Illness is a complex phenomenon which has plagued humanity since its conception; it has both shaped and destroyed us so unsurprisingly is the subject of vast amounts of research in the 21st century. The modern layman’s understanding of illness primarily revolves around pathogens infecting the complex machinery of our body- eliciting symptoms- which could result in death. This pathological lens of illness is one of vital importance.However, adopting only this view of an ailment can run the risk of becoming reductionist and missing the whole image of the ailment. From a holist stance, illness is greater than its parts and requires a trained ‘medical gaze’ to dismantle and interpret the multitude of pathological, socioeconomic and psychological factors that play across the ‘rational space of disease’. Doctors are equipped with devices and expertise to navigate this complex zone; this essay will explore why an appreciation of the Arts should also be a component of a physician’s toolkit. For the purpose of clarity, and not to engage in an unending spiral of debate, I shall take the liberty to define the context of the ‘Arts’ which I wish to add as a metaphorical scalpel to our doctor’s bountiful supply closet. ‘Art’ are any media produce as a result of creative thought be it music,painting,literature,textile design, sculpture- the capitalisation should thereby be explained.
The role of the doctor is one of vital importance and has been subject to change and debate over the years ( see figure 1 ). Following the advent of Freud, modern medical practice in the West has undergone a shift from a paternalistic approach to a ‘patient-centred’ one. Mead and Bower describe this approach rather eloquently with the ‘five key dimensions (2000)’: Biopsychosocial, Patient as a Person, Shared Power and Responsibility, Therapeutic Alliance and the Doctor as a Person. ( see figure 2). If a physician only focuses on finding the algorithms of disease they are endangered of missing the individual needs of the patient. The individual needs of a patient are important as they are the vehicle in which the disease is presented. A physician could have infinite knowledge of a given disease but if they were unable understand how to remove the casing to be able to treat the ailment then the treatment is inevitably going to be less successful. Patient-centred care allows one to translate a patient’s symptoms into a successful prognosis as it recognises the patient as the vehicle – a factor in the equation of illness that they must take into consideration to solve.
Having established the importance of Patient-centred care, the role of the Arts in understanding illness crystallises. The Arts offer a way to understand the ‘vehicle’ in order to develop an effective doctor-patient relationship which promotes trust and cooperation. Firstly, the Arts offers physicians an insight into common patterns of response in their patients. Artwork ‘rediscovers, generation by generation, what is necessary to know’ to give insights into universal human predicaments. Health workers can use these insights to reconsider their quality of care; it offers a wider creative perspective that the cut throat ends based work of the healthcare sector often narrows. Secondly, Art gives an insight into individual difference by allowing a ‘moral imagination’ to develop. When interacting with artwork one must imagine the subject and their/its psychic space: thoughts, feelings, hopes and dreams. Development of this skill encourages practitioners to connect with patients at a level of human understanding and compassion. Art allows the practitioner to work with the patient in the ‘rational space of disease’ to combat illness.
Art holds particular importance in Psychiatry. It can be used as a form of treatment which – whilst offering therapeutic relief for patients – opens the dialogue between doctor and patient. Following World War One, soldiers were returning from the frontlines with severe PTSD. This led to many mental asylums opening, which gave rise to research surrounding Art and mental illness. Art produced by patients in these institutions often falls under the category of ‘Art Brut’ – ‘rough art’ produced by people who are isolated from society and mainstream art scenes. One of the key figures of this movement was Adolf Wolfi (1864-1930). A patient in an asylum in Bern, he produced an elaborate narrative which ‘used the world as a quarry for constructing a complex mental edifice’( see figure 4). He was studied by Dr Hans Prinz who published a book titled ‘The Artistry of the Mentally Ill’(1922). Through Wolfis Art doctors sought to understand his illness; even today, combined with developments in neuroscience, art can contribute to our understanding of the mental illness. Many other visual Artists showed psychopathological symptoms ( Van Gogh, Rothko and Madge Gill to name only a few) however literature also gives insights into illness. Franz Kafka’s Metamorphosis explores the pathophysiology of chronic debilitating illness, and feelings of isolation from loved ones that patients often experience (Wordsworth’s ‘Idiot Boy’, Conrad’s Heart of Darkness are some others that explore similar themes). The language used offers doctors a means to decode nuances in the presentation of symptoms from their patients whilst also offering a perspective of the disease on the individual ( the macro) rather than the biological (the micro). Art informs the bedside manner and has the potential to aid in improving our understanding of mental illness and the best way to treat them.
An appreciation of the Arts for a physician in the modern day is of more importance than ever. Gone is the era of blind devotion to the local barber-surgeon who may accidentally remove your pancreas instead of your appendix; people are expecting more of medical professionals in western practice than ever with the advent of Dr Google and Artificial Intelligence. Maintaining the trust of the public can only be done successfully by embracing patient centred care. A strong scientific basis supplemented with an appreciation of Arts, will allow doctors to build effective relationships with their patients which in turn will result in a more accurate navigation of the ‘space of disease’ to provide a positive prognosis.
Franz Kapfka- Metamorphosis translated by Ian Johnston
Wellcome collection – Magic and Mirrors exhibition