Dopamine Country: A Tale of Poetry and Parkinson's Disease

When drug treatments unlock latent abilities

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One particular day, a 44-year old man started writing poetry for the first time.

Although this man was distantly related to a famous poet, he himself had no prior interest in literature or the arts until relatively recently. In fact, he considered himself to be less intellectually accomplished than his siblings. And yet, since picking up a pen on that first day, this man would eventually write 10 poems in his first year. Not only would he succeed in publishing his poems in newspapers and magazines, he would go on to win a prize in the annual contest for the International Association of Poets.

Not bad for a beginner.

What’s his secret? Why the sudden outburst of creativity? Was it something he saw on television? Something in the water? Perhaps, it has everything to do with the fact that he has Parkinson’s disease.

At first glance, this idea might not make much sense. Parkinson’s disease (PD) is a progressive neurodegenerative disease that affects movement. People with PD exhibit four cardinal symptoms: an abnormal slowness of movement, rigidity, tremor and postural instability. At first, symptoms can start small, like an inability to tie one’s shoes. But over time, symptoms can worsen to the point where people with PD are unable to walk or make the movements necessary for daily life.

There are many parts of the brain that control movement. Perhaps you’ve heard of the motor cortex before, or even the cerebellum. However, deep inside the brain, groups of neurons called the basal ganglia are responsible for controlling one particular aspect of motor control: the initiation and termination of movement. Similar to the gas and brake pedals of a car, accurate movement requires a finely tuned balance between stopping and starting. In fact, different injuries or diseases to different parts of the basal ganglia can either produce a lack of movement (like Parkinson’s disease), or an excess of movement (like hemiballismus, which is characterized by uncontrollable movement of the limbs).

To maintain this balance, the different parts of the basal ganglia talk to each other and to the rest of the brain through neurotransmitters – the chemical messengers used by neurons to excite or depress one another. One of the neurotransmitters that is used for communication in the basal ganglia is called dopamine. You may have already heard of dopamine as being associated with reward and happiness, but in the basal ganglia this neurotransmitter is essential for the control of movement. The source of dopamine in the basal ganglia specifically lies in a small bundle of cells called the substantia nigra, or “black stuff”, named because the cells themselves are black in color.

Parkinson’s disease is caused when the dopamine-making cells in the substantia nigra slowly and inexplicably begin to die off. When this happens, levels of dopamine decrease in the basal ganglia, and the different groups of neurons that need dopamine to function begin to act abnormally. This ends up diminishing or garbling the signals going from the basal ganglia to the rest of the brain that are necessary for coordinating movement, and as a result, the brain’s subsequent ability to generate movements is compromised. So how could this phenomenon in the brain also lead to a sudden burst of creativity?

Let’s go back to our friend the Poet. He was diagnosed with PD at age 40. Four years later, he started drug treatments. Within a month of starting his drug regimen, he had started writing poetry. Curiously, he is not alone. There are several documented cases of PD patients taking up artistic hobbies including painting, sculpture, writing and even embroidery. In all cases, these sudden bouts of creativity have manifested soon after starting treatment.

While there is no cure for PD, yet, the most common drug treatment for people with PD is dopaminergic therapy. Dopamine therapy aims to restore the missing actions of dopamine within the basal ganglia. This is done by giving the patient L-Dopa, a chemical building block that the brain uses to make more dopamine for itself, or dopamine agonists, which mimic the actions of dopamine by activating the same receptors.

So what’s going on? It is well known that the basal ganglia is not the only part of the brain to use dopamine – other brain structures also use it, and unlike the basal ganglia, their levels of dopamine are relatively normal in PD. What would happen if you then proceeded to flood the entire brain with a dopaminergic drug?

To explain this, picture a country with two small towns in it. One town is called Movement, and the other is called Creativity. Both towns originally have an ample supply of rainfall. But, one day, Movement Town starts experiencing a severe and prolonged drought, and the people there begin to suffer.

If the rainfall represents dopamine, picture dopaminergic drug therapy as the equivalent to summoning a giant storm to come along and rain on the country. Movement, which was in need of water, now has enough water to keep its citizens alive. But Creativity, which is also getting rained on, now has more water than it knows what to do with, and its citizens are flooded.

By essentially flooding the brain with dopaminergic drugs, the basal ganglia can now function somewhat correctly, and people with PD can feel their motor symptoms improve. However, the parts of the brain that deal with creativity now have dopamine in excess, and as a result these areas become hyperactive.

How are dopamine and creativity linked? The study of creativity is an exciting new field of neuroscience of which not much is known, and there are several hypotheses as to how dopamine can increase creativity in a person. One study suggests that dopamine increases the flow of sensory information into the brain, making us more susceptible to drawing more connections between different pieces of information. Another study proposes that an increase in dopamine decreases our inhibitions, making us more open to new ideas. 

When we take pharmaceuticals, we usually expect side effects to occur. When we’re dealing with a machine as complicated as the brain, side effects are practically guaranteed. We rarely think that the side effects of a drug can actually be beneficial. But, sudden creativity in PD patients is common enough that art therapy groups for PD have started appearing at hospitals. In fact, there is a PD art therapy group in Chicago at Northwestern Memorial Hospital, which specializes in singing and dance.

However, if you’re an aspiring artist, I don’t suggest you start taking dopamine to increase your ability - Creativity and Movement are not the only two towns in Dopamine Country. As mentioned previously, dopamine is well-known for its role in reward and pleasure. The ventral tegmental area of the brain, otherwise known as Reward Town, uses changes in dopamine levels to signify increases or decreases in pleasurable things like food, drugs and sex. So what would happen if Reward Town was also constantly flooded with dopamine? It’s quite common for PD patients taking medication to exhibit obsessive-compulsive and addictive behaviors, like compulsive gambling, shopping or hypersexuality.

Luckily, our Poet friend did not feel any impulse to gamble away his life savings. However, as the years went by and the Poet continued taking dopaminergic drugs, he began to show more negative side effects like impulsivity, hostility and paranoia, which put strain on his family and worsened his quality of life. Despite these complications, dopaminergic therapy remains the best pharmacological intervention for Parkinson’s disease. Yet, it is an imperfect treatment, and far from an actual cure.

What can we possibly do to restore dopamine in the basal ganglia while leaving other parts of the brain untouched? Several scientists are looking at the possibility of injecting human stem cells directly into the substantia nigra, in hopes of “regrowing” the dopaminergic neurons that have been lost. Similar to digging a well in Movement Town to restore lost water, it would restore dopaminergic function in the basal ganglia while leaving other parts of the brain alone. But, these studies are still in the early stages, and it may be years before this kind of therapy may be available to people with PD. In the meantime, we can only continue to do research into new drug treatments that can slow the progression of PD while minimizing possible side effects.

But thanks to our Poet, we have learned that not all drug side effects are bad, and in fact can tell us a lot about how the brain can create something as nuanced and abstract as creativity. So if you have a relative or a friend with Parkinson’s disease, buy them a watercolor set and ask them to make you something. Just don’t take them to Vegas.

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I have just published a book

<div id="page1"><p>I have just published a book Naked Under My Coat - Writing Under the Infleuence of Parkinson's .&nbsp; It will be available early in June.&nbsp; Here is a pre-review by Catherine Ford that was published in the Calgary Herald last January .</p><p>Joceln Burgener</p><p>I am no poet. I still cringe thinking of the truly awful poetry I wrote as a teenager.</p><p>Despite being raised with a father who loved poetry — car trips were punctuated with recitations of so-called “story poems” and I can still ream off most of the 96 turgid lines of The Ballad of East and West, by Rudyard Kipling — I remain unqualified to be a critic of poetry.</p><p>That said, Jocelyn Burgener’s poetry, which constitutes the bulk of Naked Under My Coat: Writing Under the Influence of Parkinson’s, is decidedly not turgid. Much of it is insightful, some poignant enough to make a reader pause — Hips ends with these lines: “Who will hold me/ When I cannot move” — and some are beautiful, as The Same Day, a tribute to her children’s shared birthday, two years apart on March 23. Many of her poems are visually appealing, the words forming the shape of her subject...</p></div><p></p><p></p>

I was diagnosed having

I was diagnosed having Parkinsons 5 years ago, with hindsight, I have had Parkinsons a lot longer. In early 2015 my wife saw handbill/flyer aboutique art for Parkinsons in a local shopping Centre re Art for people with Parkinsons. I had never drawn or painted anything before apart from doodling. I really love painting and drawing since then, I do it at home as well as in class,

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