Motivation and Persistence

To be successful, creative people need to have perseverance and persistence. According to Beals (1996), Thomas Edison said that being a creative genius required "ninety nine percent perspiration and one percent inspiration." The biographies of almost all creative people reveal that, independent of the domain in which they create, they persevere and persist.

Goal-oriented behavior or volition permeates almost all aspects of creativity, and the major organ of volition appears to be the frontal lobes. One mean by which neuroscientists learn the parts of the brain that perform certain functions is to study patients who have injuries to a specific portion of the brain. In the clinic we see people who have lost their initiative and drive, and this loss is called "abulia" (a = without, bulia = will or power). Harlow, in 1868, reported the famous case of Phineas Gage, one of the best-known descriptions of a person who developed abulia from a brain injury.

According to this report, Gage was a hardworking foreman of a railroad crew who had an accident. While using a tamping bar to place explosives, an explosion occurred and this iron bar flew upward and into his head. The rod struck him in the left cheek and went through his left maxillary sinus, and from the maxillary sinus, the rod impaled the frontal lobes of his brain. The iron rod then exited the top of the skull. These types of accidents can cause brain swelling, hemorrhage, and infection, but he miraculously survived this accident. The frontal lobes are important for the expression of speech and the control of movements. Thus, it was also remarkable that he did not suffer with weakness or a loss of speech. His personality, however, did undergo a dramatic change. According to Harlow (1868), before the accident Gage had "a well balanced mind. And was looked upon by those who knew him as a shrewd, smart businessman, very energetic and persistent in executing all his plans." After the accident he lost these skills. According to Harlow (1868), "His mind was radically changed, so decidedly that his friends and acquaintances said he was no longer Gage."

Even after Harlow's dramatic description of the effects of frontal lobe injury, not much research was performed on the functions of the frontal lobes until 1934, when Kleist had the opportunity to examine many of the soldiers who injured their frontal lobes during the First World War. He noted that these veterans also were apathetic and abu-lic, with a loss of drive and initiative. We still do not fully understand why the frontal lobes are so important for goal-oriented behavior; however, Nauta (1971) a Dutch neuroanatomist who worked at MIT, provided us with one of the best explanations. He noted that information from the outside world is first transmitted to the primary sensory areas. As I mentioned, the auditory system projects to the superior portion of the temporal lobes, touch projects to the anterior portions of the parietal lobes, and vision projects to the occipital lobes (see Figure 3.6). These primary sensory areas perform elementary sensory analyses. Each of these primary sensory areas sends information to modality-specific sensory association cortices. Hence the visual cortex sends information to visual association areas in the occipital, temporal, and parietal lobes; the auditory cortex sends its information to auditory association areas in the temporal lobes; and the tactile primary sensory areas send information to the tactile association areas in the superior parietal lobes (see Figure 3.6). These modality-specific sensory areas synthesize sensory information within a modality, which is important in the development of percepts. These areas also store modality-specific representations of previously perceived stimuli. For example, for a person's brain to derive meaning when the individual views an object, it must put together the lines or edges detected by the primary cortex to form a percept of object's shape, then these percepts activate the stores of iconic representation of previously seen objects, letters, or faces. Subsequently, all these sensory association areas send these activated iconic, echoic, or somesthetic (touch) representations to multimodal areas of the temporal and parietal lobes (see Figure 3.6). These multimodal areas have rich neuronal networks that store memories of the meaning of these stimuli and how these stimuli are related to other stimulus and concepts.

In people with damage restricted to the frontal lobe, such as Phineas Gage, these sensory-perceptual-semantic-conceptual systems are intact, and because these systems are working, people with frontal lobe injuries are aware of their environment, can interpret the meaning of stimuli, and have the knowledge needed to accomplish goals. To succeed in using this knowledge to achieve goals, however, one needs motivation or drive. Knowledge together with motivation leads to goal-oriented behavior. Biological drives are present in almost all creatures. In almost all vertebrates, these biological drives are mediated by the phylogenetically primitive limbic system, including the hypothalamus (see Figure 9.3). Unlike the temporal, occipital, and parietal cortices that monitor the outside world, the hypothalamus and limbic system monitor the inside world of an animal's body. When these internal monitors note a deficiency, they initiate a drive state that motivates behavior. For example, when the sugar (glucose) in the blood drops too low, the animal gets hungry and searches for food. If it finds food, it eats. When the salt in the blood becomes too high, the animal becomes thirsty and thus, looks for and drinks water.

Because patients with frontal lobe injuries have an intact hypothalamus and limbic system, they attempt to satisfy a need such as hunger by looking for and eating food. Although they have the knowledge that they need to have food accessible for the next time they get hungry, they often fail to make the necessary preparations (goal-oriented behavior). The systems important in developing drive states, such as the hypothalamus and limbic system, are strongly connected with the neuronal assemblies in the frontal lobes. The knowledge of how to satisfy these drive states is stored in the posterior (temporal-parietal) multimodal sensory association, areas which are also strongly connected with the frontal lobes. According to Nauta (1971), as the frontal-lobe networks

Fusion Hypothalamus
Figure 9.3. Diagram of hypothalamus, including the mammillary body.

develop, they fuse the information about biological drives with the knowledge of how to satisfy these drives. This knowledge fusion leads to the development of goal-oriented behavior or conation.

One of the founders of modern neurology was the 19th-century British neurologist John Hughlings Jackson. Hughlings Jackson was strongly influenced by Charles Darwin's writings on evolution, and he formulated the idea that human's central nervous system was organized phylogenetically such that "lower" or phylogenetically more primitive parts of our nervous system contain the neural apparatus of more primitive animals and the "higher" parts consist of more recently evolved neural systems. In general, the behavioral repertoire of these lower portions is limited, and the behaviors programmed by these more primitive structures are often stereotypic. Throughout evolution, as we developed new parts of our brains, such as the cerebral neocortex, these new areas allowed us to perform a richer repertoire of behaviors. For people to be able to perform these more specific or complex behaviors, we had to have a means by which we could suppress the more primitive stereotypic behaviors that are mediated by more primitive parts of the central nervous system. Thus, the frontal lobes not only allow us to plan and implement goal-oriented behaviors but also inhibit or control the more phylogenetically primitive systems, such as the limbic system. The inhibition of behaviors mediated by more primitive systems, such as the limbic system, allows us to control these more primitive biological drives and emotions, permitting a person to carry out goal-oriented behavior. When the frontal lobes are injured, a person has not only a loss of goal-oriented behaviors but also an inability to inhibit more primitive drives and behaviors.

Because the frontal lobes are important for long-term goals they allow us to perform activities that might not always make us immediately happy but might provide long-term rewards. In his book, Creativity, Mihaly Csikszentmihalyi (1996) called these behaviors "exotelic." In the beginning of this chapter, however, I wrote that while some creative artists, writers, composers, and scientists do obtain fortune and fame, very few of these people get wealthy or famous by performing creative acts. Some, when they started their creative careers, might have thought that their creativity would bring them fame and fortune, but after several years many creative people realize that these aspirations will never be fulfilled. This knowledge, however, often does not stop them from continuing their creative activities. Creative people often continue to create because performing this act brings them enjoyment and fulfillment. This self-motivated behavior, which is not performed for any future or immediate rewards, Csikszentmihalyi called "autotelic." For the fortunate few, their creative behaviors are both exotelic and autotelic. Although I agree with Csikszentmihalyi's concepts, perhaps the term endo-incentive, introduced earlier, should be used to replace the term autotelic, and the term exotelic should be replaced with the term exo-incentive.

Several years ago I had the opportunity to examine in our Memory and Cognitive Disorder Clinic a famous neurosurgeon who developed a decrement in this endo-incentive system. This surgeon was the Chair of the Department of Neurosurgery at a prestigious university and hospital. In addition to being a superb technical surgeon, he ran a very productive research laboratory and was a leading educator, training many excellent neurosurgeons. Much of his research was supported by grants from the National Institutes of Health. Until about 5 years prior to the time I saw him in our clinic, he had almost continual funding from this agency. The last proposal that he submitted for a renewal of funding was, however, disapproved. The reviewers thought that this proposal contained no new or interesting hypotheses, but rather was just a rehash of his prior work. Because he did not receive funding, he decided to close his laboratory. He did, however, continue to perform surgery and still had excellent surgical techniques. During surgery he was never very kind to the surgical nurses, his residents, or even the anesthesiologists, but it was clear something was wrong when he took to throwing instruments and cursing at people with whom he worked. The dean spoke with him about controlling his temper, but he had problems controlling this aberrant behavior. Several months after he spoke with the dean, he started coming to the operating room late and sometimes leaving early, asking his residents to complete the surgery. For more than 30 years he had always started his clinical ward rounds at 6:00 a.m. and then made rounds again before he left the hospital at about 7:30 p.m. The residents noted, however, that he started to be tardy and sometimes he did not show up until they paged him. Rounds had always been all business, but now he started going over to the nurses and ward secretaries, touching them and asking for sexual favors. The dean spoke with him again, and during this conversation the dean noticed that he had inappropriate laughter and did not seem concerned that he was being accused of sexual harassment.

The dean temporarily withdrew the surgeon's clinical and teaching privileges and requested him to be evaluated. The surgeon and his wife thought it best that he be evaluated at a different institution, and so they flew to Gainesville to be seen in our clinic.

When I evaluated him, he was 63 years old. In addition to the history I just outlined, his wife related to me that she noticed some other changes in his personality. He was always compulsively clean and took a shower both before he left to go to the hospital and when he returned from the hospital. She noticed that now, unless she said something, he rarely bathed. Often, unless she reminded him, he did not change his underwear for several days. Almost his entire adult life, until recently, he would read journals, review papers, or write papers when at home. Now he spent hours just sitting in front of the television. I could not obtain any history of what sounded like depression, and the remainder of his history was not informative.

My neurological examination determined that he had several abnormalities. To see if his visual fields were full, I asked him to look at my nose, and I extended my arms so that one was across from his left shoulder and the other across from his right shoulder. I then told him when I moved either my right or my left hand he was to tell me which hand I moved. Although I repeatedly reminded him to stare at my nose, whenever I moved either my right or my left hand he moved his eyes and looked directly at the hand I moved. When I asked him to relax his muscles and then tried to move his arm, he always seemed to be helping me (facilitory paratonia). When I lightly stroked his palm with my forefinger and middle finger, he grasped my fingers even though I asked him not to hold my fingers. His propensity to grasp my hand when told not to is called the grasp reflex. It is one of those primitive reflexes that allow infant nonhuman primates to hold on to their mothers when they are on the move. Normal human infants have this reflex, but as we mature and increase our repertoire of skilled hand movements, we inhibit this phylogenetically primitive reflex. The surgeon's eyes were also grasping. Although I instructed him to look straight ahead at my nose, his eyes grasped on to my hand movements. We know that there are at least two systems that control the eyes: a phylogenetically advanced system that is controlled by the frontal lobes and is important in goal-oriented behavior, and a more primitive system that is controlled by the colliculus, a structure in the midbrain. When one loses frontal cortical control of eye movements, the subcortical colliculus takes control, as it did in this surgeon.

When I tested his mental status, I found that his language, including his naming, was normal. For example, when given the Boston Naming Test, he was able to name all 60 items. His visual-spatial and visual-constructive skills were also excellent. For example, he could draw intersecting pentagons flawlessly. He was fully oriented and knew the day, month, year, and his current location, but when I further tested his memory with the Hopkins Verbal Learning Test by presenting to him and asking him to recall a series of 12 words (e.g., tent, tiger, opal, pearl, cave, lion, hotel, sapphire, cow, horse, emerald, hut) three times,

I found that his memory was impaired. Normally people his age are able to recall more that 20 items in three trails, and he was able to recall only 16. After about a delay of 30 minutes, all he could recall was the word tiger, and most normal people his age can recall more than 8 of these items. After 30 minutes I asked him if he could again draw the picture I asked him to copy, and he drew two diamonds rather than the intersecting pentagons.

I noticed that during my examination he often told me inappropriate jokes. This inappropriate jocularity is often associated with right-frontal dysfunction. The behavior of patients with frontal lobe dysfunction is often very dependent on environmental stimuli. This phenomenon is called "environmental dependency" (Lhermitte, 1986). There are several tests we use to see if patients are environmentally dependent. I placed a pencil and paper on a table in front of him (so that he could copy intersecting pentagons), but before I showed him the picture I wanted him to copy or gave him any instructions, he picked up the pen and started writing his name. I then placed a comb in front of him and he started to comb his hair. Fran├žois Lhermitte (1986), a Parisian neurologist, described several patients with similar behaviors. For example, in a journal article, Lhermitte wrote about a nurse with frontal lobe dysfunction. He placed a syringe with a needle on a table in front of her and she proceeded to give him an injection in one of his buttocks. This form of environmental dependency is also called "utilization behavior." Another simple test of environmental dependency is the 2-1 test devised by the Russian neurologist A. R. Luria (1969). I made a fist and told the surgeon to also make a fist. Then I instructed him to put up two fingers when I put up one finger and when I put up two fingers he was to put up one. On almost every trial this surgeon showed echopraxia, such that when I put up two fingers he initially put up two and then put one finger down. When I put up one finger he would initially put up one finger and then raise the second finger. These tests demonstrate that it is the environment rather than self-generated goals that determined his behavior.

Because the desire to achieve long-term goals allows people to persist, I wanted to test his persistence. I asked him to give me as many different words as he could that began with the letter A in 1 minute but not to give me proper names. He gave me 6 items in the first 10 seconds, and then remained silent for the remaining 50 seconds. Two of the items were proper names (Alice and Alabama), and two were derivatives (add, addition, additive). Most people of his age and intelligence are able to name at least 12 items in 1 minute. He performance was abnormal because he did not persist and he got stuck in a set. To further test his persistence, I asked him to close his eyes and to keep them closed for 20 seconds. He was able to keep his eyes closed for only about 10 seconds.

This surgeon's history of a loss of initiative, goal-oriented behavior, and persistence together with an inability to inhibit more primitive drives and emotions is typical of patients with frontal lobe dysfunction. In corporations, it is the executive's job to make long-term plans for the company and to allocate resources so that these plans can be fulfilled. Because patients with frontal lobe dysfunction often are impaired at developing and implementing long-term goals and allocating resources, some people call the deficits demonstrated by this surgeon "executive dysfunction."

To learn what may be causing this surgeon's executive dysfunction, I ordered a series of tests. All tests were normal except for the magnetic resonance images of his brain, which revealed he had severe atrophy of both frontal lobes. Because all his other tests were normal and he had this frontal lobe atrophy, we diagnosed his symptoms as a frontal-temporal lobar degeneration or frontotemporal dementia. Many of the patients with this disorder have abnormal deposits in their nerves cells, and this is called Pick's disease. Others just show swollen cells that do not take up the chemical stains used to perform histological analyses, but most of these patients' brains just show cell loss without any specific form of pathology. He requested and we considered taking a brain biopsy, but unfortunately currently there is little we can do to either reverse or treat any of these forms of dementia and knowing the histological subtype would not alter our treatment, thus we decided not to biopsy his brain. Studies of patients with frontal lobe dysfunction, such as this surgeon, do inform us that people who are creative must have well-functioning frontal lobes.

The ability to have long-term goals and to suppress biological drives when they interfere with long-term goals as well as the ability to persist and not be distracted is what I call "frontal intelligence." Frontal intelligence is one of the major factors underlying success in any profession, including those that require creativity. The frontal lobe networks, however, have another function that appears to be important for creativity: divergent thinking.

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