Neurology of the arts or neuroaesthetics is a new branch of neurology especially concerned by neuropsychology of visual artistic production and cerebral localisation of musical perception and musical memory (Seki, 1999; Rose, 2004; Chatterjee, 2004; Bogousslavky & Boller, 2005). Among the different activities the new field of research is gathering, such as study of pictorial representation of neurological symptoms in the art history, diagnosis of artists’neurological diseases, this article will focus on the study of relations between cognitive disabilities for neurological disorders and artistic production by visual artists. Neurological deficits can change the work in content or in style, but can be used also as sources of inspiration, especially in the case of epilepsy and migraine. But some final diagnosis remain controversial as regards for instance the nature of the disease of Ravel, Van Gogh, or Giorgio de Chirico, (Bogousslavky & Boller, 2005) or even De Kooning. According to Anjan Chatterjee (2004) writing about the breakdown of the visual representations: “The work produced by artists who have suffered from brain damage can contribute to our understanding of these representations“(p.1568) and it is also the opinion of Bogousslavky and Boller (2005):
It is also striking to observe how a localized damage to the brain or other nervous structures has led to subtle or dramatic changes in creativity and artistic production in famous artists. The study of how a neurological disorder can alter productivity in recognized artists and other creative people is a largely unexplored field. (p. VIII )
The interest of neurology of art for epilepsy is exemplary of the different angles of neurological research in the aesthetic field: research of visual representations of neurological symptoms in art history, research of diagnosis of epilepsy in the artists, research of elements associated to epilepsy as a source of inspiration (Rose, 2004; Engelsen, 2004).The pictorial representation of epilepsy, -its convulsive manifestations as its rituals of cure- belong to the first researches of neurology in art history. Let us only allude here to Lucas Cranach the elder who realised in 1509 a woodcut of Saint Valentine, the patron saint of epileptics. The motive of Christ exorcising, driving out the spirit of an epileptic boy may be observed in medieval iconography until the XVIIth century. The last picture of Raphael, The Transfiguration, (1520) represents an epileptic boy but there remains a controversy about the meaning of this presence, which would be, either a recall of the therapeutic function of Jesus or an image of transfiguration of Christ himself. Rubens who painted a version of this Transfiguration in 1604 represented in his work three more pictures of epileptics, among them, the Miracles of Saint Ignatius of Loyola in Antwerp in 1618. Episodes with visual hallucinations and altered states of consciousness in the autobiography by Loyola have been interpreted as seizure scenes (Lennox & Lennox, 1960). To this research of the visual representation of neurological symptoms is added another activity, the research of signs in the behaviour of the artist and his paintings driving to a diagnosis of epilepsy. As for Dostoevsky in literature, Van Gogh passed a long time for the model of epileptic in the painting. But there does not exist any longer a consensus on his pathology, theme of at least about thirty diagnosis. In 2005, an international team concluded its diagnosis by a bipolar disorder, affective or schizoaffective (Carota & Iaria & Benney & Bogouslavski, 2005).
Epilepsy became in the last decade an artistic theme for artists suffering of seizure. Among these artists with declared epilepsy, Jennifer Hall, an epileptic artist and director of a center of artistic experimentation, the Do While Studio in Boston, gathered and organized an exhibition of works of twenty-seven epileptic painters on the theme of the seizure. From the storm is a collection of works which can be seen on the site of the studio. This exhibition created in Boston in 1992 was presented in congresses of American, Canadian and Australian neurology. These works aim at suggesting the experience of the seizure, the hallucinations. In her artists’statements, she writes:
The imagery I use in a series of performances called Out of The Body Theatre, is drawn from the world in which I exist during seizures and the madness which comes from my inner storm. During these electrical firings my visions flourish and I hallucinate indescribable smells. I have felt virtual slivers slicing my throat when I draw the air to describe them, yet I am unable to re-capture their intensity with words. My ability to objectify these phenomena is relatively non-existent during an episode, because I am usually absorbed in negotiating basic survival. I have known seizures to come in repetition and last for days. I’m sucked down into the explosion, fumble through the chaos, and land disembodied from the intensity. I blink. “What happened?” It is here, between the insane and the mundane, that I have discovered the utter duality of myself. (Hall, 1992)
This transformation of a neurological disability into a source of inspiration by the artists who experimented it can be found also in the case of another neurological disorder, the commonest disorder of the brain and socially more covert than epilepsy, the migraine. About 10% of migraine, writes Rose are associated with a visual aura (Rose, 2004, p.47). Named before ophthalmic migraine, the migraine with aura precedes usually the migrainous cephalgia but sometimes can exist with it. The aura is transitory and disappears without leaving after-effects, in less than thirty minutes. It appears by the scintillating scotoma in the visual field of both eyes, with polygonal limits, compared usually to fortification figures. These broken bright moving and shimmering lines looks also like zigzags, flashes. In a contribution (Podoll & Robinson, 2000) showing the influence of ophthalmic migraine in Ignatius Brennan’s work, this Irish contemporary painter who suffered of migraine since the age of eleven comments his work, describes his perception of visual aura with the luminous zigzags :
I started with pictures of my migraine experiences unconsciously rather than deliberately, when i was at art school. I used to do a lot of drawings of landscapes at that time and often found that I would be drawing clouds not just in the sky, but everywhere, which was I think a reference to the visual voids experienced during visual loss. I also used serrated zigzag shapes in my drawings symbolizing the experience of a whole being broken up…. [..] Clouds, zigzags and other imagery are part of my own personal visual vocabulary, but which certainly has come out of migraine experiences. I’m absolutely sure.
The gallery of painters inspired by migraine would include Hildegard of Bingen (1098-1179), Giorgio de Chirico, Salvador Dali. Since Charles Singer’s study (1958), numerous Hildegard von Bingen’s visions are interpreted as signs of visual aura, symptoms of scintillating scotoma coming from migraines, what Oliver Sack confirmed later in his book, Migraine (1992). Hildegard of Bingen’s paintings would constitute the oldest testimony of influence of migraine on artistic inspiration with in her paintings, often, the pre-eminence of group of points of light shimmering and moving or series of wavering forms. Chirico is the most famous of the painters of the twentieth century with a supposed migrainous visual aura. Can be mentioned as example of his works where the visual aura may be seen, lithographs “ Calligrammes” of 1930 , “Mythologie” of 1933 and the oil painting “ Le retour au château” of 1969 (Fuller & Gale,1988). Ubaldo Nicola and Klaus Podoll (2003) shown how the migrainous visual experiences by Chirico are at the origins of paintings but also of texts including Mémoires, Hebdomeros and some essays.
Visions created by the migraine with visual aura became a popularized source of inspiration by the creation and organization of artistic manifestations in the decade 80, sponsored by pharmaceutical industries and by the launch of “the migraine Art”. The first manifestation, in the same time, exhibition and competition, was organized in the clinic of migraine of London by the British Association on migraine, with the help of a pharmaceutical laboratory, creator of the Dixarit. Its success caused the renewal and the extension of the operation until other countries. In 1991 the Exploratorium of San Francisco showed an important exhibition on “the Migraine Art”, called Mosaic Vision. A site migraine-aura.org is dedicated to the Migraine Art.
The stroke is a neurological phenomenon with potential very handicapping after-effects. In a famous article of 1948, the French neurologist Alouajine studied the influence of aphasia on the creative process from the example of three artists, the musician Ravel, the writer Valery Larbaud, translator of James Joyces’s Ulysses, who survived for 22 years to a stoke which left him with a severe aphasia and a right hemiplegia and the third one was a painter whose name remained secret in the article. Recently the French neurologist F. Boller discovered the identity of the painter: Paul-Elie Gerner (1888-1948). Boller analysed again the case of this painter who suffered a stroke at the age of 52 with aphasia and an apraxia which improved. Gerner was able to paint up to the time of his death, 8 years later. Gerner described his new condition: (Boller, 2005)
There are in me two men, the one who paints, who is normal while he is painting and the other one who is lost in the mist, who does not stick to life… When I am painting I am outside of my life; my way of seeing things is even sharper than before; I find everything again; I am a whole man. Even my right hand that seems strange to me, I do not notice when I am painting. There are two men, the one who is grasped by reality to paint, the other one, the fool, who cannot manage words any more. (p. 95)
Although Alouajine stated no changes in the skill and the style of the artist, Boller (2005) thinks differently and demonstrates a change in the style “with a tendency to produce more concrete and realistic paintings. The almost oniric poetry found in some of his previous paintings is apparently no longer found in works painted after the stroke.” (p. 95) Boller uses this example to evaluate the effects of damage on visual drawing capacities. Neurological studies show that the effects of cerebral damage are different between the artists and the untrained persons. Concerning the patients without artistic training, the drawing abilities are affected, in case of an aphasia after a stroke. But in the case of the artists, the professionally trained persons, the effect of stroke and aphasia do not show so strong a deficit in the drawing abilities and remain variable. Another effect of the stroke is what is called the phenomenon of unilateral spatial neglect. It is more common and more severe in case of stroke in the right hemisphere and subsequently appears under the form of a left side neglect. Among the artists who suffered a stroke in the right hemisphere with a left side neglect, there are Lovis Corinth, Anton Räderscheidt, Loring Hughes, Reynolds Brown but the most known case is Frederico Fellini, whose left side neglect in his drawings after the stroke in the right hemisphere has been studied by neurologists (Cantagallo & Salla, 1998). Fellini was conscious of this defect of representation of the left side in his drawings. One of them puts in scene with humor this deficiency, compared to his previous drawings; a character which represents him, asks “Where is the left? “ At the contrary, a stroke in the left hemisphere of the Bulgarian painter Zlatio Boiyadjiev caused a deep change in his theme and style: the left hemisphere lesion would have produced a “liberation of his creative possibilities” (Boller, 2005, p. 98). Brown considers that the drive to fantastic set of themes with richer colours would be explained by the right hemisphere’s looser sense of semantic boundaries. (Brown, 1977).
Numerous studies have described the melancholy in Caspar David Friedrich’s works and life. The research of a new team of the neurologists about his art, his private and public communications, testimonies and statements of his contemporaries leads to the confirmation of diagnosis of a recurrent major depression (Dahlenberg & Spitzer, 2005). But the study proposes a new investigation about a possible neurological disorder which could have influenced his artistic work. The researchers set a diagnosis for the neurological damage the painter, aged of 61 years, suffered because of a stroke, the 26th of june 1835. He had to stay in bed a few weeks at first and to follow a rehabilitation cure, with a partially paralysed hand. Although he did not look as if he had suffered of aphasia, the researchers advance the diagnosis of a left-sided subcortical infarction, a lacunar stroke he never fully recovered of. The neurologists take the last portrait of the artist in 1840, by Caroline Bardua as a probe, revealing a central paralysis of the 7th cranial nerve. Just after the stroke, he painted Seashore by Moonlight, his last oil on canvas, considered as a kind of testament which testifies a poststroke depression as for the allegories of death which can be seen among the last works, all of little format and with technique and materials requiring less manual capacities.
Alzheimer’s, the most common cause of dementia, leads to impairments of memory and other cognitive abilities, to impairments in the visual domain, altering visual attention, motion detection, depth perception, colour and angle discrimination and visuoconstructional abilities. According to Chatterjee (2004):
It would be reasonable to predict that disorders that impair cognitive systems diffusely would also impair the ability to practice art. This prediction is not quite accurate. Rather artistic skills in some of these conditions are relatively preserved or modified, and sometimes even enhanced (p. 1576).
Willem de Kooning (1904-1997) is the best known artist who continued to paint after developing Alhzeimer’s disease, although in his case the diagnosis remains controversial. In the early Seventies De Kooning started to suffer from an anterograde amnesia, forgetting people’s names, recent events and in the mid 70’s after a production decrease he finally stopped working. De Kooning’s treatment.begun by a tragic diagnosis. In addition to known problems, alcoholism, arteriosclerosis, depression, Korsakoff’s syndrome, the diagnosis included dementia associated to Alzheimer’s disease. The cure was surprisingly succesfull for an incurable disease (Espinel, 1996, Chatterjee, 2004). After two years of treatment he started to paint again, three paintings only in 1980, but from 1981 to 1986 he painted until 254, the famous “Late paintings” of the Eighties, exhibited in 1996 at the San Francisco Museum of Modern Art. This surprising remission of such an incurable disease, raising questions on a controversial diagnosis is caused in part by the sopping of the reversible components of dementia, and by his particular status of artist. According to Chatterjee, “people with AD continue to produce artwork, it seems, only when sustained by the momentum of life long routines“ ( 2004).
The New York Academy of Medicine, New York, in October 2006 presented an exhibition entitled The Later Works of William Utermohlen, with a lecture entitled “Portraits & Promises in Alzheimer’s Disease”.The catalogue of the exposition was an adaptation of Dr Patrice Polini’s study (Polini, 2005).The artist, American-born but living in England since 1957, was diagnosed an Alzheimer’s disease at he age of 61 years in 1995. The painter accepted to participate in medical and neuropsychological research about his case. As one of the specialities of the painter was the self-portrait, it was important to compare the serie of five portraits done after the beginning of the sickness, in an interval of five years, the decline in the ability to paint, to process perceptual and spatial information could be studied with neuropsychological measures. One of the most impressive changes in his style consists in a more abstract way. What is also striking, is the “continued artistic endeavour at a stage when Alzheimer’s disease has blunted the craftsman’s most precious tools”. ( … ) William Utermohlen’s late work is particularly precious to medical authorities and to the public because it offers a unique visual narrative of a patient’s subjective experience of dementia. The artist paints the gradual changes he sees in his world—changes he cannot communicate anymore in words—as he loses the power of speech and the ability for conversation.
Carolus Horn (1921-1992) was a famous german graphic artist who begun to show signs of AD in the early 1980’s: loss of memory, spatial disorientation, agnosia, aphasia. His case is especially important, for two reasons: at first, he continued to paint almost until his death and he used to paint the same scenes, especially buildings, landscapes, at various stages of his live (Maurer & David Prulovic, 2005) what enabled a quantitative analysis of disease-related changes. The analysis of theses series of paintings during his sickness shows an evolution corresponding to the progression of the handicaps. The growing use of dark colours at the first stages of the disease reflects depression feelings. With the progression of the disease, the dominating colours are brighter and brighter, which would corroborate the idea that the patients suffer an inability to discriminate the colours blue and green but keep the possibility to discriminate the bright ones, like yellow and red. The ability to representing geometrically spatial relations which is the last one to be developed by the child is the first one to disappear in the case of Alzheimer’s disease. The regression of cognitive capacities of the adult could be described as a progressive return to the competences of the child. According to Maurer & Prvulovic, the last drawings by Carl Horn, some months before his death, similar to the first drawings in children are “scribbling without any objects, spatial organization and meaning. These late drawings seem to reflect the loss of the knowledge not only of how to draw the visual world, but also of the visual world itself” (2005, p. 108).
In conclusion; collaboration between neurologists and artists suffering from neurological diseases has been created. The study of neurological deficits on the production by artists and the comparison of these effects by people without artistic skill contribute to the knowledge of theses diseases but also to the cognition of perception and of other cognitive abilities in the visual field. Chatterje writes that art is worth considering as like a neurological probe (2004), and Bogousslavsky et Boller confirm also the clinic interest of studies on artists (2005, p. VII). But this contemporary neurobiology of the arts considers also the way in which neuropsychological phenomena may be a source of artistic inspiration. The neurological diseases which constituted traditionally handicaps, obstacles to artistic creation, can in the case of epilepsy and migraine, even of strokes, be transformed by the artists into a source of inspiration and artistic production.
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