rss twitter

Creativity and its relation to Schizophrenia

Paul Kiritsis - Thursday, November 10, 2016

In pondering the initial semblance of schizophrenic psychosis and its evolutionary trajectory over the last century, one might begin to wonder why such a maladaptive condition should persist in the human gene pool over successive generations. There are ostensible detriments associated with the development of mental illness in all areas of life–personal, interpersonal, occupational, reproductive, and longevity. People suffering from schizophrenia and psychotic disorders are often riddled by cognitive deficits and impairments, insidiously undermining their social and vocational functioning and inexorably pushing them closer and closer toward the vulnerable territories of social isolation and financial poverty. Many such individuals live in abject poverty and elect to suicide, dying prematurely and well before their time. As expected, social withdrawal decreases the likelihood of courting and attuning with a possible mate, and research has substantiated this contention with finds indicating a dearth in reproductive success when juxtaposed with their non-clinical counterparts (Svensson et al., 2007).

Having troubled many a thinker, this curious and vexing phenomenon was explored in a fascinating article co-authored by the evolutionary biologists Ernst Mayr and Julian Huxley and the psychiatrists Humphrey Osmond and Abram Hoffer and then published in the 1964 edition of Nature. They wove a cogent argument based on the theory of natural selection, survival of the fittest, postulating that genes conferring neurobiological vulnerability to insidious states such as psychosis should be jettisoned from the gene pool over generations unless the same genes also bequeath compensatory advantages (Huxley et al., 1964). Electing to view the conundrum through a predominantly epidemiological lens the authors argued for compensatory polygenetic advantages associated with the conferral of immunity to infection in first and second-degree relatives of affected individuals.

Because their theory of selective advantages based on some kind of physical benefit failed to garner empirical support in the subsequent few decades, researchers began to turn to alternative domains for feasible explanations. Many exposed themselves as disappointing intellectual and theoretical impasses, however one of these, the primordial mad-creative genius connection, has proved a fertile hunting ground. On the whole, the body of research in this area, whether it be biographical and historiometric or psychometric and experimental in nature, has been fairly consistent, indicating that the association may be veridical and not just a figment of the ancient imagination. Yes, the stable prevalence rate of schizophrenia and psychosis may reflect complex polygenetic linkages with creativity and creative genius (Andreasen, 2011; Carson, 2011).

Eons before the conception of Enlightenment science and the birth of the empirical method, an adroit Stagyrite named Aristotle asked the question, “Why is it that all those who have become eminent in philosophy, politics, poetry, or the arts are clearly melancholics and some of them to such an extent as to be affected by diseases caused by the black bile? (Aristotle, 1984).” What began as nothing but a quixotic anecdote and opinion about “insane geniuses” and descriptions of artistic and literary talents in the context of mental illness was bestowed a second wind in the first half of the twentieth century by people like Wilhelm Lange-Eichbaum and Joy Paul Guilford, who introduced the concept to the scientific disciplines of sociology and psychology (Kyaga et al., 2015) and hence made it amenable to empirical investigation. The conceptual expansion to include the social environment in the hunt for etiological factors impelled a subtle shift in the semantic terminology used to describe the “creative genius” phenomenon; in developing the rationale for their studies, researchers jettisoned the holistic construct of “genius” for more modest and explicit terms like creativity, intelligence, and motivation (Becker, 1978; Lehman, 1947). Historiography shows there has been burgeoning scientific interest in the creativity-psychopathology connection too, with publications doubling each decade. The 41 studies that were made available for perusal in the first decade of the twenty-first century are a far cry from a meagre two published in the 1950s (Thys et al., 2014).  

Historiographers sympathetic to the creativity-mental illness supposition have examined biographical data on a creative luminary in hope of discovering a symptom profile or hospitalization record, in fact any ammunition for the purpose of making a conclusive psychiatric diagnosis or at the very least a cogent argument for the salience of mental illness in the respective individual’s life. Severe methodological limitations to this kind of inquiry, for instance the inaccuracies latent in subjective report and a dearth of representative samples, should not be overlooked however these are balanced by strengths like detailed narrative descriptions, phenomenological richness, and the authenticity of longitudinal case histories. With good ecological validity this approach to creativity study may be more generalizable to the general population than, say, experimental and psychometric methods which rely on artificially controlled environments for ability-based (or cognitive task) analysis and quantitative measurement of puzzle-solving behaviors (operationalized creativity). In any case remaining faithful to this quintessential ahistorical approach, the American psychologist Dean Simonton (1994) has assembled a list of eminent historical figures identified by various sources as sufferers of schizophrenia. The renowned scientists Descartes, Kepler, and Newton; the thinkers Kant and Swedenborg; the artist Leonardo da Vinci; the writer Lewis Carroll; and the renowned Joan of Arc all grace the list.

The novel objects, products, compositions, and insights offered by many of the aforementioned authors have been subjectively appraised by the aggregates as paragons of highest brilliance in pre-established domains of achievement. Sometimes identified as Big-C Creativity (Simonton, 2010), the combined dyad of creator and creative product of adoration may become an entity of such prodigious cultural importance and aesthetic worth as to echo across and transcend decades, centuries, millennia, and discrete cultures themselves whilst concomitantly influencing or altering the lives of those who experience it. Rene Descartes, a founding father of Enlightenment science, allegedly derived both his phenomenal bifurcation of the world into mental and physical properties and the proto-scientific method from a series of disquieting symbol-laden dreams, one of which involved a stranger who offered him a melon (pomegranate) (Pagel, 2014). The visionary savant and polymath Emanuel Swedenborg had numinous visions of Christ in which a higher purpose of “explaining to men the meaning of Scripture” was revealed to him (Goodricke-Clarke, 2008). He declared he could travel to the nonphysical worlds, converse with angels, spirits, and demons therein, and return with messages from deceased individuals wishing to communicate with their living relatives.

Known primarily for his iconic paintings (i.e. the Mona Lisa and the Virgin on the Rocks), the Italian polymath Leonardo da Vinci (1452-1519) was immortalizing prototypes of ornithopters (flying machines), automobiles, and suspension bridges centuries before they became exemplars par excellence of technological advancement. Published after his death, Codex Atlanticus, a twelve-volume compendium of drawings and notes, demonstrates a lifelong fixation with aviation, warfare, and motorized vehicles (Suh, 2013). Contained within its pages are detailed plans for: a triangular-shaped parachute to be constructed of linen wrapped around a wooden frame; a self-propelled cart replete with steering and brakes and mobilized by coiled springs; and a helicopter with a helical rotor made of reeds, wire, and linen. Accompanying notes pertaining to the last of these say, “If the instrument made with a screw be well made–that is to say made of linen, of which the pores are stopped up with starch and be turned swiftly, the said screw will make its spiral in the air and it will rise high (McCurdy, 2013, p. 275).” Even though our accrued scientific intelligibility now indicates that its material constitution would have precluded expression of the purpose for which it was built, Da Vinci’s underlying assumption about becoming airborne through air compression was correct and paved the way for the twentieth century invention of the modern helicopter. Working models of his other two inventions, the parachute and motorized cart, were built and tested in 2000 and 2006, respectively. Both worked. 

There are also documented cases of Big-C Creativity in sufferers of schizophrenia who never approached the status of highly eminent. Between 1908 and 1930, Adolf Wolfli, an artist hospitalized for paranoid schizophrenia, produced a staggeringly complex and symbolically rich oeuvre comprised of poetry, prose, illustrations, and musical compositions without as much as a conscious plan. Described as genius-level creativity, much of the image-making or world-generating capacity of these individuals is intimately bound up with bizarre phenomena including persistent psychological automatisms, altered or secondary streams of consciousness, symbolic thinking, and “psi” states (Kelly et al., 2007).  

Working with the mentally ill at Mendocino State Hospital in California for some seventeen years, the clinical psychologist Wilson Van Dusen conducted a comprehensive investigation into the phenomenology of his patients’ hallucinations. An uncanny one involving “psi” states was described in his book The Natural Depth in Man (1972). The hallucination in question appeared in the form of a supernal lady with a mental and aesthetic dexterity to rival the mythical Muses, Sirens, and water nymphs. Going by the mysterious epithet of, “An Emanation of the Feminine Aspect of the Divine,” this spirited Lilliputian “came” to one of his schizophrenic patients, an elementary educated gas pipefitter, with the sole intent of lifting him from his deep-seated despondency.  

Communicating through the gas pipefitter, who had no understanding of mythical, religious, and historical contexts, Van Dusen stresses that his multiple dealings with the multimodal hallucination went far in convincing him that she was, without any reasonable doubt, a master of hermeneutics; she frequently produced cosmic images, letters, and universal symbols from within herself and described the implications of archetypal myths that were unknown to the clinical psychologist.

On one occasion she orchestrated a Buddhist mandala wheel by intricately knotting together human bodies and then allowing them to roll across the office; on another she accurately reflected an inner mental state that would have been concealed from any other mortal observer with the image of a flaccid phallus; and on another still she demonstrated her extrasensory powers by stipulating in a straightforward fashion that a bypass valve and differential pressure was behind unusual variances in the temperature of water coming from the same drinking fountain.

She mimicked her planetary constituent, the rocky and crater-filled moon, when it came to answering queries—thoughtful questions were accurately mirrored by answers with philosophical latitudes while the lighter breed would be reflected by playful and mischievous answers. Compared with the majority of the populace, she was a beacon of eternal wisdom. According to Van Dusen there was simply no way that an individual of the gas pipefitter’s level of intelligence, understanding, and cognitive capacity could ever engender or conjure such a “hallucination,” not unless some external agency was involved. 

Perhaps the exemplar par excellence of unbalanced genius is mathematician John Forbes Nash, the Nobel Laureate in economics Nash believed the voices he heard were telepathic phone calls from extraterrestrials implanted intracerebrally by a central machine (Jackson, 2015). The voices were inexorably diabolical and demoralizing, the conspirators of innumerable mind games; they endeavored to convince him that his delusional idea about being the victim of Communist assassins was veridical. On one spring weekday afternoon, uncomfortably warm as it was, the Harvard professor George Mackey had the gumption and nerve to ask Nash about his seemingly paradoxical universe. How could somebody devoted to rational analysis and empiricism actually believe that extraterrestrials were recruiting him to save the world? Nash’s blunt response was, “Because the ideas I had about supernatural beings came to me the same way that my mathematical ideas did. So I took them seriously (Nasar, 1998, p. 11).”

The insinuation here, when one thinks deeply about it, is that the inner mental processes experienced as delusional beliefs and hallucinations by the inwardly disordered may also be the fountainhead and raw underpinning of creative thought. In normative functioning persons the raw underpinnings of this inner process is unconscious but under certain circumstances, perhaps an acute psychotic episode, it becomes conscious. If these two are inextricably bound, then the ability to take advantage of creative inspiration without becoming overwhelmed and suffering psychosocial impairments would depend on how far up the continua linking the subclinical and clinical associates of psychosis they sit.

The psychobiographical approach described above has been expedient in propounding an explanation for the creativity-psychosis connection based on certain personality traits. For better or for worse, it may be the characterological predisposition to psychotic states that shares genetic, neurobiological, cognitive-affective, and perhaps motivational linkages with creativity (Barrantes-Vidal, 2014). Moreover, because psychopathologies also exist on several entwining continua (i.e. schizospectrum/psychotic or bipolar spectrum/affective disorder), we would do well to infer that expressions of creative genius will not be the prerogative of one psychological profile. Indeed there is scientific consensus regarding specificity of association, with preliminary evidence identifying creative individuals as being at higher risk of developing either a mood, schizospectrum, or substance abuse disorder (Carson et al., 2011) but no other diagnoses (Kyaga et al., 2015). Having profoundly influenced and shaped biological psychiatry over the last century or so (Shorter, 1997), it should come as no surprise that schizophrenia itself, a paragon of the prototypical psychiatric condition, has taken up much of the spotlight here.

Astonishingly, clinical research seeking to ratify an association between creativity expressed either through individuals, professions, and products and schizophrenia populations has emerged empty-handed. One study examining a clinical sample of 60 schizophrenic patients who’d been admitted to The New York Hospital Westchester Division between the years 1928 and 1955 found no increased incidence of artistic occupations amongst the cohort (Herbert, 1959). Similarly, Andreasen and Powers (1975) studied schizophrenic and manic patients admitted to the University of Iowa Psychiatric Service, observing that conceptual and behavioral overinclusion was a feature of writers and the manic (bipolar) cohort only. Schizophrenic patients, in contrast, were under-inclusive in their cognitive style and expressed a dearth of conceptual richness and idiosyncratic thinking when juxtaposed with the other two study cohorts.

 Dykes and Mcghie (1974) offered more corroborating evidence, attributing these patients’ poor performance on divergent and convergent thinking tasks to an inability to consciously control widened attention. They also noted analogous attentional strategies, namely the sampling of a wider range of environmental stimuli, operant in both non-clinical samples of creative individuals and schizophrenic patients. Somewhat of a curiosity, the observation seemed to provide inadvertent evidence for a speculative theory propounded by Robert Prentky (1979) that eminently creative individuals and individuals with schizophrenia both possess overinclusive styles of thinking (Maher, 1972; Andreason & Powers, 1975). The major difference between the two, as implied by Abraham et al. (2007), is that the executive functioning impairments prevalent in full-blown schizophrenia fetter goal-directed thinking, ensuing in poor performances on specific facets of creativity tests intending to measure verbal fluency and relevance but not in other domains like originality. Aptitude for originality is not impaired in individuals with chronic schizophrenia. With a long line of studies noting fulminant schizophrenia to be detrimental and a hindrance to creative performance, would it be feasible to assume, then, that cases in the milder spectrum range will manifest the association? Or that in milder schizospectrum ranges executive functioning is not so compromised as to impair creative cognition?

Population, family, and adoption studies have been particularly fruitful here. Karlsson (1970) performed a retrospective family study on 486 first-degree and second-degree relatives of schizophrenic and manic depressive patients who’d been admitted to the Kleppur Mental Hospital in Reykjavik, Iceland, sometime between 1851 and 1940. He found the relatives were more likely to hold a creative profession and be listed in Who’s Who than members of the general population. The eminence of creative professions and incidences of psychosis in many genealogical branches was influential in Karlsson’s intuit of attributing the two to shared genetics. Later, the same researcher systematically examined a sample of 8007 relatives of individuals with psychosis and concluded that in comparison to the general population they were overrepresented as authors, graduates, and in Who’s Who (Kalsson, 1984). A study on high psychosocial functioning with a smaller sample size also found higher appraisals of creativity amongst six competent children born to mothers with schizophrenia when compared to matched controls (Kauffman et al., 1979).  Similarly, Kinney et al. (2000) found that 36 adult adoptees with genetic vulnerability to schizophrenia were ranked higher on the subjective Lifetime Creativity Scales by blind independent researchers than demographically matched control adoptees without a family history of psychiatric hospitalization. Adult adoptees with schizotypal or schizoid signs attained the highest scores.  

Lastly two nationwide studies based on longitudinal Swedish total population registers (Kyaga et al., 2011; Kyaga et al., 2013) also build a strong case for the milder spectrum range hypothesis. Results from these studies indicated an overrepresentation of creative professions (defined as artistic or scientific occupations) in parents and siblings of individuals with schizophrenia. When compared with a control group individuals diagnosed with schizophrenia were more likely to hold visual artistic occupations but less likely to hold scientific occupations. The inverse was true for the bipolar disorders. These observed relationships align with Juda’s supposition that schizophrenia is prevalent in artists and bipolar disorder in scientists (Juda, 1949). Using a much larger sample (n=1, 173, 763) and a wider range of diagnostic categories the chronologically newer study (Kyaga et al., 2013) replicated the stipulated results of the prior study along with further illuminating that as a creative profession, being a literary author was associated with higher risk of developing schizophrenia, bipolar disorder, unipolar depression, anxiety disorders, substance abuse disorder, and committing suicide.  

            The fascinating idea of shared genetics for spectrum manifestations of psychotic features and creativity first intimated by Karlsson (1970) was further investigated by Keri (2009). The latter investigation is especially engrossing because it utilizes the “Just Suppose” subtest of the TTCT as a quantitative measure for creativity, a measure comprising the creativity “battery” for this prospective study. A homogenous sample of 200 healthy and highly intelligent individuals who self-appraised as high achievers in scientific and artistic pursuits participated in this investigation. They all completed assessments for IQ, socioeconomic status, and schizotypal character traits, and creativity with the Creativity Assessment Questionnaire (CAQ) and “Just Suppose” subtest of the TTCT before having their genomic DNA extracted through venous blood samples.

Keri found that participants carrying a specific promoter polymorphism of the neuroregulin 1 gene (NRG-1) on chromosome 8, the T/T genotype outperformed participants with other genotypes in both lifetime achievement self-reports and divergent thinking scores (i.e. fluency, flexibility, and originality) obtained in laboratory settings. The same candidate gene has previously been implicated in psychosis-proneness (Mei and Xiong, 2008; Bousman et al., 2013), predisposition to the schizospectrum disorders ((Tosato, Dazzan, & Collier, 2005), lower working memory capacity (Stefanis et al., 2007), decreased activation of frontotemporal neural networks during cognitive processing (Hall et al., 2006), hypersensitivity to harsh criticism (Keri et al., 2009), and honorary eminence in creative achievement (Venkatasubramanian and Kalmady, 2010). To my knowledge these findings have not been replicated.

            What is more Wang et al. (2004) recently identified possible associations between dopamine (D2) receptor sensitivity, a neurotransmitter recognized as influential in the mediation of positive symptoms like hallucinations and delusions, and a phenomenon known as reduced latent inhibition (LI), that is, a decreased threshold for sensory gating whereby extraneous stimuli are allowed to infiltrate conscious awareness. Previously Carson et al. (2003) theorized that attenuated LI was the cognitive mechanism responsible for enhanced expression of creativity; by burgeoning the inventory of extraneous stimuli available for conscious manipulation in working memory, the likelihood of establishing novel conceptual recombinations useful in one sociocultural context or another increases exponentially. Taken together, these genetic and neurobiological studies converge on an increasingly veritable hypothesis holding the subclinical associates of hallucinations and delusions, otherwise known as subsyndromal psychotic symptoms–cases in the milder spectrum range–accountable for the manifest association with creativity.

            On reflection there is remarkable consistency across clinical and psychometric studies examining the correlation between the spectrum of psychoses and creativity in non-eminent creators. In an older study with a sample of 68 British nationals, creativity as measured by Wallach and Kogan’s Object Uses, Similarities, and Pattern Meanings Tests was positively correlated with Eysenck’s Psychotism Scale (Kidner, 1976). Subjecting 100 students to psychometric tests for divergent thinking, Woody and Claridge (1977) identified a significant positive correlation between creative thinking and the intensity of psychoticism. In a similar fashion, Schuldberg et al. (1988) showed that college students with significantly elevated scores on measures for positive schizotypy also scored high on a Freudian assessment for creativity called the Barron-Welsh Art Scale (BWAS) and the Adjective Check List (ACL), a creativity personality scale. Interestingly students with combined elevated scores for impulsive non-conformity and positive schizotypy were the most creative. Batey and Furnham (2008) also detected a correlation between impulsive non-conformity, positive schizotypy, and creativity.

Consistent with these finds O’Reilly et al. (2001) demonstrated that scores for creative arts students on psychometric tests of creativity and certain measures of positive schizotypy like dimensions of unusual experience were significantly higher than those attained by other humanities students. Again, Folley and Park (2005) found that schizotypal subjects (n=17) expressed enhanced divergent thinking abilities when compared to outpatients with schizophrenia (n=17) and healthy controls (n=17). In the same study data collected from functional near-infrared spectroscopy (fNIRS) linked engagement in divergent thinking tasks with prefrontal cortex activation, however in the schizotypal subjects the neural processing power underpinning this activity was particularly pronounced in the right prefrontal cortex. This curious feature was not observed for either of the other two groups. 

            Parallel patterns were described in relation to divergent thinking tasks and schizotypy by Weinstein and Graves (2002), but only in the context of positive signs. There was no correlation detected for negative schizotypy, the condition associated with both lack of interest or pleasure in interpersonal relations (anhedonia) and an absence of motivation (avolition). In comparing psychometric performances of visual arts students and non-artistic individuals on creativity and schizotypal measures Burch et al. (2006) also reported similar results; the visual arts students outperformed the non-artistic controls on measures for openness to experience, impulsive no-conformity, divergent thinking, and positive schizotypy but not for negative schizotypy. Nettle and Clegg (2006) subjected a sample of 425 British adults to the O-LIFE schizotypy inventory, finding that unusual experiences correlated positively with mating success as mediated by creative activity. Published that same year a more comprehensive study (Nettle, 2006) demonstrated mutual factors in information processing for poets and artists on one side and patients with schizophrenia on the other. The two cohorts differed from the healthy controls in that they were more likely to have and report unusual experiences, however phenomenal experience in creative individuals was unfettered from the introvertive anhedonia beleaguering the patients with fulminant schizophrenia.

Moreover, significant associations between self-reported capacities for imagination, creativity, and jocularity and positive schizotypy were found using a different inventory for schizotypy, the Schizotypy Personality Questionnaire (SPQ) in a non-clinical sample of 225 students from the University of New Mexico (Miller & Tal, 2007). The authors concluded that openness to experience, a Big five personality trait, predicted verbal and drawing creativity. Another contemporary study involving a sample of 100 visual artists (Nelson & Rawlings, 2010) suggested characterological traits suggestive of positive schizotypy to be the most salient, powerful predictors of deep preoccupation, present-moment awareness, shifts in phenomenological experience, and the paradoxical experience of pleasure and power, all quintessential features of the unfolding creative endeavor. The accumulating mass of data indicates overlap between schizotypy and creativity (Del Giudice et al., 2010); the correlation appears to be unidirectional, with schizotypal traits or dispositions bequeathing preferences for novelty and openness to an individual which in turn burgeons creative-seeking behaviors.

 Lamentably, no scientific research is entirely unencumbered of methodological limitations. Firstly and foremost construct and criterion validity may be threatened by informational bias; the  operationalization of creativity, the features (i.e. divergent thinking, schizotypy, imagination, etc.) deemed characteristic of the construct, and the study designs used to quantify them differ across many studies on the creativity-psychopathology connection (Kyaga, 2015). This may render results incommensurable and in many cases non-generalizable. Before the 1980s the classification of psychiatric disorders was based on idiosyncratic clinical evaluations rather than broadly implemented organized manuals stipulating explicit criteria for evaluation, and so equating studies conducted in different time periods may be more problematic than originally supposed. Similarly, studies that have utilized expert valuations on the aesthetic value of creative products and self-rating scales may be too subjective to classify as empirical support, and some of the assessments have never been validated (Thys et al., 2014).

It also appears the majority of investigations have observed smaller effect sizes (Kyaga et al., 2011), underscoring the importance of airing on the side of caution when making inferences about causation. More so because many are observational and not experimental in nature, one cannot rule out the viability that positive correlations between expressive artists and positive schizotypal features, as strong as they might be, intimate artifacts of social drift rather than common factors predicated on creativity (Kyaga, 2015). Finally there’s the issue of design; human ethical sensibilities and practicalities have kept investigations into the nature of creativity and psychopathology away from methods able to restrict genetic, environmental, and other anonymous confounds, such as RCTs.

Consistency of an association over time is of the utmost importance in ascertaining whether a pattern in nature is veridical or not. Future studies should not only look to the replication of current finds, but to the deployment of alternative design methods in replicating scientific studies which have already harnessed positive correlations between subsyndromal psychotic features and schizotypy with creativity. Using multiple creative assessments would also be optimal, for it would enable greater clarification on which aspects of the creative process relate to which features of the subsyndromal psychotic and schizotypal disposition. At any rate 75 (67.6%) of 111 studies examined by Thys et al. (2014) demonstrated a positive correlation between creativity and psychopathology, whilst 22 (22.5%) reported absence of any correlation and 11 (9.9%) a negative correlation. Thirteen of the fourteen controlled studies investigating the overlap of psychotic and schizotypal traits and creativity (Thys et al., 2014) found a positive association while the one nonconformity indicated no association (Rodrique and Perkins, 2012). On the other hand four creativity studies examining a prospective connection with full-blown schizophrenia report no correlation, while another five reported inverse correlations (Thys et al., 2014).

If the polygenetic linkage between creativity and psychosis as supported by Keri (2009) is in fact veridical, then we can assume schizotypal traits and psychotic features to be causative agencies in facilitating creative ideation, creative expression, and creative products. The link is causal and unidirectional. Moreover, the connection appears to be veridical for the positive schizotypal dimensions (i.e. magical thinking and unusual perceptual experiences) but not the negative ones (i.e. anhedonia, avolition). Research has also consistently illuminated an association of divergent thinking, a hallmark of creativity, and impulsive non-conformity with subsyndromal psychotic features. Trends in larger sample studies incorporating a heterogeneous group of patients from higher and lower levels of the schizospectrum range consistently find positive associations with creative pursuits, long-term creative endeavors, and creative occupations; studies with smaller clinical samples consistently indicate that cognitive impairments, or a dearth of prefrontal cortex activation, predict deficits in creative cognition for this same clinical population. We can also claim the existence of an inverted U pattern between schizospectrum disorders and creativity with creative cognition and expression peaking in first-degree relatives of individuals with fulminant schizophrenia (Kyaga et al., 2013; Kyaga et al., 2011).

In the milder spectrum cases, the genetic loading for novelty, imagination, creative ideation, and processing wider bandwidths of information readily manifests because the executive functions (i.e. attention, concentration, goal-directed action) necessary for channeling it have not been compromised. Individuals with fulminant schizophrenia espouse these some creative propensities, however in their case the cognitive impairments, especially the incapacity for goal-directed action, have severely impeded expression and productive channeling of that creative potential. In actual fact the inner mental processes experienced as delusional beliefs and hallucinations by an individual who is inwardly disordered but not sufficiently disordered as to suffer an acute psychotic episode may not only serve as fuel and motivation for their creative pursuits, but be the fountainhead and raw underpinning of creative thought itself.




About Schizophrenia. (2016). Retrieved October 8, 2016, from

Andreasen, N. C., Arndt, S., Alliger, R., Miller, D., & Flaum, M. (1995). Symptoms of schizophrenia: methods, meanings, and mechanisms. Archives of General Psychiatry, 52(5), 341-351.

Andreasen, N. J. C., & Powers, P. S. (1974). Overinclusive thinking in mania and schizophrenia. The British Journal of Psychiatry, 125(588), 452-456.

Andreasen, N. J., & Powers, P. S. (1975). Creativity and psychosis: An examination of conceptual style. Archives of General Psychiatry, 32(1), 70-73.

Aristotle, J. B. (1984). The complete works of Aristotle: The revised Oxford translation (Vol. ) (E. S. Foster, Trans.; J, Barnes, Ed.). Princeton, NJ: Princeton University Press.

Atkin, K., Kendall, F., Gould, D., Freeman, H., Liberman, J., & O'Sullivan, D. (1996). Neutropenia and agranulocytosis in patients receiving clozapine in the UK and Ireland. In The British Journal of Psychiatry, 169(4), 483-488.

Barlati, S., Deste, G., De Luca, P., Ariu, C., Vita, A. (2013) Cognitive remediation in schizophrenia: Current status and future perspectives. Schizophr Res Treat, 2013: 1–12. Available from: http://

Barrantes-Vidal, N. (2014). Creativity and the spectrum of affective and schizophrenic psychoses. Creativity and mental illness, 169-204.

Batey, M., & Furnham, A. (2008). The relationship between measures of creativity and schizotypy. Personality and Individual Differences, 45(8), 816-821.

Becker, G. (1978). The mad genius controversy: A study in the sociology of deviance. Sage.

Blom, J. D., & Sommer, I. E. (Eds.). (2011). Hallucinations: Research and practice. Springer Science & Business Media.

Bentall, R. P. (2004). Madness explained: Psychosis and human nature. Penguin UK.

Bousman, C. A., Yung, A. R., Pantelis, C., Ellis, J. A., Chavez, R. A., Nelson, B., ... & Foley, D. L. (2013). Effects of NRG1 and DAOA genetic variation on transition to psychosis in individuals at ultra-high risk for psychosis. Translational psychiatry, 3(4), e251. Doi: 10.1038/tp/2-13.23

Boydell, J., & Murray, R. (2003). Urbanization, migration and risk of schizophrenia. In R. M. Murray, P. Jones, E. Susser, J. van Os, & M. Cannon (Eds.), The epidemiology of schizophrenia (pp. 49-67). Cambridge, UK: Cambridge University Press.

Cannon, T. D., Kaprio, J., Lönnqvist, J., Huttunen, M., & Koskenvuo, M. (1998). The genetic epidemiology of schizophrenia in a Finnish twin cohort: a population-based modeling study. Archives of general psychiatry, 55(1), 67-74.

Carson, S. H., Peterson, J. B., & Higgins, D. M. (2003). Decreased latent inhibition is associated with increased creative achievement in high-functioning individuals. Journal of Personality and Social Psychology, 85(3), 499-506.

Carson, S. H. (2011). Creativity and Psychopathology: A shared vulnerability model. Canadian Journal of Psychiatry, 56, 144-153.

Chadwick, P. D., Birchwood, M. J., & Trower, P. (1996). Cognitive therapy for delusions, voices and paranoia. John Wiley & Sons.

Ciranni, M. A., Kearney, T. E., & Olson, K. R. (2009). Comparing acute toxicity of first-and second-generation antipsychotic drugs: a 10-year, retrospective cohort study. In The Journal of Clinical Psychiatry, 70(1), 122-129.

Del Giudice, M., Angeleri, R., Brizio, A., & Elena, M. R. (2010). The evolution of autistic-like and schizotypal traits: A sexual selection hypothesis. Frontiers in Psychology, 1, 41.

Dickerson, F. B. (2000). Cognitive behavioral psychotherapy for schizophrenia: a review of recent empirical studies. In Schizophrenia Research, 43(2), 71-90.

Fatouros-Bergman, H., Cervenka, S., Flyckt, L., Edman, G., & Farde, L. (2014). Meta-analysis of cognitive performance in drug-naive patients with schizophrenia. Schizophrenia research, 158(1), 156-162.

Folley, B. S., & Park, S. (2005). Verbal creativity and schizotypal personality in relation to prefrontal hemispheric laterality: A behavioral and near-infrared optical imaging study. Schizophrenia research, 80(2), 271-282.

Geddes, J. R., & Lawrie, S. M. (1995). Obstetric complications and schizophrenia: a meta-analysis. In The British Journal of Psychiatry, 167(6), 786-793.

Genevsky, A., Garrett, C. T., Alexander, P. P., & Vinogradov, S. (2010). Cognitive training in schizophrenia: a neuroscience-based approach. Dialogues Clinical Neuroscience, 12(3), 416-421.

Glahn, D. C., Ragland, J. D., Abramoff, A., Barrett, J., Laird, A. R., Bearden, C. E., & Velligan, D. I. (2005). Beyond hypofrontality: A quantitative meta‐analysis of functional neuroimaging studies of working memory in schizophrenia. Human Brain Mapping, 25(1), 60-69.

Goodrick-Clarke, N. (2008). The Western esoteric traditions: a historical introduction. Oxford University Press.

Gottesman, I. I., & Hanson, D. R. (2005). Human development: Biological and genetic processes. Annual Review of Psychology, 56, 263-286.

Gould, R. A., Mueser, K. T., Bolton, E., Mays, V., & Goff, D. (2001). Cognitive therapy for psychosis in schizophrenia: an effect size analysis. In Schizophrenia research, 48(2), 335-342.

Grynszpan, O., Perbal, S., Pelissolo, A., Fossati, P., Jouvent, R., Dubal, S., et al. (2011).  Efficacy and specificity of computer-assisted cognitive remediation in schizophrenia: A meta-analytical study. Psychological Medicine, 41(1):163–73.

Guttmacher, M. S. (1964). Phenothiazine treatment in acute schizophrenia: Effectiveness. The National Institute of Mental Health Psychopharmacology Service Center Collaborative Study Group. Archives of General Psychiatry, 10, 246-261.

Hall, J., Whalley, H.C., Job, D.E., Baig, B.J., McIntosh, A.M., Evans, K.L., et al. (2006). A neuregulin 1 variant associated with abnormal cortical function and psychotic symptoms. Nature Neuroscience, 9, 1477–1478.

Haut, K. M., Lim, K. O., & MacDonald, A. (2010). Prefrontal cortical changes following cognitive training in patients with chronic schizophrenia: effects of practice, generalization, and specificity. Neuropsychopharmacology, 35(9), 1850-1859.

Healy, D. (2009). The creation of psychopharmacology. Harvard University Press.

Hedges, D., Jeppson, K., & Whitehead, P. (2003). Antipsychotic medication and seizures: a review. In Drugs Today (Barc), 39(7), 551-557.

            Heinrichs, R. W. (2005). The primacy of cognition in schizophrenia. American Psychologist, 60(3), 229.

Helmes, E., & Landmark, J. (2003). Subtypes of schizophrenia: a cluster analytic approach. The Canadian Journal of Psychiatry, 48(10), 702-708.

Henquet, C., Murray, R., Linszen, D., & van Os, J. (2005). The environment and schizophrenia: the role of cannabis use. Schizophrenia bulletin, 31(3), 608-612.

Herbert, P. S. (1959). Creativity and mental illness. Psychiatric Quarterly, 33(3), 534-547.

Huxley, J., Mayr, E., Osmond, H., & Hoffer, A. (1964). Schizophrenia as a genetic morphism. Nature, 204, 220-1.

Isaac, C., & Januel, D. (2016). Neural correlates of cognitive improvements following cognitive remediation in schizophrenia: a systematic review of randomized trials. Socioaffective neuroscience & psychology, 6.

            Jablensky, A., & Sartorius, N. (2008). What did the WHO studies really find? Schizophrenia Bulletin, 34, 253-5.

            Jackson, M. (2015). Creativity and Psychotic States in Exceptional People: The Work of Murray Jackson. Routledge.

            Juda, A. (1949). The relationship between highest mental capacity and psychic abnormalities. American Journal of Psychiatry, 106(4), 296-307.

Jung, R. E., Grazioplene, R., Caprihan, A., Chavez, R. S., & Haier, R. J. (2010). White matter integrity, creativity, and psychopathology: disentangling constructs with diffusion tensor imaging. PloS One, 5(3), e9818. doi: 10.1371/journal.pone.0009818

Kahn, R. S., Fleischhacker, W. W., Boter, H., Davidson, M., Vergouwe, Y., Keet, I. P., Gheorghe, M.D. et al. (2008). Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomized clinical trial. The Lancet, 29, 1085-1097.

Kamphuis, H., Arends, J., Timmerman, L., Kappert, J., & Van Marle, J. (2010). P03-73-Myocarditis en cardiomyopathie; ernstige complicaties van clozapinetherapie. In Tijdschrift voor Psychiatrie, 52,223-233.  

Kane, J. M. (2004). Tardive dyskinesia rates with atypical antipsychotics in adults: Prevalence and incidence. In Journal of Clinical Psychiatry, 65, 16-20.

Kane, J. M. (1996). Treatment-resistant schizophrenic patients. In The Journal of Clinical Psychiatry, 57, 35-40.

Kane, J. M., Honigfeld, G., Singer, J., Meltzer, H. (1988). Clozapine for the treatment-resistant schizophrenic. A double-bind comparison with chlorpromazine. In Archives of General Psychiatry, 5, 789-796.

Karlsson, J. L. (1970). Genetic association of giftedness and creativity with schizophrenia. Hereditas, 66(2), 177-181.

Karlsson, J. L. (1984). Creative intelligence in relatives of mental patients. Hereditas, 100(1), 83-86.

Kauffman, C., Grunebaum, H., Cohler, B., & Gamer, E. (1979). Superkids: Competent children of psychotic mothers. The American Journal of Psychiatry.

Keefe, R. S., Bilder, R. M., Davis, S. M., Harvey, P. D., Palmer, B. W., Gold, J. M., & McEvoy, J. P. (2007). Neurocognitive effects of antipsychotic medications in patients with chronic schizophrenia in the CATIE trial. In Archives of General Psychiatry, 64(6), 633-647.

Kelly, E. F., & Kelly, E. W. (2007). Irreducible mind: Toward a psychology for the 21st century. Rowman & Littlefield.

Kéri, S. (2009). Genes for psychosis and creativity: A promoter polymorphism of the Neuregulin 1 Gene is related to creativity in people with high intellectual achievement. Psychological Science, 20(9), 1070-1073.

Kéri, S., Kiss, I., Seres, I., & Kelemen, O. (2009). A polymorphism of the neuregulin 1 gene (SNP8NRG243177/rs6994992) affects reactivity to expressed emotion in schizophrenia. American Journal of Medical Genetics B: Neuropsychiatric Genetics, 150, 418–420.

Kety, S. (1990). The syndrome of schizophrenia: unresolved questions and opportunities for research. British Journal of Psychiatry, 136, 421-36.

Kidner, D. (1976). Creativity and socialization as predictors of abnormality. Psychological reports, 39(3), 966-966.

Kingdon, D. G., & Turkington, D. (2005). Cognitive therapy of schizophrenia. Guilford Press.

Kinney, D. K., Richards, R., Lowing, P. A., LeBlanc, D., Zimbalist, M. E., & Harlan, P. (2001). Creativity in offspring of schizophrenic and control parents: an adoption study. Creativity Research Journal, 13(1), 17-25.

Kurtz, M.M., Moberg, P.J., Gur, R.C., Gur, R.E. (2001). Approaches to cognitive remediation of neuropsychological deficits in schizophrenia: A review and meta-analysis. Neuropsychology Review, 11(4):197–210.

Kyaga, S., Lichtenstein, P., Boman, M., Hultman, C., Långström, N., & Landén, M. (2011). Creativity and mental disorder: Family study of 300 000 people with severe mental disorder. The British Journal of Psychiatry, 199(5), 373-379.

Kyaga, S., Landén, M., Boman, M., Hultman, C. M., Långström, N., & Lichtenstein, P. (2013). Mental illness, suicide and creativity: 40-year prospective total population study. Journal of psychiatric research, 47(1), 83-90.

            Kyaga, S. (2015). Creativity and Mental Illness: The Mad Genius in Question. Springer.

            Le Fanu, J. (1999). The rise and fall of modem medicine. London: Little, Brown and Company (UK).

Lehman, H. C. (1947). National differences in creativity. American Journal of Sociology, 475-488.

            Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins, D. O., & Severe, J. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. In New England Journal of Medicine, 353(12), 1209-1223.

            Maher, B. (1972). The language of schizophrenia: A review and interpretation. The British Journal of Psychiatry, 120(554), 3-17.

Mei, L., & Xiong, W. C. (2008). Neuregulin 1 in neural development, synaptic plasticity and schizophrenia. Nature Reviews Neuroscience, 9(6), 437-452.

            Marder, S. R., & Wirshing, D. A. (2003). Maintenance treatment. In S. R. Hirsch & D. L. Weinberger (Eds.), Schizophrenia (2nd ed., pp. 474-488). Malden, MA: Blackwell.

            McCurdy, E. (2013). The mind of Leonardo da Vinci. Courier Corporation.

            Mitchell, K. J., & Porteous, D. J. (2011). Rethinking the genetic architecture of schizophrenia. Psychological medicine, 41(01), 19-32.

            Miyamoto, S., Stroup, T. S., Duncan, G. E., Aoba, A., & Lieberman, J. A. (2003). Acute pharmacological treatment of schizophrenia. In S. R. Hirsch & D. L. Weinberger (Eds.), Schizophrenia (2nd ed., pp. 442-473). Malden, MA: Blackwell.

            Morrison, A. P. (2001). Cognitive therapy for auditory hallucinations as an alternative to antipsychotic medication: a case series. Clinical Psychology & Psychotherapy, 8(2), 136-147.

            Morrison, A. P., Renton, J. C., Williams, S., Dunn, H., Knight, A., Kreutz, M. et al. (2004). Delivering cognitive therapy to people with psychosis in a community mental health setting: an effectiveness study. Acta Psychiatrica Scandinavica, 110(1), 36-44.

            Nasar, S. (1998). A Beautiful Mind: A Biography of John Forbes Nash, Winner of the Nobel Prize in Economics, 1994. Simon and Schuster.

            Nelson, B., & Rawlings, D. (2010). Relating schizotypy and personality to the phenomenology of creativity. Schizophrenia Bulletin, 36(2), 388-399.

            Nettle, D. (2006). Schizotypy and mental health amongst poets, visual artists, and mathematicians. Journal of Research in Personality, 40(6), 876-890.

            Nettle, D., & Clegg, H. (2006). Schizotypy, creativity and mating success in humans. Proceedings of the Royal Society of London B: Biological Sciences, 273(1586), 611-615.

            O'Leary, D. S., Flaum, M., Kesler, M. L., Flashman, L. A., Arndt, S., & Andreasen, N. C. (2000). Cognitive correlates of the negative, disorganized, and psychotic symptom dimensions of schizophrenia. The Journal of Neuropsychiatry and Clinical Neurosciences, 12(1), 4-15.

            O’ Really, T., Dunbar, R. & Bentall, R. (2001). Schizotypy and creativity: An evolutionary connection? Personality and Individual Differences, 31, 1067-1078.

Oltmanns, T. F., Martin, M. T., & Neale, J. M. (2011). Case studies in abnormal psychology. John Wiley & Sons.

Owen, M. J., Craddock, N., & O'Donovan, M. C. (2005). Schizophrenia: genes at last? Trends in Genetics, 21(9), 518-525.

Pagel, J. F. (2014). Dream Science: Exploring the Forms of Consciousness. Academic Press.

Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G., & Morgan, C. (2002). Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behavioral therapy. Psychological Medicine, 32(05), 763-782.

            Pogue-Geile, M. F., & Gottesman, I. I. (2007). Schizophrenia: Study of a Genetically Complex Phenotype. In B. C. Jones & P. Mormede (Eds.), Neurobehavioral genetics: Methods and applications. (2nd ed.), (pp. 209-226). Boca Raton, FL: CRC Press.

            Reichenberg, A., & Harvey, P. D. (2007). Neuropsychological impairments in schizophrenia: Integration of performance-based and brain imaging findings. Psychological Bulletin, 153(5), 833-858.

            Rector, N. A., & Beck, A. T. (2001). Cognitive behavioral therapy for schizophrenia: an empirical review. The Journal of Nervous and Mental disease, 189(5), 278-287.

            Rodrique, A. L., and Perkins, D. R. (2012). Divergent thinking abilities across the schizophrenic spectrum and other psychological correlates. Creativity Research Journal, 24, 163-8.

            Sacks, S., Fisher, M., Garrett, C., Alexander, P., Holland, C., Rose, D., & Vinogradov, S. (2013). Combining computerized social cognitive training with neuroplasticity-based auditory training in schizophrenia. Clinical schizophrenia & related psychoses, 7(2), 78-86A.

            Schizophrenia Fact and Statistics. (2010). Retrieved October 8, 2016, from


Schuldberg, D., French, C., Stone, B. L., & Heberle, J. (1988). Creativity and schizotypal traits. Creativity test scores and perceptual aberration, magical ideation, and impulsive nonconformity. The Journal of Nervous and Mental Disease, 176(11), 648-657.

Sensky, T., Turkington, D., Kingdon, D., Scott, J. L., Scott, J., Siddle, R., et al. (2000). A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry, 57(2), 165-172.

            Shinaver, C., & Entwistle, P. C. (2015). Computerized cognitive training based upon neuroplasticity. In Mental Health Practice in a Digital World (pp. 81-122). Springer International Publishing.

            Simonton, D. K. (1994). Greatness: Who makes history and why. Guilford Press.

            Simonton, D. K. (2010). Creativity in highly eminent individuals. The Cambridge handbook of creativity, 174-188.

            Stefanis, N.C., Trikalinos, T.A., Avramopoulos, D., Smyrnis, N., Evdokimidis, I., Ntzani, E.E., et al. (2007). Impact of schizophrenia candidate genes on schizotypy and cognitive endophenotypes at the population level. Biological Psychiatry, 62, 784– 792.

Stroup, T. S., Kraus, J. E., & Marder, S. R. (2006). Pharmacotherapies. In J. A. Lieberman, T. S. Stroup, & D. O. Perkins (Eds.), Textbook of schizophrenia. (pp. 303-325). Washington DC: American Psychiatric Association.

Suh, H. A. (Ed.). (2013). Leonardo's Notebooks: Writing and Art of the Great Master. Black Dog & Leventhal.

Sullivan, P. F., Kendler, K. S., & Neale, M. C. (2003). Schizophrenia as a complex trait: evidence from a meta-analysis of twin studies. Archives of general psychiatry, 60(12), 1187-1192.

Sullivan, P. F., Owen, M. J., O’ Donovan, M. C., & Freedman, R. (2006). Genetics. In J. A. Lieberman, T. S. Stroup, & D. O. Perkins (Eds.) Textbook of schizophrenia (pp. 39-53). Washington, DC: American Psychiatric Association.

Svensson, A. C., Lichtenstein, P., Sandin, S. & Hultman, C. M. (2007). Fertility of first-degree relatives of patients with schizophrenia: A three generation perspective. Schizophrenia Research, 91(1), 319-328.

Thys, E., Sabbe, B., & De Hert, M. (2014). The assessment of creativity in creativity/psychopathology research–a systematic review. Cognitive neuropsychiatry, 19(4), 359-377.

Tosato, S., Dazzan, P., & Collier, D. (2005). Association between the neuregulin 1 gene and schizophrenia: a systematic review. Schizophrenia Bulletin, 31(3), 613-617.

Turkington, D., Sensky, T., Scott, J., Barnes, T. R., Nur, U., Siddle, R., et al. (2008). A randomized controlled trial of cognitive-behavior therapy for persistent symptoms in schizophrenia: a five-year follow-up. Schizophrenia Research, 98(1), 1-7.

Turner, M.S., & Stewart, D. W. (2006). Review of the evidence for the long-term efficacy of atypical antipsychotic agents in the treatment of patients with schizophrenia and related psychoses. In Journal of Psychopharmacology, 20, 20-37.

Twamley, E. W., Jeste, D. V., Bellack, A. S. (2003). A review of cognitive training in schizophrenia. Schizophrenia Bulletin, 29(2): 359–82.

Venkatasubramanian, G., & Kalmady, S. V. (2010). Creativity, psychosis and human evolution: The exemplar case of neuregulin 1 gene. Indian Journal of Psychiatry 2010, 52(3), 282.

Wan der Heiden, W., & Häfner, H. (2000). The epidemiology of onset and course of schizophrenia. European archives of psychiatry and clinical neuroscience, 250(6), 292-303.

Wang, H., Ng, K., Hayes, D., Gao, X., Forster, G., Blaha, C., & Yeomans, J. (2004). Decreased amphetamine-induced locomotion and improved latent inhibition in mice mutant for the M5 muscarinic receptor gene found in the human 15q schizophrenia region. Neuropsychopharmacology, 29(12), 2126-2139.

Weiser, M., Van Os, J. I. M., Reichenberg, A., Rabinowitz, J., Nahon, D., Kravitz, E., et al. (2007). Social and cognitive functioning, urbanicity and risk for schizophrenia. The British Journal of Psychiatry, 191(4), 320-324.

Woody, E., & Claridge, G. (1977). Psychoticism and thinking. British Journal of Social and Clinical Psychology, 16(3), 241-248.

Wykes, T., Huddy, V., Cellard, C., McGurk, S. R., & Czobor, P. (2011). A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. American Journal of Psychiatry, 168(5), 472-485.

WHO (1973). Report of the international pilot study of schizophrenia. Geneva: World Health Organization.

            Williamson, P. (2006). Mind, brain, and schizophrenia. New York: Oxford University Press.

            Zimmermann, G., Favrod, J., Trieu, V. H., & Pomini, V. (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. In Schizophrenia Research, 77(1), 1-9.


Post has no comments.

Log in to comment on this post

Trackback Link