Recovery from "schizophrenia" and other "psychotic disorders"

I have written elsewhere about links between creativity and psychosis.  In a recent blog entry, Gianna Kali of “BeyondMeds” links to an article describing how teachers in schools all say they seek to encourage creativity, yet their favorite students all tend to be those who show traits incompatible with creativity – those who are good at agreeing, following rules, etc.  Why the discrepancy?  And what does it mean for mental health?

Creativity is extremely valuable, but it can also have high costs.  One of the costs is that people who are attempting to be creative will sometimes make errors, and their attempted improvements will sometimes make things worse.  But if we are to become a society that truly values creativity, we need to recognize that we benefit from those who live more “on the edge” and who sometimes fall off the edge:  instead of stigmatizing them or labeling them as forever ill, we might better collaborate with them in helping them figure out where they might have gone wrong while also staying open to the possibility they have a lot to teach us.

I really wonder how much creative talent is currently buried under high doses of antipsychotic medications……

In the mental health field currently, when people experience intense anxiety and depression, and when they experience mania and/or psychosis, the experience is understood to be a “disorder” or a “biological dysfunction” that is of no use and should “corrected” by any means that might be effective in doing so.  The most straightforward way of doing this is conceived to be a drug that might directly reverse the theorized “biochemical imbalance” though other methods are tried, particularly when drugs don’t work.

The primary opposition to this point of view in our culture comes from those who deny the existence of mental disorders at all:  they see “diagnosis” in the mental health field as being an illegitimate enterprise, and the DSM as a work of quackery designed to make money for drug companies and for “mental health professionals.”  It is noted that there is no physical test for any sort of “mental disorder” and no objective way of determining what should be called a disorder.  It is then imagined that people would do fine if saved from those in the mental health field who attempt to diagnose and then “help” them.

A middle ground between these two extreme views is however emerging.  In this view, the mental states that get diagnosed as “disorders” tend to be specialized states of mind which do tend to cause trouble for people, but which can also be seen as part of an evolved, problem solving strategy used by the mind.  That is, while these mental states may not be consciously chosen by the person and may cause problems, they also may solve important problems, and so in any given case it may be unclear whether they are doing more harm than good.

An example of a “biological” evolved problem solving strategy that both causes problems but also potentially solves problems is that of a fever.  Fevers cause many problems, and if quite high may cause brain damage or even death, yet we have evolved to have fevers because they often help solve the problem of infections. More »

I was recently reviewing an article, (Nettle 2006) (see the abstract below) that makes some really interesting observations that pertain to the relationship between psychosis and creativity.

The author explores how “divergent thinking” (which I believe might also be characterized as a loosening of associations) is commonly experienced by poets and artists, while “convergent thinking” is more seen in mathematical types, (which I believe could also be seen as a tightening of associations.) Divergent thinking leads to having more unusual experiences such as are seen among both artistic types and those diagnosed as psychotic, while convergent thinking is associated with experiences on the negative symptom dimension, which are more seen amongst both mathematicians and those with autism.
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I think the author misses a point though when he associates convergent thinking with autism but not “schizophrenia.” Overly convergent thinking is definitely seen in people diagnosed with schizophrenia, it is often observed in autistic type reactions, and certainly fits with the negative symptom dimension commonly seen in people given this diagnosis.

One way the interplay of excessively divergent and then excessively convergent thinking is seen in people diagnosed with “schizophrenia” is in the way a person makes associations in response to a stimulus. The tendency is to have a much greater than average initial associations, which then are overwhelming, lead to a kind of “collapse” into having a smaller than average number of associations.

Another way this interplay is observed has to do with metaphor. People who tend to get diagnosed with schizophrenia use metaphor wildly, just as the mind does in dreams, but then also typically are not very good at understanding metaphors, much as people with autism fail to get them (this is the excessively convergent thinking.)

I believe this all has to do with a sort of underlying “bipolarity” to the processes common to psychosis. It’s kind of a chicken and egg thing. It could start with a person being in a mental rut, leading to divergent thinking in an attempt to get out of it, that then leads to some kind of trouble followed by an over-correction to overly convergent thinking, which deepens the rut, etc. Or it could start at the other end, with something inspiring the person into overly divergent thinking, which leads to trouble and etc.

At any rate, I think if we get better at understanding the parallels between human creative process, both divergent and convergent, we will be much better at helping people tease out the possible meaning in their psychotic experiences, both on the positive and negative dimension, while also helping them avoid the kind of over-corrections that keeps them cycling through “bipolar” extremes rather than finding a balance.

If someone wants a copy of this article, I can email it to you.

Ron Unger

Nettle, D. (2006). “Schizotypy and mental health amongst poets, visual artists, and mathematicians.” Journal of Research in Personality 40(6): 876-890.
Many researchers have found evidence of an association between creativity and the predisposition to mental illness. However, a number of questions remain unanswered. First, it is not clear whether healthy creatives have a milder loading on schizotypal traits than people who suffer serious psychopathology, or whether they have an equal loading, but other mediating characteristics. Second, most of the existing research has concentrated on artistic creativity, and the position of other creative domains is not yet clear. The present study compares schizotypy profiles using the O-LIFE inventory in a large sample of poets, artists, mathematicians, the general population, and psychiatric patients. Poets and
artists have levels of unusual experiences that are higher than controls, and as high as schizophrenia
patients. However, they are relatively low on the dimension of introvertive anhedonia. Mathematicians
are lower than controls on unusual experiences. The results suggest that artistic creatives and psychiatric
patients share a tendency to unusual ideas and experiences, but creative groups are distinguished
by the absence of anhedonia and avolition. Moreover, different domains of creativity require different
cognitive profiles, with poetry and art associated with divergent thinking, schizophrenia and affective
disorder, and mathematics associated with convergent thinking and autism.