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
Neuroimaging and lesion studies suggest that imagining the future (i.e. envision future personal experiences) is strongly connected with retrospective memory (i.e. remembering past experiences). Two recent papers published on Neuropsychologia investigated the relationship of retrospective memory and future imagining, as well as their common neural correlates.
Kwan, Carson, Addis, and Rosenbaum (2010) report the case of H.C., a young woman with developmental amnesia associated with bilateral hippocampal loss. Episodic memory seems to depend on hippocampal function (Yancey & Phelps, 2001; Maguire, 2001). Compared to matched controls H.C. was found to be impaired both in tasks requiring past and future event generation. Her performance was similarly deficient in both tasks. According to Kwan and colleagues:
These results indicate that mental time travel can be compromised in hippocampal amnesia, whether acquired in early or later life, possibly as a result of a deﬁcit in reassembling and binding together details of stored information from earlier episodes
Maguire, Vargha-Khadem, and Hassabis (2010) report the cases of two patients (P01 and Jon) with dense amnesia and 50% volume loss in both hippocampi. P01 suffered from adult-acquired amnesia, but unlike previously reported cases was found to be unimpaired at future imagining tasks. The authors suggested that P01 could have been an atypical case, and in order to investigate this they identified another patient with similar neuropsychological profile, Jon. In spite of his dense amnesia, Jon was able to imagine future experiences in a comparable manner to control participants. According to one of the possible explanations proposed by Maguire and colleagues:
Activity in their residual hippocampal tissue supports the ability to imagine new scenarios, and that this is the key feature. Residual hippocampal tissue was active in both patients and in similar circumstances to control participants. Whilst we cannot deﬁnitely relate function to these hippocampal activations, we suggest the activations might indicate some preserved hippocampal function which is also sufficient to support their preserved ability to imagine scenarios
Kwan, D., Carson, N., Addis, D., & Rosenbaum, R. (2010). Deficits in past remembering extend to future imagining in a case of developmental amnesia Neuropsychologia, 48 (11), 3179-3186 DOI: 10.1016/j.neuropsychologia.2010.06.011
Maguire, E., Vargha-Khadem, F., & Hassabis, D. (2010). Imagining fictitious and future experiences: Evidence from developmental amnesia Neuropsychologia, 48 (11), 3187-3192 DOI: 10.1016/j.neuropsychologia.2010.06.037
Previous studies have found that the processing of faces and voices is negatively biased in major depression. Naranjo and colleagues were the first to investigate possible effects of major depression on the recognition of emotion in music. According to the authors:
as music is not directly linked to interpersonal communication, comparing a musical task with a facial and a vocal one will allow us to determine whether the impaired processing of emotional stimuli in depression is limited to interpersonal contexts
23 depressed patients and 23 matched healthy controls participated in this study. Their affective information processing was assessed through musical, vocal and facial emotion recognition tasks. Depressed participants were found to be impaired in all tasks. More specifically:
Depressed participants were less accurate in their recognition of peaceful and happy musical excerpts, for neutral and surprised voices and fearful, neutral and angry faces (whether displayed briefly or for a longer period). The depressed participants rated the intensity of the emotion higher than the control group for sad and frightening musical excerpts, and for the negative emotions of sadness, anger and fear in vocal and facial stimuli. However the depressed participants rated the peaceful musical excerpts less intense than the control group. Neutral voices and faces were frequently interpreted by depressed participants as expressing a negative emotion
These results show that there is a general emotional processing impairment in depressed participants. However, it’s hard to say that this impairment is due to the disorder itself. It could possibly be attributed to the anti-depressant medication all the participants were taking – previous research on this topic suggests that blunting of emotion is one of the effects of medication in healthy participants (Fu et al., 2004).
Naranjo, C., Kornreich, C., Campanella, S., Noel, X., Vandriette, Y., Gillain, B., de Longueville, X., Delatte, B., Verbanck, P., & Constant, E. (2010). Major depression is associated with impaired processing of emotion in music as well as in facial and vocal stimuli Journal of Affective Disorders : 10.1016/j.jad.2010.06.039
(pic from here)
Anderson et al. (2007) report a case of a 14 month boy (PF1) who sustained damage to his right inferior dorsolateral prefrontal cortex due to resection of a vascular malformation on day 3 of life. After a successful surgery he exhibit normal behaviour and reached developmental milestones at a normal rate. Also, his performance on various clinical tests was normal, as well as his social and communication skills as rated by his mother. Compared to a sample of healthy controls PF1 was impaired significantly in the regulation of emotion and engagement of attention, specifically in unstructured conditions.
In particular, Anderson et al. (2007) report that:
markedly high positive affectivity and low restraint
relative to his peers. This was particularly evident
in his intense and positive affective expressions
during free-flowing interactions, his unrestrained
approach of desirable but prohibited stimuli, and to
a lesser extent in his mildly atypical levels of anger
and resistance when physically restrained. Faced
with problem-solving tasks, when most of his peers
displayed affectively neutral expressions and
focused on finding the solutions, PF1 initially
responded with strong and under-regulated positive
emotion that interfered with attentional engagement
on the task at hand.
According to the writers the results of the study provide useful information about the impact that early damage in the prefrontal cortex may have on emotional and cognitive behaviour. I’m looking forward to their future reports on this particular case as the boy grows up.
Anderson SW, Aksan N, Kochanska G, Damasio H, Wisnowski J, & Afifi A (2007). The earliest behavioral expression of focal damage to human prefrontal cortex. Cortex; a journal devoted to the study of the nervous system and behavior, 43 (6), 806-16 PMID: 17710831
A few days ago I came across a paper by Schupak and Rosenthal (2008). They report the case of a patient presenting with a long history of excessive daydreaming.
Their patient is a 36 year old successful, educated woman with a long history of excessive and persistent daydreaming, which according to her reports is a cause of distress. What’s really fascinating in this case is the lack of known injury, drug abuse or other disorder. After more than 10 years of therapy, she only found relief from her symptoms when she was prescribed fluvoxamine, an antidepressant drug believed to influence obsessiveness and/or compulsivity. Even though, she used to spend a big part of her free time engaged in daydreaming, she was never disconnected from reality. Growing older, she was forced to hide her excessive daydreaming from colleagues and friends. However, this behaviour didn’t interfere with her education and her career.
The authors do a short review of the existing literature in mind-wandering suggesting that the hypothesis by Mason et al. (2007), according to which “mind-wandering is associated with activity in the default mode network”, could explain their patient’s symptoms. See suggested readings for alternative theories/hypotheses.
Schupak and Rosenthal (2008) conclude:
The subject of the present case study claims to be adjusted to her high level of fantasy proneness. She manages to orchestrate a complex allocation of cognitive and emotional resources toward the competitive requirements of externally- versus internally-driven attentional demands on a daily basis, though at substantial psychological cost. Our question regards the extent to which this case may represent an unrecognized population, i.e., individuals whose mind wandering/daydreaming is experienced as a causative factor in producing psychological distress or functional impairment without meeting criteria for any DSM disorder. The fact that our patient reports a positive response to a medication that influences serotonergic tone may imply neurochemical irregularity
Unfortunately, there is no report on any neuroimaging studies on this specific patient.
Gilbert, S. J., Frith, C. D., and Burgess, P. W. (2005). Involvement of rostral prefrontal cortex in selection between stimulus-oriented and stimulus-independent thought. The European journal of neuroscience., 21(5):1423-1431.
Mason, M. F., Norton, M. I., Van Horn, J. D., Wegner, D. M., Grafton, S. T., and Macrae, C. N. (2007). Wandering minds: The default network and stimulus-independent thought. Science, 315(5810):393-395.
Raichle, M. E., MacLeod, A. M., Snyder, A. Z., Powers, W. J., Gusnard, D. A., and Shulman, G. L. (2001). A default mode of brain function. Proceedings of the National Academy of Sciences of the United States of America, 98(2):676-682.
(painting: girl-daydreaming by Anthony Staynes)
Here’s a very interesting talk by Uta Frith, one of the pioneers in autism research:
A few relevant ASD studies:
Fletcher, P. C., Happé, F., Frith, U., Baker, S. C., Dolan, R. J., Frackowiak, R. S., and Frith, C. D. (1995). Other minds in the brain: a functional imaging study of “theory of mind” in story comprehension. Cognition, 57(2):109-128.
Gilbert, S. J., Bird, G., Brindley, R., Frith, C. D., and Burgess, P. W. (2008). Atypical recruitment of medial prefrontal cortex in autism spectrum disorders: An fmri study of two executive function tasks. Neuropsychologia, 46(9):2281-2291.