Editing Hypergraphia

{{Short description|Psychological condition wherein a person is compelled to write or draw}}
{{Distinguish|Hypergraphy|Hypergraph}}
{{Use American English|date=March 2023}}
{{Use mdy dates|date=March 2023}}
[[File:Herzensschatzikomm.jpg|thumb|A letter written by artist [[Emma Hauck]] while institutionalized in a mental hospital; many of her letters consist of only the written words "come sweetheart" or "come" repeated over and over in flowing script]]
'''Hypergraphia''' is a behavioral condition characterized by the intense desire to write or draw. Forms of hypergraphia can vary in writing style and content.  It is a symptom associated with [[temporal lobe]] changes in [[epilepsy]] and in [[Geschwind syndrome]].<ref>{{cite journal |vauthors=Devinsky J, Schachter S |title=Norman Geschwind's contribution to the understanding of behavioral changes in temporal lobe epilepsy: the February 1974 lecture |journal=Epilepsy Behav |volume=15 |issue=4 |pages=417–24 |date=August 2009 |pmid=19640791 |doi=10.1016/j.yebeh.2009.06.006|s2cid=22179745 |type=Biography, History article}}</ref> Structures that may have an effect on hypergraphia when damaged due to temporal lobe epilepsy are the [[hippocampus]] and [[Wernicke's area]].  Aside from temporal lobe epilepsy, chemical causes may be responsible for inducing hypergraphia.

==Characteristics==
===Writing style===
American neurologists [[Stephen Waxman]] and [[Norman Geschwind]] were the first to describe hypergraphia, in the 1970s.<ref name="Waxman1974" />  The patients they observed displayed highly compulsive detailed writing, sometimes with literary creativity.  The patients kept diaries, which some used to meticulously document minute details of their everyday activities, write poetry, or create lists.  Case 1 of their study wrote lists of her relatives, her likes and dislikes, and the furniture in her apartment.  Beside lists, the patient wrote poetry, often with a moral or philosophical undertone.  She described an incident in which she wrote the lyrics of a song she learned when she was 17 several hundred times and another incident in which she felt the urge to write a word over and over again.  Another patient wrote [[aphorism]]s and certain sentences in repetition.<ref name=Waxman1974>{{cite journal|last=Waxman|first=SG|author2=Geschwind, N |title=Hypergraphia in temporal lobe epilepsy. 1974.|journal=Epilepsy & Behavior|date=March 2005 |volume=6|issue=2|pages=282–91|pmid=15710320|doi=10.1016/j.yebeh.2004.11.022|s2cid=32956175}}</ref>

A patient from a separate study experienced continuous "rhyming in his head" for five years after a seizure and said that he "felt the need to write them down."<ref name= Mendez1961>{{cite journal|last=Mendez |first=MF |title=Hypergraphia for poetry in an epileptic patient|journal=The Journal of Neuropsychiatry and Clinical Neurosciences|date=Fall 2005|volume=17|issue=4|pages=560–1|pmid=16388002|doi=10.1176/jnp.17.4.560}}</ref> The patient did not talk in rhyme, nor did he read poetry.  Language capacity and mental status were normal for this patient, except for recorded right-temporal spikes on [[electroencephalogram]]s.  This patient had right-hemisphere epilepsy.  Functional [[MRI]] scans of other studies suggest that rhyming behavior is produced in the left hemisphere, but Mendez proposed that postictal hypoactivity of the right hemisphere may induce a release of writing and rhyming abilities in the left hemisphere.<ref name=Mendez1961 />

===Content===
[[File:PSM V55 D217 Macro and micrographic writing by the same epileptic.png|thumb|Macro and micrographic writing by the same epileptic patient]]

In addition to writing in different forms (poetry, books, repetition of one word), hypergraphia patients differ in the complexity of their writings.  While some writers (e.g. [[Alice Flaherty]]<ref name=":0">{{Cite book |last=Flaherty |first=Alice W. |url=https://www.amazon.com/Midnight-Disease-Drive-Writers-Creative-ebook/dp/B00W0LQN6W/ref=monarch_sidesheet |title=The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain |date=2015-04-28 |publisher=Mariner Books |language=English}}</ref> and Dyane Harwood<ref>{{Cite book |last=Harwood |first=Dyane |url=https://www.amazon.com/Birth-New-Brain-Postpartum-Disorder-ebook/dp/B075GXM6CV/ref=sr_1_1?crid=3T0MEJIQEVKL4&keywords=dyane+harwood&qid=1708100585&s=digital-text&sprefix=dyane+harwood,digital-text,85&sr=1-1 |title=Birth of a New Brain: Healing from Postpartum Bipolar Disorder |last2=Henshaw |first2=Dr Carol |date=2017-10-10 |publisher=Post Hill Press |language=English}}</ref>) use their hypergraphia to help them write extensive papers and books, most patients do not write things of substance.  Flaherty describes hypergraphia as a result of decreased temporal lobe function which disinhibits frontal lobe idea and language generation, "sometimes at the expense of quality."<ref name=Flaherty2005>{{cite journal |author=Flaherty AW |title=Frontotemporal and dopaminergic control of idea generation and creative drive |journal=J. Comp. Neurol. |volume=493 |issue=1 |pages=147–53 |date=December 2005 |pmid=16254989 |pmc=2571074 |doi=10.1002/cne.20768|type=Review}}</ref> Patients hospitalized with temporal lobe epilepsy and other disorders causing hypergraphia have written memos and lists (like their favorite songs) and recorded their dreams in extreme length and detail.<ref name=Flaherty2005 />

There are many accounts of patients writing in nonsensical patterns including writing in a center-seeking spiral starting around the edges of a piece of paper.<ref name="Yamadori">{{cite journal |vauthors=Yamadori A, Mori E, Tabuchi M, Kudo Y, Mitani Y |title=Hypergraphia: a right hemisphere syndrome |journal=J. Neurol. Neurosurg. Psychiatry |volume=49 |issue=10 |pages=1160–4 |date=October 1986 |pmid=3783177 |pmc=1029050 |doi=10.1136/jnnp.49.10.1160}}</ref> In one case study, a patient even wrote backward, so that the writing could only be interpreted with the aid of a mirror.<ref name=Waxman1974 /> Sometimes the writing can consist of scribbles and frantic, random thoughts that are quickly jotted down on paper very frequently.  Grammar can be present, but the meaning of these thoughts is generally hard to grasp and the sentences are loose.<ref name="Yamadori" /> In some cases, patients write extremely detailed accounts of events that are occurring or descriptions of where they are.<ref name="Yamadori" />

In some cases, hypergraphia can manifest with compulsive drawing.<ref>{{cite journal|last1=Roberts|first1=JK|last2=Robertson|first2=MM|last3=Trimble|first3=MR|title=The lateralising significance of hypergraphia in temporal lobe epilepsy|journal=Journal of Neurology, Neurosurgery, and Psychiatry|date=February 1982|volume=45|issue=2|pages=131–8|doi=10.1136/jnnp.45.2.131|pmid=7069424|pmc=1083040}}</ref> The composer [[Robert Schumann]], during periods of high musical output, also wrote many long letters to his wife Clara; similarly, Vincent van Gogh had much more written correspondence during  bouts of intense painting.<ref name=":0" />  Many drawings by patients with hypergraphia exhibit repetition and a high level of detail, sometimes mixing both compulsive writing and drawing together.<ref>{{Cite book|title=Neurology and General Medicine|last=Aminoff|first=Michael|year=2001|pages=579}}</ref>

==Causes==
Some studies have suggested that hypergraphia is related to [[bipolar disorder]], [[hypomania]], and [[schizophrenia]].<ref name=Flaherty2011 /> Although creative ability was observed in the patients of these studies, signs of creativity were observed, not hypergraphia specifically.  Therefore, it is difficult to say with absolute certainty that hypergraphia is a symptom of these psychiatric illnesses because creativity in patients with bipolar disorder, hypomania, or schizophrenia may manifest into something aside from writing.  However, other studies have shown significant accounts between hypergraphia and temporal lobe epilepsy<ref name=Frequency_of_Hypergraphia>{{ cite journal |last1 = Sachdev |first1 = H S |last2 = Waxman |first2 = S G |year = 1981 |title = Frequency of hypergraphia in temporal lobe epilepsy: an index of interictal behaviour syndrome. |journal = Journal of Neurology, Neurosurgery, and Psychiatry |quote = Patients with temporal lobe epilepsy tended to reply more frequently to a standard questionnaire, and wrote extensively (mean: 1301 words) as compared to others (mean: 106 words). The incidence of temporal lobe epilepsy was 73% in patients exhibiting hypergraphia compared to 17% in patients without this trait. These findings suggest that hypergraphia may be a quantitative index of behaviour change in temporal lobe epilepsy. |pmid = 7241165 |pages = 358–60 |issue = 4 |volume = 44 |doi=10.1136/jnnp.44.4.358 |pmc=490963}}</ref> and chemical causes.<ref>{{Cite journal |last=Flaherty |first=Alice W |date=2012-12-28 |title=Writing and Drugs |url=https://journal.equinoxpub.com/WAP/article/view/7422 |journal=Writing and Pedagogy |volume=4 |issue=2 |pages=191–207 |doi=10.1558/wap.v4i2.191 |issn=1756-5847|url-access=subscription }}</ref>

=== Temporal lobe epilepsy ===
[[File:Gray728.svg|thumb|Image of the temporal lobe]]
Hypergraphia was first studied as a symptom of [[temporal lobe epilepsy]], a condition of reoccurring seizures caused by excessive neuronal activity, but it is not a common symptom among patients.  Less than 10 percent of patients with temporal lobe epilepsy exhibit characteristics of hypergraphia.{{medical citation needed|date=December 2013}}  Temporal lobe epilepsy patients may exhibit irritability, discomfort, or an increasing feeling of dread if their writing activity is disrupted.<ref>{{cite journal |vauthors=van Vugt P, Paquier P, Kees L, Cras P |title=Increased writing activity in neurological conditions: a review and clinical study |journal=J. Neurol. Neurosurg. Psychiatry |volume=61 |issue=5 |pages=510–4 |date=November 1996 |pmid=8937347 |pmc=1074050 |doi=10.1136/jnnp.61.5.510}}</ref> To elicit such responses when interrupting their writing suggests that hypergraphia is a compulsive condition, resulting in an obsessive motivation to write.<ref name=Flaherty2011>{{cite journal|last=Flaherty|first=AW|title=Brain illness and creativity: mechanisms and treatment risks |journal=Canadian Journal of Psychiatry|date=March 2011|volume=56|issue=3 |pages=132–43|pmid=21443820|doi=10.1177/070674371105600303|doi-access=free}}</ref> A temporal lobe epilepsy may influence frontotemporal connections in such a way that the drive to write is increased in the [[frontal lobe]], beginning with the [[Prefrontal cortex|prefrontal]] and [[premotor cortex]] planning out what to write, and then leading to the [[motor cortex]] (located next to the [[central sulcus|central fissure]]) executing the physical movement of writing.<ref name=Flaherty2011 />

Most temporal lobe epilepsy patients who suffer from hypergraphia can write words, but not all may have the capacity to write complete sentences that have meaning.<ref name="Yamadori" />

=== Bipolar disorder ===
The disorder most often associated with high-output writers is bipolar disorder, especially during hypomania.<ref name=":1">{{Cite book |last=Jamison |first=Kay R. |title=Touched with fire: manic-depressive illness and the artistic temperament |date=1994 |publisher=Free Press |isbn=978-0-02-916003-9 |edition=1. paperback |location=New York}}</ref> In fact, temporal lobe epilepsy is more likely to produce hypergraphia if it also produces manic symptoms. While depression has been linked to increased writing, it appears that most writers with depression write little while depressed, and high output periods correspond to rebound mood elevation after the end of a depression, or in mixed mood states.<ref name=":1" />

=== Chemicals ===
Drugs that boost mood and energy have been known to induce hypergraphia, possibly by increasing activity in brain networks utilizing one of the body's neurotransmitters, [[dopamine]].  Dopamine has been known to decrease [[latent inhibition]], which causes a decrease in the ability to habituate to screen out unexpected stimuli.  Low latent inhibition leads to an excessive level of stimulation and could contribute to the onset of hypergraphia and general creativity.<ref>{{Cite journal |last=Carson |first=Shelley H. |last2=Peterson |first2=Jordan B. |last3=Higgins |first3=Daniel M. |date=September 2003 |title=Decreased latent inhibition is associated with increased creative achievement in high-functioning individuals |url=https://pubmed.ncbi.nlm.nih.gov/14498785/ |journal=Journal of Personality and Social Psychology |volume=85 |issue=3 |pages=499–506 |doi=10.1037/0022-3514.85.3.499 |issn=0022-3514 |pmid=14498785}}</ref>  This research implies that there is a direct correlation between the levels of dopamine between neuronal synapses and the level of creativity exhibited by the patient.  Dopamine agonists increase the levels of dopamine between synapses which results in higher levels of creativity, and the opposite is true for dopamine antagonists.

In one case study, a patient taking donepezil reported an elevation in mood and energy levels which led to hypergraphia and other excessive forms of speech (such as singing).<ref name="Wicklund">{{cite journal |vauthors=Wicklund S, Wright M |title=Donepezil-induced mania |journal=J Neuropsychiatry Clin Neurosci |volume=24 |issue=3 |pages=E27 |year=2012 |pmid=23037669 |doi=10.1176/appi.neuropsych.11070160}}</ref> Six other cases of patients taking donepezil and experiencing mania have been previously reported.  These patients also had cases of [[dementia]], cognitive impairment from a [[cerebral aneurysm]], bipolar I disorder, and/or depression.  Researchers are unsure why donepezil can induce mania and hypergraphia.  It could potentially result from an increase in [[acetylcholine]] levels, which would have an effect on the other neurotransmitters in the brain.<ref name="Wicklund" />

==Pathophysiology==
[[File:Cerebrum lobes.svg|thumbnail|left|Image of the brain lobes, including the temporal lobe and somatomotor (primary motor) cortex.]]
Several regions of the brain are involved in the act of written composition.  Handwriting depends on the superior [[parietal cortex]], and motor control areas in the [[frontal lobe]]  and [[cerebellum]].<ref name=Planton>{{cite journal |vauthors=Planton S, Jucla M, Roux FE, Démonet JF |title=The 'handwriting brain': A meta-analysis of neuroimaging studies of motor versus orthographic processes |journal=Cortex |volume=49 |issue=10 |pages=2772–87 |year=2013 |pmid=23831432 |doi=10.1016/j.cortex.2013.05.011|s2cid=22404108 }}</ref> An area of the frontal lobe that is especially active is Exner's area, located in the [[premotor cortex]].<ref name=Planton /> Writing creatively and generating ideas, on the other hand, activates multiple sites in the limbic system and cerebral cortex, including the left inferior frontal gyrus (BA 45) and the left temporal pole (BA 38).<ref>{{cite journal |vauthors=Shah C, Erhard K, Ortheil HJ, Kaza E, Kessler C, Lotze M |title=Neural correlates of creative writing: an fMRI study |journal=Hum Brain Mapp |volume=34 |issue=5 |pages=1088–101 |date=May 2013 |pmid=22162145 |doi=10.1002/hbm.21493|pmc=6869990 }}</ref> Lesions to [[Wernicke's area]] (in the left temporal lobe) can increase speech output, which can sometimes manifest itself in writing.<ref name="Flaherty2005" /> In one study, patients with hippocampal atrophy showed signs of having Geschwind syndrome, including hypergraphia.<ref name="Elst">{{cite journal |vauthors=van Elst LT, Krishnamoorthy ES, Bäumer D, et al |title=Psychopathological profile in patients with severe bilateral hippocampal atrophy and temporal lobe epilepsy: evidence in support of the Geschwind syndrome?|journal=Epilepsy & Behavior|date=June 2003|volume=4|issue=3|pages=291–7|pmid=12791331|doi=10.1016/s1525-5050(03)00084-2|s2cid=34974937}}</ref> While epilepsy-induced hypergraphia is usually lateralized to the left cerebral hemisphere in the language areas, hypergraphia associated with lesions and other brain damage usually occurs in the right cerebral hemisphere.<ref name="Ishikawa">{{cite journal|last=Ishikawa|first=T|author2=Saito, M |author3=Fujimoto, S |author4= Imahashi, H |title=Ictal increased writing preceded by dysphasic seizures.|journal=Brain & Development|date=September 2000|volume=22|issue=6|pages=398–402|pmid=11042425|doi=10.1016/s0387-7604(00)00163-7|s2cid=43906342}}</ref> Lesions to the right side of the brain usually cause hypergraphia because they can disinhibit language function on the left side of the brain.<ref name="Flaherty2005" /> Hypergraphia has also been known to be caused by right hemisphere strokes and tumors.<ref name="Yamadori" /><ref name="Imamura">{{cite journal|last=Imamura|first=T|author2=Yamadori, A |author3=Tsuburaya, K |title=Hypergraphia associated with a brain tumour of the right cerebral hemisphere.|journal=Journal of Neurology, Neurosurgery, and Psychiatry|date=January 1992|volume=55|issue=1|pages=25–7|pmid=1548492|doi=10.1136/jnnp.55.1.25|pmc=488927}}</ref>

==Society and culture==
<!-- Please review [[WP:MEDMOS]] before adding speculation here-->

Hypergraphia was one of the central issues in the 1999 trial of Alvin Ridley for the imprisonment and murder of his wife [[Virginia Ridley]].<ref name="Brownlee">Brownlee 2006.</ref> The mysterious woman, who had died in bed of apparent suffocation, had remained secluded in her home for 27 years in the small town of [[Ringgold, Georgia]], United States.  Her 10,000-page journal, which provided abundant evidence that she suffered from [[epilepsy]] and had remained housebound of her own will, was instrumental in the acquittal of her husband.<ref name="Brownlee" />

In 1969, [[Isaac Asimov]] said "I am a compulsive writer".<ref>{{Cite book|url=https://archive.org/stream/nightfallotherst00asim#page/244/mode/2up|title=Nightfall, and other stories|last=Asimov|first=Isaac|date=1969|publisher=Doubleday|pages=244}}</ref> Other artistic figures reported to have been affected by hypergraphia include [[Vincent van Gogh]],{{citation needed|date=September 2022}} [[Fyodor Dostoevsky]],<ref>"New Comments on the Epilepsy of Fyodor Dostoevsky," ''Epilepsia'' 25 (No. 4, 1984), p. 409.</ref> and [[Robert Burns]].<ref>[http://www.rbana.com/Robert%20Burns%20and%20the%20Medical%20Profession.pdf Robert Burns and the Medical Profession] {{webarchive|url=https://web.archive.org/web/20140111210524/http://www.rbana.com/Robert%20Burns%20and%20the%20Medical%20Profession.pdf |date=January 11, 2014 }} Retrieved : January 11, 2014</ref> ''[[Alice in Wonderland]]'' author [[Lewis Carroll]] is also said to have had the condition,<ref name="Flaherty">Flaherty, ''The Midnight Disease'' p 26</ref> having written more than 98,000 letters in various formats throughout his life. Some were written backward, in [[rebus]], and in patterns, as with "The Mouse's Tale" in ''Alice''.

[[Eleanor Alice Burford]], whose pen-names included [[Jean Plaidy]], [[Victoria Holt]], [[Philippa Carr]], [[Eleanor Burford]], [[Elbur Ford]], [[Kathleen Kellow]], [[Anna Percival]], and [[Ellalice Tate]], described herself as a compulsive writer.

[[Naomi Mitchison]], often called a doyenne of Scottish literature, writing over 90 books of historical and science fiction, travel writing and autobiography, has been described as a compulsive writer.

==See also==
* [[Automatic writing]]
* [[Free writing]]
* [[Graphomania]]

==References==
{{reflist}}

==Further reading==
* {{Cite book  | last = Flaherty  | first = Alice Weaver  | title = The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain  | publisher = [[Houghton Mifflin Harcourt]]  | year = 2004  | isbn = 0-618-23065-3  | url-access = registration  | url = https://archive.org/details/midnightdiseased00flah  }}
* Pickover, C. A. (1999). ''Strange brains and genius: The secret lives of eccentric scientists and madmen''. New York: William Morrow. {{ISBN|0-688-16894-9}}
* Schachter, S. C., Holmes, G. L., & Kasteleijn-Nolst Trenité, D. (2008). ''Behavioral aspects of epilepsy: Principles and practice''. New York: Demos. {{ISBN|1-933864-04-4}}

[[Category:Impulse-control disorders]]
[[Category:Writing]]