Hai Lun Liu 260604433

Hai Lun Liu 2017

Mood Disorders and Creativity

Introduction

Throughout the history, mood disorders seem to occur frequently in creative individuals.

Vincent Van Gogh was a famous artist whose artworks are widely appreciated by people around

the world. Many of his most famous paintings were created during his last 3 years of life when

he moved to Arles, France[1]. Albeit being very productive, Van Gogh suffered an acute mental

breakdown in December 1888, when he and his friend Gauguin had an argument followed by

Van Gogh cutting off his right ear. Van Gogh was taken to a hospital the next day where he was

diagnosed to have “acute mania with generalized delirium”[2]. Even though he recovered and

went home in January 1889, he returned to the hospital after the police closed his house due to a

petition signed by townspeople[3]. Two months later, he moved to stay at an asylum in Saint-

Rémy-de-Provence. During this period, he completed many paintings, including the Starry

Night, which are characterized by swirls and bright colors. He ended his life by shooting himself

in the chest in 1890[4].

Another example is the famous American writer Ernest Hemmingway. Ernest Hemmingway had

contributed greatly to the world of literature[5]. He won the Pulitzer Prize for Fiction in 1953

and the Nobel Prize in Literature in 1954. An example of his work is The Old Man and the Sea.

Given the family history, he had genetic predisposition for mood disorders and

hemochromatosis[5]. He died by suicide in 1961 by shooting himself in the head[5]. From his

biographies, he was diagnosed to have bipolar disorder[5]. During his manic episode in 1924, he
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wrote 7 short stories[6]. He then had another manic episode in 1934, and produced several

stories and articles[6]. However, he also had depressive episodes that interrupted his creativity.

From 1942 to 1945, Hemmingway described himself as “out of business as a writer”[7], and

could not bring himself to finish a trilogy he started after the World War II [7].

Sir Isaac Newton, one of the most influential scientists of all time, was an English

mathematician, astronomer, and physicist. He discovered the binomial theorem and developed

calculus[5, 8]. In addition to that, he also developed Newton’s theory of color, which states that

colors are a result of objects interacting with colored light[9]. And of course, the very famous

apple incident triggered Newton’s interest in his studies in gravitation[10]. From the delusional

letters he wrote, psychiatrists suspect that he had bipolar disorder[11].

Ludwig Boltzmann is another famous scientist who contributed a lot of work towards the atomic

theory, statistical thermodynamics and mechanics, as well as the kinetic theory and the flow of

energy under transformation[12]. He is famous for the Boltzmann’s equation and the Stefan-

Boltzmann law. He had suffered from bipolar disorder throughout his life, and was hospitalized

several times for his depression. The causes of his depression ranged from the death of his

mother, being the president of the University of Graz, the death of his coauthor, to the frustration

to prove his theories, which were rejected by his contemporaries and only vindicated after his

death. Finally, he ended his life by suicide[13].

In the modern world, we have the famous singer Demi Lovato as an example. Lovato is an

American singer, songwriter and actress. She went into rehab when she was 18 because of

depression, eating disorder, and other issues[14]. She was diagnosed with bipolar disorder in

2010. In 2013, she was a mentor to teens who suffer from mental illnesses at the Children’s
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Mental Health Awareness Day. In the same year, she also created the Lovato Treatment

Scholarship Program, to pay for the cost for patients with mental illnesses.

These examples raise the question as to whether there is a relationship between mood disorder

and creativity. This paper will explore the definition and mechanisms of creativity and mood

disorders, the possible relationships between mood disorders and creativity, and creativity as a

means to treat mood disorders.

Definition of Mood Disorders and Creativity

First, it is important to define mood disorders and creativity properly to avoid ambiguity and

confusion.

Mood Disorders

Mood disorders are divided into two categories by the Diagnostic and Statistical Manual of

Mental Disorders (DMS IV): Bipolar disorder and depression [15].

Bipolar spectrum disorder is also known as the manic-depressive disorder. It is a neurological

disorder that is comprised of manic episodes, or periods of elevated mood, and depressive

episodes, or periods of sadness and hopelessness. Both types of episodes can affect the person’s

ability to carry out day-to-day tasks [16]. Bipolar disorder is divided into 6 subtypes: Bipolar I
1
characterized by full-blown mania, bipolar I2 characterized by depression with protracted

hypomania, a state of persistent elevated mood and disinhibition less severe than mania[17],
1
bipolar II characterized by depression with hypomania, bipolar II2 characterized by cyclothymic

1
depressions, bipolar III characterized by antidepressant-associated hypomania, bipolar III2
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characterized by bipolarity masked-and-unmasked-by stimulant abuse, bipolar IV characterized

by hyperthymic depression[18].

Like bipolar disorder, depression also affects people’s ability to perform day-to-day tasks. It can

be divided into 4 different types: Persistent depressive disorder, characterized by depressed

mood that lasts for at least 2 years, postnatal depression, characterized by occurring after women

give birth, psychotic depression, characterized by the co-occurrence of psychosis and depression,

and seasonal affective disorder, characterized by the onset of depression during the winter[19].

The depressive episodes in bipolar disorder may also meet the criteria for major depression, but

it’s called the bipolar depression, which usually occurs before or after a manic episode[19].

There is also the familial pure depressive disease, which is characterized by the existence of

depressive illness in a first-degree relationship[20]. Lastly, melancholic depression is

characterized by at least one of the following symptoms: Depression that is subjectively different

from grief or loss, severe weight loss or loss of appetite, psychomotor agitation or retardation,

early morning awakening, guilt that is excessive, worse mood in the morning[21].

Mood disorders can affect people of different origins, ages, and genders.

Creativity

There are many definitions for creativity, but a common one is a brain state that generates novel

and useful ideas that can be turned into actions[22]. There are four stages in creativity:

preparation, incubation, illumination, and production[23]. For each stage, different parts of the

brain are involved. Preparation and incubation will be explored. The stage of preparation is when

learning and the formation of memory take place. Incubation is when the brain unconsciously

searches for an answer or tries to find unity. Although intelligence has been considered an
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element of creativity, there’s only a very weak relationship between creativity and IQ. Most IQ

tests use word definitions and convergent thinking to test what has been learned. However,

creativity requires disengagement and divergent thinking. Different areas of the brain are

involved in different kinds of creativity. In a study done by Chen et al., it was found that those

with higher creative achievement have larger portions of the dorsolateral frontal lobe and ventral

medial prefrontal cortex[24]. The lateral frontal lobes are very important for disengagement and

divergent thinking. Increased gray matter in the left cuneus and precuneus were found to be

related to verbal creativity[25], whereas that in the right cuneus and precuneus were found to be

related to visual creativity[26]. The default network, which includes the cuneus, precuneus,

posterior cingulate, and other parts of the brain, involves in generating internal thoughts and

images when people close their eyes[27].

Mechanisms of Mood Disorders and Creativity

In order to see whether there is a connection between creativity and mood disorders, the

mechanisms of both have to be explored.

Mood Disorders

With neuroimaging and molecular techniques, research has shown that extensive networks

between prefrontal cortex, amygdala, the ventral striatum and pallidum, the medial thalamus, the

hypothalamus, and the brain stem exists, and it’s the changes in this network that contribute to

the onset of mood disorders such as major depressive disorder (MDD) and bipolar disorder

(BD)[28-30]. These networks normally regulate the evaluative, expressive and experiential

aspects of emotional behavior in the pathophysiology of mood disorders[31]. Some examples are
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the limbic-cortical-striatal-thalamic (LCSPT) circuits consisting of the connections between the

orbital and medial prefrontal cortex (OMPFC), amygdala, hippocampal pallidum, the orbital

prefrontal network (which includes sensory association areas) consisting of visual associated

areas in the inferior temporal cortex, the somatic-sensory associated areas in the insula and

frontal operculum, and the olfactory and taste cortex, and the medial prefrontal network (which

connects with limbic structures and visceral control structures) consisting of the dorsomedial/

dorsal anterolateral prefrontal cortex, the mid- and posterior cingulate cortex, a part of the

anterior superior temporal gyrus and sulcus, and the entorhinal and posterior parahippocampal

cortex, closely resembles the default network[30]. With axonal transport based techniques, the

patterns of connectivity between fronto-limbic regions are identified in primates[32]. The

hypothalamus, the hippocampus, the amygdala and several other nearby areas constitute the

limbic system, which is responsible for our emotions and the formation of memories[33]. The

same brain areas are affected in depression and mania, although the opposite characteristic

disturbances occur with respect to emotions. Many visceromotor network structures are

abnormal in morphology or morphometry in patients with mood disorders[34]. Volumetric

abnormalities localized to prefrontal cortex (PFC), cingulate and temporal lobe structures have

been seen in early-onset, nonpsychotic MDD and BD patients[30]. Mostly, gray matter volume is

reduced in the orbital and ventrolateral PFC in MDD and BD, the frontal polar/dorsal

anterolateral PFC in MDD, and the posterior cingulate cortex an superior temporal gyrus in

BD[30]. White matter is reduced in the genu of the corpus callosum in adults with MDD or BD

and their children, and in the splenium of the corpus callosum in adults with MDD or BD[30].

Caudate and accumbens volumes have been confirmed to be decreased in MDD and BD patients

compared to controls in a post mortem study[35]. Interestingly, the pituitary and adrenal glands
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are enlarged in MDD due to the continuous overstimulation of the adrenal cortex by

adrenocorticotropic hormone (ACTH)[36]. Many brain areas that are structurally abnormal in

mood disorders also contain abnormalities of cerebral blood flow (CBF), and glucose

metabolism. The metabolism is increased in the depressed phase compared to the remitted phase

in amygdala, subgenual anterior cingulate cortex (sgACC) and ventromedial frontal polar cortex

in MDD, and increased in the accumbens area, medial thalamus, and posterior cingulate cortex in

MDD and the depressed phase of BD[37]. There appears to be elevated glucose metabolism in

the left amygdala, as well as hypersecretion of cortisol under stress in depressed patients in 3

specific groups: BD-depressed, familial pure depressive disease or melancholic[32]. Some brain

areas, including the dorsal medial/anterolateral prefrontal cortex, the frontal polar cortex, the

subgenual anterior cingulate cortex, the pregenual anterior cingulate cortex, the orbital cortex/

ventrolateral prefrontal cortex, the posterior cingulate, the parahippocampal cortex, the

ventromedial striatum, the superior temporal gyrus/temporopolar cortex, and the medial

thalamus, appear to have decreased metabolism and cerebral blood flow in early onset, recurrent

MDD and BD patients[30].

In addition to the above mentioned abnormalities, reductions in glial cells with no equivalent loss

of neurons in the pgACC, the dorsal anterolateral PFC, and the amygdala in MDD, elevations in

neuronal density, decrease in nonpyramidal neuron density in the ACC and hippocampus in BD,

reductions in synapses or synaptic proteins in hippocampal subiculum/ventral CA1 region in BD,

and reduction in the size of neurons in the dorsal anterolateral PFC in MDD have also been

observed [30]. Although one-third to one-half of individuals diagnosed with MDD experience

anhedonia, or diminished interest or pleasure in response to stimuli that were perceived as

rewarding during the premorbid state, they can still feel pleasure at the level of basic sensory
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experience. Experiments have shown that MDD patients cannot experience emotions specifically

towards reward anticipation [32]. In addition, depressed individuals are also more sensitive

towards negative information than positive or neutral information. The administration of

antidepressants shifts the biases in emotional processing towards positive direction in both

healthy and MDD individuals [32].

The glutamatergic and -amino-butyric acid (GABA) function appears altered in mood disorders.

There is an abnormal decrease in the concentrations of GABA in the blood plasma and

cerebrospinal fluid (CSF) in MDD patients[38]. On the other hand, the glutamatergic

transmission has been increased in the PFC of MDD subjects[39].

The glucocorticoid system also acts abnormally in patients with depression in that the

hypothalamic-pituitary-adrenocortical (HPA) axis is overactive in some patients. The plasma

levels of CSF-CRF increase to an inappropriate level[36].

Neurocircuits modulated by dopamine (DA), serotonin (5-HT), and norepinephrine (NE) and

many other chemicals involve in the pathophysiology of mood disorders[40-42]. Specifically, 5-

HT and NE are involved in the manifestation of depressive symptoms, whereas DA is involved

in both the depression and the manic episodes of bipolar disorder. The reduction in 5-HT

receptor binding and mRNA expression in depressive patients may be a result of cortisol

hypersecretion[43]. Reduced DA neurotransmission is observed in MDD[44].

The cholinergic system also seems to be dysfunctional in mood disorders, and may impair the

patients’ concentration and memory[30].

Astrocytes are an active component of tripartite synapse, which consists of pre-, postsynaptic

neuron, and glia[45]. Upon stimulation, astrocytes can increase glial Ca2+ and lead to release of

transmitter substance from astrocytes that can affect neighbouring glia and neurons[46].
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Sanacora et al. proposed that dysfunctional glia and their interaction with neurons may provide

an environment that can explain the effects of N-methyl-D-aspartate (NMDA) and alpha-amino-

3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) potentiation in mood disorders[47].

Recent studies suggest that the excitatory amino acid neurotransmitter system may play a critical

role in pathophysiology and treatment of mood disorders[46]. A new model of mood disorders is

suggested to involve glia mechanisms: Chronic blockade of glutamate uptake with a

glial/neuronal transporter antagonist within amygdala has resulted in the development of

symptoms of mood disorders including disrupted circadian rhythm and reduction in social

exploratory behavior[48].

It has also been found that the levels of brain-derived neurotrophic factor (BDNF) are reduced in

the brain and the serum of patients with depression. BDNF has been found to positively affect

neurons, whereas its derivatives, pro-BDNF and BDNF pro-peptide, negatively affect neurons.

All the antidepressants increase BDNF-TrkB signaling. Therefore, BDNF and its derivatives

might become biomarkers for mood disorders, and the signaling pathway can be a useful tool for

screening for new antidepressants[49].

In addition, some alleles of genes have been found to be related to a higher risk of getting mood

disorder.

Creativity

When talking about creativity, there comes the question of nature or nurture; that is, is creativity

something that is inherited from parents, or is it learned later in life? The answer is that nature

and nurture both play important roles. Although creativity is heavily dependent on nurture,

especially in childhood, the person must have the biological and genetic capacity to be nurtured.
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Different brain systems and chemicals have different effects on creativity. The right hemisphere

helps to notice novel stimuli while ignoring familiar stimuli, the left hemisphere raises approach

motivation, the frontal lobe generates actions, the temporal lobe generates perceptions, the DA

raises approach motivation and heightens visual imagery, 5-HT raises avoidance motivation, NE

raises arousal, the synapse density increases associativeness, and there are various genes that

have effects on creativity as well[22]. Increased motivation can lead to an increase in talent

through persistent practice, as well as an increase in the number of creative ideas purely because

of the large amount of ideas generated by a person who is very productive[50, 51]. Although all

the medical conditions associated with creativity increase focused goal-directed behaviour, not

all kinds of motivations are helpful for becoming creative[22]. Approach motivation and intrinsic

motivation can lead to more creative behaviour than avoidance motivation and extrinsic

motivation[52, 53]. In the 1970s, the right hemisphere was hypothesized to be the site of creative

and artistic activities, and functional imaging has shown that the activity in right hemisphere is

more than that in the left hemisphere in some creative tasks[54]. However, the simple hypothesis

does not work because while untrained individuals process music and painting with the right

hemisphere, trained and skilled musicians and painters process them more on the left[55, 56].

Greater bilateral activation has been found in highly creative individuals than individuals with

low creativity, because a previously mentioned important part of creativity, approach motivation,

is promoted by the left hemisphere by inhibiting the right hemisphere’s focus on avoidance and

withdraw[57, 58]. Frontotemporal interactions significantly affect the creative drive[22]. Like

right and left hemisphere connections, frontal and temporal lobe connections are mutually

inhibitory. Therefore, lesions in the temporal lobe can increase motivation and cause aggressive

or manic behaviour by disinhibiting the frontal lobe[22]. The frontal premotor and motor areas
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are important in generating creative ideas and actions, whereas the temporal areas are important

in assigning meaningfulness to the ideas and recognizing that they are new[59, 60]. When a

lesion occurs in the frontal lobe, the person tends to speak and move less; but when a lesion

appears in the temporal lobe, the person tends to talk and move around more[22]. The neurons in

midbrain drive creative motivation by sending DA, 5-HT and NE to the cortex. DA is thought to

be the most evident link between mental illnesses and increased creativity, and it is very

important for motivation and imagination, including reward-based rives and curiosity[61]. DA is

thought to be related to mania and substance abuse and it is most concentrated in the frontal

regions involved in motivated action [22, 62]. DA also enhances mental imagery and facilitate

mental associations[63]. 5-HT can inhibit dopaminergic activation, thus decreasing

motivation[64, 65]. NE decreases the chance of cognitive shifts between different solutions to

problems, and blocking adrenergic beta receptors increases creative flexibility[66, 67]. Creativity

strongly depends on motivation[22]. Disengagement and divergent thinking are important for

creativity. Disengagement is the act of breaking away from the known knowledge and

developing new ideas. All the animals have two basic forms of behavior: avoidance, which is

mediated by the frontal lobes, or approach, which is mediated by temporal-parietal lobes[68].

Therefore, a frontal lobe injury will cause the patient to have trouble in disengagement and

abnormal approach behaviors. Divergent thinking requires the disengagement from the sematic

networks and the activation of more remote networks. The frontal lobe is one of the few areas of

the cerebral cortex that controls locus coeruleus, which produces norepinephrine for the brain,

and the level of norepinephrine in parts of the brain may influence remote network

activation[69]. The exposure to novelty, discovery, and creativity activate the mesolimbic

dopamine system, which is also activated by recreational drugs to cause rewarding effects.
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Creativity requires the combination of previously isolated ideas. This requires interhemispheric

communication. Corpus callosum connects the right and left modular systems. It was found that

highly distributed cognitive networks are coactivated during creative processes. There are several

mechanisms proposed to coactivate the brain networks. A diversion of thought with

nonconscious thinking can lead to creative ideas and the “Ah-Ha” experience. It was found that

there’s a positive correlation between the extent of rapid eye movement (REM) sleep and

creativity, and sleep deprivation lowers creativity[70]. Also, a lot of paradigmatic shifts occurred

during the times when creative people were resting and relaxing. At the same time, depression

(whether bipolar or unipolar) tend to provide an incubation period for creative processes.

Psychological stress has been associated with higher levels of norepinephrine, while relaxation

has been associated with lower levels[71]. The vagus nerve carries information from viscera to

brain, and the activation of vagus nerve can activate the locus coeruleus which produces higher

levels of norepinephrine in the brain. Ghacibeh et al. used Torrance Tests of Creative Thinking

(TTCT) to test people’s creativity while their vagus nerves were stimulated or not stimulated,

and they found that during stimulation, there was a lower level of cognitive flexibility and

creativity[72]. This supports that reduced activity in the locus coeruleus enhances cognitive

flexibility and creativity. Regular exercise, has also been shown to enhance creativity, but the

mechanism is not related to mood[73].

Possible Relationships Between Mood Disorders and Creativity

Throughout the history, many studies have been conducted to find out whether relationships exist

between mood disorder and creativity. In general, it’s thought that positive mood promotes the

production of new ideas and cognitive flexibility, whereas negative mood encourages the
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persistence in the process of looking for a solution to solve a problem[74]. Studies by Ellis,

Galton, Lombroso, Jamison, Richards, Kinney, and Ludwig have all shown a hyper frequency of

affective disorders among artists, writers, and composers[75]. Richards and Kinney have

generalized this association between mood disorders and creativity to the general population,

showing that it is not limited to just a few highly creative geniuses[76]. With further

development, it has been found that the relationship is stronger in those that are less affected by

the mood disorders[77], and there is a higher incidence of increased creativity in the normal first

relatives of people with mood disorders, instead of patients themselves[78]. A recent study has

shown that hypomania is significantly related to creativity[79].

The possible relationships can be divided into nature or nurture. The relationships in nature are

those in genetics and neuroanatomy, whereas the nurture relationships might be caused by

substance abuse, medicinal treatments or other environmental factors.

For the nature part, many genes are at work for expressing creativity or mood disorders. For

example, the TIT genotype of the promoter of neuregulin 1 gene has been shown to relate with

creativity in people with high intellectual and academic achievements and risk of psychosis and

altered prefrontal activation simultaneously[80]. A lot of the brain areas important in creativity

are also areas that affected in mood disorders. For example, the prefrontal cortex is important in

creativity, and a reduction in glial cells is observed in patients with mood disorders[81].

For the nurture part, alcoholism and substance abuse are often thought to be related to both mood

disorders and creativity. Some creative individuals think that drinking alcohol and using certain

substances can help with their creativity. However, moderate blood alcohol level actually lowers

creativity[82]. In the long term, alcoholism diminishes creativity[83, 84]. Marijuana or cannabis
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has no positive effect on creativity in new users, and negative effect in regular users[85, 86].

Moreover, cannabis poses an increased risk in developing depression or bipolar disorder[87].

Some common medicines used to treat mood disorders include antidepressants, mood stabilizers,

and antipsychotics. Most antidepressants target neurotransmission, and this in turn may affect

microRNAs and epigenetic regulation that may influence creativity. Some medications that may

affect creativity negatively include aripiprazole, sedating SSRIs, topiramate, carbamazepine,

valproate, and sedating typical neuroleptics. Serotonergic medications can inhibit goal-directed

behaviour, and indirectly, creativity[88]. SSRIs can also cause SSRI-induced apathy syndrome,

where appetitive motivations such as libido and curiosity, are lost[89]. However, because SSRIs

lower avoidance motivation as well, it promotes an indifference to others’ opinions which is

related to creativity[90]. Antagonist dopaminergic drugs can lower motivation and creativity.

This may help a scientist to worry less about social interactions but inhibits a novelist’s

interpersonal sensitivity, a critical component for producing good writing[22]. Medications that

are safer for creativity include bupropion, lamotrigine, lithium, oxcarbazepine, stimulating

atypical neuroleptics, and antimanics. Agonist dopaminergic drugs can increase creative

motivations in some patients chronically taking the less sedating DA agonists, but they can also

cause addiction problems, hypersexuality, and hallucinations[91]. Lithium helps with creativity

by making BD patients less ill, but it may decrease associational productivity once mood is

controlled[92, 93]. Switching to valproate from lithium increase perceived creativity in some

bipolar patients[94]. The effects of SNRIs, tricyclic ADs, monoamine oxidase inhibitors, and

anticonvulsant mood stabilizers on creativity are not very clear[22].

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It has been shown that synesthetes, or people who can perceive a sense of one modality while

being stimulated with another modality, have greater white matter connectivity than

nonsynesthetes and are more likely to be creative and have mood disorders[95, 96].

It is also possible that transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS)

can improve creativity. However, these techniques are expensive and not long lasting[22].

There are no controlled studies on the effect of psychotherapy on creativity, although there are

some case studies and theories in the psychoanalytic literature.

Deacon et al. suggested that relaxed selection pressure fosters diversity, and tolerant and safe

environment fosters creativity[97].

Carson proposed a shared vulnerability model of creativity and psychopathology, which

basically states that creativity and psychopathology share genetic components that may express

as pathology or creativity depending on the presence or absence of other moderating factors[98].

This model explains why only some of the extremely creative individuals have psychological

illness, and not all people with psychological illness exhibit outstanding creativity. Attenuated

latent inhibition (LI), preference for novelty, and hyper connectivity are three shared

vulnerability factors proposed by Carson[98]. LI is the ability to ignore stimuli that are

irrelevant. For example, the ticking of the clock may catch your attention when you first start

working, but after a while, you will be so focused on working that the ticking sound is

completely screened out by your brain. Although reduced LI has been found in people who are

highly prone to psychosis[99], it is also correlated with openness to experience, which is a trait

of highly creative individuals with above-average IQ[100]. The reduction in LI means that there

will be an increased inventory for stimuli. While this increase in stimuli inventory may cause

information overload, it may also allow for a better chance of coming up with new ideas that
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involves combining different elements[100]. Novelty-seeking is the second shares vulnerability

factor. Creative individuals are usually high in novelty-seeking and prefer new or complex

stimuli over old or simple stimuli[101]. Novelty-seeking activates one’s internal dopaminergic

reward system, which provides constant motivation to attend to new ideas and creative

projects[102]. However, novelty-seeking has also been found to associate with alcohol abuse an

addiction[103], and it is very prevalent in people who go through the hypomanic or manic phases

of bipolar disorder[104]. Because novelty-seeking is related to the dopaminergic activity in the

reward system, some dopamine-related genes have been found to relate to both creativity and

mental illness, including the A1+ allele of the TAQ 1A polymorphism of the DRD2 gene, the

DRD4 gene and the SLC6A3 gene[75]. Finally, neural hyper connectivity is also a shared

vulnerability factor. It has been found that unusual cortical connection patterns, which allow for

rapid and broad connection between associational networks[105],may associate with writing,

artistic and scientific achievements[106]. Fink and Benedek have also found that there is more

alpha synchronization within and across hemispheres in the brains of highly creative individuals

than less creative individuals during creativity tasks[107]. At the same time, using white matter

diffusion tensor imaging, McCrea has found hyper connectivity between specific regions of the

brain in individuals with bipolar disorder[106].

Carson proposed 3 protective factors, including high IQ, enhanced working memory capacity,

and cognitive flexibility, which help to prevent creative people from getting mentally ill[98]. On

the other hand, low IQ, working memory deficits, and perseveration are the risk factors for

individuals to be mentally ill[98].

Generally, creativity is impeded in severe episodes of depression or mania[75]. Richards et al.

discovered the inverted-U relationship between creativity and psychopathology, where the
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highest level of creativity occurs when there’s mild symptoms of psychological disorders, and

lower levels of creativity are observed with either no symptom or with severe symptoms[108].

Therefore, antidepressants and antipsychotics have been shown to improve creativity for many.

However, the depressive episode does provide an incubation period for new ideas, and writers

and painters can often use it as the subject of future works they create.

To further the above findings, the balancing selection hypothesis suggests that susceptibility

alleles to mental disorders in patients or relatives also harbor adaptive advantages that increase

fitness by increasing creativity, which has been associated with an increased number of sexual

partners[109, 110].

Recently, Stephen Thaler created simulations of limbo-thalamo-cortical loops, which are

important in discovery, invention, and artistic endeavors, through mimicking the modulation of

synaptic activity by applying the computational equivalent of volume-released neurotransmitters

to connection weights, and found links between psychopathologies and creativity[111]. He found

that there is a cyclic variation in synaptic chaos in the artificial neural system during creative

problem solving[112]. At high disturbance levels, ideas can form as memories from different

neural modules couple into transient, subliminal notions. However, they will be unnoticed by

critic neural modules because those modules are incapacitated by the synaptic chaos. As the

disturbance level comes down, certain neural modules may perceive the notions as new and

useful, and perfecting and consolidating them into ideas that are accompanied by affective

responses. Applying these findings to human cognition, creativity can be an effect brought about

by numerous transits through chaotic and quiescent phases. The more intense the swings are, the

more creative the ideas will be[113]. However, this is likely to bring out cognitive pathologies,

including hallucinations and confusion[113].

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Creativity as a Means to Treat Mood Disorders

Many therapies used to treat mood disorders involve creative processes or activities such as art,

dance, music, and writing.

Art therapy began to appear in the late 18th century, when arts were used to treat psychiatric

patients. Adrian Hill, a British artist, consolidated the term art therapy[114]. Edward Adamson,

known as the father of art therapy in Britain, extended Hill’s work to other British mental

hospitals[115]. Nowadays, national professional associations of art therapy exist in many

countries worldwide. Flow is a state of happiness and high focus achieved when a balance exists

between challenges faced by a person and the skills of a person[116]. Flow can sometimes be

achieved in art therapies and become a very rewarding experience. Art therapy is different from

art class in that art therapy focuses on the inner experience of the person, and the emphasis is

usually on expressing images coming from inside the person.

Many art-based assessments were also invented to evaluate emotional, cognitive, and

developmental conditions. Some examples are Draw-A-Man Test[117], the Diagnostic Drawing

Series[118], and House-Tree-Person[119]. Recently, Sarid and her colleagues integrated art

therapy into the treatment for women with perinatal mood and anxiety disorders (PMADs)[120].

The patients are asked to draw images, symptoms or memories. The art component facilitates the

psychotherapy sessions for those who are not fluent in the dominant language and have low

levels of abstract and verbal skills[120]. Art therapy can also reduce work related stress in health

care professionals[121].

Dance therapy, or dance/movement therapy (DMT) uses dance and movement to support

emotional, intellectual and motor functions of the body. The four stages of dance therapy are
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preparation, incubation, illumination and evaluation. Many different dance styles can be used in

DMT, such as modern dance, ballroom dance, tango, waltz, and line dancing. In a study that was

done by treating depressed patients in three groups (dance, music only, and stationary bikes only)

showed that the dance group gained the most benefits[122].

Drama therapy is the use of theatric techniques to promote mental health and facilitate personal

growth[123]. It is usually done in groups. Projective identification and dramatic distancing are

two of the nine core processes of drama therapy. They allow people to tolerate their own

problems by distancing themselves from those problems through metaphor[123]. Psychodrama,

developed by Moreno, utilizes dramatization and role playing to let people gain insight into their

lives[124].

Music therapy helps the clients improve their social skills, cognitive functioning, and

emotions[125]. It comes in two different forms: active and receptive. In active music therapy, the

patient and the therapist make music together, whereas in receptive therapy, the therapist plays

music while the patient can draw, meditate or just listen[126]. Music therapy works on a wide

variety of illnesses ranging from coronary heart disease to depression, and on a wide age range

of patients from unborn babies to elderlies[127-130].

Writing therapy is another form of expressive therapy. Expressive writing was developed by

Pennebaker in the late 1980s[131]. In Pennebaker’s study, the subjects were divided into a

control group and an experimental group. The control group was asked to write about things in a

way that’s as objective and factual as possible, whereas the experimental group was asked to

write about their deepest thoughts and feelings from traumatic events. In the end, the

experimental group made fewer visits to a physician in the following months compared to the

control group. Later, another study showed that expressive writing can boost the immune
 Hai Lun Liu 260604433

system[132]. Another advantage of writing therapy is that the restriction of time and space is

reduced because the writing can be done remotely online or through mailing at any time.

Film/video-based therapy is used with virtual reality to treat bipolar therapy and phobia[133].

Conclusion

Van Gogh, Hemmingway, Lovato, Newton, and Boltzmann are just a few examples of many

famous artists, writers, and scientists who suffer from mood disorders. Intrigued by the vast

number of creative individuals who suffer from mood disorders, the intersection between

creativity and mood disorders have been explored by many. Lots of experimental results have

provided evidence for a connection between creativity and mood disorders, from the level of

biochemistry, to molecular biology, to neuroanatomy, and to behaviors. A few genes have been

found to relate to both creativity and mood disorders. Substance has been found to reduce

creativity and increase the occurrence of mood disorders. The highest creativity has been found

in those who have less severe symptoms of mood disorders and in the first relatives of people

who have mood disorders, and the least creativity has been found in people who have severe

symptoms of mood disorders. However, there is still a lot more that needs to be done to reveal

more details of how creativity and mood disorders are connected. Creative activities also have a

lot of potential in being used as therapies to treat mood disorders and improve people’s mental

health in general. In the future, there should be more studies on the effect of psychotherapy and

newly developed medications on creativity. With the advancement of science and technology,

more accurate models of neural networks may be developed to study creativity and mood

disorders.
 Hai Lun Liu 260604433

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