I The context for arts in health interventions

A history of the use of arts in health

The birth of the arts

The story of art is generally thought to start in the Palaeolithic era: the prehistoric period of human history. Coined by John Lubbock, an English Baron and scientist in 1865, the term ‘Palaeolithic’ comes from the Greek ‘paleo’ (meaning old) and ‘lithos’ (meaning stone).(l) The term is sometimes used alongside the ‘Stone Age, although the Stone Age continued long after the end of the Palaeolithic era, encompassing too the Mesolithic and Neolithic eras. Exact dates for these periods vary enormously, but broadly, the Palaeolithic era is thought to extend from the earliest known use of stone tools by homo habilis around 2.6 million years ago through the emergence of homo sapiens around 195,000 years ago to the end of the latest Pleistocene (glaciation) period around 10,000 years ago.(2) The breadth of history encompassed within this span means that it is commonly split into three subperiods: the early or lower Palaeolithic (from the start of the Palaeolithic period until around 250,000 years ago), the middle Palaeolithic (from around 250,000 to 30,000 years ago), and the late or upper Palaeolithic (from around 40,000 years ago until around 10,000 years ago).

The earliest evidence of art is somewhat disputed. There are some early artefacts, including small sculptures such as the ‘Venus of Tan Tan, an alleged artefact that appears to show the female figure found in Morocco, dated to around 300,000-500,000 years ago.(3) However, experts are divided as to whether this (and other very early artefacts) are actual evidence of art, or the result of rock erosion and other natural processes over the ages. Moving beyond these contested early findings, the first uncontested pieces of artwork come from slightly later: the late middle Palaeolithic era and into the upper Palaeolithic era. Archaeologist Steven Mithen argues that art began being produced around this time because of neurological developments in homo sapiens. He argues that there are three cognitive processes critical to art making: the mental conception of an image, the intentional communication of this image, and the attribution of meaning to the image. Although some of these processes were present in earlier humans, Mithen explains that it was only with homo sapiens that these three elements could be combined in a way that produced art.(4)

The most famous examples of late middle/upper Palaeolithic art are cave paintings. These were generally worked with stone (such as flint and obsidian) or wood or bone tools, and painted in red, black, and ochre through combinations of iron oxide, manganese oxide, and clay. Some of the most beautifully painted caves include Chauvet in France, dating from around 31,000 bc, Altamira in Spain, dating from around 14,000 to 12,000 bc, and Lascaux in France from around 15,000 to 10,000 bc. Images depicted include wild animals and birds alongside human hunters. The cave walls are also not just canvases for the artwork, but become part of the art itself, with a myriad of examples of rock formations woven into artwork designs, such as protruding rocks forming the heads of animals, animals emerging from crevices, or bone objects such as spearheads and teeth jammed into the rock surfaces to add extra texture.(5)

In addition to these cave paintings, a number of sculptures have been found dating from the same middle/upper Palaeolithic period. Many of these take the form of female figures, like the alleged Venus of Tan Tan, but are more deliberate artworks, with clear carvings. A defining feature of these ‘Venus figurines’, as they have been dubbed, is their anatomical exaggeration of the female figure, leading to theories that they were carved for use in fertility ritu- als.(6) Two famous examples of Venus figurines are the Venus of Willendorf, a 4 V inch limestone carving discovered in the early twentieth century in caves in Austria and dated to around 28,000-25,000 bc; and the Venus of Hohle Fels, discovered nearly a hundred years later in caves near Ulm and the Danube source and dated to around 36,000 years ago. Support for the theory of these carvings’ use in fertility rituals is the parallel discovery of a number of other sexual carvings, such as vulvar symbols carved on a limestone block from La Ferrassie rock shelter in southwest France, dated to around 35,000 years ago; and a phallus carved from the horn of a bison discovered in the Blanchard rock shelter nearby and dated to around the same time.(7) What is remarkable about these discoveries is that they suggest that some of the earliest sculptures ever made were created specifically to support rituals around fertility and health. In other words, arts and health were very much interwoven from the beginning.

It has been suggested that these fertility rituals were a part of expressions of religious ecstasy practised by shamans (healers seen to form an intermediary between humans and gods) in the Palaeolithic period. Shamanism is believed to have been ubiquitous among hunter-gatherer societies, with shamans entering altered states of consciousness to converse with spirits, welcome new life, heal the sick, and send the dead on their way.(8) Experts have suggested that cave paintings were recreations by shamans of the hallucinations they experienced during their states of consciousness, with the journeys between life and the spirit world, consciousness and unconsciousness, also epitomized in and facilitated by the networks of caves descending deep underground where these pieces of artwork and sculptures have been found.(5) The trance-like nature of many of the cave paintings, including blends of abstract and representational imagery, overlapping scenes, and sometimes surreal combinations of animals and humans has been seen to attest to their creation during the climax of ecstatic rituals.

Furthermore, it is not just paintings and sculpture that appear to have been involved in these shamanic health and healing rituals. In 2009, a series of flutes made from bird bones were discovered dating back to around 35,000 years ago, just feet away from the Venus of Hohle Fels.(9) Similar discoveries have been made of musical instruments carved from the radial bones of swans and griffon vultures and from mammoth ivory. Remains found in upper Palaeolithic graves also show that animal skin drums were in use at the time, and an archaeologist working in 2002 made the discovery that stalactites in some of the caves where these discoveries have been made also produce deep booming sounds when struck.(5) All of these elements suggest that music as well as sculpture and wall art may have played a part in cave rituals. Other scholars have theorized that dance was involved: findings from the Le Tuc D’Audoubert caves in France show children’s heel prints dated to the upper Palaeolithic time embedded in the soft clay floor next to some sculptures believed to be indicative of sexual initiation rituals; rare and important physical evidence of the involvement of movement. (8) There are also theories around the use of animal head dresses and costumes, as well as literature exploring the theatrical aspects of shaman rituals, suggesting that the rituals were a rich composite of a range of art forms. Consequently, it appears that Palaeolithic health and healing rituals were expressed in early examples of art, sculpture, music, dance, and theatre.

However, the associations between arts and health go further than this. Humans have evolved to engage with rituals that are selectively advantageous. Some scholars have speculated that the shamanic rituals helped to reduce anxiety, with the calming and repetitive behaviours helping to assert control over stressful situations, such as coming to terms with death, and helping to regulate emotions, thereby functioning in themselves not just as symbolic rituals but as health-promoting activities.(10) Another theory is that the rituals led to enhanced group bonding, leading to the release of social bonding hormones such as oxytocin and neuropeptides such as beta-endorphin. Indeed, this ties in with other theories suggesting that singing in particular helped to bond social groups, taking over from grooming as humans evolved to be part of larger social networks.(11,12) Social bonding was vital to health by encouraging early humans to stay located within communities where they could protect one another, such as through defence against dangers and care of the sick. It has even been hypothesized that this social bonding was one of the factors that facilitated the territorial and demographic expansion of modern humans relative to culturally more conservative and isolated Neanderthal populations.(9) This suggests that ritual behaviours, whether in cave painting during rituals, the sculptures produced to assist them, the music played, the costumes worn, the dancing that took place, or the theatrical presentations, may have been seen as valuable in maintaining group cohesion and supporting the health of both individuals and communities.

This picture of the birth of art may come as a surprise: it appears the arts were not separated into component parts but woven together in layers of combined artistic practice. Of course, evidence of certain art forms such as dance is harder to trace as the evidence is more circumspect than sculpture, say, where specific artefacts can be preserved. So it is possible that certain strands of art have an even longer history. Furthermore, it may be that the arts had further uses in society beyond the rituals identified by archaeologists. Nevertheless, the upper Palaeolithic period seems to be an exciting point in history during which the arts as a group began to flourish. Most tantalizingly, the evidence around the birth of the arts in early human rituals also points to the intertwining of art, health, and healing: it would seem the birth of art was also the birth of arts in health.

For further information about early cave art, Gregory Curtis’ The Cave Painters provides an accessible introduction.(13) For more on shamanism, The Shamans of Prehistory by Jean Clottes and David Lewis-Williams explores how trance and magic were interlinked with early art.(8)

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