Prescribing Creativity? Arts’ Unhealthy Relationship with ‘Health’
In ‘The Picture of Dorian Gray’, Oscar Wilde famously wrote: “All art is quite useless”. He later expanded on this in a letter where he added: “A work of art is useless as a flower is useless. A flower blossoms for its own joy”.
However, has art ever been considered “useless”? Let us take the example of music. Music has always been used for many purposes; in ritualistic ceremonies to cultivate group cohesion, in worship to connect with a higher being, and today we use playlists for functional purposes too - relaxation, concentration, exercise. In recent decades a ‘new’ kind of artistic utility has emerged: that art (including music) might be used as a means of improving our health.
This short article is informed by critical perspectives in arts and health research, my previous fifteen years spent researching the mental health of musicians, and my career as a musician signed to Sony. In it, I will draw attention to some important limitations in the climate of enthusiasm which permeates the ‘arts and health’ landscape noting some conceptual, methodological and socio-political challenges presented by this field of study.
Art, Health and the Emergence of Social Prescribing
A range of studies have interrogated whether producing or ‘consuming’ art in various contexts might lead to improvements in health and wellbeing outcomes. From singing in choirs and playing the drums, to simply looking at paintings or visiting galleries, researchers in the field of arts and health have suggested – with varying degrees of success – the potential health-improving possibilities of art. Recently, this has even taken on an economic dimension whereby researchers have sought to estimate the cost-saving benefits of artistic engagement. This empirical project has been so successful in public policy terms, that today we see the emergence of ‘social prescribing’ manifesting in, for example, healthcare professionals prescribing the consumption of art for those suffering from depression. However, Liz Bickerdike and colleagues write in the British Medical Journal: “Social prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money”. More recently, Hilary Bungay and colleagues have sounded important notes of caution around arts on prescription, highlighting some participants’ negative experiences and inappropriate referrals.
There is much to applaud both in this research and its philosophical ambitions. From my perspective, as a once-musician signed to Sony, its merit lies in forcing us all to consider the important work that artists do, and that the work they produce might not only be a source of beauty and joy in our lives – as per the flower analogy of Wilde – but that the experiencing of that joy and beauty provides us all as human beings with intangible but crucial elements of our existence: self-understanding, emotional enrichment, and yes, wellbeing. Writing, recording and performing music gave me some of the most wonderful moments of my life: from being played on BBC Radio 1 for the first time, to shooting a music video with Ed Sheeran, to performing on stage at Wireless Festival. Likewise, as a consumer of music, the moments of musical bliss I have shared with my friends at 5am in Amnesia in Ibiza are not variables one can easily operationalise. David Hesmondhalgh is right; music matters, both for those who make it and those who consume it. It has deep emotional significance. The irony is that many of those who create art suffer terribly from anxiety and depression and have one of the highest suicide rates of any occupation.
The Limits of Enthusiasm
Reports abound which act as advocacy documents heralding the transformative power of art on health, many calling for its immediate integration in healthcare systems around the world. These reports are well-meaning, but among the press releases, launch events, and catchy headlines, some politically unpopular modesty is needed when evaluating the strength of this evidence base. I – and many of my colleagues around the world - find the rampant enthusiasm about art as being ‘good for our health’ both exhausting and worrying.
Alongside colleagues from the International Network for the Critical Appraisal of Arts and Health Research, we recently evaluated the gold-standard of healthcare research – Randomised Controlled Trials (RCTs) – used in the recent EU ‘Culture for Health’ report. In doing so, we found considerable risks of bias. Alongside this, Stephen Clift – a prominent researcher in the field of arts and health over many decades – has sounded a number of clarion calls of caution concerning the optimistic claims made in many studies about the potential impact of the arts on health.
Recently, researchers Martin Skov and Marcos Nadal have suggested: “The claim that there is a “wealth of evidence” or a “high-quality evidence base” to support the conviction that art has healing powers is, in light of the evidence reviewed here, simply not true”. The authors suggest this is due to confirmation bias. They write: “Proponents of the “Art and Health” hypothesis are so enthusiastic about the idea that art can improve health and wellbeing that they are willing to accept findings that seem to confirm the idea and cite them approvingly without critically evaluating the methods and procedures that led to them”.
This enthusiasm is reflected in media coverage too. For example, a nuanced systematic review of the impact of viewing art on wellbeing by MacKenzie Trupp and colleagues found: “While convergent evidence exists for eudemonic well-being, we found no strong support for other well-being outcomes”. However, the media coverage which followed triumphantly declared: “A new review of 38 studies confirms that simply viewing visual art can significantly enhance wellbeing”. This is what I mean when I say that I find much of this work ‘exhausting’.
The Political Economy of Arts and Health
More than this, though, there is deeper cause for concern. In advancing practices which have an inconsistent evidence base, as robust critiques have shown, the adoption of the arts in healthcare by central government on cost-cutting grounds potentially provides a rationale for under-investment in health. After all, why spend large sums on, say, investing in public housing or treating serious mental illness, when we can spend tiny sums of money on, say, doing arts workshops for the homeless or suggesting those with mental illnesses attend galleries? An interesting example of this is the ‘Wellbeing While Waiting’ project, which offers ‘social prescribing' for young people who are on unconscionably lengthy waiting lists for appointments with Child and Adolescent Mental Health Services. This is wonderful and valuable on the one hand, but might it – even accidentally – limit the urgency to tackle the root of the problem, and reduce these waiting lists?
Problematically, some advocates of the integration of art in healthcare settings today are calling for means of evaluation other than Randomised Controlled Trials given the difficulty in testing ‘the arts’ using this method. It has been suggested, in the case of the arts: “some conversations […] need to take place about what is accepted as evidence in the health care system”. However, should we make an exception for art? Should art be exempt from the highest standards of clinical evidence before making its way into our hospitals? This is highly contentious, and warrants deeper reflection.
Conclusion
My fear is that sitting beneath the rhetoric and research concerning the benefits of arts on health, lies a profound insecurity within the arts about the need to show that it is not useless i.e. in an era of austerity where the arts are stripped away as an unnecessary indulgence, that the arts needs to mobilise a campaign to convince the world they still matter. And what better way to show that they are useful, than by showing that they benefit health. But, do they? How robust, in fact, is the evidence base at present? And perhaps more importantly, do the arts need to have such instrumental outcomes in order for us all to acknowledge their importance and provide them the investment they need? Music and the arts changed my life and continue to enrich it unimaginably for the better, but is a medical model an appropriate framing to understand the role they (can) play in our lives?
Do I think that the arts have the potential to improve our wellbeing? Certainly. Am I concerned about the paradox that those who make the art which enrich our lives often suffer terribly? Enormously. Do I think arts and health researchers are making important scholarly contributions which are enriching our understanding of the complex interactions between art, creativity and our emotions? Unquestionably. Am I convinced art belongs in our healthcare system and the evidence base robust enough to justify such inclusion? Not yet.
