Tommy McHugh, brawling ex-con to painter, after a Stroke

Builder Tommy McHugh became artistic; a rugby player says he woke up gay. Can having a stroke change who we are?

When Tommy McHugh had a stroke, it was the moment that someone pulled the plug on his matrix. That’s the way he puts it, anyway. Strokes usually change people’s lives but for some, like Tommy, they change everything.

He looked in the mirror and didn’t recognise the face looking back at him. His wife was a stranger. People told him he was a builder with a criminal record and a past as a streetfighter but he didn’t like the sound of that. He far preferred the vivid and fabulously varied new world he saw now. Having previously had no artistic inclinations, he’s been spending every moment since his stroke trying to capture what he sees in thousands of paintings, drawings, sculptures and poems. “I can see the beauty of the world now,” says Tommy, aged 61, from Liverpool. “I can watch a child’s cartoon and cry.”

There are hundreds of tales of personal transformations after a stroke — a bleed or bloodstream blockage that causes damage to an area of the brain. This month came reports of one of the strangest. Chris Birch, a 26-year-old rugby player, was reported to have become gay and ditched his bank job to become a hairdresser as a result of a stroke during a rugby training accident. He claims he lost interest in women, broke up with his girlfriend and hated everything to do with his old laddish lifestyle.

What’s going on in such strange cases? Strokes commonly cause significant personality and behaviour changes — people becoming more laid-back, more aggressive, more appreciative of life, more liable to take risks and gamble, more interested in or more indifferent to sex. But there is also increasing documentation of oddities: people acquiring foreign accents after stroke, people believing that they are zombies, people losing all memory of their loved ones, people who start tasting colours.

And because strokes often affect a localised part of the brain, such strange phenomena raise the tantalising prospect of better understanding the way that different parts of the brain control not just behaviour, but how we see the world. Does damage to one part of the brain sometimes mean that previously untapped knowledge, abilities and traits from another part can be unlocked?

Most researchers now believe that the truth is more complex and fascinating than that. The process by which Tommy McHugh became a more creative and appreciative person seems to be different from the process that mysteriously gives some people foreign accents after a stroke.

Mark Lythgoe, a neuroscientist who specialises in investigating brain function through MRI scanning, has studied Tommy closely and says that his is not the only case in which creativity seems to have increased after a stroke. An American chiropractor became a compulsive painter after a brain haemorrhage, and a former engineer from Ormskirk in Lancashire claims that a stroke “rewired” his brain so he became a designer of digital creatures for computer games.

All human brains, says Lythgoe, have the ability to filter out irrelevant information so they can concentrate on the task in hand, a trait known as “latent inhibition”.

“Research indicates that people with less latent inhibition tend to be more creative — they let the irrelevant into their minds far more easily, and so are constantly making associations between things,” says Lythgoe, who is Director of the Centre for Advanced Biomedical Imaging at University College London.

Some localised brain injuries may “disinhibit” the brain so that it makes connections that wouldn’t normally be made. Brain-scanning studies indicate that these changes are most likely to be caused by damage to the frontal and temporal lobes of the brain: the parts that seem to be associated with creativity and understanding meaning.

This certainly chimes with Tommy McHugh’s experience. “It hit me instantly after the stroke — so many images and pictures occurred that I had to get rid of them by painting them. I feel that my eyes are two cameras. One is like fast-moving monochrome, and the other has bright images, like neon. I write letters in rhyme, or from the bottom upwards.”

Could such brain changes explain turnarounds in sexuality too? Many researchers and stroke doctors are sceptical that it was a stroke that transformed Chris Birch’s sexual preferences. But there have been scientifically documented cases of changed sexual behaviour after a stroke. Neurologists from the University of California, Los Angeles, writing in the Journal of Neurology, said that brain damage, particularly in the temporal lobe and basal frontal lobe, can result in a disinhibition of sexual drive, often associated with a more general lack of inhibition in behaviour. So there are parallels between these cases and cases of artistic disinhibition.

The cause of “foreign accent syndrome”, however, appears to be totally different. In September, Debbie McCann, 48, was reported to have started talking in an Italian accent after a minor stroke in November last year, despite never having left her home city of Glasgow. She is one of about 60 people in the world reported to suffer from this condition.

Professor Sophie Scott, from the Institute of Cognitive Neuroscience at University College London, explains that strokes can cause people to speak haltingly, with stresses in peculiar places. Listeners make assumptions about this: they interpret the oddities as a foreign accent. Someone who sounds as if they have acquired an Italian accent is actually having problems with the complex motor nerve systems that produce speech, so they are elongating vowels and voicing vowels at the end of syllables. “It is a nice day” becomes “Eet ees a nice-a day-a”.

“Generally the syndrome arises when there is a small area of damage to the brain,” Scott says. “Major damage means people have trouble making sense in speech at all. Some lesions are near the speech centres of the brain, but the location seems to vary.”

The difficulty of linking specific syndromes with particular parts of the brain may be because it is partly how those parts work together that makes us what we are. Professor Allan House, head of psychiatry and behavioural sciences at Leeds University School of Medicine, says it is common for people to have a change in attitude to life after a stroke. Many of his patients have become more euphoric, more apathetic, less concerned about risk or more irritable. There are peculiar phenomena. “It’s quite common that people don’t recognise their own limbs for a while after a stroke,” he says. “I’ve seen people lying in bed, suddenly taken by surprise when they see their own hand.”

House has had patients with what is known as Capgras delusion — they believe that family and friends have been replaced by identical-looking impostors. Others have difficulty recognising facial expressions. “In these cases, what’s happening is that the visual part of the brain can’t connect with the emotion part,” he explains.

The same thing happens with one of the most common symptoms of stroke, apraxia, where people are unable to perform simple daily tasks because they involve co-ordinating several parts of the brain at the same time. Opening a can, for example, involves sight and strength, but damage to the association cortex, the tissue in the brain that co-ordinates all the messages involved, makes it impossible.

For all the human curiosities they throw up, strokes are traumatic and limiting, and the road to partial or total recovery is hard and often long. But for a very small number of people they can open up new and unexpected worlds.

“I don’t want to be in the past any more. I want to be in the present,” says Tommy McHugh. “I stood in a shop the other day just staring at the shelves of yoghurts, dribbling at how wonderful they all looked, until a shop assistant came and asked me if I was all right. The beautiful thing is that you’re just alive.”


  • Foreign accent syndrome: suddenly speaking as if you come from another country.
  • Cotard’s delusion: believing you are a walking corpse
  • Capgras delusion: believing your family have been replaced by replicas.
  • Dr Strangelove syndrome: believing your hand belongs to someone else, or has a life of its own.
  • Synaesthesia: two or more senses become mixed so that sounds have colours, or shapes have tastes.
  • Acquiring artistic abilities or impulses, eg, compulsive creative writing.
  • Changes in sexual orientation.
  • Changes in libido.
  • Increase in risk-taking and gambling.
  • Inability to interpret facial expression.

by Simon Crompton, medical writer and author. This piece was first published in The Times on 29 November 2011

(c) Simon Crompton