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The Starriest Night: Mental Illness, Treatment, and Creativity

The relationship between creativity and mental illness is controversial and poorly understood among laypeople (and some clinicians too). Psychiatric disorders are normally viewed through the lens of their pathological properties rather than any benefits they confer. Of course, the belief that mental illness can be disabling is not without merit. Indeed, it is proven that treating certain mental illnesses can actually increase creativity. Still, research shows that there is an empirical link between disorders, like bipolar disorder, and creative talent, especially in writing. Many historical creative figures, such as Vincent Van Gogh, Edgar Allen Poe, and Virginia Woolf, are known to have suffered from bipolar disorder. However, the actual prevalence of mental illness in other luminaries of their time may have been even higher, given the underdiagnosis of psychiatric illnesses.

Treatment of mental illness often improves one's mental state, thereby allowing for increased creativity. However, mood stabilizers such as lithium can have adverse cognitive effects while a patient is taking the medication (Pachet, 2003). A major goal in psychiatric research, then, should be to develop treatments that enhance creative thinking and productivity while effectively treating the illness and its unwanted effects. While A.D.H.D medications and SSRIs have (questionably) been posited as models, they are generally inappropriate in treating bipolar disorder.

Although people with bipolar disorder often have comorbid conditions like A.D.H.D. and anxiety, the medications used for these other conditions cannot be used in bipolar patients due to the risk of mania (which can be accompanied by psychosis). Mania is an unusually heightened state in which an individual has no desire to sleep or eat, and cannot concentrate due to how quickly their mind is racing. Someone who is experiencing a manic episode feels euphoric but lacks the ability to effectively pursue their goals and often has difficulty with maintaining the discipline and stability required for work or school. Depression, the other pole of bipolar disorder, is a horrifically numb and exhausting state in which people may oversleep and overeat for long periods of time and are unable to carry out daily tasks. (Mania and depression entail many other symptoms as well). Lithium helps to stabilize mood but its therapeutic effects are not necessarily as potent as those of SSRIs, which those who don’t have bipolar can more readily utilize without running the risk of having a manic episode.

Those with bipolar disorder often describe their hypomanic states as productive. (See our Rocky Chetata’s personal take on his own history of bipolar disorder). In this state, bipolar patients experience a less extreme form of mania and may feel a sense of artistic inspiration. Those creative figures posthumously thought to have bipolar may have been hypomanic when they produced their works. Interestingly too, since bipolar disorder is linked to verbal ability, it may be that those who have bipolar have a predisposition to become writers and poets. This does not detract, unfortunately, from the potentially persistent cognitive deficits paradoxically associated with the disorder.

The general consensus is that we should all aim to attain not hypomania but euthymia, a state in which one is neither manic nor depressed, but lucid and fulfilled. In this state one is able to access their innate creativity and intellectual curiosity without disruptive mood episodes. Yet finding the right chemical balance to achieve euthymia is a huge challenge for those with affective disorders. As psychiatry progresses, perhaps new treatments will prove to be helpful for highly creative people with such disorders. One newer medication, Symbyax, combines an antidepressant (Prozac) and an antipsychotic with mood stabilizing properties (Zyprexa). It is used in bipolar patients who are in a depressive state and treats the illness without causing an overly excitatory or flattening effect, creating a true balance. Another medication, Lamictal, also seems to have less of a dulling effect on those with bipolar disorder. Lithium and atypical antipsychotics taken together as monotherapy can be similarly beneficial to some in the throes of bipolar disorder, but also has many side effects. While patients often describe a pervasive mental fog and feeling of numbness while they are on the medication, lithium has also been shown to be neuroprotective, holding off the negative cognitive effects that can accompany bipolar disorder!

Clearly, this presents an extremely complex bioethical quandary; bipolar disorder is an illness of the brain that involves both risks and benefits in treatment, with the greatest risk in not treating it at all. The answer to the dilemma is to work harder to understand the neural correlates and biological basis of the disorder, along with the neural mechanisms of treatment. Approaching affective disorders as neurological phenomena can do nothing but benefit those who are seeking clarity about how best to function as people with non-neurotypical mental states.

In the meantime, another answer that holds deep promise for creative people with mental illness who are taking medication is psychotherapy, such as Interpersonal Social Rhythms Therapy and Cognitive Behavioral Therapy (CBT). CBT focuses on changing one’s thinking patterns and therefore improving one’s emotional state. The goal in CBT specifically for bipolar patients is to help them learn how to manage side effects and identify goals (including creative ones) to help to lift the burden of mental illness. If patients don’t feel helpless or demoralized in the process of attaining stability, they are far more likely to make use of the creative gifts that might accompany their illness. Unfortunately, although it has been shown to greatly increase positive clinical outcomes, psychotherapy is underutilized in affective disorders (Swartz, 2014).Were therapy to be used more widely, patients could learn how to lead stimulating and creatively fulfilling lives enhanced by the increased lucidity that the appropriate pharmacological treatments can help provide. Ultimately, increasing bipolar patients’ senses of agency and self will only help them derive the maximum benefit from treatment.


Andreasen, A. C. (2008). The relationship between creativity and mood disorders. Dialogues in Clinical Neuroscience, 10(2).

Greenwood, T.A. (2016). Positive traits in the bipolar spectrum: The space between madness and genius. Complex Psychiatry, 2(4).

Johnson, Sheri L., et. al. Creativity and bipolar disorder: Touched by fire or burning with questions? Clinical Psychology Review, 32(1).

Keller, M.C., Visscher, Peter M. (2015). Genetic variation links creativity to psychiatric disorders. Nature Neuroscience, 18(7).

Kyaga, S., Landen, M., Boman, M., et. al. (2012). Mental illness, suicide, and creativity: 40-Year prospective total population study. Journal of Psychiatric Research.

Pachet, Arlin K., Wisniewski, Amy M. (2003). The effects of lithium on cognition: an updated review. Psychopharmacology (Berl).

Swartz, Holly A., Swanson, Joshua. (2014). Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence. Focus (American Psychiatric Association Publication).

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