World Bipolar Day | The Curse of Genius

Van Gogh in history, Jin Xiaoyu in reality, and Andy in film and television dramas all demonstrate the huge risks that geniuses have to take. Nature provides humans with certain possibilities, but it is up to humans to turn possibilities into reality.

Written by | Shuang Chenyue

I believe many people have read the interesting book "Genius on the Left, Madness on the Right". The book collects many interviews with patients with mental illness. The author believes that the difference between a philosopher and a madman is that one is just thinking, while the other actually does it.

Although the book is controversial, it succeeds in arousing the curiosity of readers. Is there any corresponding scientific basis behind these stories that have been processed into almost legendary stories?

In real history, we do find that many well-known celebrities have close relationships with mental illness. March 30th of each year is designated as World Bipolar Disorder Day to commemorate the genius painter Van Gogh in the 19th century. The talented Impressionist painter Van Gogh created a large number of stunning works in his short life, and he also struggled with bipolar disorder all his life. Although Nash, the prototype of the movie "A Beautiful Mind", is a world-famous mathematician, and almost everyone who has studied game theory knows the "Nash equilibrium" named after him, he also suffers from schizophrenia and suffers from it for the rest of his life. Einstein's second son, Edward Einstein, was an outstanding pianist, but unfortunately he suffered from schizophrenia when he was less than 20 years old...

We can also see such examples in real life. In January 2022, Hangzhou Daily published an article titled "Our Genius Son". The life story of the protagonist, translator Jin Xiaoyu, received widespread attention and was even called the "Hangzhou version of A Beautiful Mind". Jin Xiaoyu was blind in one eye when he was young and was later diagnosed with bipolar disorder, but he has a high level of attainment in the field of translation. He taught himself English, Japanese, and German. In more than ten years, he has translated 17 books, about 6 million words.

There are many more examples like this. This makes us wonder, is the other side of genius destined to be madness? Is it possible that once a person is endowed with a certain talent, he or she may also suffer the curse of mental illness because of extraordinary creativity?

The common characteristics of "genius" and "madman"

Usually, when we talk about crazy people, we specifically refer to patients with schizophrenia (hereinafter referred to as "schizophrenia"). This is a serious chronic mental illness characterized by multiple disorders in perception, thinking, emotion, behavior, etc., accompanied by incoordination of mental activities. In addition, patients with bipolar disorder (hereinafter referred to as "bipolar") also show some crazy symptoms during the manic episode stage.

In psychology, creative people are defined as individuals who are "able to use novel methods to generate ideas or expressions that are different from conventional patterns in cognitive activities" [1]. Therefore, being able to generate ideas that are different from others is an important prerequisite for creativity. Geniuses in the literary and artistic and scientific fields are usually highly creative.

In psychiatry, both schizophrenia and bipolar disorder are caused by changes in the patient's cognitive and emotional processes, which leads to unusual thoughts [2]. For example, although schizophrenia patients usually show reduced ability to reason about reality, this style of art that is not constrained by reality seems to have some advantages in artistic creation. Does this mean that mental illness and creative traits may have a common genetic basis?

Related research on common genetic genes

In order to study the relationship between creativity and mental illness, researchers usually use two methods: 1) assessing the incidence of mental illness among outstanding creative talents, or 2) measuring the creativity of patients with mental illness and their relatives. In a large sample study from Sweden involving 300,000 subjects, scientists found that patients with schizophrenia or bipolar disorder and their siblings often also excel in creative fields, and this overlap seems to be independent of IQ factors [3] (that is, it has nothing to do with IQ).

So, is it possible that the same set of genetic genes contributes to both mental illness and creativity? To study such questions requires a large sample size, rather than focusing on a small number of mentally ill patients. Therefore, the researchers used polygenic risk scores (PRSs) to detect a person's risk of mental illness and further explore the relationship between mental illness and creativity.

For many complex diseases, a single gene variant is usually not enough to assess an individual's risk of developing the disease. The polygenic risk scoring method can aggregate the effects of many gene variants in the human genome into a total score to assess how high a person's risk of developing a complex disease is. This method has been shown to have predictive value for many common diseases and is widely used in clinical practice and research [4, 5]. For different individuals, the combination of multiple genes associated with a complex disease is also different, so each person will get a specific PRSs score for a specific complex disease. It is generally believed that the higher the PRSs score of an individual for a certain disease, the greater the possibility of developing the disease.

In an article published in Nature Neuroscience in 2015, researchers selected a large sample of 86,292 subjects from Iceland to test the predictive ability of PRSs scores for corresponding mental illnesses in a large sample. The results showed that the PRSs scores of schizophrenia and bipolar disorder can accurately detect subjects whose relatives suffer from these two diseases (including 583 schizophrenia patients and 500 bipolar patients).

Next, the researchers calculated the correlation between the subjects' PRSs scores and their creativity. The so-called creative individuals were defined in this study as subjects who were engaged in five occupations: actors, dancers, musicians, visual artists, and writers. The calculation results showed that the correlation between the PRSs scores of schizophrenia and creativity reached a significant level (P schizophrenia = 5.2 × 10^(−6)), as did bipolar disorder (P bipolar disorder = 3.8 × 10^(−6)); while in other occupations (i.e., occupations that do not require creativity), this correlation was not significant.

The above two experiments show that the PRSs scores for schizophrenia and bipolar disorder obtained by a person can accurately predict his/her risk of suffering from these two diseases. The higher the score, the greater the corresponding risk of disease. At the same time, individuals with a high risk of disease are more likely to engage in creativity-related occupations .

So, is the correlation between disease risk and creativity affected by the individual's general cognitive function level, or is it related to the individual's education level? The researchers also calculated the correlation between PRSs scores and education level. The results showed that the higher the polygenic risk score for bipolar disorder, the more likely a person is to have a higher level of education. The same is true for schizophrenia. Moreover, the number of people with higher education in the high-risk group for these two diseases is also significantly higher.

However, after eliminating the influence of education level, the PRS scores of mental illness are still associated with creativity. This means that regardless of intelligence or education, people with a higher risk of mental illness are more creative than the general population. Creativity and mental illness (schizophrenia and bipolar disorder) have the same genetic origins [6].

Is it possible that this conclusion is limited to this group of Icelanders? Can the same conclusion be drawn with another group of people? In order to verify whether this relationship can be found in other samples, the researchers used the Creative Achievement Questionnaire (CAQ), which can be quantitatively analyzed, in four longitudinal studies in the Netherlands and Sweden to further verify it. They found that in these samples from different countries, the correlation between the PRSs scores of mental illness and the level of creative achievement still reached a significant level.

Figure 1: Polygenic risk scores for schizophrenia and bipolar disorder predict artistic status in four longitudinal studies [6]

This means that "even if the influence of education level is not taken into account, the group that is more likely to suffer from bipolar disorder or schizophrenia will have higher creativity than the general population", and this conclusion is likely to be universal. However, it should be noted that this is only a correlation and cannot be further inferred that there is a causal relationship between the two. In other words, based on the existing evidence, we cannot conclude that "being prone to madness" can enhance creativity, nor can we assume that high creativity will make a person "more likely to be crazy." This correlation may also be related to some other unknown variables, which may constitute a common cause. For example, a specific combination of genetic genes may be the "common cause" of the two. On the one hand, it increases the risk of a certain group suffering from bipolar disorder or schizophrenia, and on the other hand, it makes them more creative.

For such a study published in a Nature journal, we can see that the calculation method used is not complicated, but the researchers took great pains to collect a large sample size, and the previous and subsequent experimental designs were very rigorous in verifying the initial hypothesis. This is exactly the characteristic of psychological research: the difficulty is often not in complex statistical methods, but in how to choose and find a good question, to obtain sufficient resources to collect a sufficient number of samples, to ensure that the sampling is unbiased, and to ensure that the research results can be verified repeatedly.

Beyond Genetics: Possibilities Beyond Genes

Through the above research results, we can see that while nature seems to give some people creative talents, it also increases their chances of suffering from schizophrenia or bipolar disorder - just like a "curse of genius." Is this really nature's will? In fact, no theory has been found in existing research that can explain this from the perspective of human evolution.

However, a 2018 study using a large sample of subjects in Sweden found that students who received art education in college had a higher risk of developing schizophrenia, bipolar disorder, and unipolar depression in adulthood.[7] So, is it that a certain gene or combination of genes gives a person high creativity and induces mental illness, or is it possible that a certain group of people has higher creativity due to receiving art education, but also has an increased risk of mental illness?

So, if a person can be very creative, even to the level of a genius, but can also suffer from mental illness and become a lunatic, how should he face such a curse?

Fortunately, to date, many developmental psychology or psychiatry studies have found that individual development often unfolds dynamically under the interaction of multiple factors such as genetics and the environment [8] ; and mental illness and emotional problems are also formed under the combined influence of multiple factors such as genetic genes, socioeconomic status, and parenting styles [9] .

Figure 2. Neuroscience research on emotional development from a lifelong development perspective[9]

Although the relationship between creativity and mental illness seems to have cast a magical color on the fate of many unfortunate geniuses, it is important to note that most situations in real life are not like some special cases or novels. It is very unlikely that a person is both a genius and a madman at the same time. Most of the patients with schizophrenia and bipolar disorder in psychiatric hospitals have varying degrees of cognitive and social dysfunction and need the hard care of their families.

In addition, a meta-analysis study found that the type of scale used to measure creativity, the content of the scale, and the severity of schizophrenia all affect researchers' judgment of the relationship between creativity and schizophrenia. Creativity and psychopathology seem to follow an inverted U-shaped curve relationship. Mild schizophrenia symptoms can promote creativity, while full expression of schizophrenia can destroy creativity [10].

In the popular TV series Ode to Joy a few years ago, the mother of the highly intelligent heroine Andy suffers from schizophrenia, and her half-brother also lives in a mental hospital. Andy has always been worried that one day she will suffer from schizophrenia like her mother. This plot setting is indeed in line with the conclusion drawn by scientists that " creativity and mental illness (schizophrenia and bipolar disorder) have the same genetic origin ", but according to the current overall research, perhaps her worries are unnecessary. Because Andy only has one relative with the disease, and the environment in which she grew up has given her a good education, which greatly reduces the risk of illness. And such a genetic foundation (there is a risk of mild schizophrenia symptoms) plus the elite education she received in the United States may have allowed her to fully develop her creative talent and become a financial wizard. In contrast, Andy's brother's parents are both schizophrenia patients, and no one has adopted him since childhood. In the harsh environment, he was more affected by the negative effects of schizophrenia in his parents' genes, and eventually became a lunatic. From the perspective of the group, these individuals with the disease seem to be victims of some of the gene transmission processes in such a group of people with creative talents who unfortunately grew up in a bad environment. Therefore, we should have more respect and compassion for this type of patients.

Perhaps, for people like Andy and his sister who have a higher genetic risk of mental illness, the most important thing is to actively choose a suitable environment and occupation based on their own characteristics, make the best possible use of some talents or characteristics that come with risks, control the risk of illness through acquired education and self-regulation, and better play their own creative advantages.

References

[1] Heilman Kenneth M., Nadeau Stephen E., Beversdorf David O.(2003). Creative innovation: possible brain mechanisms. Neurocase, 9(5), 369-79. doi:10.1076/neur.9.5.369.16553

[2] Sachdev Perminder S., Blacker Deborah., Blazer Dan G., Ganguli Mary., Jeste Dilip V., Paulsen Jane S., Petersen Ronald C. (2014). Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol, 10(11), 634-42. doi:10.1038/nrneurol.2014.181

[3] Kyaga Simon., Lichtenstein Paul., Boman Marcus., Hultman Christina., Långström Niklas., Landén Mikael.(2011). Creativity and mental disorder: family study of 300,000 people with severe mental disorder. Br J Psychiatry, 199(5), 373-9. doi:10.1192/bjp.bp.110.085316

[4]Torkamani Ali., Wineinger Nathan E., Topol Eric J.(2018). The personal and clinical utility of polygenic risk scores. Nat Rev Genet, 19(9), 581-590. doi:10.1038/s41576-018-0018-x

[5]Lewis Cathryn M., Vassos Evangelos.(2020). Polygenic risk scores: from research tools to clinical instruments. Genome Med, 12(1), 44. doi:10.1186/s13073-020-00742-5

[6] Power Robert A., Steinberg Stacy., Bjornsdottir Gyda., Rietveld Cornelius A., Abdellaoui Abdel., Nivard Michel M., Johannesson Magnus., Galesloot Tessel E., Hottenga Jouke J., Willemsen Gonneke., Cesarini David., Benjamin Daniel J., Magnusson Patrik K E., Ullén Fredrik., Tiemeier Henning., Hofman Albert., van Rooij Frank J A., Walters G Bragi., Sigurdsson Engilbert., Thorgeirsson Thorgeir E., Ingason Andres., Helgason Agnar., Kong Augustine., Kiemeney Lambertus A., Koellinger Philipp., Boomsma Dorret I., Gudbjartsson Daniel., Stefansson Hreinn., Stefansson Kari.(2015). Polygenic risk scores for schizophrenia and bipolar disorder predict creativity. Nat Neurosci, 18(7), 953-5. doi:10.1038/nn.4040

[7] MacCabe J H., Sariaslan A., Almqvist C., Lichtenstein P., Larsson H., Kyaga S. (2018). Artistic creativity and risk for schizophrenia, bipolar disorder and unipolar depression: a Swedish population-based case-control study and sib-pair analysis. Br J Psychiatry, 212(6), 370-376. doi:10.1192/bjp.2018.23

[8] Lenroot Rhohel K., Giedd Jay N.(2011). Annual Research Review: Developmental considerations of gene by environment interactions. J Child Psychol Psychiatry, 52(4), 429-41. doi:10.1111/j.1469-7610.2011.02381.x

[9] Xu Jiahua, Zhou Ying, Luo Wenbo, et al. Cognitive neuroscience of human emotional development: Towards future mental health and education[J]. Chinese Science (Life Sciences), 2021(6):663-678.
DOI:10.1360/SSV-2020-0285.

[10] Acar Selcuk., Chen Xiao., Cayirdag Nur.(2018). Schizophrenia and creativity: A meta-analytic review. Schizophr Res, 195(undefined), 23-31. doi:10.1016/j.schres.2017.08.036

This article is supported by the Science Popularization China Starry Sky Project

Produced by: China Association for Science and Technology Department of Science Popularization

Producer: China Science and Technology Press Co., Ltd., Beijing Zhongke Xinghe Culture Media Co., Ltd.