The Healthy Creative Balance: Between Unreason and Overthinking

Is there a connection between creativity and mental illness?

David Epstein thinks like me, and he likes thinking the way we both seem to do it. By “we” I mean “generalists” — the subject of one of his books and his Substack blog, Range Widely. One of his recent posts there is a huge validation for a lot of hunches I’ve had about creativity and mental illness over the years. Especially in these recent, hard years.

Epstein refers to a well-sourced opinion piece from Frontiers in Psychology that’s part of a series on madness and creativity. It’s called “Creativity and schizophrenia spectrum disorders across the arts and sciences,” and there’s a more digestible version in a blog post over at Scientific American. It argues:

“There is a grain of truth to the notion that creativity and mental illness are related, but the truth is much more nuanced—and we think more interesting—than the more romanticized notions of the link.

Drawing on data from another report, “Mental illness, suicide, and creativity,” that studied 1.5 million Swedes over 40 years, the authors found:

“Individuals holding creative professions had a significantly reduced likelihood of being diagnosed with schizophrenia, schizoaffective disorder, unipolar depression, anxiety disorders, alcohol abuse, drug abuse, autism, ADHD, or of committing suicide.”

This seems to demonstrate the negative thesis: creative people are less likely to experience mental illness — except for bipolar disorder, which was slightly higher for creatives.

And there’s another plot twist! The close relatives of creatives were over-represented in the total population for schizophrenia, bipolar disorder, and autism in the Swedish study:

“The Swedish authors wrote that first-degree relatives of people with schizophrenia or bipolar disorder were overrepresented in creative professions, as were siblings of individuals with autism.”

Some interesting possibilities emerge from this finding:

“Could it be that the [creative] relatives inherited a watered-down version of the mental illness conducive to creativity while avoiding the aspects that are debilitating?”

Epstein refers to another study that makes that very argument: “Genome-wide association study of school grades identifies a genetic overlap between language ability, psychopathology and creativity,” (Scientific Reports doi: 10.1038/s41598-022-26845-0).

Even more interesting is how the mechanism of creativity might work as an offramp from the road to mental illness. The authors of the original study describe an experiment where “people with schizophrenia, and their relatives, and creative people all had difficulty suppressing the precuneus — a part of the brain involved in creativity — while working on a task that scientists assigned them.”

Schizophrenia, autism, and creativity all are activated in people who have “more events/stimuli in their mental processes” than others. They’re more open and receptive to the world around them, their thoughts and feelings — even painfully so. People who fall into these categories are going to get distracted from the task at hand, but if the distracting inputs aren’t overwhelming, or if they’re able to manage the flood along with their emotional response, they may do incredible creative work:

“It seems that the key to creative cognition is opening up the floodgates and letting in as much information as possible.”

Balancing Openness with Intellect

According to the psychologists who authored “Creativity and schizophrenia spectrum disorders across the arts and sciences,” two traits must converge to find the creative balance:

  1. Openness to Experience — “Cognitive engagement with sensory and perceptual information. […] Openness is associated with fantasy-proneness, schizotypy, absorption, delusional ideation, and the tendency to make connections and see patterns that don’t actually exist.”
  2. Intellect — “Cognitive engagement with abstract and semantic information, primarily through reasoning. […] Intellect is associated with IQ, executive functioning, and intellectual engagement. Indeed, Intellect is negatively associated with positive schizotypy and delusional ideation.”

They also note there is evidence that openness “is associated with creative achievement in the arts, whereas Intellect is associated with creative achievement in the sciences….”

“This is consistent with research suggesting that schizotypy is associated with verbal and artistic creativity… whereas the autism spectrum is associated with technical-scientific interests and careers….

Being susceptible to schizophrenia spectrum disorders may enhance Openness, increasing the likelihood of ideas that are original. To develop ideas that are creative, however, one also needs protective intellectual factors (and autistic-like traits) to steer the chaotic storm.

Some reasons why this all rings true to me:

  1. Mental illness on both sides of my family for myself and my children. Some of the most affected people found balance and health in creative work. (It seems to be a good thing for everyone.)
  2. Difficulty focusing on “boring” tests and other work that doesn’t involve significant intellectual freedom, like analytical reading and writing. That describes me and some of my children with similar traits. Also, these same people have a preference for the arts and humanities over the sciences.
  3. Learning early in life the importance of finding stimulation and ways to pass time in solitary, isolated, “boring” situations — school, church, time-outs, detentions, early bedtimes in the summer, rural life, winter holidays, and other prison-like conditions commonly inflicted on children.
  4. Prison literature, Camus’s existentialist novels, and the autobiographies of African Americans from Frederick Douglass to Malcom X stress the liberating role of reading, and the ways people have kept their sanity in solitary confinement and other trying situations.
  5. Conversations with homeless and mentally ill people where the most functional, coherent, and relatable individuals are often bursting with stories. They often have a surprisingly positive outlook, at least in pre-COVID and pre-fentanyl crisis times in Alberta. They may be completely delusional, but the more their delusion explains their world coherently to them and has a positive intention, the more balanced and happy they seem to be.
  6. My own experience with remarkably abusive, traumatic, and physically challenging conditions where something like denial verging on delusion held my life together with the most meaningful interpretations of the facts that I could muster. (This led from a youthful idealism to an adult idealistic fatalism.)
  7. Growing up with people whose spiritual/religious beliefs and practices mixed up delusion, creativity, and abuse — while trying to orient myself away from this but not so radically that it excluded the creative and the spiritual. Those categories of being and knowing spoke to me the same way trees, good books, conversations, and generally beautiful, immersive things do.
  8. Finding a great creative flowering amid the worst experiences and long years around the pandemic.
  9. A creative flood of experiences in forests and cities as a child — and also dreams. Their similarity to hallucinogenic experiences — and both as goad to creative expression.

I’ve written several poems touching on many of these experiences and themes over the years, and all of them involve my paternal grandmother who had a tough immigrant life as a young woman in trouble who was sent away from her family to New York from Germany in the late 1920s. She became schizophrenic, experienced psychotic breaks, and wrote an autobiography while institutionalized for shock therapy. She was a self-taught painter and writer. This poem is from a set of three called “Only Creation.”


She never showed me a picture of Koblenz bombed flat
and people still in the streets. On walks above the Hudson,
down the lane to feed a horse, I remember her
cutting the apples, but I can only see Tarkovsky’s horses:
the one shot and shoved down stairs like a broken piano;
the other bathing in dust then prancing lightly away.
Dream or trauma, this is what we can give to children.
Even when she was tied up and fed electricity,
her painting and writing never stopped. She saw it was us
in the rubbished city. This gift or trick of sight
is from an old woman who paints everything in oil,
laying it on thick — even the light switches and toilet seats.
She’d rip out weed trees barehanded in her eighties;
maybe she imagined certain throats.

Creation is compensation and an alternative to the destruction of revenge. It can be full of rage, wrath, and darkness. It’s not all happiness and sunshine.

Dan Knauss

Dan Knauss

Hi, this is my CMT blog, and I wrote this article. You can read about me and my CMT story. Get in touch if you’d like; I’m always happy to answer questions about CMT and the medical system.

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