophical definitions. Rather, they have used standardized definitions of mental illness derived from the American Psychiatric Association’s Diagnostic and Statistical Manuals of Mental Disorders (DSM) (16–18). A variety of mental illnesses have been studied in connection with creativity, with most emphasis placed on mood disorders.
Popular Links Between Creativity and Mental Illness
There is a long history of associating creativity and mental illness in western European cultures, starting with Aristotle, who equated insanity with genius, and culminating in the “mad genius” controversy of the last 2 centuries (1,2,4–9,19). Many authors have described famous, creative individuals who reportedly had mental illnesses (5,6,9,19). Recent accounts in popular media have touted a link between creativity and various forms of mental illness (20–22).
The popularity of asserting connections between creativity and mental illness has also been fueled by recent memoirs of mental illness by prominent gifted individuals. Campbell, a Canadian medical scientist, grappled with manic-depression (23). Styron, an American writer, battled alcohol and depression (24). Millett, an American feminist, struggled with manic-depression (and with psychiatrists) (25). Mays, a Canadian art critic, suffered debilitating bouts of depression (26). Manic-depression coloured the life of Jamison, an American psychiatric researcher (27).
In summary, much recent psychiatric and popular literature has enthusiastically promoted an association between creativity and mental illness. This enthusiasm, however, has not always been balanced with scientific evidence.
The literature was searched with MEDLINE using the following terms: creativity, mental illness, depression, manic-depression, schizophrenia, and alcohol. The search was restricted to human, English-language studies from this century that assessed creativity and mental illness in the same individuals. Citations in primary sources were also searched. Studies were critically evaluated applying currently accepted scientific standards. Reviews were also assessed.
The search yielded 29 empirical studies on creativity and mental illness. Fourteen early studies surveyed creative or gifted people but did not use standardized definitions of mental illness. Fifteen later studies used standardized definitions of mental illness: 10 assessed mental illness in creative or gifted people, 1 assessed creativity in gifted people and psychiatric patients, and 4 assessed creativity in people with mental illness. There were also 34 reviews (including letters, books, and case studies) on creativity and mental illness. These studies and reviews are summarized.
Fourteen early studies assessed mental illness in creative or gifted people but did not use standardized or contemporary definitions of mental illness. First, starting in 1925, Terman’s group monitored health and social outcomes in 1000 intellectually gifted children over a 30-year period (28). While not all the gifted children became eminent, they had lower rates of mental illness than the general population.
In 1926 Ellis’s survey of 1020 eminent British people found rates of schizophrenia, bipolar disorder, and depression similar to the general population (29). Nicolson’s 1947 survey of 32 British authors found that only 6% were “insane” (30). In 1949 Juda reported that the majority of 294 gifted German artists and scientists surveyed did not have mental disorders (31).
Drevdahl and Cattell assessed 153 American writers and artists using personality tests in 1958 (32). Writers and artists did not have greater psychopathology and were more intelligent, adventurous, and mature than average Americans. In 1962 Goertzel and Goertzel found evidence of above-average rates of depression and suicide in the biographies of 400 eminent people (33).
Torrance, in 1965, reported that although creative children had less psychopathology, they suffered more sanctions and hostility and worked alone more than less creative peers (34). MacKinnon, also in 1965, found that creativity in architects was associated with unusual profiles on personality tests, including courage and independence (35).
Noreik and Odegard surveyed 12 000 highly educated Norwegians in 1966 and found psychiatric admission rates comparable to the general population (36). Barron’s 1968 study of 66 American writers found that while most were “troubled” according to psychological tests, most also had greater “ego strength” than average Americans (37).
McNeil’s 1971 study of 10 “highly creative” Danish adoptees found more “constitutional psychopathy” compared with less creative comparison subjects (38). Martindale’s 1972 assessment of the biographies of 42 English and French poets suggested that 15% were “psychotic” and half had “some” psychopathology (39).
Lucas and Stringer’s 1972 study of 84 architecture students in London found only 1 was “severely disturbed” (40). Finally, in 1979, Schou described the impact of lithium prophylaxis in 24 artists with bipolar mood disorder (41). Artistic productivity was increased in 12, unchanged in 6, and reduced in 6.
These 14 early studies were often cited later as demonstrating high rates of mental disorders in creative or gifted people. In 11 of these studies, however, either high rates of mental disorders were not clearly found (28–32,34–37,40), or creative people did better when mental illness was treated (41). Methodologically, these early studies shared several flaws: none used standardized or reproducible definitions of mental illness or creativity, none used randomized selection or blinded assessments, and most did not use comparison groups or prospective designs.
Mental Illness in Creative People: Case Series
Six recent case series assessed creative or eminent people using standardized or clearly reproducible measures of mental illness. Jamison described 47 British writers and artists in 1989: 38% had received treatment for mood disorders at some time in their lives (42). Ludwig, in 1990, surveyed biographies of 34 American writers, artists, and musicians and found that alcohol abuse impaired creativity in 75% (43).
Ludwig later examined the biographies of 1005 eminent people in academic, business, artistic, social, activist, military, and athletic fields, looking for evidence of either psychiatric difficulty or creativity (44). Writers, actors, artists, and musicians had the most psychiatric difficulty, while public officials, scientists, and military and business personnel had the least. Most creativity was found among musicians, scientists, and artists.
In 1994 Schildkraut’s group assessed 15 American artists’ biographies: 50% had suffered either depression or cyclothymia, 33% had abused alcohol, and 40% had received psychiatric treatment at some time in their lives (45).
Also in 1994, Post assessed 291 biographies of eminent males in music, art, writing, science, and political leadership (46). He found high rates of psychiatric disorders in writers and artists. In a later, expanded assessment of writers’ biographies, Post found high rates of both depression and alcoholism (47).
Four of these studies found higher than expected rates of mental disorders in creative or eminent people (42,45–47), 1 found that mental disorder hindered creativity (43), and 1 had unclear findings (44). Methodologically, these studies shared several flaws: none used control or comparison groups, none identified or assessed subjects randomly or blindly, all were retrospective, only 1 used living subjects (42), and none used clearly reproducible measures of creativity.
Mental Illness in Creative People: Case-Control Studies
Four recent case-control studies assessed creative people using standardized or reproducible definitions of mental illness. First, in 1974, Andreasen and Canter assessed 15 Americans attending a writers’ workshop, compared with 15 “non-creative” controls, who were matched for socioeconomic status, age, and gender (48). They found evidence of lifetime (DSM) psychiatric diagnoses on unblinded interviews, mostly mood disorders and alcoholism, in significantly more writers than controls (73% versus 20%).
Using object sorting tests, Andreasen and Powers then compared the 15 writers with 32 patients who were hospitalized with either mania or schizophrenia (49). Writers were more like manic patients than schizophrenic patients, although differences were not significant.
In 1984 Andreasen expanded her sample to 30 writers who were compared, using unblinded interviews, with 30 “non-creative” controls matched for age, gender, socioeconomic status, and intelligence (50). Writers had significantly higher (DSM) lifetime prevalence rates than controls for all mood disorders (80% versus 30%), for bipolar disorder (43% versus 10%), and for alcoholism (30% versus 7%).
Finally, Ludwig assessed 59 writers and 59 matched controls using a “lifetime scale” to measure creativity in “everyday” accomplishments (51). Writers had a 56% lifetime prevalence of depression (versus 14% in controls) and higher creativity scores.
Three of these studies found significantly higher rates of mental disorders in creative subjects compared with controls (48,50,51), and 1 study had unclear findings (49). These studies, however, shared several methodological flaws: subjects and controls were not identified randomly or assessed blindly, all used retrospective data, and creativity was actually measured in only 1 of the studies (51). One study appeared to be a preliminary study (48) that was later incorporated into a larger study (50).
Creativity in Gifted and Mentally Ill People
One recent case-control study assessed creativity in both gifted people and psychiatric patients. In 1983 Rothenberg used timed word-association tests to measure creativity in 12 Nobel laureates compared with 18 patients, who were hospitalized with various psychiatric (DSM) diagnoses (52). He then compared both groups with 113 “high” and “low” creativity university students, who were sorted according to records of achievement in the arts and sciences.
Creativity scores were highest in Nobel laureates, followed in descending order by “high” and “low” creativity students, then psychiatric patients. Differences among the groups were statistically significant, suggesting to the author that mental illness was not associated with creativity, although mental health was not actually assessed in the Nobel and university groups.
Creativity in People With Mental Illness: Case Series
Two recent case series assessed creative accomplishments in people with mental illness. In 1983 Karlsson surveyed 171 000 Icelanders’ records and found higher than expected educational and creative achievement among people who had been hospitalized for psychosis but not among people who had been hospitalized for alcoholism (53). In 1988 Akiskal and Akiskal reported on 750 psychiatric patients: artistic creativity was more frequent with mild, bipolar mood disorders but less frequent with severe disorders (54). Both studies were retrospective, and neither used comparison groups or randomized or blinded assessments.
Creativity in People With Mental Illness: Case-Control Studies
Two recent case-control studies assessed creativity in people with mental disorders using standardized definitions of mental illness. In 1988 Richards’ group hypothesized that mild mood disorders like cyclothymia might confer greater creativity than either good health or severe disorders such as manic-depression (55). They compared 33 manic-depressive and cyclothymic patients with 11 healthy relatives of the patients and 33 controls who were either well or had an unrelated psychiatric diagnosis. They used a “lifetime scale” to measure peak originality in various endeavours. Mild mood disorders were associated with higher creativity, whereas severe illness was associated with lowest creativity, although differences between groups were not statistically significant.
In 1993 Funk’s group hypothesized that impulsivity might confer greater creativity (56). They assessed 19 boys with attention deficit with hyperactivity disorder compared with 21 well controls matched for age, socioeconomic status, and intelligence. Creativity, assessed using drawing completion tests, was not significantly higher in subjects (on or off medication).
Neither study supported a strong association between mental disorder and creativity. Both studies used cross-sectional designs with matched controls, blinded raters, and clear measures of both creativity and mental illness.
In addition to empirical studies, 34 review and discussion papers (including books, letters, and case studies) examined purported links between creativity and mental illness (1,2,4–9,19–22,57–78). Most were selective reviews that mixed scientific evidence with journalistic or literary evidence. Only 11 reviews incorporated methodological criticisms (1,2,4–6,9,19,59,62,64,69). Most authors enthusiastically promoted an association between creativity and mental illness, and many implied that the association was causal. There were no metaanalyses.
In summary, of 29 studies, 15 negated (28–32, 34–37,40,41,43,52,55,56), and 9 supported (33,38,39,42, 45–47,50,51) an association between mental illness and creativity. Five studies suggested that creativity was hindered by severe mental illness (41,43,52,54,55), 4 studies had unclear findings (44,49,53,54), and 1 study (48) was incorporated into a later study (50).
Methodological problems with the studies on the purported association between creativity and mental illness will be discussed. A contradiction will be described between the limited scientific evidence and the resounding enthusiasm for linking creativity and mental illness. Possible explanations for this contradiction will be ventured, and social and research implications will be reviewed.
All studies used case-series or case-control designs. Fourteen early studies did not use standardized measures of either mental illness or creativity. While 15 recent studies used standardized measures of mental illness, only 4 (51,52,55,56) actually measured creativity, none selected subjects randomly, only 3 used prospective designs (52,55,56), and only 2 rated subjects blindly (55,56). Six did not use living subjects (44–47,53,54).
The quality of research evidence in the health sciences, including psychiatry, is commonly ranked in order from strongest to weakest: randomized clinical trials, prospective cohort studies, case-control studies, case series, and expert opinion (79).
The 29 empirical studies of creativity and mental illness used weaker (case-control or case series) designs. There were 34 reviews, yet these comprise the weakest form of evidence (expert opinion), and none met current critical standards for literature reviews (80). Many authors apparently suggested that mental illness and creativity were positively associated based on finding higher than expected rates of mental illness in selected populations in whom creativity was usually not (and mental illness was not always) measured.
Since many authors implied that creativity and mental illness were causally associated (2,4,5,9,19,20,22,45, 47,50,67,68,70), the following epidemiological criteria for determining causation apply (79). Was there evidence from experimental studies in humans? Was the association strong and consistent among studies? Were the temporal relationships correct? Was there a dose–response gradient? Did the association make epidemiological and biological sense? Was the association specific and analogous to a previously proven causal association? In the studies on creativity and mental illness, these criteria were not met.
There were other methodological problems with the literature on creativity and mental illness. Early studies did not use standardized definitions of mental illness, which made comparisons with current population data difficult. Most early studies also did not measure creativity but simply included subjects based on eminence or giftedness.
Recent studies did use standardized criteria to assess mental disorders, but they did not always define or measure creativity clearly, thus making it difficult to compare studies. Since most studies used unblinded assessments of retrospective data, selection biases were likely significant. No studies assessed creativity in community samples for comparison. Few studies adequately assessed confounding variables, such as socioeconomic status or intelligence.
Arguably, quantitative scientific standards may be too reductionistic to apply to studies on creativity and mental illness. No one, however, applied rigorous qualitative methods to complement the quantitative ones. Many authors suggested that creativity and mental illness were associated, but most did not discuss possible neurobiological or social mechanisms to explain this purported association.
Implications for Future Research
While definitive studies were lacking, some methodological improvements would help clarify whether creativity and mental illness are positively associated.
Larger prospective studies involving randomly selected living subjects, matched controls, and raters blinded to histories of illness or creativity would reduce the recall biases inherent in retrospective or biographical studies. Creativity, as well as mental illness, should be defined and measured using standardized instruments such as Richards’ scale (55). Knowledge about creativity and mental illness in representative community samples is needed for comparison. Different types of creativity (scientific, artistic, business) should be clarified. While randomized prospective studies would be difficult to mount, even naturalistic, prospective studies would be an improvement on the existing work.
Evidence from several different studies, all using randomized and prospective methodologies and showing a strong association between creativity and mental illness, is needed before a causal relationship can be suggested.
Contradictions in the Literature
Enthusiasm for associating creativity and mental illness exceeds the scientific evidence and persists despite evidence to the contrary. What explains this contradiction? One possibility is that the eloquence of creative or gifted people who comment on their own mental health problems attracts attention and compels us to spuriously connect their creativity with their problems.
For instance, James, a philosopher and psychologist, wrote about depression: “So much for melancholy in the sense of incapacity for joyous feeling. A much worse form of it is positive and active anguish, a sort of psychical neuralgia wholly unknown to healthy life” (81, p 129).
Lowry, a writer, described alcoholism: “the agonies of the drunkard find their most accurate poetic analogue in the agonies of the mystic who has abused his powers” (82, p 23).
Millett, a feminist, wrote: “During depression the world disappears. Language itself. One has nothing to say. Nothing” (25, p 283). Vedder, a rock singer, said: “If it hadn’t been for music, I would have shot myself in front of that classroom” (83, p 93).
Mays, an art critic, said that having depression was like living in “a clearing bounded by thickets roamed by the killing black dogs” (26, p xi). Jamison, a psychiatric researcher, described manic-depression: “So why would I want anything to do with this illness? Because I honestly believe that as a result of it I have felt more things, more deeply; had more experiences, more intensely; loved more and been more loved” (27, p 218).
Clearly, some mental disorders, especially milder ones, may enhance creativity in some individuals; for instance, hypomania may be enjoyable and may enhance creativity more than depression or mania (55,84). This, however, does not prove a general association between creativity and mental illness.
In another explanation for the persisting popular links between creativity and mental illness, Becker commented that the need to romantically link genius and madness may be rooted in society’s need to regard both as “deviant” (1). Kessel added, “If geniuses disturb society, if they misfit, then this is another characteristic they share with the mentally ill. Yet it is a dangerous conjunction to make because the reasons lying behind the two types of disturbance are so different” (69, p 203).
Sontag noted that nonrational metaphors can also dominate perceptions of illness: “The romantic view is that illness exacerbates consciousness. Once that illness was TB; now it is insanity” (85, p 36). Sontag explained this phenomenon as a “sublimated spiritualism: a secular, ostensibly scientific way of affirming the primacy of ‘spirit’ over matter” (85, p 55–56). Perhaps both mental illness and creativity have become metaphors for nonrational or spiritual needs that are sublimated in our rational, scientific age.
Kuhn commented that scientists were often slow to accept their own rational evidence when it contradicted popular theories (86). He suggested that scientific “revolutions” arose when evidence accumulated and finally overwhelmed popular theory, a nonrational phenomenon essential to scientific change. The contradiction between the enthusiasm and the lack of evidence for linking creativity and mental illness may epitomize Kuhn’s thesis.
This review examined the existing scientific evidence for associating creativity and mental illness. The evidence was unconvincing based on a critical review of 29 empirical studies: most did not support an association between creativity and mental illness, and most had methodological flaws.
Despite this limited evidence, many authors promoted a positive association in 34 review articles on creativity and mental illness. The enthusiasm for associating creativity and mental illness was not supported by the evidence.
Is there any harm in linking creativity and mental illness despite limited scientific evidence? Eardley commented: “Society treats artists . . . poorly enough to dissolve the hardiest among humans . . . to put up with all this and still get by, the artist may actually be in some way more stable, mentally or emotionally, than the norm” (87, p A15).
We may do more harm than good to the cause of creativity if we inadvertently convey the idea that creativity and mental illness are both forms of deviance. We may do more harm than good to the cause of alleviating mental illness if we romanticize mental illness and trivialize its impact by associating it with creativity. We may do more harm than good if we fail to note that mental illness impedes creativity or if promoting an association between creativity and mental illness takes precedence over either encouraging creativity or reducing mental illness.
Despite the gap between enthusiasm and solid evidence, debates about creativity and mental illness have merit. Much debate appears motivated by a desire to destigmatize mental illness. The debates may also ultimately encourage more research on preventing and treating mental illnesses and on supporting creativity.
Art provides a “path to the sacred and spiritual, even in a profane and fragmented world” (45, p 486). We need to encourage creativity and creative people in our midst. We also need to find more effective ways to prevent, treat, and destigmatize mental illnesses of all kinds. We need both good art and good science. Science and art, creativity and mental illness may all be trivialized, however, and we may do more harm than good to those “afflicted” with either creativity or mental illness if we promote romantic associations that overlook our own best evidence.
The author thanks Russell Joffe, MD, George McLauchlin, MSc, and Dan Offord, MD for their comments on previous drafts of this manuscript.
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Objectif : Évaluation critique des preuves scientifiques de l’association entre la créativité et la maladie mentale.
Méthode : Des recherches menées dans MEDLINE et la littérature secondaire ont permis de repérer 29 études et 34 articles de synthèse portant sur la créativité et la maladie mentale. Toutes les études ont fait l’objet d’une évaluation critique, et on a aussi évalué les articles de synthèse.
Résultats : Parmi les 29 études consacrées à l’évaluation des associations possibles entre la créativité et la maladie mentale, 15 études n’ont permis de découvrir aucune preuve du lien entre ces deux phénomènes, 9 études ont donné des preuves concluantes et 5 se sont soldées par des résultats incertains. La plupart des études reposaient sur des méthodologies erronées et des plans (séries de cas ou cas-témoins) superficiels. Aucune étude randomisée ou prospective des cohortes n’a été menée. Les critères appropriés visant à déterminer l’association causale n’ont pas été respectés. Dans 34 articles de synthèse sélectifs, malgré des preuves douteuses, de nombreux auteurs ont prétendu qu’il existe une association positive ou causale entre la créativité et la maladie mentale.
Conclusions : Des preuves scientifiques restreintes permettent d’associer la créativité à la maladie mentale. Malgré cela, de nombreux auteurs ont soutenu l’existence d’un lien entre ces deux phénomènes. Des explications de cette contradiction font l’objet d’un examen, et on discute des répercussions de celles-ci sur la société et les chercheurs.
Manuscript received March 1997, revised and accepted May 1997.
1Department of Psychiatry, McMaster University, Hamilton, Ontario.
Address for correspondence: Dr C Waddell, Department of Psychiatry, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5
Can J Psychiatry, Vol 43, March 1998