Independent New Hampshire Journalism · Northfield, NH

Falling and Diving: What Schizophrenia’s Genes Do in the Rest of the Family

Sixty years of family studies and the largest genome banks on Earth keep finding the same uncomfortable pattern: the inheritance that breaks some minds helps build others — and the benefit lands on the relatives, not the patients.

On September 28, 1934, a twenty-seven-year-old dancer named Lucia Joyce entered a sanatorium at Küsnacht, on the shore of Lake Zurich. The doctor waiting for her was Carl Jung. Her father was James Joyce, who had bent the English language further than anyone alive and could not accept what was happening to his daughter. He insisted her mind worked the way his did. “Whatever spark or gift I possess has been transmitted to Lucia,” he said. Lucia was later diagnosed with schizophrenia and spent most of her remaining life in institutions. She died in a psychiatric hospital in Northampton, England, in 1982.

Jung saw the same current running through father and daughter, and one difference that decided everything. The two of them, he later told the biographer Richard Ellmann, were headed to the bottom of the same river, “one falling and the other diving.”

That was a clinical observation dressed as an image, and ninety years of data keep circling back to it. Schizophrenia devastates the people who develop it. The genetic inheritance behind it does something different in the rest of the family. Swedish registries covering more than a million patients, an Icelandic genome bank, adoption studies, and molecular work on single risk genes all point the same direction: relatives who carry part of the risk, without the illness, show up in creative work more often than everyone else. The finding is real and replicated. It is also routinely mangled into a “mad genius” story the data do not support. Both halves of that sentence matter, so this piece walks through both.

A disease that should have disappeared

Start with the arithmetic that has bothered biologists for sixty years. The World Health Organization puts schizophrenia at roughly 24 million people, about 1 in 300 humans. The condition is strongly heritable: the largest twin study to date, built on 31,524 Danish twin pairs, put heritability at 79 percent. Genes are not destiny here — when one identical twin has schizophrenia, the other develops it only about a third of the time — but they carry most of the risk.

Now the cost. A 2013 study in JAMA Psychiatry followed 2.3 million Swedes born between 1950 and 1970. People with schizophrenia had less than a quarter as many children as the general population, a fertility ratio of 0.23, with men hit hardest. Natural selection punishes few conditions this severely. A strongly heritable trait that cuts reproduction by three quarters should shrink toward zero over generations. Schizophrenia has not.

In 1964, four scientific heavyweights — Julian Huxley, the evolutionary biologist Ernst Mayr, and the psychiatrists Humphry Osmond and Abram Hoffer — published a short letter in Nature titled “Schizophrenia as a Genetic Morphism.” Their argument: a gene this costly that refuses to die out must be paying for something in the people who carry it without getting sick. Their guesses ran to disease resistance and physical resilience. Later researchers went looking somewhere else. They went looking in the mind.

The family signal

The first hard numbers came from Iceland, a country with obsessive genealogy records and, at the time, a published national registry of eminent citizens. In 1970 the geneticist Jon L. Karlsson examined Icelanders born between 1881 and 1910 and found that close relatives of psychotic patients appeared in the national Who Is Who at about twice the expected rate, including the listings for artistic and scholarly achievement. In a 2001 follow-up using national archives, he reported that healthy relatives of psychotic patients outperformed the general population in publishing fiction and poetry, in school performance at age twenty, and in mathematics.

An American study had already removed the obvious objection. In 1966, Leonard Heston tracked down 47 adults who had been born to mothers with schizophrenia in Oregon state hospitals and adopted away in infancy, comparing them with 50 adoptees whose birth mothers had no such diagnosis. Five of the 47 developed schizophrenia. None of the controls did. Growing up far from the illness did not remove the risk, which settled the nature-and-nurture question in genetics’ favor. The stranger detail, reported through the later research literature, is what Heston observed in the offspring who stayed well: unusually colorful, artistic, imaginative lives, a pattern he did not find in the control group.

Small studies invite doubt, so Sweden ran the question at national scale. In 2011, Simon Kyaga and colleagues at the Karolinska Institute linked occupational records to roughly 300,000 people treated as inpatients for schizophrenia, bipolar disorder, or depression between 1973 and 2003, plus their undiagnosed relatives, against matched controls. People with bipolar disorder were overrepresented in scientific and artistic occupations. So were the healthy siblings of people with schizophrenia or bipolar disorder. As a check on their own method, the team also tested two occupations nobody calls creative, accounting and auditing, and found no link at all.

The 2013 expansion is the study everyone now cites. It tracked nearly 1.2 million patients across 40 years of records, out to second cousins, across a dozen diagnoses. Two findings stand out. First, with bipolar disorder as the lone exception, the patients themselves were not overrepresented in creative professions. Their first-degree relatives were — for schizophrenia, bipolar disorder, and anorexia, with a weaker signal in siblings of people with autism. Second, one occupation broke the pattern: authors, who showed higher rates of schizophrenia, bipolar disorder, depression, anxiety, and substance abuse, and were about 50 percent more likely to die by suicide than the general population. The signal sits next to the illness far more than in it. Writing, for reasons no one has fully explained, sits closest to the fire.

Then the genome said it out loud

Registry studies can always be accused of measuring environment: growing up around mental illness, some argue, might push a family toward art. In 2015 the Icelandic genetics company deCODE closed that escape route. Working with researchers at King’s College London, they computed polygenic risk scores — a single number summarizing thousands of DNA variants tied to schizophrenia and bipolar disorder — for 86,292 Icelanders, then checked who belonged to the national societies of actors, dancers, musicians, visual artists, and writers.

Members of the artistic societies carried measurably higher psychosis risk scores; people in the top range were about 17 percent more likely to be members than those with average scores. A replication in 18,452 Dutch and 8,893 Swedish participants found people with high scores about 23 percent more likely to work in artistic professions. The association survived controls for education and general cognition, and, critically, it could not be explained by artists simply being related to patients. The DNA itself carried the link. The Nature Neuroscience paper’s conclusion was blunt for a genetics journal: creativity and psychosis share genetic roots.

Molecular work points the same way at single-gene resolution. In 2009 the Hungarian psychiatrist Szabolcs Kéri genotyped 200 high-achieving volunteers at a promoter variant of the neuregulin 1 gene, a variant already tied to psychosis risk. The carriers of the risk genotype, T/T, scored highest on creativity tests and reported the greatest lifetime creative achievement, while the genotype groups did not differ on IQ, education, or socioeconomic status. Single-gene findings are fragile as a class and this one deserves that caution, but it ran the arrow at the level of an actual molecule, in healthy people, and found benefit attached to risk.

The leaky filter

What could one set of variants be doing that ends in a hospital for one relative and a publishing contract for another? The leading candidate is a cognitive gate called latent inhibition: the brain’s ability to tag familiar stimuli as irrelevant and screen them out. Reduced latent inhibition has long been associated with proneness to psychosis. A 2003 Harvard study by Shelley Carson, Jordan Peterson, and Daniel Higgins tested 182 students and found the gate runs loose in high creative achievers too: eminent creative achievers were seven times more likely to show low latent inhibition than high. Their model is the interaction. Pair a leaky filter with high intelligence and strong working memory, and the flood of unfiltered input becomes raw material for original combinations. Remove the scaffolding, and the same flood becomes intrusion, and eventually delusion.

That is Jung’s river with the poetry stripped off. Same water, same descent. One swimmer has a rope and training. The other is drowning.

Where the romance stops

This is the point where the research usually gets bent into a flattering myth, so three corrections belong on the record.

The illness is not the gift. The 1.2-million-person Swedish study found patients, with the bipolar exception, no more likely than anyone else to hold creative jobs. Psychosis is an involuntary fall, frequently accompanied by real cognitive cost, and most people living with schizophrenia are fighting for ordinary function, not channeling visions into art. Anyone romanticizing untreated psychosis as a creative strategy is misreading four decades of data, and doing it at patients’ expense.

The risk runs toward the artists, too. In 2018, James MacCabe and colleagues checked the arrow’s other direction in 4.45 million Swedes. People who pursued higher education in an artistic field went on to be hospitalized for schizophrenia at 90 percent higher odds than the general population, bipolar disorder at 62 percent higher, depression at 39 percent higher, and adjusting for IQ did not erase it. The shared inheritance is visible before any diagnosis. Choosing the studio over the office is itself a weak marker of the same genetic loading.

Creativity does not rescue the evolutionary story. The tidy version of this science says the relatives’ advantages balance out the patients’ losses, which is how the genes survive. The numbers refuse to cooperate. In the 2013 Swedish fecundity study, sisters of patients had a fertility bump of one to three percent, which the authors called far too small to offset the losses; a 2011 meta-analysis found siblings overall had slightly fewer children than average. Then genomics weighed in directly: a 2017 Nature Communications analysis of 150,656 Icelanders found no reproductive advantage whatsoever for people carrying high polygenic risk for schizophrenia or bipolar disorder, and a 2019 Mendelian randomization study agreed. The current best guess is less poetic. The risk is spread across thousands of variants, each nearly invisible to selection, replenished by a steady drip of new mutations. The creativity link is real. The fairy-tale accounting that made it evolution’s tidy bargain is probably not.

One more boundary worth drawing: this is a creativity story, not an IQ story. The Harvard work found the advantage in the interaction with intelligence, not as a general boost, and Kéri’s genotype groups had identical IQs. Nothing here says schizophrenia genes make families smarter. The evidence says they can make certain minds looser, and looseness pays off only in minds equipped to use it.

The New Hampshire ledger

Bring the ledger home. New Hampshire runs one of the most litigated involuntary-psychiatry systems in the country, and the last three years rewrote it in federal court.

For more than a decade the state answered that statute with a hallway. People certified for involuntary admission waited in hospital emergency rooms, days and sometimes weeks, for one of the state’s designated psychiatric beds. The ACLU of New Hampshire sued over the practice in 2018, alleging due-process violations; the state’s hospitals later intervened with a sharper theory. In February 2023, U.S. District Judge Landya McCafferty agreed with the hospitals that parking committed patients in ERs the state does not own amounts to an unconstitutional seizure of hospital property. That May she gave the state twelve months to move each committed adult into treatment within six hours of certification.

The state missed the May 2024 deadline and told the court so, then kept cutting the number anyway. A waitlist that hovered in the 40s when the order came down hit zero on single days in November and December 2024, something the state had last recorded in June 2021, and the average daily list fell 43 percent in 2024 against 2023. At an April 2025 status hearing, ten adults were waiting statewide while fifteen beds sat open; McCafferty said she was “very, very pleased,” the state conceded six hours is “probably not achievable across the board,” and the parties took ninety days to negotiate an alternative standard.

The capacity math stays tight. New Hampshire Hospital in Concord runs roughly 185 beds when staffing allows. The largest planned expansion, a 144-bed SolutionHealth behavioral hospital in Londonderry with $15 million in state pandemic-relief money attached, collapsed in November 2024 when the company and the town could not agree on terms. The current two-year state budget forces the Department of Health and Human Services to absorb $51 million in back-of-budget cuts, and the sixteen transitional beds at Concord’s Philbrook facility survived this summer only because lawmakers repealed a sale directive and a private foundation wrote the check. The department brands the whole effort Mission Zero, the operational arm of the 10-Year Mental Health Plan the state adopted in 2019.

Here is what sixty years of genetics adds to that ledger. The people in those emergency rooms are not a separate population. Power’s registry work and Kéri’s molecular work say the same inheritance runs, diluted, through their siblings, parents, and children, the relatives Kyaga found overrepresented in creative professions. A state that treats its committed patients as disposable is discounting the same family stock it claims with pride when one of them writes a book. New Hampshire has already buried one version of this story: Jason Rothe, a civilly committed patient diagnosed with schizophrenia, died in 2023 after corrections officers restrained him face down at the state prison’s Secure Psychiatric Unit; the medical examiner ruled it a homicide, the officer charged was acquitted of second-degree murder in July 2025, and his family’s federal civil suit was filed this April. The genetics excuses none of that. It removes the comfortable fiction that it is happening to somebody else’s family.

What the finding is owed

Strip away the mythology and something more useful is left. Psychosis risk is not a wall between two kinds of people. It is a dial, spread continuously through the population, and the genome refuses to sort the well from the sick. Artists sit halfway up the same scale that patients top out on. The family that produces the diagnosis and the family that produces the novelist are, at meaningful rates, the same family.

Kyaga drew the clinical conclusion himself when the Swedish results landed: if some traits traveling with an illness carry real value, then treatment stops being the removal of everything labeled morbid and becomes a negotiation between doctor and patient over what gets treated, and at what cost. That is a harder conversation than psychiatry’s black-and-white tradition, and a more honest one.

Jung’s river line has survived ninety years because it refuses both easy comforts. It will not let us pretend the diver and the drowning swimmer are different species, and it will not let us pretend the fall is a style choice. Same water. Same families. A society that celebrates its divers while walking past the ones who fall has misread its own genome, and the reading has been available, in plain print, since 1964.

— Dexter Dow, Granite State Report

Fact check

Editor’s note. Every statistical claim above was checked against the underlying journal abstract, publisher record, or WHO documentation before publication; see the fact-check table. Two items are attributed rather than independently verified: Heston’s description of artistic lives among well offspring (carried through later peer-reviewed literature) and the Jung and Joyce quotations (recorded by biographer Richard Ellmann roughly two decades after the fact). This article reports research and is not medical advice; schizophrenia is a serious illness that warrants professional care. No researchers were interviewed for this piece; all findings come from the published record. New Hampshire system figures come from federal court proceedings, state agency releases, the official statute text, and contemporaneous reporting by NHPR, the Concord Monitor, NH Business Review, the New Hampshire Bulletin, and the Union Leader, each cited in the table; the boarding litigation’s status after the April 2025 hearing could not be independently confirmed at publication. Corrections: Granite State Report corrects verified errors promptly and appends a note identifying what changed and when.