Adding the arts to the healing repertoire.

David J. Schleich, PhD

The National Student Clearinghouse Research Center (NSCRC) reports that for six years now post-secondary enrollments in America have declined. In fact, for the first time since 2010, overall postsecondary enrollments fell below 18 million students nation-wide (that’s a drop of more than 2 million students). Argh! The Center publishes updated summaries every December and May, providing unduplicated headcount data based on institutional sector, enrollment intensity, age group and gender. Because most Title IV, degree-granting institutions provide the NSCRC with enrollment statistics several times per year, what we know is quite current. In the Health Professions and Related Programs category, for example, there was a -2.2% decline in 2017 which slowed to -1.3% by 2019. 2020 looks more like 0.8% if one had to project. (https://nscresearchcenter.org/current-term-enrollment-estimates-2019/) 

This strategy of differentiating programming within existing health sciences institutions education expensive and takes time; however, the benefits endure. As we contribute to these allied professional streams, we concomitantly enhance the medicine’s profile in related professional bodies such as in public health, nutrition, gerontology and the expressive arts.  Let us take a closer look at these two latter paths, gerontology and expressive arts as potential areas for growth.

Both these fields are not only are robust in terms of employability, but also highly relevant to the character and mission of integrative medical programs in America which are reorienting health education. For example, a colleague is currently doing the groundwork for a proposed conference on Geriatrics and Gerontology in Chicago. The focus of the event is “healthy living and healthy aging”. Isn’t that what we do all the time, she asks potential Naturopathic speakers and interested sponsors? Sessions are contemplated in holistic eldercare, sleeping and ageing, dementia, nutrition and ageing, exercise strategies for the elderly, neuroplasticity and ageing, ageing diseases, stress and skin disorders, Alzheimer’s disease, mental health and more. The United States Census Bureau, she indicates by way of context, reports that older people are projected to outnumber children for the first time in U.S. history by 2035. 

Treating the health issues of the elderly more naturally

The literature shows that numerous research studies and clinical trials have been carried out focusing on osteoarthritis, hypertension and cardiovascular disease, stroke, late-life cognitive disorders and depression, anxiety and sleep disturbance, to name a few. (Pharmacogn Rev, 2014)  Siddiqui et al (2014) comment that “the use of CAM is predominantly more popular in older adults … [who] turn to CAM therapies for treating their condition, as they believe these therapies are generally more ‘natural’ and safer than conventional medicine … and are consistent with their beliefs and philosophical orientation toward health and illness.” 

This invitational terrain, the range of programming enabling integrative health professionals to focus on treating the health problems of elderly patients, is growing. The benefits of incorporating CAM into geriatric care are being more widely considered and there is strong interest in more Gerontology and Geriatric research (Siddiqui et al, 2014).  The way to a geriatric specialty includes, usually, a three year residency for board certification in internal medicine or family medicine, followed by a one or two year fellowship in an approved program of geriatrics. These steps are capped by board examinations and graduates are propelled into a burgeoning market as certified geriatricians.  

Expressive Arts as allied programs

The expressive arts is another arena where naturopathic and integrative principles would be more welcome and where demand for skilled practitioners is burgeoning. Stuckey and Nobel (2010) tell us that in the key areas of creative artistic expression “there are clear indications that artistic engagement has significantly positive effects on health” (p. 11). As a case in point there is recent research which indicates that grey and white matter neuroplasticity is tied directly to the acquisition of skills and the expanding concern about atrophying cognitive skills and declining motor function. DT-MRI (Diffusion Tensor Magnetic Resonance Imaging), for example, sheds light on connectivity among parts of our brain, it seems and patients who are encouraged to fire up their neurons by learning their scales (music), dancing twice a week or painting routinely are flexing muscles and synapses which pharmaceuticals and poor diets in seniors’ homes often harm. Buoyed by naturopathic interventions related to physical medicine, nutrition, botanicals and homeopathy, they enhance the whole enchilada by learning their scales, pushing to achieve more dexterity in arms and legs, assembling recognizable melodies into chord cascades and by one or more of these efforts light up and strengthen all those cross-hemispheric connections. The literature speaks to inconsistencies between musicians and non-musicians about the white matter structure related to “internal capsule and corticospinal tracts”. The peer-reviewed literature of expressive arts and healing also speaks to the remarkable power of creativity which enhances overall health.

The absence of illness is not enough, the more holistic health profession will proclaim. Flattened symptomology is not enough. There are numerous related creative arts therapies which significantly complement the work of holistically focused Physicians who build on the natural inclinations of the body, the mind and the spirit to eschew the drift toward pharmaceutical and reductionist therapies so prevalent in the integrative wheelhouse which is appealing even to many of our emerging doctors. Powerful partnerships in the expressive arts can include art therapists, music therapists, drama therapists and dance therapists, for example. Therapeutic programs can crop up in our practices, in hospitals, assisted care settings and community centres and agencies. 

As medical students prepare for careers in these areas, the ensuing affiliations translate into more gusto for the profession in the form of inter-professional referrals, shared governance and a broader recruitment base. Is there a place for dance-movement therapy, drama therapy, music, storytelling, drawing, and other forms of art therapy inside the evolving curricula of North American medical schools? Decidedly yes. There are many opportunities within to study the relationship of creative expression with disorders such as schizophrenia or dementia, end-of-life, and the place of spirituality in medicine.

The literature is abundant. There is the early, exemplary work of Stuckey and Nobel (2010) focused on music engagement, visual arts therapy, move-based creative expression and expressive writing which can help in these questions. Their meta-analysis of the literature zeroed in on music, visual arts, movement-based dance, theatre and creative writing: music engagement (e.g. Aldridge’s [1993]work on the use of music in the control of chronic cancer pain; or Bolwerk’s research with myocardial infarction patients), visual arts (e.g. Puig et al’s remarkable work on the efficacy of creative arts therapies with cancer patients; the success of the University of Florida’s general arts in medicine program), movement-based creative expression focusing on dance and movement to help treat stress and anxiety (e.g. Greenspan’s work involving Tai chi with older adults; Noice’s use of theatre targeting cognitive functioning and quality of life issues important for independent living). And, with regards to expressive writing, the evidence is that there is “statistically significant improvement in various measures of physical health, reductions in visits to physicians, and better immune system functioning” among patients (Stuckey, Nobel, 2008) (e.g. Petrie et al’s remarkable work on the effect of written emotional expression on immune function; or Garland et al’s unique study combining visual, music, movement and expressive writing regarding cancer patients).

Given that we believe in a very wide ecological spectrum for our patients within whom causative agents and ensuing pathogenic evolutions spell trouble, we understand that the imbalances in the lives of our patients need to be addressed. Ideally, we can strive to be partners with our patients in constructing all our lives long a psychosocial framework for well-being (physical, mental, social, spiritual), much enhanced by an enduring, deep connection to expressive arts providers and practitioners. 

In an area of profound chronic presentation, more than remedial action is essential. As we grow our reach and repertoire, we walk the talk of preventative action and spread the word. As pointed out by Staricoff and Loppert ( 2003) “there is evidence that engagement with artistic activities, either as an observer of the creative efforts of others or as an initiator of one’s own creative efforts, can enhance one’s moods, emotions, and other psychological states as well as have a salient impact on important physiological parameters.” Additionally, rolling out such programs in our medical schools enriches the profession and pays some bills at the same time.

References

Mohammad Jamshed Siddiqui, Chan Sze Min, Rohit Kuman Verma, Shazia Qasim Jamshed (2014). Role of complementary and alternative medicine in geriatric care: A mini review. Pharmacogn Rev 2014 July-Dec; 8(16): 81-87.

 https://nscresearchcenter.org/current-term-enrollment-estimates-2019/

 Emma Moore, Rebecca S. Schaefer, Mark E. Bastin, Neil Roberts, Katie Overly.

Can Musical Training Influence Brain Connectivity? Evidence from Diffusion Tensor MRI. Music and Neural Plasticity. Brain Sci, 2014, 4(2), 405-427.  https://doi.org/10.3390/brainsci4020405 June 2014

 Creative Arts Therapies. https://artshealthnetwork.ca/arts-health-101/creative-arts-therapies

 Staricoff R, Loppert S. Integrating the arts into health care: Can we affect clinical outcomes? Kirklin D, Richardson R, editors. The Healing Environment Without and Within. London, England, Royal College of Physicians; 2003: 63-80.

 Stuckey, H.L., Nobel, J. (2010. The Connection Between Art, Healing, and Public Health: A Review of Current Literature. Am J Public Health. 2010 February; 100(2): 254-263.

 Aldrige D. Music therapy research 1: a review of the medical research literature within a general context of music therapy research. Arts Psychother 1993; 20(1): 11-35.

 Bolwerk, C. (1990). Effects of relaxing music on state anxiety in myocardial infarction patients. Crit Care Nurs Q 1990; 9(1): 39-45.

 Puig, A, Lee S.M., Goodwin L., Sherrard P.A.D. (2006). The efficacy of creative arts therapies to enhance emotional expression, spirituality, and psychological well-being of newly diagnosed stage I and stage II breast cancer patients: a preliminary study. Arts Psychother 2006; 33 (3): 218-228.

 Ross, E.A. Hollen, T.L., Fitzgerald, B.M. (2006). Observational study of an arts-in-medicine program in an outpatient hemodialysis unit. Am J Kidney Dis 2006; 47(3): 462-468.

 Greenspan, “A.I., Wolf S.O., Kelley, M.E., O’Grady, M. (2007) Tai chi and perceived health status in older adults who are transitionally frail: a randomized controlled trial. Phys Ther 2007; 87(5); 525-535.

 Noice, H., Noice T., Staines, G. (2004). A short-term intervention to enhance cognitive and affective function in older adults. J Aging Health 2004; 16(4): 562- 585.

 Petrie K. J., Fontanilla, I., Thomas, M.GBooth, R.J., Pennebaker, J.W. (2004). Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: a randomized trial. Psychosom Med 2004; 66(2): 272-275.

 Garland, S.N., Carlson, L.E., Cook, S., Landsell, I., Speca, M. (2007). A non-randomized comparison of mindfulness-based stress reduction and healing arts programs for facilitating post-traumatic growth and spirituality in cancer outpatients. Support Care Cancer 2007; 15(8): 949-961.