Model #10: Paradoxical Gains

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T.s. was a 63 year old right handed gentleman with no history of any prior medical problems or brain injury. He’d been brought in by his wife for an evaluation of his memory. He’s been forgetting his words, she said, or sometimes so just use the wrong one. His neurological examination was consistent with her observations, revealing that T.S. had a non fluent or Broca’s aphasia. While he could name everyday objects when he was presented with pictures of less common objects like a cactus or a canoe, was unable to come up with the appropriate word. His comprehension of spoken language, however, was unaffected.

He could also easily follow multi-step commands an MRI of his brain that had been ordered by his primary care doctor showed no evidence of stroke or tumor, but was notable for increased prominence of the cortical GI in the left anterior temporal lobe, consistent with loss of brain tissue in this area clinically. His case was consistent with the early stages of the semantic form of frontotemporal dementia, a condition that may also be associated with impulsivity and obsessive behaviors. As he demonstrated, any other unusual behaviors, I ask? Yes, he draws all the time, she said. So that’s not typical for him last. No, he’s a car salesman. And so art was never really a hobby, huh? Not one bit. She said, I’ve never seen him draw or paint anything. He’s always claimed he was terrible at it.

I see, I replied. But here’s the strange thing, she said. His drawings are really good. I brought a few for you to see. She pulled a few of his drawings out of her purse and showed them to me. She was right. The drawings were quite good. They were mostly realistic drawings of household items or landscapes. You’re right. These are quite good, I said. His other doctor told me he may be suffering from dementia, but how could that be? Can you tell me what’s going on here?

Hi, I’m Dr. Josh Turknett, founder of Brainjo and the Brainjo Center for Neurology and Cognitive Enhancement, and this is the Intelligence Unshackled podcast.

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So this kind of sudden emergence of artistic ability and interest after an insult to the brain is actually not all that uncommon. The clinical scenario where it has occurred most often is in the case of the frontotemporal dementia is so frontotemporal dementia is a category of neurodegenerative illness that’s defined by the parts of the brain involved in this case, the frontal and temporal lobes, along with the kind of microscopic pathologies that we see in the brain, which are referred to as pick bodies.

And some of you may have heard of Pick’s disease, which was the name previously given to this condition. So that term was replaced by frontotemporal dementia. And within that, there are a number of clinical subtypes and those are categorized according to the nature of the cognitive deficits that are first observed. So as I mentioned, frontotemporal dementia is the neurological condition where these novel artistic abilities have most commonly been observed. And it turns out that it’s it’s typically seen in one of the particular subtypes of frontotemporal dementia known as semantic dementia.

And this particular subtype is characterized by early problems with spoken language. Many patients exhibiting what we would characterize as a non fluent or Broca’s aphasia, in which the ability to express ideas and concepts as speech is impaired while the comprehension of spoken language remains relatively intact. Putting that another way that the cortical networks that map ideas or concepts on to a motor program for moving the vocal apparatus are degraded by the disease.

Anatomically, that degradation tends to occur in the anterior temporal lobe, which is the part of the temporal lobe that’s closer to the nose. And I mentioned this because I think that the area involvement here likely has implications for why this particular subtype is the one most commonly associated with the emergence of artistic ability. The condition is also characterized by a loss of certain kinds of conceptual knowledge. In particular, knowledge of concrete objects is affected, whereas abstract words are comparatively unaffected and function words or words that convey grammatical relationships like “and” “although” “but” etc. Those are also comparatively intact.

And in fact this observation has been made enough times that it’s become a standard test question for neurology board exam. So my neurologist colleagues know that if you see a test question that gives a clinical history for frontotemporal dementia and then asks which of the following things may also be observed. The answer is going to be nascent artistic abilities. Now I bring up the fact that this observation has been made many times, because if you’re like most people hearing of this type of phenomenon for the first time, you would rightly be skeptical. It kind of seems like that scene from a movie where someone gets knocked on the head and then awakens with special powers.

And so it sounds like the soft stuff of science fiction and not something that would happen in real life because how is it possible that damage to the brain of one form or another could add capability to the brain that it didn’t previously possess? So much of what we’ve learned about the brain comes from the study of those who’ve suffered an insult to brain tissue in some form and the functions that are lost as a result. Tell us about how the brain is organized and the anatomical correlates of specific functions. And yet here we have what appears to be a gain of function that is resulting from a loss of brain tissue, which is why I refer to this gain as paradoxical.

Now, some of you may realize there’s another explanation, which is that the artistic capability existed in that brain all along, and that somehow the damage to the brain allowed that capability to express itself. And not only is this a logically consistent explanation for this seemingly paradoxical phenomenon, it’s also entirely consistent with what we know of how the brain is organized. So in a prior episode about the mental model hierarchy, I discussed the principle of release phenomenon where we observe certain behaviors and neurological signs following an insult to the nervous system. And looking for these kinds of release phenomenon are a fundamental part of the neurological exam.

And those new behaviors and neurological signs that we are seeing aren’t being added by the damage, but they result from the networks that control those signs and behaviors being released from suppression because of the damage to a particular area. The brain or other part of the nervous system and that organizational principle goes all the way up the chain from rudimentary motor behaviors all the way to complex cognitive operations. So the most parsimonious explanation for why we see the emergence of artistic ability after an insult to the brain is that the ability was there all along and that the reason that it wasn’t being expressed previously was that it was being suppressed by other cortical networks.

Incidentally, while artistic ability has been most commonly reported and observed, there are also cases of the emergence of other abilities, including musical abilities. Again, sometimes quite remarkable, some of which are described in Oliver Sacks as a book musical, Ophelia, as well as bursts of other forms of creative output. So as you know, one of the missions of this podcast is to explore and reexamine the nature and scope of human intelligence and to question the conventional narrative, especially when there are observations that are directly in conflict with that narrative or that raise competing alternative explanations or hypotheses that have yet to be explored.

So as I mentioned, one of the most fundamental design principles of the nervous system is this hierarchical organization, in part a reflection of our evolutionary history as well as the changing demands of the nervous system as we mature and in the prior episode about the mental model of modular and distributed.

We reviewed that specific cognitive functions have dedicated neural networks that support their operation and that those networks are both anatomically localized and distributed. And furthermore, that information processing isn’t going through one network at a time in a serial fashion like a computer, but rather operates in parallel, going through many networks all the time. So we have scores of networks that are capable of performing specific kinds of operations on the information flowing through them or extracting unique kinds of information from the data that they receive. So to me, one of the most important principles to understand about how the brain is organized because it’s so important for understanding the nature of human intelligence and how we would support and develop it is that cognition is widely distributed with information flowing through multiple networks all the time, but that the brain’s observable output.

In other words, the output that bubbles up into conscious awareness as thoughts or that produces our behaviors is a reflection of the particular networks that have won the battle for attention and influence. At any given moment. And so the output and existence of those other networks, regardless of how sophisticated they are, can remain entirely hidden to us.

If they never win that battle. So there’s this incredibly complex web of activation and inhibition going on inside the brain all the time. Yet we can only experience and we only get to see in terms of our own behaviors and the behaviors of others. We only get to see the networks that are winning that battle. So to illustrate how this affects how we think about cognition and intelligence, let’s consider the following thought experiment. So imagine if we were to stratify a group of people according to their ability in whatever domain we choose. And let’s assume for the sake of this experiment that they’ve had no training whatsoever in that domains we’re trying to give get some assessment of their innate ability.

So, for example, we could test their artistic ability, maybe have them paint a picture of something they see in front of them, or have them repeat a musical melody or test their visual spatial ability by having them manipulate some 3D image. So surely we would be able to rank all of those people along each of those domains in the traditional way of explaining the variance that we see is that these are differing innate capabilities, so that a person who is able to paint a realistic image of a flower has artistic neural networks that the person who just painted an unrecognizable blob doesn’t have.

And we could say the same of their visual spatial abilities or their math abilities and so on. And yet an entirely plausible alternative explanation would be to say that those capabilities existed in each brain tested, but in those who exhibited higher levels of performance, the particular networks that serve those capabilities won the battle for information, access and attention. So the cognitive networks were that were best suited to that task, were able to influence the ultimate behavior in those who performed best, but were suppressed for whatever reason and those who didn’t.

And so that means that many things that would have been traditionally labeled as an innate gift or capability is. Rather a reflection of a differing balance of suppression and activation in one brain versus another, rather than a capability that is unique to some brains rather than others or more well-developed. And this idea that differing balances of activation and suppression across different networks is a key driver of our cognitive performance and ability at any given moment can explain other phenomena that would otherwise seem puzzling. For example, it can explain why divergent thinkers as well as autistic savants commonly have a learning disability of some form. So in this case, a network that would typically have a powerful influence in this balance of activation in suppression has been diminished, allowing networks that process information differently.

Access to conscious awareness and an influence on behavior. It also helps to explain why so many have turned to mind altering substances to assist in the creative process. It’s unlikely that those substances are adding a capability that wasn’t previously there, but rather that they are releasing parts of the brain from suppression so that those parts can gain access to information and conscious awareness. It also helps explain why so many creative insights emerge during sleep or during during periods of downtime, when the parts of the brain that are dominant and active during wakefulness are taken off line.

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In addition to challenging the conventional narrative about human intelligence, I think this idea of paradoxical gains and the implications that springs from it along with the other models we’ve discussed, are also especially important for informing how we think about the educational process and how we support the neurological and cognitive development of a child’s brain. The way we currently educate is heavily biased towards strengthening very specific kinds of thinking, which also means developing and strengthening the neural networks that serve those cognitive functions.

And given what we know about how the brain is organized, it would be shocking if there weren’t an opportunity cost of of doing this in the form of suppression of cognitive networks that support other forms of thinking. And so the more we reinforce a particular neural network, the more we increase its influence on this balance of activation and suppression in the brain. So it’s our way of consciously influencing this process, whether we realize that or not. In one thing that concerns me is that we’re starting this process of reinforcing very specific networks earlier and earlier in childhood development.

It’s not uncommon now for three and four year olds to be taught how to read flashcards and that sort of thing. Makes me very nervous for a whole host of reasons, some of which are hopefully evident from the preceding discussion. It’s entirely possible that this sort of thing suppresses the development of other cognitive abilities in the networks that support them. In other words, just as weakening a network through an injury can lead to the gain of function, strengthening a network through reinforcement may lead to a loss of function.

Again, it’s not that the capability isn’t there at all. It’s just that the output of those networks no longer has influence over our behaviors. The concept of first do no harm is a core principle in medicine, even if it’s not adhered to as often as it should be. But the idea being don’t monkey with the body’s default physiology unless you’re certain it’s going to help. And it’s not a concept that’s really been applied to how we educate.

But I think it should. And that includes the potential harm of fundamentally altering this balance of activation and suppression amongst competing cognitive networks, especially early in development. Because again, anytime we intervene in a child’s cognitive development, we are influencing that balance in some way. And I don’t think any of us at this point appreciate and understand the opportunity costs of doing that. And so a first do no harm approach to education would mean letting the child or the child’s brain lead the process. So the brain knows exactly what sorts of inputs it needs to develop.

And so if a 6 year old would rather play or make art or hang out with their friends over learning the correspondences between squiggly lines on a page and a sound that we’ve invented, I think that’s a signal that we should take very seriously. We also know that really hard problems and novel creative ideas and solutions almost always emerge from minds that think differently or when someone brings in a fresh perspective. This, of course, makes sense. Otherwise, the problem would have already been solved. So if we’re trying to optimize for cognitive diversity so that we can have more minds that can potentially solve really hard problems and come up with really great new ideas, we should carefully examine the impact of how we choose to shape the developing brain and the types of thinking that we impose upon them.

I personally believe that if we were to take this approach of letting the brain dictate the learning process and combine that with all the tools and technology that we now have available to support a child’s interests, we’d raise the smartest and most cognitively diverse generation of humans that have ever lived by a long shot, and they would be able to solve all the problems that we find intractable right now. Also, think how much we stand to gain by better understanding how this works. If we could better understand how to alter this balance of activation and suppression.

As I said earlier, many people have turned to some. To do this, but at this point, our level of sophistication and understanding of what’s happening in that process remains very crude. There’s also an excellent book and course called Drawing on the Right Side of the Brain, which embraces this concept. And much of the instruction there is not about the mechanics of drawing, but rather about changing the way visual information is perceived, which in the language of this episode we’d say, is trying to alter the balance of activation and suppression amongst the various cognitive networks to allow the ones that support drawing realistic images of the world access to that information.

And in fact, somewhat analogous to what happens in the case of sudden emergence of artistic ability in neurodegenerative disease. There’s often a sudden leap in drawing ability. Once people make this shift in processing visual information differently. Again, it’s not coming from adding a new capability, but rather figuring out how to release from suppression. One that already exists in the book is filled with lots of dramatic illustrations of these rapid and exponential improvements in drawing ability over a very short time frame. This again was suggests that what we consider as artistic talent is simply a differing balance of activation and suppression than someone who’s not considered artistically talented. So someone who has that ability has learned how to access those networks. For the non artist, the visual world is tiled over with concepts and symbols that are likely a consequence of our heavy reinforcement of language and language abilities, which moves the visual world into the realm of abstractions and symbols. In other words, those linguistic and symbolic networks are the ones that are winning the battle for influence over our thoughts and behaviors.

I’ve mentioned before that my daughter, who is 14 now is an outstanding artist in she’s been drawing since she could hold a pencil all the time. And I would contend that all of those repetitions have strengthened the networks that allow her to see the world for what it is and that give them a stronger voice and that can stand up to those strong language networks that for many are so dominant that they suppress those artistic areas of the brain.

All right, well, that concludes this episode. As always, if you enjoy this podcast, it would be great if you left a rating in review in iTunes. Thanks so much for listening and I will see you in the next episode.

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