Neurologist Rivka Inzelberg recently noticed that her patients with Parkinson’s disease seemed to be authoring more novels than older people tend to author.
Looking closer, poems and paintings also seemed to be pouring out of afflicted patients, in a relative sense—specifically those treated with a synthetic dopamine-precursor pill, levodopa (L-DOPA).
So Inzelberg, a professor at Tel Aviv University's Sackler Faculty of Medicine, asked around. She wasn’t the only one in her field to have noticed as much. She examined the correlation in a comprehensive 2013 review study, which found creative thinking in medicated Parkinson’s patients to be higher than in their unaffected peers.
This week she published new research that breaks down the relationship in the journal Annals of Neurology, and whether the observed creativity—which she defines as a combination of originality, flexibility, and inclination to combine novel and practical ideas—might be due to obsessive tendencies.
“Because the medication can cause a loss of impulse control—let's say, obsessive painting, obsessive hobby-ism—we wanted to check if there was a correlation between creativity measures and impulsivity and compulsivity measures,” Inzelberg told me by phone from Israel. (She very courteously warned me that she may have to hang up abruptly to take shelter if a missile alarm goes off, as has been happening at her Tel Aviv medical center. “Would it be better to talk later?” I asked, dumbly. “There is no later. This is how we’re living.”)
Development of uncontrollable artistic urges has been documented in medical case studies. One 41-year-old woman with Parkinson's disease who began taking levodopa developed what neurologists called a "devastating addiction to painting." Her home became a gathering place for artists, and she began compulsively buying painting materials. She described the spiral earlier this year in a medical journal: "I started painting from morning till night, and often all through the night until morning. I used countless numbers of brushes at a time. I used knives, forks, sponges … I would gouge open tubes of paint–it was everywhere. But I was still in control at that point. Then, I started painting on the walls, the furniture, even the washing machine. I would paint any surface I came across. I also had my 'expression wall' and I could not stop myself from painting and repainting [it] every night in a trance-like state. My partner could no longer bear it. People close to me realized that I crossed some kind of line into the pathological, and, at their instigation, I was hospitalized. Today, my doctors have succeeded in getting my medication under control, and my creativity has become more tranquil and structured."
So Inzelberg’s current study tested for symptoms of impulse control disorder, as well as creativity—which it did in a variety of ways. One exam asked people to mention as many different words beginning with a certain letter and in a certain category as possible. In a remote association test, people were given three words and had to name a fourth. Another test required interpretation of abstract images and assessed imaginative answers to questions like, "What can you do with sandals?" Subjects were also asked to interpret novel metaphors.
In the end, there was no relationship between the creativity Inzelberg has been noticing and any degree of compulsive behavior.
The patients with Parkinson’s disease did significantly better than their unafflicted peers in terms of verbal and visual creativity, divergent thinking and combinational novelty.
“We also found that patients taking higher doses of dopaminergic medication had more creative answers,” Inzelberg said.
“These results support a genuine change in neuropsychological processes underlying creativity,” the Annals study concluded. That’s of interest not just to Parkinson’s patients, but an entire field of neurobiology grasping at an understanding of the chemical processes that fuel the so-desired trait.
A possible mechanism mediating the relationship between dopamine and creativity is known as novelty-seeking behavior, a tendency linked to neural areas like the ventral striatum, substantia nigra, and hippocampus, that are especially modulated by dopamine. It has been proposed that an increased in novelty seeking only occurs in Parkinson’s patients with impulse-control disorder, though, which this study did not find, suggesting that creativity is not (solely) an expression of obsessive creative drive or enhanced productivity brought about by medication.
Another proposed mechanism lies in the nucleus accumbens, the part of the brain that moderates a person’s ability to filter out irrelevant stimuli. That is called latent inhibition, and it has been associated with creative achievement. It is reduced in people suffering psychosis but it increases when those people are given antipsychotic medications. Reduced latent inhibition might enhance divergent thinking by widening (or loosening) the associative network, enhancing creative thinking.
“It is actually the other side of the coin,” Inzelberg said, “that when people are psychotic they think faster and might have less inhibition about extravagant ideas.”
Vincent van Gogh had psychotic spells, she noted, during which he painted masterpieces. Ernest Hemingway and Virginia Woolf, among other great writers, seem to have had bipolar disorder, which is now treated with medication that blocks dopamine.
In order to observe the creative effects of taking dopamine, it may be necessary to have the combination of Parkinson's disease and the medication, Inzelberg told me. “It is possible that there is a need to have a diseased dopaminergic system, where the D2 or D3 receptors [sites where dopamine binds in the brain] are abnormally sensitive.” In Parkinson’s disease, D2 and D3 receptors become abnormally sensitive because they are deprived of dopamine.
“If a normal person takes these medications and tries to become creative,” Inzelberg said, as if anticipating my question, “well, we don't know if that would work.”
"Do you think we're going to see people trying that?"
She laughed. “I would not recommend it.”
After Inzelberg’s first paper, she helped organize exhibits of patients' paintings that have raised money for Parkinson's research. She also sees it as therapeutic for patients, especially those with neurological conditions, to have artistic outlets to express themselves.
Dopaminergic stimulation is also used in women who have recently given birth and would like to stop lactation, and in people with Restless Leg Syndrome. "I don't think anyone has checked," Inzelberg said, "if people in treatment for Restless Leg Syndrome become creative."
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