Antonio Preti is a psychiatrist and psychotherapist who lives in Italy. A Serendip visitor, Antonio was asked to write about his work and The Gift of Saturn: Creativity and Psychopathology is the result. Like all materials on Serendip, it is intended not as the final word on any of the subjects considered, but rather as a window to observations, thoughts, and ideas, and a stimulus to further exploration and discussion.

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THE GIFT OF SATURN: CREATIVITY AND PSYCHOPATHOLOGY
ANTONIO PRETI, MD

1. Introduction: the difficult definition of creativity
2. Genius and madness
3. A broken mind: schizophrenia and the artistic temperment
4. The circular insanity: manic-depressive illness and the bipolar disorders
5. Mood disorders and achievement
6. An open conclusion
7. Related articles
8. Web sites
9. Glossary


INTRODUCTION: THE DIFFICULT DEFINITION OF CREATIVITY

Life in the metropolis increasingly depends on the ability to provide new and original solutions to old problems. This capacity to bring together knowledge and imagination is called "creativity". Creativity can be defined as many ways as it can be conceived.

As its simplest, creativity could be described as the ability to create products or ideas which are original and which posess a strong social usefulness. This definition, however, is not the whole answer. Frank Barron, one of the most important researchers in this field, offers a more articulate description of creativity. First creativity is considered in terms of the characteristics of the creative product and the social aknowledgement obtains. A criterion of usefulness is implied in, although not essential to, this definition. Secondly the creative product can be considered in its own context: the difficulty of the problem resolved or identified, the elegance of the solution proposed, the impact of the product itself. Thirdly creativity can be conceived on the basis of the abilities that favour it, id est as skill or aptitude.

Creativity, in fact, can be properly conceived as a cognitive capability separate from other mental functions. It appears increasingly independent from the complex of abilities grouped under the word "intelligence", although it has a strong interrelation with these mental abilities. Generally, creatively gifted individuals tend to score higher than the mean of the general population in tests measuring "intelligence", and are also evaluated as more intelligent than the mean of their peers by independent observers. Elevated performances in IQ tests, however, do not guarantee a proper utterance of creativity. The most complete studies on this topic (the Terman study on a group of gifted children followed through their lives, and the McKinnon study on a wide group of architects indicated as cleverer than the mean by their colleagues) showed that intelligence gifted people have better social skills and health than the mean of people of their own age, although with higher suicide rates, but are no more creative than the general population. So, as indicated by the study of McKinnon, there is no correlation, above an IQ level of 120, between IQ scores and creative ability, however measured. Intelligence and creativity, hence, seem independent of the other cognitive capabilities which identify an individual.

The methods used in the evaluating of creative aptitude and ability are numerous and as ingenious the argument investigated demands them to be. In 1981 Dennis Hocevar, in a circumstantial review, sumarized the ten main methods used in studies on creativity:
Tests of divergent thinking
Attitude and Interest inventories
Personality inventories
Biographical inventories
Teacher nominations
Peer nominations
Supervisor ratings
Judgment of products
Eminence
Self-reported creative activities and achievements
From Hocevar D (1981): Measurement of creativity: review and critique. J Personality Assessment, 45: 450-464

Evaluation by third parties and comparison with biographies are the most used methods in large scale investigations. Personality inventories or tests for the evaluation of the individual's style of thought are frequently used with well selected samples of volunteers. One of the most ingenious methods of investigation was developed by Albert Routhenberg, who created a test of verbal associations in order to measure a type of cognitive thought called "janusian thinking". Janusian thinking is, in Routhenberg's words, the "tendency to conceptualize opposites in a free-response situation". This process involves "actively conceiving two or more opposites or antitheses simultaneously during the course of the creative process". This tendency favours the development of mental associations which are often unusual and uncommon, and according to Routhenberg's studies it seems widespread among creatively gifted people, particularly among those who are most productive, those who attain the eminence in their field.

Verbal fluency, fluency of ideas, redefinition, openness to experience, independence of thought, capacity to bring together remote associations and expend effort in the production of ideas are all abilities which favour the expression of creativity among gifted individuals. Most studies, however, agree that the expression of creativity is not the result of a single act, like an answer to a question or the resolution of a problem, but derives from a process which implies many different phases. The moment of "eureka" will not occur without a previous phase of intense working out which implies the collection and elaboration of information relevant to the creative effort, which must be compared and associated before resulting a creative product.

Arnorld M. Ludwig, who studied extensively the cognitive and psychological abilities which associate with and favour creative achievement, described the creative process thus: "One of the better known conceptualizations regards the initial stage as one of preparation during which the individual consciously but unsuccessfully attempts to solve a seemingly unsolvable problem. Then, when the problem is put aside, there is a stage of incubation, a period of variable duration, during which ideas germinate at a subconscious level, usually while the individual is engaged in other tasks. Then comes the stage of insight, discovery or illumination, the "aha" or "eureka" experience, mostly occurring when the critical faculties are suspended, such as during relaxation or dreams - when supposedly the entire solution to the problem is gleaned. But insight in itself is insufficient for discovery. The last stage supposedly involves that of elaboration followed by verification, when the idea is developed and tested against scientific, aesthetic or social standards" (from: AM Ludwig: Reflections on creativity and madness. American J Psychotherapy, 1989; 43: 4-14). An example among the more quoted is the anecdote reported by the chemist Kekule, who recounted that he conceived the ring structure of benzene after a dream in which a serpent biting its tail appeared to him. This and other examples illustrate how an innate propensity towards introspection and the ability to access hidden dimensions of consciousness can favour the course of creativity.

In this respect psychoanalysts talk of "regression in the service of the Ego", as it sound the happy wording coined by the psychoanalyst E. Kris to indicate the ability of turning to the unconscious to wide the sphere of experience. This capacity to gain access to the hidden side of the mind seems to characterize artists and writers but also, though to a lesser extent, scientists and philosophers.

The unexpected and disquieting surfacing of unconscious feelings in daily life also characterizes another wide group of individuals: those who suffer from a mental illnesses, whether for a brief period or for longer. As shown by many studies, there is a surprising link between a creative gift and the risk of mental disorder: in fact, the prevalence of mental problems among creatively gifted people is significantly higher than in the general population. This would suggest that genius, as a result of creative aptitude, and madness are connected by a non-casual link.

GENIUS AND MADNESS

The Italian psychiatrist and criminologist Cesare Lombroso has over the past century been the most consistent supporter of this hypothesis. In one of his best known books, "The Man of Genius", Lombroso illustrates his thesis in a circumstantial way refering to the genius and the lunatic, extreme types related by a shared genetic basis, which taints the descentants of the most gifted families. Lombroso was not the first to assert that there is a tight link between mental ilness and creative achievement.

More than two millenia earlier, in the fragment known as "Problemata XXX", Aristotle, or a disciple of his, raised the question as to why the vast majority of the eminent people are afflicted by "melancholy", i. e. suffer from a mental disorder. The text, now accepted as part of the Aristotelian canon, is surprising in its modernity and accurately describes those characteristics peculiar to one of the most diffuse mental disorders, manic-depressive psychosis. The author of the Problemata XXX indicates many behavioural characteristics as attributes of the more eminent people of his time, attributes such as mood instability, proneness to depressive withdrawal, impulsiveness, tendency to alcohol and drug abuse, high risk of suicide, all of which are peculiar to patients suffering from manic-depressive illnesses. In the Problemata XXX there are also illustrative stories taken from myth and literature, with a gallery of examples mixing excellence and bizarreness, often with a tragic outcome.

The stereotype of the eccentric artist or of the mad scientist, moreover plays a protective role in the collective imagination against the fear and suspicion that excellence and diversity of others always engenders in the majority. The image of madness as a result of genius has been repeatedly expressed in the history of the western world, being codified during the Renaissance in the figure of the melancholic genius afflicted by Saturnian acedia, and resurging during Romanticism in the figure of the deracin (?) artist.

Cesare Lombroso was among the first to apply a less anecdotal method to the investigation of the relationship between the creative gift and the risk of a mental illness, offering an answer that is nevertheless the positivistic version of the romantic myth.

Most studies performed in the positivistic era in order to either confirm, or refute, Lombroso's hypothesis rest on biographical evidence. This raises the suspicion that these studies claiming a higher prevalence of psychopathologies among creative or eminent people, were biased by overexposure. For individuals, such as artists in the public eye more information is available about their private lives: this could determine an apparently higher prevalence of disorders that tend, as a result of negative stigma, to be hidden whenever possible. In addition, some temperamental traits widespread among creative people, like eccentricity, uneasiness, propensity to excess and experimentation, could be a reflection not only of an underlying mental disorder, but also, and above all, of the tolerance by society of the behaviour of individuals who obtain achievement. In some way this behaviour will be a secondary product of the achievement, rewarded since it permits the expression of dissenting demands which by the majority of people are not able to express and which are not directly linked to the creative utterance.

Despite from these reservation, even the later studies, performed using methods applying specific nosographic categories and the direct confrontation with the candidate through interviews and inventories, yielded similar results, with a higher prevalence of mental disorders among gifted people than among the general population.

The two principal studies performed in the era preceding the systematic ordering of the more recent classifications (DSM III, and now IV, and ICD 9, and now 10), show among both artists and scientists a prevalence of severe mental disorders significantly higher than among the general population, with a strong familial association between creativit, psychopathology, and higher suicide rates. In a study performed in Germany from 1927 to 1943 on 5000 individuals, Adele Juda, at that time researcher at the Institute for Psychiatry of Munich, evaluated frequency and distribution of psychiatric disorders in a well selected sample of eminent artists, scientists and their relatives. The study shows a significantly higher prevalence of mental illnesses among eminent people and their families compared to the general population. Among artists disorders of the schizophrenic spectrum and psychopaties were most common. Among scientists, instead, disorders of the cyclotimic type, in particular manic-depressive psychoses, were more frequent. In both groups there was a high suicide rate and a strong familial heredity in the transmission of the psychopathological trait and of creative talent.

Some decades later JL Karlsson, in a study of Iceland, reported a clear familial association between the diagnosis of psychosis, taken from hospital registers, and eminence in artistic or scientific fields, based citations in Who's Who. A clearly recognizable creative talent was present in the relatives of schizophrenic patients twice as often as in the general population; and in the relatives of manic-depressive patients six times as often as in the general population. Karlsson, in his conclusion, suggestes a familial link between creativity and psychoses, substained by a common genetic basis.

In both studies there is a surprising but clear association between the creative gift and the risk of schizophrenia, although mediated by a familial link, since in the concept itself of schizophrenia as illness there is implied a criterion of impairment.

A BROKEN MIND: SCHIZOPHRENIA AND THE ARTISTIC TEMPERAMENT

Schizophrenia is a psychosis, i. e. a mental disorder which implies a severe distortion of reality testing: its decourse is greatly influenced by social and economical factors far removed from the clinical side of its nature. The clinical symptomatology can be traced back to the ex novo appearence of distortions in perception, such as illusions and hallucinations, and of thought disorders leading to delusions. For a proper diagnosis of schizophrenia the symptomatology should be independent of concurrent ingestion of a drug and from the presence of a metabolic disease leading to alterations in the cerebral neurochemistry.

Generally the clinical picture of the schizophrenia is associated with severe impairment of social and occupational functioning with a negative outcome in between 30% and 50% of cases, sometimes developing into dementia. "Dementia Praecox" is the name coined by the the turn-of-the-century German psychiatrist Emil Kraepelin. Kraepelin was the first to isolate the disorder now called schizophrenia from among the myriad syndromes that crowded the treatises of the positivistic era. Kraepelin, on the basis of his observations, distinguished the psychoses with a recurrent decourse and a conservative outcome, which he put in the same group as cycloid psychoses (called by him "manic-depressive illness"), from the psychoses with a progressive and negative decourse, which he indicated with the name "Dementia Praecox". Kraepelin considered the outcome of this disorder to always be negative, biased as he was by his own position as academic psychiatrist and chairman of a center of excellence in which he had access to more severe cases, and living as he did in a age without therapy for mental illness other than the containment and shock treatment.

In 1927, for example, the Austrician psychiatrist Wagner von Jauregg was awarded the Nobel prize for Medicine for his invention of malario-therapy, a treatment that was effective in obtaining the remission of many severe psychotic syndromes, through the induction of periodical fevers after the exposure to malaria. The results of this treatment derived from the induction of anti-inflammatory effects against the aetiological agents in the syndromes that were secondary to an encephalitis, as in the case of syphilis with cerebral complications, for example.

Some years later, in the Thirties, following the observation that mentally ill patients suffering from epilepsy were well after a convulsive fit and were bad when the epileptic symptoms vanished for some reason, the Italians Cerletti e Bini introduced Electro-shock-therapy into clinical practice, obtaining results that, at the time, appeared important. Not important enough, however, for a Nobel prize, which was confered, instead, on the Portuguese Antonio Eges Moniz, for the demonstration that leucotomy (neurosurgery), used in the treatment of some otherwise refractory forms of epilepsy, could also be used for the successful treatment of some mental illnesses, like an obsessive-compulsive disorder, a disorder characterized by high anxiety and by the incontainable drive to repeat actions or ruminate about ideas or unusual thoughts: a condition that can become impairing.

All these therapeutic tools were fortunately replaced by the introduction into clinical practice of new psychoactive drugs, at the beginning of Fifties. At the age of Kraepelin, however, the only drugs used were laudane (opium), belladonna (atropine, an anticholinergic) and a few other substances, generally with a high toxicity. So the impression of incurability of mental illnesses was widespread, and most mental disorders were considered to have an unfavourable outcome. Kraepelin was so persuaded of the irreversible decourse of the disorder now called schizophrenia, that when during a study in Java he observed more favourable outcomes, sometimes even complete recovery, he was enormously impressed.

Less biased by the "illusion of the clinician", as the tendency to overstimate oneÕs own observations is called by epidemiologist , the Swiss Eugen Bleuler, who held the chair of "Burgholzi" Psychiatric Hospital, in which worked eminent psychiatrist like Jung, offered a redefinition of the concept of the psychoses coining the word "schizophrenia" (=broken mind) to indicate what was for him the most relevant aspect of Dementia Praecox: i. e. the loosening of mental associations. For Bleuler schizophrenia is characterized by an alteration of mental associative functions with a concurrent, and consequent, emotional instability, resulting in anaffectivity and autism (closure in oneself). For him hallucinations and delusions were subsequent to the loosening of mental associations, and were without influence on the outcome of the disorder, which was, even in his new formulation, severe and generally bad.

The symptomatology of schizophrenia, as it has been termed since Bleuler, remains manifold and includes many different behavioural patterns, predominantly disorganized and inappropriate behaviour and speech, loss of will and drive, and a generalized lessening of the ability to express emotions. Positive symptoms, involving excess or distortion of normal functions, tend to fluctuate over time, whereas negative symptoms, involving loss or diminution of normal functions, seem to be more stable and to be less responsive to treatment. A three dimensionsional model now appears to be a better description of schizophrenic symptomatology than the preceding positive/negative dichotomy, but there is little agreement on the neural mechanisms that generate these symptoms. Studies performed with neuroimaging techniques indicate that brain abnormalities (namely signs of cerebral atrophy) can be the basis of schizophrenia, but the extent of such abnormalities depends on the characteristics of the control groups. Social deprivation per se can determine cerebral atrophy in mammals. Educational and social premorbid adjustment is often poor in schizophrenic patients, leading precociously to defective relational abilities: so cerebral abnormalities could be the result, rather than the cause of disordered behaviour.

Neuropathological studies also suggest that schizophrenia is not due to a neurodegenerative process, but rather may result from lesions involving a neurodevelopmental process. The main support for this assertion is the lack of gliosis in histological investigation: gliosis occurs after many brain injuries and neurodegenerative conditions, but is not observed after events that occur early in development.

Epidemiological studies support the genetic transmission of the risk of schizophrenia, but this genetically enhanced risk seems to consist in a greater vulnerability to environmental factors acting in the perinatal period, such as complications in pregnancy and at birth or exposure to viral agents.

The final step in the pathogenesis of schizophrenia appears to be a distortion of the systems involved in modulation or integration of information processing. A key role for dopaminergic pathways is suggested by the therapeutic efficacy of dopamine blocker agents, but , as the development of new "atypical" neuroleptics with greater effects on serotonin indicate, many other neurotransmitters could be implicated in the defects in information processing.

The fact that such as severe illness could in some way favour the expression of creative abilities, mainly in the artistic field, raised enourmous interest and provoked myriad studies. These studies were sumarized in the Sixties by the Italian Silvano Arieti, an eminent researcher in the field of psychoses who for many years lived in the United States. In his book "Creativity, the magic synthesis", Arieti elaborates his hypothesis that the though processes typical of schizophrenic patients can favour the development of unusual mental associations which can, in turn, be inspiring to the creatively gifted individual, above all in the artistic field. Arieti supports his hypothesis in many ways, indicating the extraordinary talent of schizophrenic patients in coining new words, and giving many examples of the artistic production of patients confined in Asylums in the first half of this century. The works of these artistis are often very odd and disquieting, but althogh unusual they do not posses the requisite of being "socially enjoyable", which is essential if a product is to be judged as creative.

The impenetrability of the works produced by mentally ill artists in the studies of the Psychiatric Hospitals in Germany drove the Nazis in the 1930s to link these works with the works of avant-garde painters, which appeared equally unintelligible to the Nazists, in the ill-famed "Degenerated Art" exhibition. Interest in the artistic production of mentally ill patients lasted until the Sixties, when the introduction of more selective diagnostic categories lessened enthusiasm for the creativity enhancing virtues of the schizophrenia."

Many cases diagnosed as "Schizophrenia" were probably severe forms of manic-depression: the introduction of specific drugs for the treatment of mental disorders contributed towards a better identification of cases, with more cases diagnosed as manic-depressive psychosis. The discovery by the Australian physician Cade that lithium ion can be used for the effective treatment of less severe forms of manic-depressive illness heightened interest in this mental disorder. With the increase in the number of cases identified awareness was also raised that it was disorders with an affective (mood) component: those characterized by melancholy (severe depression) that were associated with creative achievement, just as the author of the Problemata XXX asserted.

THE CIRCULAR INSANITY: MANIC-DEPRESSIVE ILLNESS AND THE BIPOLAR DISORDERS

Manic-depressive illness, or, as it is now called, bipolar mood disorder, is a disorder with a moderately high prevalence, about 1% in the general population. The clinical picture in current literature derives from the description made by Kraepelin in his treatise, but the disorder has been well known since antiquity. In Anciet-Egyptian papyruses and Assyro-Babylonian terracotta tablets there are descriptions of an illness characterized by recurrent episodes of depression and suicidal thought, whereas the alternation of depressive episodes with euphoria is clearly described in a paper dating from the Imperial era by the physician Areteo of Cappadocia.

Effectively bipolar disorders are characterized by the alternation of depressive episodes (with melancholia, insomnia, loss of appetite, anxiety and restlessness) with other episodes with an opposite euphoric mood, excitement, higher energy and tirelessness, overconfidence, impulsiveness and imprudence. In the periods between two episodes those who are suffering from the disorder have a highly adaptive life style , sometime with very high level of functioning, thanks to the tenacity, tirelessness and social ease that are typical of these individuals. During an episode of illness, however, the social and occupational functioning of the afflicted individual is impaired, sometimes with irreparable consequences.

Bipolars (as patients suffering from manic-depressive disorders are described using a "politically correct" word) are often inconstant at work and their affectionate and social relationship tend to be stormy: their divorce rates are higher than those of the general population, and there is a very high prevalence among them of the misuse of alcohol and other drugs, which bipolar patients may take either an auto-therapy to lessen anxiety and depression, or during an impulsive euphoric period. As a whole the lives of bipolars are troubled, with a high risk of death by suicide: one patient in ten dies by suicide, and the frequence of self-inflicted injuries is even higher (1 in 5 cases, according to studies). Nevertheless these individuals appear to have a unique gift for creative activity, and show a specific talent in the arts, sciences, philosophy speculation, and political and military leadership.

The following all suffered from bipolar disorders in their lives: the scientists Boltzmann and Babbage, the father of modern computer science; the composers Rossini and Tchaikovsky, who commited suicide drinking a cup of water contaminated with vibrio colerae; the statesmen Churchill and Lincoln; the painters van Gogh and Pollock; the philosophers Wittgenstein and Kierkegaard; the writers Pavese and Hemingway, both of whom died by suicide. Poets and writers seem to be particularly prone to developing mental problems, generally of a depressive type, and has even been asserted that one cannot write with success without being "exposed to the Dark Sun of Melancholy". Nancy C. Andreasen, an eminent American psychiatrist who studied literature before devoting herself to medicine, performed an extensive study with her coworkers at the middle of the Seventies on the qualities which characterized the styles of thought of a group of writers who were participating in the annual Writer's Workshop of Iowa University, and, using the criteria of the rising DSM-III, found a high prevalence among them of mood disorders, of a bipolar type.

The style of thought of the writers investigated in addition showed more resemblances with the overinclusive and imaginative style of thought of manic patients, than with that of schizophrenic patients examined in the same study. A clear prevalence of psychopathologies from the affective spectrum among creatively talented people was later reported by KJ Jamison in a study dedicated of twenties century English poets, by JJ Schildkraut and coworkers among American Abstract Expressionist Painters, and by AM Ludwig among 30 American female writers. Kay Jamison, in a study covering three centuries, reported similar results limited to writers and poets, with high rates of mood disorders, in most cases of a bipolar type.

In the Jamison study, the suicide and alcoholism rates were also very high: as was the familial transmission of both psychopathological risk and creativity. Kay jamison reports many examples in his study, among the more representative is one which concerns the poet George Gordon, known as Lord Byron, whose familial history was full of suicides and bizzareness no less clamorous that that which accompanied his own adventurous and unfortunate life. The ability of bipolar patients and their relatives to express themselves successfully is not limited to the artistic field, however, and in fact achievement and ability seem to be attributes of the families of bipolar who appear time and again as motive powers for advancement of mankind.

MOOD DISORDERS AND ACHIEVEMENT

In an extensive review on this topic Frederic Goodwin and Kay Jamison (among the most authoritative researchers in this field) note a significantly higher success in the social and occupational fields among manic-depressive patients' relatives, and often among the patients themselves, at least in those conditions which impair working and relational abilities less. This has been confirmed by the repeated observation that the prevalence of bipolar disorders is clearly higher in the more advantaged classes. This association between proneness to cyclothymic breakdown and social achievement differentiates manic-depressive psychosis from all other mental illnesses, including closely related disorders, such as Major Depression, with the exception, perhaps, of Anorexia Nervosa, which also associate with higher levels of performance, although at the cost of higher mortality rates as a result of medical consequences and suicide. An example of the association between a bipolar disorder and achievement is offered by Jamison herself, essaist and successful researcher, who suffered from a bipolar disorder, as she herself narrates in her autobiography "An unquiet mind".

The high suicide rates and the low fertility of bipolar patients, who tend to marry less than the general population and to have less children than the mean, suggested even in the past that the carriers of the genetic burden of the disorder must have some compensatory advantage in order for a relatively high percentage of affected individuals (more than 1 %) to be mantained in the general population. Studies on the relationship between creativity and mental illnesses suggest that it is the same characteristics of the disorder, in their less severe manifestations, and not some indeterminate associated factor which confer such a compensatory advantage on afflicted individuals and their relatives.

Ruth Richards, who extensively studied this aspect of the relationship between mood disorders and creativity, found among bipolar patients and their relatives a high propensity to the development and expression of creative potential in every field, even those not mutually linked. These abilities were evident mainly among individuals with slight or subclinical forms of the disorder. The healthy carriers of the genetic burden of manic-depressive psychosis seem in some way to take advantage from exactly the vulnerability they transmit. One can only speculate as to the characteristics that confer such an advantage . Constance Holden, a member of staff on the authoritative magazine "Science", indicated in a paper apperaed on "Psychology Today" (April 1987) some of the aspects that could favour the creative achievement among bipolars. First their emotional reactivity: bipolar patients tend to be more sensitive to environmental and interior stimuli. Another factor is their greater disinhibition, which makes them both more open to experimentation and more resourceful. Another typical characteristic of bipolar patients is their greater ability to concentrate, especially in the hypomanic phase of the disorder. Further more, the greater fluidity of mental associations of these individuals favours a more fertile imagination.

It should be noted that the states of excitement that characterize manic-depressive psychosis create greater energy resource and a greater tolerance to fatigue, conditions which favour productive activity, multiplying the opportunities of creative expression and creative realization.On the other hand depressive withdrawal favours the process of introspection, permiting access to the inner dimensions of oneÕs own mind.

In general, the experience of mental illness per se permits access to dimensions of life otherwise unknowable, particularly in conditions that associate with unusual and extreme circumstances as in psychosis. Impulsivity itself, which typically associates with many mental disorders, often leads to enterprises which are occasionally very original, and which in other circumstances, would never be pursued. Felix Post, an English emeritus psychiatrist who performed a close study of the biographies of the most eminent men of our century in the arts, science and in politics noting, as have other authors, a higher prevalence of mood disorders in his sample, supposed that the psychological discomfort itself which accompanies to a mental disorder is the main drive for creative effort: many writers, in fact, asserted that through the act of writing they hold off depressive anguish. For him this relationship can be biuniform, meaning that even creative effort, like other types of stress, could favour a psychological breakdown: the intense intellectual work of the creative process is associated with higher neural activity in the brain, and this hyperactivity can determine the onset of mental problems in those already vulnerable. Even in the past, during the Renaissance, there were philosophers who supposed that intellectual work could lead to melancholy, and this was the explanation they offered for the proneness to depression in poets and other men of letters.

AN OPEN CONCLUSION

All these studies indicate that mental disorders which imply an imbalance in the neural circuits which control mood, beyond the suffering that they cause, can also, in some circumstances, favour the expression of adaptive potential. Mental illnesses are the result of underlying neurobiological variances that, as researchers like Tim J Crow and Daniel R Wilson remind us, continue to be the basis for the action of mechanisms of selection which help men to adapt to rapidly changing conditions of life, particularly in the relational sphere. Joseph Schildkraut, one of the fathers of the biological approach to the study of mental disorders, put forward a very suggestive hypothesis attributing a decisive role to artistic symbolism in favouring the social cohesion of groups, so that the group which expresses the most creative personalities will acquire an adaptive advantage which mantains the integrity of the group as a whole, in spite of the vulnerability of the individual.

Such a process, valid for scientific and technical innovation too, would warrant the mantaining in the general population of the genetic clusters carrying the risk of mental disorders, provided that they favour creativity. This genetic burden would be preserved, in spite of the malajusted potential of the individual, by mechanisms of selection operating at a group level. So, even if mental disorders bring suffering and distress, the aspects which are capable of enriching people's lives should not be dismissed. The "ungrateful guest" which torments the lives of the melancholic is, if properly assisted, also able to express its nicer side.

SUGGESTED READINGS

RELATED ARTICLES

Andreasen NC: Symptoms, signs and diagnosis of schizophrenia. Lancet, 346: 477-481

Andreasen NC, Glick ID: Bipolar affective disorder and creativity: implications and clinical management. Comprehensive Psychiatry, 1988; 29: 207-217

Barron F, Harrington DM: Creativity, Intelligence and personality. Ann Rev Psychol, 1981; 32: 439-476

Carpenter WT, Buchanan RW: Schizophrenia. The New England J Medicine, 330: 681-690

Crow TJ: A darwinian approach to the origins of psychosis. Br J Psychiatry, 1995; 167: 12-25

Frosch WA: Moods, madness and music. major affective disease and musical creativity. Comprehensive Psychiatry, 1987; 28: 315-322

Hasenfus N, Magaro P: Creativity and schizophrenia: an equality of empirical constructs. Br J Psychiatry, 1976; 129: 346-369

Hocevar D: Measurement of creativity: review and critique. J Person Assessment, 1981; 45: 450-464

Juda A: The relationship between highest mental capacity and psychic abnormalities. Am J Psychiatry, 1949; 106: 296-307

Ludwig AM: Reflections on creativity and madness. Am J Psychotherapy, 1989; 43: 4-14

Ludwig AM: Mental illness and creative activity in female writers. Am J Psychiatry, 1994; 151: 1650-1656

MacKinnon DW: The nature and nurture of creative talent. Am Psychologist, 1962; 17: 484-495

Post F: Creativity and psychopathology. A study of 291 world-famous men. Br J Psychiatry, 1994; 165: 22-34

Richards RL: Relationship between creativity and psychopathology: an evaluation and interpretation of the evidence. Genetic Psychology Monographs, 1981; 103: 261-324

Richards R, Kinney DK, Lunde I, Benet M, Merzel APC: Creativity in manic-depressives, cyclothymes, their normal relatives and control subjects. J Abnormal Psychol, 1988; 97: 281-288

Rothenberg A: The process of janusian thinking in creativity. Arch Gen Psychiatry, 1971; 24: 195-205

Schildkraut JJ, Hirshfeld AJ, Murphy JM: Mind and mood in modern art. Depressive disorders, spirituality and early deaths in the Abstract Expressionist Artists of the New York school. Am J Psychiatry, 1994; 151: 482-488

Schou M: Artistic productivity and lithium prophylaxis in manic-depressive illness. Br J Psychiatry, 1979; 135: 97-103

Wilson DR: Evolutionary epidemiology. Integrative Psychiatry, 1994; 10: 6-12

BOOKS

Arieti S: Creativity: The magic synthesis. Basic Books, New York, 1976

Barron F: Creativity and personal freedom. D Van Nostrand Co, NY, 1968

Goodwin F, Jamison KR: Manic- Depressive illness. Oxford University Press, New York, 1990

Jamison KR: Touched with fire. The Free Press, Macmillan Inc, USA, 1993

Klibansky R, Panofsky E, Saxl F: Saturn and melancholy. Studies in the history of natural philosophy, religion and art. Thomas Nelson & Sons LTD, London, 1983

Koestler A: The act of creation. Macmillan, NY, 1964

Lombroso C: The Man of Genius. (original edition in Italian) Walter Scott, London, 1891

Ludwig AM: The price of greatness. New Yor, Guildford Press, 1996

Karlsson JL: Inheritance of creative intelligence. Nelson-Hall, Chicago, 1978

Kris E: Psychoanalytic explorations in Art. International Universities Press, New York, 1952

Rothenberg A: The emerging Goddess: the creative process in art, science, and other fields. Chicago, University of Chicago Press, 1979

Storr A: The dynamics of creation. London, Secker & Warburg, 1972

Wittkower R, Wittkower M: Born under Saturn. Weidenfeld and Nicolson, London, 1963

WEB SITES

Lancet - An authoritative magazine with many interesting papers on various aspects of mental illnesses, and with a section devoted to the relationship between medicine and the arts

Neuroscience on the web - The Mother of all links to neuroscience and related sites

Psychiatry on line - A site with many interesting links, some particularly useful on bipolar and related disorders

Yahoo! Health on drugs - A good point for starting any exploration of the web concerning drug use, abuse and related problems

Web of addictions - Another source of information on drugs; rather conservative, however

Medscape - A very good on line magazine about medicine, with a section devoted to psychiatry: in the archive there is a good paper on hallucination. To consult the site one must first register, but it is free

Thesis archives - A very interesting and rich archive, with many papers on all aspects of science, with a section devoted to the psychology of the abnormal (including parapsychology)

Louvre - ART in block capitals

ArtCrime - Art on the wall

AnonimaFumetti - Art with speech bubbles. An Italian site, but with an English version as well

Steve Reich page The site of one of the most interesting contemporary music composers, with many links

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GLOSSARY

Delusion

A delusion is an idea, a belief or a credence based on erroneous inferences about the external reality or the relationships between elements of that reality. Such an idea, belief or credence is stubbornly sustained even in the face of contradictory factual evidence and despite opposition from the beliefs of the majority of other people. The delusional quality of an idea, belief or credence needs to be compared to the sum of ideas, beliefs or credences of the culture to which the patient belongs: the idea that spirits are the cause of the malaise of the patient can not be considered a delusion if the same opinion is shared by the culture to which the patient belongs (Central Africa, Central America).

The Latin word "delirium" (= delusion) contains in its etymon the meaning of "to lose one's way, to go out of the furrow". The Latin verb "delirare" (= to have a delusion) therefore indicates a significant characteristic of delusion: i.e. that it is something that diverges from the usual path of thoughts, both of the individual expressing the delusion, and the culture to which this individual belongs. The German word ³wahn² (= delusion; from the Gothic "wan", derived from the Indo-European radix "WENO", Latin "vanus", English "wane" = to be empty) alludes to the "emptiness" of meaning of the delusion, which often has no proof to support it, and which is usually sustained by weak reasoning and argumentation lacking verification. There are many classifications of delusions on the basis of their content: the most widespread themes involve persecution (by third persons, in an organized manner, in order to bring about harm or damage); jealousy (the idea of being betrayed by a partner, despite contrary evidence); grandiosity (belief in possession of particular or exceptional qualities, in the absence of verification); somatic (transformation or alteration of some part of the body). In schizophrenia delusions with a bizarre content are common, and are completely incongruous with the usual beliefs of the patient expressing them: for example a patient can abruptly sustain that he or she has been changed into a wolf, or is in contact with supernatural entities. Also frequently found in schizophrenia is a particular type of delusional perception, which the German psychiatrist Kurt Schneider considered specific to the disorder, and which concerns the idea of telepathy; mind control, reading, broadcasting and transmission of thoughts.

Hallucination

An hallucination is a sensorial perception in the absence of the appropriate stimulus: for example; seeing objects not present in the environment, or hearing voices of people too far from the individual to be effectively heard. Hallucination should be differentiated from illusion, in which a stimulus actually present, is intepreted in the wrong way: for example a pile of rags in the dark can be mistaken for a person.

False perception can occur as a result of a physiological condition, such as tiredness (hypnagogic hallucination), or during awakening (hypnopompic hallucination). Hallucinations also occur after stress or after the ingestion of psychedelic drugs in individuals without any mental disorder. When the hallucination has a clear organic basis (the action of a drug, the initial phase of migraine or of a temporal epileptic crisis) it is common for the individual to be aware of the hallucinatory character of his or her perceptions. When hallucination occurs during a mental disorder this awareness is rare. Schizophrenia often involves auditory hallucination. A patient says that he/she hears voices conversing or commenting on the patient¹s actions. Sometimes these voices make suggestions that the patient will tend to trust.

Visual hallucination is frequent after the ingestion of psychedelic drugs like LSD or during the initial phase of migraine or of a temporal epileptic crisis. In migraine the visual hallucinations are often of a geometric type: a wide description is offered by the Americal neurologist Oliver Sacks in his book Migraine. Tactile hallucinations (the sensation of having something under the skin) are often reported during abstinence from cocaine or amphetamines. Olfactory hallucinations (the perception of unpleasant smell not present in the environment) are reported as precocious symptoms in some brain tumor cases.

For more informations on hallucinations see: Ramon A. Boza: Hallucinations and illusions of non-psychiatric aetiologies. In the archives of Psychiatry on-line Barry L. Beyerstein: Believing is seeing: organic and psychological reasons for hallucinations and other anomalous psychiatric symptoms. In the archives of Medscape

Psychosis

A condition in which the patient experiences a severe impairment of reality testing mechanisms, often in association with delusions and hallucinations. The impairment of reality testing often severely interferes with the social and working ability of the patient, whose behaviour appears incongruous or disorganized. Abnormal control of impulses is frequent, with a tendency towards aggression, irritability and agitation.

A restriction of consciousness, with sensory clouding and confusion (disorientation) may be present, especially in those conditions with a clear organic basis (for example brain lesions).

Gliosis

The glia is part of the brain tissue which acts as protection for neurons and vessels. The glia essentially exerts a nutritive function, but also controls the integrity of the neuron tissues. Usually after a brain lesion, however has been provoked, the necrosed tissue is absorbed by the proliferation of glyal cells, which take the place of the dead tissue. This process occurs constantly, from the age of 6 months. The absence of glyosis (glial reactions) in the lesions observed in the brains of schizophrenic patients suggests that these lesions occur early in brain development, as a consequence of complications during pregnancy (foetal hypoxia; metabolic disorder; action of toxins or drugs; viral infection).

Information-processing

A process by which signals arriving at the brain are elaborated and integrated with the memory of previous sensations. The signals, thus elaborated, contribute to the activation of genetically pre-determined patterns of behavioural response. The brain can be conceived as a huge data processor: information reaches the subcortical and cortical centres along the sense path. Sensorial signals come from the external environment but also from within the body. The elaboration of these signals implies their transfer to gating stations. In these gating stations all inputs are potentiated or inhibited according to the status of the organism. Specific neuronal pathways, which use neurotransmitter like dopamine, serotonin, noradrenaline, take part in the filtering of inputs. According to the frequency of discharge of these neuronal pathways some signals are poetntiated and others are inhibited. The majority of the drugs used in the treatment of mental disorders act on circuits using these neurotransmitters.

Autism

Autism is a lack of reciprocity in social interaction with other human beings. Autism also is a behavioral syndrome of young children. Autism was first reported as a disease in children by Kanner in 1943. The typical child with autism avoids eye contact, does not show anticipatory movements when about to be picked up, resists being held or touched and lacks initiative. Autistic people show inability to reciprocate and the tendency to treat other people as objects. Some individuals with autism, though not all, show special abilities, particularly in the field of root memory (e.g. numarical skills), music, art and visuospatial skills.

From Mary Coleman (1997): The autistic syndrome: a review. The Italian journal of Psychiatry and Behavioural Sciences, 7 (1): 11-15 The American Neurologist Oliver Sacks describes some examples of autistic artists in his books The man who mistook his wife for a hat and An anthropologist on Mars.


Web reference update

Manic-depressive illness and creativity, text of a Scientific American article by K.R. Jamison, 1995

Mental disturbance and creative achievement, text of a Harvard Mental Health Letter article by A.M. Ludwig, March, 1996

Precis of "THE CREATIVE MIND: MYTHS AND MECHANISMS", preprint of an article by M. Boden, Behav. Brain Sci. 17: 519-570, 1994.




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