By Adora Chui
A woman wakes up in hospital after a car crash and discovers that she can taste the words that others are speaking. A man has a stroke and becomes semi-paralyzed―but now sees bursts of orchestrated colour when listening to pop music. Someone in the early stages of dementia is suddenly able to paint masterfully―without prior artistic training.
To put it crudely, these people’s brain injuries have unlocked new abilities or enhanced existing ones. But there is nothing crude about the way the brain works, even if our current understanding of its capacities and intricacies are rudimentary in comparison. Narinder Kapur (1) signifies the paradoxical brain as capable of phenomena where brain damage or lesions can result in enhanced neural function. In these cases, Kapur and colleagues (1) summarize, “what normally hinders may help.”
Following an acquired brain injury (e.g., stroke, traumatic brain injury), most individuals experience impairments in many cognitive domains (e.g., memory, attention, planning). However, when faced with such astonishing phenomena described earlier, these “jarring juxtaposition[s] of ability and disability” (3) stretch the limits of our comprehension beyond presuming impairment by default.
Instances of the paradoxical brain can be observed in the cases of neurological cross-talk like the initial two examples (acquired synaesthesia), or accidental genius like the third (acquired savant syndrome). Attempting to reconcile our expectations of how the brain recovers from injury with these exceptional instances, we struggle for an explanation but that is beyond current understanding (4).
Not that this conundrum stops us from being fascinated with the unusual, the unexplained, and the marvelous.
On the contrary, modern society is rife with bewildering examples: we have cinematic universes of characters who, through some precipitating, life-altering event (e.g., being bitten by a radioactive spider, being exposed to gamma rays during a detonation, or experiencing other generally inadvisable happenstances) become superheroes. Through a combination of circumstance, adversity, and resilience, they become more than human, or at least, some extreme version of human.
In rehabilitation practice, we are similarly captivated by the pursuit of an ideal: we dedicate ourselves to helping clients reach their full potential after a life-interrupting episode. We employ all sorts of approaches to support their return to participation in their everyday lives. We will clients to reach their highest level of functioning, all the while expecting them to follow a certain trajectory of recovery. However, where do sensational, paradoxical outliers like acquired synaesthesia and acquired savant syndrome fit in these trajectories?
In rehabilitation practice, we are similarly captivated by the pursuit of an ideal: we dedicate ourselves to helping clients reach their full potential after a life-interrupting episode.
Melissa McCracken is an artist and synaesthete who paints the music she sees. As heard through My Modern Met, her canvases exude the rhythmic and aural ecstasies of Jimi Hendrix, Radiohead, and John Lennon.
The blending of sensations is known as synaesthesia, derived from the Latin syn (together) and aesthesia (sensation) (5). In history, famous individuals across the visual arts, musical fields, and scientific disciplines have been thought to be synaesthetes. Perhaps the creative outputs of supposed synaesthetes like Vincent van Gogh and Pharrell Williams (6) can be attributed to their brains’ extraordinary neural connectivity.
Literature indicates that anywhere from 1 in 2000 to 1 in 20 people experience some form of synaesthesia, depending on the type (5,7). Two of the most commonly reported synaesthetic categories are auditory-visual synaesthesia (colours accompany certain sounds), and grapheme-colour synaesthesia (colours are assigned to certain letters) (8). Less frequent are reports of individuals whose tastes produce visual shapes (7) or for whom certain numbers or days of the week produce an “automatic and overwhelming impression of a personality type or gender.” (9)
The neural mechanisms of synaesthesia are only hypothesized (10) but conventionally taken to be the result of “hyper-association between brain regions.” (9) However, it is unconfirmed whether this higher-than-typical association is due to extra structural connectivity or altered functional processes (9). That is, synaesthesia’s cross-signaling effect may be because of extra wiring or that the pre-existing wires now carry different signals.
Most synaesthetes are born that way, but other synaesthetes acquire their condition due to brain injury (11-13). One research group postulates that the large influx of chemical messengers in the brain (e.g., dopamine and serotonin) after brain injury results in a permanent rewiring of neurons, thus allowing originally partitioned areas of the brain to communicate with one another (14).
Additionally, if synaesthesia is defined in terms of hyper-associated neural connections instead of the obvious behavioural categories (e.g., audio-visual, grapheme-colour), it implies that there may be “hidden” synaesthetes among us (e.g., one who excels as a composer, instrumentalist, and vocalist), potentially with diverse variants that have yet to be recognized (9). Perhaps anyone might be a synaesthete of a subtler nature and not yet realize it?
Acquired Savant Syndrome
Tommy McHugh the Builder was an ex-convict whose creative expression consisted of handyman work (15).
His new life began after a brain haemorrhage at the age of 61: Tommy McHugh the Artist emerged, pouring out painting after painting and poem after poem―“My head was full of rhymes and images and pictures.” (16)
Savant, meaning “knowledgeable person,” is derived from the French verb savoir (to know) and describes individuals who possess “islands of genius” amidst otherwise average or diminished abilities (3).
One expert, Dr. Darold Treffert (3), defines savants as individuals who hold not only a special skill but also a phenomenal memory. However, he further asserts “that memory alone cannot fully account for savant abilities.” For example, a memory for mathematical formulae cannot completely explain a savant’s ability to calculate at lightning speed.
Individuals with savant syndrome characteristically excel in one of five categories (3):
- music (most often piano performance),
- art (usually drawing and painting),
- calendar calculating (e.g., May 4, 1632, was a Friday),
- mathematics (e.g., computing prime numbers), and
- mechanical or spatial skills (e.g., map making).
Acquired savants account for a tenth of the entire savant population (17) and have been reported as 1 in 2000 to 1 in 1000 individuals in the general population (3). Such cases of “accidental genius” have appeared following many types of damage to the brain, including penetrating brain injury (18), brain surgery (19), epilepsy (20), sub-arachnoid haemorrhage (21), meningitis (22), and progressive aphasia (23). Additionally, there is a growing volume of literature that explores this phenomenon in previously healthy individuals diagnosed with Alzheimer’s Disease or frontal temporal dementia (24,25).
While several theories have been proposed to explain the neurophysiology of acquired savant syndrome, consider these two views.
Theory A. Injury results in a reorganization of the brain and its processing hubs, allowing areas containing musical, artistic, or mathematical memory to be readily accessed (26);
Theory B. Injury inhibits the higher cognitive functions (e.g., language, logic, comprehension) from suppressing natural creative abilities (24).
Due to the enigmatic nature of the syndrome, Dr. Treffert (3) affirms, “no single theory can explain all savants.” However, if as one theory contends, “the extraordinary skills of savants… [is] due to their privileged access to lower levels of sensory information,” (27) can everyone learn to tap into what usually flows beneath our consciousness?
Paradox and Reality in Rehabilitation
After marveling at these rare cases of extraordinary ability after brain injury, what are we to conclude about cerebral limits and capacities? Should paradoxical cases of brain recovery change our view of rehabilitation potential?
First, perhaps we ought not to assume that the acquisition of newfound abilities is necessarily desired. Both disability and unsought enhanced ability require adaptation and integration into the individual’s daily life and identity. Second, considering that acquired conditions post-brain injury are usually accompanied by some residual disability, we must not presume that gains in ability automatically negate losses. Suddenly becoming a musical genius after brain injury does not compensate for an equally sudden speech impairment.
Last, and perhaps the most challenging, we must question our societal practice of lionizing individuals―whether synaesthetes or not―who surpass rehabilitation expectations to reach herculean goals. Consider the problematic rhetoric sometimes applied to persons with disability such as “No arms, no legs? No excuses.” “[I am] not here to be your inspiration,” is a frank rebuttal.
Last, and perhaps the most challenging, we must question our societal practice of lionizing individuals―whether synaesthetes or not―who surpass rehabilitation expectations to reach herculean goals.
Of course, we can celebrate the person and their supporters for their uncommon achievement. But we must not allow our fascination with exceptional cases to create a burden of expectation for everyone else. So while our notions of rehabilitation potential may have been stretched, let us avoid synonymizing the boundary of possibility for humanity with the boundary of possibility for an individual.
Instead, we can adopt the broad view of language savant Daniel Tammet, a view that accounts for both limits and capacities: “The line between profound talent and profound disability seems to be really a surprisingly thin one. Who knows, there may be abilities hidden within everyone that can be tapped in some way.” (28)
Perhaps one day there will be a grand, unifying theory of the brain that accounts for the ordinary and the extraordinary, one that explains the unexplainable and which encompasses the entire range of cerebral ability.
In the meantime, because we know much while simultaneously acknowledging that there is much we do not comprehend, we must embrace paradox and accept that “opposites do not negate each―they cohere in mysterious unity at the heart of reality.” (29)
This commentary was inspired by an original publication authored by Tian Renton titled “The neuroscience paradox: Investigating skill and sensory gains following acquired brain injury” (unpublished).
Featured illustration by Hang Lin for rehabINK.
To refer to this article, it can be cited as:
Chui A. Accidental genius and hidden talent: Two cases of paradox after brain injury. rehabINK. 2019;6. Available from: https://rehabinkmag.com
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