Creativity

How do we define creativity?

Creativity is the ability of individuals to develop novel and useful products. Novelty, originality, innovation, ingenuity are some of the words often used to define creativity. But originality is just one component of creativity. There is another essential aspect of creativity – the idea should be effective, useful or productive. 

Creativity exists in many domains and is not just limited to the arts, as most people seem to think. Creativity is at work behind most scientific inventions, innovative gadgets, health technologies and economic theories which have changed the world.

Individuals differ in their propensity and capacity to be creative. Many of us are creative in small ways - in ways we find solutions to problems of everyday life. Only a few are highly creative and leave their mark on the world.

What does it take to be creative?

Creative individuals tend to possess some qualities or traits that may contribute to or are associated with their original thinking:

• Excellence: creative people are usually masters in their particular domains.
• Interests: they tend to be interested and curious about many things outside their main subject. This probably enables them to combine ideas or techniques from other disciplines in unusual ways to come up with novel, workable solutions to problems.
• Exploratory: They tend to be open to new experiences, ideas and ways of doing things.
• Motivation: most creative individuals are passionate about their interests and internally motivated.

Creativity is not about sitting and waiting for a sudden flash of insight or inspiration. This insight usually comes after much time spent in gaining knowledge and working hard at the task on hand. Discipline and perseverance are an essential part of the creative process.

As Edison famously said

Genius is 1% inspiration and 99% perspiration

High intelligence does not equate with creativity, however, creative people tend to have an above average IQ.

Can creativity be taught?

The generally accepted view is that creativity is not a set of skills which can be taught or learnt. However, certain habits, tools or strategies can be taught, and an environment that encourages and fosters creativity can be provided in our homes, schools and workplaces.

• Building basic skills and domain-specific knowledge
• Stimulating and rewarding curiosity and exploration
• Encouraging internal motivation, mastery and self-competition
• Providing opportunities and resources
• Promoting a willingness to take risks

Creativity and mental health

Those in creative, artistic professions tend to have a higher than average correlation with mental illnesses including schizophrenia, bipolar illness, substance abuse and suicide risk. 

Conversely, creative activities such as music, dance, art, journaling and poetry writing have been known to promote psychological well-being.

Does treatment of mental illness reduce creativity?

Treatment of mental illness could both help or hurt creativity. When treatment reduces fearfulness and avoidance it helps creativity. When it reduces motivation and flexibility it can hurt creativity. In practice there is usually a delicate balance that needs to be monitored. Some treatments are more effective at preserving creativity than others. Treatment that preserves goal-driven motivation helps all people, not only those in the arts field. As with most other aspect of health, physical exercise and adequate sleep help creativity.

Creativity is not all good nor all beneficial to society. A quick survey of the daily newspaper is enough to demonstrate how people resort to extremely creative ways to cheat, defraud or harm others.

References

1. Flaherty AW. Brain illness and creativity: mechanisms and treatment risks. Can J Psychiatry. 2011;56(3):132–143. doi:10.1177/070674371105600303
2. MacCabe JH, Sariaslan A, Almqvist C, Lichtenstein P, Larsson H, Kyaga S. Artistic creativity and risk for schizophrenia, bipolar disorder and unipolar depression: a Swedish population-based case-control study and sib-pair analysis. Br J Psychiatry. 2018;212(6):370–376. doi:10.1192/bjp.2018.23

Mental health checklists and screening tests for rampaging bus drivers

Checklists and psychological screening questionnaires for mental illness are effective, easy to use and widely available. Pune was shocked into considering the need for mental health screening of its bus drivers after one of them wilfully killed eight people and injured 32 others. He hijacked a bus at the depot and mowed down victims in broad daylight. Amidst the protests, and outrage the Pune administration has decided that all its bus driver undergo psychological testing.

We have already looked at screening of police personnel for mental health problems, and also screening of teenagers for alcohol and drug abuse. Here we specifically examine the feasibility of regularly screening the 8600 PMPL staff and Pune bus drivers for mental health problems.

Mental illness in bus drivers

• Mental health problems are higher for bus drivers who suffer from back pain, are dissatisfied with their jobs or undertake long-distance driving. This is more so for employees who have worked for >10 years. (Issever et al 2002)
• Aggressive bus drivers have more anxiety, hostility, and anger. They display competitiveness when driving aggressively, and display anger at slow drivers and traffic obstructions (Galovski 2002). Aggressive drivers with Intermittent Explosive Disorder (IED) endorse more assaultiveness and resentment. They display more impatience, hostility and have an angry temperament.
• Bus drivers have higher hospital admissions with diagnoses of mood reactions, paranoia and non-specific psychoses. (Ugesker 1989)

Ideal mental health screen

Easy to administer

it is to be conducted regularly without consuming excessive time

Culturally acceptable

anything stigmatising will be shunned

Sensitive

picks up potentially vulnerable persons

Specific

excludes those who do not have mental health problems

Easy to interpret

results should be available immediately

The aim of mental health screening is to identify individuals who require a more detailed examination. One counsellor will never be able to carry out any evaluation of 8600 staff.

Mental health checklists and screening instruments

There are already valid (test identifies persons mental illness) and reliable (results remain the same when administered by different testers and on re-testing) checklists for mental health screening. Two mental health screening instruments that satisfy many of the ideal criteria are the COOP/WONCA charts and the WHO-5 questionnaire. Both have high diagnostic accuracy for mental disorders. Specificity, sensitivity and positive predictive values range from 0.85 to 0.87 (Anything more than 0.7 is good).

COOP/WONCA

The COOP/WONCA measures six core aspects of functional status: physical fitness, feelings, daily activities, social activities, change in health and overall health through six charts. The charts have been successfully used in illiterate populations, and have guidelines for translation where required. The average time for completion is less than five minutes. One-time assessment with the COOP/WONCA Charts is a valid and feasible option for screening for mental disorders at the primary care level.

WHO-5

The WHO-Five Well-being Index (WHO-5) is a set of 5 questions that can be used when six charts are too much.

A mental health check is most acceptable as part of the regular or annual ‘health check’. Those who score above the cut-off are taken up for detailed assessment by a psychiatrist or other mental health professional. No additional man-power is required. The process will not cost in crores. Our roads will be safer.

We need to use available checklists and screening tests for early detection of mental illness in Pune’s bus drivers.

References

1. Galovski T, Blanchard EB. Psychological characteristics of aggressive drivers with and without intermittent explosive disorder. Behav Res Ther. 2002 Oct;40(10):1157-68. 
2. Issever H, Onen L, Sabuncu HH, Altunkaynak O. Personality characteristics, psychological symptoms and anxiety levels of drivers in charge of urban transportation in Istanbul. Occup Med (Lond). 2002 Sep;52(6):297-303. 
3. Joao Mazzoncini de Azevedo-Marques, MD, PhD1 and Antonio Waldo Zuardi, MD, PhD. COOP/WONCA Charts as a Screen for Mental Disorders in Primary Care.  Annals of Family Medicine 9:359-365 (2011) doi: 10.1370/afm.1267
4. C. van Weel, C. König - Zahn, F.W.M.M. Touw - Otten, N.P. Van Duijn, B. Meyboom - de Jong. Measuring functional status with the COOP/WONCA charts: a manual. Northern Centre of Health Care Research 1990. ISBN 90 72156 33 1 
5. WHO. WHO-Five Well-being Index (WHO-5) Accessed 17-Feb-2011 
6. Ugeskr Laeger. Psychiatric admissions among city bus drivers. A prospective study. Ugeskr Laeger. 1989 Jan 30;151(5):302-5. 

Recovery from mental illness

Recovery to meaningful functioning after even severe mental illness is the present standard of care in mental health treatment. Recovery is made possible by medications that are now widely available at a reasonable cost. Planning and persistence with treatment need to be ensured to achieve a quality recovery.

Recovery from mental disorders is a process of change through which individuals

1. improve their health and wellness
2. live a self-directed life
3. strive to reach their full potential

The road to recovery from mental illness has four components that together give meaning to life.

1. Health

Overcoming or managing the disease and living in a physically and emotionally healthy way.

Start with the basics - medication, meals, sleep and exercise. Establishing routines for these basic health tasks are essential for recovery of function. Medication is the corner stone on which recovery is nurtured. In the absence of medication frequent relapses and recurrences disrupt basic functions that protect the individual from the illness producing effects of daily stressors.

2. Home

A stable and safe place to live.

In daily practice we see persons with the most severe mental illnesses putting aside their disturbing thoughts, controlling their behaviours and getting back to school or work; while others with a milder illness are unable to leave their preoccupations and move ahead with life. Trusting relationships are quite often what they lack. Trust makes the home feel safe.

3. Purpose

Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society.

A person needs something to recover to. Amazing recovery can be sustained in a supportive job environment. Some bosses give this support naturally. It may be it is in their outlook; they see the illness as just one aspect of the persons identity. Vice versa, others with good symptom recovery without stigmata are unable to function in a hostile work place, and are unable to integrate with society  and lead meaningful lives.

4. Community

Relationships and social networks that provide support, friendship, love, and hope.

From volunteering at the community bookshop to joining a local football team; community interactions bring many otherwise isolated individuals into useful contact with others. These valued interactions are based on a personal identity which is not connected to their mental illness.

Recovery is a process towards achieving ones potential. The first small steps result in giant gains. Without them the individual is unable to reach any level of meaningful recovery. The first step for persons with serious mental illness is medication. Without medication, recovery from serious mental illness is long-drawn, stigmatising, and characterised by frequent relapses. Medication is the pillar around which recovery is fostered. A supportive home, work-place and community further augments this process. Recovery from severe mental illness is a process, it does not happen overnight, but for those who stay the course it brings the meaning back to life.

References

1. SAMHSA’s Definition and Guiding Principles of Recovery – Answering the Call for Feedback
    Accessed 04-Jan-2012

Why would a mother burn her daughter?

A family tragedy was played out through a small article in the Pune news. In a fit of rage a mentally ill woman set her daughter alight while she was asleep. The narrative was short and the item tucked into one of the inner pages under a largish headline.

 This was the reason - the why - mental illness

  

 A glib explanation for a horrific event lays the entire burden of its causation at the doors of a mental health disorder. The World Health Organisation  (WHO) has estimated that one in four persons will have a mental health disorder at some stage of life .

Violence is rarely a manifestation of mental illness

In this rare cause of burning (mental illness), the burning of her daughter is an indicator of the severity of the mother's mental illness. Yet society, of which this news item is a barometer, has unquestioningly accepted mental illness as a sufficient cause. In a nation with about 0.48 mental health workers of any kind  for every 100,000 people, a woman who had previously managed to access mental health care slips through the organisational net and goes on to seriously injure her own daughter. A family that had against overwhelming odds obtained mental health care for a loved one could not mobilise the resources to access it again when her illness escalated. Ease of access to mental health care is crucial. Why?

Common mental illnesses are effectively treated with medication

Most people with mental illness achieve control over their behaviour and impulses. The cost of treatment with standard and effective medication is less than Rs5-10/day. The social costs of mental illness is the major barrier, keeping those needing care from seeking it. The other barrier is institutional, keeping those seeking care from getting it. This mother could not cut through the social and institutional barriers to obtain that care. That is why a mother burnt her daughter.