REPORT on my attendance at the 2014 Arts in
Medicine Summer Intensive
July 7 -18
With the University of Florida and Shands
Hospital, Gainesville, Florida. USA
Locations: Classrooms 133 and 451: UF Cancer
& Genetics Research Complex (Genetics Institute), 2033 Mowry Road, UF. CCRC: Criser Cancer Resource Center, Shands
Cancer Hospital, 1515 SW Archer Road, room 1302. McGuire G-13 and G-13: McGuire Theatre and
Dance Pavilion, Museum Road & McCarty Drive, UF
I am deeply grateful to the DUT for making
this experience possible for me. I not only enjoyed learning much about the
intersections and applications of Arts in Medicine, but importantly, I got to
terms with how the disciplines and practice of Art Therapy, and Arts
in Medicine, have some outward similarities yet clearly differ in their
quests, and in their outcomes.
In short, Art Therapy is about a
clinical approach with distinct biomedical and mental health approaches. In Arts
in Medicine, and according to Jill Sonke of the Center for Arts in
Medicine, ‘we see health not simply as the absence of illness, but as a state
of being which gives each of us the opportunity to live to our fullest
potential. Through an interdisciplinary holistic and creative approach to
health, we engage the arts as a means to optimize opportunities both locally
and globally’. Arts in Medicine works to support biomedical and nursing activities
by assisting patients, at the bedside or in waiting/reception rooms, in order
to alleviate stress, and engages with the patient on a one-on-one basis through
a range of arts activities. These can include drawing, painting, story telling,
oral histories, photography, music, singing and movement, improvisation
‘improv’ theatre amongst others, at the bedside. In addition, projects can
entail mural painting by patients, their families and nurses, photographic
installations and healthy environment design.
Terminology, Prevalence and Professionalism: Distinctions and
boundaries of Practice:
Arts and Health
–encompasses all the disciplines that engage the arts for health. Under this
topic fall two areas of practice, namely;
Arts Therapies – these are
clinicians, who deal with emotions, set clinical goals and evaluate outcomes,
Arts in Medicine practitioners –
these are creatives who engage in the arts in healthcare settings and fields to
enhance health and wellness, and improve the healthcare environment. A common
understanding is that patients, their families and nurses like to be heard.
Hospitals and Arts in Medicine programs
- Artist in residence programs, environmental and art collections, performing arts, arts and education (credits for long stays), caring for caregivers, and volunteer art programs.
- Artists in pediatric and adult oncology wards, and gerontology - recording oral histories of patients and their families.
- ER rooms – music and art making, amongst others.
Historically, rock art images were intended
as healing, spiritual messages. It is also well known that art is used to express
our humanity, the divine and the mysteries that shape our worlds. Animism is
the belief that there is spirit in everything. The Egyptians had a very
embedded system of biomedical medicine, which included animistic healing in the
form of amulets, etc. Research shows that the idea of ‘hospitals’ can be
directed attributed to Islam who lead the way between the 8th and 9th
Century.
So what is it about the arts that may contribute to healing?
Healing can occur through active use of the
mind in developing or focussing on imagery. Using images with an intention, and
the use of the arts as a method of transcendence, can all impact healing in a
positive manner. In addition, and as I made use of in the Siyazama Project,
with the use of the arts as metaphor or symbol showed clear evidence that
indeed impacted health and healing.
The pioneering work of Dr. Robert Adler
(1975) and Dr. Candace Pert, is worth researching, as both investigated the
role of what’s happening in the mind directly affects our body.
It’s worth mentioning that Leonardo da Vinci
(famous artist) dissected the body, and by doing so, furthered the biomedical
knowledge of doctors who learnt more about the body. Of importance, there is no
point in our history, which does not recognize the arts as part of healing.
Important readings:
Making Special (Ellen Dissanayake)
Flow (Csikszentminalyi – FLOW THEORY)
Psycho (Adler)
Self-Transcendence (Reed)
Stages of Creatvity (Wallas)
Stages of Ritual (Achterberg)
Four Bridges (Sonke and Brandman)
What is Art for? (Ellen Dissanayake)
Mans search for meaning (Victor Franklin)
Brain Dance
(Anne Green Gilbert - www.creativedance.org)
Rituals of Healing (Acheterberg, Dossey, and
Kolkmeier)
Creative Arts Therapies (www.nccata.com)
Creative Aging (www.estanyc.org)
Dance for Parkinson Disease (www.danceforpd.com)
Run Lola Run (short film)
Flow Theory: Spurs relaxation response, more
blood and oxygen going to organs and brain, sustained flight or fight causes
illness. Flow state is the domain of the artist. In the Arts and Health origins
for the 21st Century, the hippies are believed to be the forebears
of these sensibilities when they were searching for change, and seeking access
for everybody to the arts. Research has reported clear evidence that music aids
recovery in premature babies, trauma patients are encouraged to record
stressful events in a diary, being in nature aids recovery and moving, dancing,
singing, laughing and playing all improve health. In short, taking theatre off
the stage, and straight to the bedside.
In a projects beyond the hospital and titled
‘Vital Visionaries’, young medical students meet and work with older folks
before they get sick. ‘Arts and the Military’ began as a project in order to
assist soldiers returning from 2nd World War and Vietnam. In all of
these projects, patients are seen as whole and not broken.
Core Values in the Arts in Medicine fields:
·
Can improve health at key moments,
·
Whole person care,
·
Can transform healthcare
environments to a place of beauty and healing,
·
Participant autonomy and
participant choice (patients may say ‘no’)
·
Beneficence and nonmaleficence (do no harm)
·
Competence and capacity to excel
·
Creativity
·
Diversity
·
Inclusion
·
Integrity
·
Respect
·
Professionalism
Professional Pathways:
·
Practicing artist, artist in
residence, guest artist, visiting artist, arts practitioner.
·
Arts Therapist (mental health
professional)
·
Arts Program Coordinator
(hospital based, community based, outside agency based)
·
Grant Writer
·
Healthcare/Healing environment design
·
Professional
·
Educator
·
Researcher
·
Others
Artist in Residence (up to 20 hours per week)
·
Short term, long term
·
Volunteering
·
Exhibiting
·
Performing
“We help connect patients with the places
within themselves that are still well” and we offer “therapy which is not
considered therapeutic” Jenny Lee.
Authentic and sustainable self-care: Self-care
for caregivers and the road to preventing compassion fatigue was a big topic.
Recognizing compassion fatigue, in oneself, is important for burnout. Web site www.compassionfatigue.com also warns of STS or Secondary Traumatic
Stress and how to be resilient.
Ethical Dilemmas was another big topic for
working in hospitals. One needs to develop ethical sensitivity, define dilemmas and options, refer at all times to professional standards, apply
ethical principles to all situations, consult with supervisor and respected
colleagues, deliberate and decide. Finally, always reflect on experience.
In a ‘Dancing for Life’ program, we danced
and sang loudly with Parkinson patients. This was an absolute highlight for me!
I also took part in a photo shoot with two very pregnant expectant mums at the
bedside. This taught me the importance
of keeping all equipment sterile, and how imperative it is to wipe down
everything between patients.
Program Planning based on the thinking of
Ponsioen (1962) – who adds arts at all levels - and the work of Maslow were
discussed. Using tools such as CDCynergy and MAPP were deemed most appropriate
when planning for community health programs. Institutional Review Board (IRB)
protocols needs to be adhered to. Evaluations are very necessary but not to be
undertaken too soon. Arts based methods
in health research at the University of British Colombia is currently seen as
the leader in this field of research. They encourage use of photo-voice and
ethnography in gathering stories (Staricoff, 2004).
I attended a specialist Arts and Aging
program with Rusti Brandman and I found this most enlightening. She spoke of
the ‘graying of the population’ and how retirement planning is essential. Erik
Erikson’s theory of the life cycle is important, as is the work of Jean Cohen
whose work takes a close look into the four stages of post-midlife brain
development.
Stage one: Midlife re-evaluation (35-65),
Stage two:
Liberation stage,
Stage three: Summing up – more synergy
between left and right brain hemispheres,
Stage four: called ‘encore’ – celebration
stage.
The funding of Arts in Medicine programs with
the aging population is cheaper in the long run: it reduces dependence of
patients (assists nurses to nurse), creates independence promotes gerontology
(study of aging) and encourages reminiscence modeling. This work engages lifelong learning, social and civic engagement, sequential learning, which directly
targets dementia. Reminiscence, imaginative storytelling, self-enquiry, skills
building for sense of accomplishment, themes honoring presence of self are all
great themes and they should all be cross generational interactions. Dance and
singing, and the contemplative arts such as yoga (which encourages mindfulness)
and breathing exercises can collectively, and directly, improve balance and memory.
Important on-line resources:
Arts in Medicine from the
clinical perspective: Narrative medicine makes medicine and doctors more
humanistic. Medical students tend to battle with the integration component of
patients, both young and old. A fourth year medical student told us that his
love of playing the guitar had rescued him from a very troubled upbringing. He
believes he gives his patients ‘a voice’. Arts in Medicine practices promote
humanism with its particular approach. The panel and feedback reports clearly
state that the patients definitely do have better hospital experiences when
engaging with Arts in Medicine approaches and activities. Its helps in
self-care, too. Most believe that biomedicine is simply not enough. Of note,
was the point about the costly and inadequate ‘end of life care’ experience
with very sick aged folk, and how misleading this approach can be whilst in a medical
facility. It is also highly expensive.
Important Readings:
Adolescence and Dying - Rebecca Brown
TED.MED
My grandfathers Blessing – Rachael Ramon
Teachers Everywhere – Rachael Ramon
In all of the above situations it is the
nurses who tend to take the brunt of the patient caring work. Yet, there is
evidence that nurses are now choosing to work at hospitals that have Arts in
Medicine offerings, as opposed to those hospitals, which do not. This supports
retention, and nurses can spend more time nursing.
In addition, we volunteered to take part in a
2 hour Pilot HPNP Public Health test that is intended to be rolled out as a
form of Certification for this field eventually.
I was invited to present on the latest
insights into my work on the Siyazama Project and I titled my talk ‘ART, Aids
and Education: Insights into the rural craft Siyazama Project
My immediate Intention:
I intend to get an ‘Artist in Residence’
program up and running at hospitals, here to begin with, in Cape Town. I am so
lucky to have the backing of all the specialist folk from the University of
Florida and Shands medical hospital, namely Jill Sonke and Jenny Lee, of the
Center for Arts in Medicine, who are very willing to assist with this new
project. I also have numerous contacts with regard artists, musicians and
dancers all of whom may be willing to volunteer this work. I have put in for funding through the DUT
Faculty of Arts and Design, and also have some funding of my own which I may
use to get the initial set-up undertaken. I have medical contacts in Cape Town
through whom I am spearheading this idea at present
I would love to get some reaction from the
DUT with regard their opinions to this work. I feel compelled to undertake this
project as a starburst program that can easily be rolled out to all hospitals
in the country.
Regards
Prof. Kate Wells
Email: kate@katewells.org
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