Issd conference: The Traumatized Imagination Paper Presentation given by: Paula Thomson, Psy. D

19^th ISSD Conference: The Traumatized Imagination
Paper Presentation given by: Paula Thomson, Psy.D.

e-mail: [e-mail]

November 11, 2002
I want to begin by giving you a brief summary of my background and how it relates to the topic, the traumatized imagination. Besides being a psychologist, I have worked professionally in the performing arts for over 25 years as a choreographer, dancer and teacher and have experienced and witnessed imagination that is constricted by trauma. To illustrate this I would like to read a diary entry by Virginia Woolf (March, 1937) that captures the heart of this topic.

“I wish I could write out my sensations at this moment. They are so

peculiar and unpleasant. … A physical feeling as if I were drumming

slightly in the veins: very cold: impotent: and terrified. As if I were

exposed on a high ledge in full light. Very lonely … And I am powerless to ward it off. I have no protection. And this anxiety and nothingness surround me with a vacuum. And I know I must go on doing this dance on hot bricks until I die. This is a little superficial I admit. For I can burrow under and look at myself display in this ridiculous way and feel complete submarine calm: a kind of calm moreover which is strong enough to lift the entire load: I can get that at moments: but the exposed moments are terrifying. I looked at my eyes in the glass once and saw them positively terrified.” (Hughes, Ed, 1999, p 129)

Woolf clearly describes her shifting states of intense arousal and eerie calm. Repeatedly, I have observed and experienced traumatized artists suffering similar conditions as Virginia Woolf and I have grown more dissatisfied with both the therapeutic and artistic training approaches that attempt to free the imagination of these artists. Over the last twelve years I have questioned and actively researched creativity, trauma and dissociation. I wanted to understand the neurobiological factors – I wanted to know what was going on. My current findings have led to several conclusions. First, creative individuals in general do not flourish in fearful situations. The adage, “Fear is the enemy of art” is true. When fear dominates, the creative individual is reluctant to explore novel situations vital for creative productivity. Second, past unresolved or dissociated traumas become a juggernaut in which all creative expression seems to migrate. The imagination becomes constricted by the heightened psychobiological encoding of these traumatic episodes. Third, the recent neurobiological studies indicate that creativity activates many of the same circuits that are altered with trauma and fourth, dissociative behavior is disproportionately present amongst creatives. Several studies have shown a strong correlation between creativity, schizotypy and dissociation (Irwin, 2001, Watson, 2001, Dorahy, 2002). Recently, I administered the DES to a group of performing artists between the ages of 22 and 50 and 84% scored above 30 and 92% scored over 30 on the absorption and imagination subscale.

In this brief presentation, I will isolate some of the significant factors that interplay in creativity, trauma and dissociation. I will first describe the major traits found within creatives and then I will discuss some of the neurobiological elements that overlap in creativity and trauma / dissociation.

Before looking at some of the behaviors or traits common to creative individuals, it is important to remember that most or all of these factors must be present during the creative act; however, it doesn’t mean that they are fundamental components of the individual’s behavior during non-creative activities. Many theorists have also argued that the rare existence of highly creative individuals is not because any one trait is unusual but rather that it is the confluence of multiple factors that operate together during the creative process that is rare. The key factors contributing to the creative process include:

1. 
   At the minimum, average intelligence, however, this variable diminishes in importance after an IQ score of 120 is reached.
   
2. 
   Cognitive flexibility, broad attention, associational fluency and divergent thinking. This suggests that the creative individual is able to employ various attentional processes to retrieve implicit and explicit memories and hold them in working memory. Interestingly, despite popular belief, divergent thinking in creatives occurs because they are able to sustain associational thought which allows them to move from the obvious to more and more remote options – they don’t just begin with unique options. This cognitive flexibility is often difficult for severely dissociated individuals and there is speculation that they display decreases in working memory and attentional systems (Dorahy, 2002, Bremner, 2002).
   
3. 
   Novelty and stimulus seeking which includes fantasy proneness. Fantasy provides an internal sensation of stimulus (McDaniel et al, 2001) and it also generates more strategies for problem solving and adaptive coping. Research indicates that fantasy prone children display less aggressive behavior because they are more adaptive (Goldstein & Russ, 2001). Fantasy proneness has been strongly correlated to hypnotizability and dissociation. In a study by Pekala et al (2000) Borderline Personality Disorder patients without dissociation had less imaginative base of thought; whereas, Dissociative Identity Disorder patients had more imaginative base and complex cognitive style. Somer and Orit’s (2001) study indicates that fantasy plays a central role in the life of DID patients and the intensity of their daydreams defied reality testing. Somer and Orit suggested that dissociative identity patients have strong links to absorption, imaginative involvement and hypnotizability, all components identified in creative individuals. In an effort to differentiate between highly dissociative individuals who are more fantasy prone, Elzinga, Bermond and van Dyck (2001) suggested that two types of dissociation might exist; 1) trait-like type of dissociation that is associated with fantasy proneness and 2) trauma-related type of dissociation that is more apparent within psychopathology. Clearly many dissociative individuals are not fantasy prone as evident in the study conducted on criminals who were highly dissociative but not able to engage in fantasy (Cima et al, 2001). It is also evident that patients suffering depersonalization are often unable to use imagery (Lambert et al 2001) and yet many creative artists such as Picasso, T.S.Eliot, Woolf and O’Neil experienced depersonalization and depict it in their work. These two speculated types of dissociation need further investigation.
   
4. 
   Intuition, emotional sensitivity, introversion and aloofness. These factors often provide a distancing quality especially during the initial phase of creativity. Research studies indicate that during the first phase of creative inspiration, frontal activation, which is necessary for sub-cortical inhibition, is lower as observed by increased theta rhythms. A state of increased disinhibition occurs which may replicate Ernst Kris’ concept of regression in the service of the ego. Interestingly, this state mimics the neurobiological development of a child’s brain. The aloofness that is observed in artists is a form of withdrawal from external stimuli during the creative process and may be linked to an attempt to reduce cortical arousal. This withdrawal is also evident in those who suffer trauma. These same creative individuals also display heightened intuition, empathy and sensitivity. (Hanrahan, 2001, Runco, 1999, Martindale, 1999, Bradley, 2000, Raidl & Lubart, 2001). The basal resting level of arousal in the brain activity is higher in creatives and they also display greater physiological variability and more physiological sensitivity. Greenacre’s research suggests that artists have heightened bodily and sensory sensitivity and display increased empathic capacity at birth (Knafo, 2001). According to Bradley, sensitive children display enhanced locus coeruleus and NE activity and enhanced dopamine activity and she speculates that they have a more sensitized limbic system. This fourth category for creatives clearly renders them more vulnerable to dissociative responses when subjected to trauma.
   
5. 
   Tolerance for ambiguity and frustration and a strong capacity to sustain focus until a problem is solved (Guilford, 1959, Runco, 1999). Albert Rothenberg (1990) has named this phenomenon the Janusian process. The image of the multi-headed god, Janus, standing on a threshold gazing simultaneously in multiple directions describes the Janusian process that occurs in creativity. The ability to tolerate the tension of simultaneous and often opposite views requires great emotional stamina and affect regulation. This ambiguous state is often a major trigger for dissociative individuals. They flee from the tension of ambiguity by assuming another identity, amnesia or depersonalization / derealization.
   
6. 
   A solid knowledge base and skill set in the creative domain and a supportive environment during the creatives’ training and career.
   
7. 
   Creatives define themselves as hard-working, risk takers, practical problem solvers with many ideas and strongly intrinsically motivated (Gliick, 2002, Kaufman, 2002). Repeatedly, researchers isolate intrinsic motivation as one of the essential ingredients for creativity and this form of motivation can easily be linked to Panksepp’s (2000, 1998) seeking system.
   

The convergence of these traits may increase artists’ heightened confidence in their creativity. Their felt sense of a creative self may allow them to use art as a healing process if they have experienced trauma and abuse (Knafo, 2001).

The creative process involves two primary stages and although theorists have identified these stages slightly differently throughout the ages, the general process remains similar - inspiration followed by elaboration or integration. Freud’s theory of primary and secondary process replicates Samuel Taylor Coleridges’s theory of primary and secondary imagination – both describe the inspiration and elaboration stages. Some theorists subdivide the initial inspiration phase into separate categories such as; preparation, incubation and illumination. The two phases employ different cognitive and affective strategies; the initial phase of creativity, inspiration, is comprised of divergent thinking, inductive reasoning and broad global focus. It involves less frontal activity and more sub-cortical and associational regions that are more lateralized in the right hemisphere. The second phase, elaboration, consists of convergent thinking, deductive reasoning and focused attention which activate more frontal and left lateral regions. The literature on right and left hemisphere specialization supports this two phase creative process since the right generally holds personalized emotional states associated with past experiences. The right hemisphere is able to contextualize events through a process of balance, focus, self awareness, self-reflection and self-monitoring and the left hemisphere applies learned rules, specificity, complexity and reason (Alexander & Stuss, 2000, Parsons & Osherson, 2001, Shuren & Grafman, 2002). Despite this delineation of hemispheric specialization both the right and the left hemispheres are necessary for coherence and for generating meanings for ambiguous words or contexts (Collins, 2002) and Ornstein (1997) states in The Right Mind that we require both hemispheres to create both content and form that shapes meaning.

I am now going to shift to a more neurobiological approach to this topic. This area is vastly complex so forgive mean if it sounds too simplistic but I want to illustrate some of the many neurobiological connections between creativity, dissociation and trauma. For example, the creative process and dissociation often involve states similar to déjà vu, trance states, out-of-body experiences and mystical moments and research indicates that these states all share diminished frontal arousal. Along with decreased frontal activation, varying activation and / or quiescence in either the right or left parietal and /or temporal regions are observed. When one region is quiet, the active region perceives and interprets the event. For example, when the left superior parietal region is inactive, hypnogogic-like reveries and an endless sense of self results (Pizzagalli et al 2000); whereas, when the right superior parietal region is quiet the person experiences a feeling of infinite space. These cortical orientation associational areas operate in conjunction with the hippocampal formation and when this region also shuts down further disorientation results. Like intense fear states and the first phase of creativity, it has been observed that intense ritual dances, drumming and incantation causes these areas to shut down.

As stated, during depersonalization and derealization, the hippocampal formation is less active; however, the parietal-occipital junction around the angular gyrus increases activation (Sierra et al, 2002). A group of Swiss scientists recently reported that increased stimulation in the right angular gyrus causes sensations of leaving the body or floating above it – states frequently described by depersonalization disordered patients. The alterations in these orientation areas may be caused by lack of oxygen or a temporary malfunction.

The hippocampal and parahippocampal regions are critical areas for creativity and numerous studies have shown decreased volume in this area is linked to trauma and dissociation. The work of Green and Woodruff (2000) delineated the parahippocampal region as the location for passive non-relational memory stores; whereas, the relational memory stores are maintained in the hippocampal formation. Both areas have feedback loops to the associational area via the fornix which connects the hippocampus to the septum, thalamus and hypothalamus, all critical areas for processing and regulating. Le Doux (2002) describes this hippocampal area as a primary convergence zone for multifaceted memory formation and claims this area is critical for a sense of unity of experience. Brain scan studies (Bremner et al, 1999) showed that childhood sexual abuse memories were stored in the medial prefrontal cortex and not in the usual autobiographical areas of the hippocampus and Wessel et al (2002) indicate that traumatized children maintain a categorical retrieval style of memory which is typical of earlier development rather than the normal multifaceted autobiographical memory that involves the hippocampal formation. Disruptions in autobiographical memory formation directly impact working memory and the fluency of associational memory necessary for creativity.

In addition to the parietal and hippocampal regions, altered perceptions evoked by specific regions in the temporal cortex may play a role in the initial stage of creativity and in dissociation. One common occurrence in creativity is the perception of a muse or other that directs the creative process. This may be connected to an active left temporal region that interprets the quiet right temporal region as the presence of another such as a muse, ghost, angel or spiritual being. For example, Picasso spoke about the “connoisseur who was always standing right beside him telling him what to do.” (Thomson, 1989, p. 35)

Studies (Pizzagalli et al, 2000) indicate that a belief in the paranormal and proneness to dissociate are strongly linked and these experiences may be connected to either a dominant right hemisphere activation or to less frontal asymmetric cortical processing. Highly trained dancers and musicians lack the typical cortical asymmetry found in non-trained individuals (Mikheev et al, 2002) and interestingly so do the brain scans of abused children (Carrion et al, 2001). Unlike the brain scans of abused children, the dancers’ and musicians’ brain scans revealed that during moments of great pleasure, a decrease in amygdala activation and an increase in the reward circuits was observed. Research has also shown that trance activates the endogenous reward neurochemicals DA, NE and endogenous beta endorphins and they have been implicated in dissociation as well. (Kawai et al, 2001, Negro et al, 2002).

Research by Sar et al (2001) indicates a decrease in orbital frontal cortex activation and increased left lateral temporal regions in DID patients. This decrease in the OFC may be linked to identity diffusion (Forrest, 2001) and the active left lateral temporal region possibly interprets the quieter right temporal region as another self. Depersonalization disordered patients rely on the dorsal and lateral prefrontal regions to interpret stimuli that is normally processed by regions such as the insula and OFC. Deficits in these regions compromise the creative ability to make decisions based on a visceral subjective sense – a felt sense that a solution has been reached or a work is complete (Phillips et al, 2001, Simeon et al, 2002, 2000).

Another area that has been designated as significant for symbolic representation and image formation is the supramarginal gyrus, a multimodal sensory convergence zone, located in the inferior parietal cortex (Yu, 2001, Galletly et al, 2001). This area is negatively affected in PTSD patients and depersonalization patients (Phillips et al 2001, Simeon et al 2000, 2002) and this sheds light on why many of these patients have difficulty with symbolic thought and psychodynamic interpretations.

According to Barber and Wilson (2000), 65% of fantasy prone subjects are able to hallucinate / image with an intensity that engages all the senses. Image formation involves both top-down and bottom-up circuits and again the higher order sensory circuits are activated during sensory visualizations (Mellet et al, 2000) The fantasy prone individual is able to engage in vivid images by continually activating top-down associational areas that stimulate the sensory circuits and by bottom-up emotional memories stored within the amygdala. Generally our perceptions are vivid because of continuous external stimulus that activates the primary followed by the associational sensory cortex. Low fantasy prone individuals are unable to sustain images – they fade rapidly (Grigsby & Stevens, 2000); whereas, high dissociatives and creatives are able to continually activate these circuits.

Creatives display more associational fluency and draw from multiple memory circuits; however, extreme high or low arousal of either positive or negative affect results in diminished fluency. Recent studies have also indicated that more creative responses are engendered during positive rather than negative affective states. Greater neural pruning has also been observed in the brains of creatives and some researchers suggest that creativity may function in the brain in a similar way as schizophrenia; however, the brains of creatives do not share the same structural deficits of schizophrenia - rather they may function in similar patterns during the creative act.

Other key cortical areas that are engaged during the creative process, both the initial inspiration phase and the second stage of elaboration include; the right dorsolateral prefrontal cortex which is activated maximally during novel learning and organizing associations simultaneously at multiple cognitive and behavioral levels; the orbital prefrontal cortex which organizes and plans future activates and is the hierarchical apex of affective regulation; the medial prefrontal cortex which is linked to a theory of mind, aspects of motoric motivational drives and a sense of self as the center for referencing; the ventral prefrontal cortex which links interoceptive and exteroceptive information; the anterior cingulate cortex responsible for motivation and error detection; and the supplementary motor area which plans and initiates the early stage of movement (Fletcher et al, 2001, Adolphs, 2002, Austen, 2000). The ‘aha’ moments in creativity have been linked to activation of the amygdala and quite possibly the novelty biased hippocampal system. All these regions are involved in subjective experience and self-initiation and all are implicated in both creativity and dissociation.

These major convergence zones and the significant gating functions of the thalamus and corpus callosum all interact in the creative’s ability to fluently associate. These areas are all compromised structurally and functionally during prolonged trauma and dissociation (DeBellis et al, 2000, Bremner, 2002, van der Kolk, 2001). From my experience, the creative individual with a trauma history senses these deficits and often expresses profound frustration over his or her inability to fluently associate and freely engage in sustained divergent thought. With the hierarchical reduction of frontal regulation, deficits or dysfunctions in these convergent zones will be revealed.

I believe creativity can help heal wounds of trauma and it is often a vital activity in dissociative patients’ lives. I believe, and I quote Bessel van der Kolk, “the body keeps the score”. The body and the brain are intimately connected and both are active participants in creativity. Body work can be a powerful healer of trauma and can help diminish dissociation. I also believe that damage does occur during prolonged periods of trauma. This damage does affect the imagination and creativity. To illustrate this point I want to share some sobering statements about traumatized artists. Herman Melville was a tormented man and he used this torment to give his writing power and richness; however, he was unable to withstand the criticism and neglect of his work and stopped writing at the age of 36. He spent the rest of his life as a customs inspector and died at the age of 72, having never created another work. Patrick Bissell, an acclaimed ballet dancer, was repeatedly physically and emotionally abused by his mother. He told an interviewer “I do good performances and then I punish myself with drugs. I try to destroy myself. It’s a weird kind of cycle.” He died shortly after this interview from an overdose. (ABC Reader, 1990) Bruce Perry (2001), a psychiatrist who treats maltreated children in England, states:

“If children are ignored, poorly educated and not protected from violence

they will grow into adults that create a reactive, non-creative and violent

society. In a brilliant analysis of this very process, Hellie (1996) describes

a dark age in Russia (1600 – 1700) characterized by excessive brutality,

violence and pervasive fear that for generations inhibited creativity,

abstraction, literacy and the other elements of humanity. All societies reap

what they have sown.” (Bruce Perry (2001) in his essay Violence and

Childhood: How Persisting Fear can Alter the Developing Child’s

Brain.)

I also wish to state that dissociation does offer unique creative perspectives as is evident in the works of numerous artists. When dissociative artists are educated about their defensive structures they gain an opportunity to regulate this response and as a result new neural circuits can begin to be employed during novel situations. To follow the treatment protocol of attachment theory, they can begin to create a coherent narrative of their disorganized traumatic personal experiences. This coherent narrative of self does not preclude the ability to maintain divergent thinking and broad associational attention. Intrinsic motivation, vital for creativity, does not have to disappear once a coherent narrative emerges.

Lucky or unlucky, the traumatic memories remain as memories and the creative trait for heightened fantasy, including the ability to hallucinate on all sensory levels, still remains as an artistic skill. Dissociation is often an indication of poor affect regulation and Allan Schore (1994, 1997, 2000, 2001, 2002) describes it as a parasympathetic conservation-withdrawal state. He claims that the quiet alert phase precedes the ergotrophic sympathetic energy engaging state of curiosity and positive affect and this helps us shift from the parasympathetic trophotropic conservation-withdrawal state of shame. Curiosity also provides a form of distancing from dissociation if it can be employed during a dissociative state. If the dissociative patient can get curious about why, how and when the dissociative state was entered then a self-reflective function is enhanced. These skills empower the dissociative patient / artist and curiosity is vital as a sustaining force for intrinsic motivation.

Great gains can be made to support the artistic freedom of traumatized artists; however, the disinhibition of the frontal regions during the inspiration phase leaves the dissociative artist vulnerable to unregulated traumatic memories. The second phase of creativity, elaboration, allows the artist to re-engage these brain regions and once again a hierarchical regulation of affect can be mobilized. With understanding and education about these shifting states of creativity, traumatized artists may be able to reduce their fear; however, the freedom to surrender to the initial phase of creativity is greatly compromised. Like the indelible memory of the amygdala, the imagination is indelibly affected by trauma.

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