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Nancy C Andreasen: creativity and mental illness
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Profile Nancy C Andreasen: creativity and mental illness
For Andreasen’s paper on rates of creativity and mood disorders see Am J Psychiatry 1987; 144: 1288–92
192
Nancy C Andreasen’s journey began in a hospital bed in Iowa City (IA, USA) in 1964. A Professor of Renaissance Literature at the local university at the time, Andreasen had had a puerperal infection after giving birth to her first child, Susan, and was on a 5-day course of intravenous antibiotics. She was finishing her first book, John Donne: Conservative Revolutionary, but it was medicine that was on her mind. “I was lying there, having my life saved by penicillin, and thinking ‘what if I dedicated my life to medicine instead?’”, says the now neuropsychiatrist at the University of Iowa. “All that work I’d put into my book, if I put that into medical research maybe I could come up with something as important as penicillin. I know that sounds grandiose, but I’ve always aimed high.” By the end of medical school it was psychiatry that had caught her attention. “In psychiatry you have unique, individual human beings with different life stories and different constellations of symptoms”, she says. “You need to link those symptoms back to their brain, to the familial milieu they live in, and try to figure out each person individually. I found it much more creative than the rest of medicine.” Creativity is a concept that captures Andreasen, especially its link with mental illness. “You’ve got the classic stereotype of the troubled artists, but there has also been a number of prominent scientists who have had mental illness in their family, especially schizophrenia. Einstein had a son with schizophrenia. Bertrand Russell had four relatives who had it, one of whom died by suicide by setting fire to herself.” Published in 1987, one of Andreasen’s first studies after medical school was into the link between creativity and mental illness. She recruited her study group from the university’s highly regarded creative writing workshop, among them authors Kurt Vonnegut and John Cheever. She found that writers had higher rates of creativity and mood disorders in their families than did matched controls. Why does she think that is? “That both creativity and depression ran strongly in these families suggests a biological component, but with so much environmental influence you can’t say anything conclusively”, she says, adding another potential factor: the day-to-day experience of being a writer. “You’ve got a solitary working environment, a great deal of introspection and rejection, and all these things you need to cope with.” After a brief sojourn into mood disorder research, she secured funding to investigate schizophrenia. “Schizophrenia is especially challenging and complex”, she says. “One patient might have one group of symptoms, another might have another, they might have nothing in common in terms of overlap and it puzzled me from the beginning.” Figuring that she “knew a lot about language”,
and that people who are experiencing mania often have disorganised speech, Andreasen created a scale for the early assessment of flawed language and communication. With a nose for nosology, she also created one of the first scales to measure the positive and negative symptoms of schizophrenia. Other firsts in a career peppered with awards and prizes included the first quantitative MRI study of schizophrenia: she identified frontal lobe abnormalities in the brains of patients with schizophrenia versus healthy controls. “When imaging measures came into our repertoires I said ‘boy, wouldn’t it be interesting to do an imaging study of creative people?’”, she says. The problem was how to design a functional imaging task that would tap into creativity. “I had to think about that for a while. I decided that people who are creative probably have an enhanced ability to make connections, or associations, and there is a part of the brain that does nothing but this called the association cortex.” She’d design tasks to stimulate association cortex activity. “I also wanted to cast the net a little wider than just writers this time.” She began recruiting in 2010 and says she’s now recruited 18 highly creative people spanning scientists to writers, Star Wars’ George Lucas to Nobel Laureates, and winners of the Pulitzer prize and the US National Medal of Science (she doesn’t mention it during our conversation but Andreasen has won one of these herself, receiving the award from Bill Clinton in 2000). She’s aiming for 50 participants (25 creative people and 25 matched controls) and hopes to start writing up in 1–2 years. “I want to again look at the relationship between familial creativity and mental illness in the more diverse group and also compare the brains of artists and scientists.” There’s purpose to Andreasen’s investigations. “I wonder if there’s something connecting mental illness and creativity, something that loosens up to a point and gives you genius, but beyond that becomes an impediment”, she says. By emphasising the link between creativity and mental illness, she says, the stigma associated with psychiatric disorders will be lessened, but there’s another reason she wants to explore it. “We need to understand how and why people become creative. Our education system doesn’t do much to enhance creativity, and it’s something that our society needs. Especially in science where there’s a huge need for creative solutions. How can we teach kids to not do things the conventional way and come up with ways of creating important things that improve our lives? Things like, I don’t know, another penicillin.”
Dara Mohammadi www.thelancet.com/psychiatry Vol 4 March 2017
Profile Nancy C Andreasen: creativity and mental illness
For Andreasen’s paper on rates of creativity and mood disorders see Am J Psychiatry 1987; 144: 1288–92
192
Nancy C Andreasen’s journey began in a hospital bed in Iowa City (IA, USA) in 1964. A Professor of Renaissance Literature at the local university at the time, Andreasen had had a puerperal infection after giving birth to her first child, Susan, and was on a 5-day course of intravenous antibiotics. She was finishing her first book, John Donne: Conservative Revolutionary, but it was medicine that was on her mind. “I was lying there, having my life saved by penicillin, and thinking ‘what if I dedicated my life to medicine instead?’”, says the now neuropsychiatrist at the University of Iowa. “All that work I’d put into my book, if I put that into medical research maybe I could come up with something as important as penicillin. I know that sounds grandiose, but I’ve always aimed high.” By the end of medical school it was psychiatry that had caught her attention. “In psychiatry you have unique, individual human beings with different life stories and different constellations of symptoms”, she says. “You need to link those symptoms back to their brain, to the familial milieu they live in, and try to figure out each person individually. I found it much more creative than the rest of medicine.” Creativity is a concept that captures Andreasen, especially its link with mental illness. “You’ve got the classic stereotype of the troubled artists, but there has also been a number of prominent scientists who have had mental illness in their family, especially schizophrenia. Einstein had a son with schizophrenia. Bertrand Russell had four relatives who had it, one of whom died by suicide by setting fire to herself.” Published in 1987, one of Andreasen’s first studies after medical school was into the link between creativity and mental illness. She recruited her study group from the university’s highly regarded creative writing workshop, among them authors Kurt Vonnegut and John Cheever. She found that writers had higher rates of creativity and mood disorders in their families than did matched controls. Why does she think that is? “That both creativity and depression ran strongly in these families suggests a biological component, but with so much environmental influence you can’t say anything conclusively”, she says, adding another potential factor: the day-to-day experience of being a writer. “You’ve got a solitary working environment, a great deal of introspection and rejection, and all these things you need to cope with.” After a brief sojourn into mood disorder research, she secured funding to investigate schizophrenia. “Schizophrenia is especially challenging and complex”, she says. “One patient might have one group of symptoms, another might have another, they might have nothing in common in terms of overlap and it puzzled me from the beginning.” Figuring that she “knew a lot about language”,
and that people who are experiencing mania often have disorganised speech, Andreasen created a scale for the early assessment of flawed language and communication. With a nose for nosology, she also created one of the first scales to measure the positive and negative symptoms of schizophrenia. Other firsts in a career peppered with awards and prizes included the first quantitative MRI study of schizophrenia: she identified frontal lobe abnormalities in the brains of patients with schizophrenia versus healthy controls. “When imaging measures came into our repertoires I said ‘boy, wouldn’t it be interesting to do an imaging study of creative people?’”, she says. The problem was how to design a functional imaging task that would tap into creativity. “I had to think about that for a while. I decided that people who are creative probably have an enhanced ability to make connections, or associations, and there is a part of the brain that does nothing but this called the association cortex.” She’d design tasks to stimulate association cortex activity. “I also wanted to cast the net a little wider than just writers this time.” She began recruiting in 2010 and says she’s now recruited 18 highly creative people spanning scientists to writers, Star Wars’ George Lucas to Nobel Laureates, and winners of the Pulitzer prize and the US National Medal of Science (she doesn’t mention it during our conversation but Andreasen has won one of these herself, receiving the award from Bill Clinton in 2000). She’s aiming for 50 participants (25 creative people and 25 matched controls) and hopes to start writing up in 1–2 years. “I want to again look at the relationship between familial creativity and mental illness in the more diverse group and also compare the brains of artists and scientists.” There’s purpose to Andreasen’s investigations. “I wonder if there’s something connecting mental illness and creativity, something that loosens up to a point and gives you genius, but beyond that becomes an impediment”, she says. By emphasising the link between creativity and mental illness, she says, the stigma associated with psychiatric disorders will be lessened, but there’s another reason she wants to explore it. “We need to understand how and why people become creative. Our education system doesn’t do much to enhance creativity, and it’s something that our society needs. Especially in science where there’s a huge need for creative solutions. How can we teach kids to not do things the conventional way and come up with ways of creating important things that improve our lives? Things like, I don’t know, another penicillin.”
Dara Mohammadi www.thelancet.com/psychiatry Vol 4 March 2017