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Medicine and the Arts

Commentary

Shannon, Mary T., MSW, MS

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doi: 10.1097/01.ACM.0000431701.47473.35
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Commentary

How do we communicate our experiences of daily life? How do we attach meaning and make sense of relationships and events, both past and present? These were the questions posed in an elective course description for the Student Wellness program at Albert Einstein College of Medicine of Yeshiva University, whose purpose was to provide an introduction to and practical application of reflective writing and visual art in the care of self and other.

Beginning with the premise that the self is the physician’s most powerful therapeutic tool, first-year students engaged in a variety of experiential exercises including photography, film, poetry, prose, music, visual art, and slam poetry to explore how they could use the expressive arts to enhance their skills of nuanced observation, increase their ability to work within interdisciplinary teams, build interpersonal communications skills, promote general health and well-being, and increase self-knowledge, understanding, and compassion.

During one of these seminars, students discussed the issue of not being able to “see” pain. Unlike a missing limb or an open wound, physical and psychic pain are not often readily visible and are therefore difficult to discern or describe in the clinical context. Furthermore, the meanings we attach to words, particularly when attempting to describe the complex and subjective experience of pain, can vary greatly from one person to another depending on one’s culture, gender, religion, and historical and ideological positions, hampering effective doctor–patient communication and creating barriers to the adequate treatment of pain.

Current research showing the potential of visual imagery to enhance physician–patient dialogue by offering each an alternative means of communication provides evidence to support the importance of expressive arts in the reflective practice of medicine. Visual representations of pain serve to reinvigorate verbal language, and vice versa, thereby generating new ways of seeing the complex, multidimensional nature of pain. This negotiation between image and word broadens the scope of language, allowing clinicians and patients to co-create a new way of understanding, a new way of knowing.

To learn firsthand how this process could work in the clinical encounter, students were given blank paper and crayons and then asked to reflect on a painful event in their own lives. When they were ready, they were instructed to give that pain a voice through color, shape, form, and texture. We explained that the exercise was not about making a pretty picture but about depicting one’s internal pain in a tangible way.

In one such session, each student elected to share what he or she had drawn, and all were surprised at how easily internal thoughts and feelings could be given external form. That evening I received an e-mail from a student who wanted to further share his experience with this exercise. He has given me permission to use his e-mail here, along with his drawing.

Hey Mary,

Just wanted to say thanks again for the class today and just wanted to let you know I was really struck by the art therapy activity. I had no idea what I was drawing, but when everyone pointed out the heart it slowly struck me what I had just drawn and I couldn’t help but smile. I wasn’t really sure why I felt so great even though I had just depicted a tragic event in my life.

I was unaware at the time, but my drawing of a rigid orange and red blob with the red heart in the center easily depicted a ball of fire. While you were holding up my drawing it hit me the exact painful moment I had drawn: One of my recent girlfriends who I had been on-and-off with for a couple years had died with her family in a house fire over a year ago.

I did not want this story to be one of “too much information,” I only wanted to give you an example of the real power of art therapy’s ability to open the subconscious. Even though I’ve been thinking back to the fire today, I have been doing so with a sense of peace. Therapy for sure. Thanks a lot. Just thought I should share.

By crossing the traditional boundary of words with color, shape, line, and texture, this student was not only able to reach closure about a traumatic event in his life but was also able to “see” his pain and, therefore, view it from a more integrated perspective. Art bridges the gap between the conscious and the unconscious, often providing a depth of clarity, understanding, and empathy otherwise difficult to achieve through words alone.

We often forget that before written words existed, humans relied solely on pictures, or more accurately, pictographs to convey our thoughts and record our experiences. These were the first link in an emerging process of communication that said, “I am here, recognize my presence.”

We can banish individual and cultural silences about pain with the power of an image, making the invisible visible, redefining, encouraging, and empowering us to think about an experience differently and then to talk about it differently. Art in all its forms is a representation of human experience, and it is in the sharing of our experiences even as we struggle to make meaning of them that we create a sense of humanity.

© 2013 by the Association of American Medical Colleges