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Creativity and mental disorder: Family study of 300 000 people with severe mental disorder

  • Simon Kyaga (a1), Paul Lichtenstein (a1), Marcus Boman (a1), Christina Hultman (a2), Niklas Långström (a3) and Mikael Landén (a4)...
Abstract
Background

There is a long-standing belief that creativity is coupled with psychopathology.

Aims

To test this alleged association and to investigate whether any such association is the result of environmental or genetic factors.

Method

We performed a nested case–control study based on Swedish registries. The likelihood of holding a creative occupation in individuals who had received in-patient treatment for schizophrenia, bipolar disorder or unipolar depression between 1973 and 2003 and their relatives without such a diagnosis was compared with that of controls.

Results

Individuals with bipolar disorder and healthy siblings of people with schizophrenia or bipolar disorder were overrepresented in creative professions. People with schizophrenia had no increased rate of overall creative professions compared with controls, but an increased rate in the subgroup of artistic occupations. Neither individuals with unipolar depression nor their siblings differed from controls regarding creative professions.

Conclusions

A familial cosegregation of both schizophrenia and bipolar disorder with creativity is suggested.

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Copyright
Corresponding author
Simon Kyaga, Department of Epidemiology and Biostatistics, Karolinska Institutet, POB 281, SE 171 77 Stockholm, Sweden. Email: simon.kyaga@ki.se
Footnotes
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See editorial, pp. 351–352, this issue.

Declaration of interest

None.

Footnotes
References
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Creativity and mental disorder: Family study of 300 000 people with severe mental disorder

  • Simon Kyaga (a1), Paul Lichtenstein (a1), Marcus Boman (a1), Christina Hultman (a2), Niklas Långström (a3) and Mikael Landén (a4)...
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eLetters

Creativity and mental disorder: proposed genetic basis

Donald E Schmechel, Medical Director; Adjunct Professor of Medicine
13 December 2011

The article by Kyaga et al (1) is an important contribution to the understanding of the selective advantage and disadvantage of common behavioral phenotypes. The accompanying editorial by Jamison puts this work in context and points out that the overlap between creativity and mental disorder is partial (2). The proportion of persons in creative professions in Sweden is about 1.1% (based on 1990 Swedish census, ages 15-64, and excluding scientific professions). This is similar to 1.4% figure for the United States (3). Our report in the neurological literature proposes that polymorphisms in the alpha-1-antitrypsin (A1AT) gene are a common genetic factor for both creativity and mental disorders (4). The proportion of persons in creative professions (US Bureau of LaborStandards)observed in 1537 consecutive patients was 3.7%. A highly significant 38% of persons in creative professions carried one or more polymorphisms of the A1AT gene compared to 13% carrier rate observed in the other persons of this series and similar to reported rate in European population (4). When the larger proportion (20-30%) of the population thatpursue creative avocations {acting, dancing, music, photography, visual arts, writing) are considered, the same relationship of A1AT carriers and creativity and 'intense mental energy' including clinical anxiety or bipolar disorders is observed (4). An extension of this series now is ca 3200 consecutive patients and confirms the initial publication (submitted). This means that creativity and mental disorders can overlap and one instance for many such cases may be the genetic and environmentally modulated interactions of A1AT liver protein and serum acute phase reactant. It is important to emphasize that not all artists are A1AT carriers and not all artists have intense goal directed energy oreven mood disorder, underlining the point of the editorial. Nevertheless,it is likely that many persons carrying A1AT polymorphisms trade the selective advantage of intense creative energy (blessing) for the disadvantage of susceptibility to lung and liver disease, and potentially significant recurrent mood disorder (curse). Pulmonary disease is associated with bipolar disorder (for references see 4), and A1AT polymorphisms would provide a genetic basis.

1 Kyaga S, Lichtenstein P, Boman M, Hultman C, Langstrom N Landen M. Creativity and Mental Disorder: family study of 300 000 people with severemental disorder. Brit J Psych 2011;199:373-379.2 Jamison KR. Great wits and madness: more near allied? Brit J Psych 2011; 351-352.3 National Endowment for the Arts: Artists in the Workforce: 2005-2009. Research Report #48, www.arts.gov 4 Schmechel DE. Art, alpha-1-antitrypsin polymorphisms and intense creative energy: Blessing or curse? Neurotoxicology 2007; 28:899-914.

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Conflict of interest: None declared

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Creativity and mental disorder: ASSESSING OCCUPATION OR MEANS OF LIVELIHOOD?

BICHITRA N. PATRA, SENIOR RESIDENT DOCTOR
13 December 2011

Kyaga et al, 2011 have explored an intriguing issue of creativity and mental illness. The study has found an association between creativity and mental disorder.1 The study draws its strength from large sample size. However the retrospective data collection methodology brings with it certain inherent limitations. The authors have acknowledged the limitations of the study. However causal links have been hinted at in some sections of the discussion by the authors.

We would like to bring to attention two issues. First, the role of potential confounders in selection of occupation has not been taken in to consideration. Choice of occupation is governed by many factors. The kind of occupation one pursues is governed by multiple factors apart from personnel interest. These include educational qualification, opportunity, awareness, location of the job, financial remuneration, familial and other social commitments.2 Many of these variables are likely to be affected by the psychiatric illness. However they are modifiable by many independent factors as well. Hence the occupation choices of both the individuals suffering from mental illness as well as their children (and other family members) are likely to be affected by many variables which need to be taken in to consideration while interpreting the findings of the current study.

Another relevant issue of consideration here is the way occupation is defined for the purpose of the study. The definition of occupation used in (mental) health studies been criticised for being restrictive.3 Occupation tends to get objectified into classes of work for economic production and the national associations tend to classifies those occupations that have economic relevance to the market place.4 Such an approach is likely to miss the creativity of someone employed as a labourer (because of many reasons other than mental illness) but painting in leisure time. Also this approach is likely to miss some sections of population in certain settings. For example in many settings majority of women are likely to get missed as they would be occupied as home makers and not formally 'employed'.

The future studies could be strengthened by use of a more comprehensive and inclusive definition of occupation.

REFERENCES

1.Kyaga S, Lichtenstein P, Boman M, Hultman C, Langstrom N, Landen M. Creativity and mental disorder: family study of 300 000 people with severe mental disorder. The British Journal of Psychiatry 2011; 199: 373-379.2.Llena-Nozala A, Lindebooma M and Portrait F. The effect of work on mental health: does occupationmatter? Health Econ 2004; 13: 1045-1062.3.Townsend E. Occupation: Potential for Personal and Social Transformation. Journal of Occupational Science: Australia. 1997; 4: 18-26.4.Employment and Immigration Canada Staff. National occupational classification: Occupational description. Ottawa, ON: Canada Communications Group, 1993.
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Conflict of interest: None declared

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