WHAT USE ARE THE ARTS? PART 5: THE ARTS AND HEALTH: The intuiitive sense that there is a link between good health and artistic activity is bolstered by recent medical research. But there is no strategy in place to make tha arts an integral element in healthcare.
"Art in its finest moment is healing, and healing in its finest moment is art"
- Bonny Bainbridge Cohen
IN The Anatomy of Melancholy, published in 1621, Robert Burton celebrated the curative qualities of music, concluding that "besides that excellent power it hath to expel many other diseases, it is a sovereign remedy against despair and melancholy". Although he draws on contemporary scientific theories, ranging from psychology and physiology to astronomy, meteorology and theology, Burton's text has always been regarded more as a literary than a medical thesis. So too has much of the research into the link between the arts and wellbeing - be that physical or mental - been dismissed as anecdotal rather than empirical. "The arts are good for us" is regarded not as a scientific statement, but as a moral one.
Increasingly, however, the connection between the arts and health is being explored by putting the arts into practice in healthcare settings in a variety of ways, from the purely visual to the participatory to therapy itself. The use of "intelligent design" in the construction of hospitals, for example, is intended to make them slightly less intimidating places. The use of clowns in children's wards aims to prove the adage that laughter is the best medicine, distracting patients from physical pain and psychological distress. Drawing, writing, dancing and pottery are all seen as ways to help patients express and expunge their fears and anxieties.
Medical research is also beginning to prove that the arts have physical and neurological benefits as well as mysterious uplifting qualities. Creative therapies are burgeoning in Ireland at the moment, using music, dance, and drama as a means of communicating with patients, while an increasing number of occupational therapists in hospitals are using art - among other activities - to encourage physical and social rehabilitation.
From the arts perspective rather than the clinical end, community arts group Create is developing a training initiative for artists wishing to work in the healthcare sector, in response to the high level of interest in the intersection between the two fields at the moment. However, as curator Grant Watson remarked in an essay commissioned by the Arts Council (in relation to its 2004 Arts and Health Conference), the increasing correlation between the arts and healthcare practices is accompanied by anxious questions about artistic value ("where does the art begin and the therapy end?"). Arts practices hold the experience of art as their central tenet, and any therapeutic effect is merely an additional benefit, Watson argued.
However, for art therapists, producing artworks with patients in a healthcare setting can be a bonus not just to their practice, but to the wider debate about the increasingly fluid definitions of art in the community setting. "Outsider art", art produced outside the boundaries of mainstream culture - such as the drawings of Swiss asylum inmate Adolf Wölfli or the sculptures of deaf Down syndrome artist Judith Scott - has become increasingly accepted in "high art" circles and commercial art markets as well as in its clinical setting. So, as continuing interaction and innovation in arts in the healthcare setting takes place, developing clinical as well as artistic models of intervention will be of increasing interest to both sectors.
ART AND ARCHITECTURE
It is in the built environment that the most fundamental level of intersection between the arts and healthcare settings emerges. As curator Clíodhna Shaffrey has commented, there is a vital "psychological link between space and feelings of wellbeing or anxiety". Hospitals are undoubtedly the institutions most often associated with what is aptly known as "sick building syndrome", with symptoms including peppermint-green-licked walls and the smell of disinfectant. It is therefore understandable that good design or "intelligent architecture" in the healthcare setting can sometimes transform a patient's experience of illness. From placing artworks in the healthcare setting to the integration of artistic ideas at the architectural level, an improvement in patients' physical environment has been seen to have what Dr Abdul Bulbulia, founding member of Waterford Healing Arts Trust, calls "a healing effect, providing an altered sense of wellbeing".
"When the new Waterford Regional Hospital was built [in 1990], it was beautiful but it had no soul," he says. "The foyer was like a railway station, just people coming and going. We transformed the hospital's atmosphere with art."
One example of the clinical benefits of environmental design is the use of multi-sensory spaces, such as the Snoezelen Room in psychiatric hospitals, which have proven to be hugely effective in alleviating anxiety in patients.
Meanwhile, on an increasingly widespread basis, entire hospitals are being designed around the idea that a creative and ergonomic environment can be potentially therapeutic. In Belfast's Royal Victoria Hospital, for example, large-scale installations by Michael Warren, Alice Maher and Janet Mullarney emerge from the hospital's interior and exterior walls, setting the relationship between the arts and the healthcare milieu, literally, in stone.
CREATIVE THERAPIES
Creative therapy is a clinical practice that uses the arts for cognitive, physical, emotional and social rehabilitation. Music, art, drama and dance/movement are commonly used to treat various conditions, both physical and psychological. Research studies have proven that art activates memory in cases of dementia, boosts confidence in the mentally ill, lifts depression and improves the energy levels of even chronically ill patients.
Michelle Dunne, vice-chair of the Irish Association of Creative Arts Therapists, which has more than 200 members, speaks of creative therapy as a "mainstream clinical intervention" that holds "expressively powerful and empowering therapeutic potential for change in the wellbeing of an individual".
As Tom Madden, director of the dramatherapy MA at NUI Maynooth, explains, creative therapies involve "the intentional use [of art] for therapeutic practice . . . to engage clients in psychological, emotional and social change". For Madden, the key is that the therapy "gives equal validity to both body and mind", enabling patients to "explore painful and difficult life experiences through an indirect approach, and without chemical application".
The MA, established five years ago, is one of four in the country dedicated to training creative therapists: Crawford College of Art and Design, in association with UCC, runs an art therapy MA, the University of Limerick has a Masters in music therapy, and Queens University Belfast awards postgraduate degrees in art psychotherapy.
Madden says "the demand for trained therapists to work in schools, mental health settings, general health and social care settings, with people with learning difficulties, has never been higher". However, for practising art therapist Catherina Brady, the big issue at the moment is finding "ways to evaluate art therapy. It can be difficult even to prescribe how it works. We need to find ways to prove that it is effective so that we can integrate it into [the healthcare setting] in a more clinical way."
While arts therapy was originally regarded with some suspicion, GPs are beginning to value its integration, even at primary healthcare level. In the UK, for example, concern about the over-medicalisation of normal life and the non-medical origin of a large number of presenting patients inspired a group of GPs to integrate art practice into the clinic environment under the Paint Yourself Better programme. They found that creative activities in the waiting room proved both therapeutic and curative for patients.
CLINICAL TRIALS
Much of the medical research conducted into the arts in a healthcare setting has emphasised holistic rather than scientific results. However, the emerging and controversial field of neuroaesthetics involves the study of the brain's response to music and art. Neuroaestheticians monitor exactly how artistic stimuli affect emotional and motor responses, and investigate the ways in which they can be effective in treating degenerative neurological conditions.
Music, in particular, has been clinically tested to find out whether it can alleviate symptoms of Alzheimer's disease, particularly in a pioneering British initiative called "Singing for the Brain".
Dr Oliver Sacks's recent book, Musicophilia: Tales of Music and the Brain,also looks at the neurological relationship between music and the brain through particular and extreme case studies. Recent research in the UK has broadened this area of investigation, finding that the use of music during cardiac surgery has an effect on the levels of vital signs (including blood pressure, heart rate, demand for myocardial oxygen), that it can also help improve clinical and behavioural states in neo-natal clinics; and that art interventions reduce the levels of cortisol (a hormonal indicator of stress) produced by patients.
Increasingly, the medical profession is beginning to take a more imaginative approach to patient care. In the UK, many third-level medical courses now offer electives in "the medical humanities". International journal Medical Humanities, founded in 2000, states the case: attention to literature and the arts, its website elaborates, "helps to develop and nurture skills of observation, analysis, empathy, and self-reflection - skills that are essential for humane medical care". The arts also provide medical practitioners with "insight into the human condition, suffering, personhood, our responsibility to each other, and offer a historical perspective on medical practice".
Studies conducted in the UK since the medical humanities were introduced to medical curricula have shown that the arts also increase mental task performance, develop observational skills (including medical drawing and three-dimensional thinking), enhance the capacity for critical thinking, and increase understanding of patient suffering.
Irish universities have yet to adopt fully the medical humanities into the medical training system, although the new medical school that opened in Limerick this year under the directorship of Prof Paul Finucane is currently designing a module for art in medicine, in collaboration with Dr Peter Jordan, a lecturer in fine art at Waterford Institute of Technology.
THE POLITICS OF ARTS AND HEALTH
"Given the parallels between the arts and health, one could argue in favour of a more direct political linking of these areas. Instead of the arts being linked to sport and tourism as at present, arts could legitimately be aligned to health," said musician Paul Roe following the 2004 Arts Council Arts and Healthcare Conference. Roe observed that the overwhelming evidence from the healthcare workers participating in the three-day conference suggested that the relationship between arts and health was a political one, one that demanded more research and more resources to maximise the mutual benefits to both communities.
Increasingly, health organisations, including the Health and Safety Executive (HSE), have begun to invest in the arts. For example, during its year as European Capital of Culture in 2005, Cork stressed the relationship between arts and health services by bringing them together as the nexus of its access/inclusion programme. After three key projects, 10 artists' residencies and more than 20 performances, workshops and events, the advisory committee concluded that "cultural conditions can impact on the social determinants of health".
This year Sligo Arts Service launched a plan similarly dedicated to fostering the connection between arts and health. Its ambitious five-year arts and health strategy, HE+ART, involving participants such as the Model Arts and Niland Gallery, Blue Raincoat Theatre Company and various HSE executives, aims "to establish effective structures, supports and services that will promote the value of arts and health" and "to increase levels of access and participation in high-quality participative arts and health programmes."
The increasing number of pilot projects is certainly encouraging for those with a stake in the arts and health. However, there is no strategic plan to develop arts in healthcare and no specific budget provided by the Department of Health or the HSE for this. More lobbying needs to be done, Dr Bulbulia insists, to ensure that "art an integral part of the health system, not a separate entity, an appendix."
