Patients Benefit From Creative Expression
By Carol Strickland
Special to The Washington Post
Tuesday, April 8, 2008; HE01
As health-care costs skyrocket, a down-to-earth approach to healing is emerging, complementing high-tech medicine with high-touch arts.
The approach is based on the assumption that incorporating music, visual art, writing and performance into clinical care can increase feelings of well-being and even improve health -- an assumption that medical researchers are beginning to recognize the need to test with evidence-based studies.
Growing belief in the healing value of the arts was on display last month at a symposium at New York's Museum of Modern Art titled "The Value and Importance of the Arts in Health Care." Participants -- physicians, hospital administrators and artists -- were as upbeat as if they were promoting a miracle drug: Integrating the arts into health care is in vogue, said Leonard Shlain, a laparoscopic surgeon in San Francisco, "because it works."
The Society for the Arts in Healthcare, which sponsored the symposium along with MoMA and Vanderbilt University Medical Center, has seen its membership rise. As of 2006, the society estimated that more than half of 2,500 U.S. hospitals that were surveyed offer arts-based programs, said Anita Boles, the group's executive director.
Carol Herron coordinates an arts in medicine program at Texas Children's Cancer Center in Houston that involves visual artists, musicians, dancers, mimes, writers and puppeteers.
"We do children a disservice if all we do is treat the disease," she said. "We need to treat the whole child and the whole family."
And at New York University Medical Center, using art to reduce stress has become a priority, according to Marianne Hardart, director of creative arts therapies.
"There's not anyone it doesn't work with," she said, including adults, adolescents and younger children.
Not all institutions are willing to incorporate approaches of this kind, though, Hardart said. "In medical settings geared toward physical and chemical interventions, we're often considered an adjunct instead of an integrated piece."
That's partly because the research supporting these programs is slim.
Some of the documented benefits -- based largely on short-term appraisals of small numbers of patients -- include enhanced quality of life, patients' increased cooperation with painful procedures and helping staff understand a patient's point of view. Mounting evidence from the few early empirical studies also report reduced fatigue, depression, anxiety, pain and stress, which may boost the patient's immune system.
Tracy Councill, who developed an art therapy program called Tracy's Kids at Georgetown University Medical Center's Lombardi Cancer Center, recalled an art project by an 11-year-old lymphoma patient who had been in isolation for months following painful bone marrow transplantation. When he came back as an outpatient, "he made a clay sculpture of a sarcophagus with a mummy-looking thing," she said, which he glazed "with a lot of red to look like blood." This grisly object, she explained, served as "a displaced way of putting that aggression for all the stuff he'd been through into art -- a good way for him to be finished and let go."
Artwork can help medical staff perceive fears that patients sometimes can't express verbally. Matthew Gerson, vice chairman of the board of the Prevent Cancer Foundation, which funds Tracy's Kids, described a 12-year-old patient awaiting bone marrow transplant who made a puppet he called Dr. Bones. In the course of dramatizing a story, the child revealed his terror that his own bones would be removed. The art therapist was able to correct the misconception.
As part of a rehab team at NYU, art therapist Alice Landry works with adults who have suffered brain or spinal cord injury. A project such as woodworking or jewelry, she says, "creates a metaphor for them rebuilding themselves." Her patients demonstrate not only emotional but functional gains. After four weeks, a multiple sclerosis patient who initially couldn't pick up a bead was stringing beads and adding clasps, she said.
Fabien Navidi-Kasmai, 15, diagnosed with a form of Hodgkin's lymphoma when he was 11, illustrated his five-day course of chemotherapy at Georgetown: "I drew a picture of me getting hit by a truck," he said in a phone interview, "then I'd get up and get hit by a train. I'd get up again and be hit by a plane. It really helps to get those feelings out on paper." The lure of the art studio made him drag himself out of bed. "Unless you've been through it," he said, "it's difficult to grasp the concept that art has the power to make having cancer a good experience."
Aziza Shad, medical director of the pediatric hematology oncology unit at Georgetown, said the facility was designed around its open art studio. "The focus of our clinic is the art therapy program."
As soon as they sign in and before blood is drawn, children race to the art table. They forget they've come for examination, as they laugh, chat, draw or do clay work. Shad believes strongly in the program's benefits: "Those children who participate in the art therapy program do so much better physically."
Karen Robinson, who lives in Washington and whose son Max was 5 when he received a diagnosis of acute lymphoblastic leukemia, found the Georgetown clinic welcoming: "We knew that this was home," she said. "It helped us mind, body and soul."
Another Tracy's Kids program has opened at the Center for Cancer and Blood Disorders at Children's National Medical Center. Max Coppes, executive director of the center, said that once the art studio was installed, children began grabbing their IV poles and rushing over to work on their projects. "My prediction is, this will become a huge success," he said.
Besides providing feel-good activity, the arts can enhance a hospital's physical environment. Brigham and Women's Hospital in Boston spent more than $1 million to spruce up a 200-foot-long hallway its patients used when going to the Dana Farber Cancer Institute for treatment.
Estrellita Karsh, who originated the project (she is a former medical writer and the widow of the famed photographer Yousuf Karsh), said the passage used to be "traversed by very depressed-looking people, hunched over with their shoulders down." After installing a mural of 149 birds carrying medicinal sprigs, the corridor was renamed "the Bridge of Hope." "Nobody," Karsh said, "goes through with their head down now." One 3-year-old girl, bald from chemotherapy, used to be prodded along to her treatments. Now, the girl points to "her" bird, a scarlet ibis, and talks to it: "Are you a good girl?"
"There's no question there are numerous facets to caring and healing, and the physical environment is a critical one," said psychiatrist Gary Gottlieb, Brigham's president. "It has been shown that people's optimism, their mental outlook and their mood affect outcome in the treatment of chronic diseases and a number of cancers."
Some educators are schooling medical students not only in the art of medicine but also in the broader arts: drawing, art history and poetry. Edith Langner, faculty director of the Arts in Medicine Project at Columbia University Medical Center, takes second-year med students to MoMA and the Metropolitan Museum of Art, where she hones their observational skills. Looking at portraits trains the students to examine patients' faces, she says.
Yet resistance persists. Many doubt the humanities belong in medical education, and when they are included they're often marginalized rather than fully embraced. The field of art and health care, as William J. Ivey, former chair of the National Endowment for the Arts, put it, is "anecdote-rich and evidence-poor."
"If, on scientific examination," Ivey said, "our anecdotes and intuitions turn out to be correct, we can then -- with the evidence required -- move forward in policy areas."
Even a physician such as Coppes, who is convinced of the value of art therapy, explains, "I'm an academic, so if something is not demonstrated in a double-blind, randomized study, it doesn't exist."
Karsh, the medical writer, remains adamant in her faith: "Anecdotal accounts always seem to precede scientific corroboration," she said. ·
Carol Strickland is an art critic and medical writer based in New York. Comments:health@washpost.com.
