Stabilizing the Soul: Coping with Chronic Illness Using Art

Written by: Beau Carson

Edited by: David Jang, Zainab Anwar, and Michelle Kwon

Illustrated by: Emily Baek

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“Suppress the thought; and the cry ‘I am hurt!’ is gone. Suppress ‘I am hurt!’ and you suppress the injury” [1]. These words of Marcus Aurelius, one of Rome’s greatest leaders, provide an important lesson in understanding the relationship between physical and mental health with quality of life—the health of the mind and the body are separate yet deeply intertwined. This is especially important to consider for medical conditions with complex mental and physical implications, such as chronic illness. According to the Centers for Disease Control and Prevention, 60% of adults and more than 40% of children in the United States suffer from at least one chronic illness [2-3]. Living with chronic illness is incredibly difficult. According to the National Institute of Mental Health, chronic illnesses can make individuals more likely to develop a mental health condition [3]. Moreover, substantial evidence indicates that chronic illness is a significant risk factor for suicidality [4]. These mental health issues caused by chronic illness pose a threat to the well-being of patients that must be addressed, but the mind cannot be treated the same as the body. While the physical conditions of patients with chronic illnesses may fluctuate, their quality of life remains unchanged as their mental state lies still in depressed resignation [5]. For this reason, treating the mental condition of patients with chronic illness through therapy is a growing initiative. 

One such practice for treating the minds of chronically ill patients is art therapy. Art therapy is a mental health treatment that improves the lives of communities, families, and individuals through using art-making, psychology, the creative process, and interaction within a relationship with a professional therapist [6]. Simply put, art therapy uses the act of creating art to improve mental health. Various studies on art therapy have shown its value in providing chronically ill patients with a sense of control, representation, and expression [7-8]. Additionally, art therapy provides a means of communication beyond words, which can advance understanding beyond the bounds of language. Such potential brings the question: To what extent should art therapy be provided for patients of chronic illness in the United States? An analysis of art therapy will reveal that art-making activities should be provided as treatment for those with chronic illnesses in the United States to help afflicted individuals cope psychologically with their condition, further understanding of pain and suffering, and promote positive social change within communities.

Benefits of Art Therapy

While the relationship between physical and psychological well-being is complex, studies have shown that art therapy significantly increases the mental health of individuals with chronic illnesses in various stages of life [5, 7, 9]. In a 2020 study, Dr. Judy Rollins, an assistant professor at Georgetown University Medical School, explored the effectiveness of creating empathetic art—art that individuals personally identify with—for children with chronic health conditions [7]. The research revealed that exposing children to art that resonates with their condition as an individual, even if they did not create the art themselves, has profound effects on how the children feel. Empathetic art can improve the children’s mental health and make children feel seen and heard. The value of art therapy lies not only with children. In a study by Professor Gil Bar-Sela, at Rambam Health Care Campus, Israel, adults with cancer who were on chemotherapy were treated for depression and fatigue using watercolor painting [9]. Treated patients’ depression and anxiety levels improved after weekly art therapy meetings, and these improvements were especially significant in depression scores. However, while Bar-Sela acknowledges that this was a small-scale, preliminary study with certain limitations, many patients were reported to be interested in the use of art therapy. Bar-Sela concluded that art therapy is highly worthy of further study in treating cancer patients. 

The intricacy of treating the physical and psychological effects of chronic illness can also be seen in an aforementioned study on the effectiveness of art therapy on older individuals with Parkinson’s and Alzheimer’s by Dr. Alisa Junaković at the Croatian Institute for Brain Research [5]. One of the most interesting conclusions of this study was that among individuals with chronic illness, even if physical symptoms of chronic illness weaken, the patient’s quality of life will remain poor due to emotional instability but may be mitigated with art therapy. Junaković’s study and Rollins’s research support the claim that even if patients’ physical conditions are capricious, art therapy provides a stable improvement in the quality of life that the treatment of physical symptoms could not provide [5, 7]. 

However, among art therapy and almost all other therapy methods, empirical evidence of effectiveness is difficult to obtain due to the intricate and unique impacts of therapy on different individuals [10]. For this reason, the effectiveness of art therapy is often called into question. However, while empirical evidence may be difficult to obtain for art therapy, it is apparent that art therapy has an impact, as seen in the patients’ remarks in Bar-Sela’s study [9]. Future studies have the potential to clear this empirical uncertainty and reveal art therapy’s impact. However, the current value of art therapy should not be dismissed. 

The benefits of art therapy are not limited solely to improvements in the mental health of a patient with chronic illness. Art therapy also helps deepen understanding of the pain and suffering of these individuals, providing insight into effective and personalized mental treatment. 

Understanding Pain 

Understanding pain is key when considering how to treat it. Dr. Jenn Tarr, at Newcastle University, explains that art is precious for expressing pain and is an alternative to medical sociology’s reliance on qualitative writing [10, 11]. Expressing pain through art in any form helps therapists and patients by allowing them to form a complex understanding of an individual’s mental situation, facilitating the greatest path to treatment: personalization. According to Dr. Calogero Casà, a radiation oncology researcher, providing individuals with cancer decision-making power for their treatment has received much recent attention as a principle of patient-centered care: the personalization of an individual’s healthcare needs [8]. In agreement with Casà’s study and Rollins’s findings, it can be said that patient-centered care provides patients with the sense of expression and control that art therapy provides [7-8]. 

Art therapy could provide a personalized mental understanding, but how should art therapy be analyzed for effect? One unique approach to understanding patients’ artwork proposed by Frances Reynolds, a professor at Brunel University London, claims that understanding the symbolic meaning behind artworks is the key to understanding how the artwork impacts patients [12]. However, understanding the symbolism behind each artwork transfers non-verbal to verbal communication like translating a book using exact definitions, which leads to a confusing, and unscientific understanding of the patient based on abstract ideas. According to Professor Zodwa Dlamini, a distinguished member of the American Association for Cancer Research (AACR), and her team, another more empirical way of personalizing medical care is through the use of artificial intelligence (AI) and machine learning [13]. These developing technologies could eventually evolve to analyze patients’ artworks produced in art therapy, all the while developing an understanding of the patient’s unique mental condition and how to treat them. The use of AI could also solve art therapy’s empirical evidence difficulties, as AI can evaluate the effectiveness of art therapy scientifically in ways that humans currently cannot. Therefore, if AI finds art therapy effective, the reliability of AI’s judgment will provide empirical evidence for art therapy.

If patient-centered care can be effectively developed for treating the mental health of individuals with chronic illnesses, specialized art therapy treatments can improve patients’ mental conditions with greater effect [14]. Art therapy can provide an understanding through a nonverbal medium. This understanding can connect communities and foster positive change.

Community and Social Change

In community art therapy efforts, not only are the patients emotionally benefited, but so are all individuals involved [15]. Art provides an indescribable connection and sense of community when created in solidarity, even in the most difficult of times. For example, after the 2010 earthquake devastated Haiti, survivors came together, physically and emotionally, to create artwork out of the rubble that the disaster created [16]. This community involvement in the arts after an incredibly devastating disaster reveals how collective involvement in the arts can help individuals cope with great hardship. 

Conclusion

Art therapy is a powerful tool with great potential. To harness the effectiveness of art therapy, future studies are critical. While it is much too early to establish art therapy in every clinic across the United States, art therapy should develop using principles of patient-centered care and be incorporated within communities for maximum value. AI has massive implications for advancing art therapy by providing a greater empirical understanding of the nonverbal expression of patients with chronic illness, which can provide greater confidence in the effectiveness of art therapy and improve understanding of how to treat the mental state of individual patients. Individuals with chronic illness should be exposed to art, providing for the continuation of studies on art therapy and the improvement of their mental health. Through gradual development, patient-centered care, and technology, art therapy has endless potential for treating patients with chronic illnesses, understanding their pain, and engendering positive reform within their communities.

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References

[1] Aurelius Antoninus, M. (1902). Book IV. In G. W. Chrystal (Trans.), The meditations of the emperor (pp. 43-48). Public Domain.

[2] Centers for Disease Control and Prevention. (2021, October 20). Managing chronic health conditions in schools. https://www.cdc.gov/healthyschools/chronicconditions.htm#:~:text=In%20the%20United%20States%2C%20more,%2C%20and%20behavior%2Flearning%20problems 

[3] Centers for Disease Control and Prevention. (2022, December 13). Chronic diseases in America. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm 

[4] Racine, M. (2018). Progress in neuro=psychopharmacology and biological psychiatry87, 87 Part B, 269–280. https://doi.org/https://www.sciencedirect.com/science/article/abs/pii/S0278584617304670?via%3Dihub 

[5] Junakovic, A., & Telarovic, S. (2021). The effects of art therapy on parkinson's and alzheimer`s disease. Medicina Fluminensis, 57(3), 236–243. https://doi.org/10.21860/medflum2021_261184

[6] American Art Therapy Association  (2017). https://www.arttherapy.org/upload/2017_DefinitionofProfession.pdf

[7] Rollins, J., Rollins, C., Boocks, L. A., & Sitz, T. (2020). Supporting children living with chronic medical conditions through empathetic art. Journal of Child & Family Studies, 29(8), 2218–2233. https://doi.org/10.1007/s10826-020-01738-w

[8] Casà, C., Dinapoli, L., Marconi, E., Chiesa, S., Cornacchione, P., Beghella Bartoli, F., Bracci, S., Salvati, A., Scalise, S., Colloca, G. F., Chieffo, D. P., Gambacorta, M. A., Valentini, V., & Tagliaferri, L. (2023). Integration of art and technology in personalized radiation oncology care: Experiences, evidence, and perspectives. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1056307 

[9] Bar-Sela, G., Atid, L., Danos, S., Gabay, N., & Epelbaum, R. (2007). Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psycho-Oncology, 16(11), 980–984. https://doi.org/10.1002/pon.1175

[10] Clapp, L. A., Taylor, E. P., Di Folco, S., & Mackinnon, V. L. (2018). Effectiveness of art therapy with pediatric populations affected by medical health conditions: A systematic review. Arts & Health, 11(3), 183–201. https://doi.org/10.1080/17533015.2018.1443952

[11]Tarr, J., Cornish, F., & Gonzalez, P. E. (2018). Beyond the binaries: reshaping pain communication through arts workshops. Sociology of Health & Illness, 40(3), 577–592. https://doi.org/10.1111/1467-9566.12669

[12]  Reynolds, F. (2002). Symbolic aspects of coping with chronic illness through textile arts. The Arts in Psychotherapy, 29(2), 99–106. https://doi.org/10.1016/s0197-4556(01)00140-x  

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[14] Jannick Kuipers, S., Murray Cramm, J., & Nieboer, A. P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. International Journal of Integrated Care, 19(4), 315. https://doi.org/10.5334/ijic.s3315 

[15] Dingle, G. A., Williams, E., Jetten, J., & Welch, J. (2017). Choir singing and creative writing enhance emotion regulation in adults with chronic mental health conditions. British Journal of Clinical Psychology, 56(4), 443–457. https://doi.org/10.1111/bjc.12149

[16] Rahill, G. J., Ganapati, N. E., Joshi, M., Bristol, B., Molé, A., Jean-Pierre, A., Dionne, A., & Benavides, M. (2016). In their own words: Resilience among Haitian survivors of the 2010 earthquake. Journal of Health Care for the Poor and Underserved, 27(2), 580–603. https://doi.org/10.1353/hpu.2016.0100