Dr. Eugen Bogdan Petcu
Senior Lecturer, Griffith University Regenerative Medicine Centre
Dr. Rodica Ileana Miroiu
Instructor, Griffith University Queensland College of Art
Reference this essay: Petcu, Eugen Bogdan and Rodica Ileana Miroiu. “Neuroaesthetics, Medicine, and Art Representation.” In Leonardo Electronic Almanac22, no. 1, edited by Lanfranco Aceti, Paul Thomas, and Edward Colless. Cambridge, MA: LEA / MIT Press, 2017.
Published Online: May 15, 2017
Published in Print: To Be Announced
Neuroaesthetics represents a new field that is currently being evaluated for its scope and purpose by both clinicians and artists. There is significant debate regarding the actual definition of this field and its relationships not only with medicine and art, but also with the philosophy of culture and religion. This paper will explain the close relationship between neuroaesthetics and the activation and processing that occur in certain parts of the brain, which can be quantified by radiological methods. It will also describe the relationship between brain damage (resulting from, for example, stroke, migraine, and neurodegeneration) and visual art production.
Neuroaesthetics, brain damage, visual art production, stroke, dementia
Obviously, artistic creation depends on a functional central nervous system. In this context, neuroaesthetics is a field that tries to reconcile various (physio-) pathological elements of brain activity with the actual act of artistic representation. However, neuroaesthetics remains controversial. Currently, there is much debate about the scope and purpose of this new, specialized field that is not only located at the interface between medicine and art, but that also has strong links to philosophy, psychology, and religion. Remarkably, clinical medicine reports a strong association between art production and various brain diseases. There is a strong correlation between certain aspects of art—style, topic, color, and form—and stroke, neurological impairment, and other central nervous system conditions. However, at present, it is impossible to understand the molecular mechanisms that explain this relationship, as the number of patients that have been studied is very limited. Further, most studies focusing on this topic have been observational because it is very difficult to conduct a prospective study. The current manuscript outlines the most important pathological settings in which central nervous damage is followed by significant artistic production.
In broad terms, cessation of blood flow to the brain due to an embolus or hemorrhage causes tissue necrosis; that is, a stroke. For a very long period of time, stroke was thought to be associated with irreversible parenchymal damage. However, recent research has shown that this is not the case, as neuronal regeneration has been observed after stroke in experimental settings.   Interestingly, visual artists develop more vibrant and dynamic styles after a stroke. However, these artist-patients are very difficult to assess, as the mechanisms behind art appraisal and neuroaesthetics are poorly understood. We believe that a quantitative approach is needed in order to explain the intricacies of the relationship between brain integrity and art production. It has been suggested that damage induced by stroke in different parts of the brain could have different effects on artistic production and evaluation. Also, the same type of lesion may have different effects in two different stroke patients. Scientists evaluated brain-art perception in a quantitative experiment that evaluated several aspects of perception including color saturation, temperature and texture, simplicity, depth, and balance—as well as conceptual characteristics such as realism, symbolism, abstraction, accuracy, emotion, and action—in right-hemisphere stroke patients. The study employed 24 paintings, including masterpieces by Holbein, Pollock, Brueghel, Cezanne, Picasso, Pissarro, and Matisse, among others. The patients’ preferences were evaluated in parallel with modern voxel-based lesion-symptom mapping.  Remarkably, lesions located in the frontal and parietal cortex induced abnormalities in aspects of aesthetic appraisal related to abstraction, action evaluation, realism, and symbolism. In addition, depth perception seems to be affected by frontal strokes. However, these patients retained their selective preferences and their capacity to label a piece of art as interesting or dull. 
While this study revealed that some stroke-related artistic/aesthetic alterations can be quantitatively measured, more research is needed in order to select the design and methods best-suited to general replicability and applicability. Recent literature has reported cases of famous artists who suffered strokes and, after recovery, created totally different styles, often more dramatic and expressive. A remarkable example is Anton Raderscheidt, member of the Magischer Realismus and Dada movements in Cologne, Germany.   At sixty-five years of age, Raderscheidt suffered a right-hemispheric stroke. This resulted in hemiplegia and hemianopsia; that is, the loss of half of his visual field. The artist continued to paint despite this deficit, depicting only the portion of the visual field that corresponded to the unaffected visual cortex. Early in his career (and prior to the stroke), as a member of Magischer Realismus, Raderscheidt created paintings that radiate a strange, cold emotion. In these paintings, characters are represented as almost frozen, with near-photographic precision. Following his stroke, the artist not only lost half his visual field, but also developed hemineglect, or the inability to recognize half of the body, as well as prosopagnosia, or difficulty recognizing familiar faces.  Paradoxically, his art from the last few years of his life became more expressive, despite the above-mentioned problems; indeed, his self-portraits from this period are the more dramatic than ever before.
Interestingly, hemineglect is one of the most commonly reported clinical features of stroke victims to have a major impact on artistic design and production. In fact, this could be essential in explaining, from a neuroaesthetic perspective, the nature of artistic visual creation. Federico Fellini, the famous film director and winner of several Academy Awards, was also an accomplished caricaturist whose style completely changed after he suffered a right-parietal stroke.  The artist developed left visual motor neglect, but without personal neglect. Most remarkably, it was reported that Fellini was fully aware of his neurologic abnormalities.  Subsequently, his style become more abrupt and expressive, focusing on representing only what could be seen in the intact portion of his visual field.
Dementia is a clinical condition characterized by cognitive impairment. It comes in numerous clinical forms associated with morphological changes in the central nervous system. Alzheimer’s disease is a form of dementia that, until recently, could only be confirmed after histopathological evaluation of the brains of deceased patients. However, following the advent of new biomarkers, it now seems possible to confirm the diagnosis while the patient is still alive. Currently, the International Working Group for New Research Criteria for the Diagnosis of Alzheimer’s disease considers Alzheimer's to be a clinical manifestation of severe cognitive impairment that is preceded by a less severe predementia stage.  Though not confirmed by histopathological methods, that famous member of the New York School, Willem de Kooning, died after a long and protracted struggle with Alzheimer’s.  Close evaluation of the works he created while suffering from cognitive impairment reveals abstract, colorful paintings. However, the actual concept and construction of his subjects is rather simple. All of these works stand in stark contrast to his early abstract expressionist portraits. Nevertheless, these later works—vivid, but simple—are quite beautiful. While we can explain such changes as having resulted from brain damage, we do not have the means to understand them from a neurologic perspective.
Another form of dementia associated with the creation of visual art is frontotemporal dementia. The literature reports one case of a patient with no prior artistic training and interest who started to paint after developing frontotemporal dementia. Interestingly, in his detailed drawings and paintings, the artist consistently used bright colors from the outset. Initially, he painted quickly, but as the disease advanced, he began to take more time to complete his works. Overall, the patient's art seems to lack symbolic content, and rather has a strikingly repetitive visual character. 
Autism spectrum disorder (ASD) includes neurodevelopmental pathologies characterized by obsessive behavior. Patients relate to family, acquaintances, and their surroundings in very particular ways. The most obvious clinical feature is impairment of communication and language abilities, which can result in inappropriate reactions and behaviors. Recent research suggests that ASD is the result of abnormalities—related to a wide range of factors—in the molecules that modulate the activity of neural cells.  For our purposes, perhaps the most relevant example of an autistic artist is the prodigious modern artist Stephen Wiltshire, a City and Guilds of London Art School graduate. Wiltshire excels in drawing highly detailed, descriptive art from memory, depicting cars, cities, and other landscapes with an obsessive fervor.  We are not aware of the neurologic mechanism that drives Wiltshire to create his amazing compositions, but, nonetheless, he continues to have a successful career as an accomplished visual artist.
Migraines represent a very common neurological condition characterized by headaches of varying intensity that can result from eating certain foods, from visual stimulation, or other causes. While we do not have a precise physiological understanding of migraines, we are certain that they represent a state of increased excitability in the cerebral cortex. Currently, scholars are rethinking the precise definition of 'chronic migraine' as they attempt to develop individualized, differential therapies based on patients' individual symptoms.  Recently, it has been argued that Pablo Picasso suffered severe, recurrent migraines.  The authors of this argument evaluated Picasso’s masterpieces and revealed that many of his portraits show vertical splitting and shifts in perspective. They explain these as representations of widespread cerebral pain. While these are speculations, similar indications can be observed in the work of less famous migraine patients. 
Numerous neurologic conditions can be associated with specific styles and aesthetics. With some pathological conditions, one can appreciate significant differences in an artist's style before and after the onset of a specific brain lesion. We know that certain areas of the brain are vital to the creation of art, and that disorders and disease of the brain can directly affect art and aesthetic styles. Yet, at present, we do not understand the neurologic mechanisms that result in these changes in artistic style and sensibility. More standardized studies are needed in order to elucidate these unknowns. Currently, neuroaesthetics remains a border project at the interface of medicine and art, one that will continue to define itself in the years to come.
 E.B. Petcu, R.A. Smith, R.I. Miroiu, and M.M. Opris, “Angiogenesis in old-aged subjects after ischemic stroke: a cautionary note for investigators,” in Journal of Angiogenesis Research 2, (published online 26 2010), http://www.biomedcentral.com/content/pdf/2040-2384-2-26.pdf (accessed Aug 17, 2014).
 E.B. Petcu, V. Sfredel, D. Platt, J.G. Herndon, C. Kessler, and A. Popa-Wagner, “Cellular and Molecular Events Underlying the Dysregulated Response of the Aged Brain to Stroke: A Mini-review,” Gerontology 54, no.1 (2008): 6-17.
 B. Bromberger, R. Sternschein, P. Widick, W. Smith II, and A. Chatterjee, “The Right Hemisphere in Esthetic Perception,” Frontiers in Human Neuroscience 14, no.5 (2011): 109.
 Ibid., 3
 F. Mir Fullana, “The Prosopagnosia of Anton Räderscheidt (1892-1970),” Archivos de la Sociedad Espanola de Oftalmologia 80, no.1 (2005): 57-9.
 Anton Räderscheidt’s official website, “The Late Work,” http://www.raederscheidt.com/Spaetwerk Praesentation/Spaetwerkpraesentation.html(accessed Aug 9, 2014).
 Ibid., 5
 A. Cantagallo and S. Della Sala, “Preserved Insight in an Artist with Extrapersonal Spatial Neglect,” Cortex 34, no.2 (1998): 163-89.
 Ibid., 8
 A. Delacourte, G. Frisoni, N.C. Fox, D. Galasko, S. Gauthier, H. Hampel, G.A. Jicha, K. Meguro, J. O'Brien, F. Pasquier, P. Robert, M. Rossor, S. Salloway, M. Sarazin, L.C. de Souza, Y. Stern, P.J. Visser, and P. Scheltens, “Revising the Definition of Alzheimer's Disease: A New Lexicon,” The Lancet. Neurology 9, no.11 (2010): 1118-27.
 Barbara Hess, Willem de Kooning 1904–1997: Content as a Glimpse (Köln and London: Taschen, 2004), 87.
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 Stephen Wiltshire’s official website, “Stephen Wiltshire Draws Sydney,” April 24-30, 2010, http://www.stephenwiltshire.co.uk/sydney.aspx (accessed Aug 15, 2014).
 P. Martelletti, Z. Katsarava, C. Lampl, D. Magis, L. Bendtsen, A. Negro, M.B. Russell, D.D. Mitsikostas, and R.H. Jensen, “Refractory Chronic Migraine: A Consensus Statement on Clinical Definition from the European Headache Federation,” The Journal of Headache and Pain 15 (2014):47.
 M.D. Ferrari and J. Haan, “Migraine Aura, Illusory Vertical Splitting, and Picasso,” Cephalalgia 20, no.8 (2000): 686.
 K. Podoll, “Migraine Art in the Internet: A Study of 450 Contemporary Artists,” International Review of Neurobiology, no.74 (2006): 89-107.
Dr. Rodica Miroiu is an academic and sports medicine and rehabilitation specialist with a special interest in anatomy and biomechanics education including rehabilitation through physical activity and arts. Previously she has authored numerous books and articles on Neurorehabilitation and Kinesitherapy which have been very well received by the academic community. She has acquired a significant experience as an accredited clinical specialist at various international and national sport events including Paralympic competitions held in Romania. Moreover, she has developed a successful multidisciplinary protocol for rehabilitation of paraplegic patients. Currently she lives on the Gold Coast of Australia where she holds an Honorary Research Fellowship at Griffith University.
Dr. Eugen Petcu is an academic pathologist based on the Gold Coast of Australia at Griffith University School of Medicine. He is a member of Menzies Health Institute Queensland and holds a Senior Research Professorship at Queensland Eye Institute in Brisbane. He has developed, in collaboration with Dr. Rodica Miroiu, an innovative academic program Anatomy for Artists which was initially hosted by the Queensland College of Art. Eugen is interested in transdisciplinary research at the interface between medicine and art. More specifically, he has developed several research projects focusing on neurobiology of artistic creation. Last but not least, he serves on editorial boards of medical and humanities journals.