arts

Article Neglect and the Kaleidoscopic : and Mental Health in Contemporary Art

Marcos Lutyens 1,* and Leonardo Christov-Moore 2

1 Independent Artist, Los Angeles, CA 90065, USA 2 and Creativity Institute, University of Southern California, 3620A McClintock Avenue, Los Angeles, CA 90089, USA; [email protected] * Correspondence: [email protected]

 Received: 9 January 2020; Accepted: 26 March 2020; Published: 8 April 2020 

Abstract: This paper seeks to explore the broad question of whether and how art can be applied to medical therapeutic practices. As part of this research, the paper outlines an ongoing project, exemplifying this combined approach, which seeks to improve function in stroke patients. We reviewed previous collaborations between art and psychology dating back to the 1960s, employing methods ranging from simple, analog, haptic interfaces to the contemporary potential of machine to improve brain function. We then outline an ongoing project employing machine learning and multisensory stimulation to improve function in stroke patients, which are being run in collaboration with Klinik Lippoldsberg, . We discuss the possibility that these same approaches may also be applied to healthy people as an open-ended inquiry into and mental optimization. It is hoped that these approaches will be beneficial to the medical community, but also equally broaden the reach and context of contemporary art, which is so often marginalized within institutions that are not readily accessible to or in communication with other disciplines.

Keywords: stroke; art; healing; neuroscience; AI; machine learning; therapy; medicine

1. Background This paper stems from a collaboration called “Symmetries of the Mind”, with Klinik und Rehabilitationszentrum Lippoldsberg, located in the Wahlsburg area of central Germany. The clinic specializes in the rehabilitation of stroke patients and is situated on the grounds of a former Nazi bomb factory in the forest near the village of Lippoldsberg. The aim of this collaborative project has been, broadly speaking, to bring artistic practices to a therapeutic context by (a) enlarging and expanding the potential for healing beyond the boundaries of established therapies and, conversely, (b) broadening the scope of what one would consider to be an artwork or art process. More specifically, this project aims to bring the tools of contemporary art, in collaboration with science, towards the improvement of function in stroke patients via multisensory stimulation, including the use of a machine learning interface. This is intended to encourage the formation of novel neural connections and thus encourage the formation of alternate, functional connectivity, bypassing the connections damaged by stroke. As psychiatrist Joseph Michaels(1935) noted, in his paper in the Journal of Orthopsychiatry, upon visiting Hans Asperger’s clinic in Austria: “In this age of ‘technocracy’ with its over-emphasis on technical procedures, it is rather unusual to find a highly personal approach characterized by an appreciable absence of what are ordinarily regarded as rigid methods, apparatus, statistics, formulae and slogans ... great value is placed on intuition.” Accordingly, the approach of this paper, which involves art practices in a medical context, makes use of intuitive and creative approaches to healing that may not fit neatly into the standard methods of a medical paper.

Arts 2020, 9, 47; doi:10.3390/arts9020047 www.mdpi.com/journal/arts Arts 2020, 9, 47 2 of 20

This project was initiated in early 2019 by the clinic director Dr. Ralf Pinnau and has been conceptualized under the title of Clinic Parcours by international curators Christoph Platz and Henriette Gallus. “Parcours” is French for “route” or “course”. Two other artists, apart from Marcos Lutyens, have been invited to participate: Imogen Stidworthy of the United Kingdom and Peter Schloss of Germany. They are working towards an exhibition for late spring 2021. This type of collaboration between art and medicine recalls other collaborations between art and science such as the embedding of artists James Turrell and Robert Irwin with the Garrett Corporation, facilitated by the L.A. County Museum of Art’s Art & Technology program, through which they worked with psychologist Ed Wortz in 1969. By bringing scientists and artists together, new lines of research may be created. Indeed, in the case of Turrell and Irwin, research on the properties of anechoic chambers were later applied to the artists’ works (Cateforis et al. 2019). Conversely, artists have also contributed to scientific advances, such as William Brockedon, inventor of the first pill-making machine. Indeed, the division between art and science has historically been a porous one (Wilkinson et al. 1971).

2. Art and Science in Therapy The focus of Lutyens’ (the primary investigator) work is consciousness, which he has researched extensively through various means that are described below. Human consciousness remains poorly understood from nearly every perspective, whether investigated by philosophers, psychologists, or neuroscientists, as highlighted by cognitive scientist David Chalmers(1995), with what he termed “The Hard Problem of Consciousness”. For this reason, Lutyens has turned to less well-established processes and methods: experimenting with groups of synesthetes, exploring the power of suggestion through collective and individual hypnosis, and mediating and promoting shamanic experiences. Lutyens combines these with more conventional methods such as conducting and analyzing online and physical surveys. Lutyens’ art endeavors have often been interwoven with healing practices, and indeed, his interest in consciousness has led him to explore not just the creative aspects of the mind, but also that of illness and healing. This approach is part of a long trajectory of healing and art being interlinked, dating back not only to hunter–gatherer societies (Whitley and Hays-Gilpin 2008, p. 44), but also much more recently with the development of creative arts therapies, which can include the use of art, music, psychodrama, and dance within a therapeutic context to promote healing in hospitals, clinics, and independent practitioner’s studios (Landgarten 1981). To give one example among many, UCLA ran a program called “Art that Heals”, which was designed to help patients to cope with the stresses related to being hospitalized through making art (Breslow 1993). Medicine and science have historically been intertwined; Lutyens was drawn to shamanic healing practices as early as age seventeen in the Amazon rainforest of Ecuador and explored it more closely after his twenties, with special interest in those of the Huichol, originally known as the Wixarika, a tribe in the Western Sierra Madre of Mexico. The healing process they use involves the application of medicinal plants (Valdivia-Correa et al. 2016) as well as the hallucinogenic cactus, peyote (Lophophora Williamsii), for psycho-spiritual rituals. Figure1 shows a Huichol Shaman conducting a healing ritual for participants in a pilgrimage to the mountains of the Western Sierra Madre, Mexico. What stood out to Lutyens was how in these traditions, unlike in Western/European medicine, the body, the mind, and the spirit were all considered to be linked and extended seamlessly into nature. This contains, in its intuitive way, the notion that healing needs a strong psycho-somatic basis and that one cannot rely solely on surgery and pharmaceutical drugs to heal. Furthermore, in the West, the ancient role of the shaman has been divided into three practices: (a) the doctor, who looks after the body as a bio-mechanical object, (b) the priest, who looks after the spirit, often in the context of a political matrix, and (c) the artist, who is often relegated to a kind of creative decorator (La Barre 1979, p. 7). However, recently the idea of integrating psychedelics back into medicine has been gaining traction, particularly in the cases of PTSD or hospice care, and has attracted mainstream through the growth of Arts 2020, 9, 47 3 of 20 the wellness industry and, most recently, through the bestselling book How to Change Your Mind by

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Figure 1. From aa journeyjourney withwith Wixarika Wixarika shaman shaman or ormarakame marakameDon Don Marcelino Marcelino in Wirikuta.in Wirikuta. His His sonic sonic hat hatand and the the bright bright colors colors he he wears wears stimulate stimulate the the heightened heightened sensing sensing that that is is integral integral toto beingbeing a marakame and extending healing to participants of the pilgrimage.pilgrimage. All All figures figures in in this this article were created by Marcos Lutyens.

Following these shamanic initiations, Lutyens became intrigued by hypnotherapy as as a way of accessing alteredaltered statesstates of of consciousness, consciousness, as as well well as itsas healingits healing potential potential to help to reversehelp reverse negative negative habits, habits,as is used as inis treatingused in addictions treating addictions or to enhance or existingto enhance mental existing or physical mental attributes. or physical A hypnotherapist attributes. A hypnotherapisthas been defined has in been the Federaldefined Dictionaryin the Federal of Occupational Dictionary of Titles Occupational as a professional Titles as whoa professional “Induces whohypnotic “Induces state hypnotic in client state to increase in client motivation to increase ormotivation alter behavior or alter patterns: behavior Consultspatterns: Consults with client with to clientdetermine to determine nature of nature problem. of problem. Prepares Prepares client to enterclient hypnoticto enter hypnotic state by explainingstate by explaining how hypnosis how workshypnosis and works what and client what will client experience. will experience. Tests subject Tests to determinesubject to determine degree of physicaldegree of and physical emotional and emotionalsuggestibility. suggestibility. Induces hypnotic Induces state hypnotic in client, state using in client, individualized using individualized methods and methods techniques and of techniqueshypnosis based of hypnosis on interpretation based on interpretation of test results andof test analysis results of and client’s analysis problem. of client’s May problem. train client May in trainself-hypnosis client in self-hypnosis conditioning” conditioning” (U.S. Department (U.S. ofDe Labor,partment Offi ofce Labor, of Administrative Office of Administrative Law Judges 1977Law, p.Judges 64). Lutyens1977, p. studied64). Lutyens at the studied now defunct at theAmerican now defunct Institute American of Hypnotherapy Institute of Hypnotherapy and began to work and withbegan patients to work struggling with patients with struggling addictions with as well addictions as other as physical well as orother mental physical issues. or mental issues. The most most challenging challenging endeavor endeavor of of the the time, time, relating relating to the to theuse useof hypnotherapy of hypnotherapy by Lutyens, by Lutyens, was wasworking working with with Los LosAngeles Angeles “at-risk “at-risk youth” youth” in in1998 1998 through through the the HeArt HeArt Project Project (now (now artworxLA), artworxLA), founded by Cynthia Campoy-Brophy. The project, called Blown AwayAway,, comprised hypnosis sessions that reframed fear and past past trauma, trauma, which which was was often often related related to to first-hand first-hand expe experiencerience of of gang gang violence. violence. The participants re-lived experiences during hypnosishypnosis and then translated those experiences into prayer flags flags that were silk-screened at Self Help Graphics, a non-profit non-profit art collective in East Los Angeles. In 2001, the flags flags were shown at the Armory Center in Pasadena, as well as at the Southern California School of Architecture and the World Festival of Sacred Music hosted by the UCLA Center for InterculturalIntercultural Performance Performance and and the Dalaithe Dalai Lama. La Thema. journey The forjourney the students for the from students the hypnotherapy from the hypnotherapysessions to the sessions creation to of the the creation flags to theirof the display flags to and their sharing display with and the sharing community with the was community a process wasdevised a process by Lutyens devised to turn by Lutyens an internal to traumaturn an into inte arnal shared trauma and openinto a gesture shared of and healing. open gesture of healing. Two years later and extending his research into trauma and art, Lutyens worked on an exhibition at Susanne Vielmetter Gallery in 2003 called “Esomotive”, which sought to psychologically restore the missing arm of celebrity drummer Rick Allen of British rock group Def Leppard. Despite losing his arm in a car accident (Wilkening 2014), Allen continued drumming successfully in the band. It

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Two years later and extending his research into trauma and art, Lutyens worked on an exhibition at Susanne Vielmetter Gallery in 2003 called “Esomotive”, which sought to psychologically restore the missing arm of celebrity drummer Rick Allen of British rock group Def Leppard. Despite losing his arm Arts 2020, 9, x FOR PEER REVIEW 4 of 20 in a car accident (Wilkening 2014), Allen continued drumming successfully in the band. It seemed that seemedhe had managed that he had to remapmanaged the to functioning remap the offunctioning his lost arm of ontohis lost his arm remaining onto his three remaining limbs, althoughthree limbs, he althoughstill suffered he physicallystill suffered and physically mentally fromand thementally loss. Through from the hypnotherapy loss. Through sessions hypnotherapy together, sessions Lutyens together,sought to Lutyens aid him sought in re-imagining to aid him his in phantomre-imagini limbng his in phantom such a way limb that in such he would a way re-integrate that he would the re-integratelost side of himself.the lost side The of hypnotic himself. ideation The hypnotic sought ideation to convert sought his lossto convert into a physicalhis loss into a physical form, whichthought for form, Allen which took for the Allen form took of a reptilian,the form of amphibious a reptilian, vehicle. amphibious In Figure vehicle.2, Lutyens In Figure pictures 2, Lutyens the picturesimagined the shape imagined as taking shape form as taking in Allen’s form mind in Alle inn’s this mind superimposed in this superimp photographosed photograph of him and of ahim 3D printedand a 3D model printed of themodel thought-form, of the thought-form, which was wh fabricatedich was fabricated following following his description. his description.

Figure 2. StillStill from from Esomotive Esomotive project project with with Def Def Leppard Leppard drummer drummer Rick Rick Allen Allen in in hypnotic hypnotic trance. trance. Exhibited at Susanne Vielmetter gallery 2003.

A decade later, and extending his research into the relationship between inner states states of of mind, mind, the body, andand thethe ,senses, LutyensLutyens worked on a projectproject at the 14th14th IstanbulIstanbul Biennial, which charted the emotional response of thousands of biennial visi visitorstors to shape and and color, color, in collaboration with the neuroscientist V.S. Ramachandran. Together with curator Carolyn Christov-Bakargiev, they brought Ramachandran’s famousfamous “mirror “mirror box” box” (Figure (Figure3) to the 3) Istanbul to the Museum Istanbul of ModernMuseum Art. of Ramachandran Modern Art. Ramachandraninvented the Mirror invented Box for the healing Mirror the Box “phantom for healing limb” the syndrome,“phantom alimb” condition syndrome, in which a condition a missing orin whichamputated a missing limb causes or amputated pain where limb the missingcauses limbpain wouldwhere be the (The missing Last Psychiatrist limb would2009 ).be The (The patient Last Psychiatristinserts her existing2009). The hand patient into inserts one side her of existing the box, hand and herinto missing one side hand of the seems box, and to appear her missing in the otherhand seemsside of to the appear box. Byin the moving other theside existing of the box. hand, By moving the patient the hasexisting a hand, that the her patient missing has hand a sense can that be herreactivated missing andhand thus can diminishes be reactivated the pain and related thus diminishes to the loss. the Lutyens pain related was inspired to the byloss. this Lutyens simple was tool inspiredto explore by how this symmetry simple tool and to theexplore use ofhow mirrors symme couldtry and be expanded the use of as mirrors a device could not justbe expanded in art but alsoas a deviceas it relates not just to therapy, in art but particularly also as it inrelates its ability to therapy, to create particularly a sense of completion in its ability in to the create psyche a sense through of completionduplication in or the even psyche multiplicity. through duplication or even multiplicity. As an extension extension of the the MirrorMirror Box Box display,display, Lutyens and Ramachandran Ramachandran conducted a collaborative survey in the museum near where the box was exhibi exhibited.ted. The The survey survey was was designed designed as a a mental mental mirror mirror held up to Biennial visitors that helped better sens sensee which groups groups of of people, people, in in terms terms of of age age and and sex, sex, were more attuned to a correlation between shape, color, and emotion. From a cultural standpoint, the goal was was to to reverse reverse the the usual usual exhibition exhibition dynamic dynamic in in which which a avisitor visitor looks looks at atwhat what is on is on display display at the museum, and instead, the artist reverses the direction of observation by observing the visitor. From a neuroscientific point of view, this was an opportunity to study variations in a cross section of the general public’s understanding of shapes and forms as they relate to emotions. Both of these dynamics could then be fed back into the way museums plan their content to be more attuned to their general public.

Arts 2020, 9, 47 5 of 20 at the museum, and instead, the artist reverses the direction of observation by observing the visitor. From a neuroscientific point of view, this was an opportunity to study variations in a cross section of the general public’s understanding of shapes and forms as they relate to emotions. Both of these dynamics could then be fed back into the way museums plan their content to be more attuned to their general public. Arts 2020, 9, x FOR PEER REVIEW 5 of 20

Figure 3. Ramachandran’s original Mirror Box. The The ampu amputatedtated hand hand seems seems to to appear in the other compartment of the box, helping heal pain associated withwith phantomphantom limblimb syndrome.syndrome.

These experiments between art and therapy were in part inspired by Chilean-French filmmaker filmmaker Alejandro Jodorowsky’sJodorowsky’s book, book,PsychoMagic: PsychoMagic: The The Transformative Transformative Power Power of Shamanic of Shamanic Psychotherapy Psychotherapy,, which describeswhich describes how prescribed how prescribed ritualized ritualized activities helpedactivities heal helped subjects heal who subjects came to who him came for psychological to him for helppsychological (Jodorowsky help 2010 (Jodorowsky). His process 2010). was akin His to process waking peoplewas akin up fromto waking a misconstructed people up world from view. a Asmisconstructed Jodorowsky explains,world view. “Birds As Jodorowsky born in a cage explains, think flying “Birds is born an illness” in a cage (Jodorowsky think flying 1973 is ).an Another illness” inspiration(Jodorowsky was 1973). Annie Another Besant and inspiration C. W. Leadbeater’s was Annie book BesantThought and Forms C. W.(Besant Leadbeater’s and Leadbeater book Thought [1901] 1975Forms), which(Besant sought and toLeadbeater describe how[1901] 1975), shouldwhich besought considered to describe to be objects how thoughts and in this should way help be toconsidered externalize to blockedbe objects mental and in states this way (Besterman help to 1934externalize). blocked mental states (Besterman 1934). As a development of this past research in Istanbul,Istanbul, LutyensLutyens’’( (2015)2015) work exploring fear and trauma in the context of hypnosis was included in the Salon Salon Suisse Suisse of of the the 57th 57th Venice Venice Biennial in 2017 by invitation of Dakar-based curator Koyo Kouoh. Lutyens Lutyens created created a a performance performance titled titled PhobophobiaPhobophobia,, meaning “the fear of fear”, which sought to isolate the location of fear in the body through hypnosis and expel it through a cathartic process centered around an expectancyexpectancy violation. This was done by smashing what appeared to be a helium-filled helium-filled balloon that had been tied around a participant’s wrist with a hammer, revealingrevealing thethe balloonballoon to bebe mademade ofof glassglass (Figure(Figure4 4).). TheThe ideaidea behindbehind thisthis processprocess isis that the mind is often often tied tied to to pre-existing pre-existing ideas ideas su surroundingrrounding challenges and illness, especially chronic ailments, and a self-fulfilling self-fulfilling dynamic develops, making the situation worse over time. As Rollo May described in his book The Meaning of Anxiety , “fear ordinarily does not lead to illness if the organism can flee flee successfully. If the individual cannot flee,flee, but is forced to remain in a conflict conflict situation which cannot be resolved, fear may turn into anxietyanxiety and psychosomatic changes may then accompany anxiety” (May(May 2015 2015,, p. p. 69). 69). When When the mindthe mind is unexpectedly is unexpectedly confronted confronted with a dynamic with a thatdynamic contradicts that previouscontradicts experience, previous experience, it may be freed it may from be its freed expectations, from its expectations, or conflicts, andor conflicts, be able toand reverse be able fixed to ideas,reverse including fixed ideas, ones including about the ones state about of one’s the health.state of one’s health.

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FigureFigure 4.4. Broken glass balloon afterafter aa performanceperformance ofof PhobophobiaPhobophobia..11 Figure 4. Broken glass balloon after a performance of Phobophobia.1 3. Applications to Stroke Therapy: The Symmetrical Brain 3. Applications to Stroke Therapy: The The Symmetrical Symmetrical Brain The application of art-related approaches to therapies dealing with fear and physical trauma, formedThe a applicationjumping off of point art-related for Lutyens approaches to investig to therapies ate art-based dealing treatments with fear for and stroke physical patients. trauma, Art formedand music aa jumpingjumping therapy o offff havepoint point long for for Lutyens beenLutyens used to to investigate ininvestig the treatmentate art-based art-based of treatments stroke treatments patients. for strokefor strokeIn patients.terms patients. of Art music, andArt musicandtreatments music therapy therapythat have are long havebased beenlong in used beenthe inunderstanding used the treatment in the treatment ofof strokehemispheric of patients. stroke lateralization Inpatients. terms ofIn music, termshave treatmentssuccessfulof music, thattreatmentsoutcomes are based (Purdiethat in are the 1997). understandingbased Lutyens in the hasunderstanding of hemisphericwitnessed th lateralizationofe Lippoldsberghemispheric have lateralizationclinic successful encourage outcomes have some successful ( Purdiestroke 1997outcomespatients). Lutyens to (Purdie engage has 1997).in witnessed singing Lutyens therapy. the Lippoldsberghas Inwitnessed terms clinicof tharte encouragetherapyLippoldsberg geared some clinic towards stroke encourage patients stroke, tosomestudies engage stroke have in singingpatientsshown that therapy.to engage art making In in terms singing (see of Figure art therapy. therapy 5) can In geared helpterms in towardsof stroke art therapy recovery, stroke, geared studies such towards haveas by shownfocusing stroke, that attentionstudies art making have and (seeshownmotor Figure skills,that5 art) as can makingwell help as in promoting(see stroke Figure recovery, social 5) can interaction help such in as stroke by and focusing recovery,emotional attention such expression as and by motor focusing (Reynolds skills, attention 2012). as well and as promotingmotor skills, social as well interaction as promoting and emotional social interaction expression and (Reynolds emotional 2012 expression). (Reynolds 2012).

Figure 5. This is an example, from the Lippoldsberg Klinik, of older art therapies combined into a Figuretactile game 5.5. ThisThis for isis an patients,an example, example, which from from helps the the Lippoldsberg them Lippoldsberg engage Klinik, wi Klinik,th ofsocial older of olderrules, art therapies artsequences, therapies combined color, combined texture, into a tactileinto and a gametactileshape. for game patients, for patients, which helpswhich them helps engage them withengage social with rules, social sequences, rules, sequences, color, texture, color, and texture, shape. and shape.

1 Another artist working with fear, in a mode that created a sense of healing in the audience, is Candy Chang, known for her 1 “Before Another I die” artist series, working which with invited fear, the generalin a mode public that to crea expressted theira sense inner of fears healing and hopesin the about audience, life and is death, Candy by Chang, writing 1 their Anotherknown thoughts for artist her on working “Before a wall. It Iwith is die” unexpected fear, series, in toawhich mode be asked invited that to considercrea theted general anda sense respond public of healing to to the express question in the theiraudience, of death, inner especially is fears Candy and in Chang, a hopes public setting and yet, perhaps because of the anonymity, people were surprisingly forthcoming and open (Hervey 2018). knownabout life for and her death, “Before by I writing die” series, their which thoughts invited on a wall.the general It is unexpected public to toexpress be asked their to inner consider fears and and respond hopes aboutto the lifequestion and death, of death, by writing especially their inth oughtsa public on se atting wall. andIt is unexpectedyet, perhaps to because be asked of to the consider anonymity, and respond people towere the surprisingly question of forthcomingdeath, especially and openin a public(Hervey se tting2018). and yet, perhaps because of the anonymity, people were surprisingly forthcoming and open (Hervey 2018).

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Clinic Parcours When invited to Lippoldsberg, which specializes in in stroke stroke therapy, therapy, for Clinic Parcours,, Lutyens’ Lutyens’ previous experiencesexperiences meshed meshed well well with with ongoing ongoing studies studies at the center.at the Onecenter. of theOne main of strokethe main symptoms stroke thatsymptoms the clinic that prides the clinic itself prides in treating itself in is treating that of hemispatialis that of hemispatial neglect ( Lineglect and Malhotra(Li and Malhotra 2015). This 2015). is aThis condition is a condition suffered suffered by 80% by of 80% stroke of patients,stroke patients, which doeswhich not does just not manifest just manifest as the paralysisas the paralysis of the bodyof the or body just or parts just such parts as such the right as the arm right or rightarm or leg right (depending leg (depending on the location on the andlocation extent and of theextent brain of lesion),the brain but lesion), also has but the also curious has the effect curious of preventing effect of the preventing patient from the beingpatient aware from of being a corresponding aware of a areacorresponding of their environment, area of their as enviro shownnment, in Figure as shown6. in Figure 6.

Figure 6.6. ExamplesExamples of of the the consequences consequences of neglectof neglect in stroke in stroke patients: patients: a plate a ofplate food of half food eaten, half a eaten, portrait a halfportrait completed, half completed, a face half a shaved.face half In shaved. all of these In all examples, of these theexamples, patient the is unaware patient is that unaware anything that is abnormalanything is or abnormal missing. or The missing. top left The shows top left eye shows tracking eye attention tracking beingattention drawn being to drawn the right, to the which right, is explainedwhich is explained below. below.

A patient with hemispatial neglect will completely ignore what is on the neglected side of their body and, even curiouser, have no awareness of itsits absence, a condition called anosognosia. A clock, for instance,instance, maymay bebe understoodunderstood by by a a stroke stroke patient patient to to be be half half a clock,a clock, with with all all the the numbers numbers from from 1 to 1 12to appearing12 appearing to be to jammed be jammed into theinto non-neglected the non-neglected side. Toside. help To combat help combat the kind the of magnetizedkind of magnetized attention toattention one side, to testsone side, using tests numbers using arenumbers designed are todesigned draw the to patient’sdraw the attention patient’s acrossattention to the across neglected to the sideneglected of their side vision of their (see vision Figure (see7). Figure 7). Previous to his work at Lippoldsberg,Lippoldsberg, Lutyens was intrigued by stimulating both sides of the brain in healthy people as part of hishis art practice, as in the case of his Ambidelious project, part of the “Intuition”“Intuition” exhibitionexhibition atat the Palazzo Fortuny, Venice inin 20172017 (curated(curated by Axel Vervoordt and Daniela Ferretti andand withwith thethe close close curatorial curatorial support support of of Davide Davide Daninos). Daninos). Lutyens Lutyens worked worked with with visitors visitors of the of exhibitionthe exhibition and and guided guided them them into ainto state a state of trance of trance as they as werethey seatedwere seated in a circle in a ofcircle 17th-century of 17th-century chairs. Lutyenschairs. Lutyens fed them fed two them diff twoerent differe narratives,nt narratives, one into one each into side each of their sidebrain, of their by brain, means by of means a hypnotic of a inductionhypnotic induction that he performed that he performed focusing firstfocusing on one first side on of one the side body of and the thenbody on and the then other. on Whenthe other. in a tranceWhen in state, a trance it is easystate, to it associateis easy to aassociate narrative a na withrrative one with side one of the side body of the (Figure body8 (Figure). Lutyens 8). Lutyens would anchorwould anchor a narrative a narrative in the left in handthe left while hand signaling while signa the leftling ear the to left be ear especially to be especially receptive. receptive. This narrative This thennarrative presumably then presumably landed in landed the right in the brain right hemisphere brain hemisphere due to the due cross-over to the cross-over of the nervous of the nervous system fromsystem one from side one of the side body of the to thebody opposite to the opposite side of the side brain. of the Lutyens brain. thenLutyens asked then participants, asked participants, still in an unconsciousstill in an unconscious state, to draw state, into tosoft draw clay into tablets soft positionedclay tablets on positioned either side on of either them withside of a bronze them with stylus a inbronze each hand.stylus in each hand.

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Figure 7. The bar between the keyboard and the screen is an eye tracking device, which helps the therapistFigure 7. understandThe bar between wherewhere the thethe keyboard patientpatient isis looking.looking.and the In screen this case is an the eye pa patient trackingtient is being device, encouraged which helps to look the attherapist all the numbersunderstand including where the the patien ones tot is the looking. right, neglectedIn this case side the of pa thetient screen, is being althoughalthou encouragedgh in the to image look theat all patient’s the numbers eyes are including drawndrawn totothe thethe ones bottombottom to the leftleft right, twotwo neglected numbers.numbers. side of the screen, although in the image the patient’s eyes are drawn to the bottom left two numbers.

Figure 8. Participant in an Ambidelious performance, drawing into clay tablets with both hands at once. FigureFigure 8. Participant in an Ambidelious performance, drawing into clay tablets with with both both hands hands at at once. once. Impressively, participants drew with fluidity—many people drew with both hands at the same time,Impressively, regardless of participantsparticipantswhich one was drewdrew supposedly withwith fluidity—manyfluidity—m dominant,any each people hand drew appearing with both to express hands at a thedifferent same time,emotion. regardless Lutyens of hoped which thatone was this supposedly “artistic therapy” dominant, would each reconnect hand appearing different tocenters express of athe different diff brain,erent emotion.under siege Lutyens Lutyens by constant hoped hoped electronicthat that this this “artistic “artisticdistractions therapy” therapy” and overspecializationwould would reconnect reconnect different diatff workerent centers(Cytowic centers of of 2019).the brain, It is underimportant siege to by note constant that this electronic project distractionswas not conducted andand overspecialization in a medical or at hospital work ((CytowicCytowic context 2019with2019). ).brain It is importantmonitoring to devices, note that but this nevertheless, project was following not conducted the cues in aof medicalmedical Hans Asperger’s or hospitalhospital approach, context with it used brain a monitoringprocess of interactiondevices, but with nevertheless, the visitors following to lear nth the eof cues possible of Hans cues Asperger’s for stimulating approach, the it mind used in a processunexpected ofof interaction interactionways. Many with with thevisitors the visitors visitorsto tothe learn performato oflear possiblen nceof possiblereported cues for cues stimulatingthat forthey stimulating had the mindbeen ininthe unexpectedsome mind way in ways.unexpected“transformed”, Many ways. visitors while Many to theothers visitors performance experienced to the reportedperforma moving thatnce reported theymoments had that beenof they incatharsis some had way beenaccompanied “transformed”, in some wayby while“transformed”,uncontrollable others experienced tears,while as thoughothers moving some momentsexperienced mental of catharsis blocmovingkage accompanied hadmoments been removed byof uncontrollablecatharsis from oneaccompanied tears, or both as though of theby someuncontrollablebrain mentalhemispheres. blockage tears, as had though been removedsome mental from bloc onekage or both had of been the brainremoved hemispheres. from one or both of the brain hemispheres.

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Italian conceptual artist Alighiero e Boetti, whose work was included in the same exhibition and whoseItalian pseudonym conceptual translates artist Alighiero as Alighiero e Boetti, and whoseBoetti suggesting work was includeddoubled inor thesplit same identity, exhibition also experimentedand whose pseudonym with this mirrored translates use as of Alighiero hands. Heand saidBoetti that suggesting to write with doubled your orleft splithand identity, is like drawing.also experimented Of the process with of this using mirrored both hands, use of he hands. stated, He “To said write that is toto writedraw. withWhenever your leftI write, hand I alwaysis like drawing. use my left Of thehand. process My left of usinghand bothis not hands, able to he write: stated, when “To writeyou see is tothe draw. results Whenever you can Ifeel write, my I physicalalways use pain; my but left to hand. me to My write left is hand in first is notinstan ablece toa great write: pleasure” when you (Catrìon see thea results 2012). youIn other can feelwords, my thephysical act of pain;writing but with to me both towrite hands is created in first instancea positive a greatand perhaps pleasure” healing (Catr ìdynamicona 2012 ).for In him. other words, the actAn of additional writing with project both involving hands created the relation a positive between and perhaps physical healing and neurological dynamic for symmetry him. was the cabinAn additional Lutyens projectdesigned, involving as part the of relation a 2012 between work titled physical Hypnotic and neurological Show in collaboration symmetry was with the Raimundascabin Lutyens Malašauskas, designed, as built part for of adOCUMENTA 2012 work titled (13)Hypnotic (Documenta Show in n.d.) collaboration in , with Germany. Raimundas The cabinMalašauskas, (Figure built9) was for the dOCUMENTA site of 340 hypnosis (13) (Documenta performances n.d.) that in Kassel, Lutyens Germany. conducted The and cabin which (Figure took9) placewas the throughout site of 340 a hypnosis period of performances 100 days. Over that 7000 Lutyens visitors conducted passed and through, which and took apart place from throughout being a culturalperiod of experience 100 days. Overin terms 7000 of visitors the visitors passed expe through,riencing and 4096 apart possible from beingnarratives a cultural delivered experience through in hypnosis,terms of the it also visitors appeared experiencing to be a 4096kind possible of healing narratives experience delivered to the throughpeople of hypnosis, Kassel, so it alsomuch appeared so that itto was be a kindreported of healing in the experience local press to that the peopleLutyens of would Kassel, “mentally so much so clean that itpeople’s was reported desktops” in the (Von local Fraschelpress that 2012). Lutyens would “mentally clean people’s desktops” (Von Fraschel 2012).

Figure 9. The ReflectionReflection Room,Room, aa cabin cabin used used for for hypnosis hypnosis sessions sessions over over 100 100 days days at dOCUMENTA at dOCUMENTA (13). (13).Note Note that therethat there is no is physical no physical mirror mirror in the in space. the space.

ItIt also became apparent that certain medical conditions ma mayy have benefited benefited from these performances, as as in in the the case case of ofHans Hans Ellis, Ellis, who who has has Parkinson’s Parkinson’s disease disease and anddiabetes diabetes and who and later who reportedlater reported that his that symptoms his symptoms had diminished. had diminished. After After the session, the session, he wrote, he wrote, “in the “in second the second session, session, my Parkinson’smy Parkinson’s rigor rigor dissolved dissolved almo almostst entirely, entirely, how how wonderful!” wonderful!”2 His2 His rigor rigor diminished diminished greatly, greatly, so so much much so, that he came back repeatedly for more sessions, bringing with him friends with similar health issues.issues. It It must be emphasizedemphasized thatthat this this project project was was not not conducted conducted as as a medicala medical trial trial but, but, rather, rather, as anas artan artproject, project, so the so authorsthe authors are relying are relying on personal on personal reporting reporting from visitors from visitors as well as impressionswell as impressions received receivedover the courseover the of course the project. of the project. Born in the art art world, world, the the project project is now morphing into a therapeutic tool. The The cabin cabin is now now being being rebuilt at at the the Klinik Klinik und und Rehabilitationszentrum Rehabilitationszentrum Li Lippoldsberg.ppoldsberg. The The particularly particularly important important aspect aspect of theof the cabin, cabin, in the in thecontext context of stroke, of stroke, is that is thatit is symmetrical it is symmetrical along along a horizontal a horizontal axis—the axis—the top part top of part the cabin,of the including cabin, including doors, windows, doors, windows, chimney chimney place, lamp place, are lamp repeated are repeated upside-down, upside-down, into the ground, into the toground, give an to giveinitial an impression initial impression that the that cabin thecabin has a has mirror a mirror for fora floor. a floor. This This creates creates an an ‘expectancy ‘expectancy violation’ (Burgoon 2015) resulting from the inability to register whether the cabin has a mirrored floor or not, creating a jolt in terms of the viewer’s usual reasoning and expectations. Perhaps this 2 Email from Hans Elis to Marcos Lutyens. Saturday, 29 September 2012. 2 Email from Hans Elis to Marcos Lutyens. Saturday, 29 September 2012.

Arts 2020, 9, 47 10 of 20 violation’ (Burgoon 2015) resulting from the inability to register whether the cabin has a mirrored floor or not, creating a jolt in terms of the viewer’s usual reasoning and expectations. Perhaps this kind of environment, over time, could promote neuroplasticity, contributing to its apparent therapeutic impact. Mirrors, or the appearance of them, have been much used in art, such as with Yayoi Kusama’s infinity mirrored rooms, which give a sense of awe and disorientation. Kusama herself is an artist who has verged on the edge of mental illness and suicide (Kusama 2005), so perhaps these mirrored spaces Arts 2020, 9, x FOR PEER REVIEW 10 of 20 are a tool to quiet the chattering mind, just as they have been used in therapeutic contexts to calm and tokind encourage of environment, self-care as over well astime, self-acceptance could promote (Freysteinson neuroplasticity, 2009). contributing to its apparent therapeuticMirrors impact. are an ideal healing tool to overcome hemispheric neglect in stroke patients, and today, we seeMirrors, Ramachandran’s or the appearance mirror boxof them, being have used been not justmuch with used phantom in art, such limb as syndrome, with Yayoi but Kusama’s in stroke therapy.infinity mirrored In the case rooms, of the which cabin, give the reflectiona sense of is awe further and disorientingdisorientation. because Kusama it is herself horizontal is an rather artist thanwho vertical,has verged but on the the fact edge that of this mental idea ofillness symmetry and suicide is witnessed (Kusama in such2005), an so unexpected perhaps these manner mirrored may breakspaces down are a tool the resistanceto quiet the that chattering patients mind, have tojust acknowledging as they have been their used “lost” in therapeutic half. This mechanism contexts to wouldcalm and be to particularly encourage useful,self-care as as one well acknowledges as self-acceptance that a (Freysteinson space or object 2009). has horizontal symmetry, and asMirrors the head are tilts an ideal to one healing side, the tool horizontal to overcome symmetry hemispheric becomes neglect vertical in stroke symmetry, patients, and theand mind today, is forcedwe see toRamachandran’s acknowledge awareness mirror box of being its missing used side.not just with phantom limb syndrome, but in stroke therapy. In the case of the cabin, the reflection is further disorienting because it is horizontal rather 4. Multisensory Stimulation: The Kaleidoscopic Mind than vertical, but the fact that this idea of symmetry is witnessed in such an unexpected manner may breakIn down the same the wayresistance that a navigationthat patients app have automatically to acknowledging reroutes thetheir driver “lost” around, half. This say, mechanism an accident onwould the freeway,be particularly recovery useful, in neuronal as one acknowledges function following that a space stroke or requires object has “rerouting” horizontal connectivity symmetry, aroundand as the the head brain tilts lesion. to one side, the horizontal symmetry becomes vertical symmetry, and the mind is forcedExisting to acknowledge therapies at awareness the Lippoldsberg of its missing clinic workside. on just one or two brain functions at a time. The patients might be asked to assemble blocks in the “box-block” test (Figure 10), identify missing numbers4. Multisensory in a lineup Stimulatio of 1–9,n: orThe to Kaleidoscopic perform cognitive Mind and physical tasks simultaneously, such as calculatingIn the same addition way problemsthat a navigation on a screen app automatically or matching images reroutes by the moving driver the around, body say, to indicate an accident one answeron the freeway, or another recovery (Figure 11in). neuronal Lutyens becamefunction curious following as to stroke whether requires combining “rerouting” multiple connectivity stimuli and exercisesaround the at brain once mightlesion. enhance brain plasticity and speed up stroke recovery.

Figure 10. TypicalTypical box-block box-block test test that that tests tests patients patients on onspatial spatial and and logical logical construction construction solutions. solutions. The Thetest asks test asksthe patient the patient to place to placethe blocks the blocks in an arrang in an arrangementement that leaves that all leaves the wh allite the facets white at facets the surface, at the surface,facing outwards. facing outwards.

Existing therapies at the Lippoldsberg clinic work on just one or two brain functions at a time. The patients might be asked to assemble blocks in the “box-block” test (Figure 10), identify missing numbers in a lineup of 1–9, or to perform cognitive and physical tasks simultaneously, such as calculating addition problems on a screen or matching images by moving the body to indicate one answer or another (Figure 11). Lutyens became curious as to whether combining multiple stimuli and exercises at once might enhance brain plasticity and speed up stroke recovery.

Arts 2020, 9, 47 11 of 20 Arts 2020, 9, x FOR PEER REVIEW 11 of 20

Figure 11. Kinesthetic-visualKinesthetic-visual association association exercise exercise at at Klinik Klinik und und Rehabilitationszentrum Rehabilitationszentrum Lippoldsberg. Lippoldsberg. Patient movesmoves his his body, body, which which is motion-tracked,is motion-tracked, to check to check thatcorrect that correct answers answers are “pointed are “pointed to” through to” bodythrough movement, body movement, in this case, in this matching case, matching the kite at the center kite of at image center to of the image corresponding to the corresponding kite on the left.kite on the left. Lutyens envisioned the treatment as a kind of forced synesthesia (Figure 12) (a condition affecting aboutLutyens 1 in 25 peopleenvisioned in which the ditreatmentfferent sensory as a kind modalities of forced are synesthesia involuntarily (F connectedigure 12) in(a thecondition brain), whichaffecting would about be 1 provoked in 25 people in non-synesthetic in which different patients sensory by presenting modalities di arefferent involuntarily simultaneous connected stimulus in modalities.the brain), Awhich synesthete would may be see provoked a color as soundin non-sy or a letternesthetic as a tastepatients or a soundby presenting as a texture. different This is asimultaneous similar state stimulus of consciousness modalities. to thatA synesthete which children may see under a color five as years sound of ageor a experience letter as a whentaste or the a neuralsound pathwaysas a texture. of theThis brain is a similar have not state yet of been consci prunedousness back to to that create which separated children brain under centers five ( Lutyensyears of 2014age experience). Based on when Lutyens’ the neural conversations pathways with of thethe clinic’sbrain have psychologist not yet been as well pruned as with back Dr. to Pinnau, create itseparated appears thisbrain approach centers could (Lutyens be beneficial 2014). toBased patients’ on cognitiveLutyens’ andconversations physical recovery. with the clinic’s psychologistLutyens isas notwell the as only with artist Dr. whoPinnau, has beenit appear interesteds this inapproach synesthesia could and be clinical beneficial processes. to patients’ Artist Dariacognitive Martin and teamedphysical up recovery. with scientist Michael Banissey, professor of psychology at Goldsmiths, in a programLutyens sponsored is not the by only the Wellcome artist who Trust. has been In responseinterested to in the synesthesia collaboration, and clinical she created processes. two 16-mm Artist films:Daria MartinSensorium teamed Tests (upMartin with 2012 scientist) and MichaelAt the Threshold Banissey,(Martin professor 2014–2015 of psychology), which exploredat Goldsmiths, the newly in a revealedprogram conditionsponsored ofby mirror the Wellcome touch synesthesia. Trust. In response A person to the with collaboration, mirror touch she senses created when two another 16-mm personfilms: Sensorium is touched Tests as if (Martin they themselves 2012) and are At beingthe Threshold touched, (Martin as though 2014–2015), there are which hyperactive explored mirror the neuronsnewly revealed being triggered condition in of the mirror brain thattouch unconsciously synesthesia. echoA person what with is being mirror seen touch around senses the person when andanother come person to conscious is touched attention as if they as a themselves hallucinatory are sensation being touched, of touch. as Thesethough films there were are hyperactive a recreation ofmirror the discovery neurons being of the triggered condition, in as the well brain as athat fictional unconsciously portrayal ofecho a mother what is and being daughter seen around who both the haveperson the and condition, come to but conscious the films attention also reflected as a thehallucinatory clinical dynamic sensation between of touch. a therapist These orfilms researcher were a andrecreation a patient, of the which discovery is sometimes of the condition, not as aligned as well as as one a fictional would hope portrayal to create of a the mother best circumstancesand daughter forwho wellbeing. both have the condition, but the films also reflected the clinical dynamic between a therapist or researcherIn the clinicaland a patient, context ofwhich stroke is treatments, sometimes Lutyens not as aligned envisioned as aone protocol would that hope provokes to create synesthesia the best forcircumstances therapeutic for ends. wellbeing. This approach built on a previous work by Lutyens titled Observatory, in which colors, smells, images, sounds, and words were orchestrated to recreate old and stimulate new collective ones. The correspondences between different sensory modalities were achieved through an augmentation of the Plutchik Wheel (Pico 2016), which maps a relationship between certain colors and certain emotions. Lutyens expanded these two correspondences to include smell and sound (Figure 13). The correspondences between color, smell, and emotions were worked

Arts 2020, 9, 47 12 of 20

out with the expertise of perfumer Stephen V. Dowthwaite and are derived from the Fragrance Wheel, which was first developed by Austrian perfumer Paul Jellinek in 1949 (Jellinek 1949; Barwich 2017). The sound to color and emotions relationships were worked out with film sound designer Julia Owen. These were based on prevailing film sound design theory in which major keys are considered to be bright and associated with happiness, whereas minor keys are emotionally darker, as well as more rigorous psychological studies related to color, emotions, and sound by PerMagnus Lindborg and Arts 2020, Andres9, x FOR K. PEER Friberg REVIEW (Lindbrog and Friberg 2015). 12 of 20

FigureFigure 12. Preliminary 12. Preliminary exploration exploration of of synestheticsynesthetic therapy therapy ideas ideas for Klinik. for Klinik.

In the clinical context of stroke treatments, Lutyens envisioned a protocol that provokes synesthesia for therapeutic ends. This approach built on a previous work by Lutyens titled Memory Observatory, in which colors, smells, images, sounds, and words were orchestrated to recreate old memories and stimulate new collective ones. The correspondences between different sensory modalities were achieved through an augmentation of the Plutchik Wheel (Pico 2016), which maps a relationship between certain colors and certain emotions. Lutyens expanded these two correspondences to include smell and sound (Figure 13). The correspondences between color, smell, and emotions were worked out with the expertise of perfumer Stephen V. Dowthwaite and are derived from the Fragrance Wheel, which was first developed by Austrian perfumer Paul Jellinek in 1949 (Jellinek 1949; Barwich 2017). The sound to color and emotions relationships were worked out with film sound designer Julia Owen. These were based on prevailing film sound design theory in which major keys are considered to be bright and associated with happiness, whereas minor keys are emotionally darker, as well as more rigorous psychological studies related to color, emotions, and sound by PerMagnus Lindborg and Andres K. Friberg (Lindbrog and Friberg 2015).

Arts 2020, 9, 47 13 of 20 Arts 2020, 9, x FOR PEER REVIEW 13 of 20

Figure 13. The emotion to color Plutchik wheel augmentedaugmented with smellsmell andand soundsound byby Lutyens.Lutyens. One could extend this to include corresponding texturestextures andand tastestastes forfor additionaladditional therapeutictherapeutic ends.ends.

At Klinik und Rehabilitationszentrum Lippoldsberg,Lippoldsberg, Lutyens is working on developing simple wooden blocksblocks that that have have multiple multiple facets. facets. Each Each facet facet has has a di ffaerent differen contentt content or quality, or quality, such as such a texture, as a atexture, color, a color, smell, a a smell, number, a number, or a letter. or a letter. These These blocks blocks are somewhat are somewhat reminiscent reminiscent of, and of, and inspired inspired by, Friedrichby, Friedrich Fröbel, Fröbel, who who initiated initiated education education for youngfor young children children through through a series a series of “gifts”, of “gifts”, simple simple toys meanttoys meant to instruct to instruct the learner the learner in increasingly in increasingly complex complex forms, forms, materials, materials, and and physical physical relationships relationships and thatand that would would lay thelay the groundwork groundwork for for modernist modernist art art and and design design pedagogy pedagogy (Provenzo (Provenzo 2009 2009).). HeHe also promoted thethe ideaidea thatthat a a classroom classroom could could become become a nurturinga nurturing garden-like garden-like space space of learning,of learning, which which we havewe have come come to know to know as kindergarten as kindergarten (Brosterman (Brosterman 1997 1997).). As the patient turns Lutyens’ faceted block in one or both hands, the mind consciously or unconsciously picks up on the different different and contrastingcontrasting qualities of each facet that stimulate different different brain centers, particularly those around the primary somatosensory cortex, which is located in the lateral postcentral gyrus, a prominent structure in the parietal lobe of the , as well as centers relatedrelated to to vision, vision, smell, smell, and and cognitive cognitive functions functions for decoding for decoding numbers numbers and letters. and Thisletters. process This complementsprocess complements current research current by research Michael by Kilgard, Michael Ph.D., Kilgard, at the Ph.D., School at of the Behavioral School andof Behavioral Brain Sciences, and UniversityBrain Sciences, of Texas University at Dallas of (TexasKilgard at etDallas al. 2018 (Kilgard), which et seeks al. 2018), to increase which neuralseeks to plasticity increase through neural touchplasticity to improvethrough braintouch function to improve and brain healing. function While and scientific healing. papers While link scientific tactile papers therapies link to tactile brain regeneration,therapies to brain there regeneration, also appears there to be also a connection appears to between be a connection the need tobetween hold onto the andneed turn to hold an object onto and stimulationturn an object in theand brain, stimulation which in has the been brain, demonstrated which has been through demonstrated tests such as through the aforementioned tests such as “box-block”the aforementioned test. Holding “box-block” and turning test. anHolding object inand the tu handsrning has an beenobject a habitin the that hands finds has new been expression a habit that finds new expression in every generation, from prayer beads to cigarettes to the current use of smartphones. Lutyens’ faceted block makes use of this predisposition to hold an object in one’s hands (Figure 14).

Arts 2020, 9, 47 14 of 20 in every generation, from prayer beads to cigarettes to the current use of smartphones. Lutyens’ faceted block makes use of this predisposition to hold an object in one’s hands (Figure 14). Arts 2020, 9, x FOR PEER REVIEW 14 of 20

Figure 14. 14. SketchSketch for for color-haptic color-haptic left left and and right right brain brain stimulating stimulating device, device, with withinternal internal recessed recessed smell smellreceptacle. receptacle.

Taking the idea of therapeutictherapeutic multimodal stimulationstimulation one step further, the possibility is being explored of teaming teaming up up with with the the nearby nearby Georg Georg Au Augustgust University University Medical Medical Center Center of ofGöttingen Göttingen to todevelop develop an anexperimental experimental platform platform of brain of brain stim stimulationulation optimized optimized throug throughh machine machine learning. learning. In Inpreparing preparing for for thisthis possibility,possibility, Lutyens Lutyens reached reached out to Leonardoout to Leonardo Christov-Moore, Christov-Moore, Ph.D., a neuroscience Ph.D., a researcherneuroscience at USCresearcher Brain at and USC Creativity Brain and Institute. Creativity They Institute. decided They to team decided up to to frame team theup to experiment, frame the asexperiment, well as to as investigate well as to precedents investigate toprecedents verify that to this verify forced-synesthetic that this forced-synesthetic approach would approach not only would be artisticallynot only be engaging artistically but engaging also produce but also positive produce therapeutic positive results.therapeutic results.

5. The Current Project: Kernel Kernel of of Consciousness Consciousness The meta-artwork Kernel of Consciousness is a unique hyper stimulant of the mind, optimized via machine learning. A A pattern pattern of of successive successive stimuli stimuli is is fine fine tuned to generate neural regeneration in targeted brain areas (Figure(Figure 1515).). Much artificial artificial (AI) research so fa farr has been aimed at optimizing its its own own processes. processes. Human intelligence has been devoted to creating machine learning or machine intelligence, with the presumption that at a certain point AI will take care of its own learning as it develops further ((MuehlhauserMuehlhauser and Salamon 20122012).). A A great great deal deal of of fear fear has has been expressed, for for instance, in Ray Kurzweil’s conceptconcept ofof thethe Singularity,Singularity, which which revolves revolves around around the the vector vector of of AI AI “taking “taking over” over” and and in soin doing,so doing, prioritizing prioritizing its its own own interests interests rather rather than than humanity’s. humanity’s. However, However, what what ifif AIAI couldcould bebe used to enhance human intelligence (HI) so that both could expand, grow,grow, andand supportsupport eacheach other?other? Neuroscience research on functional recovery following injury injury and stroke has revealed two properties of the nervousnervous systemsystem thatthat cancan bebe leveragedleveraged toto promotepromote recovery:recovery: redundancyredundancy and malleability (Wig (Wig 20172017).). First, the nervous system, pa particularlyrticularly the the brain, is massively,massively, redundantlyredundantly interconnected. For For any any damaged damaged functionally functionally releva relevantnt pathway pathway between between two ne twotworks/circuits, networks/circuits, there are thousands of alternate pathways that can be recruited to restore function, thanks in large part to the nervous system’s malleability. Indeed, studies have shown sensory stimulation both activates brain areas inducing cortical reorganization and modulates motor cortical excitability for the stimulated afferents, neurons that carry nerve impulses from sensory stimuli to the central nervous system, hence re-establishing the sensorimotor loop disrupted due to stroke (Bolognini et al. 2016).

Arts 2020, 9, 47 15 of 20 there are thousands of alternate pathways that can be recruited to restore function, thanks in large part to the nervous system’s malleability. Indeed, studies have shown sensory stimulation both activates brain areas inducing cortical reorganization and modulates motor cortical excitability for the stimulated afferents, neurons that carry nerve impulses from sensory stimuli to the central nervous system, hence re-establishing the sensorimotor loop disrupted due to stroke (Bolognini et al. 2016). Arts 2020, 9, x FOR PEER REVIEW 15 of 20

Figure 15. Feedback loop idea for Kernel of Consciousness showing how imagery and other sensory inputs are sorted by a machine learning filterfilter to st stimulateimulate a large number of brain sectors in sequence to optimize brain stimulation in strokestroke patients.patients.

Building on these principles, a small but growing body of recent work has found that enriched sensory environments and multisensory stimulation can enhance recovery in both rodent models ((HakonHakon et al. 20182018;; QuattromaniQuattromani etet al.al. 20182018)) andand humanshumans ((TingaTinga etet al.al. 20162016).). These studies have primarily employed action observation, which “hijacks” mirror neurons to create vicarious patterned motor activation; moto motorr imagery, which evokes top-downtop-down simulative processes for for similar similar effect; effect; and and music music therapy, therapy, which which combines combines aspects aspectsof the prior of thetwo prior(stimulus- two (stimulus-evokedevoked mirroring, mirroring, internal monitoring) internal monitoring) with the po withwerful the auditory powerful and auditory affective and feedback affective provided feedback providedby music. by music. This project seeks to use a feedback loop of brainbrain monitoring and machinemachine learning to optimize sequences of sensory and cognitive cues to the brain, with the aim of enhancing function in patients with stroke-related cognitive and motor deficits,deficits, as well as potentially improving function in healthy adults. The cues would be gathered from large, most mostlyly existing or scraped datasets related to visual art broken down into colors, textures, words, numbers,numbers, body parts, etc. In the more haptic cases of body parts and textures, which would be inputted as images, the process of “feeling” these would rely on the so-called mirror neurons in the brain, akin to the synesthetic process process of of “mirror “mirror touch”. touch”. Sound and musical fragments would also be incorporatedincorporated into the sensory deployment.deployment. Haptic and olfactory components could also be potentially incorporated. The aim is to activate simultaneously and dynamically as many brain networks as possible in order to stimulate the formation of novel, alternate neural pathways in order to recover and enhance brain function.function. The project is designed as much to enhance people with brain lesions such as stroke patients, as healthy adults. In In either case, we would predict some degreedegree ofof improvementimprovement inin motormotor andand cognitivecognitive abilities.abilities. Although the project, which is still in progress, could be deployed on a smartphone, or in a VR or AR treatment clinic (in coordination with haptic stimulators), Kernel of Consciousness would also be displayed for the general public as a large array of screens or a projection dome within an art exhibition context. The geography of how images are shown and hence seen by viewers (peripheral vs. frontal views) would be part of the sequencing honed through a learning algorithm, as the field of vision in itself affects different brain centers. The use of fragments from a vast array of visual art images turns the project into a kind of “meta-channeler” of a wide array of humanity’s cultures, culture being one of the primary vehicles that has enabled humans to develop beyond a level of subsistence into flourishing communities. This grows the stimulus dimensions from simply being multisensory to

Arts 2020, 9, 47 16 of 20 be displayed for the general public as a large array of screens or a projection dome within an art exhibition context. The geography of how images are shown and hence seen by viewers (peripheral vs. frontal views) would be part of the sequencing honed through a learning algorithm, as the field of vision in itself affects different brain centers. The use of fragments from a vast array of visual art images turnsArts 2020 the, 9, project x FOR PEER into REVIEW a kind of “meta-channeler” of a wide array of humanity’s cultures, culture16 being of 20 oneArts 2020 of the, 9, x primary FOR PEER vehicles REVIEW that has enabled humans to develop beyond a level of subsistence16 intoof 20 flourishingadditionally communities. evoking emotion, This grows memory, the stimulus and soci dimensionso-cultural fromcognition, simply thus being potentiating multisensory and to additionally evoking emotion, memory, and socio-cultural , thus potentiating and additionallymultiplying evokingthe complexity emotion, and memory, depth of and subjects’ socio-cultural brain stimulation cognition, thus (Figures potentiating 16 and and17). multiplying multiplying the complexity and depth of subjects’ brain stimulation (Figures 16 and 17). the complexity and depth of subjects’ brain stimulation (Figures 16 and 17).

Figure 16. Pod design for Kernel of Consciousness, hyper-stimulant of the mind.. The patient sits in a seat Figure 16. Pod design for Kernel of Consciousness, hyper-stimulant of the mind. The patient sits in a seat that is placedplaced in frontfront ofof aa concaveconcave screen,screen, whichwhich projects imagery that engages with didifferentfferent sense that is placed in front of a concave screen, which projects imagery that engages with different sense modalities. Olfactory and haptic sensations may also be deployed. modalities. Olfactory and haptic sensations may also be deployed.

Figure 17. Another view of the Kernel of Consciousness pod. FigureFigure 17.17. AnotherAnother viewview ofof thethe KernelKernel ofof ConsciousnessConsciousness pod.pod. Machine learning,learning, with with its its potential potential for hypothesis-freefor hypothesis-free optimization optimization of multiple of multiple regression regression models Machine learning, with its potential for hypothesis-free optimization of multiple regression (e.g.,models LASSO) (e.g., LASSO) (Savaram (Savaram 2019), can 2019), be employed can be employed here in threehere ways:in three ways: models (e.g., LASSO) (Savaram 2019), can be employed here in three ways: First, in the selection of stimuli prior to the study. study. By collecting collecting explicit (self-reports) and implicit First, in the selection of stimuli prior to the study. By collecting explicit (self-reports) and implicit (fixation,(fixation, heartheart rate) measures of engagement from a preliminary healthy, non-imagednon-imaged cohort,cohort, wewe can (fixation, heart rate) measures of engagement from a preliminary healthy, non-imaged cohort, we can create an optimized stimulusstimulus set.set. create an optimized stimulus set. Second, in the refinement refinement of stimuli presentation within-subject. During the training/habituation training/habituation Second, in the refinement of stimuli presentation within-subject. During the training/habituation phase of intervention, the same measures of engagementengagement outlined above can be combined with phase of intervention, the same measures of engagement outlined above can be combined with informative brain measures (such as global connectivity) derived from, for example, a sparse- informative brain measures (such as global connectivity) derived from, for example, a sparse- electrode electroencephalogram (EEG), which measures electrical activity in the brain, in order to electrode electroencephalogram (EEG), which measures electrical activity in the brain, in order to optimize stimulus selection within-subject. optimize stimulus selection within-subject. Third, machine learning could potentially be leveraged to improve our understanding of what Third, machine learning could potentially be leveraged to improve our understanding of what variables mediate or predict improvement in daily function, prior to the study, by parsing existent variables mediate or predict improvement in daily function, prior to the study, by parsing existent databases/metanalyses to examine demographic and physiological characteristics that seem to databases/metanalyses to examine demographic and physiological characteristics that seem to mediate responsiveness to similar treatments. This will allow us to better assess the true effect of the mediate responsiveness to similar treatments. This will allow us to better assess the true effect of the intervention and control more effectively for confounding variables. intervention and control more effectively for confounding variables.

Arts 2020, 9, 47 17 of 20 informative brain measures (such as global connectivity) derived from, for example, a sparse-electrode electroencephalogram (EEG), which measures electrical activity in the brain, in order to optimize stimulus selection within-subject. Third, machine learning could potentially be leveraged to improve our understanding of what variables mediate or predict improvement in daily function, prior to the study, by parsing existent databases/metanalyses to examine demographic and physiological characteristics that seem to mediate responsiveness to similar treatments. This will allow us to better assess the true effect of the intervention and control more effectively for confounding variables. While multisensory stimulation has been employed successfully to mediate motor function following stroke in both rodents (Quattromani et al. 2018) and humans (Johansson 2012; Law et al. 2018; Tinga et al. 2016), our proposed intervention presents several points of improvement on extant therapies, based on our hypotheses that (a) greater immersion and engagement will result in greater neural recruitment and hence enhanced functional outcomes and (b) a greater breadth of sensory modalities and the incorporation of stimuli with affective, cultural, temporal qualities can serve not only to improve multi-network recruitment but perhaps even enhance function beyond the motor domain. This project aims to improve on past therapies by (a) providing olfactory stimulation in addition to immersive visual and auditory stimulation and (b) exposing subjects to stimuli with affective, cultural, and temporal qualities, thus increasing the range of neural recruitment to include high-level integration/association cortices as well as subcortical areas involved in motivation and affect. Furthermore, the aesthetic, presentational expertise and breadth/richness of stimuli afforded by the visual art/art theory acumen of Lutyens has the potential to produce a multisensory experience that is richer, more engaging, and hence more effective than the simple stock/public domain images and clips typically employed in neuroscientific research.

6. Proposed Methods The participant sits in a specialized chair with haptic gloves/arrays on multiple body parts, an olfactometer, and a VR headpiece or concave screen, which would together display an array of visual imagery, sounds, haptic input (vibration, pressure, pulsing), and olfactory stimuli that slowly scroll through opposite and non-continuous themes, creating stimulus through juxtaposition. As an example, by juxtaposing the sight of a horse with the sound of someone clapping, with the color orange, with a sine wave tone, and with the smell of lavender, and a slow rhythmic force feedback to the feet, with a cascade of numbers, a landscape of shapes made of outlines, and an image of a hand feeling a rough texture the subject is exposed to a heightened sense of stimulation. Intuitively, if done in a calculated, rigorous way with the curation of machine learning, this kind of orchestration would help stimulate the brain and allow it to find new creative and functional pathways to both restore and enhance functioning. Sparse (<32 channel) EEG can provide the kind of course measures of global brain connectivity and frequency band modulation that could be informatively used to gauge engagement and examine neural correlates of functional outcomes. Additionally, functional MRI, a device that measures brain activity relative to blood flow, could be leveraged (with more spatial precision than EEG) to provide measures of functional recovery as well as perhaps predict treatment response, once sufficient data were collected to allow for the training of supervised algorithms (knowing the pre-treatment brain activity and functional outcomes in a sufficiently large sample can allow for the prediction of treatment response in a novel sample).

7. Motor Function Improvements in the patient, following multi-sensory therapy can be measured by Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA), Manual Muscle Testing (MMT), Functional Test for the Hemiplegic Upper Extremity, and Modified Barthel Index (MBI) (Gladstone et al. 2002) examine (a) low extremity function by assessing gait velocity, symmetry, and stride length and (b) Arts 2020, 9, 47 18 of 20 upper extremity function by looking at functions such as reaching, final position accuracy, precision, and trajectory linearity. Both within an artistic as well as a therapeutic context, the machine learning aspect, as it is applied to therapy, takes the journey of consciousness exploration, healing, and aesthetic experience to new places. Finally, although the abovementioned approaches are primarily directed towards stroke patients, it is worth noting that neurotypical people also live in a relationship to our habitat that is molded by negative habits. Social and political unease, as well as the degrading ecologies of our planet, can be modified or turned into positive behaviors through therapies that engage empathetically with the senses and with nature. As the French philosopher Catherine Malabou(2017, p. 46) noted, “Addictive processes have for a great part caused the Anthropocene, and only new addictions will be able to partly counter them”. We hope that Clinic Parcours will not just benefit stroke patients and their family members, but also the wider public to generate a healing process at many levels. To conclude, in this paper, we have outlined the ability of art-related approaches to both creatively engage with the general public to explore various mental states and with patients in a clinical environment to extend traditional therapeutic approaches and outcomes. We suggest that by integrating artistic approaches within a medical context, this may be beneficial to patients, particularly in the framework of the treatment of stroke patients. The use of synesthesia-related approaches that engage several brain centers at once fits previous studies suggesting that multi-sensory stimulation is beneficial to stroke patients. The evolving sciences related to AI and machine learning also open up new frontiers of therapeutic engagement.

Author Contributions: Both authors have contributed to the preparation, writing, and editing of this manuscript. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Conflicts of Interest: The authors declare no conflict of interest.

References

Medical Centers

Lippoldsberg Clinic. Available online: https://www.klinik-lippoldsberg.de. Universitätzmedizin Göttingen. Available online: https://www.umg.eu.

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