How Does Artistic Expression Help People With Mental Health Problems?

Summary: Artistic expression can help people with mental health problems in a variety of ways. Traditionally, we understand his help in symptom reduction through physiological effects, emotional release through the concept of catharsis, and increasing self-esteem by enhancing psychological and cognitive resilience. A new paper identifies another vehicle through which artistic expression can help people with mental health problems: by enhancing personal dignity.

Key Points:

• Evidence shows that expressive therapies can help patients manage and reduce symptoms of mental health disorders such as depression, anxiety, and trauma-related conditions.
• Expressive therapeutics help patients of all ages, from children engaging in creative play therapy to adults engaging in various forms of art.
• Studies show that participating in music, visual art, writing, and drama can all help improve outcomes for people with mental health problems.
• A new perspective shows that when patients engage with or participate in the arts, they can discover, or rediscover, a sense of dignity that mental health problems can reduce or degrade.

What is Dignity, and Why Does it Matter in Mental Health Treatment?

In a paper called “Artistic Expression, Self-Worth, and Mental Health: Pathways to Dignity” published in the journal Academia: Mental Health and Wellbeing, mental health expert and researcher Chris Dowrick, MD, offers a new point of view on the role of arts and artistic expression in mental health treatment:

“The perspective of this paper is that engagement with creative arts such as music, painting, and sculpture has the potential to enhance the dignity and self-respect of every person, especially those living with mental health problems.”

While most studies and research on the role of arts in mental health focus on symptom reduction, improvements in function, and enhancements in self-esteem and wellbeing, this paper identifies an element of artistic expression – either experiencing the art of others or creating art oneself – that underlies and supports all the previously identified benefits or arts in mental health treatment: an increase in a sense of personal dignity.

Research on dignity, defined as “the inherent and inalienable worth of all human beings irrespective of social status such as race, gender, and physical or mental state,” identifies two essential dimensions of dignity in mental health:

1. The worth of the individual with mental health challenges must be recognized by others:

“[Dignity] must be recognized, respected, and promoted so that the intrinsic good that the human being is himself or herself, personally and as an individual, may be preserved and assured.”

2. The individual with mental health challenges must recognize their own self-worth, as described here:

“When dignity is present people feel in control, valued, confident, comfortable and able to make decisions for themselves.”

The experience of artistic expression can help people with mental health problems via two pathways:

• Active engagement, by creating and/or performing in any artistic medium.
• Receptive engagement, by engaging with art created by others in any artistic medium.

It’s important to understand that artistic expression helps both the creator and the viewer, in both the broader cultural context and the narrower mental health treatment context.

How Artistic Expression Helps People With Mental Health Problems

We’ll start with something we rarely talk about when discussing arts in mental health treatment: the value of experiencing impactful art as an audience member or spectator. This benefit applies to and is true for everyone, including people with mental health problems.

We can go all the way back to Aristotle, and remember his concept of catharsis as engineered by the authors 5^th century B.C. tragic poetry, i.e. the classic Greek tragedies written by Aeschylus, Sophocles, and Euripides.

Aristotle describes catharsis as a process through which we can release powerful emotions, observing catharsis functions:

“…through pity and fear effecting the proper purgation of these emotions”

Canadian thinker Charles Taylor – cited in the paper by Dr. Dowrick – expands the Aristotelian concept of catharsis, describing receptive engagement with arts as:

“…the primary place where we go to recall feelings of wholeness, of harmony with nature, and existence itself.”

In addition, contemporary scientific studies show that another form of receptive engagement with artistic expression, listening to music, reduces the activity of a number of mental health-related biomarkers, the most important being those related to the stress response, such as cortisol and levels of blood glucose.

Next, we’ll review the benefits of how active engagement with artistic expression can help people with mental health problems:

• Music: studies show playing music can release chemicals in the brain that increase feelings of pleasure and reward, as well as improve perceived ability to cope with difficulty.
• Drama: evidence indicates active participation in drama and drama therapy can improve/reduce symptoms associated with anxiety, depression, hyperactivity, and oppositional behavior disorders.
• Visual art: research confirms that active participation in visual art via art therapy can help improve/reduce symptoms of anxiety, depression, mania/hypomania in bipolar disorder, schizophrenia, and cognitive decline associated with dementia.
• Writing: peer-reviewed publications indicate the process of expressing thoughts and feelings through creative writing can increase self-awareness, reduce stress and anxiety, ad improve self-esteem.

Those are the traditional avenues through which artistic expression can help people with mental health problems. We’ll now turn to the novel insight offered by the author of the study we preview in the introduction of this article: how engagement with artistic expression enhances a sense of personal dignity.

Arts, Expression, and Dignity: Identification With Resilience, Persistence, and Courage

In the paper, Dr. Dowrick discusses three case histories wherein patients accessed an increased and enhanced sense of dignity through receptive engagement with artistic expression:

1. Dignity in the context of mistreatment.

• • In this example, a patient with a history of drug misuse, incarceration, and violent, abusive relationships found strength and dignity in the music and words of folk singer Joni Mitchell. In the album “Blue,” Mitchell chronicles her difficulties and how she overcame them, drawing on her reserves of inner strength. The patient reported she found dignity – and herself – in the words and music:

“If Joni can survive all that, then so can I. I have the right to a good life.”

2. Dignity in the context of physical and emotional pain.

• • In this example, a patient with a history of chronic pain, opioid misuse, and emotional abuse found strength in the work of visual artist Frieda Kahlo. In the painting La Columna Rota (The Broken Column), Kahlo offers an abstract image of a woman subjected to both figurative and literal physical torture, yet perseveres, a look of strength, wisdom, and defiance in her eyes. The patient used the painting to bolster his own inner strength and sense of dignity, address his drug misuse, and his relationship issues:

“Look, I’m easily as tough as she is. I don’t have to put up with all of this rubbish.”

3. Dignity in facing mortality.

• • In this example, a patient experiencing the depressive symptoms and associated emotional fallout related to diagnosis with type of cancer with a low rate of survival. This patient describes spending hours contemplating a sculpture by Auguste Rodin, The Burghers of Calais, six civic leaders who traded their lives in order to save the entire population of their city, Calais:

Dr. Dowrick relates that through tears, his patient found personal dignity in the face of one of the burghers – Jean d’Aire – whose face showed a defiance and fearless strength that belied the imminent mortal peril he faced.

These three examples show us that there are a wide variety of ways we can use artistic expression to help people with mental health problems, and not all of them are directly related to quantifiable symptom reduction.

Expressive Therapies: How This Information Helps Us Help Our Patients

The use of expressive therapies in mental health treatment is common for one primary reason: for many people, they serve as an excellent way to complement the psychotherapy, medication, lifestyle changes, peer support, and education they receive during treatment.

We use writing and journaling to help patients work through thoughts and feelings they can’t yet/don’t feel comfortable discussing out loud. We use role playing – i.e. an informal type of drama therapy – in group workshops and process groups to help people practice effective communication strategies, manage stress, and set healthy boundaries. Music therapy – including traditional spiritual singing bowls – can help reduce stress and improve mood, and access/express emotions that writing, visual art, and drama may not reach.

What we understand now, after considering this new perspective, is that a core component of these expressive therapies may, indeed, be their impact on dignity. We can incorporate that awareness into our work in all of the expressive therapies we mention above.

Here’s how:

• When we assign patients journaling homework, we can look for – and encourage – various ways they find dignity through writing, and how that sense of dignity can inform the personal gains they make through their treatment homework.
• During group processing sessions – with or without role play – we can look for and find new ways to promote dignity in communication, relationships, and any interactions with others.
• When we use music, we can foreground the improved sense of self – a.k.a. dignity – after expressing difficult emotions. And in recorded music we play, we can prioritize music with empowering messages that promote a sense of personal dignity.

The most beneficial insight from this new research, however, is that individual dignity is an inherent component of artistic expression and expressive therapy: we don’t have to go looking for it, because it’s been there all along.