Artwork During Recovery From Encephalitis

By Neuroskeptic | January 6, 2013 10:37 am

I recently wrote about anti-NMDA receptor encephalitis, a neurological disorder that often manifests with psychiatric symptoms, such as depression and hallucinations.

The latest American Journal of Psychiatry features a strange series of four drawings made by a 15 year old girl during an episode of the disease, which presented as psychotic symptoms but later progressed to severe insomnia and epilepsy before it was diagnosed and treated.

“As she gradually recovered we asked her to draw something. She did not know what to draw, so we suggested an animal, such as a dog, but she did not know how to start.

When we told her that a dog has four legs, a tail, two ears, two eyes, and a mouth, she drew an abstract figure that consisted of a head with four legs (A). Her next drawing, of a cat, looked exactly the same, apparently since they share the same basic features.

Two weeks later the dog now looked more recognizable but like a human, standing upright, with two arms and four legs…All body parts were listed beneath the figure in the same color as they were drawn (B).

Two months after the patient was transferred to a local rehabilitation center, the cat was catlike for the first time; it had four legs, was normally proportioned, and was correctly positioned. Colors were used adequately. However, this drawing still looked like one by a primary school child instead of a 15- year-old girl (C).

Finally, after 5 months of rehabilitation her drawing had a normal composition. She still had the urge to write down what she drew, she did not encircle the figures anymore (D).”

ResearchBlogging.orgEsseveld MM, van de Riet EH, Cuypers L, and Schieveld JN (2013). Drawings During Neuropsychiatric Recovery From Anti-NMDA Receptor Encephalitis. The American journal of psychiatry, 170 (1), 21-2 PMID: 23288386

  • Anonymous

    why is this even considered 'science'? A series of drawings made by a sick girl is just that. N=1. Says nothing, apart from perhaps the silliness of psychiatry as a science.

  • Neuroskeptic

    You've driven me to Haiku Anonymous:

    Is it science? No:
    An interesting pic, no more. Now,
    Stop spamming like Szasz!

  • Enver

    I'm curious if all psychopats have problem with science of psychiatry

  • Bart

    Psychiatry and psychology are needed to approach the problem top down. Research from molecular level is needed, however until now it is not sufficient to explain complex mechanisms in our brain, not even mechanisms in one neuron. So psychology and psychiatry are the only means that do work a bit.

    If think every science is masquerading as exact. The only real exact science is math. But math does not cure diseases.

  • Anonymous

    'Stop spamming like Szasz!'

    Hey! I am the only Szaszian in the global village and this is my first post for a few days…

  • Neuroskeptic

    No you're not – I have a Szaszian on my desk.

    It's a big rubber stamp saying “NO” and some red ink. I just stamp everything related to psychiatry I see; it's like Szasz himself were in the room!

  • jim

    Do you always get this many trolls?

  • Anonymous

    Art training (or lack thereof) can have a huge impact on how one draws. I can't figure out the difference between C and D that leads to the conclusion. “However, this drawing still looked like one by a primary school child instead of a 15- year-old girl”.

    Nevermind the fact that professional artists do not draw alike, hence the concept of “art style”.

  • Neuroskeptic

    jim: No, but it's been getting worse lately so I'm hereby cracking down.

    Any comments that say more about the author's pet hates than about the topic of the post will be deleted.

  • spike

    why do you use A,B,C and D instead of 1-4 as labels?
    I was slightly confused for 10 secs, just thought I can tell you about it

  • julia

    I don't think pointing out the obvious counts as “Szaszian”, but whatever. Szasz was trying to point out the wrongs of unscientific data justifying social control. This is just “unscientific data,” which is not invaluable in the right context. Where would practical physics be without theoretical physics? And where would theoretical physics be without simple observation of a phenomena?

  • Neuroskeptic

    julia: The first comment wasn't Szaszian per se but that Anonymous has been spamming in a Szaszesque manner for a couple of weeks.

  • Anonymous

    As an artist concerned with draftsmanship at any level and “style”, I find this research somewhat silly.

    Ability to draw depends on mental well-being; being able to muster the mental faculties to pay attention to many things at the same time has a big effect on so called “drawing ability”, which has day-to-day variability for every artist and it's a very well known thing for any creative professional (even amateur), visual or not. This draftsmanship abilities' dependance on mental faculties is pretty much all that this paper is capable of indicating. The drawings aren't even drastically different in terms of features (as would usually be the case for drawings done at different ages) as to suggest something speciffic to encephalitis, there's nothing special to see here. Sick girl not feeling well, she can't put a lot of effort into drawing – sick girl's drawing not very good. They can repeat the same experiment involving food poisoning or severe fever and it's likely they will get similar result.

    I sincerely do not understand what is the relevance of this paper.

  • Anonymous

    A different Anonymous:

    You might find these of interest, including the discussion between “joe” and “endofthegame” near the bottom of the comments. Regardless of the interpretations one chooses, the progression is visually striking:

  • Tetyana

    I wish you could upvote comments on here. I'd upvote your Haiko and what Black Book doc said.

    Antipsychiatry is, um, interesting. I read the wiki page on it when I came across someone who said they were antipsychiatry. It is often very legitimate criticisms, but, why be “anti-” when you can work to make the field (and the science) better? It is like being anti-medicine because there are some shit doctors, and not all diseases can be cured, or whatever. It seems like misplaced anger, really. (Though, I definitely understand being angry when you've been forced to take anti-psychotics against your will and had to face awful side-effects.)

    N=1 is not science, but it is interesting and potentially useful.

  • Thhh

    can't really understand both parts arguing on psychiatry-antipsychiatry in the case of a neurological disorder -a case of limbic encephalitis, you would find autoantibodies, RM alterations, CSF proteins upregulation and other.

    not to say “psychiatry is not a science”, I'm not of that party, but in this case is not even psychiatry 😉

    @anonymous (the artist one): you could be right, but the fact here is that the organ directly affected in this case is the one that compose a drawing. If I ask a patient with dementia with lewy body to draw something he will some difficulties, and it's not just because of a “general illness negative impact”, but a special feature of that illness.
    This is just a case report, a tip, a “it could be interesting”, so it's still worth publishing -even though I won't say “anti_NMDAR encephalitis have problems in drawing ideation”

  • Anonymous

    Are any of you survivors of encephalitis? I am. Now 7 months post hospitalization from bacterial meningitis and encephalitis. While you may pick this study of one patient apart relative to it's merits as science,medicine,psychiatry, voodoo science or psychology, and/or it's simplicity, you fail to take into account how any evidence of how an injured brain may recover and progress is important to those of us who have survived and our families and caregivers and, yes, those clinicians who are treating us. It's not about how artistic the patient was or could be but about how the brain becomes able again to recognize what elements should be in the drawing, regardless of how rudimentary such drawings may be. Having been in the hospital 45 days, 18 of those in intensive care, the rest in a long term care unit, amnesia of the first 32 days and waking up, in spite of all the opinions that I would die or be in a vegetative state forever, dramatically physically and possibly cognitively and emotionally changed forever, I can tell you that victims and their families are thirsty and sometimes desperate for information and hope regarding the prognosis and outcome of having had encephalitis. I was taken to the ER 3 days in a row before I was hospitalized with bacterial meningitis and encephalitis due to pain old staph aureus. I have amnesia of the first 32 days. I have had what my clinicians term a miraculous recovery. I have read the entire contents of my medical records to gain insight on what was happening to me. I had speech and physical therapy. At no time after I became conscious did I have any sort of formal cognitive testing or therapy for cognitive recovery. I had to take it upon myself to assess myself and begin my own program of improving my cognitive state. When I asked my doctors on discharge what was the usual course of recovery I was told that patients in my condition usually did not survive at all and go home and just do things as I felt like doing them. As I communicate via the web with other survivors or their caretakers, I find that pretty much this is universal. “You had E, you have brain damage, we don't really know what to do so go home, do the best you can and carry on. Call us if you need us.” I am one of the very fortunate, lucky, blessed ones who lived, have retained or regained most of my cognitive abilities intact and have and am still recovering physical strength and ability. I have been able to return to my job as a psychiatric registered nurse supervisor in a state mental hospital on 9/18/12. ANd, Yep, I have seen a lot of things concerning psychology and psychiatry that falls into the voodoo, magical thinking, cow flop category. But observation, evaluation, education, repetition, dedication and determination can do a hell of a lot of good in the absence of “exact science.” I dare say that if the existence of the world and everything on it depended on exact science, it wouldn't exist at all. Experience, good or bad, is not an exact science either but it is the thing that propels us forward and promotes change.

  • Neuroskeptic

    I'm deleting comments because they're off-topic & have been said before, not because I disagree with them.



No brain. No gain.

About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.


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