"I'm Drawing Back My Brains"

Art Therapy and Brain Injury Awareness Month 2015, by Irene Rosner David, PhD, ATR-BC, LCAT, HLM

“I’m Drawing Back My Brains” – these were the words uttered by a brain injured young man while participating in art therapy in a New York City hospital. He intuitively seemed to know that through the positive emotional experience of drawing, he was also making gains in cognitive function. His speech impairment manifested in discordant words and lack of fluidity of thought. However, the errors in his declaration concretely and metaphorically conveyed a benefit of art therapy. Hardly reflective of a communication disorder, it was indeed a testament to the value of creating, as well as groping, when there is brain injury.

Art therapy for traumatically brain injured patients, whether caused by assault, accident, or war injuries has the potential for addressing dual clinical goals – emotional release and enhanced cognition. Agitation, anxiety, depression, diminished self-esteem and a range of feelings are clearly channeled through artistic expression. Seen through a neurological perspective, such feeling states and behaviors also result from TBI as well as psychological etiologies such as impulsivity, irritability and lack of awareness often seen with frontal lobe injuries.

If one thinks of the cognitive functions required in the process of creating art, it readily follows that those domains may be ameliorated via art therapy in TBI treatment. Clinical goals to address dysfunction include enhancing memory, attention, concentration, planning, organization, integration, implementation, sequencing and communication. Moreover, patients may be more receptive to the non-threatening inviting form of treatment than they are to task-oriented forms of rehabilitative disciplines. In my practice I have known patients who were restless in physical therapy, speech therapy and neuropsychology sessions but in art therapy were engaged, able to focus, created for longer durations and achieved significant gain.

In the case of the man who drew back his brains, his art process moved from an initial drawing of fragmented shapes, to mechanical birds-eye-view diagrams, to content-rich full perspective landscapes. His comment was an association to a drawing of his neighborhood, suggesting that personal reminiscence served as a catalyst for improved memory, attention, organization and communication. It also implied increased awareness that he was indeed impaired and was now making gains. After numerous art therapy sessions, follow-up neuropsychological pictorial assessments indicated improvement in visual organization and comprehension and a speech therapy evaluation upon discharge noted increased spontaneous language.

A concept within the rehabilitative medicine domain is that of ‘generalization’ – the broadening of a specific improvement to other realms, crossing over benefits from one activity or therapeutic endeavor to another. For example, a patient with a field of vision or perceptual neglect caused by brain injury may be guided to turn his or her head to take in the ignored side of the canvas, then would replicate the wider scope in the environment. As stated by Jackie Biggs (2015) who works with veterans, art therapy may “… accelerate healing across the facility’s integrative, patient-centered care” such as with one of her participants whose cognitive treatment was more effective after he could “better communicate and understand himself” (p. 7): http://health.mil/News/Articles/2015/03/18/Art-Therapy-Provides-Pathway-to-Healing-for-Those-with-Traumatic-Brain-Injuries.

A similar carry over has been evident with my patients who were restless in physical therapy, engaged in a focused manner in art therapy, and subsequently remained calm and motivated upon return to PT. Such behavioral modification further underscores apparent therapeutic value in art-making. In addition, the renderings created in art therapy offer diagnostic aspects to other caregivers by revealing potential capacity not otherwise seen.

Art therapy for traumatically brain injured patients seems to facilitate retrieval of cognitive function while also eliciting feelings of mastery, self-worth and identity. Neuropsychologist George Prigatano (1991) describes “the experience of normality despite brain injury” so art therapy also assists in adapting to change when the patient has “a disturbance of self-awareness of deficit after traumatic brain injury.” Art therapist Mickie McGraw (1989) similarly notes “one’s self has changed but lacks the cognitive ability to understand why or how” (p. 38).

In several dimensions the specialization within the profession of art therapy contributes to TBI treatment approaches. There is an elegant almost simultaneous cultivation of cognitive, emotional and behavioral domains. These benefits make for efficient and holistic care and are increasingly recognized by incorporating art therapists into various rehabilitation milieus.

Irene Rosner David, Ph.D., ATR-BC, LCAT, is an Honorary Life Member of the American Art Therapy Association, and is Director of Therapeutic Arts at Bellevue Hospital Center in New York City where she has practiced medical art therapy since 1973. Her work has focused on the contributory role of artistic expression in coping with physical illness and disability. Specializations have included trauma, brain injury, stroke, paralysis, dementia, oncology and palliative care. Dr. David has served on the Board of the American Art Therapy Association and is recipient of awards for her clinical work and advocacy of the field.

References Biggs, J. (2015). Art therapy and brain wellness: When words aren’t enough. Military TBI Case Management Quarterly Newsletter, 6(1), 2-7.

McGraw, M.K. (1989). Art therapy with brain-injured patients. American Journal of Art Therapy, 28(2), 37-44.

Prigatano, G.P. (1991). Disturbances of self-awareness of deficit after traumatic brain injury. In G.P. Prigatano & D.L. Schacter (Eds.), Awareness of deficit after brain injury: Clinical and theoretical issues (pp/ 111-126). New York: Oxford University.