Creativity, self creation, and the treatment of mental illness.

This paper examines how an understanding of systematic findings about creative processes involved in art, literature, and science can be applied to the effective treatment of mental illness. These findings and applications are illustrated by particular reference to the work of the poet Sylvia Plath and the treatment of a patient who aspired to become a writer.

Bipolar illness, creativity, and treatment.

There have been in recent years increasing claims in both popular and professional literature for a connection between bipolar illness and creativity. A review of studies supporting this claim reveals serious flaws in sampling, methodology, presentation of results, and conclusions. Although there is therefore no evidence for etiological or genetic linkages, it is still necessary to explain interrelationships in those creative persons suffering from the illness. Examples of the work in progress of artists with bipolar disorder, Jackson Pollock and Edvard Munch, illustrate the use of healthy and adaptive creative cognition--janusian and homospatial processes--in the former's breakthrough conception during an improvement phase in treatment leading to the development of the Abstract Expressionist Movement and in the latter's transformation of an hallucination into his famous artwork "The Scream." Treatment options that do not produce cognitive effects are important for creative persons with bipolar disorder.

Diagnosis of obsessive-compulsive illness.

Obsessive-compulsive illness has long been subject to diagnostic neglect. Moreover, obsessive-compulsive features often underlie or are intercurrent with other symptom pictures and may be quite debilitating. Diagnostic dilemmas are discussed regarding obsessive-compulsive illness and its relation to eating disorders, generalized anxiety disorder, mood disorders, alcohol abuse, and adult attention deficit disorder. Some difficulties in eliciting and recognizing obsessive-compulsive illness are presented. These include patient secrecy, shame, and social and personality features of health professionals. Specific pharmacologic and therapeutic interventions are effective when directed at the intercurrent or underlying obsessive-compulsive illness.

Creativity and affective illness: an objection.

A good deal of attention has recently been given to two studies purportedly showing a connection between creativity and affective illness. In both cases, there have been inadequate (or absent) controls, biased selection procedures, single interviewer-experimenter bias, and, in one study, misrepresentative use of statistics. We have published contrary experimental results which, on a statistically significant level, differentiate creative thinking and creativity from psychopathological modes of response.

Form and structure and their function in psychotherapy.

Psychotherapy is a creative process with the same types of effects and determinants as other creative activities in fields such as literature, visual arts, and science. In all of these activities, a focus on form and structure serves to generate new and valuable resultants or creations. As shown in the example of the poet Richard Wilbur's creation of a poem, his focus on rhyme and other formal features generated a new and valuable emotional tension in the poem. In psychotherapy, the creation consists of new and valuable aspects or structural features of personality. This creative result in therapy is produced in part by therapists' focus on form in terms of sequences, style of verbal and non-verbal presentation, and the phases of encounter, growth, and separation. As shown in the psychotherapy session excerpted, the therapist's lack of attention to the critical theme initiated by the patient at the beginning of the session (encounter) as well as to the meanings of connections between sequences in the following interactions (growth) led to a non-creative or destructive suicidal threat at the end (separation). The overall creative result arises also from therapists' attention to patients' approaches to the overall structure of psychotherapy as a regularly occurring timed experience in which the therapist does not directly intervene in the patient's life. This structural organization provides a trial domain for the patient in which creative growth and personal welfare can be facilitated. Both patient and therapist need to focus on any attempts to undermine the structural organization and its meaning. Similarly, in creative activities in other fields, writers, artists, and scientists characteristically focus on form, in a detailed as well as general way, in order to facilitate both aesthetic and social growth and welfare.

Creativity in adolescence.

Findings from an empirical research project on creativity, including controlled experimental assessment, indicate that the development of creative capacity occurs primarily during the adolescent period. Defined as the production of entities that are both new and valuable, creativity necessarily involves two specific types of cognition designated as the janusian and homospatial processes. Although there are precursors to the development of creativity during earlier childhood, both the motivation and the capacity to create appear first in the adolescent period. Important motivational factors derive from adolescent conflicts and developmental tasks such as the impetus to solve and consolidate issues relating to identity, the return of oedipal conflicts, and the pressures toward autonomy and independence. Engaging in creative types of fields and outlets helps generally to establish coherent identity during adolescence and beyond; the beginnings of a specific creative identity in adolescence are a necessary foundation for creative motivation and ability to create throughout life. The return of the oedipal conflict at the onset of puberty motivates the dual compliance and competition of the creatively disposed adolescent with his or her same-sex parent. The pressures toward autonomy and independence provide the motivational and affective substrate for the development of the homospatial and janusian processes. The homospatial process arises from the vacillating and concomitant experiences of autonomy (or separation) and connectedness. In the creatively disposed adolescent, one who activates and uses cognition to express and explore affect, the creative aspect of those experiences begins to be manifested in the concomitant cognitive separation and connection involved in superimposition of mental images. The janusian process arises from the experiences of rebellious oppositionality and intense emotional ambivalence. The creative cognitive aspect of these experiences is manifested in conscious conceptualization and use of simultaneous antitheses and oppositions. The use of simultaneous opposition in the janusian process at any age necessarily involves the capacity to grasp and manipulate abstract relations. Evidence for the first development of this capacity in adolescence comes from the research on formal operations reasoning and on understanding of the null class. Regarding the onset near that age period of capacity to use and comprehend the relational nature of opposition, supporting evidence derives from experimental data on the syntagmatic-paradigmatic shift. With regard to the homospatial process, which is largely responsible for the creation of effective metaphors, both the late appearance of class inclusion behavior and the inability of younger children to comprehend and use relational metaphors preclude a preadolescent onset of this creative capacity.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescence and eating disorder: the obsessive-compulsive syndrome.

Although it is widely recognized that eating disorders primarily begin during the adolescent period, the centrality of obsessive-compulsive symptomatology and dynamisms and their relationship to adolescent conflict and development has not been generally accepted or understood. Social pressures toward conformity with the ideal of feminine thinness, which are especially influential during the adolescent period, combine with obsessive-compulsive predispositions to produce eating disorder symptoms and patterns of behavior. Obsessive preoccupation with images of food as well as ruminative calorie counting, and ritualistic behavior regarding food, use of laxatives, and vomiting, together with an underlying focus on control, undoing and other obsessive-compulsive defenses, and a sado-masochistic orientation to the body all point to an essential obsessive-compulsive disorder. The presence of dysphoric affect and the erratic success of antidepressant medication with eating disorder patients has led to a belief in an underlying affective disorder. However, careful assessment of eleven studies presenting differential diagnostic data regarding anorexia nervosa reveals that noneating related obsessive-compulsive patterns and symptoms are second overall in incidence to depressive patterns and symptoms. With critical re-evaluation of data presented, the obsessive-compulsive condition equals or supersedes the depressive one in many samples. Moreover, given the intense achievement orientation of persons with obsessive-compulsive illness, along with other psychodynamic factors, depressive symptoms could well be considered a secondary breakdown effect. If the all-pervasive obsessive-compulsive nature of eating-related symptomatology discussed here is taken into consideration, depressive symptoms must be considered either secondary or incidental. As patients with eating disorders are notoriously secretive and oftentimes misleading about their symptoms and themselves, a diagnostic assessment of such patients in intensive treatment at a long-term hospital facility was carried out. Compared with a control group randomly selected from the remainder of the hospital patient population, obsessive-compulsive manifestations of rumination, ritualistic behavior, excessive cleanliness, excessive orderliness, perfectionism, miserliness, rigidity, and scrupulousness and self-righteousness were all significantly associated with the eating disorder patient group. The current eating disorder picture, therefore, appears to be a modern form of obsessive-compulsive illness beginning during the adolescent period.

Digestion of killed Paracoccidioides brasiliensis by neutrophils.

We previously described an in vitro assay showing that neutrophils (PMNs) from patients with paracoccidioidomycosis (PARA) have a specific digestive deficiency against suspensions of live Paracoccidioides brasiliensis. We now report that this defect is equally detectable against autoclaved, but not Amphotericin B-killed P. brasiliensis. The use of autoclaved suspensions facilitates the use of our in vitro assay. It might allow the development of an in vitro intradermal test for digestion of fungi. Differential digestive ability of phagocytes against live (or autoclaved) and Amphotericin-B killed fungi is of conceptual interest. It may be relevant in understanding therapeutic effect of Amphotericin B.

Creativity and the homospatial process. Experimental studies.

Through empirical studies involving intensive and extensive interviewing of outstanding creative persons in literature, visual art, and science, a specific creative cognitive operation involving complex mental imagery was identified. This operation has been designated the "homospatial process" and defined as actively conceiving two or more discrete entities occupying the same space, a conception leading to the articulation of new identities. Four experimental assessments involving exposure to stimuli designed to evoke the homospatial process have been carried out with groups of talented persons as follows: (1) 43 writers produced short poetic metaphors in response to 10 different pairs of slide stimuli. Subjects were randomly assigned to view the pairs either superimposed upon one another, and thereby appearing to occupy the same spatial location, or separated and side by side on the screen as a control condition. (2) 46 writers were similarly divided and exposed for a shortened period of time to the same stimuli in order to encourage mental elaboration in the creation of poetic metaphors. (3) Drawings were created by 43 artists separated into a group exposed to three superimposed images and a control group exposed to the same component images side by side. (4) 39 artists were separated into a group exposed to three superimposed images and a control group exposed to the same images constructed into a single-image figure-ground display. Findings were that, in all four experiments, subjects' productions in response to the superimposed visual stimuli were rated significantly higher in creativity, by independent experts, than productions in response to the control condition. Therefore, the externalized representations of the homospatial process facilitated both literary and artistic creativity.

Differential diagnosis of anorexia nervosa and depressive illness: a review of 11 studies.

A review of differential diagnostic information from 11 studies of patients with anorexia nervosa is provided. Both intercurrent depressive and obsessive-compulsive features are most frequently reported overall. In seven of these studies providing information about premorbid and intercurrent personality disturbances, obsessive-compulsive characteristics are reported as most frequent in four. It is suggested that presumed connections between anorexia nervosa and depressive illness may be secondary to a more direct link with the obsessive-compulsive syndrome.

Artistic creation as stimulated by superimposed versus combined-composite visual images.

The creative role of homospatial thinking in visual art was assessed in an experiment with 39 highly talented young artists. In order to compare the creative effects of visual elements occupying the same space with identical elements arrayed in a combined foreground and background organization, superimposed slide images were presented to a randomly selected portion of the subject group, and the other portion of the subject group viewed the same slide images constructed into a figure-ground composite. Both groups produced three drawings stimulated by the slide stimuli, and these drawings were independently judged by three art experts. Results were that drawings produced by the group exposed to the superimposed images were rated higher in creative potential than those stimulated by the figure-ground controls. These results extend previous experimental findings of a tendency toward homospatial thinking in creative individuals in literature and visual art.

Eating disorder as a modern obsessive-compulsive syndrome.

Psychiatric symptomatology is clearly influenced by social factors. Such classical symptoms of the hysterical or conversion disorder as glove and stocking paralysis were once fairly widespread but appear today only in rather backward and poorly educated social groups throughout the world. Such a finding decidedly indicates social and educational causes. The purpose of this paper is to show that social and educational factors have also influenced obsessive-compulsive symptomatology; classical obsessive-compulsive neurosis has emerged today in a form involving food and disorders of eating. Among women of Western culture, the conditions known as anorexia nervosa and bulimia are the modern obsessive-compulsive disorders. First, social factors and individual diagnostic considerations, based on intensive long-term assessment of patients with these conditions, will be discussed. Then, results of a controlled diagnostic study of eating-disorder patients, also based on long-term observation, will be presented, and overall nosological implications discussed.

A novel method for estimating killing ability and digestion of Paracoccidioides brasiliensis by phagocytic cells in vitro.

We describe a novel method by which phagocytosis, digestion and killing of Paracoccidioides brasiliensis yeast cells by polymorphonuclear leukocytes or other phagocytic cells may be estimated simultaneously. Suspensions of P. brasiliensis (yeast-like phase) were sonicated, counted and incubated at 37 degrees C with known numbers of phagocytes. Control preparations contained no phagocytic cells. At given intervals samples were incorporated into gelatin nutrient medium and droplets of the mixtures were incubated at room temperature. Live yeast-like P. brasiliensis germinate in vitro and produce filaments. After incubation, droplets may be melted and examined under phase contrast optics, or the cells may be washed and stained by a variation of Papanicolaou's method. Digested P. brasiliensis, intact but non-germinating yeasts and filamented (viable) yeasts may be identified and counted. Killing and digestive abilities of phagocytes may be estimated by the difference between values obtained from phagocyte-containing and control preparations.

Psychopathology and creative cognition. A comparison of hospitalized patients, Nobel laureates, and controls.

To assess a tendency to rapid opposite responding associated with the type of creative cognition called janusian thinking, timed word association tests were administered to 12 creative scientists who were Nobel laureates, 18 hospitalized patients, and 113 college students divided as controls into high and low creative groups. Nobel laureates gave the highest proportion of opposite responses at the fastest rate of all groups, whereas patients gave the lowest proportion of opposite responses at the slowest rate. Both Nobel laureates and high creative students gave opposite responses at a significantly faster rate than they gave common, popular (nonopposite) responses, and their average speed of opposite response was fast enough to indicate that conceptualizing opposites could have been simultaneous. The results support the connection between janusian thinking and creativity and indicate a distinction between creative and psychopathologic cognitive modes.