You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.

art

Art review: chronic conditions and the digital age

9 Nov, 16 | by cquigley

Changing Lanes: Art in long term conditions in the digital age – new ways to adapt

By Shanali Perera

Rheumatic and musculoskeletal diseases are the largest growing burden of long term disability in the UK, affecting over 10 million adults. The concept of empowering patients to better engage with self-management of their long-term conditions is changing the world at an ever-increasing pace. Incorporating creativity can enhance interpersonal well-being.

slide03

Through my artwork, I aim to reflect my personal experience to raise awareness on ‘Creative empowerment – exploring the healing power of art’. Personal insights as a medic and a patient into integrating creativity, healing & health on the use of creative expression as a tool to face some of the physical limitations & challenges imposed by chronic illnesses. I am keen to tell others of my experiences as they may benefit from incorporating art or similar creative expressions into their own healing. Why not challenge illness dominance? I do so by using digital art.

I am currently a patient under the care of Rheumatology services at the Manchester Royal Infirmary, treated for vasculitis. I used digital applications for artwork to cope with pain, illness experience, adjust to living with vasculitis; to communicate with health providers, family and friends. Prior to ill health retirement, I was a Rheumatology specialist trainee and this journey has indeed been a transformative experience both personally and professionally.

slide2-copy

Copyright © 2016 Shanali Perera

Eight years of numerous A&E and hospital admissions, multiple consultations from various disciplines have given me some valuable insights into a patient’s journey. Chronic diseases can turn one’s life upside down, gradually changing the landscape of daily living. Art can be a refuge for coping with the dynamic shifts in daily routine – accepting role limitations, altering perceptions and regaining some level of control. Creativity gives something to take control of and construct a positive identity. I like to highlight the potential benefits I felt by facilitating self-expression through creativity. Art was a tool for positive reinforcement and reflective thinking for me. I found expression through Art not only represents symbolic aspects of coping but also demonstrates the many facets of emotions and degrees of pain I feel at various points, as a visual narrative. This form of non-verbal communication is effective in helping family, friends and health team gain new insights into often under estimated, emotional/spiritual elements factored into the illness experience. Seeing beyond the illness – creative expression helping to redefine self-identity. I managed to achieve a semblance of normality by starting to set more realistic goals and standards for me around my limitations. From my experience, adapting to find ways around limitations plays a key role in rebuilding confidence and progressing forward. I feel that accepting the shift in roles, reshaping and reinventing one’s self is an essential part to living with a long-term illness.

slide09

People with certain disorders not only have to deal with the general disability of the chronic illness, but also the physical limitation of expressing the “art” that is in their mind. On repeated use my hands become numb and painful, pain radiating to my shoulders. I found the use of digital medium my adaptation as it enabled me to use light touch with minimal effort and alternate hands. Less pain and fatigue became apparent in my hands and arms compared to using a paintbrush on canvas or charcoal on paper. For me, artistic expression was a means of self-exploration to convey how I was feeling. This really helped me to keep the fun side alive and regain a degree of control. This newfound freedom to explore myself through the world of colours and inner creative space, gave rise to my present work.

slide1-copy

Copyright © 2016 Shanali Perera

slide1

Copyright © 2016 Shanali Perera

I think art certainly can be used to explore and represent one’s individual journey -The way chronic illnesses are constantly changing shape, defining and re-defining itself. I feel that this aspect to self-care isn’t advocated to its full potential in people with long-term physical illnesses. There is a lot of scope to develop this further as a holistic approach to care given the wealth of studies illustrating the beneficial effects of integrating creativity and healing in long-term conditions. Present day represents the Digital age where Digital technology in healthcare is continually changing the world at anever-increasing pace. The use of digital medium/applications for creativity, especially for people with limited functional capacity/pain can be a constructive as well as an enjoyable pursuit to explore one’s creative side to cope with day-to-day struggles. Why not put this into wider use in the context of self-management of chronic illness? Let’s take a closer look at our creative space.

Be Visible! Be Heard! See yourself through art.

Correspondence to:

shanaliperera@gmail.com

Art Review: Visions of Multiple Sclerosis

28 Oct, 16 | by cquigley

 

Hannah Laycocks’s Visions of Multiple Sclerosis: Perceiving Identity

Reviewed by Shahd Alshammari, PhD.

 

When artists’ work is considered provocative, you usually think that their choice of subject is taboo. While certainly not “taboo”, the disabled body, and even more interestingly the “invisible disabled body”, in itself a paradox, is a subject that medical practitioners and society continue to struggle with. What happens to the sense of ‘self’ when the body attacks the self, essentially its own being? Hannah Laycock’s photography exhibitions ‘Perceiving Identity’ and ‘Awakenings’ launched in 2015, both  exploring the disabled body and identity.

Laycock’s work is contemporary in its subject and form, while at the same time being rooted in her own personal experience with Multiple Sclerosis (MS). Like Hannah, I have similarly struggled with MS. Many times during the day, I tell my body to behave. I say it out loud. I talk to my body, telling her to wake up. With MS, the Central Nervous System – to some extent the mind – attacks the body. Disconnected, alienated from the body, there is a breakdown of communication. The body must wake up. That is my understanding of the title of the exhibition ‘Awakenings.’ I root it in a very subjective experience, while simultaneously recognizing the work’s significance in urging society to wake up, to open its eyes to “other” ways of living and being.

‘Perceiving Identity’, titled in the same thematic way that ‘Awakenings’ is, raises a central question of interest to Disability Scholars, namely identity. I have called MS, a ‘Random Disease’ in the past, one that changes one’s life course, though not necessarily affecting mortality. In one of the photographs (Figure 1), Laycock captures a simple shot of a road. Uncomplicated, it is a road that is not paved with stones, holes or obstacles. It is what it is. In fact, the colors on the road seem to resemble the light of rainbow colors. My own vision understands the colors as orange, green, and yellow. The choice of colors symbolizes the wide array of MS identities, and MS symptoms (no two individuals have the same symptoms; the course of the disease differs from one person to another). Color blends onto the road, and sometimes, since vision can be affected in MS patients, this is not always a pleasant experience. It becomes difficult to differentiate between spaces. Other questions that chronically ill patients have voiced or left unvoiced, suppressed, include “where will my life go from here?” The road is the map, the new map that you are handed along with the diagnosis. This is the path, as unknown and random as it is.

%ef%a3%a9-hl_2014_08_20150129-tif

Figure 1. Copyright Hannah Laycock

 

Figure 2 is raw in its positioning of the artist at the forefront, as we are visually forced to focus on her back, on which she dangles what seems to be redcurrants, tracing her spine.

%ef%a3%a9-hl_2014_12_20150129

Figure 2. Copyright Hannah Laycock

The spine of course is affected in MS, as well as the brain. The redcurrant lands in its vibrancy along Laycock’s flesh, a strong contrast between the redness of the fruit and the artist’s skin. Redcurrants are supposedly beneficial in terms of a healthy immune system, efficient nerve transmission signalling, protection from free radical damage, amongst other potential effects.” Whether this is actually proven to help MS is not the point. It is yet another attempt at rebuilding a central nervous system that has chosen to break up with its significant other – the self, one’s identity. The artist holds the redcurrant in place, exhibiting control of her body, an attempt at the very least to alter the course of the disease, to do one’s part, to eat healthy, to be vigilant in fighting the disease.

All of the photographs that Laycock has beautifully presented share this theme of disconnection, of a breakdown of what is essentially communication between the mind and the body. As a Disability Studies scholar and someone who sees through the difficulty, and randomness, of living with this undefinable and uncanny disease (uncanny because it is unhomely, it is a body that used to house me just fine), I can say that Laycock’s work is bold and does not attempt to rectify or beautify or inspire. It recognizes the unpredictability and confusion of the disease, both for the patient and for medical practitioners. Nobody has answers, as frustrating as it is. Laycock’s work tells a fragmented narrative, part of the fragmentation of MS, of living with this disease, and seems to force you into her lived experience, rather than just standing along the sidelines, using diagnostic words, and labeling MS as ‘degenerative.’ The photographs carry a sense of closeness and intimacy. As viewers we are almost forced to stop and think about the literal and figurative meanings in Laycock’s artistic vision. Each photograph encourages us to pause and to ask “what is going on?”

And that question in itself is a repeated and dominant one in the lives of MS patients and neurologists attempting to diagnose and cure MS.

Hannah Laycock’s work can be viewed here: http://www.hannahlaycock.com/Portfolio/Perceiving-Identity.aspx

 

Related reading

Devan Stahl, Darian Goldin Stahl. Seeing illness in art and medicine: a patient and printmaker collaboration. Med Humanities 2016;42:3 155159.

Exhibition Review: Rest & Its Discontents

6 Oct, 16 | by cquigley

leaflet-lowres_page_1

 

Rest & Its Discontents Exhibition

Curated by Robert Devcic, founder of GV Art London

Mile End Art Pavilion, 30 September until 30 October 2016

 

Reviewed by Natasha Feiner

 

Modern life is busy, exhausting, and stressful. Yet, rest remains as important as ever. But what does it mean to rest in the modern world? Does rest, or its absence, impact on individual health and wellbeing?

 

London, UK. 4th March, 2016. Campaigners from the Mental Health Resistance Network and DPAC block traffic on the busy Old St round in portest against the use of Maximus job coaches in GP surgeries to "create jobs by prescription." They say disabled people will be bullied into unsuitable work and lose benefits through sanctions. Peter Marshall/Alamy Live News

Mental Health Resistance Network, Reclaiming our lives and work struggles past, present and future

Rest & Its Discontents, a major new exhibition exploring the dynamics of rest, seeks to answer these questions. It draws on the research of Hubbub, an international collective of social scientists, artists, humanities researchers, scientists, broadcasters, public engagement professionals and mental health experts. Over the past two years the team, based at the Wellcome Collection in London, has explored the dynamics of rest, exhaustion, noise, tumult, and work, as they operate in mental health, neuroscience, the arts and the everyday. This exhibition is their final major event.

Rest & Its Discontents features the work of over twenty-five Hubbub contributors. Work from a number of different academic disciplines is presented in a multitude of formats including audio recordings, film, and interactive installations. A number of topics are explored in the exhibition, including therapeutic relaxation, breath and musical ‘rest’, and sleep studies.

antonia-barnett-mcintosh-breath-still-from-film-2015-image-courtesy-of-ed-prosser-2

Antonia Barnett-McIntosh, Breath, still from film, 2015. Image courtesy of Ed Prosser

nina-garthwaite-default-mode-radio-network-image-courtesy-ed-prosser

Nina Garthwaite, Default Mode Radio Network. Image courtesy Ed Prosser

Highlights include ‘The Cubiculum’, which invites visitors to explore the history of mind-wandering through sound and spoken word, and ‘Cartographies of Rest’, a multi-screen installation that visualises interactions between noise and mood.

The exhibition is accompanied by an event series, including workshops, poetry performances, and panel discussions with psychologists and journalists. I have booked tickets for ‘The Meditative Response’ workshop, which will bring together historian Ayesha Nathoo and composer Eugene Skeef. The workshop promises to ‘create a collective experience akin to the relaxation response’. Other events this month will centre on anti-work politics, self-tracking, and mental health.

A BBC Radio 4 series, The Anatomy of Rest, also accompanies the exhibition. First broadcast in September, the three-part series it is now available in full on BBC iPlayer. Presented by Claudia Hammond, the series asks what rest means to historians, poets, and neuroscientists. The final episode announces the results of the ‘Rest Test’, which asked 18,000 people from 193 countries why and how they rest. The data from the test has been visualised as a fabric pattern covering a series of benches in the Mile End exhibition space.

claudia-hammond-the-rest-test-rest-zone-2016-digitial-print-image-courtesy-of-lustlab

Claudia Hammond, The Rest Test & Rest Zone, 2016, digitial print. Image courtesy of LUSTlab

An open access publication, The Restless Compendium, explores many of the exhibition’s themes further. Comprising twenty-two essays on rest and its opposites, it extends and develops many of the exhibition’s major themes. The Restless Compendium is available here as a free download: http://hubbubresearch.org/restlesscompendium/

Rest & Its Discontents is wide-ranging in its exploration of rest and its opposites. It is, like the Hubbub project more broadly, truly interdisciplinary. As a result it offers novel and interesting perspectives that, while at times abstract, will no doubt interest humanities scholars, scientists, and medical practitioners. The exhibition is best enjoyed alongside its accompanying event series, radio show, and publication. These are all speak to each other and add new layers of depth and meaning to the installations and displays at the Mile End site.

sj-fowler-maja-jantar-soundings-iii-2016-image-courtesy-of-ed-prosser1

SJ Fowler & Maja Jantar, Soundings III, 2016. Image courtesy of Ed Prosser

 

For more information, and to book events, visit: http://hubbubresearch.org/

 

The Mile End Art Pavilion, Clinton Road, London E3 4QY.

Opening hours 12:00-18:00, Tuesday-Sunday. Closed on Monday.

Late opening Thursday 6 October, until 21:00.

Admission is free.

 

Natasha Feiner is a PhD student at the University of Exeter. Twitter @natashafeiner.

THIS IS A VOICE at Wellcome Collection reviewed

16 Jun, 16 | by cquigley

L0081645 'His Masters Voice'. Painting by Franci

‘His Masters Voice’. Painting by Francis Barraud, 1919. Credit:Courtesy of the EMI Group Archive Trust

 

THIS IS A VOICE

Wellcome Collection, 14 April – 31 July 2016

Reviewed by Steven Kenny

 

Approaching the exhibition entrance of THIS IS A VOICE at the Wellcome Collection, it is easy to think the voice is treated as criminal, being contained, controlled and its behaviour segregated from the world outside. Initial thoughts would suggest that it is being acoustically surveyed; with the steady opening and closing of the exhibition door, sound rushes to the exit. Yet its attempts are ultimately futile, the room has been sound proofed, noise restricted from accessing the outside world. On entering the space, grey triangular padded shapes line the walls, detail reminiscent of a kitsch science fiction film from the 1980s. The exposed patterned structures, evocative of the décor of Ridley Scott’s periled spaceship in Alien, enclose you in a warm, familiar hug of nostalgia. Sensing that this space is one visually tread before, it is easy to forget the prestigious institutional context of the exhibition. THIS IS A VOICE, a show investigating the potential of the voice in all its forms, techniques, objects and cultural baggage, is particularly engaging for it knowingly understands such a topic cannot be wholly represented (due to various cultural and language complexities). Yet it does a heartfelt job in attempting to at least understand how the voice as a product, both commercially and non-commercially viable, can be exhibited. Curatorial flourishes can be found everywhere, from the nooks and crannies of seated listening stations to the maze-like paths that allow a gentle flow of avid listeners from one space to the next. From attending numerous shows at the Wellcome Collection I must comment that THIS IS A VOICE is one of the most stimulating and generally refreshing exhibitions to be held in its space.

It would seem that an inner versus outer exploration of the body and the voice is focused on throughout. One telling example of this is immediately apparent in the work Circular Song, 1974 by Joan La Barbara. A half dome like structure hangs from the ceiling, the speaker’s hollow interior pervading the space below with sound. The experience of entering this wall of sound is generally unnerving, a constant and increasingly uncomfortable echo of inhaling and exhaling performed by the artist, breathes all over you. It is nightmarish, a deathly noise that would seem totally apt in the exhaling howls of a victim being chased by a stalker in a nerve inducing slasher film. Sound in this manner is represented as an abject substance, an uncanny emotional pulling of the visitors’ own sentiments to the body and the amplified vocalisation of a body process that now seems one of disgust. Yet this is in direct contrast to Marcus Coates multi-screen film installation Dawn Chorus, 2007, which is silly, funny and surprisingly touching. This room is filled with the fluttering sounds of birdsong, a number of monitors positioned at varying heights depicting subjects in everyday locations comically singing along to each sound created. Experiencing this work initially seemed deceptive­­–I could not understand how both image and sound aligned so perfectly, as though the birdsong was actually being produced by a human lip whistle. Subjects pursed their lips and jotted their heads up and down in perfect alignment. The façade is lifted on reading the work’s description: ‘After recording the dawn chorus with multiple microphones, the individual birdsongs were slowed down to last approximately 16 times as long, which enabled the participants to imitate them, while being filmed’. Yet not knowing these details did not matter as my imagination roamed freely around the space. I observed each subject as one would watch a bird in the wild, mesmerised by its harmonic whistle and merry bouncing of its head.

Words

THIS IS A VOICE at Wellcome Collection, 2016. Credit:Photography by Michael Bowles

Dotted around the exhibition are various textual works, the written word laid bare. Erik Bunger’s wall text I Hearby Command You to Give Voice to These Letters Silently or Out Loud, 2011 was surprising in that it forced an involuntary restriction of my own voice from permeating the gallery. I so badly wanted to shout out loud the words I was reading yet thought better than to add to the already noisy space. Yet on second thoughts maybe that would have made for some interesting spectator reactions. Bunger’s playful register, was paralleled by Mikhail Karikis’s digital prints (photographs by Thierry Bal) Sculpting Voice, 2010, where the artist was photographically recorded pulling various facial gestures. Three prints line the wall in sequence, each exhibiting Karikis’s comically retuned face, made even more comical by the muting of what would probably have been quite a painful or otherwise loud projection of sound.

L0081817 THIS IS A VOICE at Wellcome Collection, p

THIS IS A VOICE at Wellcome Collection. Credit:Photography by Michael Bowles

 

The exhibition saved its loudest and most intriguing work for last. Entering the final room of the show, you would think that you might have woken in a Lynchian nightmare. Best described as an interactive, participatory constructed, sound installation, a lone and somewhat foredooming sound booth, tempts the spectator.

L0081800 Matthew Herbert, Chorus, 2016

Matthew Herbert, Chorus, 2016. Credit:Photography by Michael Bowles

The aptly titled Chorus, 2016 is by the British electronic musician Matthew Herbert, whose work ‘asks visitors to sing a single note within a professional recording booth following a set of instructions. The visitor’s voices are then automatically added to a chorus of voices, including performers and staff from the Royal Opera House, forming an ever-expanding sound installation that plays in the exhibition space and at the Royal Opera House’s Stage Door in Covent Garden’. I entered the space to sing the requested solitary note. Escaping my throat, my voice joined the squeaks, squeals, and sometimes correctly pitched notes above. Noise reverberated violently throughout the room, puncturing the space like a diminished fifth encroaching a melodic passage. The voice in this exhibition is presented as an ever-changing entity, one that is able to attack, calm and arrest.

 

Articles from Medical Humanities on the human voice:

Kelly BD. Searching for the patient’s voice in the Irish asylums. Med Humanit 2016;42:87-91.

Demjén Z and Semino E. Henry’s voices: the representation of auditory verbal hallucinations in an autobiographical narrative. Med Humanities 2015;41:1 5762.

Puustinen R. Voices to be heard—the many positions of a physician in Anton Chekhov’s short story, A Case History. Med Humanities 2000;26:1 3742.

 

Art, Life and Illness

16 May, 16 | by cquigley

 

David Marron: Encounters

 

Columba Quigley

GV Art London, David Marron, Geras 3, 2013, charcoal and acrylic on board, 60 x 42cm

David Marron, Geras 3, 2013. Image courtesy of the artist and GV Art, London

I was fortunate to catch this exhibition, held over the May Bank Holiday weekend at Lumen Studios, The Crypt, St John on Bethnal Green.

David Marron is both an artist and a paramedic.

The exhibition consisted of 12 pieces, charcoal, acrylic and collage on paper, standing on and supported by crutches.

These are multi-layered and complex works. As you stand before each, more unfolds with every moment of prolonged gaze.

Marron’s probing work is steeped in the essence of humanness, in the complexity, vulnerability and fragility of life itself and of those who inhabit it.

The artist’s experience as a paramedic affords him a unique viewpoint – that liminal space that he witnesses between wellness and illness, between living and dying, where life is suspended and where outcome is often unknown.

Following the exhibition, I had the opportunity to chat to Marron about his work. Initially trained in fine art, his working life brought him to the world of hospitals and the unwell. This witnessing, of the transformations and experiences of illness, changed the nature of Marron’s art. Previously, he reflects, his work had been more self-obsessed. Becoming part of the world of illness transported him away from a more personal interior world and towards a consideration of that of others.

In his work as a paramedic, Marron might only spend very short periods of time with patients on their journey to hospital. The encounters that moved him emotionally resulted in a transmutation of the feelings such interactions generated into the drawings on display. Yet each piece does not represent a single encounter or a specific individual, but is rather a conflation of a number of similar emotional experiences.

The piece Run Away Robin, for example, is not a direct portrait but was informed by a number of encounters with patients suffering from dementia. The piece represents a piecing together of the emotional fragments that Marron took away from such interactions: the nobility and stoicism that accompany the manner in which the elderly deal with memory loss; the masks they create, often using obstinacy and non compliance to hide their fears; and the fragmentation of self that accompanies the condition, here seen by the snippets of repeated words that hold meaning to the utterer even if uninterpretable by us.

 

GV Art London, David Marron, Run away Robin, 2015, charcoal and acrylic on paper, 84 x 59cm

David Marron, Run away Robin, 2015. Image courtesy of the artist and GV Art, London

A Tooth for a Tooth reminded me of Munch’s The Scream – that primordial sense of pain and anguish, seemingly uncommunicable in its silence. Any yet not, as we confront the distress so vividly here on canvas. The violence of this lived experience is hard to bear witness to, and yet there is so much tenderness in the lines that Marron draws to communicate this emotion that we rest our gaze and stay with the sufferer.

GV Art London, David Marron, A Tooth for a Tooth, 2014-15, Charcoal, acrylic and collage on paper, 84 x 59cm

David Marron, A Tooth for a Tooth, 2014-15. Image courtesy of the artist and GV Art, London

Marron is unafraid to share the challenges and pathos of the lived experience, witnessing it acutely as a paramedic. Yet his work also celebrates life throughout, most notably in Fentanyl Dreams, which vividly communicates the force of the newly born.

GV Art London, David Marron, Fentanyl Dreams, 2012-14, Charcoal, acrylic and collage on paper, 84 x 59cm

David Marron, Fentanyl Dreams, 2012-14. Image courtesy of the artist and GV Art, London

Marron is also a sculptor. However, for the works and themes presented in Encounters, drawing for the artist facilitated a unique truth and directness. He works quickly. Once inspired, the initial charcoal drawing is ready within 3-4 hours. Structures are built around this draft, followed by revisions. The sense of speed involved in their creation imbues the pieces with much energy and a less calculated finished product.

The exhibition also includes a video, En Route, which takes you on a journey through London, a horizontal view from within an ambulance. Buildings and sky whizz by, the world outside continuing and ignorant of what is happening inside the vehicle and within the world of the ill. The poem Ambulances by Philip Larkin came to mind:

‘Closed like confessionals, they thread

Loud noons of cities, giving back

None of the glances they absorb.

Light glossy grey, arms on a plaque,

They come to rest at any kerb:

All streets in time are visited.’

 

The poem ends:

‘Unreachable inside a room

The traffic parts to let go by

Brings closer what is left to come,

And dulls to distance all we are.’

from Ambulances, by Philip Larkin.

 

Our fragility, vulnerability, finiteness – further exemplified by the works being mounted on crutches – are clearly evidenced in Marron’s work, and are so beautifully communicated with much tenderness and compassion.

 

http://www.davidmarron.com

GV Art London, curators, producers & artist agent, represents David Marron amongst others.

 

The Reading Room: Short-list for the 2016 Hippocrates Prize for Poetry and Medicine

22 Mar, 16 | by cquigley

 

Fragility of the human form: short-list for the 2016 Hippocrates Prize for Poetry and Medicine

 

The Hippocrates Initiative for Poetry and Medicine – winner of the 2011 Times Higher Education Award for Innovation and Excellence in the Arts – is an interdisciplinary venture that investigates the synergy between medicine, the arts and health.

Poets from New York and the UK are among the finalists for this year’s prize. Short-listed in the Open Category are Owen Lewis, child psychiatrist and poet from New York, and from the UK poets Anne Ryland from Berwick-on-Tweed and Jane McLaughlin from London.

Competing for the UK NHS 2016 Hippocrates first prize are paediatric cardiologist Denise Bundred from Camberley, former consultant haematologist Karen Patricia Schofield from Crewe and GP Chris Woods from Bury.

Find out more about the shortlisted poets.

The judges also agreed 16 commendations in the NHS category, and 17 commendations in the Open International category from Australia, France, England, Ireland, Scotland, New Zealand and the USA.

Find out more about the commended poets.

The winners will be announced at an awards ceremony in London on Friday April 15, 2016.

Check out the Medical Humanities poetry section here.

 

 

Ayesha Ahmad: Introduction to Global Humanities—Through Creation, Violence Will Die

15 Mar, 16 | by Ayesha Ahmad

Against the backdrop of violence, I have been examining through my research the qualities of our human condition that perpetuate both our survival and our spirit.

As an introduction to an ongoing series on Global Humanities, I will be discussing ways we can counter the dominant narrative of violence.

Our globalised world, or rather, the collective ‘Other’, is met through encounters from suffering—the patients that enter our clinical settings, the individuals that sacrifice their lives to reach the shores of safety, and the images that we only ever see from afar of stories that breathe suffering.

more…

Khalid Ali: Ageing (dis)gracefully from Camden pavements to Swiss resorts

10 Nov, 15 | by Ayesha Ahmad

Review of “The lady in the van” directed by Nicholas Hytner, UK release 13th November 2015, and “Youth” directed by Paolo Sorrentino, UK release January 2016

“The lady in the van” and “Youth” that recently premièred at the London Film Festival (LFF) in October 2015 are two great films about “senior citizens” in two completely different settings. “The lady in the van” is based on Alan Bennett’s (the famous English writer, https://en.wikipedia.org/wiki/Alan_Bennett) interactions with Miss shepherd in Camden Town in the late 70’s, while “Youth” is a fictional story of three mature artists set in a Swiss Alps resort. In the first instance, the viewer might not immediately see the connection between the two films; however upon closer inspection, one can appreciate that both films explore the trials and tribulations of old age in two distinct socioeconomic backgrounds with striking similarities in their points of view.

more…

The Reading Room: ‘Patients as People’

30 Jul, 15 | by cquigley

 

Emma Barnard MA (RCA)

___________________________________________________________________

 

PATIENTS AS PEOPLE – an Exhibition by Emma Barnard in collaboration with consultant surgeons and patients within the ENT department, Whipps Cross University Hospital, Barts Health NHS.

As a fine artist working predominantly within the field of photography, video and sound, I have for the past few years been resident at Whipps Cross University Hospital, Barts Health Trust, collaborating with ENT and more recently Dermatology consultant surgeons investigating what it means to be a patient within the NHS. My focus is on the human condition rather than diagnosis, and on how one might feel as a patient in a clinical, alien environment.

Four years ago, I found myself surrounded and engulfed by the pastel walls and polished floors of the hostile, medical space, as I was guided by the yellow line that led me to my appointment with an ENT consultant. Back then I was just another terrified patient sitting in a visually depleted waiting room, anxiety heightened by the wait itself. Two hours later, I was seen by the consultant when, hanging on to his every word, my auditory senses were heightened over visual ones – thinking just tell me it’s nothing serious…please! He did, I relaxed, and then without too much thought proceeded to blurt out ‘Has an artist ever done any work on patient experience?’ I subsequently wondered why I had voluntarily offered to spend time in a place that most people avoided at all costs.

The process that followed was not easy. In particular, convincing the relevant people at the hospital who believed that having an artist on site involved setting up an easel in a packed to the gills clinic, brandishing a palette and being creative with a paintbrush, took a lot of persuading.

‘Without your medical file you don’t exist within this environment’. First spoken to me by the ENT Head and Neck surgeon Michael Papesch FRACS, these powerful and thoughtful words triggered the name for the project, Patient As Paper. It was not long before the French philosopher Michel Foucault and his book The Birth of The Clinic came into view.

‘When medicine becomes the only social language, the distinction between the doctor and the patient gets more explicit. Their perception of each other becomes hierarchical. In this relationship, the physician is the healthy, wise and authoritative one; whereas, the patient is perceived by the doctor as sick and powerless, even though the doctor may also get sick sometimes. This is what Foucault calls the “medical gaze”.’

Hsuan and Lincoln 2007: 23

Foucault says: ‘Facilitated by the medical technologies that frame and focus the physicians’ optical grasp of the patient, the medical gaze abstracts the suffering person from her sociological context and reframes her as a “case” or a “condition.’

Hsuan and Lincoln 2007: 23

Image1

Patient As Paper – CType digital print 2013

 

As Nancy-Scheper Hughes exemplifies in her article ‘The Mindful Body’, ‘the doctor searches for the “real” cause of the headache, ignoring the social and personal implications of the illnesses with which the patient deals. Thus, through the discourse of medicalization, the sickness emerges as “a form of communication – the language of the organs – through which nature, society and culture speak simultaneously.

Scheper-Hughes and Lock 1987: 3

Patients are seen as the voiceless, lost in a system that reduces them to their diagnoses. Having previously been an advocate for various other groups, such as hard to reach NEETS (youth who are not in employment, education or training), Patient As Paper presented an incredible opportunity for me as an artist to once again make the unseen visible through art, by giving patients a voice. I am interested in using art to explore the patient’s perspective on being in hospital, and their emotional response to becoming a product of investigations and treatments. Patients may feel overwhelmed and disorientated by the hospital environment, and may experience loss of control. I am also interested in what doctors experience when looking after patients, particularly when this is emotionally challenging.

After a trail of recommendations, we were fortunate to meet Chris Mc Manus, Professor of Psychology and Medical Education at UCL, who wrote the following:

‘“Patient as Paper” explores photographically the meanings of silent biomedical artifacts such as notes, scans, micrographs and surgeons’ theatre drawings (be they on paper or skin). By inverting a patient and their notes, using superimposition and image-processing, photography forces a critical reflection on being a patient in the foreignness of hospitals, and on the complementarity of patients’ and surgeons’ visions of each other, as objects and people.’

Discussion dictated my next step. Following observation of the patient and surgeon consultation, I presented patients with an opportunity to express their reality, thoughts and feelings through art. In an ENT department, the face, the most potent visual correlate of the person, and personal identity are especially pertinent. The photographic portrait, taken after some discussion with the patient, is printed out and the person is encouraged to note what has impacted them the most about being a ‘patient’. Is there a defining thought, word or image? Proving that human beings can never just be a number, each individual is unique, and no two individuals have ever written or drawn the same content.

Image2

Emma Barnard working with patient Lee Anderson 2015

‘As a doctor I wanted to look at patient experience and different ways of understanding what the patients are going through mentally and emotionally and not just physically. Working with Emma allowed us to investigate this through the medium of fine art photography as a radically different way (from a medical perspective) of assessing patient experience. We as doctors are often subject to focusing on the science of medicine, despite our best intentions of treating patients as people. The core of this project is about the need for establishing this human connection as well as understanding what it means to be a patient.

To reflect upon these images invites the doctor and other healthcare professionals to consider what the patient is expressing about their care. Some images are very literal, others less so.  It is not so important that the viewer understands exactly what the patient themselves is thinking. The challenge for us as health care providers is to allow ourselves the opportunity to reflect on these images and thereby consider, in a novel, visual and artistic way, how the patient experience can affect us all.’

Mr Michael Papesch FRACS ENT Head and Neck Consultant Surgeon

‘Working alongside Emma has certainly changed my view of the patient consultation for the better. Many of the actions, words and phrases that are commonplace to me seem unusual or even shocking to a non-medically trained professional such as Emma. Emma articulates these thoughts and I gain greater insight into how the patients’ must be feeling. The images created by the patients never fail to amaze me. We all need to look at how we interact with patients during difficult and sometimes upsetting consultations. This kind of work reminds us that we are dealing with real people with real thoughts, fears and emotions and as such it has great value’.

Mr Paul Stimpson FRCS (ORL-HNS) ENT Head and Neck Consultant Surgeon

Now that I had secured this invaluable patient-centred work, it was important to give these people a voice in a more public way. Thus, the Patients As People exhibition was realized. Displaying artwork in a hospital setting comes with incredibly complex rules and regulations. Individual framed portraits on walls can be tricky, something that years of working with galleries and various venues had taught me. I sought inspiration from my biomedical environment and the many tests some of the patients had to endure in their pursuit of ‘getting better’. The idea was a play on the word and function of the X-Ray, a vision of one’s internal world. The exhibition itself could similarly be seen as a reflection of what was taking place within patients’ minds. A free-standing display was designed, containing several pockets where patient portraits could be contained.

Image3

Patients As People exhibition – George V Wing, St Barts, NHS Barts Health

Two and a half years ago, the launch at Whipps Cross University Hospital took place. Today, the exhibition is currently installed at its tenth venue, St Peters Hospital, Surrey, having toured the country to include the Department of Health London, Lancaster University and the NHS Leadership Academy in Leeds. One of the hosts Justine Thompson, Patient and Public Participation Lead, Strategic Clinical Network and Senate (East of England) Cambridge comments:

‘From the woman who is ‘boiling over’, to the young man who has totally obliterated his own face, every photograph in this powerful exhibition stops us in our tracks with its raw communication of human emotion.

Some of the pictures show outward serenity – but the self-authored graffiti often tells another story. These photographs are a graphic reminder that every person’s health story is as unique and individual as they are and that every encounter with a health care professional is likely to be an unwelcome voyage into the unknown. This is essential viewing to reconnect us all to the core of our own humanity.’

After a successful launch at St Peters Hospital the exhibition will remain there until the move to Ashford Hospital in September, launch date 19th October. If you would like to attend the launch, please contact: Giselle Rothwell on giselle.rothwell@asph.nhs.uk

Heather Caudle, Chief Nurse who commissioned the exhibition to be installed at Ashford and St Peters writes ‘Seeing the person before the patient’: http://www.ashfordstpeters.nhs.uk/about-us/message/1269-seeing-the-person-before-the-patient

 

Future bookings are now being taken, if interested please contact Emma through one of the following:

Web – www.emmabarnard.com

Twitter – @PatientAsPaper

FB – Emma Barnard Artist

The Patient As Paper project is currently seeking funding/sponsorship. If you would like to contribute to this exciting initiative please contact Emma.

Other artwork, which explores medicine and religion from the Patient As Paper project, is being shown in the following touring exhibition:

‘If Yesterday Were Today’

Tuscany – 11th – 18th July

Berlin – September 12th – 20th

London – 3rd – 6th December 2015

 

References

Hsuan L. Hsu and Martha Lincoln, Winter 2007, Biopower, Bodies . . . the Exhibition, and the Spectacle of Public Health’, Discourse, Volume 29, Number 1

Nancy Scheper-Hughes and Margereth M Lock, 1987, The Mindful Body: A Prolegomenon to Future World in Medical Anthropology, Medical Anthropology Quarterly 1 (1)

 

___________________________________________________________________________

 

 

Art in Arthritis by Nancy Merridew

22 Mar, 15 | by BMJ

 

 

I called Marco from the waiting room.

 

Everyone looked waxen under the fluorescent lights of Rheumatology Clinic. His olive skin looked grey. He rose like a grapevine on the trellis – thickset but gnarled through the seasons.

 

Marco helped his wife with her handbag and they walked together. Her gait was robust; his was antalgic and unhurried, though slower than he’d have liked.

 

In the consulting room we shared our introductions. I explained that I was aware of his medical history and asked “what are your biggest joint troubles today?”

 

Marco’s molten voice was rounded with a beautiful Italian accent and 80 years of life.

 

Apologising in fluent English Marco said that he didn’t speak English well and that it’s important to “talk the talk” of the doctors.

 

He looked down, reached into a shopping bag, and handed me three sheets of drawings.

 

I was stunned by beauty, utility, and clarity.

 

Brown ink outlined each picture, backfilled with camel watercolour. One image revealed the face of a younger man and the muscular shoulders of youth – his mind’s eye self-portrait.

 

Marco nodded to confirm that he had drawn them all.

 

Each drawing was anatomically correct and swelled from the parchment like parts of an amputee ghost. In some, his bones were bare. In others Marco had blended superficial features of skin with deeper structures of the appendicular skeleton.

 

A left hand floated on one page, like Adam’s in his Creation on the Sistine Chapel ceiling. Words – “Pain here” and “Here too” – were anchored by lines drawn to the hand, portraying metacarpophalangeal and proximal interphalangeal pain.

 

Figure.1_Hand.Shoulder_BMJ

Figure 1. Annotated drawings of right shoulder, face, and left hand:

  • “Pain here” [SHOULDER]
  • “Pain here” [5th METACARPOPHALANGEAL JOINT]
  • “Here too” [2nd METACARPOPHALANGEAL JOINT]
  • “Pain here” [FINGER]

 

Six weeks earlier a rheumatologist had diagnosed Marco with recurrence of polymyalgia rheumatica, with shoulder and small joint features, and with a possible component of new onset rheumatoid arthritis. Recurrent carpal tunnel syndrome was diagnosed in his right hand.

 

On the other pages Marco had drawn his hips, knees, and feet, and annotated their aches with cursive writing.

 

These bones it seems that they are coming apart. When I walk for about ¾ of an hour then it start to give pain. Swells up and gets quite hot. The knee.

 

Figure.2_Knee.Foot_BMJ

Figure 2. Annotated drawings of foot and knee:

  • “Pain here especially at night.” [KNEE]
  • “These bones it seems that they are comming (sic) apart. When I walk for about ¾ of an hour then it start (sic) to give pain. Swells up and gets quite hot. The knee.” [KNEE; TIBIOFIBULAR JOINT]
  • “Pain here last for days on both feet. Not all the time” [TALUS]

 

Marco was seen in the hospital’s Orthopaedic Clinic for severe osteoarthritis of his knees.

 

A carpenter, who still bent those knees to work, Marco explained that he once did a Fine Arts degree to support his business. Beyond that expertise, his careful handling of the autographed pictures revealed an artist.

 

The edge of one page cut through the word “foot” at “foo” which perhaps reflected Marco’s life.

 

Born during the Great Depression he was of the frugal generation – practical, resourceful, industrious. I wondered if Marco had ever rationed paper as a luxury, each sheet precious and saved for handsome cabinet designs.

 

Perhaps as an artist, unwilling to share flaws, he had cropped a larger page of sketches.

 

Figure.3_Hip.Foot_BMJ

Figure 3. Annotated drawings of right foot, pelvis and right lower limb:

  • “Both feet hurt at times” [FOOT]
  • “Pain in here sometimes not all the time” [HIP JOINTS BILATERALLY]
  • “Right leg. Pain here” [FEMORAL HEAD, TIBIAL PLATEAU]

 

I was enthralled.

 

Marco’s eyes danced like bubbles from the surface of Prosecco – the muted pleasure of artistic pride.

 

Already he had offered his pictures to me three times as a gift.

 

Yet I had declined as it seemed too generous. I thanked Marco and encouraged him to keep bringing the drawings to appointments given their clinical value.

 

I completed the history.

 

Marco’s main concerns were steroid-related weight gain, although his arthralgia had improved.

 

As he talked I noticed subdued hand gestures. Given his Italian heritage, perhaps Marco suffered a cultural version of locked-in syndrome from the pain that restricted his upper limbs.

 

After completing the physical examination, I liaised with my registrar about Marco’s clinical plan. In a makeshift gallery behind the consulting suites I showed his artworks to the rheumatologists.

 

They advised that I could keep the pictures, and to take photocopies for the medical record. I made an extra copy either for me or for his art portfolio.

 

I returned to the clinic room. Marco’s wife, who had been silent, was keen to hear the consultants’ opinions of his drawings.

 

She beamed on learning that they were unanimously said to be “the most beautiful ever seen in clinic”, and particularly enjoyed by the Head Professor of Rheumatology.

 

Again Marco offered his pictures and this time I accepted with delight.

 

Smiling, he received his own copies as I explained his treatment changes and follow-up plan. We shook hands. Those aching hands created beauty and conveyed exceptional insights.

 

I watched as he left with his wife and wondered about their lives, leaving Italy to bring their charisma to Melbourne.

 

Two days later I framed the drawings – an exquisite medical document and gift. They hang in my home and evoke Marco’s grace, eloquence, and vitality.

 

* * *

 

Acknowledgements and Postscript

 

Marco, a pseudonym, has consented to the release of his artworks for the purposes of this article. See Figures 1, 2, and 3. Sincere thanks to the patient for his generosity and insights.

 

Thanks to Dr Thomas Lawson Haskell BMBS for his excellent photography of the drawings.

 

Correspondence: Dr Nancy Louisa Gwen Merridew BA BSc MBBS DTMH

Basic Physician Trainee, Launceston General Hospital

PO Box 1328, Launceston, Tasmania, Australia 7250

Nancy.Merridew@gmail.com

Medical humanities blog homepage

Medical Humanities

An international peer review journal for health professionals and researchers in medical humanities. Visit site



Creative Comms logo

Latest from Medical Humanities

Latest from Medical Humanities