Spend (slightly) less on health and more on the arts
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7378.1432 (Published 21 December 2002) Cite this as: BMJ 2002;325:1432
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Lord Kabir said that bhajans and arties are the only means available
to cross this world. Bhajans and arties are poetic in nature with
embedment of excellence in rhyming and spiritualism. The Mahabharata_holy
book of Hindu’s is the longest poem in the world, containing over 100,000
verses. In Indian culture, poetry has deep routes of Vedic origin and till
date survival. However, the effect produced by past rhyming lines is
declining in the present Indian age. One reason for this being
westernization, the other still important reason is difficulty in
understanding these poetic verses. Of the 265 people whom I personally
interviewed, 213 said that they fail to understand the meaning of Sanskrit
shloks. With the first and foremost preference for learning English, the
past poetry verses remain confined to the selected few. Though, these
verses are translated in English, but in so doing they have lost their
poetic essence.
Poetry heals by its meaning and rhyme. But, the effect of healing of
poetry is paralyzed, when its meaning remains unrealized. Also, the flow
of words attains a bit of abrasion, when rhyming is missing. May be this
was the reason why past holy men of India, composed meaningful, rhyming
poetries, advocating spiritualism. By so doing drumming effect and
psychotherapy also finds roots, in the poetic plant for cure and care.
Scientific Stand of Art
The concept that poetry should be used as a healing tool 1-3 needs
scientific justification. In doing so, the following points should be
considered:
1. What percent of people do really understand and value poetry?
If one does not understand a verse, it can do him little if any good, even
if it’s written with great excellence. The figures of speech (example,
personification, euphemism, etc), a learned man can still depict, but a
man with no preliminary knowledge of poetry shall consider it only a mere
play of words, trying to fool of positivity.
2. In what disease conditions can poetry be prescribed
The disease conditions, in which poetry can help attain health, need
to be stated with reasons supported by scientific studies. Medical Science
can accept arts for cure and care but for that ‘art’ needs to be
scientifically evaluated for the proposed positive effect.
3. What poetry cannot do?
Today, we cannot expect a tuberculosis patient to seek aid of a poem, to
attain healing. But, what if faith in poetry, propagated by medical
science, shall surpass the limits, and poetry shall become a therapy of
choice. After all, it shall heal without side effects. The same virtue,
which has helped fly high the success of other alternative therapeutic
means.
Poetry should not be used
a. For people who value it little
b. For people who do not understand it or are prone to misunderstand it
c. In place of medical therapy
We are not offering a choice between medicine and poetry for every disease
condition.
Scientific Poetry
Let’s take an example, if a poetry read by tuberculosis patient reads:
“Yes! I am healed
By the aid of believe”
If after reading this verse, the patient is off the bed, believing in
poetry and refusing to take pills, then what?
Poetry lines can at times, result in instillation of more positivity than
needed. This is because a poem is usually an exaggerated version and not
restricted to reality.
For some, poetry and placebo look alike. Still for others it shall be just
a supplementary aid. But what majority shall expect from poetry after
acceptance as therapy, is hard to say. We therefore propose the concept
of scientific poetry. A scientific poetry can be defined as a poem, which
instills positivity in the simplest possible language, with the objective
to help heal, without criticizing medical science.
The following points should be present in a scientific poetry,
1. It should be easy to understand.
2. It should be in simple language.
3. It should propogate only one meaning.
4. It should not be over-exaggerating.
5. It should be composed by choosing the right choice of words.
6. It should propogate positivity of thought and action.
7. It should be supported by scientific study.
8. It should not criticize medical science, directly or indirectly.
We believe, that a right poetry, for the right patient at the right
time, can be beneficial in health care system. However, such poems should
be judged by scientific means before propagating for therapeutic means.
References
1. Smith R. Spend (slightly) less on health and more on the arts. BMJ
2002; 325: 1432-1433
2. McArdle S, Byrt R. Fiction, poetry and mental health: expressive and
therapeutic uses of literature. J Psychiatr Ment Health Nurs 2001
Dec;8(6):517-24
3. Macduff C, West B. Developing the use of poetry within healthcare
culture. Br J Nurs 2002 Mar 14-27;11(5):335-41
Competing interests:
None declared
Competing interests: No competing interests
This is a very interesting discussion but, from the viewpoint of
someone who's choosing to live on poverty level in order to help (in a
small way) her country...
V.I.S.T.A. stands for "Volunteer in Service To America". It means for
one year you agree to work in a non-profit agency while providing services
for a community "in-need". These communities are just about everywhere
here in the States. The U.S. govt. pays us a small bi-weekly stipend to
live on and we're not allowed to take outside employment. We have a basic
medical plan but no dental. Our stipend has to pay for food, housing, gas,
dental and any incidentals.
For the past year I've been living on $315 US or 201.64 UK pounds.
That $315/bi-weekly makes life really tough. I've gotten no govt.
assistance in terms of housing, utilities or food stamps. I have a cat
which is another mouth to feed and doctor bill to pay. The only reason
I've been able to scrap by is because I had some savings (which are
completely gone!) I measure my luxuries in terms of can I afford one video
rental once/month? Can I afford to buy a "real" cup of coffee once/week?
The thought of my measly medical stipend being slotted for an "artistic"
endeavor is horrifying - and, I'm an artist myself!
Art is wonderful; we can live but, not live well, without it.
However, there comes a point in your life when art means nothing if the
basic necessities of life: decent food, decent housing, adequate warmth,
decent medical/dental care...aren't met.
Would an impoverished society benefit from a renewal of art in its
community? Yes, in the admiring of a dance, art piece or theatre
production they would be able to forget, for one brief, shining moment the
utter dinginess of their lives. But, when the last bow is taken and the
curtain falls, what are they left with? The reality of their poverty.
Our world is nothing more than one big school filled with endless
homework and countless lessons. The question is: do you do your homework
first and play later or, play first and cram at midnight hoping you pass
the test?
eliza crown
Competing interests:
None declared
Competing interests: No competing interests
Response to Editorial:
Spend (slightly) less on health and more on the arts
Dear Editor,
Along with many correspondents responding to your editorial in the Christmas edition we rejoiced that arts and health had been given such a high profile platform(1).
The title of the editorial encapsulates the two issues that our organisations were founded to address. The National Network for the Arts and Health (NNAH), as well as providing services and information for its 500 members, has been lobbying hard with the Department of Health and the Department of Culture, Media and Sport to encourage better funding for the arts and health. We have calculated that, if the government were to follow your suggestion, funding for the Arts Council of England (ACE) would have to be increased by a staggering 70%! The Centre for Arts and Humanities in Health and Medicine (CAHHM) at the University of Durham is a research based organisation committed to establishing what your correspondents Christine Hamilton and Mark Pettigrew described as a 'robust' evidence base for the arts and health. The subtitle of the editorial - 'health would probably be improved' - raises this very question. The problem at the moment is that we do not yet know what that magical 70% increase in the budget for ACE could achieve.
We agree with the insight that art can 'teach you something useful about your pain'. Literature can give shape and meaning to conscious experience (2) but can we prove that reading or writing literature, or indeed any form of artistic activity, can be healing in the terms acceptable to the paradigm of evidence based medicine? There is a concern amongst artists engaged in arts and health work that if they were to orientate their programmes to answer the evaluative needs of health funders they would fail to fulfil the needs of their patients or clients. We hear from patients that what they get from engaging with artists is a sense of their own creative worth. The artist views the patient as someone with the potential for creativity; the doctor regards the patient as a problem to be solved. Artists will point to the quality of the work produced by those who participate in their projects as evidence of success.
This is a challenge for those of us who have lifted the gauntlet of producing a sound evidence base for the arts and health. We hope that we will soon find our place in journals such as the BMJ and that, perhaps in consequence, your editorial wish will come true.
References
1. Smith R. Spend (slightly) less on health and more on the arts. Health would probably by improved. BMJ 2002; 325:1432-3.
2. Lodge D. Consciousness and the novel. London: Secker and Warburg, 2002.
Jane Macnaughton, Director
Mike White, Director of Projects
Centre for Arts and Humanities in Health and Medicine (CAHHM),
University of Durham,
14/15 Old Elvet,
Durham
DH1 3HP
Lara Dose, Director
National Network for the Arts and Health (NNAH)
123 Westminster Bridge Road,
London
SE1 7HR
Competing interests:
CAHHM and the NNAH both recieve funding from organisations which support the development of the arts and health.
Competing interests: No competing interests
Because:
- "man cannot live on bread alone" (Matthew 4.4);
- there is "health", but also "real health" (ending sentence of Richard Smith's inspired proposal); and
- "medicine is the ART of healing", isn't it?
Competing interests:
None declared
Competing interests: No competing interests
Having read the original editorial and the subsequent correspondence
arising from R. Smith's article 'Spend (slightly) less on health and more
on the arts', it is clear that a potential third way has not yet entered
the debate. This would involve diverting some of the healthcare budget to
improving knowledge about and the infrastructure of sport and exercise
provision.
The literature on the physiological and psychological benefits of
exercise in the prevention and treatment of illness and injury is
overwhelmingly supportive, yet, financial support remains poor.
Art may prove a valuable adjunct to medicine, but sport and exercise
have a well documented efficacious effect and will prove an equally
worthwhile investment.
Competing interests:
Head of the Academic Study of Sport & Exercise
Competing interests: No competing interests
Richard Smith raises some important issues about the role of arts in
our society and on the relative value we attach to arts and health, as
reflected in their budgets. Perhaps a move to divert some modest funding
from the health budget into the arts might prove more popular if some
positive health benefit can be demonstrated. But, despite the experiences
of Simon Rattle (and any artist who has engaged with poverty and
exclusion), the health benefits of the arts are not immediately obvious.
While we might agree with your correspondent, Susan Brown, that the
arts have positive effects in a hospital environment, there is a lack of
robust evidence of the arts providing such benefits in other areas.
The potential health benefits of participation in the arts to the
individual and to the community have received widespread attention in
recent years. The arts have been used as a medium for health promotion,
as therapeutic interventions, and, in the case of the UK, health action
zones and social inclusion partnerships arts projects have been
specifically used to tackle social exclusion. As with other health care
and social interventions, the arts may have the potential to have an
impact on health, but these impacts need to be demonstrated, whether the
outcomes are improvements in specific health outcomes, or increases in
levels of social participation.
Perhaps now that the BMJ has put the issue on the agenda, the door
will open to supporting research in this area.
Christine Hamilton, Director of Centre for Cultural Policy Research
and Dr Mark Petticrew, Associate Director of MRC Social and Public Health
Sciences Unit, University of Glasgow.
References
Christine Hamilton, Sarah Hinks and Mark Petticrew, ‘Arts for health:
still searching for the Holy Grail?’, Journal for Epidemiology and
Community Health (forthcoming).
Susan I Brown, ‘Spend (slightly) less on health and more on arts’,
response to Editorial, BMJ 2002; 325.
http://bmj.com/cgi/eletters/325/7378/1432#28349
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir,
As usual I greatly enjoyed the Christmas issue of the BMJ. Of
particular interest to me were three of the articles at the beginning, the
link between which, other than their proximity, was underemphasised.
In the paper ‘Spirituality and clinical care’, Culliford writes that
‘much new research [shows] that prognosis is radically improved by
spiritual care.’ 1 This might well be due to the influence of the mind
over the body, the evidence for which is compellingly reviewed in Ornstein
and Sobel’s book ‘The Healing Brain’. 2 This also lends credence to
Bracken and Thomas’s suggestion that it is ‘time to move beyond the mind-
body split.’ 3 The mind is not only ‘out there’ in the social world, but
in the medical one as well.
I would agree with Culliford’s suggestion that the application of
these insights into practice is due to a number of interrelated problems
including those of education and personal obstacles. This might be
overcome by broadening medical education to encompass the humanities in
general and philosophy in particular. 4 The study of these subjects gives
us the wider perspective so sorely lacking from our super-sub-specialised
and overdetailed medical education.
Culliford also states that ‘evidence is growing in volume and
quality’ that ‘spiritual sustenance’ can help healing. Even if a patient
(or doctor) does not derive such benefits from religion, similar feelings,
and possibly benefits, might be drawn from music or art. If this is the
case, the adoption of Smith’s proposal to ‘spend (slightly) less on health
and more on the arts’5 may have tangible health benefits as well as
spiritual ones.
Competing interests:
None declared
Competing interests: No competing interests
Maybe you should consider a lateral approach to diverting the UK’s
healthcare spend to the arts.
The King’s Fund’s Enhancing the Healing Environment programme has
given £2 million to clinical teams in all London’s acute and mental health
NHS Trusts to take on projects to improve the patient environment through
art and design.
A full evaluation will be available later this year, but emerging
evidence is showing positive outcomes for patients and staff. This
supports a whole host of previous research that suggests building design
has an effect on patient wellbeing and recovery rates.
The NHS currently has a £4.5 billion building programme through PFI
alone – just think of the great art and design that could produce.
With all good wishes,
Rabbi Julia Neuberger
Chief executive
King's Fund
This article is written in response to a recent BMJ editorial: Smith
R. Spend (slightly) less on health and more on the arts (BMJ 2002; 325:
1432-1433) 21 December 2002
Competing interests:
None declared
Competing interests: No competing interests
The article is of course showing the right picture.
People want and have a right to as full a life as they can
achieve in their lifetime.That does not mean they will be healthy and well
throughout their life,or continuously lead a life withouit health problems
and without any other problems ,and meet each day feeling
happy,happy,happy.There is something unreal about people that seem
happy,happy,happy every day you meet them.Certainly it makes you a little
suspiscious-have they then not understood anything of the real world ,that
of pain,joblessness,sickness,lack of freedom,money,friends,familyproblems
of one sort of another,lack of
God intervening in their problematic lives and fix whatever they need in
the blink of an eye.That is the real world for
the majority and the everhappy people have maybe not understood that they
themselves really need help,so that they are able to get a more balanced
life ,and maybe ,maybe through generous treatment become more
understanding of the real world,and thereby become more real people with
more real emotions,making their days more fulfilling and able to lead a
fuller life also aware of the rest of the world.There will still be happy
moments,but more reflected,maybe more of a joy,besides all the other
emotions that naturally will develop as the treatment they receive will
make them more whole as individuals.
Now,what treatment in the healthservice do they need.It would be of an
alternative kind that involves discussion,
interaction between themselves and other people with to them new
experiences,some mindopeners,spicing their previous observation of the
world.And still it has to be healthy.Away with drugs,pills,the constant
flow of antibiotics from every surgery door at the first wink of an unwell
feeling or small disease,WHAT NOW.Just a couple of suggestions and there
are many many more that could follow.What now,given thew economic means
there is no reason why there should not be:
Prescription to go to churches,free ballet tickets,free concerts,maybe a
prescription to buy an artwork of own choice or of artwork{s} placed in
their home for a period of time,something that will gently or forcefully
,if preferred,encourage their mind and brain to start working again in a
broader way."What is this strange thing the health service has provided me
with,this visual image."It gives cause for discussion ,maybe there will be
a small amount of curiousity leading to further action,to discussion,to
more visits,to more activity
some way or another.All this could be provided through the health
authorities working together with the arts,or the arts given more money
direct to provide new and exiting opportunities for people,the
narrowminded always happy,happy people as well as the more traditionally
unwell.
The arts desperately need to get more money to provide revigourated
services,the health authorities falls short of
real alternatives to their traditional services.Give the money to the arts
and put up a small group of experienced and fresh artorganisers to come up
with something new for a change if I may say so.It would be a success!!!!
A lot of people in the traditional healthinstitutions are
also starving for lack of variety and challenges to their souls and
brains.The health of the people in a society and their ability to lead
fuller lives will improve only if the artists are taken along and given
their important share.
Synnove Ellingsen
Art activist.
Competing interests:
None declared
Competing interests: No competing interests
Arts as Medicine
I was delighted to see your editorial "Spend (slightly) less on
health and
more on the arts. As I had just completed a research paper looking at
the contributions arts and culture are currently making to health care
and wellness, I was very pleased to see your recognition of the
connection.
Of the research I found on the subject, much of the best comes from
the
U.K. Your government is one of what seem to be a small number around
the world which recognize that investment in arts and culture has
significant and far reaching positive social impacts, including on health.
For readers who wish to pursue the subject further, I would refer
them
to my paper for an overview on the subject: "Arts and Culture in
Medicine and Health", soon to be available on the British Columbia
government web site, under the Ministry for Community, Aboriginal and
Women's Services. The international Society for the Arts in Healthcare
web site has useful links, and the Community Arts web site Reading
Room has useful articles on the impact of participative arts.
Competing interests:
Author of the paper cited
in my response.
Competing interests: No competing interests