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Unveiling artistic minds: case studies of creativity
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ScienceDirect Unveiling artistic minds: case studies of creativity Karen Chan Barrett and Charles J Limb Research on musical creativity and expertise principally relies on cross-sectional or longitudinal experiments comparing groups of subjects (e.g. musicians vs. non-musicians, professional vs. amateur musicians). While this is vital, case studies of individuals may provide valuable insight into the variability underlying real-world creative musical performance and improvisation. We survey recent case study experiments on musical disorders, musical savants, and unique musical abilities as well as exploratory experiments that have studied renowned musicians as single data points. Using these, we build the argument that future research should utilize case studies to gain a deeper, more nuanced understanding of creative musical processes, particularly in world-class musicians whose distinctive talent may reveal unknown information about artistic creativity. Address Sound & Music Perception Lab, Department of Otolaryngology — Head & Neck Surgery, University of California, San Francisco, CA, USA Corresponding author: Barrett, Karen Chan ([email protected])
Current Opinion in Behavioral Sciences 2018, 27:84–89 This review comes from a themed issue on Creativity Edited by Rex Jung and Hikaru Takeuuchi
https://doi.org/10.1016/j.cobeha.2018.09.005 2352-1546/ã 2018 Elsevier Ltd. All rights reserved.
Introduction Over the past decades, neuroscience and psychology researchers have used interdisciplinary techniques to investigate how the brain perceives and processes complex acoustic stimuli such as music. In studies of musical creativity examining performers, composers, or improvisers, groups of artists are generally compared to control subjects while completing experimental and control tasks [1–13]. In short, much of our current knowledge in the music cognition field, and science more broadly, averages the results of a sample cohort of subjects to make inferences about the larger population. This technique is fundamental to the scientific method and necessary to identify statistically robust findings. When studying artistic attributes such as musical creativity, talent, or unusual musical abilities, however, much Current Opinion in Behavioral Sciences 2019, 27:84–89
information may be lost in averaging subjects together, particularly since art is frequently defined by so-called artistic ‘genius’ — the statistical outliers. Indeed, the uniqueness of exemplary artists would suggest the opposite notion — that mathematical averaging of multiple artists dilutes findings of interest and significance vital for understanding the artistic brain and the variety in human creative abilities. By treating artists as one homogeneous group of subjects, scientists may be averaging out crucial variability and individuality. Statistical rigor could be increased by studying one subject in depth over numerous sessions and then aggregating those sessions together (e.g. in an fMRI study). However, this method has the drawbacks of patient familiarity with the protocol and resultant changes in brain function due to repetition. It should be noted that for single-subject studies, the goal is quite different from that of random effects analysis, where the purpose of the analysis is to assess the generalizability of the findings to the larger population. In the case of single-subject studies of pre-eminent artists, it is already assumed that the brain activation will never be generalizable to the public. The more important question is whether or not the activation could ever generalize to the population of artistic experts from which the artist might be drawn (in and of itself a troubling proposition). Hence, the unique differences among eminent, accomplished musicians may give us valuable insight into how society’s best creative minds operate, yet the methods by which we ought to study single subjects, and the implications of the data for our understanding of human brain function remain unclear. One can make an analogy to clinical case reports of unusual disease presentations, which are commonplace in medicine — while these reports provide interesting material for consideration, they do not generate or improve standards of care, instead contributing to the body of anecdotal evidence that already exists. By comparison, the randomized controlled trial remains the gold standard by which new treatments are evaluated for our understanding of disease. While in the case of randomized controlled trials we generally consider the mean result to be the most important findings, the best analogy here might be looking at the few survivors of a deadly disease in which the overwhelming majority do not survive, in order to understand the pathogenesis of the condition itself. For our purposes here, the condition would be that of creativity and the rare survivors might represent the genius exemplars/statistical outliers. In this review article, we attempt to build an argument for why we should use case studies to study exemplary musicians when investigating musical creativity, treating each artist www.sciencedirect.com
Case studies of creativity Barrett and Limb 85
as a unique, individual data point. This review article discusses how case studies are already utilized to study musical disorders (such as congenital amusia), extraordinary abilities (such as in musical savants), as well as aberrant abilities (such as synaesthesia), using this literature as support for why case studies of prominent artists may be useful in research on the neuroscience of musical creativity.
Musical disorders and deficits Case studies have already been used to study deficits and disorders like congenital amusia. Early case studies helped to illuminate the symptoms of congenital amusia — a musical disability resulting in deficits in pitch processing not due to cognitive disabilities or peripheral hearing deficits [14–16]. With increased knowledge about this disorder, recent case studies have illuminated the “heterogeneity [regarding] the nature of the impairment” (pg. 1, [17]), such as in the case of an amusic who can judge musical expressiveness [18] and an amusic musicophile who attempted musical training to combat amusia [19]. While amusia usually manifests as pitch perception deficits, ‘beat deafness’ is a recently documented form of congenital amusia where individuals struggle to detect regular musical beats. Case studies reveal that amusic individuals have irregular event-related potentials compared to normal controls [20], and that some individuals can struggle with rhythm perception tasks, yet still synchronize to a beat [21]. In addition to its use in studying musical disorders, case studies of unusual patients with preserved musical abilities following supposedly debilitating medical diagnoses are documented in the medical literature. For example, recent case studies detailed how a patient learned a new instrument after developing frontotemporal dementia [22] as well as how an amnesiac patient was able to learn new musical compositions [23]. In summary, for congenital amusia, recent in-depth investigations of specific individuals have illuminated the variability in the disorder. Likewise, while medical diagnoses like dementia and amnesia usually lead to loss of musical abilities, case study research illustrates how an individual can possess preserved musical functions. These case studies therefore offer a more optimistic view on life after trauma, revealing the surprising resilience of musical abilities. Because of this, case studies may prove useful to study not only musical deficits, but also enhanced musical abilities, as in the case of musical savants and prominent musical artists.
Musical savants and aberrant musical abilities On the other side of the spectrum from congenital amusics lies the case of musical savants, rare individuals with severe cognitive and developmental impairments that yet possess ‘islands of skill’ such as exceptional musical talent. Case studies of savants [24] give insight into www.sciencedirect.com
how they learn compositions, think about music, and memorize compositions, as these individuals may utilize different processes from other expert musicians [25–27]. Savant case studies offer a singular research opportunity to probe the neural and behavioral correlates of these remarkable talents. For example, in addition to often possessing extraordinary memory and improvisation abilities, many musical savants also have absolute pitch [28,29]. One recent brain scanning of artistic savant ‘GW’ suggests that artistic skills in savants are enhanced through intense focus and over learning, which may result in atypical brain development and differences in the thickness of certain cortical structures [30]. While savants are singular and their talent can be idiosyncratic compared to normally developing artistic experts, case study research can teach us how musical talent may be separated from general intelligence. Savants offer a unique opportunity to deconstruct talent in different domains, allowing us to ponder ways in which talent may be nurtured and cultivated (see discussion in Ref. [31]). Moreover, neural scanning, cognitive testing, and perception research on individual music savants may illustrate precisely how savants’ brains and behavior differ from non-musician controls. If musical talent lies on a spectrum spanning from nonmusician controls to expert musicians to remarkable savants, biological and behavioral differences underlying musical ability (such as variations in cortical thickness and memory abilities) may exist on a spectrum as well. Case study research on savants helps to explore the ‘upper end’ of human creative abilities. Case studies of normally developing expert musicians can also illuminate information about unusual, specialized music abilities such as synaesthesia. Synaesthesia is a condition in which sounds evoke colors; notable musicians such as Olivier Messiaen, Franz Liszt, Jean Sibelius, Duke Ellington, and pop stars like Pharrell Williams and Lady Gaga anecdotally report having synaesthesia.1 Musical synaesthesia is thought to be quite rare, occurring in only about 0.2% of the population, perhaps due to aberrations in neural connectivity or communication [32,33]. Recent medical reports have used case studies of synaesthestic individuals to better understand how synaesthesia manifests, as well as how it may change with medication or head injuries [34]. While it is unclear whether synaesthesia is adaptive, harmful, or beneficial, studying individuals with synaesthesia illuminates the outlying boundaries of how musical abilities can manifest.
Musical artists as models of resilience Thus, case studies have been used to study deficits (i.e. amusia), extraordinary abilities (savants), and unusual abilities (synesthesia). In the case of creativity, science needs to similarly examine individuals who have shown 1
See this BBC News article: http://www.bbc.com/culture/story/ 20140904-i-see-songs-in-colour. Current Opinion in Behavioral Sciences 2019, 27:84–89
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Figure 1
Possible Ways to Use Case Study Paradigms to Examine Musical Creativity? Recruit eminent artists as experimental participants
Participants complete unique, tailored experimental tasks
Participants complete common experimental tasks
Case Studies: Each
Case Series: Participants’
participant’s data considered
data compared for critical
on an individual basis
comparisons
Consider case study research alongside group studies to evolve current neural models of creativity Current Opinion in Behavioral Sciences
Summary figure. Top panel: Examples of iconic musicians: Consideration of some eminent creative artists illustrates the variability and originality in musical talent and reveals the quandary of averaging such individuals together. Given the distinctive ways in which musical talent and creativity manifests, averaging these artists into a single subject pool may be eliminating crucial variability that would help to understand the cognitive and neural basis of creativity. Case studies may be of potential importance for studying creativity, expressiveness, and musical talent. Musicians listed from left to right. Top row: Duke Ellington, Miles Davis, John Coltrane, Dizzy Gillespie, Charlie Parker, Billie Holiday. Middle Row: Johann Sebastian Bach, Wolfgang Amadeus Mozart, Ludwig van Beethoven, Vladimir Horowitz, Pablo Casals, Jascha Heifetz, Aretha Franklin. Bottom row: Louis Armstrong, Ella Fitzgerald, Leonard Bernstein, John Lennon, David Bowie, Prince, Joni Mitchell. Bottom panel: Flow chart demonstrating possible mechanism for using case studies to examine creativity. Current Opinion in Behavioral Sciences 2019, 27:84–89
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Case studies of creativity Barrett and Limb 87
tremendous creativity in a wide variety of forms such as composition, improvisation, performance, and musical expressivity. Recent retrospective investigations have examined past great composers to uncover how medical incidents affected creative output and compositional style. For 20th-century composer Alfred Schnittke, strokes affecting his left cerebral hemisphere assisted his work, spurring his compositional output. Schnittke self-reported that his strokes increased his creativity by reducing his analytical processes and facilitating his intuition, which may have allowed him to compose at a faster rate [35]. Other studies have retroactively investigated the impact of left hemisphere strokes on musical performance and compositional output in notable musicians like Ira Randall Thompson [36], Benjamin Britten [37], Jean Langlais [38], Igor Stravinsky [39], and Vissarion Shebalin (see discussion in Ref. [35]). The biographies of past composers therefore serve as inspiration on productivity and creativity following adverse medical events. The lives of artists such as Duke Ellington, Bob Dylan, Frank Sinatra, Louis Armstrong, Johnny Cash and Ella Fitzgerald serve as inspirational case study models of creative resilience and facilitating creative growth in old age [40]. Likewise, living music professional performers can also serve as exemplary cases: guitarist Pat Martino underwent a left temporal lobectomy that led to profound amnesia. Over time, however, he was able to recover his memory and musical abilities, regaining his previous virtuoso status as an active professional jazz guitarist [41].
Studying renowned artists and their unique creative processes While we can retroactively learn from notable artists throughout history, present-day professional musicians serve as live models for how talent can manifest biologically and perceptually, and allow scientists to use ecologically valid, individually tailored experimental tasks. For example, the case study model can help probe creative musical processes such as memorization and improvisation with depth and detail. Researchers studied one jazz pianist in real-time to expose the cognitive processes used to memorize jazz compositions, finding that jazz improvisers rely on musical structure to aid memory in a manner similar to classical musicians [42]. In another exploratory case study, two renowned jazz improvisers who had never performed together recorded a free improvisation session and were interviewed afterwards to delineate their shared understanding and musical agreement regarding the performance. Relatively little agreement regarding the music or the performance session was found, suggesting that while some shared understanding may be necessary to perform together, differences and disagreement may be vital for creative improvisation [43]. While this may be true only of these particular performers, case studies such as this reveal insights that www.sciencedirect.com
are difficult to study using an experimental paradigm comparing subject groups. In another case report, scientists scanned the brain of pop artist Sting to examine his cortical activation when he mentally performed creative tasks; as an expert composer and instrumentalist comfortable in several musical genres, he was able to therefore perform specifically tailored experimental tasks [44].
Artists as individuals: case studies in creativity research In summary, while exemplary musicians may not be typical of other accomplished musicians, case study research could illuminate unknown information about musical talent and creativity. To our knowledge, little research has focused on preeminent artists — statistical outliers even among an elite pool of accomplished artists (see Figure 1, top panel). It would be beneficial to not only perform case studies on the ‘cre`me de la cre`me’ of artists, but also gather enough data to perform a case series with critical comparisons between these individuals (see Figure 1, bottom panel). By studying artists as individuals, this may illuminate similarities and differences among our society’s best and brightest, contributing to our evolving neural model of creativity. Research utilizing case studies could supply precious data to fill in gaps in our knowledge of creativity (see Table 1), perhaps uncovering whether individual extreme creativity is an exaggerated version of the creative mechanisms seen in group studies, or whether it is due to distinctive, previously undescribed networks of neural activity. Table 1 Pros and cons of using case studies to research the neuroscience of musical creativity Pros
Cons
- Captures some of the variability and individuality in talented artists - Unusual cases, talents, and abilities can be studied
- Possibility of idiosyncratic results that may not be generalizable to other experts - May occasionally need to take advantage of unfortunate medical circumstances, or unplanned events/accidents — therefore experimental paradigms may be harder to control - Lower statistical power
- Studying eminent artists as case studies may allow creating experimental activities that are more ecologically valid and authentic to artistic production - Allows a deeper understanding of musical processes
- Difficult to interpret individual brain data in context of existing studies that primarily represent average or aggregate data
Current Opinion in Behavioral Sciences 2019, 27:84–89
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Variability in neural patterns, behavior, and cognitive processes among outstanding, distinguished artists can add crucial information to our knowledge of creative activities like improvisation, composition, and performance. Musical talent is believed to be an intricate, complex blend of nature AND nurture [45–47]. It is, therefore, fitting that expertise would manifest in a myriad of ways, particularly in prominent musicians. Science should embrace this variability and individuality. If future research can balance subject group experiments for statistical power and generalizability with single subject case studies for individuality and unique experimental tasks, we will gain a deeper, more nuanced understanding of musical creativity.
Conflict of interest statement Nothing declared. Dr. Charles Limb serves as industry consultant and chief medical officer for work related to hearing loss that is unrelated to this study.
Acknowlegment
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This Research Lab is supported in part by an award from the National Endowment for the Arts (Award#: 1844330-38-C-18).
18. Paraskevopoulos E, Tsapkini K, Peretz I: Cultural aspects of music perception: validation of a Greek version of the Montreal Battery of Evaluation of Amusias. J Int Neuropsychol Soc 2010, 16:695-704.
References and recommended reading
19. Wilbiks JMP, Vuvan DT, Girard PY, Peretz I, Russo FA: Effects of vocal training in a musicophile with congenital amusia. Neurocase 2016, 22:526-537.
Papers of particular interest, published within the period of review, have been highlighted as: of special interest of outstanding interest
20. Mathias B, Lidji P, Honing H, Palmer C, Peretz I: Electrical brain responses to beat irregularities in two cases of beat deafness. Front Neurosci 2016, 10.
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30. Wallace GL, Happe F, Giedd JN: A case study of a multiply talented savant with an autism spectrum disorder: neuropsychological functioning and brain morphometry. Philos Trans R Soc B Biol Sci 2009, 364:1425-1432.
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31. Miller LK, Miller LK: What the savant syndrome can tell us about the nature and nurture of talent. Education 2005, 28:361-374. 32. Banissy MJ, Kadosh RC, Maus GW, Walsh V, Ward J: Prevalence, characteristics and a neurocognitive model of mirror-touch synaesthesia. Exp Brain Res 2009, 198:261-272. 33. Curwen C: Music-colour synaesthesia: concept, context and qualia. Conscious Cogn 2018, 61:94-106. 34. Farina FR, Mitchell KJ, Roche RAP: Synaesthesia lost and found: two cases of person- and music-colour synaesthesia. Eur J Neurosci 2017, 45:472-477. This case study explored synaesthesia in two individuals: ‘AB’ and ‘CD’. Both AB and CD have colored responses when hearing sounds, but they experienced a temporary loss of these synaesthetic experiences due to head trauma (experiencing a lightning strike in the case of AB) and medication (anxiolytic medication in the case of CD). Using interviews and the Synaesthesia Battery, scientists were able to characterize their pre-loss synaesthesia as well as restoration of the synaesthestic experiences (i.e. once AB recovered from the head trauma and once CD stopped taking medication). Thus, it appears that there is a neuroanatomical system underlying synaesthesia although the exact mechanism remains unclear. 35. Zagvazdin Y: Stroke, music, and creative output: Alfred Schnittke and other composers. Prog Brain Res 2015, 216:149165. This article retroactively studies the biography of 20th-century Russian composer Alfred Schnitkke, beginning with a musicological summary of his life and compositions, followed by tracing how left hemisphere strokes affected his compositional output. The strokes appeared to increase Schnittke’s compositional output as well as altering his musical style. The article also reviews how left-hemisphere strokes in other notable musicians and composers like Benjamin Britten, Igor Stravinsky, Vissarion Shebalin, and organist Jean Langlais did not seem to hinder their musical abilities or creativity. The article therefore suggests that neurological diseases do not necessarily detract from musical creative output, using the lives of past great composers as case study models. 36. Judd T, Gardner H, Geschwind N: Alexia without agraphia in a composer. Brain 1983, 106:435-457. 37. Hutcheon L, Hutcheon M: Creativity, productivity, aging: the case of Benjamin Britten. Age Cult Humanit Interdiscip J (1):2014:113-139. 38. Signoret JL, van Eeckhout P, Poncet M, Castaigne P: Aphasia sans amusie chez un organist aveugle. Rev Neurol 1987, 143:172-181. 39. O’Neill D, Macsweeney CA, Cornell IA, Moss H: Stravinsky syndrome: giving a voice to chronic stroke disease. QJM 2014, 107:489-493.
In this case report, scientists and doctors document how Pat Martino, celebrated jazz guitarist, underwent surgery to treat an intracerebral hemorrhage that required a large left temporal lobectomy. Following this surgery, he had complete memory loss as expected, forgetting information about himself and familiar people as well as a complete loss of all musical capabilities. With the help of his family and friends, encounters with other musicians, and being slowly introduced to his past by listening to his own records, Martino was able to regain musical transcription abilities and eventually play the guitar again. Functional magnetic resonance (fMRI) scanning of his brain reveal that he has smaller amygdala volume compared to control subjects, and behavioral testing reveals he has some subtle language impairments. Nevertheless, he is incredibly high functioning and has had a full return to his virtuosic skills, maintaining a busy professional performance schedule as well as recording jazz albums. This case report helps to underscore how some creative artists are able to recover and thrive following major medical procedures. 42. Noice H, Jeffrey J, Noice T, Chaffin R: Memorization by a jazz musician: a case study. Psychol Music 2008, 36:63-79. In this case study, the scientists videotaped an experienced jazz pianist as he learned a new composition. After learning the piece, the pianist marked up a score of the music in order to give reports about the musical structure as well as how he made decisions on technique, interpretation, and performance. Additionally, the pianists’ comments during practice were transcribed and then classified according to categories by two judges. By doing so, the scientists were able to see how the jazz musician learned and memorized the composition. In general, the jazz pianist used the hierachical structure of the music and phrase/section boundaries to aid memorization; thus the music’s organization served as a ‘retrieval structure’ or mental map to keep track of his progress within the piece. 43. Pras A, Schober MF, Spiro N: What about their performance do free jazz improvisers agree upon? A case study. Front Psychol 2017, 8. In this exploratory case study, a renowned saxophonist and pianist who had never performed together improvised freely for 40 min (i.e. free improvisation, not improvisation upon a jazz standard) and were then interviewed about two excerpts from their recording. Later, two commenting listeners from the same jazz-performing community were also interviewed about these excerpts. Several months later, all four participants returned and rated the extent to which they agreed with statements extracted from the four anonymized interviews. Very little overlap and agreement was found in their characterizations of the music or the performance, suggesting that a full agreement and a complete shared understanding is not necessary for improvisers to be able to perform together. In fact, creative differences may actually aid musical collaboration. 44. Levitin DJ, Grafton ST: Measuring the representational space of music with fMRI: a case study with Sting. Neurocase 2016, 22:548-557. 45. Hambrick DZ, Burgoyne AP, Macnamara BN, Ulle´n F: Toward a multifactorial model of expertise: beyond born versus made. Ann N Y Acad Sci 2018, 1423(1):284-295.
40. Lyness JM: Lessons from the lives of celebrated musicians: what Armstrong, Cash, Dylan, Ellington, Fitzgerald, and Sinatra can teach us about creative resilience and aging. Am J Geriatr Psychiatry 2017, 25:1295-1299.
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Current Opinion in Behavioral Sciences 2019, 27:84–89
ScienceDirect Unveiling artistic minds: case studies of creativity Karen Chan Barrett and Charles J Limb Research on musical creativity and expertise principally relies on cross-sectional or longitudinal experiments comparing groups of subjects (e.g. musicians vs. non-musicians, professional vs. amateur musicians). While this is vital, case studies of individuals may provide valuable insight into the variability underlying real-world creative musical performance and improvisation. We survey recent case study experiments on musical disorders, musical savants, and unique musical abilities as well as exploratory experiments that have studied renowned musicians as single data points. Using these, we build the argument that future research should utilize case studies to gain a deeper, more nuanced understanding of creative musical processes, particularly in world-class musicians whose distinctive talent may reveal unknown information about artistic creativity. Address Sound & Music Perception Lab, Department of Otolaryngology — Head & Neck Surgery, University of California, San Francisco, CA, USA Corresponding author: Barrett, Karen Chan ([email protected])
Current Opinion in Behavioral Sciences 2018, 27:84–89 This review comes from a themed issue on Creativity Edited by Rex Jung and Hikaru Takeuuchi
https://doi.org/10.1016/j.cobeha.2018.09.005 2352-1546/ã 2018 Elsevier Ltd. All rights reserved.
Introduction Over the past decades, neuroscience and psychology researchers have used interdisciplinary techniques to investigate how the brain perceives and processes complex acoustic stimuli such as music. In studies of musical creativity examining performers, composers, or improvisers, groups of artists are generally compared to control subjects while completing experimental and control tasks [1–13]. In short, much of our current knowledge in the music cognition field, and science more broadly, averages the results of a sample cohort of subjects to make inferences about the larger population. This technique is fundamental to the scientific method and necessary to identify statistically robust findings. When studying artistic attributes such as musical creativity, talent, or unusual musical abilities, however, much Current Opinion in Behavioral Sciences 2019, 27:84–89
information may be lost in averaging subjects together, particularly since art is frequently defined by so-called artistic ‘genius’ — the statistical outliers. Indeed, the uniqueness of exemplary artists would suggest the opposite notion — that mathematical averaging of multiple artists dilutes findings of interest and significance vital for understanding the artistic brain and the variety in human creative abilities. By treating artists as one homogeneous group of subjects, scientists may be averaging out crucial variability and individuality. Statistical rigor could be increased by studying one subject in depth over numerous sessions and then aggregating those sessions together (e.g. in an fMRI study). However, this method has the drawbacks of patient familiarity with the protocol and resultant changes in brain function due to repetition. It should be noted that for single-subject studies, the goal is quite different from that of random effects analysis, where the purpose of the analysis is to assess the generalizability of the findings to the larger population. In the case of single-subject studies of pre-eminent artists, it is already assumed that the brain activation will never be generalizable to the public. The more important question is whether or not the activation could ever generalize to the population of artistic experts from which the artist might be drawn (in and of itself a troubling proposition). Hence, the unique differences among eminent, accomplished musicians may give us valuable insight into how society’s best creative minds operate, yet the methods by which we ought to study single subjects, and the implications of the data for our understanding of human brain function remain unclear. One can make an analogy to clinical case reports of unusual disease presentations, which are commonplace in medicine — while these reports provide interesting material for consideration, they do not generate or improve standards of care, instead contributing to the body of anecdotal evidence that already exists. By comparison, the randomized controlled trial remains the gold standard by which new treatments are evaluated for our understanding of disease. While in the case of randomized controlled trials we generally consider the mean result to be the most important findings, the best analogy here might be looking at the few survivors of a deadly disease in which the overwhelming majority do not survive, in order to understand the pathogenesis of the condition itself. For our purposes here, the condition would be that of creativity and the rare survivors might represent the genius exemplars/statistical outliers. In this review article, we attempt to build an argument for why we should use case studies to study exemplary musicians when investigating musical creativity, treating each artist www.sciencedirect.com
Case studies of creativity Barrett and Limb 85
as a unique, individual data point. This review article discusses how case studies are already utilized to study musical disorders (such as congenital amusia), extraordinary abilities (such as in musical savants), as well as aberrant abilities (such as synaesthesia), using this literature as support for why case studies of prominent artists may be useful in research on the neuroscience of musical creativity.
Musical disorders and deficits Case studies have already been used to study deficits and disorders like congenital amusia. Early case studies helped to illuminate the symptoms of congenital amusia — a musical disability resulting in deficits in pitch processing not due to cognitive disabilities or peripheral hearing deficits [14–16]. With increased knowledge about this disorder, recent case studies have illuminated the “heterogeneity [regarding] the nature of the impairment” (pg. 1, [17]), such as in the case of an amusic who can judge musical expressiveness [18] and an amusic musicophile who attempted musical training to combat amusia [19]. While amusia usually manifests as pitch perception deficits, ‘beat deafness’ is a recently documented form of congenital amusia where individuals struggle to detect regular musical beats. Case studies reveal that amusic individuals have irregular event-related potentials compared to normal controls [20], and that some individuals can struggle with rhythm perception tasks, yet still synchronize to a beat [21]. In addition to its use in studying musical disorders, case studies of unusual patients with preserved musical abilities following supposedly debilitating medical diagnoses are documented in the medical literature. For example, recent case studies detailed how a patient learned a new instrument after developing frontotemporal dementia [22] as well as how an amnesiac patient was able to learn new musical compositions [23]. In summary, for congenital amusia, recent in-depth investigations of specific individuals have illuminated the variability in the disorder. Likewise, while medical diagnoses like dementia and amnesia usually lead to loss of musical abilities, case study research illustrates how an individual can possess preserved musical functions. These case studies therefore offer a more optimistic view on life after trauma, revealing the surprising resilience of musical abilities. Because of this, case studies may prove useful to study not only musical deficits, but also enhanced musical abilities, as in the case of musical savants and prominent musical artists.
Musical savants and aberrant musical abilities On the other side of the spectrum from congenital amusics lies the case of musical savants, rare individuals with severe cognitive and developmental impairments that yet possess ‘islands of skill’ such as exceptional musical talent. Case studies of savants [24] give insight into www.sciencedirect.com
how they learn compositions, think about music, and memorize compositions, as these individuals may utilize different processes from other expert musicians [25–27]. Savant case studies offer a singular research opportunity to probe the neural and behavioral correlates of these remarkable talents. For example, in addition to often possessing extraordinary memory and improvisation abilities, many musical savants also have absolute pitch [28,29]. One recent brain scanning of artistic savant ‘GW’ suggests that artistic skills in savants are enhanced through intense focus and over learning, which may result in atypical brain development and differences in the thickness of certain cortical structures [30]. While savants are singular and their talent can be idiosyncratic compared to normally developing artistic experts, case study research can teach us how musical talent may be separated from general intelligence. Savants offer a unique opportunity to deconstruct talent in different domains, allowing us to ponder ways in which talent may be nurtured and cultivated (see discussion in Ref. [31]). Moreover, neural scanning, cognitive testing, and perception research on individual music savants may illustrate precisely how savants’ brains and behavior differ from non-musician controls. If musical talent lies on a spectrum spanning from nonmusician controls to expert musicians to remarkable savants, biological and behavioral differences underlying musical ability (such as variations in cortical thickness and memory abilities) may exist on a spectrum as well. Case study research on savants helps to explore the ‘upper end’ of human creative abilities. Case studies of normally developing expert musicians can also illuminate information about unusual, specialized music abilities such as synaesthesia. Synaesthesia is a condition in which sounds evoke colors; notable musicians such as Olivier Messiaen, Franz Liszt, Jean Sibelius, Duke Ellington, and pop stars like Pharrell Williams and Lady Gaga anecdotally report having synaesthesia.1 Musical synaesthesia is thought to be quite rare, occurring in only about 0.2% of the population, perhaps due to aberrations in neural connectivity or communication [32,33]. Recent medical reports have used case studies of synaesthestic individuals to better understand how synaesthesia manifests, as well as how it may change with medication or head injuries [34]. While it is unclear whether synaesthesia is adaptive, harmful, or beneficial, studying individuals with synaesthesia illuminates the outlying boundaries of how musical abilities can manifest.
Musical artists as models of resilience Thus, case studies have been used to study deficits (i.e. amusia), extraordinary abilities (savants), and unusual abilities (synesthesia). In the case of creativity, science needs to similarly examine individuals who have shown 1
See this BBC News article: http://www.bbc.com/culture/story/ 20140904-i-see-songs-in-colour. Current Opinion in Behavioral Sciences 2019, 27:84–89
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Figure 1
Possible Ways to Use Case Study Paradigms to Examine Musical Creativity? Recruit eminent artists as experimental participants
Participants complete unique, tailored experimental tasks
Participants complete common experimental tasks
Case Studies: Each
Case Series: Participants’
participant’s data considered
data compared for critical
on an individual basis
comparisons
Consider case study research alongside group studies to evolve current neural models of creativity Current Opinion in Behavioral Sciences
Summary figure. Top panel: Examples of iconic musicians: Consideration of some eminent creative artists illustrates the variability and originality in musical talent and reveals the quandary of averaging such individuals together. Given the distinctive ways in which musical talent and creativity manifests, averaging these artists into a single subject pool may be eliminating crucial variability that would help to understand the cognitive and neural basis of creativity. Case studies may be of potential importance for studying creativity, expressiveness, and musical talent. Musicians listed from left to right. Top row: Duke Ellington, Miles Davis, John Coltrane, Dizzy Gillespie, Charlie Parker, Billie Holiday. Middle Row: Johann Sebastian Bach, Wolfgang Amadeus Mozart, Ludwig van Beethoven, Vladimir Horowitz, Pablo Casals, Jascha Heifetz, Aretha Franklin. Bottom row: Louis Armstrong, Ella Fitzgerald, Leonard Bernstein, John Lennon, David Bowie, Prince, Joni Mitchell. Bottom panel: Flow chart demonstrating possible mechanism for using case studies to examine creativity. Current Opinion in Behavioral Sciences 2019, 27:84–89
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Case studies of creativity Barrett and Limb 87
tremendous creativity in a wide variety of forms such as composition, improvisation, performance, and musical expressivity. Recent retrospective investigations have examined past great composers to uncover how medical incidents affected creative output and compositional style. For 20th-century composer Alfred Schnittke, strokes affecting his left cerebral hemisphere assisted his work, spurring his compositional output. Schnittke self-reported that his strokes increased his creativity by reducing his analytical processes and facilitating his intuition, which may have allowed him to compose at a faster rate [35]. Other studies have retroactively investigated the impact of left hemisphere strokes on musical performance and compositional output in notable musicians like Ira Randall Thompson [36], Benjamin Britten [37], Jean Langlais [38], Igor Stravinsky [39], and Vissarion Shebalin (see discussion in Ref. [35]). The biographies of past composers therefore serve as inspiration on productivity and creativity following adverse medical events. The lives of artists such as Duke Ellington, Bob Dylan, Frank Sinatra, Louis Armstrong, Johnny Cash and Ella Fitzgerald serve as inspirational case study models of creative resilience and facilitating creative growth in old age [40]. Likewise, living music professional performers can also serve as exemplary cases: guitarist Pat Martino underwent a left temporal lobectomy that led to profound amnesia. Over time, however, he was able to recover his memory and musical abilities, regaining his previous virtuoso status as an active professional jazz guitarist [41].
Studying renowned artists and their unique creative processes While we can retroactively learn from notable artists throughout history, present-day professional musicians serve as live models for how talent can manifest biologically and perceptually, and allow scientists to use ecologically valid, individually tailored experimental tasks. For example, the case study model can help probe creative musical processes such as memorization and improvisation with depth and detail. Researchers studied one jazz pianist in real-time to expose the cognitive processes used to memorize jazz compositions, finding that jazz improvisers rely on musical structure to aid memory in a manner similar to classical musicians [42]. In another exploratory case study, two renowned jazz improvisers who had never performed together recorded a free improvisation session and were interviewed afterwards to delineate their shared understanding and musical agreement regarding the performance. Relatively little agreement regarding the music or the performance session was found, suggesting that while some shared understanding may be necessary to perform together, differences and disagreement may be vital for creative improvisation [43]. While this may be true only of these particular performers, case studies such as this reveal insights that www.sciencedirect.com
are difficult to study using an experimental paradigm comparing subject groups. In another case report, scientists scanned the brain of pop artist Sting to examine his cortical activation when he mentally performed creative tasks; as an expert composer and instrumentalist comfortable in several musical genres, he was able to therefore perform specifically tailored experimental tasks [44].
Artists as individuals: case studies in creativity research In summary, while exemplary musicians may not be typical of other accomplished musicians, case study research could illuminate unknown information about musical talent and creativity. To our knowledge, little research has focused on preeminent artists — statistical outliers even among an elite pool of accomplished artists (see Figure 1, top panel). It would be beneficial to not only perform case studies on the ‘cre`me de la cre`me’ of artists, but also gather enough data to perform a case series with critical comparisons between these individuals (see Figure 1, bottom panel). By studying artists as individuals, this may illuminate similarities and differences among our society’s best and brightest, contributing to our evolving neural model of creativity. Research utilizing case studies could supply precious data to fill in gaps in our knowledge of creativity (see Table 1), perhaps uncovering whether individual extreme creativity is an exaggerated version of the creative mechanisms seen in group studies, or whether it is due to distinctive, previously undescribed networks of neural activity. Table 1 Pros and cons of using case studies to research the neuroscience of musical creativity Pros
Cons
- Captures some of the variability and individuality in talented artists - Unusual cases, talents, and abilities can be studied
- Possibility of idiosyncratic results that may not be generalizable to other experts - May occasionally need to take advantage of unfortunate medical circumstances, or unplanned events/accidents — therefore experimental paradigms may be harder to control - Lower statistical power
- Studying eminent artists as case studies may allow creating experimental activities that are more ecologically valid and authentic to artistic production - Allows a deeper understanding of musical processes
- Difficult to interpret individual brain data in context of existing studies that primarily represent average or aggregate data
Current Opinion in Behavioral Sciences 2019, 27:84–89
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Variability in neural patterns, behavior, and cognitive processes among outstanding, distinguished artists can add crucial information to our knowledge of creative activities like improvisation, composition, and performance. Musical talent is believed to be an intricate, complex blend of nature AND nurture [45–47]. It is, therefore, fitting that expertise would manifest in a myriad of ways, particularly in prominent musicians. Science should embrace this variability and individuality. If future research can balance subject group experiments for statistical power and generalizability with single subject case studies for individuality and unique experimental tasks, we will gain a deeper, more nuanced understanding of musical creativity.
Conflict of interest statement Nothing declared. Dr. Charles Limb serves as industry consultant and chief medical officer for work related to hearing loss that is unrelated to this study.
Acknowlegment
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This Research Lab is supported in part by an award from the National Endowment for the Arts (Award#: 1844330-38-C-18).
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References and recommended reading
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Papers of particular interest, published within the period of review, have been highlighted as: of special interest of outstanding interest
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In this case report, scientists and doctors document how Pat Martino, celebrated jazz guitarist, underwent surgery to treat an intracerebral hemorrhage that required a large left temporal lobectomy. Following this surgery, he had complete memory loss as expected, forgetting information about himself and familiar people as well as a complete loss of all musical capabilities. With the help of his family and friends, encounters with other musicians, and being slowly introduced to his past by listening to his own records, Martino was able to regain musical transcription abilities and eventually play the guitar again. Functional magnetic resonance (fMRI) scanning of his brain reveal that he has smaller amygdala volume compared to control subjects, and behavioral testing reveals he has some subtle language impairments. Nevertheless, he is incredibly high functioning and has had a full return to his virtuosic skills, maintaining a busy professional performance schedule as well as recording jazz albums. This case report helps to underscore how some creative artists are able to recover and thrive following major medical procedures. 42. Noice H, Jeffrey J, Noice T, Chaffin R: Memorization by a jazz musician: a case study. Psychol Music 2008, 36:63-79. In this case study, the scientists videotaped an experienced jazz pianist as he learned a new composition. After learning the piece, the pianist marked up a score of the music in order to give reports about the musical structure as well as how he made decisions on technique, interpretation, and performance. Additionally, the pianists’ comments during practice were transcribed and then classified according to categories by two judges. By doing so, the scientists were able to see how the jazz musician learned and memorized the composition. In general, the jazz pianist used the hierachical structure of the music and phrase/section boundaries to aid memorization; thus the music’s organization served as a ‘retrieval structure’ or mental map to keep track of his progress within the piece. 43. Pras A, Schober MF, Spiro N: What about their performance do free jazz improvisers agree upon? A case study. Front Psychol 2017, 8. In this exploratory case study, a renowned saxophonist and pianist who had never performed together improvised freely for 40 min (i.e. free improvisation, not improvisation upon a jazz standard) and were then interviewed about two excerpts from their recording. Later, two commenting listeners from the same jazz-performing community were also interviewed about these excerpts. Several months later, all four participants returned and rated the extent to which they agreed with statements extracted from the four anonymized interviews. Very little overlap and agreement was found in their characterizations of the music or the performance, suggesting that a full agreement and a complete shared understanding is not necessary for improvisers to be able to perform together. In fact, creative differences may actually aid musical collaboration. 44. Levitin DJ, Grafton ST: Measuring the representational space of music with fMRI: a case study with Sting. Neurocase 2016, 22:548-557. 45. Hambrick DZ, Burgoyne AP, Macnamara BN, Ulle´n F: Toward a multifactorial model of expertise: beyond born versus made. Ann N Y Acad Sci 2018, 1423(1):284-295.
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