A lot of it was cultural. A lot of medieval art favoured expressionism over naturalism or realism, particularly religious works as it was more important to evoke feeling and encourage individual interpretation of the biblical stories than anything else. But if you look at a painting of Henry VIII (early 16th Century) or the tomb of Richard I ‘The Lionheart’ (12th Century) you’ll find they did do realism in certain instances, where it was deemed important to capture something as it appeared properly.
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