Standing in Monet’s Garden in Giverny, I donned a pair of scratched, plastic-covered, yellowed glasses and watched the once-breathtaking view in front of me melt into a muddied and obscured version of its former beauty. As a class, we had taken a day-trip to explore the place that Monet painted his famous water lilies. Monet is thought to have had worsening cataracts as he aged, which
Monet’s garden (Personal image)
impacted his vision and therefore his artwork. To simulate his experience, in class we had made “cataract glasses” by altering a pair of safety glasses, and we wore them for part of our time in the garden. I sketched the scene, noting how the vibrant, defined foliage lost its form and beauty. Certainly, this distortion altered my perception and gave me a unique perspective. However, at the time, I did not consider my final product a very appealing result.
My Monet-inspired glasses, meant to imitate vision with cataracts (Personal image)
But, this representation of the scene wasn’t inherently bad, and being impaired didn’t necessarily make my depiction worse for its lack of accuracy! It may even be that “impairments” enhance creative ability: even with the failing functionality of his own vision, Monet was able to transform any scene into a masterpiece.
My sketch of the same scene without (left) and with (right) the glasses (Personal Image)
In other realms as well, what may be deemed an impairment may turn out to be neutral or even beneficial to an individual’s creativity or artistry! Perhaps surprisingly, recent research suggests that this may be the case for some dementia patients.
One study by Midorikawa et al. (2016) involved analyzing new or increased positive abilities that appeared in patients with behavior-variant frontotemporal lobe dementia (bvFTD) or Alzheimer’s Disease (AD). These types of dementia are the ones in which enhanced abilities—such as new or improved drawing, singing, or painting skills—are most commonly reported after disease onset, leading to an apparent boost in creativity or artistry.
First, to briefly introduce the diseases of interest: FTD and AD are both types of
The different brain regions affected by FTD and AD. (Image from ElderlyCareAssistance.info)
dementias, diseases in which brain cells begin to die. FTD is a rather rare type of dementia that begins early in life. Cells die in parts of the brain that deal with social skills, decision-making, and emotion—especially the front and the side (What is Frontotemporal Dementia?). The specific type called behavior-variant FTD (bvFTD) is characterized by changes in personality such as disinhibition, inappropriate behavior, and loss of empathy. (Kurz et al., 2014). AD, which is one of the most common types of dementia, usually begins later in life. A lot of the initial cell death happens in the hippocampus, a structure associated with memory, so memory problems are often some of first symptoms (Miller and Hou, 2004).
Some of the items from the questionnaire (Image from Midorikawa et al., 2016)
In this study, caregivers of people with FTD and AD filled out a questionnaire, ranking the patients on a variety of positive behaviors in three different categories: sensory processing, cognitive skills, and social/emotional processing. On a four-point scale, caregivers indicated the frequency of the listed behaviors in each category for their patient “before the illness” and “at the present time.” Prior to the study, each patient was also diagnosed by a neurologist and assigned a clinical dementia rating, or CDR. (Higher CDR numbers indicate a more advanced or severe stage of disease.) This would allow the researchers to see if there were differences in ability between various stages and types of dementia.
Study results: y-axis indicates the average score. X-axis indicates clinical dementia rating (CDR) for Alzheimer’s Disease or frontotemporal dementia. (Image from Midorikawa et al., 2016)
Subtracting the “before” score from the “present” score, the researchers obtained a representative value, where a positive number indicates more of the behavior since diagnosis. Averaging these values for each diagnostic rating, Midorikawa et al. (2016) performed a statistical test to assess the magnitude of change in that behavior. What they found was that some of these positive behaviors significantly increased after disease onset! In particular, they found that (as can be seen in the graphs below) both AD and bvFTD patients actually exhibited more language-related activities–meaning creativity in self-expression through language–in the earliest stages of the disease. Additionally, a small portion of patients of both dementias experienced an increase in visuospatial activities, which includes things like being able to depict scenes through painting or drawing!
Although patients at later stages of the disease experienced decreases in these behaviors, it is a very intriguing finding that patients’ creative expression actually increased after disease onset. Moreover, there have also been many case reports documenting increased artistic output following neurological damage due to other causes, such as traumatic brain injury, Parkinson’s Disease, and semantic dementia (Midorikawa and Kawamura, 2015; Canesi et al., 2016; Hamauchi et al., 2019). Just like with Monet, it appears that what appears to be a deficit may in reality not be quite so detrimental to the creative process!
One strength of this study was how all patients underwent a comprehensive neurological evaluation by the same experienced neurologist. This was effective to confirm the diagnoses of the patients using consistent parameters and to assess disease severity. However, being survey-based, these measures were quite subjective and may not be entirely accurate. What it contributes to the field, though, is that it is one of the first studies to systematically analyze these changes in artistic ability: others have primarily been case studies of individuals. The study also offers a unique perspective: most work on dementia serves to analyze the deficits that occur due to cell death. This study, however, highlights
Painting by one AD patient without previous artistic training or ability before disease onset (Image from Schott, 2012).
some positive aspects of the disease, contributing to a rather new initiative that is working to change the dynamic around mental impairments. Rather than viewing perceptual differences as incorrect or indicative of pathology, maybe we should allow ourselves to appreciate the creativity.
In sum, even though I felt a bit ridiculous in the moment, wearing my cataract glasses in Monet’s garden taught me a powerful lesson: A change in perspective is not necessarily bad, even when the conventionally beautiful scene undergoes some alterations in the process. Perhaps if more people would be willing to look a bit silly and try on some Monet cataract glasses, we could all come to appreciate those with neurological damage and perceptual differences a little bit more, valuing them for the unique perspectives they bring to the world.
References:
Canesi, M., Rusconi, M.L., Moroni, F., Ranghetti, A., Cereda, E., Pezzoli, G. (2016). Creative Thinking, Professional Artists, and Parkinson’s Disease. J Parkinsons Dis. 6:239-246. doi: 10.3233/JPD-150681.
Frontotemporal Dementia- Signs and Symptoms. (n.d.). Retrieved from https://www.ucsfhealth.org/conditions/frontotemporal_dementia/signs_and_symptoms.html
Hamauchi, A., Hidaki, Y., Kitamura, I., Yatabe, Y., Hashimoto, M., Yonehara, T., Fukuhara, R., Ikeda, M. (2019). Emergence of artistic talent in progressive nonfluent aphasia: a case report. Psychogeriatrics. 10.1111/psyg.12437.
Kurz, A., Kurz, C., Ellis, K., Lautenschlager, N.T. (2014). What is frontotemporal dementia? Maturitas. 79:216-219. doi: 10.1016/j.maturitas.2014.07.001.
Midorikawa, A., Cristian, L.E., Foxe, D., Landin-Romero, R., Hodges, J. R., Piguet, O. (2016). All is not lost: positive behaviors in Alzheimer’s Disease and Behavioral-Variant Frontotemporal Dementia with disease severity. Journal of Alzheimer’s Disease. 54:549-558. doi: 10.3233/JAD-160440.
Midorikawa, A., Kawamura, M. (2015). The emergence of artistic ability following traumatic brain injury. Neurocase. 21:90-94. doi: 10.1080/13554794.2013.873058.
Miller BL, Hou CE. (2004). Portraits of Artists: Emergence of Visual Creativity in Dementia. Arch Neurol. 61:842–844. doi:10.1001/archneur.61.6.842.
Schott, G. D. (2012). Pictures as a neurological tool: lessons from enhanced and emergent artistry in brain disease. Brain. 135:1947-1963. doi: 10.1093/brain/awr314.
Images:
http://www.elderlycareassistance.info/care-for-elderly-own-home/
https://academic.oup.com/brain/article/135/6/1947/327597
https://content.iospress.com/articles/journal-of-alzheimers-disease/jad160440
Hyperlinked videos and sites:
https://www.youtube.com/watch?v=fmaEql66gB0