Psychosis and the Creative Advantage

Are you more creative if your relative has schizophrenia?

Posted Jan 02, 2012

The study of evolution is all about the persistence and passing on of certain genes.  In psychiatry, an important question needs to be asked - how do partially inheritable diseases such as schizophrenia or autism, which in their worst forms can be detrimental to reproduction, persist in the gene pool?  It doesn't make much sense at first glance.

We know of other dangerous and deadly diseases that persist because they give close relatives a survival advantage in certain conditions.   Heterozygote carriers of sickle cell anemia are relatively protected against malaria, while the affected homozygote sufferers of the disease endure pain, infections, and often early death.  Having some schizophrenia-risk genes. then, might convey some sort of benefit for close relatives. And one must also consider the possibility that the schizophrenia phenotype is worse now than it may have been for much of human history - with plenty of vitamin D, no wheat (speculatively :-) ) or common modern pathogens, it is possible the schizophrenia may not have developed as fully or been as debilitating in the past as it is today.

Part of the pathology of schizophrenia involves too much or too little of the neurotransmitter dopamine in various regions of the brain.  Given dopamine's role in creativity, motivation, and drive, the suspected genetic advantage of being a relative of a schizophrenic is that you may have a bit of extra dopamine, but not so much it will make you psychotic. Psychotic thought is disjointed and disorganized - creative thought is taking seemingly unrelated or unexpected ideas and bringing them together in a novel way.

Sounds reasonable. But what about the data proving it? Well, there has been a lot of speculation looking back at known geniuses and their psychopathologies. It is felt it is no coincidence that many geniuses were not particularly psychologically healthy. A more recent study selected 30 creative writers at a workshop and compared them to controls - writers had higher rates of affective disorders (several variations of this study have been done with the same results). Studies of bipolar individuals showed they scored higher on scales measuring creativity than folks with unipolar depression or non-creative controls - the bipolar folks scored the same as creative healthy controls.

In Iceland, the histories of 486 male relatives of schizophrenics were investigated - these men were more likely to be prominent historically than the general population, and there was a significant increase in those who were specifically successful in creative endeavors.

But all those studies are small, and many rely on (perhaps unreliable) historical records. However, a recent paper from the British Journal of Psychiatry documents a large, population based study of 300,000 individuals with severe forms of bipolar disorder, major depression or schizophrenia from a large population registry in Sweden, where there is data on hospital admissions, diagnoses, IQ, occupation, and detailed family records as well. The were able to find several tens of thousands of folks with bipolar disorder and schizophrenia, and over two hundred thousand diagnosed with unipolar depression.

The results? People with schizophrenia and bipolar disorder (with the effect stronger in schizophrenia) were more likely to have parents and siblings who were in creative professions. Bipolar patients also were more likely to have creative offspring.  There were no strong statistically significant correlations between having a relative with unipolar depression and engaging in creative professions (described as "including scientific and artistic occupations.") As one would expect for a genetic link, as relationships got further away (half-siblings, cousins, etc.) the correlations weakened accordingly.

The reverse sort of "non-creative" correlation was also true - folks with schizophrenia were significantly less likely to have relatives who were accountants and auditors.

There is no question that innate creativity not only would increase our survival in a tricky situation, but also increase our sexual attractiveness (what is poetry and rock and roll for, if not originally to woo a romantic interest?).  Is our creative advantage as a species bought at the cost of psychosis in the unlucky few?  More research and more knowledge of the brain might make this link more clear.

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Copyright Emily Deans, MD

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