Lara K Ronan M.D.

The Neurobiology of Wellness

Trauma

Visual Art May Soothe Traumatic Experiences

Can we create images we want to remember?

Posted Dec 13, 2018

Pierre Bonnard was a late French Impressionist who painted more than 350 portraits of his ailing wife Marthe. In Bonnard’s portraits, Marthe is portrayed as a lovely, young woman, despite the fact that Marthe obviously aged over the 60 years of his painting career. She was a perpetually the young girl he had just met, even when she was in her fifties when most of the work was painted, and in her seventies towards the end of his career. His portraits portrayed her in the bath dozens of times. She reportedly spent long hours languishing in their bathtub as she suffered chronically from an ailment variably reported as tuberculosis, shingles or obsessive neurosis. While the images pulse with vibrant color, the body in the bath is often cadaveric. Her face is rarely shown in the bath paintings.

© VOLKER NAUMANN© 2012, PROLITTERIS, ZURICH)
Pierre Bonnard, "La Grande Baignoire" (Nu), 1937–1939. Huile sur toile, 94 × 144 cm. Collection privée
Source: (PHOTO: © VOLKER NAUMANN© 2012, PROLITTERIS, ZURICH)

The motivation for Bonnard’s work has been interpreted to reflect his silent expression of grief for Marthe’s plight. The many portraits juxtapose youth and beauty against the probable lived experience of his wife diminished into a haggard, middle-aged woman in the throes of significant illness. Bonnard created an alternative image to literally carry with him to obscure reality. We can imagine that he was painting the fantastical image of loveliness and beauty that her illness had robbed from them both and that he cherished and wanted to remember. While Bonnard himself did not comment on this idea, the notion that he was processing the trauma of losing the wife he envisioned is compelling.

The mother of a friend recently entered hospice care with terminal cancer. My friend has been struggling, as expected, with her impending loss of a loved one. She is an artist and she asked if we would like to see a pastel painting of her mother that she had just completed. The portrait revealed a lovely, middle-aged woman smiling demurely into the middle distance. She has shoulder length dark brown hair without a hint of grey, a rosy complexion on full cheeks, and no hint of the wrinkles that would betray her age or suffering. Her mother was beautiful and at ease. This was the image of her mother that she wanted us to see. "I did this in about two hours last night," she said. I knew that she had also spent the day at her mother’s house holding her hand and watching her fade away. She was terribly upset and struggling to find the strength to return again. The strain was wearing her down.

After my father died unexpectedly, I found a cache of old photos from the 1960s. I spent the next year recreating portraits of my father from those curled and forgotten photos. Those paintings now hang in my house and are a great source of consolation and joy. I am able to look at the young, vibrant man that I have chosen to remember. These images have pushed out the terrible memory of the unrecognizable man that I saw last at the funeral. That last image can still be called up if I attempt to recall it, but the "better" memories that I created after his death take precedents in my daily working memory now.

Mental images of trauma can torment and can form a basis for distress, ranging from intermittent unpleasant memories to Post-traumatic stress disorder (PTSD). Words are often insufficient and unhelpful tools to process trauma. For some people, talking about trauma can actually intensify unwanted and intrusive memories of traumatic events. Research has suggested that at least 30% of patients with PTSD do not benefit from evidence-based therapies such as Cognitive Behavioral Therapy of Eye Movement Desensitization and Reprocessing (EMDR). This can be especially true for patients with poor verbal memory or emotional over-modulation. Karin Schouten and her group recently reported a pilot study of trauma-focused art therapy for adults with PTSD in which they showed that it is feasible and beneficial on patient-reported measures of increased relaxation, externalization of memory and emotion onto artwork, less intrusive thoughts of traumatic experiences and increased confidence in the future. This type of expressive art therapy was described by Cathy Malchioldi, Ph.D. The therapist strives to calm emotion with creativity in order to engage with higher cortical brain functions such as rational thought and verbal memory to address trauma without overwhelming a person emotionally. Art therapists use the creation of visual work with psychoanalytic counseling to process trauma with reported benefit.

The compulsion to create preferred images of an ill or deceased loved one provided some apparent solace for myself, my friend and conceivably for Pierre Bonnard, given the immense number of portraits he painted. The unspeakable trauma of witnessing illness or death found, in these examples, an outlet to communicate itself with the outside world. Replacing an emotionally unacceptable memory with a "better" one would seem to be a coping strategy that engages visual memory circuitry in a parallel to that responsible for creation of traumatic visual memory. Holding the preferred image in the working memory seems to mitigate grief, other negative emotion in these examples. There is a neurobiological correlate, the Adaptive Resonance Theory (ART) that may well explain this effect. The brain can achieve learned memories that are stabilized by top-down higher cortical expectations, attentional focusing, and memory search. Matching learning to memories is used by the brain to adapt to a changing world (Grossberg).

As a coping strategy, this concept has a huge practical application for any individual struggling with undesired memories. We can co-opt brain circuitry to process trauma, stabilize memory and emotion by engaging in focused creative activities.

References

Schouten, KA, Knipscheer JW, Kleber RJ, Hutschemaekers GJM. Trauma-focused art therapy in the treatment if post-traumatic stress disorder: A pilot study. J Trauma Dissociation. 2018. Aug 15

Grossberg, S. From Brain synapses to systems for learning and memory: Object recognition, spatial navigation, timed conditioning, and movement control. Brain and Memory: Old arguments and New Perspectives. Michel Baudry and Gary Lynch, eds. Br

Pierre Bonnard, "La Grande Baignoire" (Nu), 1937–1939. Huile sur toile, 94 × 144 cm. Collection privée Source: (PHOTO: © VOLKER NAUMANN© 2012, PROLITTERIS, ZURICH)

ain Research. 2015. 270-293.