Brain Illness and Creativity: Mechanisms and Treatment Risks

Article excerpt

Brain diseases and their treatment may help or hurt creativity in ways that shape quality of life. Increased creative drive is associated with bipolar disorder, depression, psychosis, temporal lobe epilepsy, frontotemporal dementia, Parkinson disease treatments, and autism. Creativity depends on goal-driven approach motivation from midbrain dopaminergic systems. Fear-driven avoidance motivation is of less aid to creativity. When serotonin and norepinephrine lower motivation and flexible behaviour, they can inhibit creativity. Hemispheric lateralization and frontotemporal connections must interact to create new ideas and conceptual schemes. The right brain and temporal lobe contribute skill in novelty detection, while the left brain and frontal lobe foster approach motivation and more easily generate new patterns of action from the novel perceptions. Genes and phenotypes that increase plasticity and creativity in tolerant environments with relaxed selection pressure may confer risk in rigorous environments. Few papers substantively address this important but fraught topic. Antidepressants (ADs) that inhibit fear-driven motivation, such as selective serotonin reuptake inhibitors, sometimes inhibit goal-oriented motivation as well. ADs that boost goal-directed motivation, such as bupropion, may remediate this effect. Benzodiazepines and alcohol may be counterproductive. Although dopaminergic agonists sometimes stimulate creativity, their doing so may inappropriately disinhibit behaviour. Dopamine antagonists may suppress creative motivation; lithium and anticonvulsant mood stabilizers may do so less. Physical exercise and REM sleep may help creativity. Art therapy and psychotherapy are not well studied. Preserving creative motivation can help creativity and other aspects of well-being in all patients, not just artists or researchers.

Can J Psychiatry. 2011;56(3): 132-143.

Highlights

* Psychiatric and neurological drug choice may alter patients' creativity, sometimes in counterintuitive ways.

* To preserve creativity, treatments that enhance dopaminergic function are more helpful than those that decrease dopaminergic function.

* Traits that in stressful environments increase vulnerability to illness may, in permissive environments, help creativity.

Key Words: creativity, motivation, hypomania, writer's block, mood disorder, bipolar disorder, antidepressant, treatment, dopamine, hemispheric laterality, frontotemporal connections

Abbreviations

5-HT serotonin

AD antidepressant

ADHD attention-deficit hyperactivity disorder

BD bipolar disorder

BDZ benzodiazepine

DA dopamine

DBS deep brain stimulation

FTD frontotemporal dementia

LI latent inhibition

SNRI serotonin-norepinephrine reuptake inhibitor

SSRI selective serotonin reuptake inhibitor

TMS transcranial magnetic stimulation

As research uncovers the ways in which creativity can emerge from illness, it also reveals the relation between lack of creativity and illness. Both topics are politically charged. Some commentators do not want to infer that illness can cause creativity because they consider creativity part of the full expression of human health. Conversely, clinicians may not want to treat loss of creativity as a medical symptom if they fear embroilment in the so-called cosmetic psychiatry debate. Rescuing an artist's creativity that has been damaged by disease is not clearly distinct from enhancing the creativity of someone whose creativeness is already well above average.

Nonetheless, the relation between creativity and illness is a practical issue that clinicians should consider with each patient they see, not just when they treat artists or publishor-perish academics. For instance, a businessman may lose his job if he is prescribed a DA antagonist and then comes up with fewer new marketing ideas. Even if a drug does not cause creativity loss, the fear that it might do so can make patients discontinue it. …