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 Review
Psychopathology
DOI: 10.1159/000339458
Creativity and Psychiatric Illness:
The Search for a Missing Link –
An Historical Context for Current Research
E. Thys a, b B. Sabbe c, d M. De Hert a, e
a
University Psychiatric Centre KU Leuven, Campus Kortenberg, Kortenberg, b Psycho-Sociaal Centrum St.-Alexius
Elsene, Brussels, c Medical Faculty, Antwerp University, Antwerp, d Psychiatric Centre St.-Norbertushuis, Duffel, and
e
Medical Faculty, KU Leuven, Leuven, Belgium
Key Words
Creativity ⴢ Psychiatric illness ⴢ History ⴢ Art ⴢ Schizophrenia ⴢ
Psychosis
Abstract
Creativity is an important human quality upon which many
achievements of humankind are based. Defined as the abil-
ity to produce something that is novel and useful or mean-
ingful, it is difficult to operationalize for research. This text
provides an overview of the historical and cultural context of
this research. The assumption that creativity is related to psy-
chiatric vulnerability dates back to antiquity. The modern in-
terest in the subject stems from the romantic era and gained
a scientific aura in the 19th century. In the 20th century, a
further entanglement of creativity and psychopathology
came about through the influence of patient artists on regu-
lar art. Psychometric, psychodiagnostic and genetic research
supports a connection between creativity and psychiatric ill-
ness within the bipolar-psychotic continuum, with schizo-
typy/thymotypy as prototypes of creativity-related disor-
ders. Evolutionary hypotheses link the schizophrenia para-
dox to a survival advantage through enhanced creative
ability. The relevance of scientific research in this complex
and heterogeneous area can be increased if creativity and
© 2012 S. Karger AG, Basel
0254–4962/12/0000–0000$38.00/0
Fax +41 61 306 12 34
E-Mail karger@karger.ch Accessible online at:
www.karger.com www.karger.com/psp
Received: December 5, 2011
Accepted after revision: May 1, 2012
Published online: September 13, 2012
psychopathology are further operationalized and if underly-
ing art concepts are made explicit and placed in a broader
cultural context. There is a continuing need for meaningful
definitions and measures, as well as a multidisciplinary col-
laboration. Copyright © 2012 S. Karger AG, Basel
Introduction
The intuition that there could be a link between cre-
ativity and psychiatric illness has a long history dating
from antiquity until the present time. Different causal
relationships have been proposed to explain this possible
link. Creative people were thought to be more at risk for
psychiatric illness; creative activity was thought to be dis-
tressing, or both were thought to rely on deeper dysfunc-
tions, seen by some as superior qualities, by others as
manifestations of ‘degeneration’. The relevance of the
subject is sometimes questioned. However, the impor-
tance of creativity in itself cannot be underestimated;
many achievements of humankind are the fruit of the cre-
ativity of a relatively limited number of people. If this
ability is connected with psychiatric illness, then this is
an important issue.
Erik Thys
Renbaanlaan 37
BE–1050 Brussels (Belgium)
Tel. +32 484 951 874
E-Mail erik.thys @ skynet.be
 Present-day scientific research in this domain focuses
on the link between creativity and specific psychometric,
psychiatric and neurobiological parameters. However,
these parameters are often easier to operationalize than
creativity itself. Defined as the ability to realize something
that is new and useful or meaningful within a certain so-
cial context [1], creativity is difficult to capture in a strict-
ly formatted framework. It can be argued that the differ-
ence between ‘meaningful’ and ‘useful’ also marks the
difference between art (creativity ‘per se’) and more func-
tional forms of creativity like scientific or political creativ-
ity. Reductions are necessary to quantify the elusive phe-
nomenon of creativity, but ‘in vitro’ creativity should
maintain some relevance to its real world counterpart.
In order to contextualize current research and to pre-
serve a wide scope, this text provides a selective historical
overview of the subject. It has to be noted that the pre-
sented views only pertain to the Western world, as both
mental illness and creativity can be perceived differently
in other cultures. In many cultures, the artist is anony-
mous and his or her creations automatically belong to the
community, in contrast to the individualistic and fame-
driven Western artistic practice. Also, novelty is a highly
valued aspect in contemporary Western art and in cre-
ativity research, while it seems to be less important in
many non-Western cultures.
Creativity and Psychiatric Illness before the 20th
Century
Antiquity
Creativity had a mythical status in early antiquity. In-
spiration and creation were believed to be the result of
divine intervention. In later antiquity, the divine inter-
pretation was toned down and creativity was linked to the
personal ‘Daimon’ or ‘genius’ of the creative person [2].
In Aristotle’s era, creativity was considered more and
more as a natural, personal ability. A similar shift from a
divine to a personal phenomenon can be seen in the way
mental illness was viewed. At the same time, a connec-
tion between creativity and mental illness was noted. Pla-
to quoted Socrates as saying that ‘the poet has no inven-
tion in him until he has been inspired and is out of his
senses’ [3]. This connection was also acutely formulated
in the famous quote ascribed to Aristotle: ‘Why is it that
all those who have become eminent in philosophy, poli-
tics, poetry or the arts suffer from melancholy, and some
of them to such an extent as to be affected by diseases
caused by black bile, as is said to have happened to Hera-
2 Psychopathology
cles among the heroes?’ (Problemata [4]). On closer in-
spection, Plato’s and Aristotle’s quotes propose different
causalities: Socrates implies that some madness is neces-
sary for creativity, Aristotle that both are the result of an
excess.
Middle Ages
The religious overtones of the Middle Ages reinstalled
a moralistic view on illness and the divinity of inspiration
but also warned of the sin of pride that could accompany
exceptional creativity. The story of Hugo van der Goes
(1440–1482), a well-known Flemish Primitive, provides
an interesting case study of the medieval outlook on cre-
ativity and mental illness. Van der Goes, already a fa-
mous painter, entered a monastery in 1475 but retained
the privilege of painting and working for rich customers.
After a few years, he was struck with severe mental ill-
ness, probably major depression, with suicidality. As a fel-
low brother noted, God probably heaped him with mel-
ancholy to force humility upon him and to protect him
from a further downfall. Indeed, melancholy or acedia
(listlessness) was not considered a disease, but as a pre-
cursor to the capital sin of sloth. As a consequence, Van
der Goes gave up his privileges, abandoned painting al-
together and died in devout isolation [4]. In this story,
mental illness is not linked with creativity itself, but with
the grandiosity that creative activity could engender, de-
pression being a defense mechanism against it.
Renaissance
The Renaissance saw the rebirth of the concepts of Pla-
to’s ‘mad poet’ and Aristotle’s ‘melancholic genius’ in the
writings of the philosopher Marsilio Ficino, who tried to
synthesize Platonism and Christianity. At a time when
the role of the artist in society was elevated, Ficino pro-
vided a philosophical base for Renaissance art [4]. How-
ever, the confrontation of the ancient Greek views on cre-
ativity and insanity with Christianity divided opinions;
for Platonists, melancholy was merely a consequence of
exploring the heights of creativity and in itself incompat-
ible with divine inspiration, while for Aristotelians, in-
spiration and melancholy were intrinsically linked.
Romanticism
The modern interest in the connection between cre-
ativity and psychiatric illness is rooted in the romantic
era, when industrialization first originated and the seeds
of the alienation of modern humans were sown. As ratio-
nalism was questioned and fantasy and imagination were
embraced, many enthusiastic publications reconnected
Thys /Sabbe /De Hert

Fig. 1. Milestones of outsider art: Bildnerei der Geisteskranken by Hans Prinzhorn [6], Jean Dubuffet’s L’art brut préféré aux arts cul-
turels [8], Outsider Art by Roger Cardinal [9] and the catalogue of Documenta 5 (designed by Ed Ruscha) [10].
the opposite extremes of genius and madness in an al-
most ideological way. The psychological suffering of art-
ists was not only considered to be inevitable, but neces-
sary for creativity. Extreme emotions were cultivated and
raised to the status of ultimate artistic motive, exempli-
fied in the suicide wave after the publication of Goethe’s
Die Leiden des jungen Werthers (1774). In the 19th cen-
tury, the link between creativity and psychiatric illness
received a scientific aura for the first time, through the
work of Italian criminologist Cesare Lombroso, whose
influential best-seller Genio e Follia (1864) built on the
confused but popular contemporary ideas on degenera-
tion [5]. Degeneration essentially referred to the acquired
yet hereditary loss of normal characteristics, according to
pre-Darwinian concepts of evolution. Lombroso stated
that genius was a form of hereditary madness. His ideas
were influential for both art theory and eugenics.
Creativity and Psychiatric Illness in the 20th Century
The Prinzhorn Collection
In the 20th century, the entanglement between cre-
ativity and psychiatric illness went even further, when
many artists sought and found inspiration in the work of
psychiatric patients. They expected to find a pristine
form of creativity there, which had been lost in the some-
what fossilized official art. After World War I, Hans Prin-
zhorn’s best-seller Bildnerei der Geisteskranken [6] be-
came the unintended inspirational bible for many expres-
Creativity and Psychiatric Illness
Color version available online
sionist and surrealist artists. The adventures of the
collection of work by psychiatric patients that Prinzhorn
curated and presented in his book provide an interesting
but confronting illustration of the turbulent relationship
between art, psychiatry and politics in the past century.
Because this story is exemplary in many respects, it is
summarized below (table 1).
20th Century Tendencies
Some common threads can be discerned in the re-
markable history of the Prinzhorn collection, marking
the intimate association between art and psychiatry in
the 20th century.
Firstly, it can be pointed out that artwork by psychiat-
ric patients has exerted a substantial influence on 20th
century art, among others through Prinzhorn after
World War I and the Art Brut movement after World War
II. Statements on modern art cannot escape this associa-
tion between ‘madness and modernism’ [7], as it is de fac-
to connected with mental illness.
Secondly, there is the ever-returning but highly doubt-
ful idea that creative expression by people suffering from
major psychiatric illness has a pure, pristine quality that
serves both as an observatory for the naked mechanisms
of creativity and as a source of inspiration.
Thirdly, within the heterogeneous bulk of work by
psychiatric patients, patterns were recognized that de-
fined it as a genre in its own right (fig. 1). A genre, accord-
ing to some, that saw its end when antipsychotics were
introduced in the 1950s. The mechanisms of this format-
Psychopathology 3
Table 1. History of the Prinzhorn collection

1891 Start of a collection of work by psychiatric patients in the Heidelberg university hospital by its then director Emil Kraepelin.
This so-called ‘Lehrsammlung’ had a diagnostic goal.
1919– Psychiatrist and art historian Hans Prinzhorn (1886–1933) studies, inventorizes and extends the collection with the intention
1921 to establish a museum for it. The artistic value of the works is acknowledged for the first time.
1922 Publication of Prinzhorn’s richly illustrated book Bildnerei der Geisteskranken. The word ‘Bildnerei’ (literally: ‘imagery’ or
‘artistry’ in the English translation of the book) in the title betrays the author’s hesitation to consider this work as art. The
subtitle ‘A contribution to the psychology and psychopathology of configuration’ refers to Prinzhorn’s ambition to found a
general theory of creativity on the presumed primal creativity in psychiatric patients.
1922 Dada artist Max Ernst moves from Cologne to Paris and gives a copy of Prinzhorn’s book to artist and ideologist André Bre-
ton. Together with Paul Éluard, Breton is working on a long and bizarre poem for which they invent the term ‘surrealistic’.
The ‘Bildnerei’ becomes a great source of inspiration for them and for Max Ernst himself, who joins the surrealists.
1937 Opening of the exhibition ‘Entartete Kunst’ in Munich, where modern artists are ridiculed and threatened [28]. This Nazi
propaganda operation consisting of confiscated artwork is still the most visited exhibition of modern art ever. From 1938 on,
works from the Prinzhorn collection are included in order to sarcastically infer a connection between modern art and mental
illness [29].
1939 Start of Aktion T4, the Nazi eradication programme for psychiatric patients, the handicapped and chronically ill, a precursor
to the Holocaust [30]. At least 275,000 patients are killed, among them some of the Prinzhorn artists from the Heidelberg
psychiatric hospital.
1946 Rediscovery of ‘psychopathological art’ by French artists Jean Dubuffet and (again) André Breton, who found the ‘Compa-
gnie de l’Art Brut’ [31]. The work of psychiatric patients and other non-professional artists is launched once again as a source
of inspiration and a benchmark for modern art. Remarkably, these patients are not considered to be real artists; the label ‘art
brut’ is only applicable to work that is not meant to be art.
1955 The no longer complete Prinzhorn collection is stored in the attic of the Heidelberg hospital due to the renovation of the
building.
1963 Rediscovery of the Prinzhorn collection by curator Harald Szeemann, who exhibits a selection for the first time after World
War II.
1972 Introduction of the term ‘outsider art’ for the artwork of patient artists by British art critic Roger Cardinal [32]. Integration
of works from the Prinzhorn collection in the Documenta 5 exhibition in Kassel in 1972, along with the works of famous art-
ists like Joseph Beuys, Marcel Broodthaers, Marcel Duchamp, Dan Graham and Panamarenko. This exhibition signifies an
important rehabilitation of the work, even if the names of the patient artists are not included in the list of participating artists
in the catalogue [33].
From Selections from the collection are shown in international exhibitions, in Charleroi (La beauté insensée, 1995), Ghent (Museum
1980 on Dr. Guislain, various exhibitions) and Herford (Loss of Control, 2008, curated by Jan Hoet).
2002 An association of experience experts in psychiatry stops its attempts to remove the Prinzhorn collection from the Heidelberg
hospital, linked to both ‘Entartete Kunst’ and the Aktion T4, and to house it in a new museum in Berlin.

ting process are probably selection and collection biases,
the psychodiagnostic outlook on art (which the Prinz-
horn collection was originally aimed at) and in the worst
cases commercial intentions.
Finally, it has to be noted that art by psychiatric pa-
tients has been instrumentalized over and over again for
various purposes: by Prinzhorn as a way to elucidate hu-
man creativity, by the Nazis as propaganda material, by
Dubuffet as a model of an art form and a philosophy that
would become the basis of his own success and by
Szeemann as a rather anonymous showcase. Of course,
these situations are very different, but the tendency to-
ward political and artistic recuperation of Prinzhorn’s
and similar collections probably has to do with what is
possibly the only real common feature of this work: that
it is created by people who are unable to show, publish or
sell their work by themselves due to their illness or dis-
abilities. They need more help than other artists to do so
and tend to develop a dependency towards their curators,
who inevitably leave their mark in the process.

4 Psychopathology Thys /Sabbe /De Hert

     
 The Link Revisited
After all, the question remains whether creativity is
associated with increased psychiatric vulnerability and
how this can be understood. Around this question differ-
ent views have evolved, based on different concepts of
creativity and psychiatric illness. The prototypes of the
‘deranged artist’ and the ‘visionary mental patient’ differ
in artistic but also in psychiatric respects. This is exem-
plified in the controversy between Jamison and Sass [1,
11, 12], both psychologists with important publications
on creativity and psychopathology. Jamison proposes a
link between creativity and bipolar disorder but is criti-
cized by Sass for exaggerating this link by broadening the
disorder’s diagnostic criteria. Sass proposes a link be-
tween creativity and schizophrenia but receives similar
criticism from Jamison. In fact, both authors not only
have different views on psychopathology, but also on art
[11]; Jamison links a romantic conception of art with bi-
polar disorder, Sass a modernist outlook on art with
schizophrenia. Implicitly, both approaches agree on a
gradual causation by a certain psychological configura-
tion that feeds creativity at an optimal level but causes
significant pathology and impedes creativity when ex-
treme. This interesting controversy can be summarized
as shown in table 2.
Another view, like that of Nancy Andreasen [13, 14], is
to associate artistic creativity with bipolar disorder and
scientific creativity with schizophrenia. Some authors
suggest a reverse association, notably Kyaga et al. [15],
who found more scientific professions in first-degree rel-
atives of bipolar patients and more artistic professions in
first-degree relatives of schizophrenic patients.
Current Scientific Views on Creativity and
Psychopathology
The Problem of Measuring Creativity
Remarkably, the psychometric interest in creativity,
which only came about in the 1950s [Guilford in 16], did
not originate in the interaction between art and psychia-
try as described above, but in the research and harnessing
of creativity in industrial processes. From the 1970s on,
interesting clinical and epidemiological research was per-
formed in this domain [13]. However impressive, some of
these studies showed methodological limitations, for in-
stance by building on ample but posthumously collected
descriptive data [17]. As stated above, the methodological
core problem is to define creativity in both a relevant and
quantifiable way. Most assessments of creativity can be
Creativity and Psychiatric Illness
Table 2. Jamison’s and Sass’s contrasting views on creativity and
psychopathology
‘Normal creativity’ = emotional ‘Genius’ = ‘revolutionary’
creativity according to Jamison creativity according to Sass
Associated with bipolar disorder Associated with schizotypy,
schizophrenia
Socially acceptable Maladaptive, alienated
Emotional Cold, self-conscious
Romantic (Post)modern
19th century art conception 20th century art conception
The deranged artist The visionary mental patient
Prototype: Vincent Van Gogh Prototype: Adolf Wölfli
Mostly insider art Mostly outsider art
located along the dimensions of ‘in vivo’ versus ‘in vitro’
creativity and quantitative versus qualitative assessments.
An objection to real-life creativity as the sole criterion
could be that it involves other aspects than creativity
alone, like social skills, environment and opportunities.
In quantitative in vitro assessments, the number of novel
combinations of a given set of objects (e.g. a brick and a
paperclip [18]) is counted, which sometimes seems remote
to genuine creativity. On the other hand, qualitative as-
sessments, where experts judge creativity, are limited by
subjectivity. Rather than measuring creativity itself, many
authors assess the capacity for divergent thinking, i.e. a
flexible, associative and open thinking style appropriate
for open-ended, complex problems or tasks. It is opposed
to convergent thinking, i.e. step-by-step problem solving
of clearly defined problems with only one solution. Scien-
tific discovery requires more convergent thinking, while
artistic creation requires more divergent thinking. Ade-
quate assessment of creativity should probably include
quantitative, qualitative, in vivo and in vitro evaluations.
Psychometric and Psychodiagnostic Approaches
Psychometric and psychodiagnostic research of the
past decade appears to gravitate towards a connection be-
tween creativity and personality traits like ‘openness to
experience’ and ‘psychoticism’ [16] and mild and more
stable forms of psychotic and bipolar psychopathology,
defined as schizotypy and ‘thymotypy’ [19]. The data
suggest that these personality types and disorders can be
located along the continuum between schizophrenia, bi-
polar disorder and normality, which corresponds to cur-
rent dimensional views on psychiatric diagnostics [20].
The association between creativity and schizotypal char-
acteristics in bipolar patients further supports this di-
Psychopathology 5
 Color version available online
Conceptual
disorganization
Mania Positive
symptoms

Artistic
creativity

Divergent
thinking,
empathizing

Content: Drive:
schizotypy/ Thinking Thymotypy/
schizophrenia style bipolar disorder

Convergent
thinking,
systemizing

Scientific
creativity

Fig. 2. Graphical representation of diag- Negative

Depression symptoms
nostic dimensions and the optimal config- Autism
uration for artistic and scientific creativity
(E. Thys).

mensional view [21]. Remarkably, this view also recon-
ciles the Jamison-Sass controversy (both are right). It also
supports the observation that psychopathology displays
an ‘inverted U’ relationship with creativity. And finally,
it also does justice to the Aristotelian intuition that cre-
ativity has to do with an optimal amount of a factor that
can also be pathogenic (be it the temperature or the black
bile). These elements can be tentatively summarized in
the diagram shown in figure 2, where artistic creativity
finds its place at the hypomanic position of the bipolar
dimension, the positive symptoms of the psychotic di-
mension and the divergent pole of the cognitive dimen-
sion. Scientific creativity seems to find its place in the
depressive bipolar position, the negative symptoms and
the convergent thinking style (fig. 2).
Neurophysiologic and Neuroimaging Research
Currently, neurophysiologic and neuroimaging stud-
ies are not very enlightening because they produce con-
tradictory results as to brain locations that could be rel-
evant for creativity (fig. 3). This could mean that creativ-
ity cannot be simply allocated to discrete brain structures,
that the resolution of current neuroimaging is insuffi-
cient or that the assessment of creativity in a scanning
situation is unreliable.
Neuro-Aesthetics
An innovative outlook on neuroscience and creativity
is provided by neuro-aesthetics [23]. This new discipline
merely considers the perception and not the creation of
art. Nevertheless, neuro-aesthetics holds the view that
the neurobiological principles of perception and creation
are the same.
The artistic experience is explained through the neu-
rophysiology of the visual cortex [24, 25]. The artist is
thought to exploit the specific features of this system as
an ‘unconscious neurologist’ [24]. Neurologist V.S. Ra-
machandran and philosopher W. Hirstein summarize

6 Psychopathology Thys /Sabbe /De Hert

     
 Color version available online
SPECT, PET, fMRI, DTI

Right hemisphere

= Possible association with creativity

Left hemisphere

Fig. 3. The many Brodmann areas that have been associated with creativity in recent neuroimaging research [22].

these features as the ‘laws of art’ [26]. Examples of these
laws are peak shift (an extreme stimulus causes an ex-
treme reaction), grouping of visual information and the
preference for bilateral symmetry.
Although it convincingly shows that neurobiological
principles govern visual perception and thus the artistic
experience, the neuro-aesthetic core principle that the
viewer’s perception and the artist’s creation are identical
cannot be maintained from the point of view of art the-
ory [27]. Also, art cannot be reduced to facilitated visual
perception. Typically, images that are difficult to read
can be very intriguing and stimulating, and extremely
facilitated images like traffic signs are not automatically
to be considered art. Art seems to have less to do with
strict obedience to these perceptual laws than with ‘elud-
ing the paradigm’, to put it in the words of Roland Barthes
[28], i.e. playing with these laws. Another fundamental
objection is the focus on perception, whereas the bulk of
contemporary art is highly conceptual and is even less
reducible to visual technique than previous art forms.
For example, ‘La Gioconda’ by Leonardo da Vinci (1503–
1507) and Marcel Duchamp’s ‘L.H.O.O.Q.’ (1919), a post-
card of the Gioconda with added mustache and beard,
are perceptually almost identical, yet conceptual oppo-
sites.
Despite this criticism, the neuro-aesthetic principle
that art makes explicit through distortion remains valid,
even more so if also understood conceptually. Or, in Pi-
casso’s words: ‘Art is a lie that reveals the truth’.
Evolutionary Hypotheses and Genetic Research
Evolutionary psychiatry proposes some hypotheses
that explain the link between creativity and psychopa-
thology and place it in a broader context.

Creativity and Psychiatric Illness Psychopathology 7

 An important starting point is the so-called schizo-
phrenia paradox, i.e. the apparent contradiction be-
tween the continuing prevalence of schizophrenia in the
human gene pool and the low procreation rate of people
suffering from schizophrenia, given its genetic origins.
The schizophrenia paradox can be explained by the as-
sumption that non-schizophrenic subjects are the carri-
ers and propagators of the genetic factors that underlie
schizophrenia. That these factors did not disappear de-
spite the disadvantages of the disorder for the patient,
the community and procreation itself could mean that
they also provide some advantage for the carriers. This
advantage could be creativity. In an impressive recent
large-scale study, Kyaga et al. [15] showed a familial
cosegregation of both schizophrenia and bipolar disor-
der with creativity. If schizotypy and thymotypy are as-
sociated with creativity, and as such with an evolution-
ary advantage [29, 30], then it can be assumed that ge-
netically related disorders like schizophrenia continue
to exist as well, even if the patients have fewer children.
The evolutionary advantages of creativity could be the
ability to work out inventive solutions for life-threaten-
ing conditions, like the early inventions of prehistoric
humans (clothing, the harnessing of fire, tools). Other,
seemingly less functional creative abilities could offer a
survival advantage by enhancing social cohesion. Music
and dance, for instance, can literally ‘synchronize’ com-
munities, from African dance to discotheques [31]. A
third advantage could be that creative people have more
sexual partners than on average. This has been shown
by Nettle and Clegg [29], who did not investigate, how-
ever, whether this resulted in more offspring. More con-
troversial hypotheses link the continuing prevalence of
schizophrenia with special abilities of the people suffer-
ing from schizophrenia themselves and not their rela-
tives. The shaman theory states that visionary, psychot-
ic individuals took the lead of early human communities
[32].
Recent molecular genetic research seems to support
dimensional diagnostics, assuming that schizophrenia,
bipolar disorder and probably autism as well are only di-
mensions of a continuum [33]. The hypothesis that cre-
ativity is linked with schizotypy and/or thymotypy is
compatible with this framework. This view is supported
by a study showing that the DRD2 and TPH genes are as-
sociated with creativity while also coding for dopamine
metabolism, which is central in psychosis [34], and the
recent finding of an association between creativity and a
specific genetic polymorphism that has previously been
linked with proneness to psychosis [35].
8 Psychopathology
Psychosis, Creativity and Life Stage
A rarely discussed topic is the evolution of creativity
through different life stages. Apart from the exceptional
case of child prodigies, creativity seems to peak espe-
cially in adolescence. Even artists, musicians and scien-
tists who remain active at old age often build on ideas
they developed in their adolescence. This is also the life
stage when psychosis or bipolar disorder first become
manifest, and perhaps both phenomena are somehow
connected. There are indeed many similarities between
‘normal’ adolescent behaviour and psychotic or bipolar
manifestations. Bizarreness in behaviour, dress code and
music and dichotomizing the world into good and bad
could be akin to positive symptoms. Being ‘confused’
and the creation of neologisms are similar to cognitive
symptoms. Boredom, emptiness, apathy, social isolation
and hypersomnia resemble negative symptoms. Extreme
moods can be seen in dysphoric tantrums, manic over-
estimation of oneself and depression. At the same time,
adolescents typically tend to innovate, be it in politics,
fashion or technologic-social phenomena like the recent
Arabic revolutions. Led by adolescents, every new gen-
eration brings about small or large paradigm shifts in
many domains. The similarities between normal and ab-
normal crises in this creative life stage possibly indicate
a deeper connection between the psychotic sensibility
and creativity as a motor of social cohesion and cultural
evolution.
Conclusion
The current literature about creativity and psychiatric
illness shows a broad spectrum of theories and approach-
es, with interesting diagnostic, anthropological and evo-
lutionary implications. However, research in the field is
hampered by difficulties in defining creativity, psychopa-
thology and also art. The concept of creativity is still in
need of a more consistent, multidisciplinary and useful
definition to enhance assessment while preserving rele-
vance. In psychodiagnostics, the concept of the psychot-
ic-bipolar continuum opens up interesting perspectives
but needs to be corroborated. As for art, the quest for a
definition is probably less relevant than the need for re-
searchers to disclose and discuss their conception of art.
The Jamison-Sass controversy reveals implicit but funda-
mental differences in the conception of art, and in neuro-
aesthetics, some conceptions of art are maintained that
are untenable for art theory.
Thys /Sabbe /De Hert
 These conceptual problems show that more interdisci-
plinary collaboration is needed, as can be expected in this
border area.
Despite the remaining inconsistency of the current
findings, it seems to be a plausible hypothesis that artistic
creativity is associated with specific thinking styles that
can also be identified in schizotypy/thymotypy. This re-
lationship seems to pertain to deeper connections; the
elements that enhance creativity (divergent thinking, un-
usual associations, maniform thought, etc.) are the same
as those that can be identified in a psychotic state. Both
creativity and schizotypy/thymotypy appear to be con-
tinuous phenomena, rooted in the human genetic mate-
rial. Creativity and the psychopathology that is related to
it appear to be fundamental human characteristics that
share an evolutionary history and that are sources of both
suffering and human culture.

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