Art in Salutogenic Design

So, what is Salutogenesis?

So, what is "salutogenesis?" Mother Theresa once said that she would not join a march against war but would join one for peace. Such a march, she argued, would not only empower people to end war, but also help them create the basis for peace. In her view, the process of creating peace was different from merely ending war. In the same way, the concept of salutogenesis implies that professionals - and not just health professionals - should work to create health rather than simply focusing on treating or preventing disease.[1]

Since my last blog about salutogenic design I have been offered the above description of salutogenesis which I thought I would share with you. In this second part of my blog post about salutogenesis I would like to focus on the role of art within this theory.

 Using art to reinforce the salutogenic model

A salutogenic approach to healthcare design can be strengthened through the use of artwork. If an artwork in a hospital waiting area can provoke positive contemplation, offer a sense of beauty, reflect the calming quality of nature, it surely offers a sense of meaning. This is especially the case when the creation of artworks is carried out in collaboration with patients. I work with landscape, focusing on the experience of nature and people’s memories. For the last 10 years I have worked on healthcare projects and witnessed the positive effect of landscape and nature images on patients and staff in the healthcare environment.

  

Apart from the obvious calming qualities of nature and landscapes, there is an aspect of inspiration, encouraging people to go and discover places for themselves, promoting rehabilitation and a healthy lifestyle. For the infirm or elderly for whom it may be difficult to access the landscapes so easily, there is a therapeutic benefit of talking about landscapes and places, opening up positive memory paths and encouraging healthy contemplation and discussion. We often think of landscape as only physical, an environment separate from us which we enter into, but in fact the very notion of landscape and our experience of it can only be viewed in terms of the human mind. As the historian Simon Schama in his book on landscape and memory points out:

"Before it can ever be the repose for the senses, landscape is the work of the mind. Its scenery is built up as much from strata of memory as from layers of rock" [2]

A sense of coherence

So, to return to Antonovsky’s notion of a sense of coherence which is supported by three elements; meaningfulness, comprehensibility and manageability , it is clear that artwork has a role to play in building that triangle. Creative workshops underpin the making of artwork and open up dialogue between patients (and staff), fostering a sense of positivity, a healing process which lessens the sense of isolation and accentuates the meaningfulness of life. Creative intervention in the healthcare environment not only works to increase the patient’s sense of meaningfulness but also their sense of comprehensibility and manageability. For if creative workshops and the experience of art can work to give meaning to life they also increase one’s understanding of life (comprehensibility) and also motivate an individual’s belief that they have the skills and abilities to persist (manageability), in spite of stress and anxieties they may feel.

Just last week on a workshop at St Giles Palliative Care Hospice one patient made the comment: ‘Whilst we were working together in the sessions, I forgot I had cancer.’ This is what it is all about, using creativity to harness a sense of wellbeing. Artwork and creative workshops in the healthcare environment can play a vital role in the healing process but could also be part of our general well-being, not just when we are in poor health. For a true salutogenic approach to healthcare should not just be in place when we are ill, but should be in place when we are healthy and with the intention to create health and not just treat disease.

"At its heart, the salutogenic approach focuses on the maximisation of those assets which create health, wellbeing and successful lives of individuals. The traditional pathogenic approach focuses more on avoiding problems than on enhancing potential."[1]

 Creativity - a vital part of life

Exposure to sunlight, breathing fresh air, experiencing nature, going for a walk, playing or listening to music, reading poetry and seeing visual art are vital aspects of our human existence, but sadly so much of our existence is devoid of these experiences that a sense of meaningfulness is not achieved in many lives, whether they are physically healthy or not. I've recently been reading I'm Still Here by John Zeisel and feel that this quote from the book below emphasizes this point:

"We each have a need and natural aptitude for art that we realize how much we miss only when we find ourselves without other supports in our lives....For older people in general and people living with Alzheimer's disease in particular who have lost work roles and take part in fewer intimate family activities, engagement in art and art experiences play a special role. The arts can provide meaning in what to many is experienced as an ever increasingly meaningless life. Art connects people to their culture and to their community. It gives meaning to life and it is meaning that people with Alzheimer's so dearly crave."[3]

Creative Arts into Health Project for St Giles Hospice

Over the past 6 months I have been working on a project for the St Giles Palliative Care Hospice near Lichfield. I feel this project has been very supportive of the salutogenic model. The St Giles Arts into Health project has been a collaborative effort, creatively engaging everyone in the hospice community; patients, staff, volunteers, carers and managers. The fun yet purposeful sessions led by creative people have  encouraged people to connect and share memories from their lives through a positive, meaningful process. Poems have been written and artworks created, inspired by memories shared. The project has resulted in a book "Being Here" which is due to be published shortly and launched during Dying Matters week 2014 (May 12th - 16th). More about this nearer the time....

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Photos by Ming de Nasty - http://www.mingdenasty.co.uk

[1]Annual Report of the Chief Medical Officer, Scottish Government, 2013

[2] Schama S, (1995), Landscape and Memory, pp. 6/7; Harper Collins, London.

[3] Zeisel, John, I'm Still Here, published in 2010 by Piatkus. Taken from chapter 4, Art and Alzheimer's, pp 70-71

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Art for Hospitals – the healing process

 A case study on the benefits of art for hospitals

The relationship between art and therapy has existed since the beginnings of humanity. In ancient times the figure of the healer and artist would often overlap.The shaman in many primitive cultures would play the role of a healer and incorporate art such as dance, visual art, music, etc. in his healing processes. It was believed - actually throughout the whole human history - that soul and body were connected and the attempt to heal the body was not done without an attempt to heal the soul. There is an ancient Roman and Greek proverb: Mens sana in corpore sano (in Greek: Νοῦς ὑγιὴς ἐν σώματι ὑγιεῖ - "Healthy spirit in healthy body"). Even in Christianity the first icon-painter, St Luke the Evangelist, was also a doctor. 

Our physical health goes hand in hand with our mental and emotional health. We need to be healthy, but we also need to feel healthy. Art is connected to the human spirit; we are creative beings, whether it is to create or to experience a created work. Art gives us strength, inspiration and a feeling of being alive. All this applies to all kinds of art and creativity in general, but even more so to visual art. Out of the five senses, the sense of vision is the most developed one in humans. Have we not heard the expression: "The eyes are the windows of our minds"?

So while it may seem that the idea of art for hospitals is something new, it is in fact an old concept which has been somewhat abandoned in recent times and only just making a come-back.

“There are ample reminders of art placed in hospitals in previous centuries. William Hogarth's 18th-century painting "Pool of Bethesda" still hangs on the grand staircase of Bart's Hospital. But paintings were often banished from the wards by the post-war trend of brutal minimalism that swept through hospitals and other public buildings. It is only in recent years that hospitals have witnessed a modern renaissance.”­ 

Dr Lee Elliot Major, The Independent, 2008

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  Hogarth's Painting "The Pool of Bethesda" in the stairwell of Bart's Hospital, London

The Burns Centre, The Queen Elizabeth Hospital, Birmingham - bringing a sense of light and nature into the clinical space

The Burns Centre before installation of artwork

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Above: before and after artwork installation

I was commissioned alongside two other artists (Kate Green and Mark Renn) to make a body of artwork for the new Burns Centre at the Queen Elizabeth Hospital in Birmingham. The new hospital, completed in 2010, is a modern state-of-the-art building in many respects but due to its design with internal courtyards, some departments such as the Burns Centre found themselves relocated to new spaces with little or no natural daylight. The 15 spacious and private patient rooms all have windows but only to the internal courtyard where daylight hardly reaches. Artists were therefore brought in to bring a sense of light and the outdoors into the Burns Centre. The function of the artwork was intended to have both environmental and psychological benefits.

Speaking to staff and patients, I soon realised that there was a desire for light and nature, particularly horizons and long reaching views which they were otherwise deprived of during their stay. Many critical patients stay from days to weeks or months in the department and for many it is a place of rehabilitation after serious surgery. For many the corridors of the centre are the areas in which they begin to walk and get out and about again for the first time. My brief was to make artworks for these corridors.

Artwork to help the rehabilitation process

The artworks I made act as 'way-markers' not only for navigating around the centre but also as individual ‘goals’ for rehabilitation patients to reach as they become more mobile. It was therefore essential to discuss the project with patients before making the work. Patients spoke of wanting to see nature, to see a big horizon, trees, water and the sky.It was decided to make the body of photographs within the catchment area of the hospital, therefore keeping it local and also with the addition of plaques with maps, hopefully each of the photograph represents a ‘real’ place that they can go and explore for themselves one day. Both patients and staff were happy to talk about places they would go for walks and time out and I soon had a long list of places to visit. I hope that with my artworks I offer the patients not only photographs of these places but also how it feels to be there.

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artwork-for-hospitals-plaque

Winter Woodland, 2012                                               A plaque was made for each piece to identify the

                                                                                      location and to encourage people to go and

                                                                                      find places for themselves

Cool colours for Burns Centre

Colour was an important factor to consider when making work for the Burns Centre. Since many patients are coming in having suffered burns from heat or fire, a cool, soothing colour palette was desired. Thankfully it was winter and I was able to take advantage of the frosty mornings and even some snow on the hills around Birmingham.

Psychologists report on impact of artwork in hospital

From the early stages of this project a psychologist was involved to assess the improvements made. A survey was carried out before the art was installed and then three months later. Before, staff reported that patients would complain about the blank walls, lack of things to look at and absence of daylight. After the installation of artwork, there was a noticeable difference in the comments from patients and staff, a general consensus of a better feeling.

As a result of the project, comments such as "the rooms were boring and offered little distraction", coming from patients and staff, were reduced by more than three quarters.

Some of the comments recorded in a survey before and after the installation of artwork:

Time 1 – prior to artwork installation

Time 2 - after artwork installation

“Boring, nothing to look at”

“It’s a talking point”

 “Blank walls need brightening up”

“The pictures give a bit or respite from being stuck in a room”

 “monotonous”

“The pictures have a calming influence on the corridors and reception”

 “Lack of distraction”

“Patients are walking up to pictures in corridors”

In terms of improvements to the clinical environment, the report suggests that as a result of the artwork, patients and staff were beginning to feel more positive about their surroundings. Besides the visual, 'decorative' function of my work, I do hope that the presence of my work will also offer spiritual healing to some people, to offer contemplation, to inspire imagination and ultimately to give hope.

When I sometimes receive feedback from patients who contact me, explaining how my work helped them during their stay in hospital, it all seems worthwhile. If art can supplement the healing process, then surely it has a place in our hospitals as it does in our lives.

artwork-for-healthcare-buildings-clent-hills-sunrise

Bingley Health Centre- commission complete

Bingley Health Centre- commission complete

Three new pieces commissioned by Bingley Health Centre in Yorkshire were installed last week. The brand new centre opened its doors to patients on Monday the 1st of February.

See below for some photos of the work installed and here is a web-link broadcast for opening of the centre:

http://vimeo.com/11138047