Hypergraphia
Hypergraphia is a behavioral condition characterized by the intense desire to write or draw. Forms of hypergraphia can vary in writing style and content. It is a symptom associated with temporal lobe changes in epilepsy and in Geschwind syndrome.[1] Structures that may have an effect on hypergraphia when damaged due to temporal lobe epilepsy are the hippocampus and Wernicke's area. Aside from temporal lobe epilepsy, chemical causes may be responsible for inducing hypergraphia.
Characteristics
Writing style
American neurologists Stephen Waxman and Norman Geschwind were the first to describe hypergraphia, in the 1970s.[2] The patients they observed displayed highly compulsive detailed writing, sometimes with literary creativity. The patients kept diaries, which some used to meticulously document minute details of their everyday activities, write poetry, or create lists. Case 1 of their study wrote lists of her relatives, her likes and dislikes, and the furniture in her apartment. Beside lists, the patient wrote poetry, often with a moral or philosophical undertone. She described an incident in which she wrote the lyrics of a song she learned when she was 17 several hundred times and another incident in which she felt the urge to write a word over and over again. Another patient wrote aphorisms and certain sentences in repetition.[2]
A patient from a separate study experienced continuous "rhyming in his head" for five years after a seizure and said that he "felt the need to write them down."
Content
In addition to writing in different forms (poetry, books, repetition of one word), hypergraphia patients differ in the complexity of their writings. While some writers (e.g.
There are many accounts of patients writing in nonsensical patterns including writing in a center-seeking spiral starting around the edges of a piece of paper.[7] In one case study, a patient even wrote backward, so that the writing could only be interpreted with the aid of a mirror.[2] Sometimes the writing can consist of scribbles and frantic, random thoughts that are quickly jotted down on paper very frequently. Grammar can be present, but the meaning of these thoughts is generally hard to grasp and the sentences are loose.[7] In some cases, patients write extremely detailed accounts of events that are occurring or descriptions of where they are.[7]
In some cases, hypergraphia can manifest with compulsive drawing.[8] The composer Robert Schumann, during periods of high musical output, also wrote many long letters to his sister Clara; similarly, Vincent van Gogh had much more written correspondence during bouts of intense painting.[4] Many drawings by patients with hypergraphia exhibit repetition and a high level of detail, sometimes mixing both compulsive writing and drawing together.[9]
Causes
Some studies have suggested that hypergraphia is related to bipolar disorder, hypomania, and schizophrenia.[10] Although creative ability was observed in the patients of these studies, signs of creativity were observed, not hypergraphia specifically. Therefore, it is difficult to say with absolute certainty that hypergraphia is a symptom of these psychiatric illnesses because creativity in patients with bipolar disorder, hypomania, or schizophrenia may manifest into something aside from writing. However, other studies have shown significant accounts between hypergraphia and temporal lobe epilepsy[11] and chemical causes.[12]
Temporal lobe epilepsy
Hypergraphia was first studied as a symptom of temporal lobe epilepsy, a condition of reoccurring seizures caused by excessive neuronal activity, but it is not a common symptom among patients. Less than 10 percent of patients with temporal lobe epilepsy exhibit characteristics of hypergraphia.[medical citation needed] Temporal lobe epilepsy patients may exhibit irritability, discomfort, or an increasing feeling of dread if their writing activity is disrupted.[13] To elicit such responses when interrupting their writing suggests that hypergraphia is a compulsive condition, resulting in an obsessive motivation to write.[10] A temporal lobe epilepsy may influence frontotemporal connections in such a way that the drive to write is increased in the frontal lobe, beginning with the prefrontal and premotor cortex planning out what to write, and then leading to the motor cortex (located next to the central fissure) executing the physical movement of writing.[10]
Most temporal lobe epilepsy patients who suffer from hypergraphia can write words, but not all may have the capacity to write complete sentences that have meaning.[7]
Bipolar disorder
The disorder most often associated with high-output writers is bipolar disorder, especially during hypomania.[14] In fact, temporal lobe epilepsy is more likely to produce hypergraphia if it also produces manic symptoms. While depression has been linked to increased writing, it appears that most writers with depression write little while depressed, and high output periods correspond to rebound mood elevation after the end of a depression, or in mixed mood states.[14]
Chemicals
Drugs that boost mood and energy have been known to induce hypergraphia, possibly by increasing activity in brain networks utilizing one of the body's neurotransmitters, dopamine. Dopamine has been known to decrease latent inhibition, which causes a decrease in the ability to habituate to screen out unexpected stimuli. Low latent inhibition leads to an excessive level of stimulation and could contribute to the onset of hypergraphia and general creativity.[15] This research implies that there is a direct correlation between the levels of dopamine between neuronal synapses and the level of creativity exhibited by the patient. Dopamine agonists increase the levels of dopamine between synapses which results in higher levels of creativity, and the opposite is true for dopamine antagonists.
In one case study, a patient taking donepezil reported an elevation in mood and energy levels which led to hypergraphia and other excessive forms of speech (such as singing).
Another potential cause of hypergraphia is
Pathophysiology
Several regions of the brain are involved in the act of written composition. Handwriting depends on the superior
Society and culture
Hypergraphia was one of the central issues in the 1999 trial of Alvin Ridley for the imprisonment and murder of his wife
In 1969,
Naomi Mitchison, often called a doyenne of Scottish literature, writing over 90 books of historical and science fiction, travel writing and autobiography, has been described as a compulsive writer.
See also
References
- S2CID 22179745.
- ^ S2CID 32956175.
- ^ PMID 16388002.
- ^ a b Flaherty, Alice W. (April 28, 2015). The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain. Mariner Books.
- ^ Harwood, Dyane; Henshaw, Dr Carol (October 10, 2017). Birth of a New Brain: Healing from Postpartum Bipolar Disorder. Post Hill Press.
- ^ PMID 16254989.
- ^ PMID 3783177.
- PMID 7069424.
- ^ Aminoff, Michael (2001). Neurology and General Medicine. p. 579.
- ^ PMID 21443820.
- PMID 7241165.
Patients with temporal lobe epilepsy tended to reply more frequently to a standard questionnaire, and wrote extensively (mean: 1301 words) as compared to others (mean: 106 words). The incidence of temporal lobe epilepsy was 73% in patients exhibiting hypergraphia compared to 17% in patients without this trait. These findings suggest that hypergraphia may be a quantitative index of behaviour change in temporal lobe epilepsy.
- ISSN 1756-5847.
- PMID 8937347.
- ^ ISBN 978-0-02-916003-9.
- PMID 14498785.
- ^ PMID 23037669.
- ^ S2CID 22404108.
- PMID 22162145.
- S2CID 34974937.
- S2CID 43906342.
- PMID 1548492.
- ^ a b Brownlee 2006.
- ^ Asimov, Isaac (1969). Nightfall, and other stories. Doubleday. p. 244.
- ^ "New Comments on the Epilepsy of Fyodor Dostoevsky," Epilepsia 25 (No. 4, 1984), p. 409.
- ^ Robert Burns and the Medical Profession Archived January 11, 2014, at the Wayback Machine Retrieved : January 11, 2014
- ^ Flaherty, The Midnight Disease p 26
Further reading
- Flaherty, Alice Weaver (2004). The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain. ISBN 0-618-23065-3.
- Pickover, C. A. (1999). Strange brains and genius: The secret lives of eccentric scientists and madmen. New York: William Morrow. ISBN 0-688-16894-9
- Schachter, S. C., Holmes, G. L., & Kasteleijn-Nolst Trenité, D. (2008). Behavioral aspects of epilepsy: Principles and practice. New York: Demos. ISBN 1-933864-04-4