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Biology 202
2001 Third Web Report
On Serendip

Toward a Neurobiology of Creativity?
Making Connections Between Art, Manic-Depressive Illness, and Frontotemporal Dementia

Diana C. Applegate

"And Something's odd - within -
That person that I was -
And this One - do not feel the same -
Could it be Madness - this?"
-Emily Dickinson

Those of us who enjoy the arts, either as participants or avid fans of the creative process, are very much aware of the so-called "myth of the artist" and other similar stereotypical sketches that link the artistic genius to an inner, emotional world of tumultuous highs, lows, and sheer "madness". Mental illness, particularly manic depression, has somehow become an inseparable part of the successful artist's experience in the romanticized biographies of famous poets, painters, and musicians of our time. In her book, Touched With Fire: Manic-Depressive Illness and the Artistic Temperament, Dr. Kay Redfield Jamison lends some evidence to this widely-recognized cultural myth, and exposes a fascinating relationship between the mood cycles involved with manic depression and the creative process.

Despite her convincing results, Jamison's approach does not necessarily offer any particular insight about why this correlation exists, or where creativity actually originates in the brain. In order to paint a more complete picture, so to speak, of what occurs inside the brain during the creative process, it seems that scientists should take advantage of the advances in brain imaging technologies that can be performed on healthy control subjects, as well as those who may be suffering from manic-depressive illness or other conditions.

Interestingly enough, recent studies by Dr. Bruce Miller, MD, a neurologist from the University of California, San Francisco, involving patients who suffer from frontotemporal dementia, approach the issue of creativity and the brain from a more functionalist perspective. As a result of FTD, a condition proven by SPECT (single photon emission computed tomography) images of the patient's brains, Miller noticed that his patients seemed to spontaneously develop artistic talents and creative interests they had never possessed before (5).

Combining Jamison's research along with Miller's new foray into studying creativity via brain imaging, I feel it is possible to begin to work toward constructing a tentative neurobiological explanation of creativity. In this final paper, I will first present a review of Jamison's book on manic-depressive illness and the artistic temperament, discussing her method, her evidence, and her conclusions. Next, I will introduce Miller's research, and attempt to show how his functionalist approach tackles some of the unanswered questions that Jamison's research leaves up for grabs. It is my belief that a synthesis of these two approaches to the question of how neurobiology relates to creativity yields a productive way of examining the issue.

In her book, Jamison does not assume the reader has any clinical knowledge about manic-depressive illness. She starts from scratch, explaining the condition in traditional scientific terms, and also illuminates manic-depressive illness throughout the book by sharing the poetry and prose of those who lived with it. After thoroughly defining and describing the disease, Jamison presents biographical and scientific evidence suggesting a relationship between manic depression and artistic creativity. In her next chapter, she forges even further ahead, discussing the psychological and biological arguments in support of an overlap between madness and art. Before concluding with a chapter on the problems with, and objections to, the treatment of manic-depressive illness, as well as the ethical concerns surrounding the possible isolation of a gene or genes responsible for the disorder, Jamison devotes an entire chapter to George Gordon, Lord Byron, a famous poet who suffered from manic-depressive illness.

So what exactly is Jamison's evidence? Her biographical sources linking manic-depressive illness and the artistic temperament include personal accounts such as letters and other autobiographical excerpts from the likes of Robert Lowell, Robert Burns, F. Scott Fitzgerald, Robert Schumann, Theodore Roethke, Edgar Allen Poe, Vincent Van Gogh, Lord Byron, and others. In addition, Jamison occasionally analyses the work of these artists, which often describe, in detail, the emotional and intense highs and lows they experienced. The author's scientific discussion of manic-depressive illness allows the reader to recognize the similarities between the artists' accounts of their symptoms and the clinically accepted symptoms of manic depression that are used in diagnosis today. Furthermore, Jamison includes numerical figures which indicate that writers, in particular, have a vastly disproportionate rate of manic-depressive illness as compared to the general population.

Even more compelling is Jamison's discussion of moods as they relate to creative productivity: "Many of the changes in mood, thinking and perception that characterize the mildly manic states - restlessness, ebullience, expansiveness, irritability, grandiosity, quickened and more finely tuned senses, intensity of emotional experiences, diversity of thought, and rapidity of associational processes - are highly characteristic of creative thought as well." (105) She notes that two aspects of thinking, in particular, seem to show up in both creative and hypomanic thought: "fluency, rapidity, and flexibility of thought on the one hand, and the ability to combine ideas or categories of thought in order to form new and original connection on the other." (105)

Manic-depressive illness, of course, is a mood disorder, and those afflicted with the condition experience alarming variations in mood, ranging from energetic, euphoric highs to melancholy, listless lows. Some have suspected that the melancholic periods experienced by so many artists are key in determining why, if at all, they are possibly more attuned to the subtleties of human emotion and experience. However, Jamison argues that one must pay equally close attention to the manic phase of the disorder, and that, perhaps, it is even more crucial to understand and appreciate the interplay between these two interacting cyclic stages or phases of manic-depressive disorder and how they relate to one another when assessing how mood may affect creative output. For example, the birth of new ideas often takes place during the manic phases, but the refinement of such thoughts may occur during the artist's melancholic periods. The creative process requires a certain amount of emotional involvement as well as a more logical perspective in order to put the new ideas into practice. Jamison also relates creative productivity to the cyclic nature of the seasons and months of the year, mapping mood cycles on top of natural cycles with very interesting results.

What interested me in particular was Jamison's discussion of treating manic-depressive illness, and the resistance that artists may have to drug therapy. Those who experience such a range of highs and lows often become accustomed to them, and do not wish to give them up. Furthermore, if artists are more productive during a certain phase of the illness, they fear that medication will change that. And, in some cases, it does. Lithium, one of the more commonly prescribed drugs to regulate the manic's highs and lows, often has the effect of making the transition from one mood to the next a lot less pronounced. The stability that the drug offers to patients can make them feel almost lifeless in comparison to the dramatic mood swings experienced during manic-depressive illness. However, Jamison stresses that manic-depressive illness can end in suicide if not treated, and, of course, there are many creative and productive people in the world who do not experience the symptoms of manic depression. Therefore, it is still possible to create, even when undergoing drug treatment. Changes in productivity levels will vary from person to person.

Jamison's Touched With Fire is highly relevant to this course, and our continuing discussion of whether or not the brain really equals behavior. The author does not discuss manic-depressive illness in neurobiological terms. However, she draws a parallel between the behavioral characteristics of manic-depressive illness, and those experienced during the creative process. Earlier in the course, a few students objected to the brain=behavior idea by saying, "What about creativity?" Jamison's book does not provide us with any answers, but it raises several new and interesting questions. If the behavioral characteristics of the creative process are similar to those of a genetic, neurobiologically-related disorder, then it is conceivable that creativity arises from the interaction of certain neurons in the brain. Nevertheless, creativity is still very much a puzzle for neurobiologists and psychologists alike, and further study is needed in order to come to any definitive conclusions.

Miller's investigation of frontotemporal dementia, in many ways, seems to pick up where Jamison left off. FTD is a degenerative condition of the anterior portion of the brain, marked by dramatic changes in personality and behavior. Some individuals suffering with the condition may seem "overactive, restless, distractible and disinhibited" while others are "apathetic, inert, aspontaneous and emotionally blunted" (4). Miller recently discovered that a number of his FTD patients, many of whom were experiencing a great deal of distress over losing communication skills and being unable to recall even the simplest of words, also experienced a simultaneous emergence of creative interest and artistic abilities. He hypothesizes that the selective loss of function in the anterior temporal lobes of the brain may somehow have a causal effect on the sudden emergence of artistic skills. It is suspected that degeneration in one part of the brain could lead to enhanced function and acuity in another area, which in this instance would be the visual and musical areas of the brain (7).

Miller published the stories of five of these special patients in Neurology in October 1998, and commented on this unusual phenomenon by saying, "The last place one would expect to find any aptitude flourishing, let alone emerging, is in the brain of someone slowly wasting away with dementia..." (6). The stories of Miller's patients are nothing short of amazing, in my opinion. Jennifer O' Brien, in an article titled "Rare Cases of Dementia Stimulate Artistic Juices", summarizes the sudden transformations that these FTD patients experienced:

In one case, a mild mannered stockbroker with no prior interest in art shunned his conservative attire in favor of brash, bold fabrics, and began painting with passion, winning awards at local art shows even as his social and language skills eroded. A 53-year-old man with a tenth-grade education and no prior interest in art entered a period of intense artistic activity, initially drawing vases and bridges, ultimately painting churches and haciendas remembered from his childhood. A 51-year-old housewife without previous artistic training began painting rivers, ponds and rural scenes recalled from her childhood, while a 57-year old man who had developed a successful advertising agency began traveling to remote areas of Central America, often putting himself in harms' way to photograph buildings and people, working from multiple angles to achieve the "perfect" image (7).

To date, neuroimaging techniques have not yet pinpointed a "creativity center" within the brain. However, Miller's FTD studies do provide some additional insight into the "physiological basis" of the artistic process (8). I wonder whether the use of neuroimaging could be extended even further in order to attempt to discover a possible neurobiological basis for creativity. For example, researchers studying the effects of Alzheimer's Disease, another dementia, on brain and behavior will often scan a patient's brain while he or she is attempting to perform a given task (i.e. remember a word, or recognize and repeat a word from a list). In addition, the brains of "normals", or people unafflicted with Alzheimer's disease, are also scanned and analyzed as a control group. Although I realize there are limitations in terms of what actions one can perform while inside a CAT scan machine, why not aspire to scanning the brains of creative people while they are actually performing a creative task? As one might imagine, Jamison's research could be extended to include brain images of normals, manic-depressive patients, famous living artists, and those with no supposed artistic ability. It might then become possible, at some point in the future, to begin mapping the brain for so-called creative hot spots. Actual brain images would help strengthen Jamison's argument linking manic-depressive illness and creativity, adding a neurobiological component to her work.

The mystery of creativity is something that artists, philosophers, psychologists, and biologists alike have been puzzled by for quite a long time. I believe that the field of neurobiology, specifically the advancements in neuroimaging technology and so-called brain mapping, has a lot to contribute to this continuing dialogue. Increased collaboration among interested constituencies may yield a more complete and cogent explanation of the creative process in years to come.

WWW Sources and other Related Works of Interest

1)A Brief Bio on Dr. Kay Redfield Jamison, on the Random House Reader's Club Website

2)Live from Lincoln Center: Interview with Dr. Kay Redfield Jamison, on the Lincoln Center Backstage Website

3)"Research explains lithium's dual anti-manic/anti-depressive effect", on the University of Wisconsin - Madison Website

4)Fact Sheet: Frontotemporal Dementia, on the Family Caregiver Alliance Website

5)"Emergence of Artistic Talent in Frontotemporal Dementia," Miller, B.L. et al. Neurology, 51, 978-82, 1998.

6)Grasping Creativity, Part 3: Creativity and Frontotemporal Dementia, on About.com's Art/Technology Website

7)"Rare Cases of Dementia Stimulate Artistic Juices", on Daybreak, UCSF's Electronic Daily News Website

8) "Creativity and Psychopathology", by Rachel Friedman, on the Harvard Brain's Website




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