Top of the class, mentally ill in life? It might seem counter- intuitive, but it can be true and it raises the equally interesting question of why some high achievers are happy bunnies, but not others.
Studies suggest that people who develop schizophrenia are significantly more likely than average to achieve an exceptional academic performance.
On the other hand, being severely disturbed at the time of exams does not boost results. A study of Cambridge undergraduates in 2000 (Surtees et al) found that women who were more than averagely neurotic but not actually mentally ill were four times more likely to get firsts than the non- neurotic (for men it was twice as likely). But women who were so neurotic that it qualified as a mental illness were 10 times less likely to get firsts. In other words, exceptional achievement is more likely if you're a bit screwy but not too much - at least when taking exams.
Coming at it from a different angle, young children and adults from high social classes do better academically than those from low income homes. Overall, the latter are also twice as likely to be mentally ill. However, among teenage girls and undergraduates the pattern is reversed.
There is no more mentally ill group in Britain than 15-year-old girls from the most affluent social classes. A 1999 study at Glasgow University (West et al) of 5,000 children of this age group found that 38 per cent of girls from the top classes were suffering depression or anxiety, compared with 27 per cent from the bottom classes.
Similar disparities between the classes were also found in two samples of American 13 and 16-year-old girls. Since achievement is strongly linked to social standing, these upper-class girls may be the most depressed, but they are also likely to get the best results. These findings show that high achievement and mental illness correlate in girls in their mid- teens.
There is evidence that the pattern continues among American undergraduates. They are significantly more likely to be suffering mental illness than non-students of the same age.
Also in America, pupils at high achieving schools and at Ivy League universities have lower self-esteem than ones at less exalted institutions. Annoyingly, British data is not detailed enough to demonstrate whether the same pattern is found here.
But most interesting of all is why some high achievers suffer but not others.
Richard Ryan and colleagues at Rochester University in New York have shown that parents use two main methods for socialising their offspring. The first is a controlling pattern, pressurising the child using rewards, threats, deadlines and hectoring words. Above all, love is conditional upon achievement of goals laid down by the parent - there is no love for the child who does not achieve them.
By contrast, the supportive pattern of care takes the child's perspective, minimising pressure and encouraging it to find out for itself what it wants. Parents value self-determination.
These two patterns result in very different types of parental relationship.
Controlling care results in introjection - children unquestioningly accept their parents' wishes and obey them compulsively. Supportive care results in identification, where the child has actively decided to adopt a parental wish.
A host of studies show that controlled children who have introjected parental values are at much greater risk of self-critical depression. They lambast themselves as failures at the smallest sign and get little succour from successes. They are liable to be perfectionist and, if girls, are prone to eating disorders.
Above all, although they may be extremely diligent, they do not succeed any more, academically, than children who had supportive parents and who identify with their values. Identifying with their parents, rather than simply obeying them, is what sets the mentally healthy high achiever apart from the mentally ill.
Taken as a whole, it's clear that it is possible to be academically exceptional and mentally healthy. It depends on whether you were badgered into working so hard or chose to do so.
Oliver James is a child clinical psychologist and author of Affluenza and Selfish Capitalist. For more of his writings and broadcasting, visit www.selfishcapitalist.com
Alaraisanen, A., Miettunen, J., et al (2006) Good school performance is a risk factor of suicide in psychoses: A 35-year follow up of the Northern Finland 1966 Birth Cohort, Acta Psychiatrica Scandinavica, 114, 357- 362
Surtees, P. G., et al (2000) Student mental health, use of services and academic attainment, Report to the Review Committee of the University of Cambridge Counselling Service
West, P., et al (2003) Fifteen, female and stressed: Changing patterns of psychological distress over time, Journal of Child Psychology and Psychiatry, 44:3, 399-411
Luthar, S.S., Becker, B.E. (2002) Privileged but pressured? A Study of Affluent Youth, Child Development, 73, 1593-1610
Luthar, S.S., D'Avanzo, K. (1999) Contextual factors in substance abuse: A study of suburban and inner-city adolescents, Development and Psychopathology, 11, 845-867
Richard Ryan's work: see James, O.W., Chapter 8 Affluenza (London: Vermilion, 2008); James, O.W., The Selfish Capitalist (London: Vermilion, 2008).