The Creativity Post | The Essential Psychopathology Of Creativity

If we could identify a gene for creativity, let's call it the "creativity gene", you would be hard pressed to find very many people who would consider it a "negative gene" or a hazard to possess or carry. But what if, purely hypothetically, we could identify a gene for Schizophrenia? Or Bipolar Disorder? Or Depressive Disorder? Or ADHD? Would you select for those traits if you could genetically engineer your offspring at will? If you wanted to give birth to a creative child, the answer should be yes.

The very traits that make someone creative, passionate, and likely to achieve a high degree of success in their domain, are the same traits that define psychological disorders such as Bipolar Disorder, Schizophrenia, and ADHD. So what is the difference between creativity and psychopathology? Where do we draw the line between functional excess of extreme traits and the point at which they define a psychological disorder? Is there a discriminating characteristic that separates these two groups? Yes, there is, and it's called cognitive control, or high executive function. We'll discuss this more in a bit.

An article in the NY Times titled, "Just Manic Enough: Seeking Perfect Entrepreneurs", described individuals that were unnaturally creative, passionate, energetic, charismatic, and those most sought-after by venture capitalists as "hypomanic". They go on to describe how these individuals, while successful and gifted at what they do, meet the criteria in the DSM as suffering from Hypomanic Episodes (one of the defining features of Bipolar Disorder). From the DSM:

DSM IV Criteria for Hypomanic Episode:

A) Distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days that is clearly different from the usual nondepressed mood.

B) During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

Inflated self-esteem or grandiosity
Decreased need for sleep (e.g. feels rested after only 3 hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
Increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C) The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D) The disturbance in mood and the change in functioning are observable by others.

E) The mood disturbance not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F) The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment) or a general medical condition (e.g., hyperthyroidism)

Now, I don't know how many of you creative-types out there began to panic when you started reading this list of defining criteria, but I know I did. In fact, of all the creative people I know in various fields of work and study (and I know a lot), I don't know too many who don't meet these criteria. It's called being In The Zone, or Flow, as defined by Mihaly Csikszentmihalyi. This is usually that happy-productive-place that we all love to be in, and don't seem to get enough of. However, according to the DSM criteria, it appears if you are too intensely creative, you might very well be suffering from Hypomanic Episodes.

Is there a difference between being hypomanic and being extremely creative? Yes, there is. While being an intensely creative person may imply you are meeting most of those criteria a lot of the time when you are in that state of flow, that doesn't mean you are dysfunctional. This list also doesn't specify a degree or intensity of the symptoms. There is a big difference between "people notice the change in your behavior" and "people are freaked out by the change in your behavior". One seems a little bit more problematic than the other.

Having untreated Bipolar Disorder or Hypomanic Episodes can be severely debilitating; let's see how debilitating it is to be in a creative flow. Do you get hyper-focused on your task? Yes. Stay up all night working on it? Sure, at times. Do other people notice a change in your behavior? Well, I'd hope my colleagues and friends can tell the difference between me sitting around mindlessly working and me in my creative flow. Definite change in attitude- yes, we get happy when those creative moments hit.

In fact, writing this very article, I have now stayed up all night, have been focused intensely on my work, yet easily distracted, AND I'm in a pretty noticeably good mood. Oh, damn! Someone call the psychiatrist! Andi is having "an episode"!!!

This list from the DSM also doesn't account for the balancing out of those traits by regulatory mechanisms that are present in successfully creative people. You can have intense personality traits, while still maintaining control over them. This is a mere checklist, which is one of the big problems I have with the DSM in its current form.

To be honest, the Times article was pretty positive, and real "Yeah, you go, you crazy kids!" regarding this type of creative individual, but there was this disconcerting labeling of extremely creative people as having a "disorder". This bothers me, because I don't think most people understand the bigger picture of genetics, balancing of traits, and the definition of a "disorder". We see items adding up on the handy-dandy DSM checklist, and we are quick to classify people as having a disorder. Stigma ensues.

Yet another story, similar in message, has been circulating the last few days about Narcissists and their ability to convince people of their (not so) creative ideas. I have many problems with that story for reasons I won't get into right now (like the criteria for labeling subjects as Narcissists, for one), but the main point was that individuals identified as having a personality disorder were actually the most successful at the task that was being measured - one that involved coming up with creative solutions, then convincing a group of people of the value of those ideas. These are good traits to have - don't we define disorders partially by their degree of maladjustment and failure to function in society? So why did the "pathological" individuals show more skill and have a higher rate of success?

Bigger question I have for you: Why is everyone so surprised at this?

The Essential Truth of Creativity

The truth is, in order to be truly exceptional at something creative in nature, whatever domain it may be, you need to have those extreme traits that get you labeled by the DSM as meeting the criteria for some kind of a personality disorder. However (and this is the catch), in order to have those extreme, intense traits and not suffer from a disorder, you also need to have some sort of regulatory mechanism that helps to control those traits.

The psychologist interviewed for the Times article, John Gartner, and author of the book The Hypomanic Edge, essentially describes this type of excessively-creative-yet somehow-able-to-function-normally individual. He says that the "attributes that make a good entrepreneur are common in certain manias, but are harnessed in ways that are hugely productive." That harnessing, or cognitive control, is the one thing that really separates extreme, yet functional traits from dysfunction and psychopathology.

Let's look at one more example involving the link between Schizophrenia and creativity.

The traits that define schizotypy: divergent thinking, mental flexibility, and over-inclusive thinking style (lack of latent inhibition, or attending to irrelevant details and stimuli), are also traits that are necessary (yet necessarily regulated) in order to have the most success in creative achievement.

Dr Liane Gabora, creativity researcher, described the phenomenon of having schizotypal traits while being functionally and successfully creative in her Beer Can Theory of Creativity. A person with schizotypal traits with no cognitive control was like having all the cans of beer in the 6-pack, but no plastic thingy to hold them all together. Divergence of thought without cognitive control doesn't give you that ability to discern if your wild ideas are delusional, real, appropriate, or even good ideas to pursue. That plastic thingy makes all the difference between those same schizotypal traits manifesting as a schizophrenia spectrum disorder, or as successful creativity. Thus, we can think of creativity here as "optimally functional schizotypy".

Creativity Across Different Domains

However, this distinction of functionality based on the presence or absence of cognitive control isn't limited to just Schizophrenia, or Bipolar Disorder. It applies to other DSM disorder classifications as well - Depressive Disorder (features high emotional sensitivity), Narcissism (features high confidence and charisma), ADHD (features lots and lots of ideas coming in at all times) even Autism Spectrum Disorders (features very focused attention to detail). Taking into account the traits involved in those disorders, and looking at different types of creativity, we could define it as "domain-specific-optimal-versions-of-pathological-traits", given the person has a high level of cognitive control.

We Need Psychopathology If We Want Geniuses

The point here is this: Were it not for those "disordered" genes, you wouldn't have extremely creative, successful people. Being in the absolute middle of every trait spectrum, not too extreme in any one direction, makes you balanced, but rather boring. The tails of the spectrum, or the fringe, is where all the exciting stuff happens. Some of the exciting stuff goes uncontrolled and ends up being a psychological disorder, but some of those people with the traits that define Bipolar Disorder, Schizophrenia, ADHD, and other psychological conditions, have the fortunate gift of high cognitive control paired with those traits, and end up being the creative geniuses that we admire, aspire to be like, and desperately need in this world.

So now, after this discussion, let's go back to that original question. If we were to be able to identify the genes for Schizophrenia, or for Bipolar Disorder, or for ADHD... would we want to eliminate them? If we were making a "designer baby", would you choose those genes to be added into your child's genome?

I say yes.

The more crucial variable that we should be trying to manipulate is the neural mechanisms for cognitive control, in order to take the most advantage of the gifts associated with those extreme and intense traits, or to allow someone with a debilitating disorder to gain control over it. In this way, I don't look at psychopathology as "disorders", but rather an inability to maintain control over the set of traits you have. Some people with more extreme traits need more control, others can do with less. But if we want to continue to have exceptional, creative geniuses, those pathological traits are an absolute necessity.

References:
Just Manic Enough: Seeking Perfect Entrepreneurs, by David Segal (New York Times)