The Molecule of More

improved, and he decided to enroll in a local community college, where he 
studied graphic design. It was early in his recovery, and the plan was too 
ambitious. After a few months he dropped out.
Over time, the medication progressively improved his symptoms, but it 
was a challenge for his parents to persuade him to take it on a regular basis. 
He continued to doubt that he had a psychiatric illness. His doctor switched 
William to a new drug that didn’t require him to take pills every day. He 
just needed to come in once a month for an injection, allowing him to experi-
ence uninterrupted treatment. On this formulation he improved to the point 
where he was able to work full time as a cook and live independently in his 
own apartment.
Schizophrenia
1
is a form of psychosis notable for the presence of hallu-
cinations and delusions. Hallucinations can cause a person to see things 
that aren’t really there, feel their touch, even smell them. The most 
common type of hallucination is the auditory hallucination—hearing 
voices. The voices may comment on the person’s behavior (“You’re eat-
ing lunch now.”). There may be more than one voice holding a conver-
sation about the person (“Have you noticed that everybody hates him?” 
“It’s because he doesn’t shower.”). Sometimes they’re command hal-
lucinations (“Kill yourself!”). Occasionally, the voices are friendly and 
encouraging (“You’re a great guy. Keep up the good work.”) Friendly 
hallucinations are the least likely to go away, which may be just as well. 
Overall, they have a positive influence.
1 “Madness” is not a psychiatric diagnosis. We use it here as it’s used in conversa-
tion, meaning severe mental illness, including delusions and chaotic or disordered 
thoughts. The diagnosis most commonly referred to by the informal term 
madness
is schizophrenia.

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THE MOLECULE OF MORE
Another component of psychosis is delusions. These are fixed 
beliefs that are inconsistent with the generally accepted view of reality, 
such as “Aliens have implanted a computer chip in my brain.” Delu-
sions are held with absolute certainty, a level of certainty that is rarely 
experienced with nondelusional ideas. For example, most people are 
confident that their parents really are their parents, but if you ask them 
if they are absolutely certain, they will confess that they are not. On the 
other hand, when a schizophrenic patient was asked if he was sure that 
the FBI was using radio waves to implant messages in his head, he said 
there could be no doubt. No amount of evidence could convince him 
otherwise.
A good example of this phenomenon comes from John Nash, a 
Nobel Prize–winning mathematician, who lived with schizophre-
nia. Silvia Nasar, who wrote about Nash in her book A Beautiful Mind, 
recounted the following exchange between Nash and Harvard profes-
sor George Mackey:
“How could you,” began Mackey, “how could you, a 
mathematician, a man devoted to reason and logical proof . . . 
how could you believe that extraterrestrials are sending you 
messages? How could you believe that you are being recruited 
by aliens from outer space to save the world? How could 
you . . . ?”
Nash looked up at last and fixed Mackey with an 
unblinking stare as cool and dispassionate as that of any bird 
or snake. “Because,” Nash said slowly in his soft, reasonable 
southern drawl, as if talking to himself, “the ideas I had 
about supernatural beings came to me the same way that my 
mathematical ideas did.”
Where, in fact, do these ideas come from? One clue comes from what 
we know about how to treat schizophrenia. Psychiatrists prescribe 
medications called antipsychotics that reduce activity within the dopa-
mine desire circuit. At first glance, that seems odd. Stimulation of the 
desire circuit typically leads to excitement, wanting, enthusiasm, and 

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CREATIVITY AND MADNESS
motivation. How could excess stimulation cause psychosis? The answer 
comes from the concept of salience, a phenomenon that will also play a 
crucial role in understanding the roots of creativity.
SALIENCE AND THE DOPAMINE CONNECTION
Salience refers to the degree to which things are important, prom-
inent, or conspicuous. One kind of salience is the quality of being 
unusual. For example, a clown walking down the street would be more 
salient—more out of place—than a man in a business suit. Another 
kind of salience is value. A briefcase with $10,000 in it is more salient 
than a wallet with $20. Different things are salient to different people. 
A jar of peanut butter is more salient to a boy with a peanut allergy 
than to one who is allergy free. It would also be more salient to a girl 
who loves peanut butter sandwiches compared to one who prefers 
tuna salad.
Think about how salient the following things are: a grocery store 
you’ve seen a hundred times before versus a grocery store that just 
opened yesterday, the face of a stranger versus the face of the person 
you secretly love, and a policeman as you are walking down the street 
versus a policeman after you just made an illegal left turn. Things 
are salient when they are important to you, if they have the potential 
to impact your well-being, for good or for evil. Things are salient 
if they have the potential to affect your future. Things are salient if
they trigger desire dopamine. They broadcast the message, Wake up. 
Pay attention. Get excited. This is important. You’re sitting at a bus stop, 
glancing at a newspaper article about a Canadian trade agreement. 
Unless the mind-numbing details of the negotiation will impact you 
in some way, your desire dopamine circuit is at rest. Then all of a 
sudden you come across the name of one of your classmates from 
high school. She’s been involved in the negotiation of the pact. Bang! 
Salience. Dopamine. As you read further, your interest rising, you sud-
denly come across your own name. You can imagine how that would 
affect your dopamine.

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THE MOLECULE OF MORE
A PSYCHOTIC SHORT CIRCUIT
What happens, though, if the salience function of the brain 
malfunctions—if it goes off even when there is nothing happening that 
is actually important to you? Imagine you’re watching the news. The 
anchorman is talking about a government spying program, and sud-
denly your salience circuit fires for no reason at all. You might then 
believe that this story on the news has something to do with you. Too 
much salience, or any salience at all at the wrong time, can create delu-
sions. The triggering event rises from obscurity to importance. 
A common delusion among people with schizophrenia is that peo-
ple on TV are talking directly to them. Another is that they are the 
target of investigation by the NSA, FBI, KGB, or Secret Service. One 
patient said he saw a stop sign, and thought it was a message from his 
mother telling him to stop looking at women. Another patient saw a 
red car parked outside her apartment on Valentine’s Day, and believed 
it was a message of love from her psychiatrist. Even people who have 
never been psychotic might learn to attach salience to things that appear 
unimportant to others, such as black cats or the number 13.
2
There’s wide variation in how much salience different people attach 
to different things. Everyone has a lower limit, though. We have to cat-
egorize some things as having low salience, being unimportant, so we 
can ignore them for the simple reason that noticing every detail in the 
world around us would be overwhelming.
BLOCKING DOPAMINE TO 
TREAT PSYCHOSIS
People with schizophrenia control their dopamine activity by 
taking medications that block dopamine receptors (Figure 4). 
2 Is superstition a very mild form of delusion, or is it a choice? Research indicates 
that superstitious people have a preponderance of dopaminergic traits, so there is 
probably a genetic tendency for some people to adopt superstitious beliefs.

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CREATIVITY AND MADNESS
Receptors are molecules that sit on the outside of brain cells 
and catch neurotransmitter molecules (such as dopamine, 
serotonin, and endorphins). Brain cells have different recep-
tors for different neurotransmitters, and each one affects the 
cell in a different way. Some receptors stimulate brain cells 
and others lull them into a state of tranquility. Changing cell 
behavior is how the brain processes information. It’s similar 
to transistors turning on and off in a computer chip.