Readers of this blog probably know I’m very interested in creativity. Recently, I came across a very interesting review paper on artistry in brain disease by Schott. Even though, many studies focus on the loss of various abilities as result of brain injury or disease, this review is focused on cases where brain disease resulted in enhanced artistic creativity in people with an interest in art or emergence of artistic creativity in art naive patients. Pictures created spontaneously by patient with brain disease sometimes present an excellent opportunity for studying that disease and revealing underlying mechanisms of cerebral dysfunction. It can also provide some useful information about creative processes in the healthy brain.
Dementia and stroke are very common. However, cases of patients who exhibit enhanced artistic output in these and other neurological disorders are rare or very rare. Miller et al. (2000) showed that enhanced artistry is probably more common but it is often under-reported, since new or preserved visual or musical ability was found in 17% of 69 patients with frontotemporal dementia.
In fact, frontotemporal dementia seems to be the brain disease more closely associated with increased creativity. Miller et al. (1996) were the first to report a patient with frontotemporal dementia that had developed new artistic creativity in the face of advancing dementia. A number of papers (Tanabe et al., 1996; Snowden et al., 1996), as well as Miller at al.’s seminal letter in the Lancet published in the same year brought more attention to the subject of preserved or increased artistic creativity in the presence of brain disease. Miller et al. (1996) described a 68-year-old male with a 12-year history of frontotemporal dementia,who, at the age of 56 years, started to paint having had no previous interest in art.
Patients with Alzheimer’s disease have also been reported to exhibit enhance artistic creativity. Professional painter, Danae Chambers, whose dementia started at around the age of 49 years (Fornazzari, 2005) is a striking example. Even though she was diagnosed with Alzheimer’s disease and her MRI scan revealed mild to moderate brain atrophy, there was no effect on her talent and creativity. However, it should be noted that typically during the progression of the disease stylistic changes leading to frank deterioration and eventual cessation of painting have been reported, especially in professional artists (see Crutch and Rossor, 2006).
In the case of autism there have been several cases of even very young autistics who could produce impressive works of art. A famous example is Stephen Wiltshire, who was able to draw astonishingly faithful architectural representations at the age of 7 years (Sacks, 1995).
According to Schott unexpected artistic creativity experienced by many patients has many features that suggest compulsive behaviour. Moreover, emergence of artistry after brain disease reflects innate rather than learned skills.
The brain correlates of emergent artistic creativity are rather obscure. It appears that dysfunction of the anterior temporal lobes is important if not crucial for the production of unexpectedly enhanced artistry, but the findings are often inconsistent. In some cases frontal lobe involvement is present too (Seeley et al., 2008). Thus creative drive is thought to increase not only with abnormalities of temporal lobe function and ‘release’ of frontal lobe-mediated creativity, but also by involvement of the dopaminergic mesolimbic system (Flaherty, 2005)
One might wonder; is this emergence of artistic talent observed in patients with various brain diseases really creativity?
De Souza et al. (2010) then concluded: ‘The emergence of artistic talent in patients with fvFTLD is explained by the release of involuntary behaviors, rather than by the development of creative thinking’, and also recommended avoiding consideration of ‘pseudo-creative production, or the emergence of “artistic talent”, as a mastered mental production’.
The author, however, disagrees and concludes:
…the notion of pseudo-creation and identification of ‘artistic talent’ create more difficulties than enlightenment; rather, they emphatically confirm the importance of patients’ pictures. The evidence for creativity surely lies in the creation itself rather than in perfusion patterns or psychological tests.
Schott, G. (2012). Pictures as a neurological tool: lessons from enhanced and emergent artistry in brain disease Brain, 135 (6), 1947-1963 DOI: 10.1093/brain/awr314
The ‘extreme male brain’ theory suggests females with Autism Spectrum Conditions are hyper-masculinized in certain aspects of behaviour. Jones and colleagues (2007) predicted that females with Gender Identity Disorder would have elevated Autism Spectrum Quotient (AQ) scores.
AQ scores from five groups were compared: the first group consisted of 61 transmen (female-to-male transsexual people, the second of 198 transwomen (male-to-female transsexual people), the third one of 76 typical males, the fourth of 98 typical females, and the fifth of 125 individuals with Asperger Syndrome (AS).
Autism Spectrum Conditions (ASC) are characterized by difficulties in social interaction and communication, alongside restricted interests and repetitive behavior (APA 1994). The diagnosis of ASC is more common in males. The Extreme Male Brain (EMB) theory of autism proposed by Baron-Cohen and Hammer in 1997 attempted to explain this . According to the EMB individuals with an ASC display an extreme of the typical male pattern of cognition and behaviour.
Studies on females with ASC have found that they are hyper-masculinized in specific aspects of behaviour and cognition. Also, women with ASC report higher rates of tomboyism in childhood (Ingudomnukul et al., 2007). Also, female-to-male (FM) transsexuals (referred to as ‘transmen’) follow a handedness pattern more similar to genetic males (less exclusively right-handed) (Green & Young, 2001) and the same has been found among women with ASC (Soper et al., 1986).
Jones et al. used the AQ to test the specific prediction from the EMB theory that transmen will have more autistic traits than typical women, and that a higher proportion will score in the ASC range for autistic traits. Their scores were compared to maleto-female transsexual people (‘transwomen’).
The AQ is a self-report questionnaire published by Baron-Cohen and colleagues in 2001 and consists of 50 item. It assesses social skills, communication skills, imagination abilities, attention switching, and attention to details.
Scores on the AQ can be used to categorise individuals as having the ‘broader autism phenotype’ (BAP: defined as AQ 23-28), ‘medium autism phenotype’ (MAP: defined as AQ 29-34) or ‘narrow autism phenotype’ (NAP: defined as AQ 35+) (Wheelwright et al. 2010). The transmen had significantly more autistic traits than control men and their mean AQ score lied in the BAP range. Approximately 30% of the transmen group had an AQ in the MAP or NAP range. Transmen had a 11-fold increase in the rate of NAP relative to typical males.
This study confirms clinical case studies and reports in adolescents and children that genetic females with Gender Identity Disorder (GID) have an increased number of autistic traits. The results of this study show that transmen relative to control women exhibit more autistic traits. In addition to that, transmen had more autistic traits than control men, and their mean AQ score lies in the Broader Autism Phenotype (BAP) range.
The authors speculated:
that this increased number of autistic traits is likely to have made the transmen (in their childhood and adolescence) less able to assimilate in a female peer group, instead gravitating towards males. This may also have led to difficulties socializing in a female peer group, and a feeling of belonging more in a male group, thus increasing the probability of GID.
Very interesting findings but what I’ve been thinking while reading the paper was the possible effects of hormone treatment on the AQ scores. Jones et al. had an answer to that:
…a proportion of the transsexual groups were taking hormone treatments and for obvious ethical reasons it was not possible to control for this factor but it is of interest that analysis comparing those on or off testosterone treatment did not lead to significantly different AQ scores.
They go on suggesting that current sex steroid levels do not seem to affect AQ, which seem to depend mostly on foetal levels of sex steroids.
Jones RM, Wheelwright S, Farrell K, Martin E, Green R, Di Ceglie D, & Baron-Cohen S (2011). Brief report: female-to-male transsexual people and autistic traits. Journal of autism and developmental disorders, 42 (2), 301-6 PMID: 21448752