Is creativity inherently related to mood disorders? It’s a common belief today that there exists some intimate relationship between the two. Consider common paragons of creativity: Vincent van Gogh, Sylvia Plath, Virginia Woolf, Ezra Pound, Anne Sexton (and countless others), all reaching new creative heights while struggling with a terrible mental disorder of some kind. This idea of a connection between the two stems from the Romantic Era, when mental disorder was thought to be a sign of creativity – an idea that remains remarkably tenacious today. But is there any scientific reason to believe in a connection? Trying to answer this question illustrates how difficult it is to address knotty, multi-layered problems like this with research. It is not as straightforward as just seeing if ‘creativity’ is correlated with ‘mood disorder’. We’ve got to dig deeper.

The relationship is deeply enmeshed in the public mind for a couple of reasons. For many, the idea of the ‘creative person’ comes from popular media, which inundates us with news stories and movie portrayals of the suffering artist and the mad genius. And there are anecdotal accounts closer to our real lives: many of us have heard stories about someone who suffers from a deep depression – but also creates beautiful poetry. Repeatedly hearing these accounts fuels a stereotype. When we frequently see two unique things (eg, extraordinary creativity and mood disorders) occur together, they become paired in our minds, creating what is termed an illusory correlation.

This effect is compounded by the availability heuristic, wherein we judge how common something is by how easily it comes to mind. If our mental representation of a creative person is based on this notion of genius and disorder, it will be easier to remember creative people who have a disorder, rather than those that don’t. This makes the connection seem more common. These two types of biases occur unconsciously and are often beyond our control. It is only by studying the issue scientifically, limiting our bias to the greatest extent possible, that we can we truly understand if creativity is related to mood disorders.

The scientific study of creativity and mood disorders is limited. There are vastly more reviews and commentaries discussing why and how a relationship might exist than there are studies examining if there is a relationship at all. And the studies that do ask this fundamental question are frequently plagued by methodological issues that introduce bias, in part stemming from the available methods for measuring creativity and mood disorders, and the ambiguities inherent in the concepts themselves. It is important to understand just how difficult it is to establish a connection with scientific precision.

Creativity researchers commonly define ‘creativity’ as novel (original or unique) and useful (appropriate). Therefore, a creative person is one with the aptitude to create novel and useful products or ideas, and the creative process is the mental processes by which creative products or ideas are formed. However, because neither of these concepts is directly measurable, researchers must come up with indicators of creativity to infer whether or not a person is creative or engaged in a creative process. It’s a particularly slippery thing to study. Creativity is complex, and assessments are limited. They typically measure one indicator of creativity (such as personality characteristics typical of creative people or the subjectively rated creativity of a product, such as a poem), and only in one domain (such as science versus art). If we measure a person’s creativity by asking them to write a poem, inferences shouldn’t then be made about that person’s creative ability in science. The method of assessing creativity has to be carefully considered, as some types of mood disorder might be related to some types of creativity, but not others.

Also, a mood disorder is not directly measurable. It must be diagnosed based on a series of behaviours and symptoms, which themselves can be difficult to identify. Mood disorders are characterised by specific patterns of mood episodes: depressive, hypomanic, and/or manic. Depressive episodes can be identified by things like decreased pleasure in usual activities, fatigue, and a diminished ability to concentrate. Meanwhile, someone in the throes of a hypomanic episode will have an unusually elevated or irritable mood, increased energy, inflated self-esteem, and racing thoughts. Manic episodes are similar, but last longer and are more severe, sometimes even requiring hospitalisation. An overly simplified explanation of this is that a person who experiences a depressive episode might be diagnosed with Major Depressive Disorder, while a person who grapples with a depressive episode and a hypomanic episode might be diagnosed with Bipolar II Disorder. Someone who endures manic episodes (and can also experience depressive episodes) could be diagnosed with Bipolar I Disorder. Each type of disorder might – or might not – be related to a specific kind of creativity.

Research into the creativity/mood disorder link falls into three distinct categories. The first compares the instances of mood disorders exhibited by creative people and by less-creative people; the second compares the creativity of people with mood disorders and those without; and the third examines whether or not the symptoms of mood disorders are correlated with creativity (usually in the general population or students). Each approach is able to answer a different question. For instance, the question: Do creative individuals have more mood disorders? is distinct from: Do individuals with mood disorders have more creativity? Erroneously drawing conclusions about the answer to one from evidence for or against the other is known as the fallacy of the inverse, which is very common in this line of research. This explains, in part, why this research area is so muddied.

To get some clarity on the relationship, I conducted three meta-analyses (that is, an analysis of the studies that have already been conducted), one for each of the three research approaches above. This tactic combined the effect sizes of all of the relevant studies. As expected, the results were different for the analysis of studies comparing mood disorders in creative and less-creative people than they were for the analysis comparing creativity in people with a mood disorder and those without. Although creative people do exhibit a greater instance of all types of mood disorders when compared with less-creative people (except for dysthymia, a chronic and less severe depressive disorder), the analysis comparing the creativity of individuals with a mood disorder to those with no mental disorder was more nuanced. The creativity of people with a mood disorder did not differ from those without. However, there were differences in some domains of creativity (people with a mood disorder were more creative in verbal and performance creativity) and for specific disorders (cyclothymic disorder and unspecified bipolar disorder). But of course, meta-analyses by nature inherit the methodological limitations of the studies they analyse. So if the studies that go into the meta-analysis are biased, then the conclusions of the meta-analysis might themselves suffer from bias. Therefore it is vitally important to understand the context of each analysis – and by that route we get closer to understanding the psychological relationship.

Does having a mood disorder make you more creative? That’s the most frequent question I hear about the relationship. But because we cannot control the instance of a mood disorder (that is, we can’t turn it on and off, and measure that person’s creativity under both conditions), the question should really be: Do individuals with a mood disorder exhibit greater creativity than those without? Studies that attempt to answer this question by comparing the creativity of individuals with a mood disorder against those without have been, well, mixed.

Studies that ask participants to complete surveys of creative personality, behaviour or accomplishment, or to complete divergent thinking measures (where they are asked to generate lots of ideas) often find that individuals with mood disorders do not differ from those without. However, studies using “creative occupation” as an indicator of creativity (based on the assumption that those employed in these occupations are relatively more creative than others) have found that people with bipolar disorders are overrepresented in these occupations. These studies do not measure the creativity of participants directly, rather they use external records (such as censuses and medical registries) to tally the number of people with a history of mood disorders (compared with those without) who report being employed in a creative occupation at some time. These studies incorporate an enormous number of people and provide solid evidence that people who have sought treatment for mood disorders are engaged in creative occupations to a greater extent than those who have not. But can creative occupations serve as a proxy for creative ability?

The creative occupations considered in these studies are overwhelmingly in the arts, which frequently provide greater autonomy and less rigid structure than the average nine-to-five job. This makes these jobs more conducive to the success of individuals who struggle with performance consistency as the result of a mood disorder. The American psychiatrist Arnold Ludwig has suggested that the level of emotional expressiveness required to be successful in various occupations creates an occupational drift, and demonstrated that the pattern of expressive occupations being associated with a greater incidence of psychopathology is a self-repeating pattern. For example, professions in the creative arts are associated with greater psychopathology than professions in the sciences whereas, within creative arts professions, architects exhibit a lower lifetime prevalence rate of psychopathology than visual artists and, within the visual arts, abstract artists exhibit lower rates of psychopathology than expressive artists. Therefore, it is possible that many people who suffer from mood disorders gravitate towards these types of professions, regardless of creative ability or inclination.

Writers in the Romantic Era cultivated an ‘aura of mania’ to appear possessed of extraordinary ability

Do creative people have more mood disorders? To answer this question, researchers have to compare the instance or rate of mood disorders in creative people to people they consider less creative. Even though these kinds of studies appear to provide fairly consistent support for the creativity-mood disorder link, they are in fact highly controversial among creativity researchers.

Consider the method called autopsy diagnosis. Here researchers examine biographical and historical records to provide a post-mortem diagnosis for eminently creative people. But establishing the presence of a mental disorder for someone who is long-deceased is fraught with uncertainty at every step of the process. To be labelled a creative genius, a person must have creativity and the characteristics that we associate with creativity at that time. So the historical context is crucial. For instance, there are certain time periods for which being moody and irrational was seen as positive evidence of genius itself, particularly for those in the arts. Writers during the Romantic Era sometimes cultivated an ‘aura of mania’ in order to appear possessed of extraordinary ability. These artists were more likely to be recognised for profound creativity, and therefore recorded in the sources that many researchers use today. But there’s no way for us to tell whether that artist was actually suffering from a mood disorder. So whether the characteristics of a creative person just happen to fit the ideology of genius during that time, or whether, as some researchers have suggested, these characteristics are exhibited purposefully to make an impression, they might be more likely to be represented in historical records than someone with equivalent talent and creativity who does not fit this image.

There are more problems with the autopsy approach. The historically creative people included in today’s studies must have had a sufficient amount written about them to establish a diagnostic status, and, naturally, people with more sensational lives have had more written about them. Staid lives don’t sell. Judith Schlesinger, in her book The Insanity Hoax (2012), illustrates the point: multiple biographers abandoned projects about the American saxophonist Bud Shank because they were unable to uncover any salacious details about his life. Plus, biographers need to tell a story, so they inevitably emphasise and distort the details of their subject’s lives in order to engage their readers (or perhaps to adhere to their own romantic conceptions of what creativity is).

Finally, diagnostic reliability – the extent to which different clinicians and researchers agree on a diagnosis – is elusive with living patients, let alone those who have been dead for centuries. Many researchers believe that Van Gogh suffered from bipolar disorder, but a sizeable number vehemently insist that he actually suffered from schizophrenia, temporal lobe epilepsy, syphilis, Ménière’s disease, or absinthe or lead poisoning. Indeed, just last year at an event sponsored by the Van Gogh Museum in Amsterdam, a room full of doctors and art historians could not reach a consensus as to what caused the artist’s suffering. (It’s also worth noting that the American Psychiatric Association’s Goldwater rule suggests that diagnoses should never be provided for people whom the psychiatrist has not examined in person.) Looking to the past to establish a connection between creativity and mood disorder is, if anything, more difficult than examining the present.

And what of the studies that use in-person diagnoses to report that creative people exhibit greater instances of mood disorders than less-creative people? They might be vulnerable to bias as well, since these studies frequently lack random sampling and/or experimenter-blind procedures. Although psychological researchers are often able only to approximate random sampling, the goal is to ensure that every person within a specified population has an equal chance of being chosen to participate in the study, which is not what happens. Most people chosen to be included in the creative groups are successful writers or artists, while those in the less-creative group are typically average people living nearby to wherever the study is taking place. This is a problem since there are differences that might vary systematically between the groups: for instance, people who have achieved real creative success typically face the stress of being in the public eye, while the average person does not. Just that component could account for any number of differences in the instance of mood disorder, given that stress is a major cause for the onset of mood disorders.

Additionally, diagnostic status is determined by lifetime prevalence, or if a person has ever experienced the symptoms associated with a disorder. One issue that researchers conducting diagnostic interviews face when asking people to remember their symptoms is recall bias, which means that when creative people are asked to recall if they have experienced mood-disorder symptoms, they are more likely to remember symptoms they view as influencing their creativity, whereas people in a ‘less-creative’ comparison group would have more trouble remembering past symptoms.

This leads us to the single greatest hurdle to studying a potential relationship between creativity and mood disorders. Because there is no agreed-upon objective way of measuring either one, the conclusions regarding their relationship end up being based on symptoms. Consider how this is a problem: increased energy, ideational fluency, reduced need for food or sleep and extreme task-absorption can accurately describe intense creative activity – or a (hypo)manic episode. Which one? Researchers have difficulty telling.

The stereotype that creativity is enhanced by a mood disorder is dangerous, both for those with mood disorders and those pursuing creativity

Indeed, one study found that 89 per cent of a sample of creative writers and artists suggested that they experienced symptoms indicative of both (hypo)manic episodes and creative activity (such as ideational fluency), but only 10 per cent suggested that they experienced episodes of excessive and impulsive spending – which is characteristic of a (hypo)manic episode, but not creative activity. Increased creative thinking has also been included as a symptom of hypomania itself, for instance in the 3rd edition of the Diagnostic and Statistical Manual for Mental Disorders (1980). It’s true that this overlap in symptoms might itself reflect a shared underlying cause, but this is difficult to test since it is quite possible to experience similar symptoms due to completely distinct underlying causes. No one would suggest that the flu is somehow linked to pregnancy, yet they can both cause fatigue, headaches and nausea.

I don’t mean to merely disparage others’ work. Psychological research requires a great deal of time and resources, and no study is perfect. But it crucial to understand how the difficulties of studying this subject with scientific precision can affect conclusions. If the meta-analytic finding that creative people suffer from most types of mood disorder at a heightened rate reflects a true real-world phenomenon, it might indicate that people engaged in creative pursuits are not receiving adequate support and resources to maintain good mental health. If the finding simply reflects our own biases and romantic conceptions of creativity and mood disorders, this needs to be demonstrated with methodologically sound research. In either case, the stereotype that creativity is somehow enhanced by a mood disorder is dangerous, both for those with mood disorders and for those pursuing creativity.

Believing that creativity is due to some underlying, uncontrollable factor reinforces the idea that few people are capable of true creativity, which prevents many from realising their own potential. It also undermines the skill and effort that creative endeavours require, if we can simply chalk it up to the consequence of a disorder. And the connection between mood disorders and creativity influences the very way we view the creative work of others: university students who were told the story of Van Gogh cutting off his ear before they examined his painting Sunflowers (1888) took a more favourable view of it than those who weren’t told the story. Similarly, students priced a piece of artwork higher when a fictitious artist’s biography briefly mentioned that he was ‘often described as very eccentric’.

This is a dangerous message for those engaged in creative pursuits – and for those creators who do suffer from a mood disorder: it could keep them from seeking treatment if they believe treatment would diminish their creative ability. This is why a meticulous and bias-free examination of creativity and its relation to mood disorders must be taken seriously – and must be held to high scientific standards. It’s not an easy task.