Hektoen International

A Journal of Medical Humanities

Can the neuroaesthetics response unleash a path to psychosis?

C. Ann Conn
Covington, Louisiana, United States


Prehistoric rock art implies a primitive grammar of the mind found in art and which can be universally accessed.
Photo by Cazz on Flickr.

How does the brain perceive beauty and what is the biology of transcendent artistic appreciation? Is this epiphanic reaction hijacked during delusional thinking and psychosis? Perhaps the emerging field of neuroaesthetics can offer clues. After I witnessed the transformation and fall of my two sons, Austin and Colin, into psychotic illness, I find myself wondering about a connection.

Neuroaesthetics is the scientific study of the aesthetic perception of art, music, and any object or experience that gives rise to aesthetic judgment. Art arouses complicated emotion — the sense of being touched by a painting, music, moral beauty, and even equations. Response to art is highly personal and deeply felt, and it is, in some sense, universal. Art reaches within. The accompanying sense of awe is profound and difficult to articulate. While in college, my son, Colin, began obsessively studying and talking in circles about the beauty of philosophy and physics.

The burgeoning field of neuroaesthetics explores the bodily and intellectual pleasure felt when we admire art, the engagement that invokes our feelings of being “moved.” The field combines the study of aesthetics — the relationship of the mind, emotion, and sensation to the appreciation of the sublime — with neuroscience and modern neuroimaging techniques.

During full force aesthetic admiration, the brain is engaged simultaneously with a focus on external stimulation and captivation of the default mode network (DMN). The DMN is, in effect, the brain on idle and the seat of the autobiographical self. During the neuroaesthetic response, functional neuroimaging reveals rare whole-brain activation, the state of both systems together illuminated. I saw the eyes of my sons open too wide and alight with a hunger for knowledge taken too far.

Observation of DMN activity with functional brain imaging reveals the network operating below baseline activity levels when the brain responds to external stimulation: the DMN is held in check. Only the most evocative neuroaesthetic responses unleash the DMN to full activation. Strikingly individualized perception, imagination, and emotion constellate during aesthetic appreciation. Perhaps this reflects autobiographical aspects of the DMN and its role in neuroaesthetics evident in statements like, “I love this song.” In this context, DMN based self-reflection is paired with beholding of beauty. Neural sensory and emotional network activity merges with subjective personal relevance. The internal and external networks operate at full intensity, a signature response, in a state of dynamic equilibrium. This pleasure drives response to art.

Brief psychotic episodes are sometimes triggered by viewing art or religious sites of great personal significance. In 1817 during his first visit to Florence, the French author Stendhal regarded the Basilica of San Croce’s Giotto frescoes. His charged attraction “that spoke so vividly to my soul” ignited a brief psychosis. The Stendhal syndrome, also called Florence syndrome, bears his name. A parallel ecstatic response occurs in the Jerusalem syndrome, seen in Jews, Christians, and Muslims when visiting Jerusalem. A religious-themed, psychotic reaction to the overwhelming neuroaesthetic experience of Jerusalem, though named in the 1930s, was described in Margery Kempe’s fifteenth-century biography, and through time in writings of other pilgrims. Similar extreme reactions have been reported in French travelers visiting India. These syndromes often resolve over days or when removed from the location. Perhaps the brain recovers equilibrium by modulating and then extinguishing the psychotic material. Although some do not recover. It was during summer school in the eternal city of Rome that Colin’s first psychotic episode began.

A sense of helplessness overcame me as Austin, my older son, began an obsessive study of religion and blockchain calculations. Witnessing this behavior in another son shook me with concern and fear. In predisposed people, like my sons, an anomalous experience “demands” a search for meaning in a brain with reduced prefrontal monitoring and control. The brain operates like a rollercoaster without brakes. John Perceval, in his celebrated Narrative, described the excessive study of religion and philosophy during the onset of his madness. Perceval is not alone in describing this connection.

How then can a psychotic episode be precipitated? Anomalous experience, so-called benign hallucinations, occur in people in good mental and physical health, with and without triggers. Over a lifetime, about 10% of the population has experienced a hallucinatory episode. Common examples are seeing a person or thing not present, an out-of-body experience, or a strong feeling of the presence of an otherwise absent person. In the efficiently regulated brain, the anomalous experience is attenuated, the brain applies the brakes, and the precarious balance between internal and external networks are maintained.

Modern neuroimaging techniques reveal the medial orbital frontal cortex activated during the perception of beauty. It is precisely this prefrontal region of the brain that is poorly regulated in psychotic disorders. Ungoverned, is the neuroaesthetic response a portion of the path to psychosis?

When the check and balance system in the frontal region of the brain is weakened, unfiltered ideas emerge into consciousness. The pre-psychotic state, brimming with remarkable thoughts, may be a common ground between madness and creativity. The poet Robert Lowell, hospitalized on twenty occasions during episodes of bipolar psychosis, described the interval before fulminant psychosis as his most artistically productive. These exceptional ideas, if unchecked, form a pre-psychotic anomalous experience. Filled with perplexing tension, the person hungers for an explanation. On his path to psychosis, Austin described elusive angst, “Something was going on that I could not explain, and I absolutely had to find the answer.”

Electrified by a drive for meaning, the individual attempts to interpret slippery ideas. Sense must be made of it. Then enters the epiphany, the “ah-ha” moment, the primitive perceptual grammar of the brain recognized. The limbic system ignites with ancient pleasure, neuroaesthetic pleasure. Of his evolving ideas, Austin insisted, “This is pure truth! It’s paramount!” A sense of rightness and irresistible explanation forms and supports nascent delusional beliefs and later serves to maintain those beliefs. Colin described his manic psychosis as, “A feeling of divine illumination filled everything, and I forgave everyone.” This is the thrill of psychosis, the feeling of being moved, a sense of meaning, that signals order: a unique feeling of necessity, coherence, and harmony coalesce. Like the neuroaesthetic response, psychosis is subjective and personal, yet embedded in universal human experience.

Psychotic manias of light and love inevitably turn dark — the barely restrained beast is unleashed. As seen in artistic expressions, dark visions emerge from a psychotic source as in Munch’s The Scream. When Austin’s mania turned, our home echoed with rants of the blood moon that signaled imminent destruction of the world economy. Horror filled me as I heard his disorganized words emerging from a different version of reality, of shapeshifters and false flag operations.

This ineffable quality — essentially incommunicable — is central to psychosis. The process of aesthetic beholding, in those predisposed to psychosis, is a building block for the construction and maintenance of delusional ideas. During the consolidation of delusions, Jung’s emotion, imagination, and intellect then converge and ignite. Perhaps the brain’s dopamine-laden pleasure response maintains the false or absurd proposition, the delusion, that becomes held as truth without evidence and even in the face of contrary evidence. Dynamic equilibrium of the two systems is no more; the car flies off the tracks. Fueled by neuroaesthetic pleasure, a delusional belief feels a “good fit” and therefore true and right. Over time solidified and elaborated, the delusion becomes unshakable.

As the brains of my sons rewired, their facial expressions reflected these changes. Strange grins formed and eyes became distant. The family commented that Austin and Colin somehow appeared unwell. However, when lost in a sea of psychosis, islands of clarity sometimes appear. Colin said, “Even in the midst of it, I know the visions and voices are not real.” This tension is an ordeal of the psychotic mind.

And it is the essentially ineffable nature of delusions and psychosis that leave those loved ones around the person often mystified by the person’s beliefs, behaviors, and sadly sometimes their suicide.


End notes

  1. Vessel EA, Starr GG, Rubin N. Art reaches within: aesthetic experience, the self and the default mode network. Front Neurosci. 2013;7:258.
  2. Vessel EA, Starr GG, Rubin N. The brain on art: intense aesthetic experience activates the default mode network. Front Hum Neurosci. 2012;6:66
  3. Nicholson TR, Pariante C, McLoughlin D. Stendhal syndrome: a case of cultural overload. BMJ Case Rep. 2009;2009. pii: bcr06.2008.0317. doi: 10.1136/bcr.06.2008.0317. Epub 2009 Feb 20.
  4. Airault R, Valk TH. Travel-related psychosis (TrP): a landscape analysis. J Travel Med. 2018;25(1).
  5. Mangan BA. Sensations’ ghost: the non-sensory “fringe” consciousness. Psyche. 2001;7(18).
  6. Ishizu T, Zeki S. Toward A Brain-Based Theory of Beauty. PLOS ONE, 6:e21852.
  7. Jamison KR. Robert Lowell, Setting the River on Fire: A Study of Genius, Mania, and Character. Alfred A. Knopf, 2017.
  8. Rogers-Ramachandran D, Ramachandran V. The Neurology of Aesthetics, Scientific American. May 1, 2008.
  9. Carr V. Beauty and belief: William James and the aesthetics of delusions in schizophrenia. Cogn Neuropsychiatry. 2010;15(1):181–201.



C. ANN CONN, MD, is an Interventional Pain Medicine specialist in Covington, Louisiana. She is Board Certified in Neurology, Pain Medicine, and Headache Medicine. She has recently completed Lightning Twice, which recounts a portion of her family’s journey as her two sons struggled with psychosis and died by suicide. She continues to devote herself to her remaining family, patient care, mental health advocacy, and the spiritual practices that sustain her.


Highlighted in Frontispiece Volume 11, Issue 4 – Fall 2019
Spring 2019  |  Sections  |  Psychiatry & Psychology

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