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Friday, October 10, 2008
Creativity and mood disorders.
The present understanding is that Type II bipolar disorder is the underlying disorder in creative persons. When depressed people tend to look back at life and the world with a philosophical outlook. Mind goes into an introspective attitude, analyzing everything with detachment. Such mental state may give rise to profound insight about everything. Later when they become hypomanic, there is increased energy and activity, thoughts race through the mind with extreme clarity and pace. Such state helps the writer to complete the creative work. It has to be emphasized that the severe form of mania is not compatible with this ability to control one's mind and produce works of art. This is why Type II Bipolar disorder is found to be more prevalent. Alcoholism could also be related to this. When depressed they may self medicate with this to improve mood state. During the hypomania it may be used to curb the excess energy and obtain sleep. Other than this, excess use of alcohol may occur as a hazard of being a celebrity. Many of these creative persons are as vulnerable to vices as any of us, if not more. Some think they have a licence to get away with any sort of behaviors, like some of our professional politicians.
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hi, we are talking about two issues that are not clearly defined. Technhcal clasrifications exist in classifying mood disorders, but i assume these are subject to revision any time somebody comes up with something better. The same with creativity. Isnt novelty the cornerstone of creativity ? If i drew an exact replica of the Mona Lisa, i wouldnt be thought of as being creative, although its equally beautiful. But if you had never heard of the Mona Lisa, you would congratulate me on my creative accomplishment. Must creativity have a material aspect ? Can a rishi sitthng in a cave, thinking about existence and what not, be considered lndulging in creative thinking ? If novelty, either in thinking or behaving, is basic to creativity, then all mentally ill patients are creative by default. How does a prychiatrist or a psychologist define creativity ? Since perception ol creativity seems to be subjective, and dependent on the degree ol novelty aroused in the examiner to the matter evaluated, will not a bias creep in in the assessment of creativity, and the subsequent management of the patient ? thank you
Thank you Sashi. It is true that classifications in psychiatry (of mood disorders or others) keep changing over time. But the basic level of understanding reached is not lost. Emil Kraepelin described MDP or Manic depressive psychosis. The current term Bipolar disorder still includes those original MDP cases as one of the subtype. So these changes are not a problem. Your second point confuses between creativity and originality. Copying Mona Lisa or Yesudas's song can still be creative if you add some improviastions (or sangathis to use the technical term in music). In my discussions I only meant a very broad concept of creativity. A friend who comes up with a new brilliant befitting one liner can be considered creative in this sense. Same is the case of a rishi or yogi. Some of the fantasies narrated by psychotics have creative qualities, but we have to consider the total picture. I have some difficulty regarding abtract art which does not communicate anything to me. I am not ashamed to state that I have difficulty in understanding a Picasso work. But I should listen to an expert in that area before labelling it as trash or a masterpiece. Obviously, the evaluation of any art is based on subjective opinion of a handful of experts. But psychiatrists need not bother about such nuances as long as there is general agreement about a person's creative talent.
harish thanks for the clarificatiom on creativity and originality. The only point that needs explanation is that the example you suggested regarding changes to music is innovation rather than creation. For example, a person who makes a ceiling fan from studying a table fan is an innovator, not a creator, and so on. Al this is only semantics, i get your point, in the sense that we draw upon a broad canvas to come to a decision, not isolated episodes. I have not been to a modern art exhibition myself either since i an not a masochist by disposition. the only painting that sticks to my memory is 'the scream' by edward munch, a facsimile of which you may see on the net. Its simple but sticks to the mind. Its nice you can find time after your busy official engagements to attend to your blog. Thank you
"But psychiatrists need not bother about such nuances as long as there is general agreement about a person's creative talent."
Was there a general agreement with Copernicus or Socrates at their time? A lot of creative talent came to light only after their (creative people's) death. Isn't it true that lay people, may be including mental health practitioners take years or generations to understand creativity? It is like a post mortem diagnosis of Alzheimer’s! When you* treat thousands of psychotic people, some people or some delusions may have creative value. These may come from any subjects and nobody is supposed to be a master of all subjects.
In psychiatry, treatment has improved a lot but diagnosis is still in its infancy. We need diagnostic methods that no Rosenhan wants to play with. Sometimes I wish I could make such bold statements those current classifications of mind/brain disorders are pseudoscience!?
* ‘you’ is not personal, I am referring to all psychiatrists. I know many and you are the best so far I have seen.
Thank you
I think the whole issue of grading the abnormality should be better discarded than discussed. We should have a different approach. We must try to grade the ’quality of life’ instead of trying to grade the abnormality. The problems of insanity vs. creativity get worse when we try to grade the abnormality of people. Buddha may perform badly on an ‘abnormality grading scale’ but he will outperform all others in the world if we test him on a ‘quality of life grading scale’. Suppose in a scale ranging from 0 to 10, Buddha may get -3 for abnormality and +9 for quality of life with a definite winning advantage of +6. A schizophrenic John Nash is more deserved or qualified to live here on the earth than a dumb politician without any mental illness. Gandhi or Buddha becomes a problem when we try to analyse them with DSM or ICD. It is my opinion that the current direction of diagnosis and classification of mental disorders should be changed. It should integrate the positive elements of spiritual, philosophical or artistic life. It may not be a pleasing suggestion to the drug mafia though we need it. Mental problems tend to co-exist, it may be difficult to find a person with a single mental illness only. It is like either there are many problems or there are not any. Am I right? A psychiatrist has to rely on a patient’s narration of his problems up to a large extent. When a patient becomes more realistic or good at explaining his symptoms, the chances that he might be normal also increases. The difficulty to explain problems increases with the severity of the psychosis. Outsiders will not be of any help to know the inner feelings of a patient but you have to listen to the patient and the patient have difficulty recalling, disorganized speech and thoughts, poor cognition etc… Patients may also filter out some information, he may hide his egosyntonic problems and explain only the egodystonic nature of the disorder to the psychiatrist. Patient will be happier to get treated for his particular problems that he seems disgusting than solving all basic problems. Patients tend to change psychiatrist regularly, they get interested in a new psychiatrist and lose the interest after some visits, starts looking for a new one. You need to regularly appreciate them otherwise they are going to ditch you. A really challenging profession but you have a lucky time because of drugs that work for a wide range of problems. A combination of an SSRI with a new atypical antipsychotic may cover from generlised anxiety disorders to schizophrenia or OCD, Bipolar, PTSD, Panic attacks etc… If there were different drugs for different problems every psychiatrist had to spend hard time finding the right classification for each patient.
Waiting for your valuable comments.
Thank you.
Are delusions and hallucinations relative? A person believing that a magnetic field around his cow can control this world is having a delusion. But if there are thousands of people to follow his ideas he can make a religion and we will not consider him having delusions anymore. A ‘velichapadu’ or a pope talking with god or hearing voices from heaven as not considered hallucinating by the society. Is it irrationality of the belief or the context of the belief that makes a belief a delusion?
hi, ajeesh and harish, i think all delusions held by a person are his beliefs, but all his beliefs are not delusions. if he thought what he had was a delusion he would disown it for its spuriousness. So there is no material difference between beliefs and delusions as far as the individual is concerned. Now, we know all insanes are not creative, and all creatives are not insane. We have not even defined creativity to our fullest satisfaction. Like ajeesh says, the criteria doesnt seem to be capable of univerral application. I do not know whether the chinese follow the DSM criteria. Somehow, out of intellectual laziness or civilisatinal fatigue, we seem always happy with hand-me-down theories. I am sure prychiatrists would try to bring their intellect to bear upon their practices and procedures, but as harish said, they are governed by a legal mental health act and are probably constrained by the same to follow the reccomended criteria.. Doesnt ajeesh see that 'creatives' in modern societies are pretty much left alone as long as their behaviour does not threaten public order or causes trauma to others. It must be thought that a psychiatrist has duties towards society as well as individuals. More creativity has been snuffed out by theological and militaristic vested interests than by psychiatrists.You asked whether evolution favours mental illness. I would like harishs opinion before carrying on. Thank you
Hi Sashi,
I disagree with what you said "if he thought what he had was a delusion he would disown it for its spuriousness". It may not be always possible for a person to act against his belief even if he is well aware of its irrationality. Dr.Harish may comment about it. Almost all people have some kind of delusions, some times it become pathological.
I agree that creative people in our society are safer than ever before in history but this statement is true for any particular period. Is Buddha safer now? I do not know. The problem is that we all lag behind a genius. That's what a genius is.
I am aware of the limitations of psychiatrists so I said it is one of the challenging professions.
Thank you.
yes ajeesh, a person who knows he has a delusion will naturally try to get rid of it, alone or with psychiatric help, because of his insight. That implies that he thinks the delusion is irrational aod out of context and so not worth holding as a belief.. That is what i meant by saying all delusions held by him is his belief. That which he is in the procesr of discarding is cannot be, of course.
Evolution occurs in all living things. It's not a process with a beginning or an end, it is the name we give to somethong that we have observed occuring. Any feature acquored can impose either a beneficial or malicious effect. We see only the beneficial effects because the maliciously formed entities are extinguished. Similarly in mental illness the outcome depends on nature of the illness. Some are beneficial and thrive, for example a painter or writer, some are exterminated, like psychopathic killers etc. So a blanket statement in favour of what is a very random and unencubered phenomena cannot be accepted by the layman, let alone a psychiatrist. Harish may have a different opinion, i don't know. Like in war, so in evolution. It's the winners who write the history Q thank you
Reply to Ajeesh's comments
1) Oct 12th - I agree that psychiatric diagnoses have a certain degree of arbitrariness. This is because they are not based on objective biochemical, histopathological or radiological criteria. But this does not warrant lebelling as pseudoscience. Pseudoscience is something that goes against the basic tenets of science. Here the difficulty is because we have not been able to evolve any objective criteria based on symptoms ot their desriptions. Looking carefully at the current criteria shows that the diagnostic names are nothing but shorhand versions for a long list of symptoms. I would humbly suggest you to read my posts on these issues in the first 2 weeks that is 20th July to 3rd August where these are disucssed.
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