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There have been in recent years increasing claims in both popular and professional literature for a connection between bipolar illness and creativity. A review of studies supporting this claim reveals serious flaws in sampling, methodology, presentation of results, and conclusions. Although there is therefore no evidence for etiological or genetic linkages, it is still necessary to explain interrelationships in those creative persons suffering from the illness. Examples of the work in progress of artists with bipolar disorder, Jackson Pollock and Edvard Munch, illustrate the use of healthy and adaptive creative cognition--janusian and homospatial processes--in the former's breakthrough conception during an improvement phase in treatment leading to the development of the Abstract Expressionist Movement and in the latter's transformation of an hallucination into his famous artwork "The Scream." Treatment options that do not produce cognitive effects are important for creative persons with bipolar disorder.
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Psychiatric Quarterly, Vol. 72, No. 2, 2001
BIPOLAR ILLNESS, CREATIVITY,
AND TREATMENT
Albert Rothenberg, M.D.
There have been in recent years increasing claims in both popular and profes-
sional literature for a connection between bipolar illness and creativity. A re-
view of studies supporting this claim reveals serious flaws in sampling, method-
ology, presentation of results, and conclusions. Although there is therefore no
evidence for etiological or genetic linkages, it is still necessary to explain interre-
lationships in those creative persons suffering from the illness. Examples of the
work in progress of artists with bipolar disorder, Jackson Pollock and Edvard
Munch, illustrate the use of healthy and adaptive creative cognition—janusian
and homospatial processes—in the former’s breakthrough conception during an
improvement phase in treatment leading to the development of the Abstract
Expressionist Movement and in the latter’s transformation of an hallucination
into his famous artwork “The Scream.” Treatment options that do not produce
cognitive effects are important for creative persons with bipolar disorder.
KEY WORDS: creativity; bipolar illness; Jackson Pollock; Edvard Munch; homospatial
process.
A number of creative people in the arts have been reliably diagnosed
as having bipolar disorder (formerly manic depressive illness) such
as writers Ernest Hemingway, Robert Lowell, Theodore Roethke, and
Albert Rothenberg, M.D., is with the Department of Psychiatry, Harvard University.
Address correspondence to Albert Rothenberg, M.D., Box 1001, Canaan, NY 12029;
e-mail: albert rothenberg@hms.harvard.edu.
131
0033-2720/01/0600-0131$19.50/0 C
°2001 Human Sciences Press, Inc.
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132 PSYCHIATRIC QUARTERLY
Virginia Woolf, composers Robert Schumann and Hugo Wolf, artists
Jackson Pollock, probably Vincent Van Gogh, Edvard Munch, and
Arshille Gorky, and actors Vivian Leigh, Dick Van Dyke, and Jason
Robards. To know that such highly valued achievement is possible
should therefore be encouraging for people suffering from the disorder
and, as some have argued, might even help dispel some of the heavy
layer of stigma connected with mental illness in general. On the other
hand, it has been alleged that the illness makes creative persons more
sensitive because of depressive diatheses (1) and more productive while
undergoing manic episodes (2). These allegations represent a roman-
tic notion about creativity—the saga of the suffering artist—with little
evidence to support them. Only comedians such as Jackie Gleason and
Dick Van Dyke have seemed to derive direct benefit in their work from
manic and hypomanic tendencies. Artistic products containing depres-
sive or manic flight of ideas content have, only at particular times in
history, been of social and aesthetic interest.
Despite the erroneous emphasis on the advantages of bipolar illness,
its presence and effects among highly creative persons are of medi-
cal and social importance. For instance, several of the eminent cre-
ators I mentioned—Schumann, Woolf, Hemingway, Van Gogh, Gorky,
Pollock—reached premature deaths through suicide or preventable ac-
cident, at a great loss to society. Mental suffering and debilitation are
intrinsic factors in such illness and appropriate treatment and treat-
ment approaches are required. Such treatment and approaches, how-
ever, are a challenge requiring knowledge of creativity and the creative
processes in conjunction with the course and permutations of the disor-
der. Moreover, it is important to emphasize that creativity is something
all prize very highly. In a special recent issue of the New York Times
Magazine on the next millennium, a feature article asks “What sepa-
rates humans from animals and ever more advanced machines?” and
gives the answer: “We make art.” The production of art, literature, music
of all types, dance, motion pictures, great inventions, scientific discover-
ies, political breakthroughs, exceptional business enterprise, all are due
in large degree to creativity. Creative people are admired and prized,
and creative achievement is widely appreciated. The creative process
inspires awe and is sometimes considered virtually miraculous—many
people believe it to be totally mysterious. Therefore, as the discussion
to follow shall pertain to all levels of creativity, from everyday creativ-
ity in living, cooking, spare time painting and writing all the way to
the achievements of Einstein and Shakespeare, it shall be focused on a
highly valued and complicated process.
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ALBERT ROTHENBERG 133
REVIEW OF STUDIES OF BIPOLAR DISORDER
AND CREATIVITY
Presumed support for the idea of an intrinsic connection between bipo-
lar illness and creativity has come primarily from a handful of studies.
Andreasen (3,4) carried out psychiatric interviews with 30 Writers-in-
Residence at the University of Iowa Program in Creative Writing and
with 30 controls. An incidence of 43% bipolar illness was reported in the
writer group and 10% in the controls. This investigator has stated that
several well-known writers such as “Philip Roth, Kurt Vonnegut, John
Irving, Robert Lowell, Flannery O’Connor and John Cheever” (p. 1288)
had at one time been visiting faculty in the program. Although the
writer group she interviewed were matched for age, sex, and educa-
tional status with controls, the latter group consisted of the following:
“hospital administrators, businessmen, social workers, lawyers, med-
ical and computer science students” (p. 125) (4). Variables pertinent
to creativity such as socio-economic class, academic or peer recogni-
tion and success, were not at all compared for the control and sub-
ject groups. Intelligence, an important variable, was only matched in a
non-randomly selected second later half of the subject groups, the test
period covering a span of fifteen years. Moreover, as the investigator
carried out all interviews herself and no independent ratings or evalu-
ations were carried out, investigator “blindness” was absent regarding
assessments of both subjects and controls. Another confounding factor
influencing the type of group selected and the diagnosis of depressive
features is that the Iowa Program has long served as a retreat for writ-
ers at times of career shifts or setbacks.
Jamison (5) studied a British group of 47 prizewinning artists and
writers. Stating that the design of the study could not allow for system-
atic diagnostic inquiry regarding mania and hypomania, Jamison re-
ported that 38% of the sample had been treated for an “affective” illness.
No controls, however, were used in the study. Investigator interviews
here also were not “blind” and no attempt at differential diagnosis was
made. Subjects were asked only “whether or not they had received treat-
ment, and the nature of that treatment, for a mood disorder” (p. 126),
and no further diagnostic assessment was reported. This problem was
compounded by the fact that subjects were self-selected which, in the
absence of controls, introduces the possibility of an overrepresentation
of psychiatric illness in the group. In addition, reported results were pri-
marily only applicable to the playwright and poet subjects because num-
bers of designated mood disordered subjects in other categories were too
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134 PSYCHIATRIC QUARTERLY
small, e.g. 1 biographer, 1 artist, 2 novelists (calculated from given per-
centages).
Ludwig (6) carried out an investigation of individual biographies
(primarily English language) of 1004 persons reviewed in the New
York Times during the period 1960–1990. The New York Times list
was cross-checked with other popular biography listings. Subjects in
the sample ranged from Albert Einstein and William Faulkner to Mae
West and Casey Stengel. Three percent of all subjects and 10% of artists
(including writers and others) were assessed as having at least one
episode of mania during their lives compared with a cited U.S. sam-
pling incidence of manic illness of 0.4 to 1.2%. Despite the large num-
ber of subjects studied, the Ludwig sampling of primarily popular and
celebrity biographies, exclusive reliance on single biographical sources,
and use of nonprofessional assessors for constructing psychiatric di-
agnoses, limit the validity of the investigatory conclusions. Although
biographies may provide reliable information of various types, they
are primarily non-professional secondary sources which often tend to
include, even emphasize, the disabilities and foibles of famous people.
For diagnostic purposes, therefore, they are often misleading. Major
biographers refused over several years to write a biography of the
comedian Jack Benny because he lived what was considered an un-
interesting happy life. Biographies (English language) have been pub-
lished for 100% of American and English Nobel Laureates in Litera-
ture but for only 6% of all American and English Nobel Laureates in
Economics, Peace, Physics, Chemistry, and Medicine (Physiology) com-
bined (7). Famous writers are clearly popular as biographical subject
and anecdotal and hearsay accounts of flamboyant or aberrant behav-
ior, often richly elaborated, may be prima facie construed as evidence for
psychopathology.
In a survey claiming published evidence for a connection between
bipolar illness and creativity, Andreasen and Glick cited studies by
Juda (8), Ellis (9), and McNeill (10). Juda (8) investigated, primar-
ily through psychiatric interviews, 294 German artists and scientists.
She, however, reported an incidence of only 1.3% manic-depressive psy-
chosis and, for her overall results, concluded the following: “There is
no definite relationship between highest mental capacity and psychic
health or illness, and no evidence to support the assumption that the
genesis of highest intellectual ability depends on psychic abnormali-
ties” (p. 306). Ellis (9) studied the biographies of 1,020 eminent per-
sons listed in the British Dictionary of National Biography and di-
agnosed the following: 4.2% insane, 8% melancholic, 5% with traits
suggestive of a personality disorder. No bipolar or manic-depressive
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ALBERT ROTHENBERG 135
illness was diagnosed in this early account and no behavior suggestive
of that condition was described. In his study attempting to determine
familial and genetic associations between creativity and mental illness,
McNeill (10) assessed 72 Danish adopted subjects and their relatives,
the subjects being designated as highly creative on the basis of having
had official recognition in the fields of performing arts, graphic arts,
literary pursuits, science, and commerce/business. He found only one
subject with manic depressive psychosis, and one and two subjects re-
spectively in the possibly related categories of affective reaction and
reactive psychosis.
Richards, Kinney, Lunde et al (11) also drew their subjects from a
Danish adoption study, using documented diagnostic assessments of 77
adoptee relatives and then assessing creative accomplishments. Three
levels each of vocational and avocational creativity were defined. The
following example presented of the vocational category of “high peak
creativity” indicates different types of criteria for creativity or emi-
nence than those considered in data from the studies already cited:
“Entrepreneur who advanced from chemist’s apprentice to independent
researcher of new products before starting a major paint manufacturing
company, and whose operation surreptitiously manufactured and smug-
gled explosives for the Danish Resistance during World War II” (p. 285).
Results failed to demonstrate a connection between such presumably
peak creativity and manic depressive illness but instead did show an
association with cyclothymic disorder (chronic fluctuating mood distur-
bance involving numerous periods of hypomanic symptoms and of mild
depressive ones). Richards, Kinney, Lunde et al interpreted this result
as suggesting that the creative subjects had a “bipolar liability” (p. 287)
rather than manifest bipolar illness.
Overall, therefore, there is little evidence for an association between
bipolar or manic-depressive illness and creativity. Because of the possi-
bly highly detrimental effects when the disorder does occur in creative
people, however, it is necessary to attempt to understand and explain
interrelationships. To do this, some clarification of the empirically de-
fined nature of creative thought processes is required.
JANUSIAN AND HOMOSPATIAL PROCESSES
In previous investigations, I have found evidence for specific forms of
creative cognition, the janusian (12–16) and homospatial (12–26) pro-
cesses. The janusian process (the name derives from the Roman god
Janus whose multiple faces looked simultaneously in 4–6 opposite di-
rections) consists of actively conceiving multiple opposites or antitheses
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136 PSYCHIATRIC QUARTERLY
simultaneously. During the course of the creative process, opposite or
antithetical ideas, concepts, or propositions are consciously
conceptualized as simultaneously co-existing. Although seemingly illog-
ical and self-contradictory, these formulations are constructed in clearly
logical and rational states of mind in order to produce creative effects.
They occur as early conceptions in the development of artworks and
scientific theories and at critical junctures at middle and later stages
as well. Because they serve generative functions during both forma-
tive and critical stages of the creative process, these simultaneous an-
titheses or simultaneous opposites usually undergo transformation and
modification and are seldom directly discernible in final created prod-
ucts. They are formulated by the creative thinker as central ideas for
an artwork and solutions in working out practical and scientific tasks.
The homospatial process (the name derives from the Greek homiois,
meaning the same) consists of actively conceiving two or more discrete
entities occupying the same space, a conception leading to the articula-
tion of new identities. In this process, concrete entities such as rivers,
houses, human faces, as well as sound patterns and written words, are
superimposed, interposed, or otherwise brought together in the mind
and totally fill its perceptual space—the subjective or imaginary space
experienced in consciousness. Superimposed images may be derived
from the visual, auditory, gustatory, olfactory, or tactile sensory modes.
These processes have been identified in the creative work of Nobel
laureates (15,16) in science and literature and other outstanding cre-
ative people. Although they are unusual and difficult to use, the evi-
dence indicates that they are adaptive and conscious healthy processes.
Despite a given artist’s mental illness, therefore, and despite the suffer-
ing it may cause, creative production is carried out by healthy mental
processes during periods of lowered symptom activity and anxiety. I
shall illustrate the operation of these healthy processes in the work of
two artists who have suffered from bipolar disorder. In one case, the
Norwegian Edvard Munch, a product of the illness underwent trans-
formation into a work of art and in the other, the American Jackson
Pollock, psychiatric treatment brought about a period of improvement
during which a creative breakthrough occurred.
CREATION OF EDVARD MUNCH’S “THE SCREAM”
Edvard Munch (1863–1944) was one of the founders of the Expressionist
Movement in art. A diagnosis of bipolar disorder with psychosis is based
on his own diary descriptions of visual and auditory hallucinations,
a multiply documented instance of his travelling throughout Europe
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ALBERT ROTHENBERG 137
manifesting manic disrupted behavior that culminated in his shooting
two joints off the ring finger of his left hand, and his psychiatric hos-
pitalization in 1908 for an intensification of auditory hallucinations,
depression, and suicidal urges (23,24). He also suffered from bouts of
alcoholism.
In his diary, Munch recorded his initial conception in 1891 for his
most famous artwork, titled in translation as “The Scream” or “The
Screech” (Figure 1) as follows:
“I was walking along the road with two of my friends. Then the sun set. The sky
suddenly turned into blood, and I felt something akin to a touch of melancholy. I
stood still, leaned against the railing, dead tired. Above the blue black fjord and
city hung clouds of dripping, rippling blood. My friends went on and again I stood,
frightened with an open wound in my breast. A great scream pierced through
nature.” (p. 109) (25)
This experience, clearly a visual hallucination, was creatively trans-
formed by Munch over a period of eighteen months into a work of art.
The phases of that transformation are illustrated in the accompanying
Figures 2–5.
In his first drawing right after the hallucination, Munch showed a
solitary man far in the distance leaning in profile over a bridge and
looking at the sky and a boat on a small lake (Figure 2). As an observer
of the scene, the man was quite separate from the elements of nature
depicted. In the next version, a painting (Figure 3), the still-profiled
leaning solitary man was by Munch portrayed in the front portion of
the scene where he then appeared closer both to the lake and the viewer
of the artwork. Introduced into the next charcoal drawing (Figure 4) was
a round bowler hat on the man as he continued to look in profile at the
lake. This rounded shape of the hat eventually became emphasized in
the curved lines of both sky and man’s body in the completed artwork.
Following this drawing, he did two more pen and ink sketches, one
(Figure 5, left) depicted a round-hatted man in the same position as
previously and the other showed the man, for the first time, looking
frontward (Figure 5, right). This shift constituted a critical and cre-
ative change of presenting the man within and connected to the na-
ture scene rather than turned in profile and separately observing it.
In the final version (Figure 1), first done as a lithograph and later
as a painting, the hatless but round headed forward facing man is
portrayed with an oval open screaming mouth and with differently
oriented but similarly rounded shapes in both the red sky and the
man’s body. Munch had thereby visually integrated the screaming man
with the scene and produced what has been described as a universal
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FIGURE 1. Edvard Munch, The
Scream 1893. Oil pastel and casein
on cardboard. Oslo National Gallery,
Oslo. Reproduced with permission.
FIGURE 2. Edvard Munch, Study c.1891-2. Pencil
on paper. Munch Museum, Oslo. C
°2001 The Munch
Museum/The Munch-Ellingsen Group/Artists Rights
Society (ARS), New York. Reproduced with permission.
FIGURE 3. Edvard Munch, De-
spair 1892. Oil on canvas. Thiel
Gallery, Stockholm. Reproduced
with permission.
138
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ALBERT ROTHENBERG 139
FIGURE 4. Edvard Munch, Despair
1892. Charcoal and oil on paper.
Munch Museum, Oslo. C
°2001 The
Munch Museum/The Munch-Ellingsen
Group/Artists Rights Society (ARS), New
York. Reproduced with permission.
type of metaphor, an artwork displaying a “scream of nature” or “the
scream of man and nature.”
The last two steps indicate the use of a homospatial process. The artist
juxtaposed the front facing round hatted man with the nature vista
and, as indicated by the composition, he then mentally superimposed
an image of that man upon the scene. In this way, he developed the
rounded shapes of head, mouth, sky, and body and the expressive im-
ages integrating the man with nature.
Although the artwork began with the psychotic experience of a visual
hallucination, it was necessary for the artist to transform his initial
image in work and thought over the period of more than a year to
produce a creative work of art. Visual hallucinations such as Munch’s
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140 PSYCHIATRIC QUARTERLY
FIGURE 5. Edvard Munch, Despair c.1892 (both).
Pen and ink. Munch Museum, Oslo. (Right: Facing
viewer). C
°2001 The Munch Museum/The Munch-Ellingsen
Group/Artists Rights Society (ARS), New York. Reproduced
with permission.
commonly occur in psychotic illnesses but creative processes are nec-
essary to transform them into art. The homospatial process involving
superimposition of images is a conscious, intentional form of cognition
and not a product of the pathological condition. It is used to bring about
innovations and unifications and, as in the case of “The Scream,” to
articulate the emotional underpinnings of ideas and experiences.
POLLOCK’S CREATIVE BREAKTHROUGH
Jackson Pollock (1912–1956) is credited with the founding of the Ab-
stract Expressionist Movement in art. This was the first truly American
artform and its development had worldwide repercussions. Whereas up
to the time of the artform’s appearance, France had been considered the
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ALBERT ROTHENBERG 141
art center of the world, abstract impressionism moved the focus of the
art world to the United States where it has remained ever since.
Pollock ushered in the abstract expressionist form with the genesis
of a dramatic new style of painting which has been given such names as
“drip painting” or “action painting.” An example drawn from his works,
entitled “Number Three, Tiger, 1949” is shown in Figure 6. The initial
formulations leading to the creation of this form of painting occurred
while the artist was in psychiatric treatment and at a point when his
bipolar illness was showing improvement.
Evidence for the diagnosis of Pollock’s bipolar illness is based on
the report by his treating psychiatrist Dr. Richard Hendersen of pe-
riods of “violent agitation” alternating with “paralysis or withdrawal”
(p. 14) (26), another therapist Dr. Violet de Laszlo’s direct assessment
that Pollock was “manic depressive” (p. 852) (27), and his wife Lee
Krasner’s description of his extremes of temperament and behavior as
follows: “Whatever Jackson felt, he felt more intensely than anyone
I’ve known; when he was angry, he was angrier; when he was happy,
he was happier; when he was quiet, he was quieter” (pp. 9–10) (26).
Like Munch, Pollock also used alcohol in excess to deal with his mood
upheavals.
In an unusual public presentation of psychiatric treatment, Dr.
Hendersen, who became Founder of the Jungian Institute in San
Francisco, gave an open lecture to colleagues about his therapy of
Jackson Pollock from late 1938 to September, 1940 (28). In this therapy,
as is commonly practiced by Jungians, the patient Pollock regularly de-
livered drawings and other artwork to his sessions for analysis. Eighty
three of these works were preserved by Dr. Hendersen (29). Although
the exact sequence of the creation of the artworks is not known, a
distinctly early one is shown in Figure 7. This and many subsequent
works show the influence of his mentors, Thomas Hart Benton, Diego
Rivera, Jose Clemente Orosco and other Mexican muralists. It is a large,
brightly colored drawing with a suggestion of an Aztec or other native
Mexican icon. There is also an otherworldliness that indicates Pollock’s
known interest in surrealism at the time. In numerous other drawings
done around the same period, he adopted both the styles of Picasso,
portraying that artist’s earmark bull and horse, and Miro, with the
frequent use of decorative seemingly suspended symbols. There was
little in the early group of drawings of the generative originality of his
late abstract expressionistic work.
As the treatment progressed, the symbolism in Pollock’s artwork be-
came more obscured and he began to produce the type of expressive com-
positions that characterized his eventual breakthrough. At this point,
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FIGURE 6. Jackson Pollock, Num-
ber Three, 1949, Tiger. Oil, enamel,
aluminum, paint, string and cigarette
fragement on canvas. Hirshhorn
Museum and Sculpture Garden,
Smithsonian Institution, Gift of Joseph
H. Hirshhorn, 1972. Photographer:
Lee Stalsworth. Reproduced with
permission.
FIGURE 7. Jackson Pollock, Untitled. Colored
pencil, lead pencil. Nielsen Gallery, Boston.
C
°2001 The Pollock-Krasner Foundation/Artists
Rights Society (ARS), New York. Reproduced
with permission.
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ALBERT ROTHENBERG 143
he had also sustained definite albeit temporary improvement in his
illness. During the summer of 1939, he was devoid of moodiness and
anxiety, attending parties where he was the only person abstaining from
drinking (27). His artworks of this time, as described by curator and art
critic C.L. Wysuph, showed “automatic drawing to elicit unconscious
imagery; [together with] obscuring or veiling this imagery” (p. 20) (26).
Pollock spoke explicitly later of working to obscure images and sym-
bols and to express them at the same time (p. 537) (27). This
breakthrough idea, which achieved representation in the drip paintings
(see Figure 6 where formed images can be vaguely discerned), is an in-
stance of the janusian process described above. Opposites of obscuring
and expressing were by Pollock actively conceived simultaneously in
the drawings done during 1939.
The janusian process is not a matter of dialectical thinking where op-
posites are posited sequentially and contradictions are superseded or
resolved, nor is it a matter of Jungian fusing of opposites. Opposites and
contradictions such as obscuring and revealing are posited or presented
simultaneously and developed into a final product. It is a conscious pro-
cess and, unlike psychopathological processes, which involve rigidity,
irrationality, exteme self-absorption and self-focus, the janusian pro-
cess is flexible and rationally based as well as directed toward other
human beings and the environment (as is the homospatial process as
well).
As the therapy with Dr. Hendersen progressed further, Pollock began
a period of intense activity. A year later, his artist brother Sanford wrote
to another artist brother Charles as follows: “[Jackson] is doing work
which is creative in the most general sense of the word. ... Although
I ‘feel’ its meaning and implication, I am not qualified to present it in
terms of words. We are sure that if he is able to hold himself together his
work will become of real significance. His painting is abstract, intense,
evocative in quality” (30). The breakthrough had occurred during the
therapy with Dr. Henderson, a therapy Pollock spoke of positively for
the rest of his life.
Bipolar disorder, although it may exist concurrently with creativity,
does not convey a special gift. Creative persons must struggle to deal
with or overcome the effects of illness through psychological creative
processes which are in themselves healthy and adaptive. The disorder
itself, like any mental illness, brings suffering rather than accomplish-
ment. Further testimony for this point comes from the experiences of
two outstanding American poets, Robert Lowell and Theodore Roethke,
both of whom had well documented bipolar illness. Lowell told an in-
terviewer, Ian Hamilton: “One wakes, is happy for about two minutes,
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144 PSYCHIATRIC QUARTERLY
probably less, then fades into dread of the day. [Depression being] no gift
from the muse, [I was unable at all to write]” (p. 40) (31). For Theodore
Roethke, his wife Beatrice reported: “when Ted and I were first married
he thought it [mental illness] might be a requisite, but over a period of
years he revised his thinking about this, I believe. What are generally
thought of as his best poems were written when he was well and out of
the hospital” (p. 290) (32).
TREATMENT AND TREATMENT APPROACHES
In the case of both artists suffering from bipolar disorder, a strug-
gle away from illness seems to have given power to their art; this is
sometimes true for emotionally ill creative persons in general. How-
ever, such illness itself is neither causative nor facilitative of creativity
and it incurs a serious loss to society. Effective psychiatric treatment is
therefore vital.
One of the impediments to such treatment is that creative people
themselves often erroneously believe in an intrinsic connection between
suffering and mental illness. They too have followed the romantic myth
of Western society that tampering with or ameliorating their illness
will damage their creative talent. As a result, they often resist seeking
treatment or if they eventually accept it, they are openly or covertly
non-compliant. Robert Lowell, for example, frequently stopped taking
lithium carbonate for extended periods of time, with resulting severe
manic episodes (33). One approach to such non-compliance, either with
medication regimens or with psychotherapy or both, is to apprise such
patients of the evidence discussed above. By and large, creativity is
improved with proper treatment rather than impeded.
Another type of treatment issue is the tendency for practi-
tioners either to overestimate or to underestimate the creative patient.
Underestimation occurs when there is lack of appreciation for the com-
plexities of creative work, the special difficulties in achieving success in
artistic fields, the patient’s need for extraordinary persistence, or simply
an absent aesthetic sensibility. This underestimation results in biases
and faulty or even destructive therapeutic intervention and support.
Overestimation may also be destructive when a therapist withholds
needed interventions and courses of treatment or otherwise suspends
sound clinical judgment either out of excessive fear of undermining
creative work or because of awe or misassessment of the patient’s ac-
complishments. For example, the famous Ernest Hemingway was ap-
parently prematurely discharged from the Mayo Clinic because of an
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ALBERT ROTHENBERG 145
overestimation of his judgment and capacities. Shortly after the author
returned home, he shot himself (34).
Intercurrent substance abuse, especially the abuse of alcohol, is not
uncommon with creative persons suffering from bipolar disorder. The
dual diagnosis of alcohol abuse, probable in the cases of the two artists
discussed here, requires separate treatment in its own right. Use of
substances is probably more common with creative people than in the
population as a whole, the complex reasons for which are discussed
elsewhere (35). One factor is that creative work itself arouses anxiety
and substances are used for anxiety relief. Self-medicating use of sub-
stances is also often present in persons suffering from bipolar disorder,
whether creative or not, as a way of reducing the severity of cyclical
disturbances.
A major treatment issue for creative persons with bipolar disorder
is the risk of cognitive impairment resulting from otherwise effective
treatment modalities. By and large, high levels of cognitive capacity are
required for creative activities and some possible deleterious effects to
this capacity result both from ECT and lithium carbonate treatment.
With ECT, sometimes a critically important and life saving treatment
in bipolar disorder, there is an attendant memory loss and dysfunction
which is usually shortlived but may become prolonged and to some
degree permanent. With lithium carbonate, Shaw and associates have
assessed presumed creativity factors of associative productivity and
idiosyncrasy in patients receiving that medication for mood disorder
and showed a decrease in both factors (36). Judd et al have shown slower
rates of cognitive processing in a population of normal persons receiving
lithium carbonate for assessment purposes (37). Schou, an early pioneer
in the use of this medication, qualitatively reported variable lithium
effects with creative patients: some improvement in the severely ill, a
decline in productivity in those who believed their creativity depended
on mania, no decrease in productivity but some qualitative changes in
their work in a small number of patients (38).
Unless lithium carbonate and ECT are necessary for the treatment,
it is usually preferable to use anticonvulsants for bipolar disorder in
creative people. Carbamazapine and valproate have, over a consider-
able period of time at this point, clinically demonstrated high levels
of effectiveness in patients with both rapid and slower cycling condi-
tions with no definite evidence of accompanying cognitive impairment
with either medication. Calcium channel blockers such as verapamil
have been used with some benefit and little side effect but the greatest
promise for treatment are with newer anticonvulsants such as lam-
otrigine, gabapentin, tiagabine. Recent studies have demonstrated the
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Psychiatric Quarterly [psaq] PH015-294626 May 4, 2001 10:18 Style file version Nov. 19th, 1999
146 PSYCHIATRIC QUARTERLY
efficacy both of lamotrigine and gabapentin (39) in bipolar disorder with
a generally high margin of safety. These medications may be effectively
used alone or in combination with lower and consequently less impair-
ing doses of lithium carbonate.
Psychotherapy, with or without medication use, remains a treatment
of choice for creative patients with bipolar disorder. This was illustrated
above with regard to the facilitation of a creative breakthrough in the
case of Jackson Pollock. Once myths about connections between cre-
ativity and mental illness are dispelled, creative persons do especially
well in psychotherapy. They generally prize exploratory activity and
are independent minded and therefore benefit both from the opportu-
nity for self exploration and the intrinsic and detailed freedom of choice
about change. For both highly creative persons as well as lesser ones,
psychotherapy helps to resolve the conflicts and anxiety connected with
creative work, bipolar disorder, and everyday life; it promotes medica-
tion compliance when necessary, and also may function as a support
for the development and maintenance of a creative identity, the inner
confidence and belief in one’s creative capacities, an all important factor
in creativity.
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... Rothenberg [22] discussed three concepts of the creative process: articulation, Janusian process and homospatial process. During the articulation, the entities are interposed and overlapped, which means that different parts of an art work are linked in a new and different way and come together as a whole. ...
... It is affected both by the signs of direct illness and by the cognitive structure of an artist who is invariably presented as sick. [22] Mental disorders, although they can exist concurrently with creativity, do not imply a special gift. ...
... Rothenberg [22] discussed three concepts of the creative process: articulation, Janusian process and homospatial process. During the articulation, the entities are interposed and overlapped, which means that different parts of an art work are linked in a new and different way and come together as a whole. ...
... It is affected both by the signs of direct illness and by the cognitive structure of an artist who is invariably presented as sick. [22] Mental disorders, although they can exist concurrently with creativity, do not imply a special gift. ...
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... Jones et al., 2012) and they are fundamental to inductive (Gale and Ball, 2012) and deductive reasoning (Augustinova, 2008). They are also involved in creative thinking (Rothenberg, 2001). In particular, the study reports the results of research carried out with the aim of investigating whether prompting problem solvers to use a strategy based on the manipulation of opposites (i.e. ...
... Evidence that opposites support visuo-spatial insight problem solving (Bianchi et al., 2019;Branchini et al., 2016;Branchini et al., 2015aBranchini et al., , 2015bBranchini et al., 2009) is in line with other studies in the field of Cognitive Science which have demonstrated the role of opposites in several human cognitive abilities. These range from perception (Bianchi et al., 2017) to the organization of conceptual spaces (Jones et al., 2012), to inductive (Gale and Ball, 2012) and deductive reasoning (Agustinova, 2008) and also to creative thinking (Rothenberg, 2001). ...
... Yaratıcı süreçlerin otomatik ve kendi kendine geliştiğini ifade edenTorrance ve Hall (1980) yaratıcılığın mantık dışı düşünmekten geldiğini iddia etmektedir. Yaratıcılıkla şizofrenlik(Sass, 2000), bipolar bozukluk(Rothenberg, 2001), depresyon(Post, 1994) arasında olumlu korelasyonlar gözlenmiştir. Sanat alanında odaklanmayı olumsuz etkileyen alkol ve afyon kullanımıyla yaratıcılık arasında da olumlu ilişkiler bulunmuştur(Goodwin, 1992).Bunun yanında yaratıcı problem çözümünü içten ve sistematik bir sürecin sonucu olarak ifade eden karşıt görüşlerde mevcuttur(Weisberg, 1993; Boden, 1998). ...
... One aspect is the negative consequences for the creative persons themselves (Ludwig, 1992;Silvia et al., 2011), which shows that creative thoughts are accompanied by damage to personal physical and mental health, and a link has been found between mental illness and creativity. For example, Rothenberg (2001) found that manic patients had higher creativity scores. The other significant aspect is the negative consequences for others or society. ...
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