Extremes in mood, thought and behavior—including psychosis—have been linked with artistic creativity for as long as man has observed and written about those who write, paint, sculpt or compose. The history of this long and fascinating association, as well as speculations about its reasons for being, have been discussed by several modern authors and investigators, including 1975, 1976, 1978, 1978, 1979, 1981, in press, & in press. The association between extreme states of emotion and mind and creativity not only is fascinating but also has important theoretical, clinical, literary and societal-ethical implications. These issues, more thoroughly reviewed elsewhere (Jamison et al 198044ya; 1981; in press), include the understanding of cognitive, perceptual, mood and behavioral changes common to manic, depressive and creative states; the potential ability to lessen the stigma of mental illness; effects of psychiatric treatment (for example, lithium) on creativity; and concerns raised about genetic research on mood disorders.
The current study was designed to ascertain rates of treatment for affective illness [bipolar disorder] in a sample of eminent British writers and artists; to study differences in subgroups (poets. novelists, playwrights, biographers, artists); to examine seasonal patterns of moods and productivity; and to inquire into the perceived role of very intense moods in the writers’ and artists’ work. One of the major purposes of this investigation was to look at possible similarities and dissimilarities between periods of intense creative activity and hypomania. Hypothesized similarities were based on the overlapping nature of mood, cognitive and behavioral changes associated with both; the episodic nature of both; and possible links between the durational, frequency and seasonal patterns of both experiences.
…Subjects (n = 47): The poets, playwrights, novelists, biographers and artists in the study were selected on the basis of having won at least one of several specified prestigious prizes or awards in their respective fields. All painters and sculptors, for example, were either Royal Academicians or Associates of the Royal Academy. Literary prizes used as selection criteria included the Queen’s Gold Medal for Poetry and the Hawthornden, Booker, and James Tait Black Memorial Prizes. In addition, 9⁄18 poets in the study sample were already represented in The Oxford Book of 20th Century English Verse. Of the 8 playwrights, 6 were winners of the New York Drama Critics Award or the Evening Standard (London) Drama Award; several had won both, had won one of these awards more than once, and/or had received Tony Awards.
…History of Treatment for Affective Illness: The artists and writers were asked whether they had received treatment, and the nature of that treatment, for a mood disorder. The results are shown in Table 2: A very high percentage of the total sample, 38%, had been treated for an affective illness; 3⁄4 of those treated had been given antidepressants or lithium, or had been hospitalized. Poets were most likely to have required medication for their depression (33%) and were the only ones to have required medical intervention (hospitalization, electroconvulsive therapy, lithium) for mania (17%). Fully 1⁄2 of the poets had been treated with drugs, psychotherapy, and/or hospitalization for mood disorders. The playwrights had the highest total rate of treatment for affective illness (63%), but a relatively large percentage of those treated (60%) had been treated with psychotherapy alone. It is unclear whether this was due to a difference in severity of illness or in treatment preference.
…As Table 3 shows, however, about 1⁄3rd of the writers and artists reported histories of severe mood swings, essentially cyclothymic in nature, and 1⁄4 reported histories of extended, elated mood states. Novelists and poets more frequently reported the prolonged, elated states; playwrights and artists, on the other hand, were more likely to report severe mood swings. The relatively low rate of treatment for affective illness in those who are creative in predominantly nonverbal fields (painting and sculpture) is interesting and may be due to the fact that artists are less inclined than writers to seek psychiatric help (especially if psychiatric treatment is perceived of as primarily verbal in nature). It is as likely, however, that mood disorders may not convey to visual artists the same experiential and cognitive advantages that are useful to writers.
…The modal duration of these episodes was two weeks (35%); 55% of the episodes lasted 1–4 weeks and 25% continued for longer than a month. 1⁄5th of the episodes lasted 24 hours or less. The episodes were characterized by increases in enthusiasm, energy, self-confidence, speed of mental association, fluency of thoughts, elevated mood and a strong sense of well-being (see Figure 1). A comparison with DSM-III criteria for hypomania reveals that mood and cognitive symptoms showed the greatest degree of overlap between intensely creative and hypomanic episodes. Several of the more behavioral changes typically associated with hypomania (hypersexuality, talkativeness, spending of money) were reported by only a minority of subjects.
Subjects were asked about changes in sleep and mood occurring just prior to these intense creative episodes. Almost all the writers and artists (89%) reported a decrease in the need for sleep; 28% spontaneously reported waking abruptly at 3–4 A.M. and being unable to return to sleep. Changes in mood were profound. 1⁄2 of the subjects reported a sharp increase in mood just prior to the beginning of an intensely creative period: for example, “excited, anticipatory, energetic”; “I have a fever to write, and throw myself energetically into new projects”; “elated:’”euphoric”; “ecstatic:’ Dysphoria preceded enhanced creativity in 28% of the subjects: for example, “more anxious”; “near suicide”; “fearfulness, general mood of distress and slight paranoia”. Finally, ~1⁄4 (22%) of the sample reported mixed mood changes and psychomotor restlessness:”mixture of elation together with some gloominess, feeling of isolation, sexual pressure, fast emotional responses”; “restlessness”; “low ebb bordering on despair often precedes good phase when work will flow almost as though one is a medium, rather than an originator”; “restless, dissatisfied”. When the subjects were asked specifically about the importance of very intense feelings and moods in the development and execution of their work, 90% stated that such moods and feelings were either integral and necessary (60%), or very important (30%). Consistent with their rate of treatment for affective illness, more poets than any other group regarded these moods as essential to what they did and how they did it.
…Rates of Treatment for Affective Illness: The rate of treatment for affective illness (38%) was strikingly high in this sample of outstanding British writers and artists. Lifetime prevalence rates for bipolar and unipolar disorders in the general population are 1% and 5%, respectively. The proportion of individuals who actually seek or receive treatment, even though they meet the formal diagnostic criteria for affective illness, is far smaller. Therefore, rates in this study represent a conservative estimate of the actual prevalence of affective illness in the sample.
…These surprisingly high rates of treatment for affective illness are, however, comparable to those reported by Andreasen and her colleagues. In an update of earlier work done with the well-known University of Iowa Writers’ Workshop, 1987 found that 80% of her sample of 30 writers (90% males) had experienced an episode of affective illness; 43% had had manic or hypomanic episodes.