Creativity And Mental Illness Research Paper

Is it true that creative people are more likely to be mentally ill than non-creative people? Are artists and writers are more likely to be alcoholics? Clinically depressed? Commit suicide? Most people can think of at least one famous artist or writer who committed suicide (Hemingway, Plath) or did something wildly eccentric (Van Gogh cutting off his ear). Hollywood seems to believe in a link; think of movies like A Beautiful Mind (2001) and Shine (1996).

But these are just isolated anecdotes. Is there any research? Voila: a new study has just been published by a Swedish research team, providing suggestive evidence that creativity may be connected to mental illness. This exciting new publication, along with an earlier 2011 publication by the same team, was reported in BBC News, CBS News, and here on the Huffington Post. The lead author of the study, Simon Kyaga, has presented his research at TEDx in Sweden. Kyaga's research seems to provide confirmation of one of our deepest beliefs about creativity: that it is somehow linked with mental illness.

There's a problem with these news stories, however: There is no link between creativity and mental illness. Creative people are not more likely to be diagnosed with mental illness, and mentally ill people are not more likely to be creative than normal people. Multiple studies, going back over a century, have consistently found the same proportion of mental illness in creative people as we find in the general population. In this post, I'll review the research, I'll discuss why the Kyaga findings came out differently, and I'll suggest what the findings might really mean.

There are four major past studies that are similar to the new Kyaga study--they examine large numbers of creative and eminent individuals. None of these studies found an elevated degree of mental illness in creative people:
  • In 1904, British psychologist Havelock Ellis studied 1,030 eminent individuals and found that the incidence of mental illness was essentially the same as in the general population. He concluded that there was no relationship between genius and mental illness. In 1947, W. G. Bowerman replicated Ellis's study and found only a 2% incidence of mental illness among geniuses.
  • Austrian psychiatrist Adele Juda spent 16 years analyzing 19,000 German artists and scientists who worked between 1650 and 1900. As with Ellis's study, the incidence of mental illness was only marginally higher than in the general population. In her 1949 article about this research, Juda concluded "There is no definite relationship between highest mental capacity and psychic health or illness...Psychoses, especially schizophrenia, proved to be detrimental to creative ability" (p. 306)
  • In 1962, the married couple Mildred and Victor Goertzel published a study of 400 eminent people, and they found less than a 2% rate of mental illness--lower than the general population. Their son, Ted Goertzel, became a professor of sociology at Rutgers university, and republished their study in 2004. The study also found that the parents, brothers, and sisters of the 400 geniuses had a lower than average incidence of mental illness (pp. 237-238).
  • In 1994, Felix Post published a study of 291 biographies of famous men. None of these geniuses met the criteria for any DSM-III psychiatric diagnosis.
Despite these many studies that found no link between creativity and mental illness, in recent decades contemporary researchers have continued to search for evidence to support the Western cultural belief that mental illness is connected to creativity. (Most non-Western cultures do not share this belief.) These more recent studies, when well designed, consistently deliver the same finding: There is no link between creativity and mental illness. (Also see my blog post here.)

In my 2012 textbook overview of creativity research, Explaining Creativity, I conclude:

Despite almost a century of work attempting to connect creativity and mental illness, evidence in support of a connection has been remarkably difficult to find....The consensus of all major creativity researchers today is that there's no link between mental illness and creativity (p. 171)

See the end of this post for a list of prominent creativity researchers who agree that there is no link.

If you search around on the web, you'll see that people who claim there's a link between creativity and mental illness often refer to studies by Nancy Andreasen, Kay Redfield Jamison, and Arnold Ludwig. But these are not well designed (using overly broad diagnostic criteria, or using sampling methods that might easily bias the results) and have been criticized by many scientists (see pages 168-171 of Explaining Creativity, the book The Insanity Hoax, and my review of it here).

So what's going on with Kyaga's findings? When a scholar publishes new research that contradicts a century of past scientific research, we have to pay close attention. Here's what I think is going on.

The strength of Kyaga's study is that he had access to huge databases of diagnoses, provided by the Swedish national health system--in their 2011 article, the team had data on anyone who had in-patient care for schizophrenia, bipolar disorder, and unipolar depression, between 1973 and 2003. But the weakness is that they didn't have any way to measure these people's creativity. So, as a proxy for creativity, the team used occupational information--also provided by the Swedish government, from self-reported information on the official census questionnaires in 1960, 1970, 1980, and 1990. In the 1990 census, the average age of the people Kyaga studied was over 45, so most of the people in this study are retired or deceased by now (22 years later).

Their definition of "creative people" was anyone who reported one of the following occupations on the Swedish government census: university teachers, visual artists, photographers, designers, display artists, performing artists, composers and musicians, and authors. For their control group of "uncreative" people, they used the occupation code for accountants and auditors.

Using these measures of mental illness and of creativity, Kyaga's 2011 paper reported that there was no link between being in a creative occupation and being diagnosed with schizophrenia or unipolar depression. However, individuals with bipolar disorder were 1.35 times more likely to report being in a creative occupation than a noncreative occupation.

In Kyaga's 2012 paper, again there was no link between having a creative occupation and schizophrenia or unipolar depression. In addition to the diagnoses examined in their 2011 paper (schizophrenia, bipolar disorder, unipolar depression), the 2012 paper also found no relationship between having a creative occupation and anxiety disorders, alcohol abuse, drug abuse, or committing suicide. The one exception, again, was bipolar disorder. But this 2012 study had a new finding: one specific occupational subgroup--authors--was more likely to be diagnosed with unipolar depression, anxiety disorders, alcohol abuse, drug abuse, and to commit suicide.

These two studies also analyzed the occupations of relatives of those individuals diagnosed with mental illness, and found that their relatives were more likely to be in creative professions (although the relatives were not diagnosed with mental illness: they were completely healthy). The Kyaga articles refer to a well-established genetic basis for mental illness, and suggest that relatives of people diagnosed with mental illness might have a latent propensity for mental illness that never manifested, and that this undiagnosed propensity is what caused them to choose creative occupations. There are several existing studies that provide evidence that an undiagnosed propensity to mental illness might lead to enhanced creativity, but these prior findings are controversial and these studies are difficult to interpret (see pages 172-174 of Explaining Creativity).

So the overall bottom line is that these studies did not find a link between creative professions and mental illness. But there were some sub-findings that seem to suggest a partial link--with bipolar disorder, with authors, and with healthy relatives. Why do the Kyaga studies seem to suggest a link between creativity and mental illness (although a fairly small link) when so many other large-scale studies found no link?

First, many of the subjects were diagnosed using the ICD-8 diagnostic criteria, which is no longer in use. ICD-8 used older and now-repudiated Freudian diagnostic criteria that American psychologists stopped using with the third edition of the DSM in 1980. (And that I suspect are no longer in use internationally in the current ICD-10.) Prior to the 1980 DSM-III, psychologists used overly broad conceptions of schizophrenia, and American diagnostic criteria have narrowed considerably; I suspect the same has happened with the ICD (See Explaining Creativity, page 167).

Second, regarding the 2012 finding that authors are more likely to commit suicide: Author occupation, as with all other occupations, was self-reported on the Swedish census. As Kyaga himself pointed out (2012), people with severe mental disorders are likely to have trouble finding a job, but they can still seek self-employment in artistic occupations. "Artistic occupations would then be the result of social drift rather than a creative propensity" (p. 7). In Explaining Creativity, I agree with this explanation (on page 171):

Artistic occupations don't police their borders to keep people out, like other professions that require licensure...the arts can't keep you out. And because our society has so many stereotypes about artistic professions being unconventional, it becomes a self-fulfilling prophecy: no one gets upset (and no one can fire you) if a painter is eccentric or unconventional. (p. 171)

Third, Kyaga's measure of creativity, occupational choice, is a questionable measure of creativity:

  • Your occupational choice is the result of many things that are unrelated to creativity: Educational qualifications, opportunity, awareness, location of the job, salary, family values, and social commitments.
  • Although I'm a university teacher, I'd be the first to admit that a large percentage of university teachers are not creative.
  • Even within the artistic occupations, there's a wide range of creativity. Take people who are photographers by occupation, for example. Some photographers are very creative, but most of them make their money shooting weddings and families, using highly constrained and repetitive formats.

It's interesting that the Kyaga studies have received so much media attention, when they essentially conclude (2012 p. 6) that "individuals with overall creative professions are not more likely than controls to suffer from psychiatric disorders in general." I think it's because the very weak connections Kyaga has identified seem to affirm our widely held cultural belief that madness and creativity are related. Psychiatrist Albert Rothenberg, in his 1990 book Creativity and madness, observed "The need to believe in a connection between creativity and madness appears to be so strong that affirmations are welcomed and quoted rather uncritically" (p. 150).

But still, how else can we explain these results? I can think of a lot of alternative explanations that aren't related to creativity at all. For example, it could simply be that accountants and auditors have a remarkably low level of bipolar disorder (lower than the general population) perhaps as a result of the steady and stable nature of their work. And likewise, they may have a lower level of suicide than unemployed authors, perhaps because they make a good salary and have a happy, stable life. Or, it could be that people who choose academic or artistic careers tend to come from higher social classes than people who choose accounting or auditing, and there's something about class differences that accounts for differential diagnoses of mental illness (and this explanation could account for the different career choices of the relatives of the diagnosed patients). The two Kyaga papers have revealed some interesting patterns, that's for certain, and I agree that they are worthy of further exploration.

If you're a creative person, the good news is that there is lots of research showing that creativity is connected to normal mental functioning and elevated mental health. Much of creativity involves working with existing conventions and languages; you can't make up your own separate universe. Creative success requires networking and interacting with support networks, and this requires social skill and political savvy. And creativity is mostly conscious hard work, not a sudden moment of insight; getting the work done takes a highly effective person. Many psychologists have demonstrated that when people engage in creative work, they attain a state of peak experience, sometimes called "flow," that represents the pinnacle of effective human performance. Creativity is related to higher than average mental health--just the opposite of our belief in a connection between creativity and mental illness.

It's interesting that those few scholars who still think there might be a creativity-madness link are psychiatrists (who treat mentally ill patients) rather than experimental psychologists. As Gordon Claridge wrote in 2009, "The purpose of researching the madness/creativity connection is not to rubbish the original but troubled mind; it is rather to give optimism to the mentally ill and their kin." When mood disorder patients are told there's a link between their disorder and creativity, it increases their morale and self-esteem. And they're more likely to take their medication when they're told "if you can control your disorder you have great creative potential" (Explaining Creativity, p. 176). As I conclude in my book:

Psychotherapists, in an understandable desire to help their suffering patients, could quite naturally be led to over-interpret what is rather weak evidence.

I empathize with these patients, and with their therapists, but I feel obliged to report the consensus that has emerged from decades of scientific studies: There is no link between creativity and mental illness. There may be a link between an undiagnosed tendency toward mental illness and elevated creativity; but we don't really know, because that's almost impossible to study (how do you study an undiagnosed tendency?). The jury is still out on that issue, and the Kyaga studies represent a contribution to that continuing debate. I'm impressed by the massive volume of data used in the Kyaga studies, and the patterns revealed are interesting, and worthy of further exploration.

The articles:

Kyaga et al., 2011. Creativity and mental disorder. British Journal of Psychiatry.

Kyaga et al., 2012. Mental illness, suicide, and creativity. Journal of Psychiatric Research.

The creativity research consensus:

All four textbook overviews of creativity research (mine and three others) reject any link: Weisberg (2006) says it's a myth. Kaufman (2009) says the studies are flawed, and no link has been proven. Runco (2007) concluded that "there are indications that creativity has benefits for health" and that there are many flaws with the research claiming a link with madness, and concluded "this area receives so much study because it is newsworthy" (p. 152). Also see (Glazer, 2009; Rothenberg, 2001; Schlesinger, 2009; Waddell, 1998; Silvia & Kaufman, 2010; citations all from the bibliography of Explaining Creativity).

Weisberg, R. W. (2006). Creativity: Understanding innovation in problem solving, science, invention, and the arts. Hoboken, NJ: Wiley.

Kaufman, J. C. (2009). Creativity 101. New York: Springer.

Runco, M. A. (2007). Creativity: Theories and themes: Research, development, and practice. Burlington, MA: Elsevier Academic Press.

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Abstract

Background:

There has for some time now been recognition that there was a relationship between exceptional creative talent and mental disorder. The works of Andreasen (2008) and others in this area have been very significant. However, most of the research has been carried out in USA and Europe. Very little has come out of Africa on the subject.

Aim:

To survey the beliefs of different groups within an African society, concerning the possibility of a relationship between creative talent and mental disorder. To assess creativity within a community of people with a formal diagnosis of mental disorder.

Materials and Methods:

Some of the mythology of the Yoruba was examined for content, concerning the behaviour of certain notable individuals and the existence of psychopathology based on modern-day criteria. The beliefs of members of the general public and mental health professionals concerning the existence of a relationship between creative talent and psychopathology were surveyed using a questionnaire designed for the project. A sample of patients with formal diagnoses of affective disorder or schizophrenia drawn from two units, the Lagos State University Teaching Hospital and the Federal Neuropsychiatric Hospital Yaba, were assessed for ‘Creativity.’

Results

Although there are notable ‘eccentric’ figures in local mythology, the overwhelming majority of the people surveyed do not believe there is any relationship between creativity and mental illness. They however believe that engaging in creative activities helps the mentally ill to recover from illness. The mental health professionals, who were clinical psychologists and psychiatrists, had a significant minority who believed that a relationship does exist, and they also strongly assert that creative activity has a therapeutic effect for the mentally ill. A survey of in-patients diagnosed with schizophrenia and affective disorder failed to show a significant difference in the creativity of the two populations, as measured by the originality score of the Rorschach scale. The survey of patients is inconclusive, based on small sample size (ten patients with a diagnosis of schizophrenia, ten with bipolar affective disorder.). The linkage between formal mental disorder is only recognised by a significant minority of mental health professionals. A significant proportion of the population believe that creative activity aids recovery from mental illness. More research is required into this important subject in Africa.

Keywords: Creativity, Cultural beliefs, Mental illness, Personality, Recovery

Introduction

The relationship between exceptional talent, especially ’creative’ talent, and the possibility of odd, unusual or frankly abnormal behaviour is one that has intrigued various writers over time. Creativity is a difficult subject to define. How does one quantify the talent of the novelist, or the atomic scientist who breaks new grounds in his research?

The Longman Active Study dictionary (Adrian-Vallance et al., 2004) defines creativity as ’… involving the use of imagination to produce new ideas or things.’

In the past, creativity tended to be equated with intelligence. It is now known that the two factors are independent, though most creative people appear to have an IQ of 120 and above (Andreasen and Glick, 1988). For the most part, the definition of creativity has been based on the perceived originality of the ’creative’ product.

More recently, attempts have been made to quantify ’creativity’ independent of the subject’s fame or intelligence quotient. This often involves a combination of an operational definition (what the person has produced) and the use of psychological markers that are said to be characteristic of creative persons (nonconforming, adventurous, sensitive, introspective, independent).

Much of the early interest of researchers focussed on a suggested relationship between creativity and schizophrenia. Lumbroso (1891) introduced the concept of ’hereditary taint’ to describe the relationship between the manifestation of exceptional talent (’genius’) in certain people and the presence of ’madness.’ In a study published in 1926, (Ellis, 1926) a researcher selected 1,020 eminent people in the U.K. They included politicians, scientists and artists. They were actually chosen more for their fame than any creative talent. The researcher found that 4.2% of his sample were ’insane’ (i.e., psychotic), 8% ’melancholic’ (depressed), 16% imprisoned and 5% had ’personality disorder.’ Brain (1948) observed that geniuses were more ’nervous’ than other people. When they became ’insane,’ the diagnosis was often ’cyclothymia.’ Juda (1949) explored the records of 113 artists and 18 scientists. He found ’personality disorder’ to be the commonest diagnosis. Artists showed alcoholism and schizophrenia, while scientists more frequently had affective disorder. Other researchers have sought to establish linkages between creativity and mental health syndromes (Murray et al., 2010; Moses, 2010; MacCabe et al., 2010; Akinola and Mendes, 2010).

A Danish study (McNeil, 1971) measured psychopathology in some creative people (who had been adopted away from an early age), and also in their biological and adoptive relatives. It found that 3% of the ’creative’ sample had psychiatric diagnosis. 28% of their biological parents also had a diagnosis, while only 5% of the adoptive parents were ill. The commonest diagnosis was ’Reactive Psychosis’ (A Scandinavian term equivalent to Affective disorder). Rust and collaborators (Rust et al., 1988) reported a study designed to test the traditionally assumed relationship between creativity and schizophrenia. They found a relationship between creative originality and the positive cognitive aspects of schizotypal thinking. Richard (1988), working from Harvard University, set out to answer the intriguing question-is there a compensatory advantage in Manic-Depressive Illness? In entertaining such a possibility, he had in mind the examples of sickle cell disease, where the heterozygote is supposed to enjoy relative immunity from malaria. He selected a sample of Manic-depressives, cyclothymes and normal first-degree relatives along with matched controls. He measured their creativity using a ’Lifetime Creativity Scale.’ He found creativity to be higher among the test sample than the controls. There was also more creativity among normal first-degree relatives than among the ill patients themselves, with those diagnosed as cyclothymic being in-between. The conclusion was that the liability to Manic-Depressive illness carries an advantage for Creativity, especially among individuals who are not actively ill.

Working from another direction, another researcher (Jamison, 1989) took a sample of 47 famous living British Writers and Artists. They were people who had won major awards such as the Booker Prize, or were distinguished members of the Royal Academy of Arts. She found that 38% of them had received treatment for affective disorder (antidepressant, lithium and/or hospitalisation). Poets and novelists were particularly prone to mood swings, whereas visual artists were less vulnerable. It was generally recorded that the writers had intense creative episodes lasting 1 to 4 weeks, marked by increased enthusiasm, increased energy and self-confidence and high speed of mental association. These resemble the mood and cognitive components of Hypomania, without the behavioural nuisance attributes of talkativeness, hypersexuality and excessive spending. In a similar vein, Andreasen in Iowa (Andreasen, 1987), and over the years, collected a sample of famous writers who came to work on the University faculty. She found that 80% of the writers had had an episode of affective illness at sometime, compared with 30% of a control sample. 43% of the writers had bipolar disease. There was also a higher incidence of illness and creativity in the writers’ first-degree relatives (see also, Andreasen, 2011).

Africa is a continent on which the issue of creative expression plays a central cultural role in the everyday life of the people. Although there are myths that imply an expectation and tolerance of odd behaviour among powerful creative figures, no formal study of the relationship between creativity has been carried out on the continent.

The present research is an attempt to add an African dimension to the discussion.

Materials and Methods

The study was carried out in two parts. The first part involved a survey of a sample of the population in South-West Nigeria on their perception of the possible connection between creativity and mental illness. The following three groups of participants were surveyed: (i) 50 members of the professional mental health community comprising of psychiatrists, psychologists and mental health nurses; (ii) An urban sample comprising of 200 residents of Lagos city and (iii) 100 participants from a rural area in South West Nigeria.

The second part of the study involved assessing the creativity, specifically originality, of 10 participants diagnosed as schizophrenics and 10 manic depressive participants. The identification of these participants was based on the administration of the Mini Mental State Examination protocol, which was carried out by resident doctors in two psychiatric facilities in Lagos.

Instruments

1. The perception of the relationship between creativity and mental illness was surveyed using two versions of a questionnaire specifically customised for the mental health professionals on one hand, and the general public on the other. The questionnaire for the rural sample was translated into Yoruba for easy understandability. The following perceptual variable were surveyed using the questionnaire:

  • Perception of relationship between creativity and mental illness

  • The nature of the relationship, if any

  • Creative persons’ proneness to mental illness

  • Whether mentally ill persons are more creative than others

  • The potential for the creative process to have therapeutic effect for mentally ill persons

2. The Rorschach Inkblot test was administered to participants diagnosed as schizophrenic and manic depressive psychotics. Specifically, the Rorschach ’O’ originality score was computed as an index of creative perception. The participants were placed in diagnostic categories based on case note diagnosis and the Mini Mental State Examination.

Procedure

Two researchers surveyed the professional mental health group of participants. They included graduate students, psychiatrists, psychiatry resident doctors and psychiatric nurses. Urban and rural members of the general public were surveyed by two collaborators (a social worker and a psychiatric nurse). The Rorschach Ink Blot test was administered and scored by the clinical psychologist member of the research team.

Analysis of data

The nonparametric techniques of Chi square and the Man Whitney test were used to analyse the data. The SPSS statistical package was used for this purpose.

Results

General comments

  1. There appears to be notable difference in the way mental health professionals perceive creative persons’ proneness to mental illness compared with both the urban and rural general public participant groups. These groups distinctly perceive creative persons as not being prone to mental illnesses, whereas the mental health professional group seems to be divided in their perspective. A sizable minority of them appear to feel that creative persons are prone to develop mental illnesses [Tables ​1–3].

    Table 1

    Participants’ profile and obtained frequency of study variables

    Table 3

    Man Witney U test result of comparison of Rorschach ’O’ originality scores between schizophrenics and manic depressives

  2. Rural participants do not see any notable relationship between creativity and mental illnesses, whereas both professional and urban groups appear to perceive a significant relationship.

  3. There appears to be a strong consensus of opinion that mentally ill persons are not significantly more creative than others.

  4. All groups uniformly perceive as significant the possible therapeutic effects of engaging in creative activities for mentally ill persons.

Table 2

Chi Square analysis for study variables

Discussion

Mentally ill participants with a diagnosis of affective disorder did not show a significant increase in creativity compared with others who had a diagnosis of schizophrenia (although there was a slight positive difference). The research used a limited sample size and did not include a control group of people who did not have either schizophrenia or Affective Disorder. The reason for considering this finding interesting is that the relationship for which there exists at present the most positive evidence is that between creativity and Affective Disorder. The failure to find an association may be due to confounding factors listed above. The result may also be influenced by existence of symptoms of active illness in the patients surveyed.

The findings from the questionnaire survey showed that all the groups surveyed were unanimous in their belief that mental illness did not make people more creative than others, and any relationship that existed between mental illness and creativity was a negative one. All the groups also concluded that engaging in creative activities was therapeutically beneficial to persons with mental illness.

A finding of note is that although mental health professionals tended to believe that creative persons were more prone to mental disorders than others, members of the general public in both urban and rural populations felt that creative persons were not more prone to mental disorders than other people. This difference might be due to the greater level of interactional experience of mental health professionals with persons with psychological and psychiatric disorders. The general public on the other hand were mostly acquainted with the creative manifestation of creative individuals. Any psychopathological tendencies might be concealed from them.

Mental health practitioners and the urban sample surveyed significantly believed that there was a relationship between creativity and mental illness, whereas the rural sample believed that there was no significant relationship. This might be due to idolization by rural folk of the creative geniuses in their midst. Urban folk and mental health professionals might be able to have a more objective viewpoint stemming out of their higher level of education.

There was a general consensus that mental illness did not make anyone more creative, but that engaging in creative activity was beneficial for the recovery of the patient. The perception of the potential therapeutic effect of creative activity is of particular interest in the context of this study. The possible applications of this relationship abound in the design of therapeutic programmes for treatment of the mentally ill, but are not much recognised or used currently in the African environment. A useful item of cultural information in this connection is that traditional practitioners routinely use creative activities, such as music and drama, in the treatment and rehabilitation of mentally ill patients.

Concluding Remarks

The one area where there is uniformity of cultural opinion (the usefulness of creative activity in promoting patient’s recovery) is a useful area of future activity, by way of practice and research [Figure 1]. The information is not new, but the fact that it has widespread acceptance means that the people, including the patient and his relations, would have certain expectations of what environment is required for the promotion of recovery. Creating such an environment may not only directly influence the patient’s recovery positively, but also increase the level of cultural confidence such a person would have in the treatment system as a whole, given the fact that he has an alternative in traditional medicine.

Take home message

The whole area of the relationship between creativity and mental disorder in the African context requires more active research. It would be interesting to do quantitative research to establish if the widespread view that creative activity can have a positive influence on recovery from psychotic illness is borne out by evidence.

Acknowledgments

The authors wish to acknowledge the contributions of the following persons to the research:

  1. Dr Rahman Lawal: Consultant Psychiatrist, Federal Neuro-Psychiatric Hospital, Yaba.

  2. Mr B. Isichei, Social Welfare Department, Lagos State University Teaching Hospital, Ikeja

Footnotes

Conflict of Interest: None declared.

Declaration

The material in this paper is the original, unpublished work of the authors, not under consideration for publication elsewhere

CITATION: Olugbile O., Zachariah M. P., (2011), The Relationship between Creativity and Mental Disorder in an African Setting. In: Brain, Mind and Consciousness: An International, Interdisciplinary Perspective (A.R. Singh and S.A. Singh eds.), MSM, 9(1), p225-237.

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