Arts & Health
‘Arts’ and ‘health’ are both ‘feel good’ words. And it does feel good to be healthy and creative. But art making, and thinking about health and illness, have a lot more depth than that. This brief introduction to the field, and Insider Art’s approach to it, is intended to provide a simple outline of what are complex issues. At its heart is our conviction that, as H.L Mencken observed, ‘to every complex problem there is a simple solution, and its wrong’
The arts and health can be seen as functioning across four main ‘hubs’.
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The Medical Humanities
Medicine can’t avoid dealing with the human condition, including the realities of suffering and death. Humane medical care means self reflection, analysis, observation, and empathy. All of these can be helpfully developed through the arts. Historical and philosophical perspectives can also be accessed through an appreciation of the arts. A doctor who reads (and writes!) novels and poetry will be a better doctor, because the engagement of imagination and fellow-feeling will produce better interactions and outcomes. The arts help us appreciate other’s experiences and viewpoints.
The effects are startling measurable: research at the Harvard Medical school showed that an anaesthetist spending ten minutes longer with a patient the night before an operation, was warm and sympathetic, sat on a bed and held a hand halved the amount of pain relief that patient asked for, and produced hospital discharges three days earlier on average. (Egbert et al, ‘Reduction of post operative pain by encouragement and instruction of patients’ New England Journal of medicine, 270, 835-827). The arts are being used, for instance by using actors for ‘practice’ in many medical schools to improve practice.
Community Arts:
‘Community arts practice involves community arts professionals creating opportunities within communities for people to develop skills and to explore and develop ideas through active participation in the arts. Community arts practice generally targets disadvantaged individuals and communities and by its nature leads to positive personal and community change and regeneration. Underpinning community arts practice is the aim to engender change, authorship and ownership.’
(Welsh Arts Council
http://www.artswales.org.uk/publications/CommunityArtsAuditBrief.pdf
Community arts are within themselves a wide spectrum, but share a perspective that art making not only happens in a social context, but can itself be a form of social activism. This can, and does, have health implications: Social exclusion is known to have devastating effects on physical and mental health, and the arts are an effective way of working with towards social inclusion. Real ‘base line’ mental health benefits of well facilitated projects include improved self esteem and sense of personal effectiveness. A model of health has to include at least four ‘kinds’ of health: genetic, physical, social and emotional/ psychological, which are all intertwined. Social and emotional health are particularly related, and the community arts and the arts therapies offer different kinds of approach to them.
Arts and Healing Environments:
Where we go to receive health treatment give us immediate and profound messages that substantially affect our experience of the care we receive. If the health care environment looks uncared for and neglected we may, understandably, be concerned that we may be uncared for and neglected.
Research into integrating art and design into a health care environments demonstrates that arts in hospitals also have a measurable medical impact. They can:
- Induce significant differences in clinical outcomes
- Reduce amount of drug consumption
- Shorten length of stay in hospital
- Improve patient management
- Contribute towards increased job satisfaction
- Enhance the quality of service
(A Study of the Effects of Visual and Performing Arts in Health Care: research carried out at Chelsea and Westminster hospital http://chelwestcharity.org.uk/binary_data/263_study_visual_performing_arts.pdf )
The Arts Therapies:
Arts therapists are dual trained: in the art form in which they specialise, art, drama, dance movement or music, with an extensive psychotherapy training. Therapists need to be fluent in the ‘language’ of their art form to use it effectively as therapeutic medium. The therapies work with the capacity of art making, alongside therapeutic relationship, to contain, express and transform distress and disturbance. The understanding of therapeutic relationship is a key aspect of an arts therapists training, and one of the most helpful things to bring to other areas of practice, even as simply as the Harvard anaesthetist’s extra ten minutes. (In mental health this is vital: 'One of the most robust findings in psychotherapy research is that a good therapeutic alliance is the best predictor of outcome in psychotherapy'
Jeremy Holmes 'All you need is CBT?', British Medical Journal 2002;324:288-294)
Arts Therapists work in wide range of contexts: in mental health, schools and prisons for example. It is not unusual for the arts therapies to be seriously misrepresented by some arts and health groups. It is important to be very clear: arts therapists do not ‘diagnose’, we do not work ‘with a deficit model’ and we do not reduce art making to an ‘interpretation’. We do work with the innate creativity and resilience in emotionally intelligent and psychologically literate ways that can catalyse self healing.
Insider Art have worked in each of these ‘hubs’ for many years: you’ll found examples of some of our projects and services on this site. Wide experience convinces us that because health and illness are inseparably linked, that the ‘feel good’ of health has to include working with the losses, sadness and suffering that are implicitly in not being healthy. As Ivan Illich put it:
‘Health designates a process of adaptation….It designates the ability to adapt to changing environments, to growing up and ageing, to healing when damaged, to suffering, to the peaceful expectation of death. Health embraces the future as well, and therefore includes anguish and the resources to deal with it.’
Ivan Illich: Limits to Medicine, Marion Boyars, London 1976
The introduction to the 2007 Department of Health Working Group on the arts and health made the same point by including this quotation:
“Do not imagine that Art is something which is designed to give gentle uplift and self-confidence. Art is not a brassiere. At least, not in the English sense. But do not forget that brassiere is the French for life jacket.”
Julian Barnes, Flaubert’s Parrot, 1984
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications
/Publications
PolicyAndGuidance/DH_073590
The risk of approaching any of the arts and health hubs from the point of view that ‘art is nice’ and ‘health is nice’, so arts and health must be really nice, is that it tends to trivialise art without necessarily improving health. Or worse, trivialise health issues and produce poor art.
Working effectively with the resilience, energy, and creativity of the arts in a health context demands practitioners who are educated, supported, reflective, sensitive, responsive and able to cope with the complexity, difficulty and ambivalence generated by health issues.
Insider Art see Emotional Intelligence (See Daniel Goleman’s book of that title) as a key determinant of what works and what doesn’t. Whether we are working with:
- Medical and psychology students about the personal costs of working with distress day in, day out.
- Staff and service users designing collaborative art works to improve a healthcare environment.
- Service user led art groups on exhibiting their work.
- A local museum on a workshop for Big Draw day.
- Or working as therapists and supervisors around complex mental health needs like depression, self harm or eating disorders.
We believe the common threads of being psychologically informed, emotionally sensitive and able to create the ‘safe spaces’ where art making and health making happen best are the keys to effective and ethical practice.
There is nothing inherently emotionally intelligent in most art trainings to actively address developing skills around helping relationships, working with groups, the centrality of health concepts like Duty of Care or the complex issues involved in showing work. Insider Art have responded to the need for trainings, courses and conferences that take the strengths of the art therapy perspective and ally it to other arts based skills need to work safely and effectively in the arts and health area. After all, if there is demonstrable effect on physical and mental health through arts based interventions, then in the vast majority of situations this effect must be psychologically based. (There are exceptions, where the arts are the agent of an effective physical treatment, for instance asthmatic children benefiting for play a wind instrument, but they are the exceptions that prove the rule. Even highly measurable physical health outcomes are being achieved through psychological means).
This is not just about more effective practice: it is also about the safety and well being of both arts practitioners and their health ‘customers’. An artist who, for instance, suddenly encounters severe mental health problems, or the realities of an oncology ward, is entitled for their own well being, to have some preparation before, support during (and perhaps after) a project confronting them with such potentially emotive issues. Participants too are entitled to expect that practitioners understand psychological and emotional safety. Where there are strong feelings involved working with the enormous power of the arts to express without knowing how to also work with their equivalent capacity to contain is potentially risky for all concerned. Understanding how instrumental the relationship with the facilitator is to managing intense expressions of emotion, may leave many ‘customers’ and artists/ facilitators in much deeper emotional water than they had signed up for.
Mary Robson. NESTA Fellow at the Centre for Arts and Humanities in Health and Medicine (CAHHM), University of Durham, wrote about the benefits to an artist in a health setting of getting that support from an arts therapist:
‘I have worked as a freelance for over twenty years. One day in 2000, an incident at work left me dwelling unhealthily on what I perceived were my professional failings. The problem was that I dwelt only on the negative aspects of the incident and I found it increasingly affecting my professional self-confidence. I realised I needed support different to that proffered by friends, family and colleagues. I needed to be able to articulate challenging issues for myself; I wanted to grow and learn professionally whilst contending with the challenging nature of the work and I wasn’t looking for therapy.
Professional supervision was recommended by two colleagues, both recent converts to its benefits. I have been seeing a supervisor ever since. Within the first eighteen months I noticed an increase in self confidence, I had attended two training courses and effectively changed some unhelpful thinking processes as a result of the monthly sessions. My supervisor is trained as a counsellor, psychotherapist and drama therapist.’
http://www.dur.ac.uk/resources/cahhm/articles/Every%20Person%20Matters.pdf
In such a ‘multi territorial’ field as the arts and health, it is perhaps inevitable that there are attempts to expand and defend professional empires and ideologies. It is striking how frequently for instance the arts therapies are missing altogether from some accounts of the arts and health landscape.
This map is adjusted from an original by: www.worldatlas.com
Conferences are held, and books are published, claiming to represent the arts and health field, from which the newcomer to the field would never guess that the arts therapies have been developing the arts as a health intervention for over sixty years. This is a bit like a cartographer who, irrationally and prejudicially, didn’t like the French deciding to publish maps of Europe without showing France. The result might be an accurate map of that cartographer’s fantasy, but is objectively untrue and would make it unhelpfully difficult for someone trying to use the map to travel from Barcelona to Prague.
Insider Art stand for joined up practice in the arts and health: we believe an informed, inclusive and mutually respectful approach means better, safer, projects, better health outcomes, confident and competent practitioners, and higher quality art works. Our projects, courses and events are committed to that aim.
The article Support for the Arts in Health from Art Therapy by Malcolm Learmonth & Karen Huckvale was written for the National Network for the Arts in Health is available by clicking on the title and is on the Publications & Documents page.