Avances en Salud Mental Relacional / Advances in relational mental health
Vol.4, núm. 2 - Julio 2005
Órgano Oficial de expresión de la Fundación OMIE
Revista Internacional On-line / An International On-line Journal
Medical Art Therapy
A useful supplement to classical medicine?
By Johanne Hatteland Sømme
INTRODUCTION
Most people, skilled or not in art, have experienced how art can transform their state of
mind and how they feel in a given moment. A painting might make you feel sad, one
piece of music cheers you up and another makes you angry. A poem or a photograph may
make you think about something from a different point of view. Or reading a good book
might make you forget how much your back is hurting.
It seems quite clear that art can influence people in many ways, evoking feelings,
distracting your attention and giving you new insights. These are all functions that might
be used in favour of medicine, but also the making of art can be used as a tool in
medicine as seen in "medical art therapy". Medical art therapy is; "The specialised use of
art expression and imagery with individuals who are physically ill, experiencing trauma
to the body, or who are undergoing aggressive medical treatment such as surgery or
chemotherapy." 1
Below we will look more closely at some of the benefits of medical art therapy and also
see one example of the use of art therapy in the treatment of chronic pain.
The benefits of medical art therapy
Although there are few studies regarding the benefits of medical art therapy, the
experience of the people working in this field shows that it has a great potential as a
complimentary treatment to classical medical and surgical treatment. These benefits are
as we will see found both on a psychological and physical level.
Art therapy as a help to "open up"
Patients suffering a serious physical illness might feel isolated and have trouble
expressing their worries, fears and other thoughts regarding their illness. There are
obvious psychological benefits from "opening up" and confiding in others, but several
researchers also verify the physiological benefits of this. Pennebaker confirms that people
ASMR Revista Internacional On-line - Dep. Leg. BI-2824-01 - ISSN 1579-3516
CORE Academic, Instituto de Psicoterapia, Manuel Allende 19, 48010 Bilbao (España)
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Avances en Salud Mental Relacional / Advances in relational mental health
Vol.4, núm. 2 - Julio 2005
Órgano Oficial de expresión de la Fundación OMIE
Revista Internacional On-line / An International On-line Journal
who express their traumas, feelings and secrets have a healthier psychological profile, a
more active immune system and experience far less illness than those who don't2. The
psychiatrist Spiegel found in his studies that sharing the experience of life-threatening
breast cancer can in fact increase the patient's life expectancy3. Similar studies using art
therapy in groups of e.g. cancer patients has yet to be conducted but there are many
indications that it might have a similar positive impact.
Art has the advantage of providing a mean to express beliefs and feelings that the patient
might not be able to express with words, and is more likely to express a more private
perception of his illness, conscious or not4. This might helping the physician as well as
the patient, giving useful insight into the patients real concerns regarding his illness.
Patient empowerment through art expression
The presence of medical illness or disability may leave a person with a lack of selfesteem and autonomy, due to, among other, the dependence upon medical treatment and
loss of control over their body. In the making of art the patients are given the freedom to
choose between different materials and styles, and to create what they want to create. The
experience of art therapists is that this can help regain the "lost" autonomy, giving the
patient a feeling of mastery and ability to control events5.
Art therapy as a complement to medicine
According to Achterberg et. al. imagery is one of medicine's oldest and most powerful
tools6. In healing rituals and ceremonies imagery of dreams and visions have been used
for centuries, however modern medicine seemed to have forgotten this between all the
recent scientific progress. In the last couple of decades there has been an increasing
interest in a more holistic type of medicine including alternative forms of treatment such
as art therapy.
Art can form a connection between the physiological changes in the body and the
conscious level of information processing, and may thus, if interpreted, give much
information regarding the somatic state of the patient. In addition art making can provide
an escape and relief from physical suffering, such as pain, as well as emotions as fear,
loneliness and depression7.
Not much research has so far been done regarding what physical effect creative processes
produce in the body, but the results so far are interesting. Chopra found that creative
experiences increased the blood flow to the brain, and that enjoyable creative activity
gives rise to -wave pattern on EEG which is typical of a relaxed but aware state of mind
called restful alertness (also found in meditation)8. Thus, it seems creative activities can
enhance brain functioning, and also serotonin, a chemical known to decrease feeling of
depression, is found to be increased during creative activity. In hospitals where art
ASMR Revista Internacional On-line - Dep. Leg. BI-2824-01 - ISSN 1579-3516
CORE Academic, Instituto de Psicoterapia, Manuel Allende 19, 48010 Bilbao (España)
Copyright © 2005
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Avances en Salud Mental Relacional / Advances in relational mental health
Vol.4, núm. 2 - Julio 2005
Órgano Oficial de expresión de la Fundación OMIE
Revista Internacional On-line / An International On-line Journal
therapy programs have been introduced there have been reported many benefits both on a
physical level, improving heart rate, blood pressure and respiration, and on a
psychological level, by increasing the abilities to communicate feelings regarding
symptoms and by reducing the stress9.
Art therapy to encourage personal growth and change
The potential of art therapy to change the patients focus and experience of life has been
very well described by Oliver Sacks using the term 'awakening': 'Awakening, basically, is
a reversal...the patient ceases to feel the presence of illness and the absence of the world,
and comes to feel the absence of his illness and the full presence of the world'10.
Art therapists often find that art expression can help patients transform, finding new
meaning in life, adopting more adequate coping mechanisms, even creating a new 'postillness' identity11. This treatment modality thus offers qualities that traditional medicine
will never be able to offer with all it's medications and technical advances.
Medical art therapy in the treatment of chronic pain
The information in this section is from 'Expanding Treatment Possibilities for chronic
Pain through the Expressive Arts' by PM Camic in "Medical Art Therapy for Adults'12.
The role of medical art therapy in the treatment of chronic pain is based on the
biopsychosocial approach to pain and the 'gate control theory' (GCT) of pain. The GCT
says that pain depends on impulses transmitted from a site of injury to a place in the
spinal cord, 'the gate', where the signals are modulated before continuing to the brain for
perception. This gate is affected by the intensity of the signal, local factors in the spinal
cord and messages descending from the brain. The messages from the brain are thought
to be influenced by both emotional and cognitive factors and it is on this level that
medical art therapy can have an effect.
Camic describes a case study were he used music, visual art and writing in a pain
management group. The group consisted of 7 male patients, from 29 to 44 years old, all
without any recent experience with any of these art forms for a significant number of
years and none of whom had completed college. The participants were all suffering from
pain of at least 2 years duration and not related to malignancy or life threatening illness,
having been employed or ruled out all medical and surgical procedures. None suffered
active substance abuse.
The therapy was structured as a workshop of 90 minutes meeting once a week for 15. The
pure art therapy was combined with other techniques to enhance the effectiveness of the
intervention:
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CORE Academic, Instituto de Psicoterapia, Manuel Allende 19, 48010 Bilbao (España)
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Avances en Salud Mental Relacional / Advances in relational mental health
Vol.4, núm. 2 - Julio 2005
Órgano Oficial de expresión de la Fundación OMIE
Revista Internacional On-line / An International On-line Journal
-
Cognitive-behavioural therapy, working as a clinical framework in which to
incorporate the expressive art activities and a theoretical justification for the use of
art.
Mindful meditation, at the beginning of every workshop to relax and help refocus on
the present.
Existential philosophy and therapy, was used in exercises and group discussions as a
guide to help the participants come to terms with the meaning of the events in their
life.
Guided imagery, was used at the beginning of every workshop to assist concentration,
increase relaxation and reflective distance, and to facilitate the creative process..
The different elements of the workshop were introduced gradually together with an
explanation in each case of their usefulness. The interventions using expressive art were
varied and combined the different forms of art.
In the post-workshop evaluation it is noted that two factors of the workshop that proved
useful to all patients were 'being able to distract oneself from pain and seeing oneself as
being able to create -although still in pain-'. In addition to this anxiety levels (measured
by STAI and through self-report) were decreased for all individuals, depression levels (by
BDI and self-report) were lower in six of seven participants, and pain management
strategies (self-report) were increased in six members. 5 members organised a 'homestudio' to be able to continue with the art making, a clear indication that they have found
the workshop useful.
Ideally this study should be followed up with controlled studies using for example
cognitive behavioural therapy in the control group to be able to see what effect the
addition of the art interventions has. And while the definite results from this study are not
yet clear it does however indicate that art therapy may deserve a place in chronic pain
management.
Conclusion
As we have seen medical art therapy opens many possibilities and may show to be a
valuable addition to classical medicine providing a more holistic view of disease and
alternative treatments where medicine and surgery come short. Medical art therapy shows
the importance of not reducing a patient to an illness, but rather encourage the person to
stand above his illness not letting the disease take control over his life. Something that
can easily be forgotten in today's 'modern' medicine.
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CORE Academic, Instituto de Psicoterapia, Manuel Allende 19, 48010 Bilbao (España)
Copyright © 2005
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Avances en Salud Mental Relacional / Advances in relational mental health
Vol.4, núm. 2 - Julio 2005
Órgano Oficial de expresión de la Fundación OMIE
Revista Internacional On-line / An International On-line Journal
1
Malchiodi CA. Medical Art Therapy: contributions to the field of arts medicine. International Journal of
Arts Medicine 2, 1993, 2; 28-31
2
Pennebaker J. Opening Up: The Healing Power of Confiding in Others. 1997. New York: The Guilford
Press.
3
Spiegel D, Bloom J, Kraemer H, and Gottheil E. Effect of psychosocial treatment on survival of patients
with metastatic breast cancer. The Lancet 2, 888-891
4
Malchiodi CA. Medical Art Therapy with Adults. (p. 15-16). 2000. London: Jessica Kingsley Publishers
Ltd.
5
Malchiodi CA. Medical Art Therapy with Adults. (p. 16-17). 2000. London: Jessica Kingsley Publishers
Ltd.
6
Achterberg J, Dossey B, and Kolkmeier L. Rituals of Healing: Using Imagery for Health and Wellness.
1994. New York:Bantam
7
Malchiodi CA. Medical Art Therapy with Adults. (p. 17-19). 2000. London: Jessica Kingsley Publishers
Ltd.
8
Chopra D. Ageless Body, Timeless Mind. 1993. New York: Harmony Books
9
C.Everett Koop Centre. ArtCare Program. Online: http//www.koop.dartmouth.edu/programs_arts_5.html/
10
Sacks O. Awakenings. 2000. New York: HarperPerennial.
11
Malchiodi CA. Medical Art Therapy with Adults. (p. 19-20). 2000. London: Jessica Kingsley Publishers
Ltd.
12
Malchiodi CA. Medical Art Therapy with Adults. 2000. London: Jessica Kingsley Publishers Ltd.
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