The Frontal Cortex

Via Vaughan Bell, comes this wonderful essay by Tom Stafford on confabulation and creativity:

In those patients with frontal damage who do confabulate, however, the brain injury makes them rely on their internal memories--their thoughts and wishes--rather than true memories. This is of course dysfunctional, but it is also creative in some of the ways that make improvisation so funny: producing an odd mix of the mundane and impossible. When a patient who claims to be 20 years old is asked why she looks about 50, she replies that she was pushed into a ditch by her brothers and landed on her face. Asked about his good mood, another patient called Harry explains that the president visited him at his office yesterday. The president wanted to talk politics, but Harry preferred to talk golf. They had a good chat.

Improvisers tap into these same creative powers, but in a controlled way. They learn to cultivate a "dual mind," part of which doesn't plan or discriminate and thus unleashes its inventive powers, while the other part maintains a higher level monitoring of the situation, looking out for opportunities to develop the narrative.

I recently discovered a quite interesting case report of a 48 year old male patient named SB who, after suffering a subarachnoid hemorrhage in his frontal lobe, became a chronic confabulator. The following description is from a medical report on SB by his neurologist, Dr. Anthony Coughlan:

SB would claim, first thing in the morning, to have fictitious business appointments, when in fact he was attending a day centre, and would frequently dress for dinner in the evening in the mistaken belief that guests were coming. He would also attempt to take cups of tea outside, saying that these were for his foreman, who had discontinued employment with him several years earlier. During the interview, his memory was confabulatory even for events an hour earlier and he would sometimes claim to have been engaged in imaginary business appointments when in fact he had been undergoing psychological tests. When inconsistencies in his confabulations were pointed out to him, he would become perplexed and either profess ignorance of recent events or invent a new confabulation. His confabulations were not limited to his former business life, for when questioned about holidays or outings over the previous few days, he would again report events that bore no relationship to actual happenings.

This was SB's perpetual tragedy: he told lies without knowing that he was lying. Although his mind had mostly recovered - his memory problems and "inappropriate actions" had largely disappeared* - he would always be left with this terrible symptom, spinning fictions but thinking they were facts. It's not that he wanted to deceive - he just couldn't help it. And so, although SB never learned to tell the truth, his wife learned to stop listening.

And SB isn't alone: chronic confabulation is often seen in patients with frontal lobe damage. Like SB, these people invent fantastical fictions about their lives, telling stories that make little literal sense. They lie about anything and everything, if only because the truth is too confusing. Such confabulations tells us something important about the mind: spontaneous creativity - the ability to make up a story on demand - is a fundamental feature of human cognition. We're all natural storytellers, weaving narratives out of the confusion. In other words, SB's brain damage didn't lead to some special new mental capacity, which the rest of us are missing. Instead, it released a latent creative capacity that we all have, if only we learned how to stop holding it back.

We can observe a similar process at work in fMRI studies of jazz musicians, who learn how to temporarily silence those brain areas that keep us from confabulating. I wrote about this research earlier this year:

The first study, led by Charles Limb of the NIH and Johns Hopkins University, examined the brain activity of jazz musicians as they played on a piano. The musicians began with pieces that required no imagination such as the C-major scale and a simple blues tune they'd memorized in advance. But then came the creativity condition: The musicians were told to improvise a new melody as they played alongside a recorded jazz quartet.

While the musicians riffed on the piano, giant magnets whirred overhead monitoring minor shifts in their brain activity. The researchers found that jazz improv relied on a carefully choreographed set of mental events, which allowed the musicians to discover their new melodies. Before a single note was played, the pianists exhibited a "deactivation" of the dorsolateral prefrontal cortex (DLPFC), a brain area associated with planned actions and self-control. In other words, they were inhibiting their inhibitions, which allowed the musicians to create without worrying about what they were creating.

This research reminds me of that wonderful Picasso quote: "Every child is an artist. The problem is how to remain an artist once we grow up." From the perspective of the brain, Picasso is on to something, as the frontal lobes (and the DPLFC in particular) are the last brain areas to fully develop. And so the super-ego settles in, and we become too self-conscious to create. Obviously, we need the frontal lobes to function - just look at the tragic life of SB - but every talent comes with a tradeoff. When we repress our urge to confabulate we also repress the urge to create. To quote Picasso once again: "Art is a lie that makes us realize truth." But it's still a lie.

*Gotta love the droll way the doctors describe SB's behavior immediately following the injury: "SB manifests gross behavior disturbance...He feeds guests with biscuits like monkeys at a zoo, endeavors to eat his children's toys, draws erotic pictures and masturbates in front of others."