A lot of people believe that it’s just a given that artists are “crazy,” that being mentally ill makes you more creative and able to “think outside of the box.” Is this true? It’s something I have wondered about many times. The short answer is probably not, but it’s a lot more complicated than that.

There have certainly been a lot of high-profile artists with mental health issues (including substance use issues): comedian Margaret Cho (who had an eating disorder, depression, and drug and alcohol addiction), painter Edvard Munch (who had depression and agoraphobia, as well as hallucinations), painter Georgia O’Keeffe (who dealt with anxiety and depression), poet Sylvia Plath (who had depression and ultimately killed herself), Vincent van Gogh (who probably had depression or bipolar disorder and, like Plath, killed himself), novelist David Foster Wallace (who dealt with depression and also killed himself), street and neo-expressionist artist Jean-Michel Basquiat (who suffered from heroin addiction and paranoia), actress and writer Carrie Fisher (who had bipolar disorder and also was addicted to drugs and alcohol) … The list could go on and on. But, does having a mental illness or addiction play a direct role in being creative?

In a 2013 study, Kyaga and colleagues looked at a huge sample of Swedes–more than 1 million–and found that people with a mental health issue (including psychosis, bipolar disorder, depression, anxiety disorders, substance abuse, autism, ADHD, anorexia nervosa, and completed suicide) were no more likely to work in a creative profession (defined as artistic or scientific careers) than those without a mental disorder. However, in this and previous studies, these authors did find that people with psychotic disorders or bipolar disorder were more likely to work creatively and that authors were more likely to have certain mental health problems. Interestingly, Kyaga and associates also found that the siblings of patients with autism and the first-degree relatives of patients with schizophrenia, bipolar disorder, and anorexia nervosa were significantly overrepresented in creative professions. Scott Barry Kaufman, in a blog post for Scientific American, postulates: “Could it be that the relatives inherited a watered-down version of the mental illness conducive to creativity while avoiding the aspects that are debilitating?” This makes some sense, since a number of traits associated with some mental health conditions may be more conducive to creativity, whereas full-blown mental illness typically would make a person too dysfunctional to succeed in their profession or creative pursuit.

Some researchers have found that a few of the traits associated with schizotypal personality (specifically, unusual perceptual experiences, such as “magical thinking,” visual or physical illusions, and superstitions, and impulsive nonconformity–a tendency toward unstable mood and behavior, especially around rules and social norms), often found in first-degree relatives of people with schizophrenia, fit with a creative personality. Similarly, people with an “overinclusive” way of thinking (trouble thinking precisely and selectively), who thus allow many thoughts and stimuli to enter their consciousness–a trait associated with schizotypy but also with psychosis–but who are also intelligent, with good executive functioning skills (e.g., organization, memory, and direction–traits typically absent or impaired in those with psychosis) tend to think more creatively and also have the ability to succeed in their work.

It’s a fascinating and complicated topic. I leave you with some examples of work by artists who had a mental illness. Given some of the research, one might consider these artists to be the exceptions–whether their mental illness contributed to their creative thought process or not, they were able to overcome the struggles and challenges that come with mental illness to produce amazing work.