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Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial

BMJ 2012; 344 doi: (Published 28 February 2012) Cite this as: BMJ 2012;344:e846

Re: Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial

The authors of this paper (1), who have appeared committed to art therapy over the years, must be disappointed by its results. It indicates no great advantages for art therapy over standard care.

The design was necessarily only single blinded ('rater blinded'), for the patients and art therapists knew themselves what arm of the trial they were in. The ideal- double blinding- was not possible (2).

Also, the trial was restricted to patients in the community, for whom art therapy would be diluted in its impact. They would have to travel to a day hospital, presumably. Art therapy would not have had the immediate impact it possesses in an in- patient context.

As a former psychiatric in- patient, I would mourn the downplaying of art therapy. Hospitals in general have a policy of displaying paintings and sculptures, without which the corridors and wards might become bald and bare. Museums such as the National Gallery allow people suffering from brain injury or dementia to engage in personal interaction with works by masters including Van Heysam (3).

The typical psychiatric unit is dominated by meals and meds- by stodgy stuff on plates and by tablets doled out with clockwork regularity.To reduce the in- patient experience only to food and medication would mean an impoverishment. Art therapy appeared in my case a means to escape the feelings of containment and compulsion on the ward. The emphasis was not on producing great visual design, but on communicating oneself, albeit with inevitable hesitancy, to other patients in the art group.

Psychiatric medication has grim side effects- from movement disorders such as Parkinsonism and Tardive Dyskinesia to the metabolic syndrome, with chronic weight gain and type II diabetes. The side effects of art therapy at most involve some gouache or acrylic spilled on a patient's clothes.

The paper in the BMJ has a sister paper in the International Journal of Art Therapy: Inscape (4). In this latter article, there is no statistical approach, but, instead, the views are given of art therapists, some within the MATISSE trial. There seems to be a degree of Freudian influence among them. They confess that art therapy can come across as 'incredibly wooly'. The therapists see themselves as bringing autonomy to their patients, and as representing 'alternativeness' in a mental health system that can be too medicalized and machine- like. 'They shared a belief in the life enhancing qualities of creative expression and without exception considered art therapy intrinsically valuable, whether or not measurable incomes are achieved.'

There is the customary linkage between art and mental illness, manifested most tragically in Van Gogh. Art could seem real therapy for some individuals whose creativity is tinged by insanity. The possible connection between mental illness, particularly bipolar disorder, and creativity (5), might mean that to focus only on medication would deny and nullify the artistic abilities of patients. "Mental health' provision without the arts would stigmatize the mentally ill as grey puppets in a grim scientific system.

Currently, there is 'very limited access to art therapy' (6). Art therapists are usually only part- time. Art therapy operates in the NHS as a mere post- scriptum. It would be tragic if this paper by M.J. Crawford et al ensured that art therapy remained a cinderella service on the periphery. During this period of austerity, the problem surely is not enough art therapy for patients.

In his 'Hard Times' (7), Charles Dickens derides the harsh statistical approach of Mister Grangrind, who is obsessed with facts at the expense of all human feelings. How miserable, how bleak, mental hospitals would be without some acknowledgement of the arts! To diminish art therapy in mental health services would be a Grangrind-esque mistake.


(1) Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomized trial. M.J.Crawford et al. BMJ 2012;344:e846.

(2) The Cambridge Dictionary of Statistics in the Medical Sciences. B.S. Everitt. CUP. 1995. Pg. 31.

(3) Helping Catherine get creative. Samantha Moy and Michelle Baillie. British Journal of Healthcare Assistants. March 2012. Volume 6. Number 3. Pgs. 150-151.

(4) Art therapy for people diagnosed with schizophrenia: Therapists' views about what changes, how and for whom. Sue Patterson et al. International Journal of Art Therapy, Inscape. December 2011; 16 (2):70-80.

(5) Creativity and bipolar disorder:Touched by fire or burning with questions? Critical Psychology Review 32 (2012) 1-12.

(6) Provision and practice of art therapy for people with schizophrenia: Results of a national survey. Sue Patterson et al. Journal of Mental Health, August 2011; 20 (4): 328- 335.

(7) Hard Times. Charles Dickens. penguin.

Competing interests: No competing interests

31 March 2012
Zekria Ibrahimi
psychiatric patient
Coombs Library, West London Mental Health Trust
Southall, UB1 3EU