Rates of Mood Disorders

Alfred, Lord Tennyson, who experienced recurrent, debilitating depressions and probably hypomanic spells, often expressed fear that he might inherit the madness, or "taint of blood," in his family. His father, grandfather, two of his great-grandfathers as well as five of his seven brothers suffered from insanity, melancholia, uncontrollable rage or what is today known as manic-depressive illness.

His brother Edward was confined to an asylum for nearly 60 years before he died from manic exhaustion.

For years, scientists have documented some kind of connection between mania, depression and creative output. In the late 19th and early 20th centuries, researchers turned to accounts of mood disorders written by prominent artists, their physicians and friends. Although largely anecdotal, this work strongly suggested that renowned writers, artists and composers—and their first-degree relatives—were far more likely to experience mood disorders and to commit suicide than was the general population. During the past 20 years, more systematic studies of artistic populations have confirmed these findings. Diagnostic and psychological analyses of living writers and artists can give quite meaningful estimates of the rates and types of psychopathology they experience.

In the 1970s Nancy C. Andreasen of the University of Iowa completed the first of these rigorous studies, which made use of structured interviews, matched control groups and strict diagnostic criteria. She examined 30 creative writers and found an extraordinarily high occurrence of mood disorders and alcoholism among them. Eighty percent had experienced at least one episode of major depression, hypomania or mania; 43 percent reported a history of hypomania or mania. Also, the relatives of these writers, compared with the relatives of the control subjects, generally performed more creative work and more often had a mood disorder.

A few years later, while on sabbatical in England from the University of California at Los Angeles, I began a study of 47 distinguished British writers and visual artists. To select the group as best I could for creativity, I purposefully chose painters and sculptors who were Royal Academicians or Associates of the Royal Academy. All the playwrights had won the New York Drama Critics Award or the Evening Standard Drama (London Critics) Award, or both. Half of the poets were already represented in the Oxford Book of Twentieth Century English Verse. I found that 38 percent of these artists and writers had in fact been previously treated for a mood disorder; three fourths of those treated had required medication or hospitalization, or both. And half of the poets—the largest fraction from any one group had needed such extensive care.

Hagop S. Akiskal of the University of California at San Diego, also affiliated with the University of Tennessee at Memphis, and his wife, Kareen Akiskal, subsequently interviewed 20 award-winning European writers, poets, painters and sculptors. Some two thirds of their subjects exhibited recurrent cyclothymic or hypomanic tendencies, and half had at one time suffered from a major depression. In collaboration with David H. Evans of the University of Memphis, the Akiskals noted the same trends among living blues musicians. More recently Stuart A. Montgomery and his wife, Deirdre B. Montgomery, of St. Mary's Hospital in London examined 50 modern British poets. One fourth met current diagnostic criteria for depression or manic-depression; suicide was six times more frequent in this community than in the general population.

Ruth L. Richards and her colleagues at Harvard University set up a system for assessing the degree of original thinking required to perform certain creative tasks. Then, rather than screening for mood disorders among those already deemed highly inventive, they attempted to rate creativity in a sample of manic-depressive patients. Based on their scale, they found that compared with individuals having no personal or family history of psychiatric disorders, manic-depressive and cyclothymic patients (as well as their unaffected relatives) showed greater creativity.

Biographical studies of earlier generations of artists and writers also show consistently high rates of suicide, depression and manic-depression—up to 18 times the rate of suicide seen in the general population, eight to 10 times that of depression and 10 to 20 times that of manic-depressive illness and its milder variants. Joseph J. Schildkraut and his co-workers at Harvard concluded that approximately half of the 15 20th-century abstract-expressionist artists they studied suffered from depressive or manic-depressive illness; the suicide rate in this group was at least 13 times the current U.S. national rate.

From Touched With Fire: Manic-Depressive Illness and The Artistic Temperament by Kay Redfield Jamison. Copyright ©1993 by Kay Redfield Jamison. Used with the permission of The Free Press, a Division of Simon & Schuster.

In 1992 Arnold M. Ludwig of the University of Kentucky published an extensive biographical survey of 1,005 famous 20th-century artists, writers and other professionals, some of whom had been in treatment for a mood disorder. He discovered that the artists and writers experienced two to three times the rate of psychosis, suicide attempts, mood disorders and substance abuse that comparably successful people in business, science and public life did. The poets in this sample had most often been manic or psychotic and hospitalized; they also proved to be some 18 times more likely to commit suicide than is the general public. In a comprehensive biographical study of 36 major British poets born between 1705 and 1805, I found similarly elevated rates of psychosis and severe psychopathology. These poets were 30 times more likely to have had manic-depressive illness than were their contemporaries, at least 20 times more likely to have been committed to an asylum and some five times more likely to have taken their own life.

These corroborative studies have confirmed that highly creative individuals experience major mood disorders more often than do other groups in the general population. But what does this mean for their work? How does a psychiatric illness contribute to creative achievement? First, the common features of hypomania seem highly conducive to original thinking; the diagnostic criteria for this phase of the disorder include sharpened and unusually creative thinking and increased productivity. And accumulating evidence suggests that the cognitive styles associated with hypomania (expansive thought and grandiose moods) can lead to increased fluency and frequency of thoughts.

Web Resources

Virginia Woolf and Creativity
Brief analysis of Virginia Woolf's psychiatric history.

Mania and Creativity

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