Brighter Than a Cloud
How to describe a scintillating scotoma? It’s one of the most common symptoms of a migraine, but unless you’ve had one, it sounds unreal. A scintillating scotoma is like a barbed ripple in the pool of sight. It’s a skeletal Magic Eye raised up from the flatness of the world. It’s a glare on the tarmac as you drive West at sunset on a rain-slick freeway—only when you turn your head, it’s still there, so you have to pull over, close your eyes, and wait out the slow-motion firework working its way across your brain.
Medieval migraine sufferers compared the jagged shape of their scintillating scotoma to fortresses, and medical literature describes their “fortification patterns.” I never quite understood the analogy until I took a water tour of Copenhagen—as our boat slid down the Øresund alongside the island citadel of Kastellet, I saw my own scotoma in stone. A migraine aura, too, has ramparts and ravelins, bastions against a zig-zag world. At their edges, chaos reigns. The thin interface between a scotoma and normal vision is a boiling tar, a volley of arrows, a violence of inputs and light. In the midst of an attack, it’s tempting to think that perception is always at war with reality.
In the absence of an organizing mind, everything comes unglued. Faces go missing and dark holes seem to eat half the universe. Migraine sufferers can experience the uncanny sense of consciousness doubling known as déja-vu, or its cousin, jamais-vu, in which the world feels newly-made. The world might feel suddenly very unreal, fracture into a mosaic, or slow to a stop-motion pace, dropping frames. The self might cleave in two in a fit of somatopsychic duality. Writing about these bizarre and horrifying perceptual phenomena, the late Oliver Sacks observed that migraines “show us how the brain-mind constructs ‘space’ and ‘time,’ by demonstrating what happens when space and time are broken, or unmade.”
It’s true that migraines offer a rare vantage on the brain and its mysteries. As the scotoma’s shining edges recede across your field of vision, they trace a corresponding wave of electrical activity, a “spreading depression” crossing the cortex at 3 millimeters per minute. You can watch it happen in real time, as you might watch a cloud track across the sky on a windy day. You might even have time draw a picture of the scotoma as it passes overhead—a landscape en pleine tête.
The Wellcome Collection, in London, hosts a remarkable collection of such pictures: some 545 submissions to a British migraine art competition than ran throughout the 1980s. Each image has its own vernacular charm. The scotomas explode into tidy living rooms and block bucolic country roads. They dazzle a woman’s smile. They arc like ball lightning across the faces of row houses. The collection is worth appreciating on an aesthetic level alone, as sublime outsider art, but it’s valuable, also, because it reveals the scotoma’s universal form. Like dreams, migraines map terrain we all share.
Perceptual distortions are difficult to measure, but they can be approximated in paint and pencil, which makes migraine art a powerful diagnostic and scientific tool. The earliest depictions of migraine phenomena were illustrations made by physicians who happened to be migraineurs themselves, like the German ophthalmologist Christian Georg Theodor Ruete, who illustrated the three successive stages of his own “flimmerskotom” in 1845, and the 19th century British physician Hubert Airy, whose ink renderings wouldn’t be out of place in the Wellcome’s migraine art collection.
Nor, for that matter, would the illuminated manuscripts of the 12th-century German Christian mystic Hildegard of Bingen. Hildegard, who spent most of her childhood as an anchoress, enclosed in a one-room cell adjoining the Benedictine monastery at Disibodenberg, described lifelong gripping pain and a persistent umbra viventis lucis: a reflection of living light. “The light which I see…is not spatial, but it is far, far brighter than a cloud which carries the sun,” she wrote. Descriptions like these, supplemented by her visionary artwork depicting fortifications, mandalas of stars, flaming eyes, and openings in the sky lapped with white-crested waves, have led many neurologists to retroactively diagnose her as a chronic migraine sufferer.
Does such a diagnosis negate Hildegard’s holy ecstasies? Is it reductive to pathologize the shimmering visions that led a Medieval abbess to compose some of the most stunningly beautiful liturgical music of all time? Oliver Sacks, again, answered these questions wisely, in his 1970 book Migraine:
“Invested with [a] sense of ecstasy, burning with profound theophorus and philosophical significance, Hildegard’s visions were instrumental in directing her towards a life of holiness and mysticism. They provide a unique example of the manner in which a physiological event, banal, hateful, or meaningless to the vast majority of people, can become, in a privileged consciousness, the substrate of a supreme ecstatic inspiration.”
Hildegard’s ecstatic inspiration was religious in nature, but the migraine experience is non-denominational. Lewis Carroll transmuted his acute migraine symptoms—the visual disturbances of Lilliputian and Brobdignian vision, which made him feel as though his limbs were shrinking and growing away from him—into Alice in Wonderland. Giorgio de Chirico, who suffered from scotoma, depersonalization, déja- and jamais-vu, among other migraine symptoms, repeatedly painted wobbly suns, jagged voids, zig-zags and disproportionate figures into his metaphysical canvases.
According to Migraine Art: The Migraine Experience From Within, migraine auras are as old as humankind—so old, perhaps, that they may have inspired the geometric forms of Stone Age cave drawings. Which makes recent attempts to generate migraine auras using convolutional neural networks seem particularly poignant to me: what began in stone, animated by the hot flicker of firelight, continues 5,000 years later, deep in the heart of servers whose mineral components were mined from the same dark Earth.
xo
Claire
I had this about a year ago and had never heard of it. Thanks for the post and Sacks reference!
I relate to Hubert Airy's 1870 illustration, my own scintillating scotoma look very similar. Bolts of lightning, block parts of my vision, usually happens after high concentration or stress. Fascinating article, thank you for the insight.