Creativity and mental health

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Composer Ludwig van Beethoven may have had bipolar disorder. Joseph Karl Stieler's Beethoven mit dem Manuskript der Missa solemnis.jpg
Composer Ludwig van Beethoven may have had bipolar disorder.

Links between creativity and mental health have been extensively discussed and studied by psychologists and other researchers for centuries. Parallels can be drawn to connect creativity to major mental disorders including bipolar disorder, schizophrenia, major depressive disorder, anxiety disorder, OCD and ADHD. For example, studies [3] [4] have demonstrated correlations between creative occupations and people living with mental illness. There are cases that support the idea that mental illness can aid in creativity, but it is also generally agreed that mental illness does not have to be present for creativity to exist.

Contents

History

It has been proposed that there is a link between creativity and mental illness. Major depressive disorder appears among playwrights, novelists, biographers, and artists at a higher rate than the general population. [5] Association between mental illness and creativity first appeared in academic literature in the 1970s, but speculation about a link between "madness" and "genius" dates back at least to the time of Aristotle. The word "genius" may refer to literary genius, creative genius, scholarly genius, "all around" genius, etc. [6] The Ancient Greeks believed that creativity came from the gods, in particular the Muses (the mythical personifications of the arts and sciences, the nine daughters of Zeus). In the Aristotelian tradition, genius was viewed from a physiological standpoint, and it was believed that the same human quality was perhaps responsible for both extraordinary achievement and melancholy. [7] Romantic writers had similar ideals, with Lord Byron having pleasantly expressed, "We of the craft are all crazy. Some are affected by gaiety, others by melancholy, but all are more or less touched".

Individuals with mental illness are said to display a capacity to see the world in a novel and original way; literally, to see things that others cannot. [8] However, people do not require a mental illness to do so.

Studies

For many years, the creative arts, from visual arts and writing to music and drama, have been used in therapy for those recovering from mental illness or addiction. [9] [10]

Another study found that increased levels of creativity were more common amongst those with schizotypal personality disorder than in people with either schizophrenia or people without mental health diagnoses. While divergent thinking was associated with bilateral activation of the prefrontal cortex, schizotypal individuals were found to have much greater activation of their right prefrontal cortex. [11] This study hypothesized that such individuals are better at accessing both hemispheres, allowing them to make novel associations at a faster rate. Consistent with this hypothesis, ambidexterity is also more common in people with schizotypal personality disorder as well as people with schizophrenia.[ citation needed ]

Three studies by Mark Batey and Adrian Furnham have demonstrated the relationships between schizotypal [12] [13] and hypomanic personality [14] and several different measures of creativity. Specifically, Divergent Thinking Fluency, the Biographical Inventory of Creative Behaviors, as well as Self-rated Creativity.

Particularly strong links have been identified between creativity and mood disorders, particularly manic-depressive disorder (a.k.a. bipolar disorder) and depressive disorder (a.k.a. unipolar disorder). [15] In Touched with Fire: Manic-Depressive Illness and the Artistic Temperament, Kay Redfield Jamison summarizes studies of mood-disorder rates in writers, poets and artists. She also explores research that identifies mood disorders in such famous writers and artists as Ernest Hemingway (who shot himself after electroconvulsive treatment), Virginia Woolf (who drowned herself when she felt a depressive episode coming on), composer Robert Schumann (who died in a mental institution), and famed visual artist Michelangelo.

A study by Simon Kyaga and others looked at 300,000 people with schizophrenia, bipolar disorder or unipolar depression, and their relatives, found overrepresentation in creative professions for those with bipolar disorder as well as for undiagnosed siblings of those with schizophrenia or bipolar disorder. [16] There was no overall overrepresentation, but overrepresentation for artistic occupations, among those diagnosed with schizophrenia. There was no association for those with unipolar depression or their relatives. [16]

A study involving more than one million people, conducted by Swedish researchers at the Karolinska Institute, reported a number of correlations between creative occupations and mental illnesses. Writers had a higher risk of anxiety and bipolar disorders, schizophrenia, unipolar depression, and substance abuse, and were almost twice as likely as the general population to kill themselves. Dancers and photographers were also more likely to have bipolar disorder. [17]

However, as a broader group, those in the creative professions (defined as "scientific and artistic occupations") were no more likely to experience psychiatric disorders than other people, although they were more likely to have a close relative with a disorder, including anorexia and, to some extent, autism, the Journal of Psychiatric Research reports. [17]

Research in this area is usually constrained to cross-section data-sets. One of the few exceptions is an economic study of the well-being and creative output of three famous music composers over their entire lifetime. [18] The emotional indicators are obtained from letters written by Wolfgang Amadeus Mozart, Ludwig van Beethoven and Franz Liszt, and the results indicate that negative emotions had a causal impact on the creative production of the artists studied.

Psychological stress has also been found to impede spontaneous creativity. [19] [20] In fact, Robert Epstein describes it as a creativity killer. Instead, people must work to cultivate creativity like any other skill. He found that capturing your ideas, seeking out challenges, increasing your knowledge, and surrounding yourself with others who do the same help creativity grow rather than focusing on your stress. [19] [21]

A 2005 study at the Stanford University School of Medicine measured creativity by showing children figures of varying complexity and symmetry and asking whether they like or dislike them. The study showed for the first time that a sample of children who either have or are at high risk for bipolar disorder tend to dislike simple or symmetric symbols more. Children with bipolar parents who were not bipolar themselves also scored higher dislike scores. [22]

A study by Sally Anne Gross and George Musgrave suggested that high levels of self-reported anxiety and depression amongst musicians might be explained, at least in part, by the nature of their working conditions. [4]

Mood and creativity

There have been many studies on the correlation between mood and creativity with very different results. Some studies seem to show a correlation between positive mood (affect) and heightened creativity. [23] Other studies show that negative moods seem to be correlated with heightened creativity. One such research paper concludes, "Negative moods signal that the status quo is problematic and that additional effort needs to be exerted to come up with new and useful ideas." [24] The debate is not binary, with some studies saying that both positive and negative emotions play a role in creativity. [25] [26] Additionally, the connection between mood and creativity is rarely direct; rather, being in certain moods forces or fosters people into certain actions that make them more creative at the moment. For instance, negative emotions have been shown to increase the amount a person will reflect and ruminate, which then can cause a person to be more creative. [27]

Bipolar disorder

Bipolar disorder may stimulate creativity, as manic episodes can include prolonged periods of elevated energy. The first empirical study about this topic was done by Nancy Andreasen in the 1970s. She expected for the correlation to be between Creativity and Schizophrenia. She instead discovered that the correlation was actually between creativity and those with mood disorders. Specifically, that 80% of her sample had experienced at least one major episode. [28] In her follow-up study 15 years later, she found that 43% had been diagnosed with bipolar disorder and 2 had committed suicide. [29] In her book Touched with Fire, American clinical psychologist Kay Redfield Jamison wrote that 38% of writers and poets had been treated for a type of mood disorder, and 89% of creative writers and artists had experienced "intense, highly productive, and creative episodes". These were characterized by "pronounced increases in enthusiasm, energy, self-confidence, speed of mental association, fluency of thought and elevated mood". [30] Although mania is characterized by reckless and possibly self-destructive behavior, in milder forms, the energy and free-flowing thinking of mania can fuel creativity. [31]

There is a range of types of bipolar disorder. Individuals with Bipolar I Disorder experience severe episodes of mania and depression with periods of wellness between episodes. The severity of the manic episodes can mean that the person is seriously disabled and unable to express the heightened perceptions and flight of thoughts and ideas in a practical way. Individuals with Bipolar II Disorder experience milder periods of hypomania during which the flight of ideas, faster thought processes and ability to take in more information can be converted to art, poetry or design. [32] In a study done by Shapiro and Weisberg, they found that it was not the depressive episodes, but rather coming out of them that sparked the creativity. Specifically, the self-image that one has during hypomania causing them to be more self-confident and allows them to have the confidence to create. [33]

Dutch artist Vincent Van Gogh is widely theorised to have had bipolar disorder. Other notable creative people with bipolar disorder include Carrie Fisher, Demi Lovato, Kanye West, Stephen Fry (who has cyclothymia, a milder and more chronic form of bipolar disorder), [34] Mariah Carey, Jaco Pastorius, Catherine Zeta-Jones, Jean-Claude Van Damme, Ronald Braunstein, [35] [36] and Patty Duke. [37]

Schizophrenia

People with schizophrenia live with positive, negative, and cognitive symptoms. Positive symptoms (psychotic behaviors that are not present in healthy people) include hallucinations, delusions, thought and movement disorders. Negative symptoms (abnormal functioning of emotions and behavior) include flat affect, anhedonia, among others. Cognitive symptoms include problems with executive functioning, attention, and memory. [38] One artist known for his schizophrenia was the Frenchman Antonin Artaud, founder of the Theatre of Cruelty movement. In Madness and Modernism (1992), clinical psychologist Louis A. Sass noted that many common traits of schizophrenia – especially fragmentation, defiance of authority, and multiple viewpoints – happen to also be defining features of modern art. [39] However, it has been found that those who have it are the most creative either before or after active periods, not during them. [40]

Multiple research studies study a link between reduced latent inhibition, and the psychopathology of acute-phase schizophrenia. This is suggestive of a correlation between psychopathology and creativity, but should not be interpreted as a causal relationship. [41]

In a 2002 conversation with Christopher Langan, educational psychologist Arthur Jensen stated that the relationship between creativity and mental disorder "has been well researched and is proven to be a fact", writing that schizothymic characteristics are somewhat more frequent in philosophers, mathematicians, and scientists than in the general population. [42] [ unreliable fringe source? ] In a 2015 study, Iceland scientists found that people in creative professions are 25% more likely to have gene variants that increase the risk of bipolar disorder and schizophrenia, [43] with deCODE Genetics co-founder Kári Stefánsson saying, "Often, when people are creating something new, they end up straddling between sanity and insanity. I think these results support the concept of the mad genius." [44]

Bipolar disorder

Many famous historical figures gifted with creative talents may have been affected by bipolar disorder. Ludwig van Beethoven, Virginia Woolf, Ernest Hemingway, Isaac Newton, Judy Garland, Jaco Pastorius and Robert Schumann are some people whose lives have been researched to discover signs of mood disorder. [45] In many instances, creativity and mania – the overwhelming highs that bipolar individuals often experience – share some common traits, such as a tendency for "thinking outside the box," flights of ideas, the speeding up of thoughts and heightened perception of visual, auditory and somatic stimuli.

It has been found that the brains of creative people are more open to environmental stimuli due to smaller amounts of latent inhibition, an individual's unconscious capacity to ignore unimportant stimuli. While the absence of this ability is associated with psychosis, it has also been found to contribute to original thinking. [46] [ unreliable medical source? ]

Emotions

Many people with bipolar disorder may feel powerful emotions during both depressive and manic phases, potentially aiding in creativity. [47] [ unreliable medical source? ] Because mania and hypomania may decrease social inhibition, performers who have bipolar disorder may become more daring and bold during an episode. Other creators may exhibit characteristics often associated with mental illness that are not necessarily equivalent to a full-blown manic episode. [48] [ unreliable medical source? ]

Posthumous diagnosis

Some creative people have been posthumously diagnosed as experiencing bipolar or unipolar disorder based on biographies, letters, correspondence, contemporaneous accounts, or other anecdotal material, most notably in Kay Redfield Jamison's book Touched with Fire: Manic-Depressive Illness and the Artistic Temperament . [49] [ unreliable medical source? ]Touched with Fire presents the argument that bipolar disorder, and affective disorders more generally, [50] [ unreliable medical source? ] may be found in a disproportionate number of people in creative professions such as actors, artists, comedians, musicians, authors, performers and poets.

Scholars have also speculated that the visual artist Michelangelo lived with depression. [51] [52] In the book Famous Depressives: Ten Historical Sketches, MJ Van Lieburg argues that elements of depression are prominent in some of Michelangelo's sculptures and poetry. Van Lieburg also draws additional support from Michelangelo's letters to his father in which he states:

"I lead a miserable existence and reck not of life nor honour – that is of this world; I live wearied by stupendous labours and beset by a thousand anxieties. And thus I lived for some fifteen years now and never an hour's happiness have I had." [53]

Positive correlation

Several recent clinical studies have also suggested that there is a positive correlation between creativity and bipolar disorder, although the relationship between the two is unclear. [54] [55] [56] Temperament may be an intervening variable. [55] Ambition has also been identified as being linked to creative output in people across the bipolar spectrum. [57] Can Music Make You Sick? Measuring the Price of Musical Ambition [4] by Sally Anne Gross and George Musgrave suggests that high levels of self-reported anxiety and depression amongst musicians can be explained, at least in part, by the nature of musicians' working conditions.

Mental illness and divergent thinking

In 2017, associate professor of psychiatry Gail Saltz stated that the increased production of divergent thoughts in people with mild-to-moderate mental illnesses leads to greater creative capacities. Saltz argued that the "wavering attention and day-dreamy state" of ADHD, for example, "is also a source of highly original thinking ... CEOs of companies such as Ikea and Jetblue have ADHD. Their creativity, out-of-the-box thinking, high energy levels, and disinhibited manner could all be a positive result of their [condition]." [58] Mania risk has also been credited with aiding in creative accomplishments [59] because "when speed of thinking increases, word associations form more freely, as do flight of ideas, because the manic mind is less inclined to filtering details that, in a normal state, would be dismissed as irrelevant." [39]

Brain imaging studies have consistently reported that low-latent inhibition is associated with originality, creative personalities, and high levels of creative achievement. There have also been genetic studies conducted to consider genetic links between creativity and psychopathology. Several genes that have been flagged as linking to some forms of psychopathology have also been linked to creativity. These include polymorphisms of the DRD2 and DRD4 genes, the 5HT2a gene, and the NRG1 gene. [41]

Correlation but not causation

Several studies suggest a consistent link between creativity and those with either mild forms of bipolar disorder or family histories of bipolar disorder, but not full-blown Bipolar I Disorder. These findings reiterate that creative individuals are more likely on the mild end of psychosis spectrums, but not repeatedly beyond that point. One study wrote that "only elevated levels of schizotypy and psychosis-proneness found in divergent thinkers or possessing some indicators of schizotypy promotes creative achievement but not full-blown schizophrenia". Another article writes that "it is likely that psychopathology and creativity are closely related; sharing many traits and antecedents but outright psychopathology may be negatively associated with creativity". [41]

These correlations could be due, in part, to shared vulnerability factors between creativity and psychopathology, including neural hyper-connectivity, novelty salience, cognitive disinhibition, and emotional lability. There are also shared environmental factors that can simultaneously increase potential for creativity and vulnerability to psychopathology. These factors continue to drive further research, like the study Anxiety and Adverse Life Events in Professional Creative and Early Psychosis Populations (Crabtree et al. [60] ).

Creativity and mental well-being

There is a popular Indian cultural belief that 'deep pain enhances creativity and creative acts may actually help in healing the wounds'. [41] The healing powers of creativity are seen frequently in everyday life, as artistic outlets are often encouraged as a way to improve well-being. For many people, creativity serves to overcome psychic crises, traumatic events and depression. [61] [ page needed ] Creativity can also have an incredible impact on mental health and well-being by not only helping people find meaning and significance, but providing an increased sense of purpose. [62]

Notable individuals

This is a list of individuals whose creative sensibilities have been linked to their mental health.

I wrote [I Never Promised You a Rose Garden] as a way of describing mental illness without the romanticisation [ sic ] that it underwent in the sixties and seventies when people were taking LSD to simulate what they thought was a liberating experience. During those days, people often confused creativity with insanity. There is no creativity in madness; madness is the opposite of creativity, although people may be creative in spite of being mentally ill.

This statement from Greenberg originally appeared on the page for Rose Garden at amazon.com and has been quoted in many places[ weasel words ] including Asylum: A Mid-Century Madhouse and Its Lessons About Our Mentally Ill Today, by Enoch Callaway, M.D. (Praeger, 2007), p. 82.[ full citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Bipolar disorder</span> Mental disorder that causes periods of depression and abnormally elevated mood

Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks. If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy or irritable, and they often make impulsive decisions with little regard for the consequences. There is usually also a reduced need for sleep during manic phases. During periods of depression, the individual may experience crying and have a negative outlook on life and poor eye contact with others. The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm. Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.

Bipolar I disorder is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode, with or without mixed or psychotic features. Most people also, at other times, have one or more depressive episodes.

Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect." During a manic episode, an individual will experience rapidly changing emotions and moods, highly influenced by surrounding stimuli. Although mania is often conceived as a "mirror image" to depression, the heightened mood can be either euphoric or dysphoric. As the mania intensifies, irritability can be more pronounced and result in anxiety or anger.

<span class="mw-page-title-main">Mood disorder</span> Mental disorder affecting the mood of an individual, over a long period of time

A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.

<span class="mw-page-title-main">Mood swing</span> Extreme or rapid change in mood

A mood swing is an extreme or sudden change of mood. Such changes can play a positive part in promoting problem solving and in producing flexible forward planning, or be disruptive. When mood swings are severe, they may be categorized as part of a mental illness, such as bipolar disorder, where erratic and disruptive mood swings are a defining feature.

<span class="mw-page-title-main">Sylvia Plath effect</span>

The Sylvia Plath effect is the phenomenon that poets are more susceptible to mental illness than other creative writers. The term was coined in 2001 by psychologist James C. Kaufman, and implications and possibilities for future research are discussed. The effect is named after Sylvia Plath, who died by suicide at the age of 30.

<i>Touched with Fire</i> (book)

Touched with Fire: Manic-Depressive Illness and the Artistic Temperament is a book by the American psychologist Kay Redfield Jamison examining the relationship between bipolar disorder and artistic creativity. It contains extensive case studies of historic writers, artists, and composers assessed as probably having had cyclothymia, major depressive disorder, or manic-depressive/bipolar disorder.

Cyclical variations in moods and energy levels have been recorded at least as far back as several thousand years. The words "melancholia" and "mania" have their etymologies in Ancient Greek. The word melancholia is derived from melas/μελας, meaning "black", and chole/χολη, meaning "bile" or "gall", indicative of the term's origins in pre-Hippocratic humoral theories. A man known as Aretaeus of Cappadocia has the first records of analyzing the symptoms of depression and mania in the 1st century of Greece. There is documentation that explains how bath salts were used to calm those with manic symptoms and also help those who are dealing with depression. Even today, lithium is used as a treatment to bipolar disorder which is significant because lithium could have been an ingredient in the Greek bath salt. Centuries passed and very little was studied or discovered. It wasn't until the mid-19th century that a French psychiatrist by the name of Jean-Pierre Falret wrote an article describing "circular insanity" and this is believed to be the first recorded diagnosis of bipolar disorder. Years later, in the early 1900s, Emil Kraepelin, a German psychiatrist, analyzed the influence of biology on mental disorders, including bipolar disorder. His studies are still used as the basis of classification of mental disorders today.

A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".

<span class="mw-page-title-main">Bipolar disorder in children</span>

Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare mental disorder in children and adolescents. The diagnosis of bipolar disorder in children has been heavily debated for many reasons including the potential harmful effects of adult bipolar medication use for children. PBD is similar to bipolar disorder (BD) in adults, and has been proposed as an explanation for periods of extreme shifts in mood called mood episodes. These shifts alternate between periods of depressed or irritable moods and periods of abnormally elevated moods called manic or hypomanic episodes. Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously. Mood episodes of children and adolescents with PBD are different from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time and cause severe disruptions to an individual's life. There are three known forms of PBD: Bipolar I, Bipolar II, and Bipolar Not Otherwise Specified (NOS). The average age of onset of PBD remains unclear, but reported age of onset ranges from 5 years of age to 19 years of age. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.

In medicine, a prodrome is an early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

<span class="mw-page-title-main">Grandiose delusions</span> Subtype of delusion

Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, and also informally known in Japan as eighth-grade syndrome or chūnibyō, are a subtype of delusion that occur in patients with a wide range of psychiatric disorders, including two-thirds of patients in a manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, frequently as a comorbid condition in narcissistic personality disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. Around 10% of healthy people experience grandiose thoughts at some point in their lives but do not meet full criteria for a diagnosis of GD.

Cognitive epidemiology is a field of research that examines the associations between intelligence test scores and health, more specifically morbidity and mortality. Typically, test scores are obtained at an early age, and compared to later morbidity and mortality. In addition to exploring and establishing these associations, cognitive epidemiology seeks to understand causal relationships between intelligence and health outcomes. Researchers in the field argue that intelligence measured at an early age is an important predictor of later health and mortality differences.

Cyclothymia, also known as cyclothymic disorder, psychothemia / psychothymia, bipolar III, affective personality disorder and cyclothymic personality disorder, is a mental and behavioural disorder that involves numerous periods of symptoms of depression and periods of symptoms of elevated mood. These symptoms, however, are not sufficient to indicate a major depressive episode or a manic episode. Symptoms must last for more than one year in children and two years in adults.

The associated features of bipolar disorder are clinical phenomena that often accompany bipolar disorder (BD) but are not part of the diagnostic criteria for the disorder. There are several childhood precursors in children who later receive a diagnosis of bipolar disorder. They may show subtle early traits such as mood abnormalities, full major depressive episodes, and attention-deficit hyperactivity disorder. BD is also accompanied by changes in cognition processes and abilities. This includes reduced attentional and executive capabilities and impaired memory. How the individual processes the world also depends on the phase of the disorder, with differential characteristics between the manic, hypomanic and depressive states. Some studies have found a significant association between bipolar disorder and creativity.

Hypomania is a mental and behavioral disorder, characterised essentially by an apparently non-contextual elevation of mood (euphoria) that contributes to persistently disinhibited behaviour.

Secondary mania, also known as organic mania, is a variation of bipolar disorder that is caused by physical trauma or illness. Bipolar disorder has a one percent prevalence rate in the United States and secondary mania is likely a small subset of that percentage. Secondary mania exhibits symptoms similar to that of mania in bipolar I and bipolar II disorders. This includes an elevated mood or affect, psychotic state, accelerated speech, increased motor activity, irritability, and flight of ideas. A unique criterion for secondary mania is the lack of history of mental illness that causes mania, such as bipolar disorder. Unlike bipolar disorder, which has an average age of onset at 25 years, secondary mania has an average age of onset at 45 years. Little is known about secondary mania, as much of the research on it is case studies and retrospective accounts. However, it has been connected to several causes such as traumatic brain injury, HIV/AIDS, and stroke.

Epigenetics of bipolar disorder is the effect that epigenetics has on triggering and maintaining bipolar disorder.

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