Rephrasing the madness and creativity debate: What is the nature of the creativity construct?

Personality and Individual Differences 46 (2009) 755–764

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Rephrasing the madness and creativity debate: What is the nature of the creativity construct? Emilie Glazer Department of Experimental Psychology, University of Oxford, South Parks Road, Oxford OX1 3DW, United Kingdom

a r t i c l e

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Article history: Available online 25 February 2009 Keywords: Creativity Schizophrenia Schizotypy Psychosis Bipolar disorder HFA/ASP

a b s t r a c t This paper aims to reframe the debates about the association between creativity and mental illness. For centuries the link between the two has been debated, yet research has largely ignored the underlying nature of creativity in this context. The full understanding of the creativity construct, however, is essential to completely grasp its relationship with psychopathology. Three possible models for the creativity construct are proposed: the existence of different kinds of creativity each associated with specific types of psychopathology, creativity operating as a continuum, and creativity as a single entity. Support for each model is examined among the current literature. It is concluded that all three models are viable possibilities for the conceptualization of the creativity construct, each offering ample predictions and hypotheses for future research. Ó 2009 Elsevier Ltd. All rights reserved.

1. Introduction The knowledge of a link between creativity and madness has persisted throughout history. Socrates and Plato were both aware of the association, while over the past century questions of creativity and madness have entered the world of scientific research, fuelling debates about the nature of this association. Despite its sceptics, it is now generally accepted that the link is empirically grounded. The debate has instead shifted to determining exactly which types of psychosis, either schizophrenia or affective disorder, are connected to creativity. Underlying these questions are intrinsic disagreements within psychiatry research. One of the most controversial subjects is whether affective disorder and schizophrenia are inherently distinct, or the alternative products of the same underlying aetiology. An additional key question that remains unexplored within the current literature is the definition of creativity itself. Most research assumes that creativity is a single construct. But creativity can be conceived in different ways. Paralleling dimensional conceptualizations of psychosis, the creativity construct could extend along a continuum; or it could exist in different distinct and independent forms. Each conceptualization of creativity will lead to specific implications for its association with psychopathology. Identifying the underlying nature of creativity is thus necessary. In this paper, three possible conceptualizations of the creativity construct are proposed, the support for each being assessed from current theories and research. Part I will set out the background for these models, reviewing the consensuses and deE-mail address: [email protected] 0191-8869/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.paid.2009.01.021

bates within the literature about the different psychopathologies and their association to creative ability. Part II will then propose three models for the conceptualization of the creativity construct. Finally Part III will establish their compatibility in evolutionary psychology accounts, revealing the role of creativity in the evolution of human nature. 2. Part I: current state of the field 2.1. Psychoses: categorical versus dimensional perspectives The classification of the different psychoses carries important implications for the association of mental illness with creativity (Claridge, 1998). Views on the distinction between the two major psychoses, affective disorder and schizophrenia, provide the parameters for any research using these concepts, thereby constraining investigations on the link between psychopathology and creativity. Kraepelin (1919) first formally described and distinguished the psychopathologies dementia praecox and manic-depression. Later, the latter term was called bipolar disorder, while Bleuler (1911/1950) renamed dementia praecox as the ‘schizophrenias’, the plural noting the definition’s inclusion of a spectrum of psychopathologies. Schizophrenia is now described as a disorder, recognized by a specific combination of positive and negative symptoms instead of a single neurobiology. It is more pervasive than affective disorder, and has a wide spectrum of impairments of mental functions affecting the individual’s perception, language, thought, emotion and motivational capacities. It has a chronic course with recurring psychotic episodes. Bipolar disorder on the

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other hand consists of alternative episodes of mania and depression. During each, psychotic symptoms can occur, with periods of seeming normality between each state. The Kraepelinian distinction between affective disorder and schizophrenia is still a common assumption, reflected in their official listing as different illnesses in both ICD-10 and DSM-IV manuals. However, the Eintheitpsychose, or unitary psychosis theory (a theory which has varied in popularity throughout history), and a mounting body of evidence failing to detect statistical significance between the two forms of psychosis at a symptoms level (Kendell, 1991), provide a strong argument for the opposite dimensional perspective: viz that both affective disorder and schizophrenia are only superficially distinct, in reality rising from a single form of insanity. Crow (1986, 1991) provides an interpretation of this perspective, suggesting a dimensional model of psychosis ranging from normality through to affective disorder with schizophrenia at the extreme. Similarly, other researchers have proposed a continuum extending from normality to borderline states, ending at the fullblown manifestation of a particular psychosis. Stemming from personality psychology, a third influential interpretation proposes that the interaction of the personality variables, extraversion–introversion (E), neuroticism (N), and psychoticism (P), accounts for the existence of different kinds of psychoses along such a dimensional model (Eysenck, 1952, 1992). 2.2. Creativity and madness The association between madness and creativity was first scientifically addressed by Lombroso’s (1985) ‘The Men of Genius’. Although many of the book’s ideas are inherently flawed, Lombroso insightfully acknowledged an empirical relationship between creativity and a predisposition to mental illness. Psychobiographical studies in the latter half of the 20th century began to directly test this contention. For example, Jamison (1993) revealed the rate of mood disorders, suicide and institutionalization to be twenty times that of the normal population at the time in a sample of major British and Irish poets between 1705 and 1805. These studies demonstrate the greater prevalence of psychosis among the eminent creators of the past compared to the general population, suggesting an empirical link between madness and creativity. Along with these retrospective historical analyses, studies examining living eminent creative individuals and conversely psychiatric patients have also been conducted. This research confirmed the association, propelling the field into a new debate. Questions of the reality of the link between creativity and madness were replaced with studies investigating which forms of madness are associated with creativity. During most of the 20th century the association was thought to lie in the schizophrenic spectrum. More recently researchers have argued that creativity is instead linked to affective, particularly bipolar, disorders. Representing these opposing perspectives, Jamison (1993) claims that creativity is only associated with affective disorders while Sass (2001) refutes this narrow view and argues for a more systems approach, acknowledging the contribution of culture and societal norms to the controversy. Despite these debates most theorists, such as Claridge, Pryor, and Watkins (1998), for example, agree that it is not the full-blown illness itself, but the milder forms of psychosis at the root of the association between creativity and madness. The underlying cognitive styles and personality traits linked with mild psychopathology enhance creative ability; in their severe form they are debilitating.1 1 Researchers however are careful to note that creativity is not dependent on madness, and that psychopathology does not necessarily imply high creative ability. The observation of mental illness in the eminent does not undermine their work; it only completes our understanding of their unusual original world view.

Studies have determined a correlation between creativity and the milder ends of the schizotypy scale (e.g. the schizotypial personality) or the bipolar spectrum (e.g. hypomanic or cyclothymic traits). Schuldberg, French, Stone, and Heberle (1988) for instance demonstrated a positive correlation between undergraduate students with positive schizotypy and creativity test performances. Consistent with such dimensional perspectives, Eysenck (1993) proposed one of the most influential theories in the field. He claimed that his psychoticism (P) personality dimension is directly related to creativity, the association being mediated by high divergent thinking and low inhibition, governed by raised levels of nervous system dopamine. Studies have also examined the heritable nature of the association between creativity and madness, proposing that a genetic component underlies the association. If an empirical link between creativity and mental illness can be attributed to genetics, normal relatives of the mentally ill may carry similar psychotic traits, only in milder forms. The presence of the underlying cognitive style associated with these may thereby predispose and enhance creative ability. Karlsson (1970) supported this contention, finding that first degree relatives of psychiatric patients, admitted to a hospital in Iceland between 1851 and 1940, were twice more likely than the normal population to work in creative professional fields. Along with similar studies, these results have further cemented the conviction within the field of an empirical link between mental illness and creativity. Finally, researchers have pondered the causal relationship between creativity and mental illness. Does psychopathology directly lead to creativity? Or is it the reverse effect? There are a number of causal possibilities, all of which have been shown to prevail in certain individuals and at particular times. Richards and Kinney (2000) posited five scenarios: psychopathology either directly or indirectly leading to creativity, creativity either directly or indirectly projecting onto psychopathology, or a third external factor affecting the relationship, such as a family liability for mental disorder. Ludwig (1995) also tackled the question, suggesting four possibilities: psychopathology causing either a decrease or an increase in creativity, and creativity potentially issuing in an enhancement or assuagement of the psychopathological symptoms suffered by an individual. However it is conceived, the relationship between creativity and psychopathology is complex, differing among the individuals in question, the nature of the illness and the environmental factors involved. 2.3. Research limitations Although current research provides convincing evidence for a link between creativity and madness, many studies are biased by the individuals who conduct them, and by the sources from which the samples are obtained. Biographical investigations for instance are limited by their retrospective methodology. Researchers draw references from autobiographies and historiographies, both unreliable sources often tainted by authors’ biases. Studies where researchers assess the level of creativity and mental illness in participant samples are also flawed. For example, Andreasen’s (1987) interviews were conducted by herself, the ratings of her sample neither independent nor controlled. Jamison (1989), herself had neither controls nor attempts at differential diagnosis in her investigation of psychopathology in her sample of British playwrights and poets. Limitations also exist in the distinct fields of creativity and psychiatric research. As reviewed, current measures for classifying disorders are still unreliable and controversial. The fact that the DSM and ICD manuals only represent the current psychiatric consensus reflects the inconclusive state of agreement about mental illness classification. Debates also inhabit creativity research, most impor-

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tantly surrounding the basic definitions of creativity itself. Furthermore current creativity tests have poor reliability and validity (Claridge et al., 1998), as well as being based on a variety of measures all making certain implicit assumptions. Often, researchers assume that simple creativity tests of divergent thinking indicate all creative potential, a fact that may be inherently flawed. If different kinds of creativity exist, perhaps divergent thinking tests only tap into a certain kind of ability, leaving other types undiscovered.

3. Part II: the creativity construct The existing literature of the link between madness and creativity demonstrates that a complete understanding of these constructs, particularly about creativity itself, is a research path still to be fully explored. Part II proposes a framework for this research, suggesting three different possible models of the creativity construct. 3.1. Different creativity associated with different madness The assumption in this section is that whatever the causal relationship between creativity and madness, the creative ability found within an afflicted individual is intrinsically linked to the predisposing psychopathological traits. Based on this contention, it is possible that individuals with particular psychoses exhibit a different kind of creativity compared to an individual with a different type of psychological disorder. This section explores these hypotheses, both in terms of the existence of different kinds of creative ability within different domains, and among different types of mental illnesses. 3.1.1. Schizophrenia versus affective disorder: different kinds of creativity for each? The debate about which psychoses are related to creative ability can be used to support the proposal of the existence of different kinds of creativity. Jamison’s (1993) and Sass’ (2001) opposing perspectives provide such a platform. Assuming the existence of only one type of creativity, Jamison (1993) claims that creativity is related only to affective disorder, her sample of eminent creators yielding a much higher prevalence of affective disorder than the general population, and a non significant presence of schizophrenic psychoses. She suggests that each mood experienced in affective disorder provides specific contributions to creative ability. Mild manic periods enable high energy, rapidity, flexibility and fluidity of thought, the cognitive aspects of hypomania paralleling imaginative thinking. Depression allows the meticulous refinement, focus and organization of the wild ideas formed during the manic period. Fluctuating between these two mood states allows the individual to experience a range of human emotions, placed in the unique position to express basic human universals, facilitating an empathic relationship with the audience. Andreasen and Powers’ (1974) study, where creative writers’ thinking style more closely matched that of affective disorder rather than schizophrenic patients, and Richards and Kinney’s (1988) finding that a higher than normal prevalence of hypomania and cyclothymia correlated with creativity and professional success in first degree relatives of bipolar disorder patients, provide further support. Although Jamison’s (1993) theory is supported by such research, the creativity of individuals with affective disorder may not be a universal manifestation of this capacity, but instead could be a specific form of creativity, distinct to the traits of that particular psychopathology. Sass (2001) argues this point, drawing on the history of the debate to explicitly suggest a distinction between the types of creativity produced by different psychopathologies. Sass (2001) notes that all the eminent individuals used in Jamison’s

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(1993) samples, such as William Blake (1757–1827) and Lord Byron (1788–1824), lived during the Romantic period (late 18th and early 19th centuries). During this time creators refuted earlier views of the Enlightenment, where madness was ostracized, now accepting and even encouraging its connection with creativity (Becker, 2001). The stereotype of the genius’ temperament mirrored affective disorder, suggesting that eminent individuals during this period were likely to have been afflicted with this acceptable psychopathology. In turn, the underlying traits of mood disorder probably contributed to the florid, expansive, and emotive style of the Romantics. Ruskin (1819–1900) and Byron’s work are examples of this interaction. Jamison’s (1993) findings thus only reflect the cultural expectancies and constraints imposed during the Romantic period from which her eminent sample was drawn. Conversely schizophrenia leads to an opposite and distinct type of thinking. Individuals experience a sense of alienation, hyper selfconsciousness, detachment and affinity for non-conformist thought. These are at odds with the philosophy bred during the Romantics, accounting for the paucity in findings of schizophrenic tendencies in geniuses of that time. However, schizophrenic traits share many features with the 20th century Post-Modernist movement which demanded an identical removal of the individual from the constraints of social norms to observe the world in a completely objective way. A plethora of 20th century geniuses, such as Dalí (1904–1989) and Kafka (1883–1924), have been diagnosed as being on the schizotypy spectrum. The fact that the Romantic and Post-Modernist cultures, two distinct historical climates, have fostered, accepted and deemed creative different styles of thought – each correlated with a specific type of mental illness – suggests an inherent distinction in the types of creativity associated with particular psychopathologies. Sass (2001) recognizes that the term ‘creative’ is intrinsically intertwined with cultural boundaries and social interpretations. Based on Kuhn’s (1970) theories, Sass (2001) further distinguishes between the two types of creativity obtained with affective disorder and schizophrenia. Kuhn (1970) separates ‘normal’ and ‘revolutionary’ science, a dichotomy that according to Sass (2001) can be extended to any domain. ‘Normal’ creativity involves puzzle-solving within a prevailing cultural paradigm; while the ‘revolutionary’ demands a creativity transcending cultural and domain boundaries, forming new paradigms that alter the face of an existing field. Sass (2001) argues that both ‘normal’ and ‘revolutionary’ work harness different kinds of creativity, each linked with a specific psychopathology. Individuals with affective disorder are preoccupied with cultural norms: manic states claim grandiosity within a social hierarchy, and depressed individuals have a heightened sensitivity to social phenomena. Hence, affective disorder perpetuates creativity limited to the ‘normal’. Meanwhile, the schizoid person is predisposed to a sense of detachment from the world, free from social boundaries and able to consider alternative frameworks, producing creativity within the ‘revolutionary’ sphere (Storr, 1972). Newton (1643–1727) and Einstein’s (1879–1955) schizotypal orientation for instance, enabled their revolutionary stamp in the sciences. Contrary to Jamison’s (1993) view that the schizophrenic is devoid of imagination, Sass (2001) proposes that schizophrenia enables a more superior and innovative form of creativity compared to affective disorders. It is ironic that this can be supported by Goodwin and Jamison’s (1990) findings that in three quarters of the research a positive correlation exists between individuals with affective disorder and the upper class. These individuals are deeply bound by social hierarchies and norms, breeding a type of ‘normal’ mentality constrained by these cultural structures. Csikzentmihaly’s (1998) systems perspective on genius further supports Sass’s (2001) views. Csikzentmihaly (1998) claims that a piece of work is only officially creative once it has been accepted and judged so by individuals within a culture or a domain. With

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varying times and cultures, different types of creativity and thereby their association with specific mental illness, will vary in their acceptability. Sass’s (2001) arguments and the Kuhnian (1970) dichotomy can be merged within this overarching perspective. Because of its operation within pre-existing parameters, ‘normal’ creativity, made by individuals with affective disorder, will more likely be judged creative by any relevant society than ‘revolutionary’ work, created by individuals with schizophrenic tendencies. There will thus be greater amounts of ‘normal’ creative products than ‘revolutionary’ work, and by extrapolation a generally higher prevalence of affective disorder creative individuals, with a smaller number of creative geniuses on the schizophrenic spectrum occupying the highest tier of eminence. These differences are not due to varying extents of the psychopathologies’ association with creativity. Instead, they are a result of their intrinsic association with different kinds of creative ability. 3.1.2. Creativity and autism Less often discussed in questions of creativity and madness is how the presence of creativity in other mental illnesses can enrich our current understanding of creativity in general, and by default illuminate our understanding of its connection with psychosis. If indeed different types of creativity are associated with different types of madness, the creativity associated with other mental illnesses will yet again be different from that described with schizophrenia or affective disorder. The link between creativity and high functioning autism (HFA) provides such an example. Originally suggested by Baron-Cohen, Leslie, and Frith (1985), the general consensus among autism researchers is that creativity cannot be associated with autism: the characteristic theory of mind and imagination deficit hindering any creative capacity. In contrast, Fitzgerald (2004) argues that this limitation prevails only for low-functioning autism. High-functioning autism (HFA), however, is distinct. For Fitzgerald (2004) it is in fact joined with Asperger’s syndrome (ASP), to be grouped together and termed as ‘‘HFA/ASP”. Indeed, HFA/ASP is related to a specific kind of creativity, untapped and distinct from that tested in diagnostic manuals (DSM-IV; American Psychiatric Association [APA], 1994) and mentioned by Baron-Cohen and Craig (1999). Fitzgerald (2004) distinguishes between autistic imagination, or an advanced ‘folk physics’, held by eminent geniuses showing signs of HFA/ASP such as Einstein (1879–1955), and social imagination or ‘folk psychology’, absent in these individuals and masking their genius. Fitzgerald (2004) characterizes autistic intelligence as being linguistic, spatial, musical, and logical, with an interest in abstraction, logic and science. Generally HFA/ASP eminent individuals’ work lies within the domains of mathematics, philosophy, and the sciences. Fitzgerald (2004) argues that the genius of HFA/ASP creators is inherently tied to these individuals’ genes. The characteristic HFA/ ASP personality traits significantly contribute to these individuals’ creative work. Many features enhance creativity, such as intense focus on a particular topic, high energy, motivation, and a strong compulsion to understand the world. Stemming from an unconventional mental state detached from cultural and societal paradigms, HFA/ASP individuals tend to reject current world views while becoming experts in their domain. Their intelligence is pure and original, highly similar to that of truly creative mentalities. Fitzgerald (2004) claims that such features are the result of a stunted development of a representation of the self, from an inability to use narrative thinking styles and form social relationships. The deficit may also arise from an impaired capacity to integrate sensory input to form functional representations of the world across different modalities. This associative ability is crucial in general accounts of the creative process demanding the formation of original and novel connections. Hence creativity in HFA/ASP individuals operates by a completely different process. The

philosopher Wittgenstein (1889–1951), whom Fitzgerald (2004) diagnosed with HFA/ASP, provides an example of this characteristic detachment from the self, in writings based on a sense of self disconnected with the world. Fitzgerald’s (2004) proposals can in fact be supported by Baron-Cohen, Bisarya, Gurunathan, Richler, and Wheelwright’s (2003) later research based on the E-S theory of autism. Suggesting the presence of an inherent human dichotomy between ‘empathising’, or affective capacities, and ‘systematizing’, the drive to analyze detail and construct systems (a mental operation demanded in the quantitative domains of mathematics and the sciences), HFA/ASP individuals have been found to display superior systematizing capacities. Baron-Cohen et al. (2003) demonstrated higher HFA/ASP scores on the systematizing quotient than on the empathising quotient scales, as well as finding that university students in the scientific, rather than humanity domains, have a higher score on the autistic spectrum quotient (Baron-Cohen, Wheelwright, Skinner, Martin, & Clubley, 2001). The higher systematizing, and thereby scientific abilities attributed to HFA/ASP individuals (Baron-Cohen et al., 2003), parallels Fitzgerald’s (2004) thesis, associating this mental disorder with a unique cognitive style, predisposing to a specific type of creative work. Both theories support the existence of different types of creativity, each associated with particular psychopathologies. 3.1.3. The sciences and the arts The distinction between the domains of science and the arts suggests a deeper differentiation in the creative capacity harnessed in each. Fitzgerald’s (2004) views and Baron-Cohen et al.’s (2003) findings propose the particular creativity found in individuals with HFA/ASP relates to the sciences, confirming a degree of specificity to the type of creativity involved in that domain. Moreover Sass (2001) identifies intrinsic differences between the types of creativity linked to each of the psychoses. Perhaps these can also map onto the different kinds of creative ability required for particular domains. Post’s (1994) study, examining 291 eminent and creative men in different fields, provides an initial demonstration that the creativity related to the science and the arts interacts with different kinds of mental illness. Of his sample, 69% had a mental disorder of some kind. Scientists were the least affected, while artists and writers had elevated diagnoses of psychosis. This difference suggests that the kinds of creativity demanded by each domain are not equivalent, each associated with a particular configuration of psychopathological traits. Investigations about the link between mental illness, creativity and IQ provide further clues. Testing the correlation between IQ and creativity traits, Guilford (1968) found that symbolic and semantic divergent thinking, linked to creativity in writers and scientists, was correlated with a higher IQ than figural divergent thinking, which was more closely related to creativity in the visual arts, harnessed by artists and musicians. Certain forms of creativity are thus distinct, each requiring different levels of IQ. The relationship between IQ and specific creativity domains can account for differences in the associations of psychopathology with each of these modes of creativity. While Guilford (1968) demonstrated that higher levels of IQ are related to creativity in the sciences, Claridge et al. (1998) have noted that high IQ can protect from the full-blown development of psychopathology. As such, creators in the sciences are more protected from severe mental illness, compared to a lower and thus less protective association with IQ in the arts. Posts’ (1994) study supports this prediction of a higher prevalence of psychopathology in the arts compared to the sciences. Claridge et al. (1998) also suggest that various types of artistic creativity map onto different aspects of psychosis. Schizophrenia, with strong links to language and thought disorders, is associated

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with creative writing. Painting and musical composition, relying on sensory and perceptual processing, are created through a different form of thought to language and thus mediated by different creative processes. For each of these types of creative expression, emotion based traits have different effects on the outcome, influencing and shaping different stylistic forms within different domains. Scientific creativity harnesses yet another type of processing. Chadwick (1992) linked theory building demanded in scientific original thinking to the schizophrenic delusional thought processes, claiming the two operate through similar mechanisms. Thus, convictions about the truth of scientific theories parallel schizophrenic patients’ firm belief in their delusions, and may share the same grandiosity of thought. The main difference between delusions and scientific theory building is that the latter is grounded in reality and rational awareness. Along with Claridge et al. (1998), Prentky (1980) is one of the few researchers to explicitly address the possibility of different types of creativity for the science and art domains, each associated with separate psychopathologies. Prentky (1980) proposes a dimensional model of psychosis and creativity within a neurocognitive information processing framework. Each end of his spectrum governs a different type of creativity, the middle being the ‘normal range’ for ambicognitive thought processes. On one end of the spectrum are withdrawn or C (concrete) type psychotic thought disorders, with low tonic arousal, low distractibility, strong attentional focus, and a tightening of ideational boundaries (underinclusive thinking). This person type is analytical, focuses on problem solving of critical relations, meaningful and unexpected anomalies, showing schizoid-like symptoms (such as flat affect, withdrawal, and apathy). Meanwhile at the other extreme are active or A (abstract) type psychotic disorders, sharing symptoms with affective disorders, showing high tonic arousal, high distractibility, weak attentional focus, and a loosening of ideational boundaries (such as overinclusive thinking). Supporting Prentky’s (1980) creativity model, Brod (1997) proposed that certain schizotypy profiles map onto Prentky’s A or Ctypes. ‘Introverted Anhedonia’ mapped onto C-type personalities, the creativity of these non-clinical types characterized as having highly ‘incestuous’ connectivity in its information processing contents, producing goal-directed, scientific, and philosophical products. At the opposite end of the spectrum, Brod (1997) found that ‘Cognitive Disorganisation’ best mapped onto the A-type personal-

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ity. This profile leads to a more open-ended creativity, the individual struggling to constrain and control the flow of ideas and association of emotions, leading to creativity with emotional references and symbolism use, relevant to poetry, literature, dance, and musical composition domains. Using schizotypy theory, Brod (1997) and Prentky (1980) therefore distinguish between two separate personality profiles each leading to different, though equally creative, abilities and outcomes in specific domains. Taking these findings one step further, Nettle (2006) tested normal individuals from the different creative disciplines with the OLIFE questionnaire scale assessing schizotypal profiles. Individuals in the artistic domains showed positive schizotypal traits, greater unusual experiences and lower introverted anhedonia than controls, while individuals specializing in mathematics and the sciences showed higher scores in the negative schizotypal traits such as the introverted anhedonia dimension, matching Brod’s (1997) findings. Different constellations of psychopathological traits lead to specific cognitive styles, and correspond to distinct abilities in different creative domains. 3.2. Creativity continuum Alternative to a model with a rigid divide between the types of creativity among different disorders and domains, suppose creativity existed along a spectrum, existing along two separate and individual axes, similar to dimensional views of psychoses (see Fig. 1). Axis A corresponds to the extremities of creativity ranging from everyday creativity to the genius work of the eminent, reminiscing Kuhnian (1970) distinctions. Axis B extends from creativity of the sciences to creativity harnessed in the arts. An individual’s personality traits, underlying psychopathological tendencies, environmental factors and cultural context interact non-linearly to determine the individuals’ position along the axes. Depending on the specific configuration and interaction of these factors, the individual will fall within one of the four quadrants, so that either everyday or eminent creativity types are possible within every domain. The likelihood of psychopathological tendencies increases as axis A extends from the everyday to the eminent. This does not imply that all eminent creators have psychopathological traits; it only suggests a higher probability of displaying these tendencies compared to the normal population at the everyday creativity end. Axis B’s relationship with psychopathology is perhaps similar to the sci-

Axis A eminent creativity

Axis B science domain creativity

art domain creativity

everyday creativity Fig. 1. The continuum model for the creativity construct. Axis A extends from everyday creativity to eminent creativity. Axis B ranges from creativity in the sciences to that of the arts. As axis A tends towards eminent creativity there is a higher likelihood of psychopathological traits. Psychopathology interacts along axis B to influence the individual’s involvement with particular creative disciplines.

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ence and art creativity distinction arguments discussed earlier. Differing extents and types of psychopathological tendency interact with domain demands, as well as the above variables, to influence an individual’s position along the axes. 3.2.1. Axis from the everyday to the eminent: the example of Outsider Art Outsider Art, first coined by Jean Dubuffet (1901–1985) as ‘Art Brut’ (literally ‘Raw Art’), is the creative work produced by individuals naïve to the art world. Resistant to ‘codification’, (Cardinal, 2006), Outsider Artists are generally autonomous, passionate, focusing on their interior existence, often preferring an autisticlike comfort in the private rather than communication with the external world. They work with a compulsion to express, to ascribe order and to adorn. Identified as unique, yet separate from recognized art movements, Outsider Art has always been placed on the fringes of the discipline. Although rarely recognized by the mainstream, the mentally ill nevertheless provide the most prolific examples of Outsider Art. The marginalization of Outsider Art suggests a distinction between art of the mentally ill versus that of eminent artists. However, Outsider Art played a significant role in 20th century Modernism. Strong parallels exist between qualities characteristic of Outsider Artists and artists of the Modernist movement. Modernism was intent on breaking conventions, ignoring social norms, and extreme self-awareness (Cardinal, 2006). Outsider Art, with its characteristic naivety and detachment from the world, fulfils these stipulations more so than any other group of artists at the time. That artists such as Kandinsky (1866–1944), Paul Klee (1879– 1940) and Picasso (1881–1973) were inspired by work from this demographic further supports the lack of a distinct separation between the two creative groups. Thompson (2006) argues that Outsider Artists’ creativity is similar to any Modernist artist: both objectify thought, providing novel and original interpretations of the recognizable world. It is thus increasingly seen as a facet of Modernism as opposed to a category distinct from any particular movement. Placing Outsider Artists and Modernist geniuses on the creativity continuum can resolve the changing perspectives on the relationship between the two groups. Both Outsider Art and Modernism fall within the artistic domain, and so are equally placed on the right-hand side of axis B in Fig. 1. Of particular interest is their differing position along axis A, extending from everyday to eminent creativity with an increased likelihood of psychopathology. Past research, however, has established that full-blown mental illness is debilitating for creativity. Hence along axis A, past eminent creativity and thus with a heightened probability of psychopathology, a unique creative type can be conceived, producing work of associations so remote that it is unrecognizable. Work of the ‘Art Brut’ or mentally ill such as Madge Gill (1882–1961), exists beyond the eminent, between this stage and the incoherent works of individuals with higher probabilities of psychopathological tendencies. Meanwhile, universally recognized Modernist artists, such as Picasso, exist at the eminent stage of the continuum (Fig. 2). Because both Outsider Art and mainstream Modernists lie on a gradual continuum, the establishment of a severe distinction between the two would be an unnecessary and impossible enterprise.

everyday creativity

eminent creativity (Picasso)

Both are creative, distinguished only by an interaction with different extremes of probabilities of psychopathological traits and thus operating by different processes. The inclusion of Outsider Art as a particular manifestation of Modernism supports this continuum model, especially in terms of Csikzentmihaly’s (1998) systems perspective: creativity drives cultural evolution, so that perceptions of creativity vary and develop with time. Critics’ increasing recognition of Outsider Art is a result of this evolution. 3.2.2. Continuum models in the literature Support for the continuum model of creativity can be found in the existing literature. Schuldberg’s (2001) dynamic systems approach is an extreme form of the dimensional model, supporting the necessity for a more flexible approach to the relationship between creativity and madness compared to the either/or view of previous research. Schuldberg (2001) suggests a curvilinear view, where continuous cognitive and affective dimensions underlie creative production. The fluctuations in individual personality differences, cognitive style and behaviour are non-linearly linked with varying dimensions of creativity, leading to a chaotic system with unpredictable outcomes. This system always has a different starting point with large and diverging effects on the course and outcome, leading to ‘serendipity’. Paths never return to the same place while in the same direction, which produces ‘novelty and originality’, while the behaviour of a chaotic system manifesting self-similarity, symmetry, and scaling phenomena fractal properties, allows a recognizable ‘style’ of an individual’s work (Ludwig, 2000). Creativity is thus a complex, unpredictable process, influenced by a number of variables, producing novelty and original possibilities. Also compatible with continuum models is Simonton’s (2000) Darwinist perspective of creativity and psychopathology, where the creative process is assumed to be analogous to natural selection. Some domains of creativity – e.g. the sciences – have intrinsic restrictions on the range of ideational variations permitted; others, for example the arts, are less restrained. Meanwhile, an individual’s tendency towards psychopathology influences the extent of their ideational variation. Simonton (2000) hypothesizes that along a continuum of psychopathological tendencies science disciplines rest at the low end of the spectrum, interacting with a lesser degree of psychosis, and extending from the Kuhnian (1970) ‘normal’ to the ‘revolutionary’ (see Fig. 3). Art follows, tending towards a higher degree of psychopathological traits, the avant-garde existing at a higher extent of psychosis than academic work. For the continuum model proposed in this section, Simonton’s (2000) proposals imply that individuals at the scientific creativity end of axis B will have a lower probability of demonstrating psychopathological tendencies compared to the artistic creativity extreme. With an increase in psychopathological tendencies, the general unconventional nature of creative work also increases. This holds for both the sciences, from the ‘normal’ to the ‘revolutionary’ and the arts from the ‘academic’ to the ‘avant-garde’. The sciences interact with lower psychopathological tendencies, while the arts exist at a higher prevalence of psychopathological tendencies. Moreover the diagonal slant representing each domain category reflects a higher presence of creative genius with greater psychopathological tendencies.

Outsider Art (Madge Gill)

unrecognizable creativity

Fig. 2. Outsider Art on axis A. Axis A ranges from everyday creativity, through to the eminent and finally to the unrecognizable, with remote creative associations that extend past culturally recognizable work. As the axis extends from the everyday to the eminent and beyond, there is an increasingly higher likelihood of psychopathological tendencies. Outsider Art fits this continuum model, existing in-between the eminent and unrecognizable creativity and probability for psychopathological traits.

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Creative genius

Science Normal Revolutionary

Art Academic Avant-Garde

HIGH

G

LOW LOW

HIGH

Psychopathological tendencies Fig. 3. Simonton’s (2000) Darwinist perspective. With an increase in psychopathological tendencies, the general unconventional nature of creative work also increases. This holds for both the sciences, from the ‘normal’ to the ‘revolutionary’ and the arts from the ‘academic’ to the ‘avant-garde’. The sciences interact with lower psychopathological tendencies, while the arts exist at a higher prevalence of psychopathological tendencies. Moreover the diagonal slant representing each domain category reflects a higher presence of creative genius with greater psychopathological tendencies.

Ludwig (1995) provides evidence for Simonton’s (2000) model in his investigation of the incidence of a variety of psychopathological conditions in a sample of eminent modern achievers from a broad range of professions and domains. Eminent individuals consistently showed a higher rate of mental illness compared to the normal population. For example the incidence of mania in the general population was found to be 0.8%, while that of the eminent sample was 7%. Within this group, artistic professions had a higher incidence of mental illness than investigative types, including the sciences. As Simonton (2000) predicted, this suggests different interactions of creativity with psychopathology across the different domains, the sciences interacting with a milder mental illness configuration than the artistic extreme. Whether this is purely a result of the different expectancies and demands from each domain, or an intrinsic difference in the creative process remains to be established. 3.3. Creativity as a single construct While the proposed models discussed above treat creativity as a variable concept, many current theorists in the field assume that creativity is a single construct, though different measures and terms have been attributed to the creative process, and each has generated certain debate. Perhaps these assumptions are indeed based on empirical fact. Observed differences in creativity may only reflect a perceived superficial distinction, with a single underlying cognitive process at the root of every creative work. 3.3.1. Different names, one construct The many terms used to quantifiably describe creative ability can all be seen to converge on the same single cognitive process. Divergent thinking is one of the main cognitive processes described as underlying creativity. The ability to generate multiple solutions to a problem (Guilford, 1968) is tested in divergent thinking tasks: participants produce a range of solutions to an open-ended problem with no apparent solution, nor a single correct response (for example identifying alternative uses for an item). Creativity is also described as underpinned by a capacity for associative thinking, or the novel combination of remote elements; the more remote the elements, the more creative the process and outcome (Mednick, 1962; Spearman, 1931). Eysenck (1993) conceived of this in terms of horizons. A person with a

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wide associative horizon deems more associations relevant to a particular task. ‘Overinclusive thinking’ is another component of Eysenck’s (1993) theory identified as key to the creative process. High scores on the psychoticism (P) personality dimension correlate with performance on ‘overinclusive thinking’ tasks, marking high creative ability (Cameron, 1938). However, originally coined to describe the characteristic cognitive style of schizophrenic individuals – and later noted in affective disorder – ‘overinclusive thinking’ has been characterized as a dysfunction where irrelevant thoughts intrude into an individuals’ awareness, hindering their ability for rational problem solving. As a creative measure, ‘overinclusive thinking’ is thus debatable, with theorists such as Csikzentmihaly (1993) noting that it is primarily a debilitating conceptual disorder instead of a fruitful cognitive process. Despite the controversy, Andreasen and Powers (1974) found high ‘overinclusion thinking’ in their sample of creative writers, and Griffith, Mednick, Schulsinger, and Diderichsen (1980) demonstrated more deviant associations in children of schizophrenic parents, implying that it is a cognitive style tied to the predisposition to psychotic traits. ‘Overinclusive thinking’ thus implies an abnormally high access to a range of thoughts, as envisaged in other descriptions of creativity. Thus, divergent thinking and associative models incorporate this basic idea, claiming that the creative individual forms novel combinations of otherwise distinct concepts. Another conceptualization of creativity is Rothenberg’s (1993) Janusian process, the ability to simultaneously consider multiple opposites. It is the first of a three stage process contributing to creative work, the following homospatial and articulation stages manipulating Janusian mental imagery and structuring thoughts in organized representations. Rothenberg (1983) found that Nobel Prize scientists and creative students produced a greater number of opposite word associations, a Janusian process test, than did low creative potential students and psychiatric patients. With the low creativity among psychiatric patients possibly due to a small sample size and severe manifestations of psychopathology, this study suggests Janusian processes and thus cognitive association mechanisms account for creativity. Psychoanalysis provides yet another description of creativity. First described by Freud (1958), primary process thinking is an early primitive system of thought, below conscious awareness, driven by basic human instinct and free from formal thinking constraints. It allows fluidity of thought, flexibility in the search of ideas and associations, and facilitated divergent thinking. Kris (1952) claimed that creativity arises from the ability to regress and tap into primary process thought, relating it to the more mature, rational secondary process thinking. A defocused attention is thought to lead to this heightened access (Russ, 2001). Russ (1987) further conceived of primary process thinking as a subtype of affective content in cognition. As such, different disorders interact with primary process thinking in different ways. Schizophrenia involves the more cognitive aspects of primary process thought, while mood disorders harness the more affective. Mental illnesses thus interact differentially with a single core underlying creative ability to produce different creative outcomes. Martindale’s (1989) theory on creativity complements primary process thinking. According to Martindale (1995, 1999), creativity arises from the oscillations about a continuum of two poles. One pole involves analogical, free associations and concrete, irrational thinking. It is characterized by defocused attention, low cortical arousal, and is the area where creative insight occurs. The other pole involves logical, abstract, reality oriented thinking with focused attention, higher levels of cortical arousal, and the verification of creative ideas. Creativity thus arises from fluctuations in attentional focus, types of thought, and general levels of cortical activation. The bipolar disorder profile parallels this, since the

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creative individual gains insights from manic flights of ideas, while mildly depressive phases enable their structuring into meaningful products (Jamison, 1993). Moreover, the change of cortical arousal state agrees with primary process thinking and the Janusian creative process. Flitting between cortical states allows the achievement of the Janusian process, conceiving of different mindsets and representations simultaneously. Meanwhile, the pole of free associations and irrational thinking is comparable to primary process thinking. These processes can also be seen as being underpinned by associative models and divergent thinking. Martindale’s (1989) changing physiological states leads to primary process thinking which facilitates divergent thought. Meanwhile the Janusian process can be conceived as a component of divergent thinking and associative creativity models. Thus, a single creative construct is possible given the current theories. That recent evidence now demonstrates possible genetic and physiological underpinnings for the creative process, specifically concerning dopamine and serotonin receptors in the central nervous system (Martindale, 2000), also suggests a single neural process underlying creativity. 3.3.2. One core process across different illnesses and domains? Granted, the different terms for the creativity construct may all relate to a single entity, but is this core process harnessed in both the sciences and the arts? Claridge (1993) argues so, claiming that only the particular demands of each domain lead to different manifestations of creativity. The Arts allow freedom of cognitive association exploration, while the sciences, led by empirical and objective observation, impose stronger limitations to the creators in the field. Hence, although specific patterns of psychotic traits mediate the creative process for each domain, the underlying core ability is the same. Rothenberg’s (2000) Janusian process is equally compatible with a single creativity construct across domains. Both Janusian and homospatial processes, essentially part of the same creative core, allow different types of reasoning each issuing in particular outcomes. The Janusian process leads to analogical reasoning of particular relevance to the arts. Similarly scientific creativity is aligned with reasoning derived from the homospatial process, allowing figurative and abstract representations from the active conception of discrete entities occupying the same space. The distinction between everyday and eminent creativity also accommodates a single creative core construct. Though Richards (1993) distinguishes between the two, she notes shared features, implying a unitary creative root, differing along these extremes only in levels of cognitive capacity. A single underlying creative core can also exist among different psychopathologies. As previously outlined, both schizophrenia and affective disorder seem to facilitate distinct creative work. However, different creative outcomes must be distinguished from the underlying creative process. Variations in the manifestation of creativity may depend on an individual’s predisposed psychopathological configuration; but the creative process itself, involving associative and divergent thinking, is the same whatever the mental illness. The example of HFA/ASP for the intricate link between a particular mental condition and creativity can also be interpreted from this opposite perspective. HFA/ASP has much in common with schizophrenia, sharing symptoms, such as a ‘loss of contact with reality’ (Ogilvie, 2001), and recently demonstrating an empirical overlap with schizotypy, with evidence of a positive correlation between the Baron-Cohen AQ and the O-LIFE Introvertive Anhedonia scale (Rawlings, 2008). Both disorders demonstrate an overlap in the type of creativity produced, and exhibit a certain degree of interchangeability in the eminent creators diagnosed with either illness. Fitzgerald (2004) claims Wittgenstein has HFA/ASP, yet Ogilvie (2001) cites the philosopher as exhibiting schizophre-

nia-type traits. The common traits of both disorders lead to a similar interpretation of the same underlying creative core. In this case, the overlap of negative symptoms enables the convergent aspect of creative thinking, a facet of the unitary process described by Martindale (1989) and Russ (1987). Although the parallels between both disorders may reflect the limits of current diagnostic classification methods, they certainly suggest a single underlying construct for the creative process, at least for these two kinds of mental illness. Creativity in other abnormal mental conditions can also inform us on its underlying nature. The well-documented correlation between creativity and synaesthesia is a good example. Synaesthesia is the unity between and among different sensory modalities, when individuals experience a sense other than that being directly stimulated. Mulvenna and Walsh (2005) identify studies establishing synaesthetes as having a greater than normal aptitude for creative and abstract thinking, while studies have found that synaesthesia is disproportionately experienced by artists, writers, and musicians (Dailey, Martindale, & Borkum, 1997), Kandinsky’s (1866–1944) art is a clear example. Dailey et al. (1997) proposed that synaesthesia and physiognomic perception (the fusion of affect and perception) involve aspects of primary process thinking. Hubbard and Ramachandran (2001) further suggest that synaesthesia experiences are underpinned by a failure of neural pruning or some form of disinhibition. A recurrent theory within the literature, disinhibition as an explanation for synaesthesia matches mainstream divergent thinking and associative accounts of the creativity concept. These seem to be universal core abilities held by the creative individual in any domain, and facilitated, albeit differentially, by various psychopathologies. 3.3.3. Spiritualism, creativity, and madness Insight about the nature of creativity can also be gained by investigating its association with another universal and uniquely human by-product of psychopathology: spiritual experience (Richards, 2001). Shamans, revered religious figures in societies of the far North, provide an example. According to Nettle (2001), shamans’ influence relies on both their visions and séances, where possessed by spirits they sing mystical utterances. Both must be powerful and mysterious in order to capture the attention and following of their community. Their work therefore requires creativity; the more creative, the more valued a shaman in his society. A variety of studies have found empirical evidence for a link between creativity, shamanist magic, and psychosis (Richards, 2001). Nettle (2001) noted parallels in the capacity to hear voices, have paranormal visions, and be inhabited by supernatural spirits, while Jackson (1997) found a strong positive correlation between individuals with schizotypal signs and scores on a spiritual experience scale of ‘mystical experience’, especially ‘numinous experience’ (sense of supernatural presence). Kinney et al. (2001) demonstrated that among adoptees with biological schizophrenic parents those who did not have full-blown schizophrenia themselves, but showed signs of personality disorders on the schizophrenia spectrum or had multiple schizotypal tendencies, had more creative accomplishments, as compared with controls, especially if they scored highly on factors of magical thinking, recurrent illusions, and odd speech. Based on these correlations, experiences of the supernatural may stem from the same cognitive processes underlying creativity. Jackson (1997) suggests that schizotypy theory can account for spiritual experience in the same way as it does for psychotic experience. Both are governed by anomalous patterns of attentional inhibition and unstable central nervous system homeostasis. These states clearly parallel the general processes leading to divergent thinking and creativity, such as a lack of inhibition and fluctuating cortical arousal states. Richards (2001) argues that if the capacity

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for mystical experience is linked to psychosis, shamanism and spiritual experience, it may, like creativity, act as a compensatory advantage (see Part III) of psychopathology, the characteristic departures from reality enabling a broad and novel perspective to everyday life. Jackson (1997) suggests that the compensatory advantage of spiritual experience is one of a general problem solving process, a mechanism identical to that described in studies exploring eminent creativity in the arts and sciences. According to Jackson (1997) benign spiritual experience, psychotic experience, and the creative process are all underpinned by the same underlying cognitive phenomena, supporting a unitary concept of the creativity construct.

4. Part III: evolutionary psychology perspectives To ensure the validity of the three proposed creativity construct models, they must be compatible with evolutionary accounts explaining the purpose of the creativity/madness association. Evolutionary psychology theorists propose that since psychopathology has a clear genetic component, its maintenance within our society must be propelled by an associated compensatory advantage, counter-balancing the illness’ debilitating effects with a beneficial advantage to our species (Huxley, Mayr, Osomond, & Hoffer, 1964). Inspired by Huxley et al. (1964) and Miller’s (2001) artistry and aesthetic presences as sexual selection fitness indicator theory, O’Reilly, Dunbar, and Bentall (2001) suggested that schizophrenia’s compensatory advantage is the sexually selected trait of creative ability. Creativity is an embodiment of Homo sapiens’ sophisticated intellectual ability, capacity to exploit mental cognition and trigger aesthetic processing and empathy. It also drives cultural evolution (Csikzentmihaly, 1998). Creativity thus marks an individual’s fitness, enhancing reproductive competition, and benefiting society at large. Although demanding replication, Crespi, Summers, and Dorus’ (2007) genetic analysis provides evidence of positive selection in genes underlying schizophrenia, also shown to be associated with measures of creativity and imagination in the normal population (Reuter, Roth, Holve, & Hennig, 2006). That both creativity and psychosis are universal across cultures and time, and the exhibition of aesthetic features as sexually selected traits occurs in other species (e.g. the peacock’s tail), provide further evidence (Nettle, 2001). Evolutionary psychology accounts all treat creativity as a single cognitive construct. For example, despite Nettle’s (2001) evolutionary account distinguishing two axes for psychopathology (schizotypy, operating through divergent thought, and thymotypy, the umbrella term for affective disorders mediating creativity through mood), these psychoses are assumed to be maintained by their association with creativity as a unitary capacity. An evolutionary stance need not, however, be incompatible with other models of the association of creativity with psychopathology. It is possible that different kinds of creativity are sexually selected separately, providing distinct compensatory advantages, each indicating the presence of specific kinds of cognitive capacities. Perhaps creativity in the Arts, tied to affective disorder or thymotypy, is an extension of a highly developed social module, allowing a heightened sensitivity to human nature and enabling an enhanced ability to express these moods. Meanwhile a highly developed capacity for problem solving and unconventionality may be reflected in schizotypal creativity, marking sophisticated brain development, possibly for prefrontal reasoning abilities. HFA/ASP creativity, particularly within the context of the male brain theory (Baron-Cohen & Hammer, 1997), adds to the evolutionary model. Strongly heritable (Folstein & Rutter, 1988), and demonstrating evidence of being an extreme form of the neurobiological development of the male brain, the persistence of HFA/ASP

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suggests it provides valuable benefits to society, with male brain capacities sexually selected for the advancement of mankind. Baron-Cohen, Tager-Flusberg, and Cohen (2000) have even suggested that the associated highly developed folk physics enabled the evolution of our species; without such sophisticated capacity Homo sapiens would still be pre-historical. These compensatory advantages outweigh the disabilities suffered by the affected individual, to the cost of the individual but the benefit of human society. 5. Conclusion The field of creativity and madness research should examine the issues within the context of the underlying nature of the creativity construct. Theorists have failed to directly address this, yet the establishment of a universal definition of creativity is vital to fully understand its association with mental illness. Whether different kinds of creativity exist, and if so whether they relate to distinct forms of psychopathology would have arresting implications for treatment of patients, education, and societal and cultural perceptions of creativity. The three proposed models for the creativity construct are all equally plausible, each supported by existing research, and fitting into evolutionary perspectives. Furthermore, all three models offer predictions for future findings and routes for exploration. A model involving different kinds of creativity related to different psychopathologies suggests that the science and art domains each harness a different creative capacity, each underlined by and intricately tied to specific psychopathologies. Though this may be a reductionist approach for a highly complex interaction, it provides initial hypotheses to test in future research. Future studies could devise creativity tests tapping into the cognitive styles of each psychopathology and determining their specificity to that particular mental illness and domain. Conversely, creativity as a dimensional concept predicts a higher prevalence of mental illness among the Kuhnian (1970) ‘revolutionary’ work than the ‘normal’ (Simonton, 2000), as seen in Outsider Art and among eminent versus everyday creators. This could be determined by comparing creativity and psychosis test scores between eminent and everyday creators. Chaos theory (Schuldberg, 2001) offers another dimensional perspective, though its intrinsic unpredictable nature limits the quantitative verification of possible results. The final model of a single creativity construct predicts that all types of creative capacity across domains and psychopathologies involve divergent thinking and associative cognitive processes. If a neural correlate for divergent thinking were established this model could be tested by determining its presence with in all eminent creators. However, the conceptualization of creativity as a single construct may be too simplistic. As Blackeslee and Ramachandran (1998) notes, the most creative insights – Shakespeare’s poetry for example – are grounded in reality and simplicity, entailing more than mere associations of concepts. This unique touch of genius is a mystery to us still and perhaps can never be explained and quantified by scientific methods. Science, however, has unlocked many of the universe’s secrets in the past; understanding the link between creativity and madness may yet be the key to unravelling insights into the root of creativity, psychopathology, and human nature. References American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. Andreasen, N. C. (1987). Creativity and mental illness: Prevalence rates in writers and first-degree relatives. American Journal of Psychiatry, 144, 1288–1292. Andreasen, N. C., & Powers, P. S. (1974). Overinclusive thinking in mania and schizophrenia. British Journal of Psychiatry, 125, 452–456.

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