At the Intersection of Creativity and Psychopathology: The Muse and The Mad Hatter

Dr. Paul Kiritsis Psychologist | Clinical Redwood City, California

Dr. Paul Kiritsis, PsyD, MScMed, is a licensed medical psychologist practicing in Redwood City, California. He specializes in the diagnosis and multimodal treatment of neuropsychiatric and functional neurological disorders, as well as coordinating care for patients suffering from these ailments. He offers heterogeneous... more

The current state of affairs in psychiatry can be construed as lamentable and fatalistic. Why? Well, in contemporary parlance, clinical labels like “schizophrenia,” “bipolar,” and “depression” encompass a pejorative chime and sometimes carry unjustified associations with violence and disconnectedness from the consensus reality. Schizophrenia and its notorious symptom-cluster (such as hallucinations, delusions, emotional blunting, anhedonia, and cognitive deficits), in particular, has been erroneously and absolutely identified as a veritable brain disease with a chronic degenerative course, lifelong deficits and impairments, and devastating psychosocial implications for both sufferers of the dreaded condition and their immediate relatives. Then there’s the social stigmatization that comes hand-in-hand with the gravity of that label. Individuals with the condition are often fighting two discrete but interconnected battles—an internal war with seemingly conflicting and disparate aspects of their own selves and a civil war involving social cues that corroborate their core conjectures around alienation and marginalization.   

Other permutations of this invalidation are deeply entrenched in the professional consensus and in the long history of neuropsychiatry itself. For example, hallucinatory phenomena, often appraised as hallmarks of schizophrenia, have been subject to empirical investigations for around 150 years now. They are defined as percept-like experiences occurring in the absence of corresponding sensory stimuli under the auspices of the traditional biomedical model. This same model also decrees that they aren’t amenable to conscious control and can’t be differentiated from veridical perceptions. However, because vision is a constructive process guiding adaptive behavior, and because none of our perceptions are objectively “true” anyway, it would be more appropriate to define them as idiosyncratic perceptual constructions occurring in the absence of appropriate contexts. This second operationalization is complemented well by neuroimaging studies which show the same neural networks to be active during both a sensory perception of stimuli and a corresponding hallucinatory phenomenon. They may be visual, auditory, musical, tactile, olfactory, gustatory, synesthetic, or pain-oriented in nature, and occur in both clinical and non-clinical populations. (In my eyes, the clinical-nonclinical binary system in psychiatry is somewhat specious and will soon become antiquated.)

The delegitimization of experience and its personal significance can also be witnessed in the treatment of individuals subject to the hallucinatory process. Hallucinatory content, in particular, isn’t given much credence as psychiatrists and other general practitioners rush to ameliorate positive symptoms with a prescription of antipsychotic medications, many of which block dopamine D-2 receptors in the limbic system. It appears that approaching clinical phenomena with the curiosity, respect, and nonjudgement they deserve has been the prerogative of a select few. Wilson Van Dusen, a clinical psychologist who worked with the mentally ill at Mendocino State Hospital in California for approximately seventeen years, belongs to this magnanimous cohort. He launched a comprehensive investigation into the nature of his patients’ hallucinations, finding that the ratio of higher-order to lower-order content was around 1:5. In his clinical appraisal, he defined higher-order sensory experiences as feeling-related, nonverbal, and symbolic or allegorical; more often than not, he found that experiences of this type possessed intellectual, instructive, and creative merit, far surpassing the implicit understanding and IQ level of the individual they’d manifested through.  These hallucinations—if one could call them that—expressed the utmost respect for volition and usually broadened the patient’s values. On the other hand, the lower-order types were micro managerial, malicious, and punitive voices with mutable qualities and a simple and limited vocabulary, and expressed themselves as running critiques that undermined, ridiculed, threatened, and beleaguered the patient.  

What I’m attempting to underscore here is the enduring distortion of an innocuous idiosyncratic neurocognitive profile that parades under the banner of “schizophrenia.” Pathological magnification can be seen in the zealous over-prescription of labels (and psychotropic drugs for that matter) and in the minimization and devaluation of phenomenology, that being the personal significance of direct experience and the integral role it plays in therapeutic contexts. I would confidently declare that my book, The Creative Advantages of Schizophrenia: The Muse and the Mad Hatter, is an epiphenomenal child of this injustice, birthed from an inner desire to compensate for the historically disproportionate emphasis on pathological aspects of the disorder. Yes, the gaping deficits in working memory capacity, attention span, defocusing, and perspective-taking are blatantly obvious for those of us who have a relative or partner with schizophrenia. We know about the temporal intervals of heightened paranoid ideation; for instance, believing that the neighbors are conspiring with the FBI or CIA in order to incarcerate them. We know about the global cognitive dysfunction that can incapacitate them and render them unfit for any vocation or role in society.

If we were to approach the clinical phenomenon through the lens of evolutionary psychology, then these patently maladaptive deficits are nothing but vehicles of an evolutionary disadvantage when it comes to the “survival of the fittest” hypothesis. A heterogeneous neurocognitive profile connected with the schizo-spectrum or psychotic disorders and its genetic footprints should have either been attenuated or eradicated from the gene pool by now, but it hasn’t. One popular theory is that schizotypal thinking, a form of creative cognition punctuated by hyper association and making nonconventional connections between objects and ideas, is common in individuals with schizophrenia (and some other clinical populations) and confers compensatory advantages. There are two sides to each coin, and, in this case, each neurocognitive profile. Is the nebulous swamp that births the demons of psychopathology also the spring of the Muses from whence the gold nuggets of exceptional ingenuity and inspiration come forth? Are the people who are overcome, possessed, and seized by the throes of “madness” also those that create novel products praised for their inventiveness, aesthetic beauty, unprecedented utility, and the sheer ineffable awe they’re able to evoke in the sophisticated and layperson alike?

These are questions we must ask ourselves, and even dare to answer.