“Almost everywhere it was madness which prepared the way for the new idea, which broke the spell of a venerated usage and superstition. Do you understand why it had to be madness which did this?”
— Nietzsche, Daybreak #14
How could ‘madness’ be helpful for idea-generation, brainstorming, artistic expression, and other creative processes? Mental disorders, as neural-cognitive differences that often misalign with a social context, may enable the kinds of divergence that contribute to creativity. I argue that conditions like bipolar disorder, Tourette’s syndrome, and ADHD (the ‘C-disorders’) share features that substantially increase generative creativity. Although they may not have a common etiology, the C-disorders have important shared cognitive styles and neural patterns. Part 1 provides a theoretical framework, describing generative creativity within a dual-process model, defending its value, and considering how it can be effectively studied. Part 2 analyzes the empirical evidence indicating that the cognitive styles and neural correlates of generative creativity are exceptionally exhibited in the C-disorders. I conclude by tying together these threads and calling for a new approach to treating the C-disorders that takes these findings into account.
1. The Dual-Process Model and Generative Creativity
1.1 — What is Creativity?
Creativity lies at the intersection of novelty and value. To be creative, an idea, invention, artwork, or other product must be both useful and new. Of course, this definition is vague and subject to difficult questions. For instance, what does it mean for a creative product to be valuable? This question is subject to social and evaluative norms. Often, the standards used are social consensus, scientific-technological innovation, or material-economic benefits, but it is not clear these are necessary or sufficient. The definition of creativity, and the best construct to measure and describe it, remains hotly disputed (Ford & Harris, 1992). In part to bypass some of these theoretical issues, this essay will be restricted to a specific sub-component: generative creativity.
1.2 — The Dual Process Model of Creativity
Creative thinking proceeds in phases—an initial phase of unconstrained generation or brainstorming, and a subsequent more-constrained and systematic evaluation. Under this dual-process model, creativity starts by generating a wide range of initial ideas and associations and finishes by exploring these crude options with evaluation and testing. Generative creativity is the first process. Computationally, a generatively creative system is one that creates new patterns regardless of their estimated benefit to the system, while evaluative or adaptive creativity involves creating patterns that fulfill established value-functions (Bown, 2012, pg. 364). Evidence suggests that the dual-process model has a basis in the brain, as the two phases of generative and evaluative creativity involve distinct neural systems: creative generation recruits primarily medial temporal lobe regions like the hippocampus, while evaluation co-recruits the default mode and executive control networks (Ellamil et al, 2012). Furthermore, this study finds that the generative and evaluative networks were somewhat competitive: “the more successfully [participants] were able to engage in creative generation while avoiding evaluative processes, the more they recruited MTL regions associated with creative generation.” These phases are both vital to successful creative production, but they are underpinned by diverging cognitive styles and neural correlates.
Indeed, the two processes often conflict. Brainstorming demonstrates the importance of quarantining the generative process from critical, evaluative, goal-directed, convergent mental processes. Listening to the critic in one’s head is the fastest way to make a brainstorming session crash on the runway. Unfettered generation is especially critical because “the more creative concepts you have to choose from, the better” (Adams, 2001, pg. 22). If one does not take the time for unconstrained, generation-focused, divergent thinking, it is far more likely that the creative process will be prematurely mired in conceptual blocks and arbitrary limitations. Effective brainstorming entails avoiding premature evaluations and quality checks, and instead focusing on ideational speed and fluency – producing a large number of new concepts, designs, or ideas. When it comes to creativity, quantity has a quality all its own.
1.3 — Modal Cognition and Generative Creativity
Research on modal cognition also has important theoretical import for generative creativity. Under the theory of the psychological representation of modality developed across multiple papers by Phillips et al, the initial set of possibilities we consider is limited by the constraints of probability, physics, and morality (Phillips & Knobe 2018). With limited time, we default to only considering a systematically limited subset of possibilities. For instance, both children and time-constrained adults tend to consider immoral options (e.g. stealing or lying) or unlikely and irregular options (e.g. painting polka dots on an airplane) as impossible (Phillips, Morris, & Cushman, 2017). Indeed, experimental data from the PhilLab suggests that as people generate more options, these options become less constrained by norms of probability, normality, morality, and rationality.[1] This may imply that possibilities become more divergent, unconventional, novel, or surprising as the quantity of ideas generated increases.
Using simple heuristics to delimit the most relevant and useful possibilities is computationally cheap, quick, and often adaptive. But for generative creativity, one must minimize constraint and mental friction to produce maximal options. Phillips theorizes that there are two processes in modal cognition: the default and the deliberative representations of possibility (2017). Perhaps generative creativity relies on the deliberative representation: as more possibilities are generated in a creative flow state, the ordinary restraints loosen, and the consideration set expands. Mental disorders may facilitate surpassing the default modal limitations, allowing unconstrained generation.
1.4 — Methodological Considerations in Creativity Studies
Empirical research on mental disorders and generative creativity should keep a few important considerations in mind. First, research should be constrained to adults. Including children and adolescents would introduce too many confounding variables, as neuroplasticity and other features of the developing brain likely influence generative creativity and interfere with attempts to isolate the effect of the C-disorders. Second, it should avoid an excessive focus on the DSM-V constructs — which are unlikely to map perfectly onto brain differences, are subject to change, and have serious conceptual and methodological problems (Hadfield, 2020). Instead, I emphasize the neuro-cognitive patterns exemplified in these disorders.
Finally, a key problem with creativity research is its focus on ‘demonstrated creativity’: concrete observable outcomes valued in a social context. For instance, creative professions, eminence, and forms of creative output are used as proxies for creativity. However, this paper is more concerned with creative processes than outcomes. Demonstrated creativity is a very ‘noisy’ measure, as actual generative creativity is filtered through social, economic, and pragmatic pressures. Therefore, it may be systematically biased against people with socioeconomic disadvantages, the mentally ill, and others for whom it is particularly difficult to conform to social criteria and fit within existing systems. Similarly, it would be misguided to measure intelligence (g) by financial or academic achievements alone. I will concentrate on measures of generative creativity that are process-based rather than outcome-based.
2. Review of Empirical Evidence
This cannot be a comprehensive research review. Rather, it is a sampling of some available evidence to provide preliminary support for the view that C-disorders increase generative creativity. The C-disorders are united by being approach-based rather than avoidance-based psychopathologies (like anxiety and depression), and meta-analyses have shown that approach disorders are associated with creativity (Baas et al, 2016). Compellingly, a DTI analysis found that there is “specific white matter architecture underlying the normal variance of divergent thinking, openness, and psychotic-spectrum traits,” which supports the idea of a continuum between creativity and psychopathology (Jung et al, 2010). The C-disorders share some specific cognitive styles and neural correlates connected to generative creativity.
2.1 — The C-Disorders and Ideational Speed
First, the C-disorders are associated with increased ideational fluency, racing thoughts, and some measures of cognitive speed. This could result in a higher pace of generation that outputs more ideas. A subjective acceleration of consciousness and an overproduction of ideas are involved in both adult ADHD and hypomania (Martz, 2021). ADHD symptoms like hyperactivity and impulsivity are associated with enhanced divergent thinking, originality, and cognitive flexibility, and improved performance on open-ended generation tasks (Boot et al, 2017). People with ADHD also generated more original ideas than controls when under competition, although they had trouble constraining ideas by practicality (Boot et al, 2020). Additionally, manic patients exhibited higher fluency scores, producing more novel word associations, and their associational fluency increased after discontinuing lithium (Johnson et al, 2012, pg. 8). A catalytic combination of ideational speed, fluency, and an excess of thought could allow people with C-disorders to brainstorm at an exceptional allegro-like tempo. The neural correlates of these processes are unclear, but possible candidates are dopaminergic hypersensitivity and potentially even a higher rate of synaptic transmission throughout the brain.
2.2 — The C-Disorders, Openness, and Divergent Thinking
Second, the C-disorders increase divergent thinking and openness, resulting in unexpected connections and more unpredictable mental pathways. While at its extreme this can lead to psychosis, it also amplifies the exploratory processes essential to generativity. Both bipolar and ADHD are associated with significantly higher openness to experience (Van Dijk et al, 2017; Quilty, 2009). Openness is linked to trait creativity, is even used as a measure of creativity, and is associated with higher volume in brain regions that inhibit control and reduce constraint (Li, 2015). The highly-open personalities of C-disorder patients seem to facilitate highly associative, fluent, and originative brainstorming.
Furthermore, mania risk is associated with divergent thinking (Johnson et al, 2012). The more adaptive symptoms of mania – reduced need for sleep, hyperactivity, excitement, motivation, and enhanced mental speed – are particularly related to generative creativity, while more damaging symptoms like hypersexuality, anger, and poor judgement were not helpful (Johnson et al, pg. 12). However, even seemingly negative symptoms of mania like impulsivity and distractibility can be essential to generative creativity, as they can enable expression with reduced constraint and cognitive control. Bipolar also correlates with many measures of demonstrated creativity: this review finds that mean occupational creativity and lifetime ratings of creative accomplishment are significantly higher in bipolar patients, and the disorder is over-represented in eminent creatives like famous writers and artists (Johnson, pg. 6). As a whole, the kinds of cognitive and neural divergence seen in the C-disorders are valuable for generative creativity.
2.3 – The C-Disorders and Weakened Constraints
Third, the C-disorders are linked to looser cognitive limitations, weakened top-down control, and more unconstrained thinking. Creative tasks benefit from a state of hypofrontality, in which reduced PFC activation enables more spontaneous, bottom-up thought patterns. Bipolar I patients exhibit disruptions in the frontoparietal control network which reduce top-down constraints (Ramey & Chrysikou, 2014). Mania involves hypofrontality, a “significant attenuation of task-related activation of right lateral orbitofrontal function” that results in disinhibition and distractibility (Altshuler et al, 2005). Further, individuals with ADHD have impaired executive inhibition, which reduces the person’s ability to suppress creative but unconventional ideas – and ADHD patients exhibit improved performance on tasks like the Unusual Uses Test (White & Shaw, 2006). All of the C-disorders involve similar neuro-cognitive disinhibitions.
2.4 – The C-Disorders and Creative-Expressive Motivation
Fourth, one important driver of creativity in the C-disorders may simply be motivation: a desire to express and be creative. My personal experience with bipolar has involved strange, unusual, and difficult-to-explain conscious experiences like free-wheeling hallucinations, the sense that my imagination is bleeding into reality, and profound states of inspired joy. This has instilled an intense motivation to try and communicate these experiences and convert the imaginative richness of mania into some real, sharable artifact. For instance, Tourette’s syndrome is also highly correlated with musical creativity, perhaps in part because artistic expression is an enjoyable and effective way to manage tics (Espert et al, 2017). Sacks describes how, for one friend, “the half-convulsive excitement of Tourette’s continually stimulates his perception and imagination, producing a ceaseless stream of extraordinary images” (1992). A rushing river of creative thought can evoke an inspired motivational state that drives people to actualize ideas. Indeed, a desire to act creatively is connected to dopaminergic modulation of a mesolimbic pathway altered in ADHD (Boot et al, 2017). Often, those with C-disorders pursue generative creativity as an autonomous interpretative response to their experiences.
2.5 – A Note on Tourette’s
Tourette’s syndrome (TS) is mentioned sparingly here because it is the least-studied of the three — the most comprehensive review to date called Tourette’s connection to creativity an ‘uncharted topic’ (Colautti et al, 2021). Although it is understudied, this review still shows that TS results in higher generative creativity and is associated with higher openness to experience and divergent thinking. The neural structures implicated in TS correspond to the systems involved in creativity, and “it has been postulated that the excess of dopamine characterizing TS can enhance creative thinking” (Coluatti et al). In short, it seems that Tourette’s facilitates rapid mental associations through hypersensitivity in postsynaptic dopamine receptors and reduced executive control via altered PFC circuitry.
3. Conclusion
Viewed holistically, this evidence establishes the initial plausibility of the hypothesis that the C-disorders (TS, BD, and ADHD) involve similar mental and neural mechanisms that result in enhanced generative creativity. Specifically, the disorders are connected to an increased rate of ideational production, augmented divergent thinking, reduced constraints, and higher motivation toward creative expression. These cognitive styles and brain differences form a loosely grouped cluster of traits that are remarkably valuable for the generation-focused initial steps of the creative process, like brainstorming.
While the core aim of this paper is to construct a hypothesis and ground it in existing empirical evidence, the findings reviewed here also have important practical implications. First, the C-disorders are not entirely pathological and have demonstrable and impactful benefits. This provides support for a neurodiversity approach, where psychiatry seeks to support patients with managing their conditions, channeling their creativity, and adjusting to society, rather than trying to ‘cure’ the disorders. However, existing treatments for ADHD, BD, and TS result in a state of diminished creativity that many patients find unpleasant. For instance, lithium, one of the most common medications for bipolar, produces well-documented creativity deficits (Rothenberg, 2001). Antidopaminergic medications for Tourette’s syndrome have also been documented to reduce creativity (Thenganatt & Jankovic, 2016). Psychiatric treatment should not be exclusively oriented toward mitigating all symptoms. Instead, it should aim to enhance the positive and creative features of these disorders, while minimizing the negative symptoms in line with patient’s wishes.
Second, this research suggests that cooperative, neurodiverse communities are essential for a maximally fruitful creative process. This is fundamentally based on the fact that the systems underlying generative and evaluative creativity are rivalrous. Exceptional generative and evaluative creativity, or remarkable talent in both divergent and convergent thinking, are therefore very unlikely to appear simultaneously in a single brain. The best creative solutions will be social. Highly generative, unconstrained thinkers can help break the ice of social norms, shatter conceptual blocks, and produce a gamut of novel ideas, but they will need the help of more structured, analytic, evaluative thinkers to turn the ideas into something valuable. Attempting to confine the creative process to a single individual’s mind is outdated, misguided, and mythologically rather than scientifically rooted. Instead, creativity operates in an extended way through multiple minds and in connection with external tools. Combining generative and evaluative processes through interpersonal synergy mixes together sparks of novelty and value that can light an inferno of creativity.
Works Cited
Adams, J. L. (2019). Conceptual blockbusting: A guide to better ideas. Hachette UK.
Altshuler, L. L., Bookheimer, S. Y., Townsend, J., Proenza, M. A., Eisenberger, N., Sabb, F., … & Cohen, M. S. (2005). Blunted activation in orbitofrontal cortex during mania: a functional magnetic resonance imaging study. Biological psychiatry, 58(10), 763-769.
Baas, M., Nijstad, B. A., Boot, N. C., & De Dreu, C. K. (2016). Mad genius revisited: Vulnerability to psychopathology, biobehavioral approach-avoidance, and creativity. Psychological bulletin, 142(6), 668. https://doi.org/10.1037/bul0000049
Boot, N., Baas, M., van Gaal, S., Cools, R., & De Dreu, C. K. (2017). Creative cognition and dopaminergic modulation of fronto-striatal networks: Integrative review and research agenda. Neuroscience & Biobehavioral Reviews, 78, 13-23. https://doi.org/10.1016/j.neubiorev.2017.04.007
Boot, N., Nevicka, B., & Baas, M. (2017). Subclinical symptoms of attention-deficit/hyperactivity disorder (ADHD) are associated with specific creative processes. Personality and Individual Differences, 114, 73-81. https://doi.org/10.1016/j.paid.2017.03.050
Boot, N., Nevicka, B., & Baas, M. (2020). Creativity in ADHD: goal-directed motivation and domain specificity. Journal of attention disorders, 24(13), 1857-1866. doi: 10.1177/1087054717727352.
Bown, O. (2012). Generative and adaptive creativity: A unified approach to creativity in nature, humans and machines. In Computers and creativity (pp. 361-381). Springer, Berlin, Heidelberg.
Ellamil, M., Dobson, C., Beeman, M., & Christoff, K. (2012). Evaluative and generative modes of thought during the creative process. Neuroimage, 59(2), 1783-1794. https://doi.org/10.1016/j.neuroimage.2011.08.008
Espert, R., Gadea, M., Alino, M., & Oltra-Cucarella, J. (2017). Neuropsychology of Tourette’s disorder: cognition, neuroimaging and creativity. Revista de neurologia, 64(s01), S65-S72.
Ford, D. Y., & Harris, J. J. (1992). The elusive definition of creativity. The Journal of Creative Behavior, 26(3), 186–198. https://doi.org/10.1002/j.2162-6057.1992.tb01175.x
Hadfield, Jeremy (2020). The Conceptual Engineering of Mental Illness. Retrieved 9 June 2021, from https://jeremyhadfield.com/the-conceptual-engineering-of-mental-illness/.
Johnson et al (2012). Creativity and bipolar disorder: touched by fire or burning with questions?. Clinical psychology review, 32(1), 1-12. https://doi.org/10.1016/j.cpr.2011.10.001
Jung, R. E., Grazioplene, R., Caprihan, A., Chavez, R. S., & Haier, R. J. (2010). White matter integrity, creativity, and psychopathology: disentangling constructs with diffusion tensor imaging. PloS one, 5(3), e9818. https://doi.org/10.1371/journal.pone.0009818
Li, W., Li, X., Huang, L., Kong, X., Yang, W., Wei, D., … & Liu, J. (2015). Brain structure links trait creativity to openness to experience. Social cognitive and affective neuroscience, 10(2), 191-198. https://doi.org/10.1093/scan/nsu041
Martz, E., Bertschy, G., Kraemer, C., Weibel, S., & Weiner, L. (2021). Beyond motor hyperactivity: racing thoughts are an integral symptom of adult Attention Deficit Hyperactivity Disorder. Psychiatry Research, 113988. https://doi.org/10.1016/j.psychres.2021.113988
Partridge, D., & Rowe, J. (1994). Computers and creativity. Intellect Books.
Phillips, J., & Cushman, F. (2017). Morality constrains the default representation of what is possible. Proceedings of the National Academy of Sciences, 114(18), 4649-4654. https://doi.org/10.1073/pnas.1619717114
Phillips, J., & Knobe, J. (2018). The psychological representation of modality. Mind & Language, 33(1), 65-94. https://doi.org/10.1111/mila.12165
Phillips, J., Morris, A., & Cushman, F. (2019). How we know what not to think. Trends in cognitive sciences, 23(12), 1026-1040. https://doi.org/10.1016/j.tics.2019.09.007
Poincaré, H. (1908). L’invention mathématique, conférence faite à l’Institut général psychologique. Au siège de la Société.
Quilty, L. C., Sellbom, M., Tackett, J. L., & Bagby, R. M. (2009). Personality trait predictors of bipolar disorder symptoms. Psychiatry Research, 169(2), 159-163. https://doi.org/10.1016/j.psychres.2008.07.004
Ramey, C. H., & Chrysikou, E. G. (2014). “Not in their right mind”: the relation of psychopathology to the quantity and quality of creative thought. Frontiers in psychology, 5, 835. https://doi.org/10.3389/fpsyg.2014.00835
Rothenberg, A. (2001). Bipolar illness, creativity, and treatment. Psychiatric Quarterly, 72(2), 131-147.
Sacks, O. (1992). Tourette’s syndrome and creativity. BMJ: British Medical Journal, 305(6868), 1515.
Thenganatt, M. A., & Jankovic, J. (2016). Recent advances in understanding and managing Tourette syndrome. F1000Research, 5.
White, H. A., & Shah, P. (2006). Uninhibited imaginations: creativity in adults with attention-deficit/hyperactivity disorder. Personality and individual differences, 40(6), 1121-1131.
Van Dijk, F. E., Mostert, J., Glennon, J., Onnink, M., Dammers, J., Vasquez, A. A., … & Buitelaar, J. K. (2017). Five factor model personality traits relate to adult attention-deficit/hyperactivity disorder but not to their distinct neurocognitive profiles. Psychiatry research, 258, 255-261. doi: 10.1016/j.psychres.2017.08.037
