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Focus on Art Therapy

The Art of Therapy

CARROLL, LINDA

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Linda Carroll is a medical and science writer whose work has appeared in The New York Times and Health magazine as well as on msnbc.com.

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Abstract

How the mere act of painting or sketching can draw out memory and movement in people with brain disorders

The two older women sit silently across from one another as Jacqueline Baroch spreads art supplies out on the table. Toni, 58, picks through a set of multicolored markers while 88-year-old Mae slouches deep into her aqua-colored bathrobe, glassy-eyed, appearing not to notice the pens, markers, and colorful pastels laid out in front of her.

Baroch encourages the women to draw pictures of houses that have been homes, and Toni leans forward and begins to sketch the outlines of a building. Mae picks up a pen and listlessly scrawls a line on the paper in front of her. As Baroch gently prods with questions about Mae's childhood home, about sisters and brothers, about farm animals and flowers, Mae's posture starts to change. Her shoulders come back and her head lifts. Her eyes brighten and she starts to draw with more focus. The clouds of dementia begin to part, and Mae starts to reminisce about her youth.

Mae's awakening through the act of drawing allows her to reconnect, for a time, with an earlier self and to retrieve memories that she might not be able to find without a pen in her hand, says Baroch, an art therapist at the Albert Einstein Medical Center in Philadelphia.

Such is the power of art, experts say. At a minimum, art therapy sessions can help an Alzheimer's patient recall forgotten memories and express tangled emotions when verbal abilities are eroding. Parkinson's patients who can't hold a trembling hand still enough to pen out a sentence are able to paint fluid brush strokes across a canvas. Stroke patients who can't utter a word are suddenly able to speak their names.

No one knows exactly how art taps into physical and intellectual memories muddled by neuro-degenerative diseases. But scientists suspect that the process allows people to find alternate routes to misplaced memories.

Information in the brain appears to be organized much like the entries in a library's card catalog. A book will have one card as its main entry, but also several others organized by category linking back to the book. Similarly, a memory of an event can be reached directly or through its links with other information stored in the brain. Start drawing a picture of your childhood home, for example, and suddenly you might have access to memories of events that occurred there.

It's not surprising that drawing works to bring back memories, says Nancy Gerber, Ph.D., director of graduate art therapy education at Drexel University in Philadelphia. “If you look at a newspaper or a photo album, those pictures can instantly transport you to another time and place in life,” she says. “And the process of creating images from one's own unconscious is even more powerful than looking at the painting of another. Both can evoke responses, but the process of creating the image is more likely to evoke personal memories.”

At an art exhibition in New York City, visitors get a rare window into the ravages of Alzheimer's disease: On display is a series of self-portraits that illustrate one painter's descent from diagnosis to severe dementia.

William Utermohlen was told he had Alzheimer's in 1995. Over the next five years, he focused his energies on portraits that reflected the course of his cognitive decline. The work provided a canvas for the expression of his emotional response to the disease.

What makes the series of paintings so powerful is Utermohlen's decision to focus on the face, says Jeffrey Cummings, M.D., director of the Alzheimer's Disease Center at the University of California—Los Angeles. “So much of how we relate to other individuals and the world is based on how we see faces,” Dr. Cummings explains. “We have this man painting his own face and we see it disappearing as the disease progresses. We can take this to reflect how he perceives other people's faces and how his interpersonal world is becoming more and more chaotic.”

If Utermohlen had painted animals or landscapes—something so much less interpersonal—the work would have revealed far less about the disease, Dr. Cummings says. Just compare the first and final faces. Artistic devices fall by the wayside as the image becomes increasingly simple. “He loses the ability to make anything but the most rudimentary shapes,” Dr. Cummings observes. “The final one just manages a round shape. And there is such a loss of detail that it's difficult to tell whether the two black dots are eyes or nostrils.”

These changes in the paintings mirror deterioration of specific brain areas. One area vulnerable to Alzheimer's is the parietal cortex, which mediates visuospatial abilities. “So the paintings reflect this visuospatial disintegration,” Dr. Cummings says.

The paintings become far less cerebral over time and what's left, in the end, is the emotional aspect of the painter. And this emotional quality comes through even in the last paintings of the series.

“There is an emotional power in these paintings,” Dr. Cummings says. “There are two aspects to our emotional reaction to them. One is our own—which includes horror at what is happening. The other is Utermohlen's ability to continue to communicate emotion even in the most structurally challenged of his paintings.”

That ability to communicate emotions through drawing and painting isn't limited to the professional artist, experts say. And it is why art therapy can help dementia patients deal with emotions when cognitive abilities decline. Often behavioral problems result as verbal abilities erode and words fail to express strong feelings.

“Through art, you can try to maintain a connection between a feeling and how you express it,” says Penelope Orr, Ph.D., assistant professor of art therapy at Florida State University in Tallahassee. “For example, a person might feel that they're not getting enough attention or that they're being neglected or not being taken seriously. Instead of being able to express frustration at not being listened to, they may express this emotion as anger. Drawing can sometimes help them express the frustration.”

And sometimes it may be enough just to find a way to communicate when language skills are flagging. “In Alzheimer's and other types of dementia, the channels of communication close down,” says Raquel Chapin Stephenson, art program coordinator for New York University's Creative Aging Therapeutic Services Program. “The creative arts can help provide a way to communicate that is not verbal. Often those with Alzheimer's will lose awareness of those around them, but sometimes during an art therapy session they will respond to those across the table from them. And that helps pull people together and give them a sense of community.”

Mae and Toni have stopped drawing, and are becoming absorbed in a discussion about pets. Mae giggles as Toni describes the antics of her cat. Engaged in conversation, Mae leans forward. She moves on to other subjects: her mother, her siblings, her opinions on disciplining unruly children. When her wheelchair is pushed out of the rec room, she's still smiling.

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The art therapy has unlocked Mae's memory and soothed her soul. It's allowed her a respite from her disease. And it's given her something most people take for granted and most Alzheimer's patients find impossible: an hour of idle chat.

But the power of art therapy isn't limited to refreshing faded memories. In her years as an art therapist, Baroch has also seen it unleash language in people who have lost the ability to talk after a stroke.

She recalls working with a woman who could recite only the five vowels. After making the first letter of her name out of Popsicle sticks, the woman was able to utter her name for the first time since her stroke. “She smiled and laughed,” Baroch recalls. “She couldn't do it on her own until she had the visual cue. It was very exciting, especially since she was able to say it again afterwards.”

Art's ability to unlock frozen brain circuits isn't limited to speech and memory. It may help with tremor due to Parkinson's. Anjan Chatterjee, M.D., recalls a Parkinson's patient who took up painting after being diagnosed with the disease. When writing, the man's hands shook, says Dr. Chatterjee, associate professor of neurology at the University of Pennsylvania in Philadelphia. But when painting, the man moved the brush with strokes that were both sinuous and smooth. It's not clear why painting brings this out, says Dr. Chatterjee.

Ultimately, experts say, there's much left to learn about how art works its magic on the brain and whether the therapy can lead to any permanent improvements.

Baroch has noticed that some of her Alzheimer's patients appear to retain art lessons that she's taught—an unexpected result in people who usually can't create new memories.

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INNOVATIVE THERAPIES

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This is the second in a series of regular articles covering complementary therapies. Also known as alternative therapies, they are now being accepted by doctors to augment standard medical treatments.

By making art, patients can find a way to reconnect to their former selves.

©2006 American Academy of Neurology

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