Feeling, Thinking, And Creativity In Bipolar Disorder: Terence Ketter (Transcript)

And so there are a couple of things that are out there.

One is that there’s increased creativity in people with mood disorders, and that’s the perspective I’m coming from, working in a mood clinic, okay? There’s also, perhaps better established, increased mood disorders in highly creative individuals, okay? So those are two different strategies for looking at these links.

The studies that we’ve done inside our clinic, these are individuals who have bipolar disorder who are getting treated. And it looks like changeable and at times negative feelings combined with open-minded and intuitive thought processes probably have something to do with the creative advantage that some people are able to find in bipolar disorder populations. Okay, so that’s the one line of what we’re going to do today.

Eminent vs Everyday Creativity

So I was thinking of ways of simplifying this, and there are studies of eminent creativity. So there’s eminent and everyday creativity. Some people say big C creativity, which this is, and then little c creativity, which is non-eminent creativity. And so the strengths of doing research in eminent creativity, probably the main strength is face validity.

So if somebody has a picture hanging in the MoMA, you’re not going to get too many arguments about whether that person’s creative or not. So the validity is the strength. The limitation is the generalizability, because that’s an important section of our society, but there’s a lot of other people who don’t fit into that category. Okay, so high validity and limited applicability.

Ludwig’s Study

And so this is some work performed by a guy called Ludwig, and he had a pretty good idea. He said, “Okay, let’s find people who are eminent. Okay, so if you’re eminent, how can we find those guys?” So he went to the New York Times Book Review and looked at people who had biographies in that. That’s a test of eminence. That’s got face validity, I suppose.

And then he read the biographies to figure out if they had mood problems. It’s kind of a cool idea. So there’s like 1,000 of these people, and then he looked at different vocations, and that’s down the left-hand side there, and looked at the presence of depression or mania, so mood disorder.

And so these are rank ordered by the length of the bars on the right, but you can see they’re kind of aggregating towards more creative at the top and less creative at the bottom. And so this, as far as eminent creativity, this is probably as good as it gets. Okay, there’s 1,000 people there. Very high rates of mood disorders. Okay, so poetry. Look at that, don’t write poems, whatever you do.

Non-Eminent Creativity

All right. So the other way of looking at it, non-eminent creativity, like creativity with a small c. So now the strength is going to be the greater generalizability or broader applicability, okay? So there’s a lot more people that this would be relevant to. The limitation is, what’s the face validity of creativity if you’re not putting the bar as high as having like a painting in the MoMA or something like that? Okay, so that’s the trade-off.

And so some of the main naysayers will say, “Write articles like this, creativity and the person who will never produce anything original and useful, okay?” So there are, people get into these great big fights of, you know, there’s an association with mental health or mental illness or, you know, everyday creativity is a bunch of junk versus eminent creativity is for elitists, you know? And so this is fair balance, okay?

Clinic Study on Creativity

So in spite of the limitations, we applied a battery of creativity tests to a group of our patients in the bipolar clinic, okay? And we got a number of papers that we wrote as a result of this, but we looked at creativity performance on these tests, okay? Which is probably the main limitation of this, okay?

So we’re using creativity tests. We looked at temperament. Temperament is sort of emotional tone, okay? And some people think that temperament is relevant to mood disorders, okay? So some people have kind of moody temperaments and things. And so we also looked at having mood disorder or not, okay?

Study Groups

And so when we did this, we had 50 patients who had bipolar disorder, those are just folks in our clinic. We wanted some kind of control group, okay? And so we went out and recruited some so-called healthy controls, at least people who didn’t have mood disorders, okay? And then we thought, “Okay, so that’s the control group for the bipolar folks. What about something to control for the creativity testing?”

So we collected about 30 people from the product design group, writing fellows, and fine arts graduate students at Stanford, okay? So a creative control group. And we thought, “Well, what about unipolar major depressive disorder? It could just be having a mood disorder that does it.” So we had a control group of about 25 of those guys, okay? So there’s one study group, the bipolar folks, okay? And there’s three control groups.

This is already kind of complicated. So long story short, we found increased creativity in our bipolar patients. And it was at a level similar to that scene in the creative controls. So if you find that, then the next question is, “Well, how’s that work?” Okay, and what we did with the temperament testing was to try to test the hypothesis that temperament is somehow relevant, not only to mood disorders, but also to creativity, okay?

Mechanisms of Creativity

And so these are some mechanisms of possible creativity. So I mentioned before, negative and changeable feelings combined with intuitive and open-minded thought processes, okay? So that could do it, okay? So these words have been decoded from academic jargon, okay?

And so there’s something called the Barron Welsh Art Scale, and we had a battery of tests. And when you first look at this thing, it doesn’t have the greatest face validity. But there is a mood task to this. You look at line drawings, and you say, “Like that, don’t like that, like that, don’t like that,” forced choice. And there’s a theory, this was developed at Berkeley, this battery. There’s a theory that people who are creative will like complexity and asymmetry, and they’ll dislike simplicity and symmetry.

So you can make points on this by liking and disliking. And so the total score is the total of the like and the dislike subscales. And what we see here, so this is bipolar, creative control, major depressive disorder, and healthy controls. You see there that the bipolar and the creative controls, they’re edging up towards 50%, higher scores. So the baseline is what the healthy controls scored, okay? And this is how much higher than the healthy controls they scored.

Major depressive disorders, they’re a little bit above the line, but those stars indicate statistical significance, okay? Now when you break it up in terms of dislike and like, you can see that the lion’s share of the advantage is coming on the dislike side. You can also see the people with major depressive disorders, they’re pretty good at not liking stuff, okay, but they’re actually worse than the healthy controls at their ability to like stuff.

Okay, so it’s not enough to just dislike everything, okay? You gotta like some things, okay? And so, now here’s the jargon. So neuroticism means access to negative emotion, basically, okay? And it’s got a kind of pejorative sound to it. You could say that somebody who does not have neuroticism has passion deficit disorder, or something like that, right? So neuroticism, cyclothymia, so neuroticism is negative emotion. Cyclothymia is changeable emotion.

In intuition, or intuitive thinking, this comes from something called the Myers-Briggs type inventory, okay? It’s used in occupational psychology. And then openness to experience comes from something called the five factor model, okay? So does neuroticism, actually, of personality, okay?

Contribution of Temperament

And so, neuroticism and cyclothymia, combined with intuition and openness to experience, underlie the creative advantage. It doesn’t sound quite as accessible as changeable and at times negative feelings and open-minded intuitive thoughts underlie a creative advantage. And so, you see curious things like this. The more stars there are, the more statistically significant it is.

There’s a bunch of boring statistics on how this works, but even though these aren’t very tall, because the variance is so low, these are highly significant, okay? So there’s an increased neuroticism. In bipolar and unipolar, it’s pretty similar, actually, okay? It’s access to negative feelings. Interestingly, the creative controls had that, too. And we excluded any creative control who had bipolar disorder.

So people who had depression or a drug or alcohol problem or something like that, they were okay, but bipolar we excluded. And all of these people who had had a history of problems, when we did the testing, their mood was level, okay? So it’s not considered as interesting if somebody’s hypomanic or somebody’s highly creative, okay?

The fact that there’s a trait when somebody’s not having a mood episode that gives some kind of an advantage is more interesting. And so what you see here is that the bipolar patients on cyclothymia, they’re like six times higher than the healthy controls, okay? They’re way, way up, okay? And intuition performed pretty well. Openness to experience performed pretty well as well.

Summary

So just trying to collapse all this data into something that can mean something for folks, feeling and thinking, changeable emotions, okay, negative emotions. These things here, these arrows here, are an estimate of how much each contribution is, okay? So we’re not seeing 25%, 50%, we’re seeing some little things that are 5, 4. So you add it all up, you might get into the ballpark at 10%, okay? But you see these contributions, and it’s tilted a little bit towards the feeling side, right? A little bit more on that side.

Well, you can break it into the dislike scale and the like scale. When you do that, you can see these affinities are pretty strong on the like side for this information processing or thinking piece. Whereas the main strength on the dislike side is the feeling state, okay? So these things are still not exceeding, the highest number on this is 6.6%, okay?

So these are not like saying creativity is one thing, okay? But amongst these people, it seems to work this way. And it seems to work this way not only in the folks who have bipolar disorder, but also the creative controls, and even the people with unipolar depression. Okay, so whether or not you have a mood disorder may not be as crucial as having a certain temperamental type to get this kind of advantage, okay?

So if you pull all that together, okay, so this is massive data reduction, okay? But what it’s suggesting is that these changeable and at times negative emotions combined with open-minded intuitive thought processes can help some people in their creative pursuits. So the kind of people that they look like they’re helping are people who happen to attend our clinic, okay, and some graduate students at Stanford. Thank you very much.

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