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The tradition of integrating healthcare and art has a long and profound history; it can be traced far back to when the first hospitals grew out of hostels run by the church for pilgrims and other travelers. In order to understand the development and importance of art in healthcare, we must understand the vast change in healthcare institutions throughout the decades because as healthcare institutions changed throughout the years, so did the art inside. Taking a quote from Florence Nightingale, a prolific nurse who raised the standards for nursing during the Crimean War in 1854, she spoke of the importance of aesthetic pleasure and distraction:
I have seen in fevers… the most acute suffering produced from the patient, not being able to see out of the window, and the knots in the wood being the only view. I shall never forget the rapture of fever patients over a bunch of bright-colored flowers. People say the effect is only on the mind. It is no such thing; the effect is on the body too.
During the 6th century BC, it is evident that the Ancient Greeks saw a link between the arts and healing; a hospital in Epidaurus stood next to a statue of Asclepius- the God of healing. They also had temples that were dedicated to both physical and spiritual healing dating back to 200 BC, adorned with marble reliefs and statues. People would dedicate imagery of what body parts had been causing them problems – they acted as a souvenir to what had been healed as a token of ‘thank-you’ to the healing god. The word hospital derives itself from the Latin word hospital, meaning a house for the reception and entertainment of pilgrims, travelers, and strangers – with no connection to illness.
Although the Ancient Greeks may not have understood the healing power of art – the principal of art was there to enlighten and to transcend the viewer or provide hope for those in need of help during times of ailment. As we move on to the medieval period, we see a more definite connection between art and the institution’s moral principles. It was during these times that brought about the origins of the modern hospital.
Paradoxically, in certain respects Christianity had a rather negative effect on medicine: anatomy was denounced, human dissection was prohibited because a man’s body is the temple of the Holy Spirit, the occurrence of miracles advanced superstition, and diseases were regarded as a punishment for sin. The Church progressively monopolized the predominantly monastic hospital system, which for its time rendered an able service to the ill and the aged but contributed little to the advancement of medical science.
Medieval hospitals contained incredible artistic embellishments; which usually reflected the religious nature of the institution and offered images which set illness clearly in a context of belief, the interior would reflect the wealth of the patron or founder. This can be seen throughout the renaissance, but perhaps more ornately done. Renaissance hospitals had highly regarded art pieces in places of healing – works that reflected their place in history. The hospitals of Renaissance Italy were the ‘concrete embodiment of physical and spiritual healing’.
Moving on to the 15th century we see Kings and rulers moving their charitable work from the building of cathedrals to that of hospitals in order to achieve good works on this earth and to help them to the next. An interesting example of this is the St Wulstan Hospital in Worcester; where there was once a room where patients were brought to spend their last days of sickness, this room contained 10 panels including scenes of St Erasmus, and on the opposite wall was ‘St Michael weighing souls to decide their destiny, to heaven or hell’.[
One of the most discussed and historical pieces of hospital artworks is William Hogarth’s ‘Christ at the Pool of Bethesda’ in St Bartholomew’s Hospital London Hogarth painted this large fresco for no fee but did so in order to promote himself as an artist. The painting is a visual narrative of the art requested at this time for hospitals, to show what St. Bartholomew’s represented as a healthcare institution. It was painted in 1736 depicting an episode in Saint John’s Gospel, the painting features Jesus Christ tending to a leper reclining on the ground, surrounded by other sick people. Hogarth himself said regarding his work in St Bartholomew’s – “my object dramatic, and my aim to draw tears from the spectator”. I think this is an excellent example of what art in healthcare once was and what it once represented, in some ways, it carries the same principles of hope and recovery addressing the mind and spirit of patients. Dr. Hugh Baron puts it perfectly in his essay on the History of Art in Hospitals ‘Patients were exposed to images of the deity so that they could pray for their recovery, pray for the patrons of the hospital, or pray for immortality’
An interesting article from 1877 from the British Medical Journal from Joseph Moore, Chairman of the Committee of Management of the Seamen’s Hospital, started a public appeal to “assist him in decorating the wards of the institution with pictures so as to dissipate the depressing monotony of the dead walls… the pictures should be simple, colored prints”.
With the proliferation of Victorian public welfare, those elaborate forms of art in hospitals had largely disappeared, however, it was after 1910 when little to no art was placed in hospitals in Europe due to the changes in architectural fashion. The architectural fad was exemplified by August Perrier ‘decoration always hides an error in construction’ and by his pupil Le Corbusier – ‘a house is a machine for living in, it is the wall which is the work of art’ and this attitude was reflected in healthcare institutions in the early 20th century. An interesting point in which Dr. Hugh Baron points out as an element for the dismissal of art from architecture at this time may have been because of ‘the then fashionable dogma that Romanesque and gothic cathedrals and Greek temples and their structure were all white’ because they appeared in textbooks as black and white photographs, this myth from the 1920’s ‘persisted until the 1960s and for many decades hospitals, wards and patients had to suffer environments in which color and decoration were taboo’.
During the NHS’s early years ‘they paid little regard within their walls to the aesthetic dimensions of existence. They were very much settings for the treatment of disease’. It was during this time we really began to segregate the two disciples of art and healing. Art in healthcare settings was ‘frequently seen as an optional extra as something to be added when resources allow, and in hospitals, as a comfort rather than as an integral part of the healing and caring process’. Rules and regulations were enforced for greater hygiene but the buildings became drab and lifeless ‘patients were lying in bed with nothing to look at but a blank wall’. Asylums were placed in the countryside away from urban areas, but also for a nice scenery – the same was not thought of in TB wards. During the 1960s and 70s – less care ‘stark settings for care became the standards, accompanied perhaps by an unwritten but nevertheless strong assumption that decoration was frivolously self-indulgent and in any case leached away funds needed for the ‘real’ purpose. ‘The great bulk of buildings which comprised the NHS in its early years paid little regard within their walls to the aesthetic dimensions of existence. They were much the settings for the treatment of disease’.
From this we can see a clear reflection of what was happening in society and what was happening in hospitals, from ancient Grecian times; a deep connection between art and healing, to the 15th century when art in hospitals became more about the patron and money, the early 20th century reflected minimalist sensibilities which carried for over 50 years.
Art should not be seen as one of those activities like physiotherapy that is ancillary to medicine; nor as an alternative to medicine. It is concerned without common sensibility and our shared vision of what life is about and how it should be lived. Art has the power to reconcile us to the painful problems that life presents, its truths, and the suffering and sacrifices that it entails for so many people.
The idea that art may have constructive benefits in healthcare is not a new concept and has been recognized by artists and healthcare professionals. Although the benefits may not have been known back in ancient Greek times but ‘our forebears lived in a state of unity between the physical and spiritual, the visible and invisible’. However, there is a constant conflict between human standards on one hand and institutional efficiency on the other; art can sometimes be disregarded. The potential for the arts in healthcare is vast since everyone needs healthcare at some point in their lives. The quality of people’s lives is the main consideration however It is very difficult to measure in any scientific way claims made about the effort of the arts and visual environment on patient recovery. I will be introducing the main case studies that have proven art in healthcare to have benefits on patients and staff. It can’t be easy to be healed in a soulless concrete box with characterless windows, inhospitable corridors, and purely functional wards. The spirit needs healing as well as the body.
Over the last twenty years, there has been increasing recognition internationally of the contribution the arts can make to the health, quality of life …and to those in healthcare settings. Since the 1980s, arts programs have opened in hundreds of hospitals, clinics, and community centers across the world, and there has been an increase in government support for this work.
The earliest and most recognized study on the influence of surroundings and aesthetics in healthcare settings was one conducted by Dr. Roger Ulrich in 1984, called ‘A View Through a Window May Influence Recovery from Surgery’ in which Ulrich showed us that a view of nature from your hospital bed can significantly hasten postoperative recovery, Ulrich describes that ‘most natural views apparently elicit positive feelings, reduce fear in stressed subjects, hold interest and may block or reduce stressful thoughts, they might also foster restoration from anxiety or stress’ by analyzing nurses notes and patient’s hospital time, comparing with the patient’s in a room with a blank wall and patients in a room with a window. In another study on the effects on the environment, Ulrich emphasizes ‘in spite of the major stress caused by illness and traumatizing hospital experiences, comparatively little emphasis has been given to creating surroundings that calm patients, strengthen their coping resources or otherwise address psychological and social needs’.
The most comprehensive and large-scale study of reviewing the social impact of art initiatives in Britain was undertaken between September 1995 and March 1997. The study concluded that “the participation in the arts is an effective route for personal growth” and that the arts have a positive impact on how people feel, it also contributes “to social cohesion by developing networks and understanding”.
Since 1997 there weren’t many studies conducted in this field of research, however, there have been many papers discussing the importance of art, one of which is by Anne Scott, entitled The Relationship between the Arts and Medicine, written in 2000. Where she outlines the three main contributions that art can make towards ‘whole person understanding’ meaning to understand the individual; she discusses how art can stimulate and share common experiences with the viewers and a way to open conversation between viewers. ‘Medicine and art have a common goal; to complete what nature cannot bring to a finish, to reach an ideal, and to heal creation’. In 2006 the Department of Health in New Zealand reported that the arts have a clear contribution to make and offer major opportunities in the delivery of better health, wellbeing, and improved experience for patients, service users, and staff alike. ‘Good design must have central consideration, and will ensure that the hospital provides a high-quality environment that supports a positive healing experience’.
A more recent study conducted in 2016 study called ‘How do patients actually experience and use art in hospitals? The significance of interaction; a user-orientated experimental case study’ explores the contribution that visual art in hospitals has to heal outcomes. Conducted by four scientists from Denmark. An experiment was conducted for two weeks, week one had the walls stripped and painted white, and in week two art pieces were hung up. It proved that ‘artworks influence the practice and atmosphere of sociability. And that the artworks showed a positive effect on the social environment in the day room by activating patients to engage in dialogue’ It was more than just healing, the artwork was being used as a common frame of reference and engaging a mood of togetherness, ease, and relatedness’. Patients experienced that art had the potential to positively distract them from uncomfortable situations of illness by directly addressing their memories of themselves as an individual, social and cultural beings… positive distraction, in praxis, speech, and atmosphere. These effects are particularly important in relation to patients who experience deprivation of identity and power during hospitalization.
Although there have been studies conducted on art in healthcare to prove to social and holistic benefits of including art in healthcare settings, it’s understandable to see why clients and health service users want art to be justified. “The question of evidence has become a pressing one in relation to art practices in healthcare” Healthcare users work in an environment of ‘cure or care’ and evidence-based medicine “the purpose of EBM (evidence-based medicine) is to identify safe, replicable, and cost-effective interventions that can provide positive, clinical outcomes to a target population and this is applied to every aspect of the healthcare setting, including art. Although the full extent of art can not be measured and “art practices are not replicable”. Evaluation is still needed on art pieces and art initiatives, however, it debilitates the artist to expect art to heal on a scientific level. I will be discussing more about this in chapter two and the role of the artist. In John R. Graham-Pole’s article ‘The Marriage of art and science in healthcare’ he quotes quite aptly that ‘there will be the arts, and some will call them soft data – whereas in fact, they are hard data by which our lives are lived’.
In reviewing these case studies and journals the main effects art can have in healthcare settings are as follows:
Increased recognition of the power of that arts to shape emotional as well as the physical environment lends strength to a growing movement to incorporate the arts into healthcare facilities, this new partnership seeks to re-humanize the healthcare environment with the tools of aesthetic experience and expression.
In conclusion, we see how art in healthcare has progressed throughout the centuries; how it reflected the trends of the holistic gods to the minimalist ideals of Le Corbusier, to the strict rules and introduction of the clinical environment. Art has a clear impact and a place in our health care settings. Again, Florence Nightingale recognized the importance of art in medicine and raised issues that are still highly relevant today ‘the effects of beautiful objects, of various objects, and especially the brilliance of color is hardly at all appreciated. Little as we know about the way in which we are affected by form, by color, and light, we do know this, that they have an actual physical effect, variety of form and brilliancy of color in the objects presented to patients are actual means of recovery’.
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