10 Questions You've Always Wanted to Ask About Bipolar Disorder

Kanye West has had a revealing year. Throughout the pandemic, the rapper chose to take part in a number of interviews where he discussed his struggles, diagnosis and subsequent approach to living with bipolar disorder, and specifically his decision not to medicate his condition.

Following the latest confab, a three-hour chat with Joe Rogan, the podcast host reasoned in his typically sensitive way, “If you have a choice between this medicated, overweight Kanye who doesn’t get anything done, or manic, crazy Kanye... you want manic, crazy Kanye!” Rogan then took issue with the use of the term “mental illness” when referring to Ye’s bipolar, romanticising it as just another facet of his creative genius.

This relationship – between bipolar and creativity – has a long history; one of the most googled questions about the disorder reads: “Is bipolar a sign of genius?”

In an interview with David Letterman, Kanye claimed to be “the most famous person with” bipolar – but there are plenty of other high-profile sufferers, including Selena Gomez, Mariah Carey and Demi Lovato. Outside of music, many other creative heavyweights have been diagnosed with, or were thought to have had, the disorder, including Ernest Hemingway, Virginia Woolf and Jackson Pollock.

So is there any link between bipolarity and creative genius? In search of answers, I spoke to one of the world’s leading experts in the treatment of bipolar disorder, Professor of Psychiatry at the University of Barcelona, Eduard Vieta Pascual. 

This interview has been edited for length and clarity.

VICE: Why are there so many high-achieving creative people who suffer from bipolar disorder?
Eduard Pascual: There is clear scientific proof this is the case. One of the potential reasons is that the genes that configure the risk for bipolar disorder are also genes that are related to processes that include creativity and leadership. To some extent, if you have too many bipolar genes it will increase the chance of the illness. If you get some of those genes, but not too many of them, then you will get the good side of it. This is probably the reason why nature is still producing bipolars; the genes are related to some good and some bad things.

Can you pinpoint the balance of those genes and work out a “tipping point”?
We’re not there yet. We know a lot about the genetics of bipolar disorder, but we don’t know the exact connection between creativity and leadership.

Is it fair to say that if you’re a high-achieving, creative person, you’re more susceptible to having those genes?
Yes, it is. But it doesn’t mean that everyone that is creative or an artist is going to get bipolar, or be at risk of bipolarity. But clearly they have an increased risk of this condition.

If bipolar is part nature, part nurture, could working in the creative industries play a part in cultivating the condition?
I think there’s some truth in that. The use of cannabis and stimulants, and sleeping in an irregular way, can both encourage bipolarity, as does the lack of routine. Things like this may all cause one to develop the condition. Stressful factors like that facilitate the emergence of the condition too.

Descriptions of hypomania – the pre-manic state – can sometimes be interchangeable with descriptions of a creative mastermind hitting the heights of inspiration. How do you tell the two apart?
Hypomania can make you more creative, but it can also induce much self-criticism. When [the person experiencing it] later sees what they did, they didn’t actually do anything of worth. The difference between hypomania and a spiritual high, or real happiness, is that hypomania is recurrent, and it is usually preceded by or followed by depression. This is a very good clue.

The problem with hypomania is that it doesn’t last too long. It’s clearly an episode. The behaviour of the person having hypomania is recognised by others that know them as not their usual self. It ends up being something that is not as good as it feels. Hypomania makes you feel very good, but it doesn’t mean you have a great advantage. You may be active, you may be more creative, but your insight may be impaired and [you] may not end up doing things as well as you feel.

How common is it to get a bipolar diagnosis and choose not to medicate and live with the symptoms?
Well, it happens. Some people choose to deny the condition, or just to deny the treatment of it. But those that choose to do that and have a severe case can end up destroying their lives, or end up destroying the lives of their loved ones. For severe kinds of bipolar disorder, it’s generally a bad choice. But, of course, some people choose to do that.

There are plenty of people that are reluctant to take meds for psychiatric conditions. This is to do with certain narcissistic traits that we all have. We believe that we are as good as we are, and have a paranoid feeling that medications may change our personality, which is not true. One of the symptoms of bipolar can be suicide, and the risk of suicide for those not on medication is 20-fold from those who medicate.

What do you think about the idea of medication hampering creative genius?
I don’t think this is the way to look at it. You can be creative with bipolar disorder and be totally euthymic in remission. Creativity doesn’t go along with being manic or hypomanic, it comes with some personal factors that we may never know. That’s not to say that having bipolar implies some creativity by itself – but also because some of the genes associated with bipolar disorder may foster your own talent.

So it’s not the illness that compensates creativity, that’s a confusion. When people are manic or hypomanic, often the things they do are crazy things that really aren’t creative. To be a good writer, or a good artist, or a good musician, you need some quietness, some reflection. It’s not only inspiration, but transpiration. It’s working hard at what you do. So, commonly, craziness tends not to be a good component of creativity.

Delusions of grandeur is a common symptom of mania. For the high profile bipolar patients who really are important and experience this state, that sounds hard to reconcile.
Yes, it is. I wrote a book about Ferdinand the 6th, one of the kings of Spain, who had bipolar disorder. He was literally one of the most powerful men on Earth – at the time, Spain was an empire. It was very difficult for all of his advisors to engage with him, because he was so manic. He wanted to declare war on both England and France, his two main rivals, at the same time.

How common is it for someone’s fundamental viewpoints and opinions to change in an extreme way when suffering from bipolar?
Very. When people change from the state of hypomania to depression, they often change their mind. Things that they may feel in one state are completely normal, they suddenly feel very guilty about. In bipolar, we see that patients change from one state to another, and that what they thought and believed strongly two days ago has suddenly changed in two days or less.

Can bipolar ever be a positive force in someone’s life?
I don’t think it’s something that is very positive. But I think for people who have it – and for people that have any handicap – using it to improve as a person, and to overcome the barrier that the handicap is having in your life, could make you a better person. So I believe having something bad could make you a better person. But I don’t think this makes the bad thing a good thing.

It’s true that bipolarity has some potentially good sides, but it’s often the loved ones that end up suffering from it, and that’s not ideal. But if you have this condition, I do agree that you should try to make the best of it.