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Rapid Responses: Rapid Responses published:
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Kind of manipulation
- Ljuba Bacharova (20 December 2002)
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The medicine of art
- Steven Wrigley-Howe (20 December 2002)
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More on the arts? What about the family?
- Graham R Williamson, EX2 6AS (20 December 2002)
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Arts v Health
- Peter Johnstone (20 December 2002)
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Logic
- Ken Hanagriff, Mark, Randy and Wendell (20 December 2002)
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Humanities and Medicine
- Joan Hunter (20 December 2002)
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Health spending on art
- John Hurdley (21 December 2002)
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Spending on Health Care
- Umesh Prabhu (23 December 2002)
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Why is healthcare free and food not?
- Peter W Ward (23 December 2002)
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Detached? Not sure
- Kerry S. Kidd (23 December 2002)
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If you cannot define health adequately, then define art!
- Ian Guy (23 December 2002)
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Public Health as art as well as a science
- John Boyce (24 December 2002)
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Support (wholeheartedly) for the arts in health.
- Guy Eades (24 December 2002)
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BRAVO BMJ!
- Nick Ewbank (24 December 2002)
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Reason for voting "No" in the online poll
- Alfred Scott (25 December 2002)
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ART IS THAT WHICH MAKES THE MAN'S DAY
- B. M Hegde (25 December 2002)
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Breath of fresh air
- Philip J Whitaker (26 December 2002)
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On Art and health
- Peter Morrell (26 December 2002)
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why not spend it all (totally) on the arts and then become an artist
- Daniel J. McCarty (27 December 2002)
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A dose of art
- Dr.B.C. Rao (29 December 2002)
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Art and elitism
- Philip V Kaye (30 December 2002)
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A Spurious Question
- Hyman Davies (30 December 2002)
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Arts and Health - what divide?
- Phil G Manning (1 January 2003)
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Spend More on Spectacles for Journalists
- Tony Floyd (1 January 2003)
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Spend (slightly) less on health and more on arts
- Susan I Brown, Arts Committee - All Volunteers (3 January 2003)
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For a fuller life
- Synnove K Ellingsen (7 January 2003)
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Spend (slightly) less on health and more on the arts
- Rabbi Julia Neuberger (8 January 2003)
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looking beyond the disease to the patient
- c mark harper (8 January 2003)
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Need for robust research
- Christine M Hamilton, Mark Petticrew (8 January 2003)
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A Third Way?
- Jim Golby (9 January 2003)
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Yes! Without slightly...
- Ioannis D Dimoliatis (16 January 2003)
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'Arts funding up by 70% to support health!'
- Jane Macnaughton, Mike White, Lara Dose (28 January 2003)
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from the perspective of a V.I.S.T.A.
- eliza crown (6 April 2003)
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Poem - A Verse for Care and Cure
- Ekta K Kalra (30 April 2003)
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Arts as Medicine
- Nancy J. cooley (23 July 2003)
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Ljuba Bacharova, International laser centre 812 19 Bratislava, Slovak Republic
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The arguments provided are rather manipulative, and I do not like to be manipulated. Competing interests: medical doctor, senior research worker, amateur painter |
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Steven Wrigley-Howe, Director York, YO32 3LU
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We are a rich nation but parsimonious in both healthcare and the arts. Perhaps we should prescribe art alongside rather than instead of medicine, say a performance of Simon Rattle's recent life-enhancing production of 'Parsifal' for those suffering from the many chronic mental and physical illnesses medicine can do little to relieve? Competing interests: None declared |
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Graham R Williamson, senior lecturer IHS, University of Plymouth, Exeter, EX2 6AS
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Your editorial on increasing spending more money on the arts in this country is a good idea, welcome even at the expense of health spending. However, you leave aside the issue of the consequences for the arts of such an injection of state cash: you mention the 'medicalization' hypothesis (that increased money spent on medical treatments has the consequence of more deeply embedding people in the web of medicalized definition and treatment of their aliments, which previous generations would have 'coped' with as best they could). Is it not possible that more state cash for the arts would create an art establishment politicized by the experience, and required to accept governmental preconditions and direction about what they should use the money for? This may actually be a good thing if recent Turner prize winners' work is anything to go by, but we should not forget that (after the brutality and lack of political and economic freedoms), one of the worst things about living in communist societies was widely acknowledged to be the dreadful, kitsch, socialist- realist art and architecture that citizens had to endure. If a state controlled art establishment in the Soviet Union produced thousands of busts of Lenin, would a UK system require busts of Blair? If more money is to be spent on the arts, it should enrich the fabric of people's lives, and for me this means neither state control, nor the miserable, squalid, craftless nonsense that is currently paraded as modern art. A more useful idea would be to look at some of the areas you argue have been recently medicalized: 'ageing, unhappiness, tiredness, loneliness'. If you add drug abuse to this list, there is a strong argument that these stem from the breakdown of communities and families. It is difficult to see how more money could be usefully spent on the family; easier to see how much less money might be taken from the pockets of families, making these arrangements extremely attractive and encouraging parents to stay together. In this way individual adults and children might continue to recieve the support they need to make sense of life's setbacks, and how to cope with them without so much medical intervention. Indeed, if the modern trend for both parents to work was reversed, and one partner were able to stay at home with children, the health and social benefits would be immense, and local community life would also be strengthened. Competing interests: None declared |
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Peter Johnstone, Head of Medicines Management North Liverpool PCT
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Richard Smith proposes that we should divert funding from the NHS to the arts. Whilst working in a more effective and efficient way will release money, such benefits take time to accrue and now is not the time to do it. Instead, take 0.5% of the funding from another substantial budget such as defense, or politicians salaries. Competing interests: None declared |
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Ken Hanagriff, tomarrow Crowley, LA USA 70526, Mark, Randy and Wendell
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Health care would appear to be of current import.
Competing interests: None declared |
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Joan Hunter, Head of Learning Resources West Suffolk Hospital IP33 2QZ
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There is already a blurring of the lines between science, medicine and the humanities. Courses in Literature and medicine are already featuring in top medical schools throughout the UK. It is recognised that music, art and drama have a strong role to play in many aspects of healthcare. So perhaps the argument should not be diverting funds from health but identifying areas in the health agenda that could be used to support the arts. Competing interests: None declared |
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John Hurdley, Retired B17 9JG
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There has been work done, although I cannot cite the reference, showing that a pleasant environment in terms of gardens and art has positive health benefits in a hospital setting. This being so there is no distinction between health spending and spending on the aesthetics of our surroundings. Competing interests: None declared |
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Umesh Prabhu, Consultant Paediatrician and Medical Director Bury, OL11 5RF
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How could one think of spending on art when we have underfunded health care system. Art is a luxury but illness is not. Art is by choice but most diseases are not. We have one million patients waiting for their surgical procedures, 2 million waiting to be seen by hospital consultants and everyone who works in our NHS talks about "lack of resource" and its effect and how can one evne think of spedning some of this money on art. if one wants luxury in life one has to pay for it and not from my tax. I am sure you can guess that I feel very strongly on this topic umesh prabhu Competing interests: None declared |
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Peter W Ward, GP Gateshead. NE6 5LD
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Richard Smith argues in his editorial in the Christmas BMJ that health would be improved if the country spent more on arts than healthcare. I suspect many doctors recognise the weak link between healthcare spending and peoples health and applaud this clearly stated sentiment in an influential medical journal. At present in Britain healthcare is largely free at the point of use, a status it shares with the air we breathe but not a lot else. We must pay for clothing; shelter, water, warmth, food and other essentials, which one may argue are by some degree more vital to us than things that come under the healthcare bracket. If one accepts this then it is difficult to justify providing many of the things we do as doctors free to the public. If authors like Ivan Illich are correct about modern healthcare, that much of it is harmful as it prevents us coping with our inevitable decline and death, then the present situation is preposterous. It is not just increased arts spending at the expense of healthcare, that would benefit our health, but spending on transport infrastructure, housing, food, education and the environment. Competing interests: A GP in the NHS in an inner city area with many patients suffering from poverty of lifestyle |
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Kerry S. Kidd, Nottingham University - Postdoctoral Wellcome Research Fellow Institute for Genetics and Biorisks In Society, Nottingham University, University Park, NG7 2RD
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To replace Rheumatoid tablets with Rattle, state-funded bathchairs with free access to Bach. Is there anything new here? Utopian concepts to an artist, hellish to a fiscal utilitarian; academics have been quibbling for years about the relative worth of funding the written word, at the expense of the high-tech lab; families and teachers have been split for generations over whether taking the 'arts' or 'science' track at A-level is likely to lead to a more socially useful career. The debate has raged uselessly for at least forty years. Whether it is 'good' for society or not to give fiscal encouragement to the arts, the Philistine nature of contemporary political culture means it is highly unlikely that such a proposal would produce any more than a scornful or indifferent media or public response. Fortunately, there is an alternative. Health care budgets can - and in many countries, do - include money for the arts. This can range from money for arts-inspired health care education (through theatre-in-education or arts information projects), to formal strategies of occupational and artistic therapy, to university teaching modules which strive to educate doctors and nurses into more empathetic human beings through the use of art and literature, to artistic attempts to brighten hospital environments and reduce the clinical atmosphere, to the long-standing culture of 'hospital radio...' All these activities are potentially classifiable as 'arts,' and all these are also a real, integral and generally accepted part of NHS life and national health care. We don't need to change anything to divert the arts into the nation's health: they're there already. What we can do is learn more from other countries - obvious ones like the US in the case of medical humanities, but also surprising ones, such as Cuba and/or South Africa - about how health care and the community arts can work together and how low budget health education programmes, relayed through the medium of the arts, can do so very much to improve the general picture of a country's 'health.' Competing interests: I am currently working on a grant project for Humanities in Medicine |
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Ian Guy, Nurse Consultant Rotorua
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The editor cites the difficulties in providing a nebulous definition for health; however, define art. Such a move would be unpopular with the masses, who already reel in anger at lottery monies being channeled into elitist areas such as the Royal Opera House, something that as little meaning to the average individual who is satisfied with their weekly diet of Coronation Street and Eastenders. How about a slightly different suggestion - divert 0.5% of the health spending into facilitating participation in sports and leisure activities - think what that could do for the physique as well as the psyche! Competing interests: None declared |
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John Boyce, Public Health Practitioner East Lothian Health Care Co-operative, Edenhall Hospital, Musselburgh, East Lothian, EH21 7TZ
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I read with interst your editorial and recalled an article some years ago in BMJ: "Attendance at cultural events, reading books or periodicals, and making music or singing in a choir as determinants for survival: Swedish interview survey of living conditions" by Lars Olov Bygren, Boinkum Benson Konlaan, and Sven-Erik Johansson (BMJ 1996; 313: 1577-1580) This article concluded: "When other determinants of survival were controlled for, this study found that people attending cultural events often had a better chance of survival than those attending rarely" Given your publications august interest, the body of literature on social capital, health and social exclusion and the wealth of local projects in deprived areas with an arts focus, should a small part of expenditure on health not be spent on art using as wide as possible a definition: "the product of human creativity; the creation of beautiful or significant things" Much creative and expressive work can and has been done in and with local communities using drama, poetry, collage, dance reading, writing, oral history etc. So go on. Support your local arts project or your local health project to experiment with the arts in your local community. Get involved and put your money where your mouth is. Merry Christmas Competing interests: None declared |
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Guy Eades, Healing Arts Director St.Mary's, Isle of Wight PO30 5TG
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Spend (slightly) less on health and more on the arts. The "medicalisation" (horrible word) of life's problems which you comment on in your article is a response by most of us to the unfairness of illness and ageing. We react as if to say there must be some way of halting and preventing it - there must be someone who can do something about it - to stop it happening to us. The arts approach the subject (slightly) differently. Fight and resist, know wider and deeper, enlist the help of doctors and the medical sciences and professions. However the experience is your own, your body, your mind, to be treated in the way you want life to be lived and not to surrender to the "medicalisation" of the experience. Whether through images, language, performance or music, the creative encounter with the arts at the time of ill health offers deeper self knowledge of the experience of life and (with the grace of God) for the life still to be lived and our common humanity. Thank you for challenging (slightly) the orthodoxy. Competing interests: None declared |
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Nick Ewbank, Director, Metropole Galleries Metropole Galleries, The Leas, Folkestone, CT20 2LS
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Bravo BMJ for your fresh-thinking editorial. Yes, health service budgets are untenably over-stretch, but the stretching will surely give way to breaking as the demographic timebomb explodes over the next two decades unless something radical is done to curtail demand for health and social care. At Upstream Healthy Living Centre, we believe that the health and social care systems already permit (not to say condone) a great deal of avoidable suffering. Early intervention, designed to engage vulnerable people in self determined programmes of valuable participatory creative, social, leisure and learning activity will, we believe, reduce morbidity, improve outcome and overall well-being, and, at the same time, help to rebuild our increasingly fragmented communities. Of course there are doubters - given the lack of hard evidence this is inevitable, but common sense and stacks of anecdotal evidence tell us our approach must be right. Upstream HLC is commencing a programme of rigorous research as we roll out our activities. You can find out more at www.upstream-uk.com Arts in health is set to run and run. Competing interests: Non-pecuniary interest: Trustee of Upstream hlc a Healthy Living Centre "without walls" which aims to enable older and isolated people in rural Mid Devon to engage in valuable creative, leisure and learning activity. |
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Alfred Scott, Paediatric SHO London, N19
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Although I agree that better funding of the Arts budget would (probably) reduce (pscho-)morbidity and associated illness, this is the wrong budget to take the money from.... Take it from the "Defense" budget. love & rage Alfred Scott MRCPCH Competing interests: I am a dedicated anti-war campaigner |
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B. M Hegde, Vice Chancellor MAHE University, Manipal-576 119. India
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Dear Sir, "To affect the quality of the day-that is the highest of arts." wrote Henry David Thoreau. Medicine certainly has the capacity to affect the quality of the patient's day-that is an art. Health is a state of "soundness or wholeness" (to have it all together), poetically and dialectically called hale. Absence of disease is a minor part of the definition of health. Occasional people with advanced physical disability are more productive and whole compared to some others with robust physical wellbeing. Intolerance, of any type, is another sign of ill health. Today medicine has gone to the market place, riding piggyback on technology. Market forces, naturally, have altered its original noble aim of doing most good to most people most of the time. It is a business now, with all the attendant pulls and pressures. In this scenario the "art" of medicine is the first casualty. Health of the population, especially of the less fortunate in society, depends on clean drinking water, (this alone is supposed to save two million lives in a year and prevent annually half a billion serious illnesses, according to the 2002 WHO report) food, uncontaminated by human and/or animal excreta, avoiding cooking smoke from coming into the house, and economic empowerment of the masses. Doctors and hospitals do not do much to preserve health, although they do a lot in an emergency situation or accident set up. Even in the industrialized west it is the improvement in food, housing and sanitation that has made a dent in the health of the populace. Very little of the latter could be attributed to hi-tech medical interventions. Medical education today does not inculcate values of the "art of medicine". Medical education is not meant to provide doctors with an opportunity to earn a living, it should aim to improve the health of the public. In a recent real life situation, a North American, freshly qualified, intern was asked by the Professor of Medicine: "Who is a well man?" The answer was: "A man who has not yet been fully investigated." The next question was: "When does a man become a patient?" The answer was: "A man becomes a patient when he sees his doctor." "When does he become a man again?" The shocking answer was: "Rarely ever, if ever." Interventions, even in those apparently healthy people, have become the order of the day. I would like to add a word to the existing medical jargons-health expectancy. It is the number of years a newborn child could expect to live without the help of doctors and medicines. I feel it is the lowest in those rich societies where even very young children are on some medicine or the other. It is the highest in those poor nations where some people would have spent all their lives having had no contact with the medical world! Time was when doctors were the wisest people in society who could play the role of a friend, philosopher and guide to others. This needed a well-rounded education with a good knowledge of the humanities. Today, the emphasis has shifted from this kind of an art in a role model, young students look up to the heroic (poor patient in the hero's role) divine interventionists. It is time we encouraged students who have graduated in literature, music, history, and other humanities to come to the medical school. I am sure they would make better doctors in place of the present natural science students who could be skilled technologists. Music is being used even in therapeutics! Time has come to let future doctors know that the art of medicine shall play the key role in caring for the suffering patient in the future as much as it had done in the centuries gone by. To that end in view society would benefit a lot by investing more money to nurture the various art forms. A timely and thought provoking editorial, indeed! It is a great intellectual Xmas feast. We, doctors, in the words of Michel De Montaigne, embarrass ourselves in what we do not accomplish in society, " Nostri nosmet paenitet." Yours ever, Bmhegde Competing interests: None declared |
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Philip J Whitaker, General Practitioner 27 Beaumont St, Oxford, OX1 2NR
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Congratulations to Richard Smith and the BMJ.
As other editorials in the Christmas edition (1,2) discuss, to be a healthy human depends on so much more than the absence of disease. We are beings who strive for meaning, and who yearn for a spiritual dimension. Orthodox medicine can supply precious little of either. It is the arts, and religion, that offer sustenance in these fundamental aspects of our lives. To advocate a little more public funding for the arts is not to denigrate the work of health professionals; it is merely to recognise that there is a great deal more to life than that which goes on in surgeries, hospitals, and clinics.
Do not leave us grinding a narrow existence until such time as we fall ill. Support efforts to accentuate the colour, imagination, meaning and purpose in the lives we lead. Which may promote our health, and which will sustain us in our inevitable illnesses.
An apple a day keeps the doctor away, but life is more than the consumption of fruit. It is sharing it with others; it is providing it for our loved ones; it is the appreciation of colour, texture, taste, feel and smell; it is the story of how, why and where it was grown. At the apple's core lies seeds. Do we throw them in the bin, useless for our nutrition, the mere by-product of our 'five portions a day'? Or do we plant them, water them, nurture the seedlings that result?
Phil Whitaker
1. 'Time to move beyond the mind-body split', Bracken P, Thomas, P; BMJ 325; 21-28 December 2002 pp 1433-1434
2. 'Spirituality and clinical care', Culliford, L; BMJ 325; 21-28 December 2002, pp 1434-1435
Competing interests: PJW is both a doctor and a novelist |
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Peter Morrell, freelance researcher, history of medicine, UK ST4 2DG
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Sir, When Ian Guy asks for someone to: “define art,” [1] then this is a good question. As an artist myself, I have long pondered some definition of art and what makes it so therapeutic. It can be linked to a sense of well-being and health. Art is not simply a means of expression, but also a way of understanding our world and ourselves. By making pictures, sculpture, film, etc, one becomes creative, less dependent on the dictates of the outer world, but able to make a world of one’s own: "I begin with an idea and then it becomes something else." [Pablo Picasso] Through copying [art as representation] we incorporate subtle change into the image [art as symbolism], which can head in the direction of greater abstraction, making the work fresh and new, more than a photograph, subtly bending the ‘rules’ of reality: "only when he no longer knows what he is doing does the painter do good things." [Edgar Degas] Although art teaches us about the outer world, light and shade, colours, we also learn a lot about ourselves, our preferences; our dormant aesthetic sense comes to life through the visual arts, just as listening to or playing music enlivens our musical sense: "I try to apply colours like words that shape poems, like notes that shape music." [Joan Miro] Implicitly there is a sense of exhilaration, and freedom; art is liberating. Paintings, “with their colours, their formalities, their extensive light and shade, compete with nature. They try to seduce the visible, to solicit the scene painted.” [2; 563] Though the artist is engaged in a “direct interrogation of the visible,” [2; 562] yet, copying nature creates a new reality of which the artist is the sole, and often unconscious, perpetrator: "mistakes are almost always of a sacred nature. Never try to correct them." [Salvador Dali] Art is some kind of criminal; it defies all definitions we try to impose upon it. Above all, it boldly crosses barriers, limitations and restrictions – ignoring, challenging or erasing them - its free acts cut through such boundaries and sever the strings that bind us to who we think we are: "to become truly immortal, a work of art must escape all human limits: logic and commonsense will only interfere. But once these barriers are broken, it will enter the realms of childhood visions and dreams." [Giorgio DeChirico] A dirty snowball of defiance and rebellion on the road to a greater liberation, or an imagined liberation, art attempts to overthrow the tyranny of the world and others. This is the essence of European art since about 1860. It demolishes shackles of the past, and traditions or ‘truths’ dictated by others. The individual artist becomes a pioneer engaged in a war with everyone and everything, an assault upon ‘normality’ – conventions dominating colour, form, subject, light, anatomy and the accepted norms of life. When Berenson said: “genius is the capacity for productive reaction against one's training,” [Bernard Berenson] he meant that the best art seeks to overthrow the imperialism of norms and any respect they may demand of us. Much like punk rock, really. All truly original art is a rebellion of the individual against preconceptions and prejudices of subject, style and technique, a struggle against incipient suffocation by rules that conspire against hard-won creative freedoms. Art bends and re-shapes rules by continuous acts of defiance and rebellion, invention and imagination. You don’t even have to mention Picasso, Matisse, Bacon or Pollock to see this. This sense of liberation pervades artistic expression: "I just feel that I'm in tune with the right vibrations in the universe when I'm in the process of working." [Louise Nevelson] By creating and going into another visual dimension, you somehow defy the rules of reality itself. As Berger says, “the act of drawing is triumphant.” [2; 560] Drawing involves “a sort of optical emigration by which the artist, following his own gaze, settles on the person, or tree or animal or mountain being drawn.” [2; 561] Your glance “constantly moves between the scene itself and the marks on the canvas: but these glances tend to arrive loaded, and return empty.” [2; 211] In this way, “a drawing…[can become] miraculous…[and] acquires another temporal dimension.” [2; 563] In “the act of drawing and the pleasure of that act,” [2; 560] art is liberating and exhilarating by the triumphal act of creation itself; being insolent, it defeats the rules of the world. During those “moments of triumph one has the sensation of having mastered the landscape according to its own rules and simultaneously of having been liberated from the hegemony of all rules. Some might describe the position as god-like.” [2; 213] In the act of making things, you somehow thumb your nose at God. You have created your own rules. Such God-like powers over the visual world, make on into a transformer of familiar things into new and original things. This goes for all creative arts. Art thus thrills all participants, making a more confident resident of a more creative life. This is so obviously true in the performing arts, but even in embroidery and knitting as well as all the visual arts. They all invoke a greater sense of freedom, of liberation, of creativity, fun and making something new: "art evokes the mystery without which the world would not exist." [René Magritte] These are validating, enriching and morale-boosting activities, and healthwise, they enrich one’s sense of self, value, purpose and life meaning, and perhaps inner peace. There is also a fundamental optimism in art, a sense of triumph, hope and vision. It says people can change, new things happen, the past is gone, the future holds hope. This very optimism and joy holds the real world in disrespect and contempt. Such a sentiment also follows from the artist’s absorption into an inner world of feelings, responses and thoughts, generating contempt for the world and its ‘rules,’ upon which the artist turns their back. Thus, art transcends death and materiality or the apparently fixed nature of things. Under art’s impact, time dissolves and rules are transcended. Being contemptuous of time, schedules, deadlines and punctuality, artists regard external reality as an imperialism that threatens their inner world. Such optimism and contempt for the world also signal forgiveness and tolerance for “the teeming variety of human relations,” [3] an addiction to sensuality, using art to work through one’s own pathology, blending into purgation and catharsis: "art washes from the soul the dust of everyday life." [Pablo Picasso] Such therapeutic themes emerge in all the arts, indicating that change, optimism and spirituality tinge the metaphysic underpinning much art, traditionally painting. The links to medicine involve, firstly, that art emphasises expression and creativity, which subtly place the reins of power into the hands of the self, rather than in external things or other people. Indeed, art enfeebles the power of others and the world and places it back in the hands of the individual. Such validation can boost self-confidence, neatly disarming the conspiracy that we are puppets of world and things. This reinforces one’s sense of autonomy and usefulness, reducing powerlessness or dependency – factors common in all forms of sickness, often to an oppressive degree. Second, art heals inner wounds that no medicine can reach, by helping people to reconcile old worries and expressing through their art, their style, their interests and diverse aspects of technique. For example, in painting one thinks of brush-stroke, layering of paint, choice of colours, choice of subjects [still life, landscapes, portraits, etc] and preferred medium. The history of painting is littered with myriad differences in technique. A modern painter can choose whatever suits them, and can experiment, with nobody to interfere or say ‘no, you cannot do that.’ In art, it is green lights all the way: "there is no must in art because art is free." [Wassily Kandinsky]. There are no restrictions and experimentation is encouraged, regardless of one’s level of skill. In these ways, who can say how deeply art heals things in us? All art engages a form of meditation: focused peaceful time with yourself, in which reflection and insight can arise. This is quality time for yourself. When attention is absorbed in sketching, breathing drops down to a slow and deep abdominal rhythm as in Zen meditation. The sense of self dissolves, as mind, observer and subject melt into one egoless being. This can give the sensation that the flow of time has been impeded or even arrested, like the pause between two breaths in Zen meditation. States of deep tranquillity and bliss often arise. This links art directly to contemplative religion as well as healing. Who can say how much inner unhappiness is ‘purified’ through painting or sketching? Or how much unhappiness and unresolved hurts underpin physical sickness? Thus, a sense of well-being derived from artistic activity can have a purifying effect, giving an inner peace that enriches one’s sense of meaning and purpose: "beauty is the purgation of superfluities." [Michaelangelo] Such peace is hard to find elsewhere. Maybe through religion, possibly through companionship and keeping pets, looking after others, even gardening, we build meaning and purpose into our lives. Art is popular with the disabled, in prisons and psychiatry and among old people, where its peace-conferring qualities are cherished. The psychic state of the elderly, the imprisoned and the mentally sick, enables them to secretly appreciate the comfort and power artistic expression can bring. Artistic work validates the artist; it feeds their sense of purpose and pleasure and instils inner satisfaction. It makes their life worth living and gives them a greater sense of control: “a painter paints to unload himself of feelings and visions.” [Pablo Picasso] The added sense of power and autonomy can neutralise a sense of helplessness. Art appreciation and self-expression have a soothing effect, especially I would say for people who feel isolated and marginalised or those closer to death than the rest of us hope we are. Endless links exist between art and healing and for the same reasons hospitals ought to provide pencils, paper, crayons and other art materials to patients, with art volunteers to tour wards and give appreciative feedback. Exhibitions, displays and prizes could further validate the work of patients, and even staff, which could grace walls and corridors, or even be sold. The miniscule cost might be handsomely repaid by considerable benefits: a patient could then say, “yes, I was in hospital for two weeks, and while there I learned how to draw!” How positive is that? Sources [1] Ian Guy, BMJ e-letter, if you cannot define health adequately, then define art! 23 December 2002 http://bmj.com/cgi/eletters?lookup=by_date&days=2#28109 [2] John Berger quotations from: Drawing on Paper, [559-565, 1987], Painting a Landscape [210-214; 1966]; in John Berger - Selected Essays, Edited by Geoff Dyer, London: Bloomsbury, 2001 [3] Isaiah Berlin, The Proper Study of Mankind, London: Pimlico, 621 Competing interests: None declared |
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Daniel J. McCarty, Epidemiologist Marshfield Medical Research Foundation, Marshfield, Wisconsin, USA
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I agree with Richard Smith, but why not spend it all (totally) on the arts and then become an artist. Many health care professionals could make the leap (though exponents of EBM may fall a bit short). Suggestions include: Classical musician: General internist (violin), endocrinologist (viola), nephrologist (cello), oncologist (bass), orthopedist (xylophone), surgeon (drums) and anesthesiologist (cymbals), cardiologist (organ), rheumatolgist (piano), gastroenterologist, urologist and gynecologist (various wind instruments), and registered nurse (conductor). Drug reps could supply the sheet music and hospital administrators could act as page -turners. Other musician: pediatrician (likely to play in a rock band), family practitioner (folk musician - popular, but there’s no money in it) and ENT specialist (strictly a cappella). Visual artist: radiologist, ophthalmologist, pathologist, physiologist, dermatologist and hematologist. Writer: psychologist and psychiatrist (playwright), epidemiologist (novelist - producing the occasional classic but mostly pulp fiction, see page 1437-38) and basic scientist (abstract or absurd novellas). Performance artist: Dean and Medical Director Busker (play anything for spare change): Editor Competing interests: unpublished novelist |
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Dr.B.C. Rao, G.P. Apoorva Diagnostic Centre,CMH Road, Indiranagar, Bangalore 560008.India.
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We are trained to fit physical signs and symptoms into known disease entities and brand our patients with the name of a disease. Then follows the attempts at treatment. The results are not always on the expected lines, as any doctor with some experience will have realised. There is altogether another dimension to patient management other than scientific learning and logical thinking. Art is a part of this as yet ill defined dimension. Some times I feel there is a close link between religious experience and intense involvement in artistic feeling. Human brain in all probability produces some soothing and healing chemicals in abundance in persons who are thus endowed. Evolved music, what ever maybe the style of rendition, is an absorbing experience. So is looking at a painting. Creating something which is beautiful and looking at it [though it is in the eyes of the beholder] is an enriching experience. I am pretty sure that physicians and patients will greatly benefit with a dose of art. It was a timely and well written editorial. B.C.Rao Competing interests: None declared |
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Philip V Kaye, Histopathologist Queens Medical Centre, Nottingham NG7 2UH
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The problem with art is that it is profoundly elitist. Switching money from Health to Art benefits the upper classes (who probably have medical insurance anyway). What percentage of the population: 1. read poetry? 2. goes to opera? 3. enjoys/is touched by contemporary art? 4. cares who wins the Booker prize? Cultural things that most people identify with tend to be self funding eg football, pop music, trashy television soaps etc. Perhaps diverting public health money to things which are relevant to most people (eg ailing football clubs, youth sport projects, community centres) would be easier to justify - but it really should be up to the public to decide this. Competing interests: None declared |
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Hyman Davies, retired gp n/a
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I think that the question as to which is the more worthy of funding health or the arts deflects us from the real issue which is : Why do we spend such astronomical sums of money on arms which are inimical both to health and the arts? How tragic that despite the pleas and warnings from Pope to peasant, our government, obsequiously tagging on to that of the United States, presses on regardless with its plans to plunge an entire region into unimagineable terror. Seemingly there is ample funding when it comes to waging war. Competing interests: none |
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Phil G Manning, Director - BeatsTHINKING 16 Chudleigh Road, Twickenham, TW2 7QR
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Your editorial is both timely and persuasive. There is also a valid concern, elicited by a number of your correspondents, that redirecting funding towards the arts will take scarce resources from healthcare. No one is suggesting sonatas as an alternative to surgery for those cases which demand the latter, although there may be some mileage in exploring the role of, say, music in pain management. It is also unfortunate that several other of your correspondents too readily tag the arts as "elitist". While the enjoyment of certain arts may tend to be restricted to narrow social groups, many artists must recoil at the idea that their work is only to be enjoyed and appreciated by a privileged few. Take the case of Simon Rattle, an artist who has consistently sought the highest standards of performance, but who is clearly, from your example, seeking to use his highly developed (and in that sense, yes, "elitist" art to breach social barriers. I am not medically qualified, but I have simply seen too many people's faces light up and their mood change for the better when they experience the joy of playing percussion in a group not to believe that such activities have a positive effect on health. One noticeable benefit can be to build a sense of group belonging, so often threatened by chronic, debilitating illness. So much of modern medical treatment seems, no doubt much against the therapeutic instincts of its hard-pressed practitioners, to undermine its own efforts to heal by not addressing the needs of the whole person. Many artists are both willing and able to assist in plugging this gap, which would surely be in the interests of all stakeholders in our healthcare system. As you suggest elsewhere in this issue, it is about time we moved on from Descartes… Best wishes Competing interests: BeatsTHINKING is a business dedicated to enabling people of all levels of musical experience to make percussion music for their own pleasure and that of others |
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Tony Floyd, Medical Student Newcastle University, Newcastle Australia 2006
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Dear BMJ, It may amuse you to know that Richard Smith's recent editorial(1) recently found mention in The Sun Herald(2). The Sun Herald unequivocally cites the Journal as urging that we 'spend more on the arts than health', rather than slightly less on health and more on the arts. Not a subtle or semantical difference, as to spend more on the arts than health would require an increase in the arts budget of around 1,700% or a decrease in the health budget so severe that hospitals would have to sell all of their equipment and possibly all of their patients as well. But wait! There's more - Richard Smith also apparently 'railed against medical intrusion into many such natural processes such as... depression', even though depression was not mentioned in the editorial (although unhappiness was). His comments that mankind faces an 'unwinnable battle against death' were labelled as 'taking a radical stance'. According to who? It is one thing for the media to fail to understand the difference between relative risk and absolute risk causing excess panic over a HRT trial, but to get things so wrong when reporting on a simple editorial? Spend (slightly) more on journalistic eye care. A happy and healthy New Year to you all, Tony Floyd References: (1) Smith, R. Spend (slightly) less on health and more on the arts. Editorial BMJ 2002; 325: 1432-1433 (2) Teutsch, D. Our 'unwinnable' battle. The Sun Herald (John Fairfax Holdings Limited); Sunday December 29, 2002. p34 Competing interests: None declared |
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Susan I Brown, Volunteer - Marketing the Arts Milton Keynes General NHS Trust, Arts Committee - All Volunteers
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Yes - The British government should spend more on the arts, BUT this could be still be considered as spending it on health. The National Network for Arts in Health have much evidence that art in all its forms in a hospital environment is beneficial to health. Music in areas of stress, storytelling on children's wards, sculptures to touch and paintings to see are all the forms of art that hospitals around the country are striving to incorporate into their everyday activities. The government support these efforts (morally) but not with financial assistance. Volunteers are doing what they can. Some hospitals have succeeded in getting lottery money to provide core funding for arts committees. PLEASE can the arts have more financial recognition in the part they play towards providing a healthy uplifting environment. Competing interests: None declared |
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Synnove K Ellingsen, painter and careworker Loughborough
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The article is of course showing the right picture. People want and have a right to as full a life as they can achieve in their lifetime.That does not mean they will be healthy and well throughout their life,or continuously lead a life withouit health problems and without any other problems ,and meet each day feeling happy,happy,happy.There is something unreal about people that seem happy,happy,happy every day you meet them.Certainly it makes you a little suspiscious-have they then not understood anything of the real world ,that of pain,joblessness,sickness,lack of freedom,money,friends,familyproblems of one sort of another,lack of God intervening in their problematic lives and fix whatever they need in the blink of an eye.That is the real world for the majority and the everhappy people have maybe not understood that they themselves really need help,so that they are able to get a more balanced life ,and maybe ,maybe through generous treatment become more understanding of the real world,and thereby become more real people with more real emotions,making their days more fulfilling and able to lead a fuller life also aware of the rest of the world.There will still be happy moments,but more reflected,maybe more of a joy,besides all the other emotions that naturally will develop as the treatment they receive will make them more whole as individuals. Now,what treatment in the healthservice do they need.It would be of an alternative kind that involves discussion, interaction between themselves and other people with to them new experiences,some mindopeners,spicing their previous observation of the world.And still it has to be healthy.Away with drugs,pills,the constant flow of antibiotics from every surgery door at the first wink of an unwell feeling or small disease,WHAT NOW.Just a couple of suggestions and there are many many more that could follow.What now,given thew economic means there is no reason why there should not be: Prescription to go to churches,free ballet tickets,free concerts,maybe a prescription to buy an artwork of own choice or of artwork{s} placed in their home for a period of time,something that will gently or forcefully ,if preferred,encourage their mind and brain to start working again in a broader way."What is this strange thing the health service has provided me with,this visual image."It gives cause for discussion ,maybe there will be a small amount of curiousity leading to further action,to discussion,to more visits,to more activity some way or another.All this could be provided through the health authorities working together with the arts,or the arts given more money direct to provide new and exiting opportunities for people,the narrowminded always happy,happy people as well as the more traditionally unwell. The arts desperately need to get more money to provide revigourated services,the health authorities falls short of real alternatives to their traditional services.Give the money to the arts and put up a small group of experienced and fresh artorganisers to come up with something new for a change if I may say so.It would be a success!!!! A lot of people in the traditional healthinstitutions are also starving for lack of variety and challenges to their souls and brains.The health of the people in a society and their ability to lead fuller lives will improve only if the artists are taken along and given their important share. Synnove Ellingsen
Competing interests: None declared |
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Rabbi Julia Neuberger, Chief executive King's Fund, W1G 0AN
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Maybe you should consider a lateral approach to diverting the UK’s healthcare spend to the arts. The King’s Fund’s Enhancing the Healing Environment programme has given £2 million to clinical teams in all London’s acute and mental health NHS Trusts to take on projects to improve the patient environment through art and design. A full evaluation will be available later this year, but emerging evidence is showing positive outcomes for patients and staff. This supports a whole host of previous research that suggests building design has an effect on patient wellbeing and recovery rates. The NHS currently has a £4.5 billion building programme through PFI alone – just think of the great art and design that could produce. With all good wishes, Rabbi Julia Neuberger
This article is written in response to a recent BMJ editorial: Smith R. Spend (slightly) less on health and more on the arts (BMJ 2002; 325: 1432-1433) 21 December 2002 Competing interests: None declared |
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c mark harper, Anaesthetic research fellow/SpR Centre for Anaesthesia, Middlesex Hospital, Mortimer Street, London, W1T 3AA
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Dear Sir, As usual I greatly enjoyed the Christmas issue of the BMJ. Of particular interest to me were three of the articles at the beginning, the link between which, other than their proximity, was underemphasised. In the paper ‘Spirituality and clinical care’, Culliford writes that ‘much new research [shows] that prognosis is radically improved by spiritual care.’ 1 This might well be due to the influence of the mind over the body, the evidence for which is compellingly reviewed in Ornstein and Sobel’s book ‘The Healing Brain’. 2 This also lends credence to Bracken and Thomas’s suggestion that it is ‘time to move beyond the mind- body split.’ 3 The mind is not only ‘out there’ in the social world, but in the medical one as well. I would agree with Culliford’s suggestion that the application of these insights into practice is due to a number of interrelated problems including those of education and personal obstacles. This might be overcome by broadening medical education to encompass the humanities in general and philosophy in particular. 4 The study of these subjects gives us the wider perspective so sorely lacking from our super-sub-specialised and overdetailed medical education. Culliford also states that ‘evidence is growing in volume and quality’ that ‘spiritual sustenance’ can help healing. Even if a patient (or doctor) does not derive such benefits from religion, similar feelings, and possibly benefits, might be drawn from music or art. If this is the case, the adoption of Smith’s proposal to ‘spend (slightly) less on health and more on the arts’5 may have tangible health benefits as well as spiritual ones. Competing interests: None declared |
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Christine M Hamilton, Director Centre for Cultural Policy Research, University of Glasgow, Glasgow G12 8QQ, Mark Petticrew
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Richard Smith raises some important issues about the role of arts in our society and on the relative value we attach to arts and health, as reflected in their budgets. Perhaps a move to divert some modest funding from the health budget into the arts might prove more popular if some positive health benefit can be demonstrated. But, despite the experiences of Simon Rattle (and any artist who has engaged with poverty and exclusion), the health benefits of the arts are not immediately obvious. While we might agree with your correspondent, Susan Brown, that the arts have positive effects in a hospital environment, there is a lack of robust evidence of the arts providing such benefits in other areas. The potential health benefits of participation in the arts to the individual and to the community have received widespread attention in recent years. The arts have been used as a medium for health promotion, as therapeutic interventions, and, in the case of the UK, health action zones and social inclusion partnerships arts projects have been specifically used to tackle social exclusion. As with other health care and social interventions, the arts may have the potential to have an impact on health, but these impacts need to be demonstrated, whether the outcomes are improvements in specific health outcomes, or increases in levels of social participation. Perhaps now that the BMJ has put the issue on the agenda, the door will open to supporting research in this area. Christine Hamilton, Director of Centre for Cultural Policy Research and Dr Mark Petticrew, Associate Director of MRC Social and Public Health Sciences Unit, University of Glasgow. References Christine Hamilton, Sarah Hinks and Mark Petticrew, ‘Arts for health: still searching for the Holy Grail?’, Journal for Epidemiology and Community Health (forthcoming). Susan I Brown, ‘Spend (slightly) less on health and more on arts’, response to Editorial, BMJ 2002; 325. http://bmj.com/cgi/eletters/325/7378/1432#28349 Competing interests: None declared |
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Jim Golby, Head of the Academic Study of Sport & Exercise Teesside University TS1 3BA
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Having read the original editorial and the subsequent correspondence arising from R. Smith's article 'Spend (slightly) less on health and more on the arts', it is clear that a potential third way has not yet entered the debate. This would involve diverting some of the healthcare budget to improving knowledge about and the infrastructure of sport and exercise provision. The literature on the physiological and psychological benefits of exercise in the prevention and treatment of illness and injury is overwhelmingly supportive, yet, financial support remains poor. Art may prove a valuable adjunct to medicine, but sport and exercise have a well documented efficacious effect and will prove an equally worthwhile investment. Competing interests: Head of the Academic Study of Sport & Exercise |
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Ioannis D Dimoliatis, Assistant Professor of Hygiene & Epidemiology University of Ioannina, Medical School, Department of Hygiene & Epidemiology, Ioannina, Greece 45110
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Because:
- "man cannot live on bread alone" (Matthew 4.4); - there is "health", but also "real health" (ending sentence of Richard Smith's inspired proposal); and - "medicine is the ART of healing", isn't it? Competing interests: None declared |
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Jane Macnaughton, Director of CAHHM CAHHM, University of Durham, 14/15 Old Elvet, Durham DH1 3HP, UK, Mike White, Lara Dose
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Response to Editorial: Spend (slightly) less on health and more on the arts Dear Editor, Along with many correspondents responding to your editorial in the Christmas edition we rejoiced that arts and health had been given such a high profile platform(1). The title of the editorial encapsulates the two issues that our organisations were founded to address. The National Network for the Arts and Health (NNAH), as well as providing services and information for its 500 members, has been lobbying hard with the Department of Health and the Department of Culture, Media and Sport to encourage better funding for the arts and health. We have calculated that, if the government were to follow your suggestion, funding for the Arts Council of England (ACE) would have to be increased by a staggering 70%! The Centre for Arts and Humanities in Health and Medicine (CAHHM) at the University of Durham is a research based organisation committed to establishing what your correspondents Christine Hamilton and Mark Pettigrew described as a 'robust' evidence base for the arts and health. The subtitle of the editorial - 'health would probably be improved' - raises this very question. The problem at the moment is that we do not yet know what that magical 70% increase in the budget for ACE could achieve. We agree with the insight that art can 'teach you something useful about your pain'. Literature can give shape and meaning to conscious experience (2) but can we prove that reading or writing literature, or indeed any form of artistic activity, can be healing in the terms acceptable to the paradigm of evidence based medicine? There is a concern amongst artists engaged in arts and health work that if they were to orientate their programmes to answer the evaluative needs of health funders they would fail to fulfil the needs of their patients or clients. We hear from patients that what they get from engaging with artists is a sense of their own creative worth. The artist views the patient as someone with the potential for creativity; the doctor regards the patient as a problem to be solved. Artists will point to the quality of the work produced by those who participate in their projects as evidence of success. This is a challenge for those of us who have lifted the gauntlet of producing a sound evidence base for the arts and health. We hope that we will soon find our place in journals such as the BMJ and that, perhaps in consequence, your editorial wish will come true. References 1. Smith R. Spend (slightly) less on health and more on the arts. Health would probably by improved. BMJ 2002; 325:1432-3. 2. Lodge D. Consciousness and the novel. London: Secker and Warburg, 2002. Jane Macnaughton, Director Mike White, Director of Projects Centre for Arts and Humanities in Health and Medicine (CAHHM), University of Durham, 14/15 Old Elvet, Durham DH1 3HP Lara Dose, Director
Competing interests: CAHHM and the NNAH both recieve funding from organisations which support the development of the arts and health. |
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eliza crown, worker alliance for youth 95405
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This is a very interesting discussion but, from the viewpoint of someone who's choosing to live on poverty level in order to help (in a small way) her country... V.I.S.T.A. stands for "Volunteer in Service To America". It means for one year you agree to work in a non-profit agency while providing services for a community "in-need". These communities are just about everywhere here in the States. The U.S. govt. pays us a small bi-weekly stipend to live on and we're not allowed to take outside employment. We have a basic medical plan but no dental. Our stipend has to pay for food, housing, gas, dental and any incidentals. For the past year I've been living on $315 US or 201.64 UK pounds. That $315/bi-weekly makes life really tough. I've gotten no govt. assistance in terms of housing, utilities or food stamps. I have a cat which is another mouth to feed and doctor bill to pay. The only reason I've been able to scrap by is because I had some savings (which are completely gone!) I measure my luxuries in terms of can I afford one video rental once/month? Can I afford to buy a "real" cup of coffee once/week? The thought of my measly medical stipend being slotted for an "artistic" endeavor is horrifying - and, I'm an artist myself! Art is wonderful; we can live but, not live well, without it. However, there comes a point in your life when art means nothing if the basic necessities of life: decent food, decent housing, adequate warmth, decent medical/dental care...aren't met. Would an impoverished society benefit from a renewal of art in its community? Yes, in the admiring of a dance, art piece or theatre production they would be able to forget, for one brief, shining moment the utter dinginess of their lives. But, when the last bow is taken and the curtain falls, what are they left with? The reality of their poverty. Our world is nothing more than one big school filled with endless homework and countless lessons. The question is: do you do your homework first and play later or, play first and cram at midnight hoping you pass the test? eliza crown Competing interests: None declared |
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Ekta K Kalra, Research Scholar 302. Krishna Kunj, Gurunanakpura, Nagpur - 440017, India
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Lord Kabir said that bhajans and arties are the only means available to cross this world. Bhajans and arties are poetic in nature with embedment of excellence in rhyming and spiritualism. The Mahabharata_holy book of Hindu’s is the longest poem in the world, containing over 100,000 verses. In Indian culture, poetry has deep routes of Vedic origin and till date survival. However, the effect produced by past rhyming lines is declining in the present Indian age. One reason for this being westernization, the other still important reason is difficulty in understanding these poetic verses. Of the 265 people whom I personally interviewed, 213 said that they fail to understand the meaning of Sanskrit shloks. With the first and foremost preference for learning English, the past poetry verses remain confined to the selected few. Though, these verses are translated in English, but in so doing they have lost their poetic essence. Poetry heals by its meaning and rhyme. But, the effect of healing of poetry is paralyzed, when its meaning remains unrealized. Also, the flow of words attains a bit of abrasion, when rhyming is missing. May be this was the reason why past holy men of India, composed meaningful, rhyming poetries, advocating spiritualism. By so doing drumming effect and psychotherapy also finds roots, in the poetic plant for cure and care. Scientific Stand of Art The concept that poetry should be used as a healing tool 1-3 needs scientific justification. In doing so, the following points should be considered: 1. What percent of people do really understand and value poetry? If one does not understand a verse, it can do him little if any good, even if it’s written with great excellence. The figures of speech (example, personification, euphemism, etc), a learned man can still depict, but a man with no preliminary knowledge of poetry shall consider it only a mere play of words, trying to fool of positivity. 2. In what disease conditions can poetry be prescribed The disease conditions, in which poetry can help attain health, need to be stated with reasons supported by scientific studies. Medical Science can accept arts for cure and care but for that ‘art’ needs to be scientifically evaluated for the proposed positive effect. 3. What poetry cannot do? Today, we cannot expect a tuberculosis patient to seek aid of a poem, to attain healing. But, what if faith in poetry, propagated by medical science, shall surpass the limits, and poetry shall become a therapy of choice. After all, it shall heal without side effects. The same virtue, which has helped fly high the success of other alternative therapeutic means. Poetry should not be used
Scientific Poetry Let’s take an example, if a poetry read by tuberculosis patient reads:
“Yes! I am healed
If after reading this verse, the patient is off the bed, believing in poetry and refusing to take pills, then what? Poetry lines can at times, result in instillation of more positivity than needed. This is because a poem is usually an exaggerated version and not restricted to reality. For some, poetry and placebo look alike. Still for others it shall be just a supplementary aid. But what majority shall expect from poetry after acceptance as therapy, is hard to say. We therefore propose the concept of scientific poetry. A scientific poetry can be defined as a poem, which instills positivity in the simplest possible language, with the objective to help heal, without criticizing medical science. The following points should be present in a scientific poetry, 1. It should be easy to understand.
We believe, that a right poetry, for the right patient at the right time, can be beneficial in health care system. However, such poems should be judged by scientific means before propagating for therapeutic means. References 1. Smith R. Spend (slightly) less on health and more on the arts. BMJ 2002; 325: 1432-1433 2. McArdle S, Byrt R. Fiction, poetry and mental health: expressive and therapeutic uses of literature. J Psychiatr Ment Health Nurs 2001 Dec;8(6):517-24 3. Macduff C, West B. Developing the use of poetry within healthcare culture. Br J Nurs 2002 Mar 14-27;11(5):335-41 Competing interests: None declared |
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Nancy J. cooley, President Nancy J. Cooley & Associates: Embracing Change Creatively, Inc. Victoria, B.C. Canada V9C 3Y1
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I was delighted to see your editorial "Spend (slightly) less on health and more on the arts. As I had just completed a research paper looking at the contributions arts and culture are currently making to health care and wellness, I was very pleased to see your recognition of the connection. Of the research I found on the subject, much of the best comes from the U.K. Your government is one of what seem to be a small number around the world which recognize that investment in arts and culture has significant and far reaching positive social impacts, including on health. For readers who wish to pursue the subject further, I would refer them to my paper for an overview on the subject: "Arts and Culture in Medicine and Health", soon to be available on the British Columbia government web site, under the Ministry for Community, Aboriginal and Women's Services. The international Society for the Arts in Healthcare web site has useful links, and the Community Arts web site Reading Room has useful articles on the impact of participative arts. Competing interests: Author of the paper cited in my response. |
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