Tuesday, July 2, 2013

A Creative Balance

When it comes to creativity, one might most readily think of children. The young, innocent imagination is a great conduit for idea generation. Or perhaps the term calls to mind an image of a prolific artist who could be well described by the term "eccentric." Generally speaking though, the thought of creativity may not be immediately associated with mental illness.

However there are mental illnesses that lend towards greater creativity, and some have believed that there are medicines which reduce creativity. Does our chemical attempt to monitor distraction and promote productive behavior tamper who we are at an essential level? Do the aspiring artsy-fartsy need to have some form of ADHD, bipolar disorder, psychosis, frontotemporal dementia, temporal lobe epilepsy, or depression in order to succeed? Are these types of illnesses part of our personhood makeup and consequently deserve to be embraced instead of adjusted? Perhaps a fine line can be drawn outlining what types of actions should be taken regarding mental health, creativity, and the value we place on humans in general.

Creativity does not exclusively apply to the modern day Da Vincis, Picassos, and Dalis. Creativity is a tool used and needed by each human being in everyday life. It is an approach to problem solving and idea generation, providing flexibility and availability to think in more than a single uniform way. Dr. Alice W. Flaherty has her Ph. D. in neuroscience from M.I.T. and is known for her work studying creativity. She also has bipolar disorder from which she experiences hypergraphia, the intensive urge to write. It is through her depressions that she is able to empathize with patients. She explores the relationship between creativity and mental illness in her paper Brain Illness and Creativity: Mechanisms and Treatment Risks. She concludes: "Creativity requires brains with adequate capacity for goal oriented motivation, novelty seeking, flexible associative networks, and lower inhibition. Creativity's link to illness stems from the fact that most novel ideas are bad ones and, in dangerous environments, unhealthy ones. Creative solutions usually require many failed experiments first. The novelty-seeking and unusual behaviours that confer vulnerability to environmental stressors may underlie inventiveness in tolerant surroundings. One way to separate illness from creativity, then, is to place patients in more enriched or supportive environments. Although that is often not possible, we should not ignore the situations where it is" (Flaherty, p. 140). It is unclear to me whether or not it is indeed the case that most novel ideas are bad ideas. While the qualitative status of novel ideas may be unclear, I do agree that the solutions require trial and error, and that when and if possible, we should place individuals in environments that support, encourage, and promote well-being.


The nature of the brain illness (psychiatric or neurological), the location within the brain, and the type of medicine used each has its own influence on creativity. According to Flaherty's review, though she does not intimate the guidelines she employs, the following illnesses are generally considered to be psychiatric:

(1) Hypomania: It is the moderate form of self-confidence and hyperassociativeness accompanying hypomania that generates more "focused goal-directed activity."
(2) History of depressed episodes: The rebounding energy after a depressed episode boosts creativity, by the [approach] motivational drive the positive energy provides. The increase in creativity that “activating moods” produce is explored by De Dreu CK, Baas M, and Nijstad BA.
(3) Psychosis: Flaherty notes that traits associated with psychosis, manic psychosis rather than schizophrenic, are better indicators of creativity. This is most likely annotated by reduced latent inhibition (LI), discovered by Carson SH, Peterson JB, and Higgins DM.
(4) Belief in favor of substance abuse: "Substance abuse is common in creative artists. However, it may not cause creativity; it may instead be the case that many artists have illnesses that increase addictions" (Flaherty, p. 134). Contrary to (especially American because of the amount of alcoholic American writers in the 20th century) popular opinion, consuming alcohol does not increase creativity - in fact, as Flaherty points out from Gustafson’s study on “Effect of alcohol on quantity of creative production using the Purdue tests”, even a moderate amount lowers levels of creativity.
(5) ADHD: Here she notes that with ADHD there is an increase in general activity level, but not selectively for creative activity. Creative activity, I would imagine, is any activity that assents to Flaherty’s definition of creativity: “a brain state that generates actions that are novel and useful to a community” (p. 133). This is a sticky definition of creativity for I would argue that an idea or action’s usefulness, (as deemed by society) is neither necessary nor sufficient in order for it to be creative. Although Flaherty thinks her 3-factor definition encompasses the cultural context creativity is examined within. She further explains that research does not support the claims that ADHD increases creativity, nor that the medicine for it diminishes creativity.

The following illnesses Flaherty lists as generally considered neurological:
(6) Temporal Lobe Epilepsy: One-tenth of those with temporal lobe epilepsy exhibit hypergraphia, a pressured drive to write that occurs between seizures and is not weakened by anticonvulsants.
(7) Frontotemporal Dementia: (FTD) can cause patients to become "suddenly and intensely motivated to paint or draw." FTD is more likely to motivate artistic production if the degeneration is worse in the temporal rather than the frontal lobes (p. 134).
(8) Amyotrophic or Primary Lateral Sclerosis is the neurodegeneration of temporal lobes and motor areas. Patients with this illness, similarly to those with FTD, will "occasionally manifest new artistic creativity as other parts of the brain fail" (p. 134).
(9) Parkinson Disease Medication: While the disease is associated with apathy and depression, the dopamine agonist medicine will spark highly focused goal-directed behavior. "In some patients with Parkinson disease, the chief compulsive behaviour is a de novo passionate artistic drive to write, compose music, or paint."
(10) Autistic Savant Syndrome: This syndrome exhibits an increased skill level of detail-oriented processing, usually concentrated within calculation, math, or musical performance. This skill often arises due to the savant's single-minded pursuit of practicing their talent (Flaherty, p. 134).




Unfortunately, negative stigma is often attached to mental illness. However, there are advocates, such as those with Mad Pride, who provide support, encouragement, generate discussion on mental illnesses, and argue for a "pro-choice" attitude towards medicine. The Stanford Encyclopedia of Philosophy’s entry on identity politics cites Sonia Kruk in explaining the focus of different groups gaining recognition: “The demand is not for inclusion within the fold of ‘universal humankind’ on the basis of shared human attributes; nor is it for respect ‘in spite of’ one’s differences. Rather, what is demanded is respect for oneself as different.” Certainly this raises an important issue: do patients with brain illnesses reserve the right to voluntarily consent to take medicine? In Gabrielle Glaser's article on Mad Pride for the New York Times, she outlines the weary concerns psychiatrists have about this pro-choice attitude. Dr. E. Fuller Torrey raises the question of whether we should allow someone with a brain illness such as Alzheimer's "who wants to walk outside in the snow without their shoes and socks" to decide to take medicine that manages the disease. It seems that there is a gradient amongst brain illnesses in how they affect our decisions for our overall well-being. Most would agree that the patient with Alzheimer's walking barefoot in the snow needs medicine or some intervention to maintain their ultimate well-being. But what if we compare some of the brain illnesses mentioned above? Do the diseases, at any stage, demand involuntary treatment?

I like the terms "manage" and "maintain" when referencing treatment for the illnesses. These terms, I think, uphold the respect of the persons with the disease, and the focus is on managing disruptive symptoms and maintaining some level of consistency. Does managing treatment diminish creativity in cases of related brain illnesses? If this is the case, are we affecting the value we place on ourselves as well as others? If we were to treat these mental illnesses entwined with creativity, would we tamper the way in which we value Van Gogh? Would we tamper the way in which Van Gogh values himself? It is also important to note that not all individuals respond to treatments in the same way. While some may be able to manage symptoms with their own coping strategies others may in fact need psychiatric medication for management.



Alfred Lord Tennyson, Fyodor Dostoevsky, Charles Dickens, and Lewis Carroll are some of history's prolific writers who suffered from epilepsy. Would we have the stories of Alice in Wonderland and Through the Looking Glass without Lewis Carroll’s epileptic experience? “The very sensation initiating Alice’s adventures – that of falling down a hole – is a familiar one to many people with seizures. Alice often feels that her own body (or the objects around her) is shrinking or growing before her eyes, another seizure symptom.”

Madigan Shive, a musician and Mad Pride member, asks a similar question: “I think often that if Da Vinci were alive during our time, would we just dope him up? What would we do?” She embraces her mental illness, viewing her bipolar disorder as a part of who she is and not a psychiatric label. She pleads, “please don’t change this thing inside in me that creates this music and keeps me alive…I need my madness.”

The nature of these occurrences in the brain figure into the equation of our personhood and therefore require a careful approach to avoid altering creativity while mitigating suffering related to mental illness. Although the term person or personhood is a controversial term, especially in philosophy, I will reconcile with Cressida Heyes’ simply put explanation: “one’s sense of self and its persistence.”  This sense of self and its persistence is what demands such careful consideration when approaching mental illness. This is to say that our status as persons demands respect: a certain threshold of moral obligation in the way we treat each other. We should respect everyone’s sense of self and its persistence while also considering their overall well-being, finding the balance. This respect for selves merits our worth as human beings. Of course, overall these questions are difficult to tackle. The definitions of mental illness, creativity, and worth have become increasingly controversial.  In Michelle Roberts’ article for BBC News Creativity ‘closely entwined with mental illness’, Dr. Simon Kyaga explicates: “If one takes the view that certain phenomena associated with the patient’s illness are beneficial, it opens the way for a new approach to treatment. In that case, the doctor and patient must come to an agreement on what is to be treated, and at what cost.” This is an excellent point to take note of when faced with the challenges of mental illness and personal integrity. Dr. Alice W. Flaherty has realized herself the empathic ability that her bipolar disorder has provided. An article in the New York Times  focuses on the bipolar empathic doctor. “‘What made me empathic was my depressions,’ she said recently. ‘People’s emotions were pounding me in the face. The mania is like wasps under the skin, like my head’s going to explode with ideas. But the depressions help the doctor aspect of me.’”

While some components of a disease may be beneficial, especially in a creative way, other effects may be detrimental in other avenues of life. A precarious balance is established taking into account a person’s worth, the demands of one’s daily life, and the effects of one’s illness. On one side we want to uphold and respect a person’s worth when managing symptoms, while on the other side also wanting to preserve the creativity of each human being and our present day Dalis and Carrolls. This is not to say that we should keep someone suffering from epilepsy because they write great stories – but that we should develop and advocate a system of treatment that will manage symptoms of the illness while maintaining the person’s sense of self, in turn preserving attributes that make them who they are, including creativity.

References

Ely, Elissa. (2009). From Bipolar Darkness, the Empathy to be a Doctor. The New York Times.Retrieved from
http://www.nytimes.com/2009/03/17/science/17prof.html?pagewanted=all&_r=0

Flaherty, A.W. (2011). Brain Illness and Creativity: Mechanisms and Treatment Risks. Canadian Journal of Psychiatry, 56(3), 132-143. Retrieved from
http://connection.ebscohost.com/c/articles/60818694/brain-illness-creativity-mechanisms-treatment-risks

Glaser, Gabrielle. (2008). ‘Mad Pride’ Fights a Stigma. The New York Times.Retrieved from
http://www.nytimes.com/2008/05/11/fashion/11madpride.html?pagewanted=all&_r=2&

Roberts, Michelle. (2010). Creative minds ‘mimic schizophrenia’. BBC News Health. Retrieved from
http://www.bbc.co.uk/news/10154775

Roberts, Michelle. (2012). Creativity ‘closely entwined with mental illness’. BBC News Health. Retrieved from
http://www.bbc.co.uk/news/health-19959565

Robinson, IA, & Rodrigues, Astrid. (2009). ‘Mad Pride’ Activists Say They’re Unique, Not Sick. ABC News. Retrieved from
http://abcnews.go.com/Health/Story?id=8382903&page=1#.UdGfKthQiCd



Want to cite this post?
McCoyd, C. (2013). A Creative Balance. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2013/07/a-creative-balance.html.

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