St. Xavier's College (Autonomous), Mumbai, Maharashtra, India
The fine arts have historically been haloed with an aura of exclusivity. This viewpoint has meant that the rift between creative arts and society has gradually widened over time, especially, if we must say, since the Industrial Revolution. As more and more, we turn our gazes towards the concerns of mental well-being as an essential component of health, it is high time to rethink and redefine such artificial boundaries. The “artist” is not a professional title, but a version of humanity that exists within everyone to some degree and is more often than not, suppressed. What makes them a truly universal calling is that the creative arts can appeal to all, irrespective of socio-cultural differences, breaking boundaries of gender, race, language, community, even species, at the same time reconciling us to our deep cultural roots. Creativity is innate, each person carries a creative kernel, every individual is capable of self- expression. Thus, art can lend itself as a potential tool in the process of healing through a journey of self-discovery.
For the longest while, science and arts have been treated as antonyms and this is arguably one of the fundamental blunders of the past two centuries of human civilization. The human race cannot survive without the subtle perceptions of beauty and expression through art as much as it cannot do without the progress of science and technology. True development comes from being able to successfully merge the two domains. A world without a feeling for compassion, self-understanding, empathy, and kindness is a war-torn, stress-creased, vulnerable, criminally-inclined, diseased, miserable place. And increasingly, the role of art in incorporating the seed of realism, vision, and fraternity in our pretty concrete jungle is being established. Creativity is vital for progress.
The coronavirus pandemic has provided unprecedented proof of the power of Creative Arts Therapies (CATs) in forging a sense of well-being amid what is essentially the biggest mass emotional crisis of our generation, which makes this the ideal time and occasion to explore this field in some detail. At a time when personal loss, professional downfall, uncertainty, insecurity, and prolonged isolation are factors adversely affecting the emotional landscape of one and all across the globe, artistic expression has come to the rescue of many. Interestingly, the field of CATs reared its head significantly in the form that we know of today, i.e., majorly as a part of psychotherapy, in the wake of the last major global crisis- the second world war.
One can identify five major players in the current scenario of CATs- music therapy, visual arts therapy, dance/ movement therapy, drama therapy, and bibliotherapy (notably, through poetry and expressive writing). Self-expression, empathy, emotional awareness, self-actualization, integrated sense of self, and identity are some of the notable psychological effects commonly experienced by the receivers of CATs. The two cornerstones for the effectiveness of these therapies are catharsis and containment. Catharsis is simply the release and relief art can provide, in its nonverbal and behavioral format, as a medium of expression of the various emotions that are hidden in the daylight of verbal communication. This effect has made art therapy a key tool in fighting stress, depression, and trauma. Catharsis is the space art affords to a patient or participant to get rid of the repressed fallout of various unfortunate experiences, as it has been experimentally proven that reliving the causes of mental unhealth can often lead to better understanding, and hence the acceptance of the situations. Moreover, a symbolic representation of one’s predicament can be another powerful tool for comprehending and making peace with one’s condition, as is often seen among terminally ill patients. Through creative expression, a degree of openness can be reached with the therapist that is otherwise unimaginable. And this is where the question of containment comes in. It is the space of trust and safety between patient and psychotherapist which can make any treatment possible. The creations of the patient give deeper insight into the roots of the problem, making it easier to treat. Thus, art therapy works on two levels- first, it induces well-being in the patient by making them better equipped at self-understanding, and secondly, it is an aid to the therapist for communication with the patient. Both these effects are of consequence as mental disorders treatment, to date, is largely qualitative and empirical, and the major goal for effective treatment is always to get a better glimpse into the patient’s mind.
Various hospitals across India and abroad are increasingly adding an art therapy unit to their services, recognizing its role in aiding treatment and recovery. Israel, for instance, is one of the leading stakeholders in this field. In India, one of the pioneers in this venture was Ahmedabad’s Sterling Cancer Hospital. One can classify the modalities of CATs into two broad groups- receptive therapy, and active therapy. Receptive therapy is where healing is achieved by giving the patient the position of the audience. Two main ways in which this is done is through playing music, live or recorded, to the patients, and through poetry readings. On the other hand, active or expressive therapy is where the patient actively participates in the process of creation. For instance, in music therapy, this would mean singing, composing music, or learning to play an instrument; in visual arts, it takes the form of making paintings, mandalas, needlework, etc.; in literary interventions, journal writing, essay writing on assigned themes, composing poetry are some common techniques; in drama therapy, it usually comes to role-playing. Movement-based therapy is always active.
Some of the major problems, clinical and otherwise, addressed by Creative Arts Therapies are stress, addictions, anxiety, attention disorders, grief and bereavement, dementia, depression, eating disorders, post-traumatic stress disorder (PTSD), trauma, relationship issues, fibromyalgia, cancer (especially breast cancer), AIDS, hemodialysis, coronary artery disease, etc. Here, it might be useful to emphasize that the use of art in all these cases is therapeutic and not clinical or even curative. In any physical illness, CAT does not have the power to cure, but simply trigger, support, and accelerate recovery. Therefore, it is usually a secondary form of treatment which is important for achieving the desired results of primary treatments such as active medication.
Various major impacts of CATs have been observed on different target groups of critical illnesses. Among coronary heart disease patients, music engagement has been seen to result in reductions in heart rate, respiratory rate, myocardial oxygen demand, and anxiety and improvements in peripheral temperatures. Among cancer patients, music therapy has a role in promoting relaxation and psychological well-being, lowering tension and serum cortisol levels, visual arts therapy reduces stress and anxiety, increases positive emotions, improves focus on positive life experiences, self-worth, and social identity, while among breast cancer patients, movement-based therapy is found to improve quality of life, shoulder range of motion, and body image. Expressive writing is seen to have a very positive impact on fibromyalgia patients, causing an enhancement in terms of well-being, pain, and fatigue among interpersonally distressed groups. For PSTD, drama therapy is particularly efficacious due to its place in imaginal exposure which means recreation or representation of the trauma scene. On the whole, CATs have a significant role in managing depression, stress, anxiety, and pain symptoms thus leading to elevation of quality of life.
The exploration of the neuroscience behind the success of art therapy has been largely lacking given its widespread applicability in most modern medical systems. Emily Dickinson famously wrote “The Brain—is wider than the Sky—/ …/ The Brain is deeper than the sea—” We don’t really understand “why it works” half as well as we wish we could. The branch of science that deals with the neuroscience of artistic perceptions is called neuroaesthetics. The biggest spur to artistic creativity is certainly survival through adaptability. The brain has two systems- the explicit, and the implicit. The explicit system deals with active cognition while the implicit is more related to the unconscious, experiential, the more automatic involuntary responses. A layman way to understand the difference is possible between opinion and intuition. Scientists predict that artistic expression gives a person access to the implicit system of the brain, otherwise inaccessible through mainstream communication.
The current impetus of creative arts in therapeutic functions is one towards its greater integration in general lifestyle. More and more, the call is to pull out art therapy from the confines of a clinic-centered system to a community-centered one. It is imperative to once again embed cultural arts into the very fabric of our societal development. And the reason for this is simple- not all mental illnesses reach the clinic or the therapist, only the severe ones do. The general mental health of the population has been declining over the years, especially in cities around the world, and emotions of discontent, unhappiness, and stress are becoming a major cause of much bigger diseases and disorders. Giving art a place in one’s daily life is one of the simple preventive measures against such ailments. We can start simple, from choosing soft cheerful colors in our surroundings, minimalistic interior design and soothing music for our homes, to promoting community cultural activities such as musical performances and theatre to art and literary discussions, and on a personal front, developing at least one creative hobby as a vent to one’s day’s storms. None of it is very difficult to carry out, yet the effect of such simple changes in lifestyle can bring forth is almost miraculous, not to mention, persistent.
India, historically, has given a place to diverse art forms in its socio-cultural arena. In that sense, we are farther ahead than many countries, as art culture has always been an integral part of our lives in more than one aspect. Indians sure know how to revel in and find release through art. The need then is simply to revive this culture. And the call, this time, is urgent because the big monster of the pandemic with its associated social changes has pushed us all, to some extent, towards a gaping abyss of insanity. Making sense and finding one’s own niche amid the pandemonium of an unsettled world is of the utmost importance if we are to sustain any semblance of normalcy. And art is the weapon here, to fight for, to seek, and to find a place of our own.
Fig.1 Visual Arts Therapy in cancer treatment. Extracted from chicagotribune.com
1. Stuckey, H. L., & Nobel, J. (2010, February). The connection between art, healing, and public health: A review of current literature. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804629/
2. Johnson, D. R., Lahad, M., & Gray, A. (n.d.). (PDF) Creative therapies for adults. Retrieved from https://www.researchgate.net/publication/285885723_Creative_therapies_for_adults
3. The Neuroscience of Art: What are the Sources of Creativity and Innovation? (Rep. No. 547). (n.d.). Retrieved from https://www.salzburgglobal.org/fileadmin/user_upload/Documents/2010-2019/2015/Session_547/SalzburgGlobal_Report_547_FINAL_lo_res.pdf.
Salzburg Global Seminar