“The effect on sickness of beautiful objects, of variety of objects and especially of brilliancy of color is hardly at all appreciated… People say the effect is only on the mind. It is no such thing. The effect is on the body, too. Little as we know about the way in which we are affected by form, by color and light, we do know this, they have an actual physical effect. Variety of form and brilliancy of color in the objects presented to patients are actual means of recovery.”
Florence NightingalE – The Dietetic and Hygienic Gazette, 1895
As the COVID-19 pandemic continues to dominate the news, I keep coming across articles about the individuals and organizations stepping up to make masks for hospitals and healthcare workers facing a shortage of personal protective equipment. It seems that many of these altruistic DIY-ers come from the creative community – crafters and designers sewing masks out of scrap fabric, architecture firms and other makers printing 3D masks and face shields, and museums and art schools donating nitrile gloves, masks, goggles, and other protective gear. While experts advise that these homemade solutions are not as safe or effective as the rigorously tested N95 masks, they do provide at least a layer of protection and are, like my daily excursion out of the house to walk the dog, better than nothing.
This outpouring of help from the arts and creative community got me thinking about the role of art in medicine more broadly. After all, this is hardly the first time the two have crossed paths; students of the human body have worked at their intersection for centuries. While art has thus long been an integral part of anatomy drawings and medical textbooks, science and medicine too have featured in art. Leonardo da Vinci’s anatomical studies, Rembrandt’s Anatomy Lesson paintings, and Thomas Eakins’ The Gross Clinic are just a few more well-known examples.
Art is being used to illustrate the current health crisis as well, as a New York Times piece reveals in a look at the CDC illustrators tasked with creating an “identity” for the novel coronavirus. The resulting detailed closeup of the digitally-rendered spiky red and grey virus – apparently called a “beauty shot” in the world of professional medical artists – was carefully composed to make it appear tangible, tactile and to “grab the public’s attention.” The artists explain that the use of such illustration helps to make complicated and emotionally difficult medical concepts feel more real and approachable. In giving the virus a face, a persona, we are able to visualize it and therefore better able to understand it and – the hope is – the gravity of the situation it represents.
Art as medicine
In the contemporary healthcare setting, art often also plays a more direct role in medicine, as not only representation or decoration, but as a source of healing itself. In the US, the presence of artworks in clinical facilities began in the 1930s with the federally funded Work Progress Administration, which commissioned artists to paint murals in hospitals and other public places. This evolved further during the 1970s and 80s alongside the wider “arts in communities movement” that supported the production of artworks and advocated for increased accessibility to the arts. Around the same time, hospitals began to place more importance on marketing and patient/family satisfaction surveys, which revealed the desire for a more pleasant and attractive environment. This has culminated recently in a growing interest among the academic community and awareness in the wider public of the relationship between the arts and health.
Today, it is widely accepted that art can play a healing role, with numerous studies demonstrating its beneficial effects on patient recovery and a growing number of hospitals and other healthcare institutions incorporating art programs in their care remit. Carefully selected paintings displayed in patient rooms and common areas can enhance well-being by making an otherwise sterile setting inviting and enriching and provide a distraction from pain and isolation. Beyond creating a more pleasant and welcoming space, art provides opportunities for self-expression and gives patients a sense of control through creative expression. Research has even linked arts programming – permanent displays of art but also performances and bedside activities – to improved health outcomes, including reduced length of hospital stays as well as lower medication use and higher pain tolerance.
Evidence-based design
Architecture and design can also play an important role in both patient and staff well-being. The 1984 study conducted by Roger Ulrich that demonstrated the restorative effects of natural views on the recovery of surgical patients is probably so ubiquitous that it doesn’t bear repeating here (but I’ve done it anyway). Even more widely studied and understood is the positive effect of natural light on well-being generally. Thoughtfully-designed medical buildings can readily supply both through an abundance of well-placed windows with views out to trees or landscaped lawns and gardens. Hospitals too are incorporating gardens and courtyards with seating and even water features for both patients and visiting family members to enjoy.
Ulrich’s findings paved the way for evidence-based design (EBD) approaches that look at the relationships between the design of hospitals and health outcomes. Utilizing documented research and best practices, EBD practitioners make design decisions that are intended to improve patient safety and well-being while increasing the quality and effectiveness of care delivery. While there are nuances to what makes an ideal restorative space, general consensus is that a healing environment should support the patient’s 1) control over their environment (i.e. through lighting and climate control), 2) social connections (i.e. furniture arrangements that promote interaction and accommodations for visitors), and 3) unrestricted access to nature and other positive distractions (i.e. art and music). An integral aspect of this includes countering or eliminating negative external factors that are common to medical facilities. So a lack of privacy and abundance of noise can be remedied through single patient rooms and noise dampening materials, while disorientation and patient falls and other accidents are countered through improved way-finding (hospital layout and signage) and better design of patient rooms and bathrooms (i.e. strategic handrail placement and larger door openings).
Visual literacy
The benefits of art and good design don’t stop at the patient, as hospital staff too can gain from art programs and well designed hospitals that enable more efficient care, such as through the placement of decentralized or portable workstations nearer to patients’ rooms. Beyond EBD, many medical schools, recognizing the importance of the arts to a well-rounded education, are including arts and humanities as a part of their curriculum. The use of visual art forms like painting and film in medical schools is shown to improve students’ reflective and analytical thinking.
Critically, studies demonstrate that the arts can build keener observation skills among medical students by helping them develop “visual literacy”, which is a kind of aesthetic reasoning informed by careful observation of the patient. Identification and analysis of facial features, emotions, and bodily presentations, as well as contextual features like clothing and hair provide a holistic picture of the patient and help generate meanings that can be used to diagnose and treat. While observation of such nonverbal cues is especially useful in cases where a patient can’t or won’t directly communicate their symptoms, it also attunes students to the emotional, psychological, and spiritual aspects of the patient. In this whole-person approach to care, the patient is seen not as a mere collection of parts or a machine in need of repair, but as an individual human being in need of empathy and compassionate care.
Art has always been a medium for understanding, a common language connecting humanity across cultures and centuries. In the dialogue between the artist and the audience, we find both familiar and unexpected ways of looking at the world and opportunities to escape our own circumstances and to live, momentarily, that of another. In our current reality of uncertainty and isolation, it is more important than ever that we seek out and embrace these kinds of connective experiences. Art might not be able to heal us from the ravages of viral infection, but it certainly provides a powerful antidote against the affliction of the human condition.
