A Stroke of Creativity

If you were asked to pick something that you thought would trigger an undiscovered artistic talent, you probably wouldn’t reply, “degenerative brain disease”, but it’s completely plausible. In one such case, Tommy Mchugh was brought to a hospital, in 2001, because of a sudden onset of severe headache. Testing showed that he suffered from subarachniod hemorrhages caused by a stroke. After surgery he complained of what can be described as a “split mind disorder”, where his perceptions and personality were altered (3)(6). He began to compulsively express these altered perceptions through art, which he had shown no interest or ability in, prior to the stroke.  

Studies of these cases are suggestive of mild frontotemporal dysfunction. Specifically, Tommy’s tests of executive function showed impairment, mainly in tasks which required alternating between categories or tasks, but not to the extent found in previous studies of frontotemporal dementia. Clinical characteristics include; “…a profound alteration in character and social conduct, occurring in the context of relative preservation of instrumental functions of perception, spatial skills, praxis and memory”(7). Patients also experience a decline in social conduct, “breaches of interpersonal etiquette, tactlessness and disinhibition” as well as “impairment in regulation of personal conduct”(7). They also experience speech impairment and cognitive changes (7)

However, in a small subset of patients with frontotemporal dementia there is an emergence of artistic or musical creative ability despite the nature of this degenerative disorder and the progressive impairment of verbal and social processes.

            Frontotemporal dementia (FTD) is a specific category of cortical degeneration; the deterioration of the outer part of the brain. Dementia occurs when cells in certain regions in the lobes of the brains’ cerebral cortex become atrophied or swollen (3). The neurons in these affected parts lose their ability to communicate with each other, causing them to die or degrade. In unusual instances the loss of function in the anterior temporal lobes, which are related to language and social skills, may cause a sudden facilitation of creative abilities. Patients with this variant of FTD have selective impairment of the left anterior temporal lobe and semantic dementia (they experience a loss of semantic memory but retain other types). They are generally characterized as having an impaired ability to use words, symbols and the concepts they represent, but they develop or preserve an artistic ability (3).

            Dr. Bruce Miller, professor of Neurology, UCSF/Mt Zion Hospital, has worked with this small subset of patients who developed new artistic or musical skill despite the advances of dementia. The emergence of creativity appeared only with the unilateral left sided variant of FTD which seems to indicate that the loss of function in one part of the brain can release new functions elsewhere. In this case, the parts of the brain related to language and social skills (left anterior temporal lobe) seem to inhibit creative ability and drive. With a loss of function in those regions one may observe an emergence of creativity (2).

            In his studies, Miller ran tests on 57 patients with frontotemporal dementia, 12 of which showed left-sided dysfunction and developed or maintained a creative ability (2). Of the 45 without the emergence of artistic ability, 12 showed left sided dysfunction. FTD was detected using single photon emission computed technology, or SPECT. In this process chemicals, tagged with a radioactive atom, are used based on their absorption properties with in the brain. The brain selectively uptakes certain amounts of the chemical, which are then seen as colored areas in the SPECT image. In all subjects with the ability, SPECT showed a left sided temporal lobe “hyperfusion deficit” (2). Those without any artistic ability showed wide spread frontal and temporal hyperfusion.

            Miller compared the 12 individuals with creative ability to those without this specific subset of FTD using tests to distinguish asymmetrical left-sided from bilateral and right-sided FTD. The tests included “the Boston Naming Test (testing for lower with left-sided lesions), verbal IQ minus performance IQ (higher with right-sided lesions), and ‘D-word’ minus design fluency (higher with right-sided lesions)”(2). Patients with artistic ability tended to score lower on verbal IQ, but higher on the depression scale. Patients with the variant FTD never manifested abilities in the verbal sphere and seemed to lack a symbolic and abstract component in there artwork; mainly relaying on copying, perfecting and memorizing. “They had totally non-symbolic art there was no abstract, conceptual component to it. What they tended to do was produce an image which was dependent on memory and their imagination. In some cases these images were modified by components in the left hemisphere” (3). Miller may have been able to identify what he supposes to be the source of their creativity, and believes that these patients give clues to what goes on in the right hemisphere of the brain and the effect of other regions on its functions.

            The emergence of creativity suggests that the affected areas (anterior temporal regions) are involved in inhibiting the areas of the brain which are involved in creative processes (dorsolateral frontal and posterior temporal and parietal regions) (2). “The abilities that remain and indeed flourish are probably in the back part of the brain in the posterior temporal and parietal lobe” (8). This type of dementia seems to disinhibit the brain which allows individuals to be creative where they weren’t before. Dr. Miller now describes the left hemisphere as “a bully, a dominant hemisphere that suppresses these visual and musical abilities and when it is turned off we can see some of these abilities that were obviously, always there” (3).

            The right hemisphere of the brain is presumed to regulate internal or self representation while the left hemisphere is where language originates. It would seem that patients who degenerate primarily on the left side of the brain, in the left temporal lobes, lose the ability of language in a profound way along with the meaning of words (as do patients with non-variant FTD). Paradoxical functional facilitation possibly contributes to the unexpected development of talents in patients. In normal subjects inhibitory and excitatory mechanisms interact in complex harmony. “The role of inhibitory processes may be critical in mediating specific restorative paradoxical functional facilitative effects” (5). Basically, if one area of the brain is injured another part is released and an increased function in that area can be observed.

            In the case of left-sided variant FTD, the affected areas are degraded resulting in diminished function associated with those areas. The onset of creative ability suggests an inhibitory connection between the affected areas and the regions of the brain involved in the creative process (3). Selective degeneration of left anterior temporal cortex leads to decreased inhibition of the “right-sided and posteriorly located visual and musical systems, and dorsolateral frontal regions” (2), thought to be involved with working memory, and thus enhancing artistic ability.

            Disfunction in the brain reveals a lot about the function of its parts, because we are able to pinpoint the area of disturbance and observe its effects. For instance, the function of the hippocampus, as the structure that creates new memory traces, was discovered when doctors removed it from a patient, unaware of the implication, and that individual was no longer able to create new memories.

            Maybe it is incorrect to refer to the symptoms described above as abnormal, after all the same processes are occurring in all our brains, though they are inhibited. What these patients lack is the ability of their brain to control the areas of the brain responsible for creativity. Without the inhibiting power of their left, dominant hemisphere, their artistic urges are give free range. By assuming that these types of neural disfunctions are often exaggerations of normal processes, we can use then to use them to get a better idea of how the brain actually works by making simple behavioral observations and comparisons.

1) Sudden Emergence of Visual Creativity

2) Functional Correlates of Musical and Visual Ability in Frontotemporal Dementia

3) BBC News | Health

4) The Harvard Brain

5) Kapur, Narinder. Paradoxical Functional Facilitation in Brain-Behaviour Research. Brain, Vol. 119, No. 5, 1775-1790, 1996 © 1996.

6) Prolific Artistic Output Following Subarachnoid Hemorrhage 

7) Frontotemporal Lobe Dementia 

8) The Art of Dementia 

9) The Temporal Variant of Frontotemporal Dementia