The healing power of art

Nuffar by Siba Sahabi, audiovisual installation, photography: Aisha Zeijpveld, 2018. The kinetic ‘pattern machine’ contains a layer of sand. A hand, similar to that of a clock, rotates continuously, and its integrated keys make grooves in the sand. This work visualises an accompanying musical composition.

How literature, music, and the visual arts alleviates illness

By Siba Sahabi

Since the well-known research by the American architect Roger S. Ulrich from the 1980s, we have known that art can impact and speed up a patient’s recovery. Art has played a role in healthcare for centuries. In this article we take a closer look at the impact that art, music, and literature can have in healthcare.

The challenge of diversity
A hospital brings a wide variety of people together: young and old, sick and healthy, with pain and without, highly educated and less so, hearing and deaf, seeing and blind, with positive and negative states of mind, and with all sorts of cultural and ethical backgrounds. This diversity also entails a range of personal preferences for spending time and waiting activities. Unfortunately, there is no universal technique to address all these different needs. However, the good news is that a diverse, inspiring set of techniques is being used to stimulate different types of people. Everyone is familiar with CliniClowns, but what about the healing power of art, literature, and music? In what way can these disciplines be put to use? And how autonomous and experimental can hospital art actually be?

The hospital as a part-time art museum
Art has a long history in healthcare. Healthcare facilities have been collecting and displaying art for a good six centuries. In the 15th and 16th centuries, art had a religious function: it reminded you about life and death. In the 17th and 18th centuries, art belonging to health institutions was used to obtain donations. And secular themes were eventually added alongside the religious themes, such as works depicting medical treatments. After this, a period followed in the 20th century where modernist thinking allowed art to fade into the background. During this period the focus was entirely on efficiency: the healing effect of medicines and operating techniques. An ill person was viewed as a broken machine. To cure the patient, the ‘defective part’ would be studied and subsequently ‘repaired’. It was only after the Second World War that people gradually started paying attention to art in hospitals, mainly because the effect of stress and its negative consequences for health had been discovered. Neuroscience and psychology were developing into sciences. From that point on, a patient was no longer a ‘machine’, and his physiological, mental, and social well-being were seen as a whole. From that point on, art could again make a contribution to a patient’s well-being.

In the Netherlands, a special law came into effect in the 1950s: when constructing government buildings, 1.5 per cent of the total construction costs were to be spent on art. That is also why over the past few decades, hospitals have succeeded in amassing immense art collections. Today’s hospitals resemble museums. The Amsterdam UMC–AMC location possesses 6,000 works worth several million euros in total. The collection consists of a permanently accessible collection of post-war Dutch art that is even larger than that of the Stedelijk Museum in Amsterdam.

The question as to what kind of art works well, and what kind should or should not be displayed is a tricky one. Various studies by Yvonne Clearwater show that patients generally appreciate images of nature the most. Urban scenes, animals, buildings, people, or technology were not valued as much. What works best of all is a combination of figurative/nature and abstract works. Specialists agree that it is a good idea to tailor the art for the specific group of patients (such as palliative care).

Being engaged with art can speed time up or make one forget it. Art offers recognition, consolation, and inspiration. It can distract patients from their worries and pain, as well as stimulate new ideas and topics. While art is not alternative medicine, it can definitely contribute to a patient’s well-being.

Smart hospitals now also sponsor so-called ‘artists in residence’ programmes, where artists are invited to temporarily take up living quarters and a studio in the hospital. This gives artists the opportunity to conduct research, create new work, and/or prepare an exhibition. In this way, attention is paid not only to the result (the artwork), but also to the creative process and to the contact between the creator and his or her audience.

Nuffar by Siba Sahabi, audio-visual installation, photography: Aisha Zeijpveld, 2018

Literature therapy
Care facilities are often used as a setting in literature. Just think of Michael Ondaatje’s The English Patient and Ken Kesey’s One Flew Over the Cuckoo's Nest. But what about literature? What role does it play in a hospital?

This piece is about the hospital library, which should not be confused with the medical library for physicians. The target groups for a hospital library are patients and hospital staff. Aside from medical information, here you will likely find works of fiction: stories in which you can completely forget yourself. Literature enriches your use of language and exposes you to new thoughts.

It turns out that the use of books for therapeutic purposes has its origins in the late Middle Ages. Books were introduced into healthcare parallel to art. That’s not really so odd, considering that society in Europe was changing at the time. More attention and energy was being devoted to hospitalising patients by doing things like establishing hospitals and hospices (often linked to monasteries).  

In 18th- and 19th-century Europe,  reading fiction was prescribed as therapy in psychiatric hospitals. At the beginning of the 19th century, the first hospital libraries were introduced for psychiatric patients in America. A century later, the first libraries were also established in military and general hospitals. The First World War helped speed up this development.

Since that time a number of large international commissions have given thought to various guidelines that a good hospital library should adhere to. These include substantive choices concerning the collection, such as inclusiveness: the books should be accessible for an audience with diverse intellectual, ethical, and cultural backgrounds. And from a practical point of view, a patient in a wheelchair should be able to take books off the shelf without assistance.

Since e-books first appeared on the scene, the value of a physical book has changed and hospital libraries have practically disappeared. Strangely enough, nowadays you often see well-stocked bookcases in public. There are countless bookcases hanging outside on houses where random passersby can pick out an interesting book and take it for free. This sort of library is called a book exchange, although the central concept here is giving books away rather than exchanging them. You might just wonder, why aren’t book exchange cabinets with literature and non-fiction in various languages not standardly found in hospital waiting rooms?

Music to drive out demons
It has since been demonstrated, but we have known it intuitively for as long as homo sapiens have existed: music can promote a person’s well-being, be he sick or healthy. Australian aborigines have been using the didgeridoo to support people’s recovery for 40,000 years. What is interesting is that sounds that are used in music therapy are quite similar to those made by the didgeridoo.

Music can touch you in different ways: physically, emotionally, mentally, socially, spiritually, and aesthetically. Intelligent use of music during medical treatment can reduce your pain and stress, as well as improve your mood. In the past it was assumed that sick people were possessed by demons. People tried to use ‘magic’ songs, sounds, and rhythms to expel demons and heal the sick.

In classical antiquity it was assumed that sick people were in disarray and that music could restore mental and spiritual harmony. For example, Hippocrates – the ‘father of Western medicine’ – played music for mentally ill patients. A rich musical tradition exists to treat patients with sound, especially in the Middle East.

As far back as the 9th century, Arab scholars described the effect that music had on people and the possibilities for treating all sorts of ailments using music. The 10th-century Arab physician Haly Abbas treated toddlers’ pain with music. In 1284, sultan Qalawun opened his hospital in Cairo, where musicians worked alongside doctors and social workers. At night, they would ‘console’ patients who couldn’t sleep.

In Renaissance Europe, a great interest arose in emotions such as melancholy, as well as in the relation between various emotional states and music. In the Romantic period that followed, a great deal of attention was devoted to the relation between the body, one’s mental state, and the nervous system. The study of the effect of music continued during this period. Since the 20th century, modern-day music therapy, a form of non-verbal psychotherapy, developed into a discipline with diverse schools having a variety of visions. However, now music is also being being used to treat patients with physical complaints rather than only those with psychological problems.

‘Evidence-based medicine’ uses scientific evidence to decide on the best method to treat a patient. This includes studies on the relation between music and the healing process. A nice example: scholar Jenny Hole studied the effect of music before, during, and after an operation. She showed that the influence of music led patients to experience less anxiety and pain and that their overall satisfaction increased. Hole discovered that all sorts of musical genres can be effective as long as they are chosen by the patient. (In her study, patients most often selected calm music rather than heavy metal.) Even while in an anesthetized state during surgery, a patient felt slightly less pain after the operation than a patient who was unable to listen to music during his or her operation. So, if you go to the hospital for a treatment, don’t forget to take your favourite music with you on your mobile phone. And if you’re really lucky, chamber music recitals will be organised in your hospital, in a similar way to how things were in 13th-century Egypt. One place doing this is the children’s ward of the Maastricht UMC+. These recitals are held in the daytime rather than at night.

Siba Sahabi is a German–Iranian artist engaged in interdisciplinary and intercultural issues. In addition to research projects, she also creates limited design editions and art installations. Her work has been exhibited in venues including the Saatchi Gallery in London, the Museum Direktorenhaus in Berlin, and in the Museo Nacional de Bellas Artes in Buenos Aires.