Creativity and Mood Stabilizers: To Take or Not to Take

The following was written for week 11 of Abnormal Psychology and is a response to the question:

We have evidence that highly creative individuals are at greater risk for mood disorders (especially bipolar disorder) than other individuals. Many creative people claim that mood stabilizers inhibit or “kill” creativity. If you were treating a highly creative individual with bipolar disorder (someone who had already made a substantial contribution in a creative field), would you insist that he or she comply with a mood stabilizing medication regimen? Why or why not?

(article by Dr. Shelly Carson linked below)

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It is well known that creative people often suffer from a mental illness. According to Carson, research has shown 3 types of disorders to be most associated with the highly creative: mood disorders, schizophrenia spectrum disorders, and substance abuse disorders. Those who suffer from mood disorders are most likely to be diagnosed with one from the bipolar spectrum. Kay Redfield Jameson has shown us how difficult it is for someone with BD to remain on medication due to the distasteful side effects. It’s been reported that these medications may stifle, or even kill one’s creative thought process. For a highly creative person this becomes quiet the dilemma: take medication to control unpleasant and even dangerous symptoms, but lose creative drive; or stay off of medication, remain creative, but have to struggle to control potentially uncontrollable symptoms. This dilemma exists for the individual’s treater as well: do you force someone to take medication that would suppress a fundamental part of their personality, or livelihood, for the sake of relieving symptoms? When does symptom management outweigh preservation of the creative process?

You’re treating a highly creative person, someone who has already made a substantial contribution in their field, they present to you with severe Bipolar I and require mood stabilizers. After being on the mood stabilizers for a bit your patient tells you that they no longer wish to be on the medication because they feel it takes away their ability to think and create as they used to. For me the course of treatment would depend on the severity of their symptoms, the degree to which they’re impaired, and how their vulnerability and protective factors manifest. If the patient’s symptoms were moderate, I would be open to having a discussion about alternatives for mood regulation, such as CBT and ACT. If their symptoms were more severe or the level of impairment was very high, the conversation would perhaps be geared more toward reducing rather than stopping the mood stabilizer.

Carson lists reduced latent inhibition, novelty seeking, and neural hyperconnectivity under shared vulnerabilities of creativity and psychopathology; and low IQ, working memory deficits, and perseveration as risk factors. Protective factors include high IQ, working-memory skills, and cognitive flexibility. In discussing shared vulnerabilities, Carson mentions that creative people may depend on these to enhance their work, but may also use them to work through their psychopathy.

Learning to interpret the potentially inappropriate signals a highly creative person receives in new or different ways might allow that person to successfully remain medication-free. For example, someone with BD could feel as though they experience a flight of ideas, or that their thoughts are going very quickly. They could practice reining in these ideas/thoughts with mindfulness exercises; the goal being able to identify an idea, hold onto it long enough to create something, then move on to the next idea without getting distracted by competing thoughts or urges.

If someone is unable to manage their symptoms effectively without medication, keeping their creative impulse may weigh too heavily against simply being able to function in life. No matter what kind of contribution, if any, they’ve made to their field, safety and functionality is more important than the pursuit of creativity. If only temporarily, a medication regime should be kept to until a person can learn to control their symptoms.

Carson – Shared vulnerability

Carson, S.H. (2011). Creativity and psychopathology: A shared vulnerability model. Canadian Journal of Psychiatry, 56(3), 144-153.

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