Between the end of the Middle Ages and the start of the Enlightenment period, advances in thinking and practice of arts in health predominantly followed on from previous thought, with Platonic and Arabic texts continuing to hold sway. As many of the key theoretical writings to be preserved pertained to music, this became one of the art forms that drew the most attention. For example, humoural medicine (blood, phlegm, choler, and melancholy) remained popular, based on the principles of Hippocratic and Galenic medicine. The Italian music theorist and composer Gioseffo Zarlino theorized in his Istitutioni harmoniche of 1558 that the four musical modes corresponded to the four humours of the body and the four elements of the Earth. In addition, the Florentine philosopher Marsilio Ficino’s De vita (1480-1489) explored the associations between music and melancholy, suggesting that music was linked to the spiritus mundi; a channel of influence between the heavenly bodies and the sublunar world.(34) This theory was widely disseminated in popular literature and also taken up in some seventeenth-century texts, including Robert Burton’s Anatomy of Melancholy (1620) and Athanasius Kircher’s Musurgia universalis (1650). But many of the prevailing beliefs about the healing value of the arts were still steeped in mysticism and magic from the Middle Ages and Ancient world.
However, with the beginning of the Enlightenment period in the late seventeenth century, physicians and philosophers began to break away from previous ways of conceptualizing the arts in health. This did not, at first, lead to a decrease in the number of sources citing the arts. Indeed, the sheer quantity of medical treatise that included references to the arts increased in the late seventeenth and eighteenth centuries. However, it did affect the tone of writing and the way that past theories were cited. One of the most influential examples of this new tone is Richard Brocklesby’s Reflections on the power of musick from 1749. Brocklesby was a physician and Surgeon General of the British Army. Brocklesby was enthusiastic about music’s therapeutic potential for illnesses that ‘have hitherto too frequently eluded the ordinary powers of medicine’ and was keen to show its widespread practice in America, Africa, Asia, and Europe. But Brocklesby was also wary of previous theories. Indeed, he warned against ‘superstitious and fabulous accounts’ of music’s effects, explaining that the tales passed down from ancient times ‘partly consist in an elegant exaggeration of physical truths’. He also took a critical view of society for being so gullible, labelling it a ‘surprising readiness ... to deceive [itself], and be imposed on, with the grossest improbabilities, and silliest delusions that folly could entertain or craft could devise’.(35) Brocklesby wanted arts in health not just to be debated theoretically but researched scientifically.
It was not only physicians who wanted to break from the previous mythical tales of music and the other arts. Artists, musicians, and historians too were keen to separate fact from fiction. Historian Charles Burney’s A General History of Music (1776) discussed with excitement the possible applications of music within medicine, but complained about how ‘men delight in the marvellous, and many bigoted admirers of antiquity ... have given way to credulity to so far as to believe, or pretend to believe, these fabulous accounts’. This is not to say that physicians stopped believing in the use of the arts within health; indeed, the more scientific and rational approach to the arts (in particular music) and health encouraged more physicians to engage in what began to be taken seriously as a means of treatment.(36)
However, at the same time that scientific appreciation of the arts was growing, there were two developments that presented challenges. First, the efforts of people such as Brockelsby and Burney were insufficient to turn the tide of superstition and mysticism surrounding arts in health entirely. For example, in the 1750s, a centuries-old theory that the sound from rubbing glasses filled with liquids could produce healing effects on the listener was given a new lease of life, when scientist and founding father of the United States, Benjamin Franklin, invented his own version of the glass armonica. Franklin himself is purported to have cured listeners by playing the armonica, including Princess Izabella Czartoryska of Poland, who heard it on her deathbed in 1772 and then went on to live another 60 years. And the German physician Franz Mesmer, caused a scandal by playing the armonica at his seances to heal patients, leading to claims that the armonica’s music could wake the dead. Over 300 bespoke compositions were written for the instrument, including by Wolfgang Amadeus Mozart.(37)
The second development was the parallel advancement in modern medicine. Since the sixteenth century, there had begun to be countermovements to the Ancient theories. For example, physicians Andreas Vesalius and William Harvey produced detailed anatomical depictions and descriptions of the circulation of the blood that ran counter to prevailing Ancient thought.(38) Initially, these countermovements were simply seen as corrections on Ancient thought. However, as discovery into the anatomical make-up of the body, its ‘biology’ (coined around 1800), its chemistry (including discovering carbon dioxide and its role in respiration), and later the pathological factors of disease developed, it became clear that medicine was entering a new chapter, less concerned with a holistic understanding of disease and more focused on an anatomical one. The development of laboratory medicine, microscopy, and experimental medicine furthered this thinking. To begin with, these early developments in modern medicine were of help to the field of arts in health, providing fresh ideas to apply to how the arts could be supporting health. But as the modern medicine movement gathered momentum, the core biomedical pursuit began to outpace other aspects of care.
This is not to say that the arts ceased to be practised. Indeed, the nineteenth century saw the development of some exciting new movements within arts in health. As just one example, the Guild of St. Cecilia was formed ‘for the purpose of supplying trained musicians who may promptly obey the summons of physicians desiring to use their services’.(39) The group built up a reputation in medical circles, appearing several times in the Lancet and British Medical Journal where they set forth ideas about how to provide calming music to patients through music boxes so it could be on demand, reported case studies of impact, were credited with helping patients during a scarlet fever epidemic in 1892, and proposed research ideas around topics such as music and pain.(40) The Guild is just one example; other individuals and organizations continued to have sustained success in delivering arts interventions within hospitals and for health. However, within mainstream medical documents, the growing scientific understanding and increasing number of options for treating patients essentially served as competition for the use of the arts in health.
Nevertheless, the nineteenth century also afforded new opportunities for the use of the arts in health, in particular in what was to become the field of psychiatry. In medieval and pre-modern times, people regarded as ‘mad’ were labelled as ‘lunatics’ or ‘spiritually afflicted’ and looked after (or locked up) at home or in monasteries.(41) However, in the eighteenth and nineteenth centuries throughout Europe and the Eastern side of North America, ‘madhouses’ or ‘lunatic asylums’, as they were labelled, began to open. Treatments initially involved attempting to control people through drugs or restraints, often with barbaric techniques. However, ‘madness’ gradually came to be seen not just as a physical disease but as a product of bad habits and personal afflictions. As the nineteenth century moved on, madness became more prominent as suggestions were made that cases were developing in response to modern living with the new industrial pace of life leading to mental strain; an idea that became a precursor to the work of Sigmund Freud in the early twentieth century. Instead of asylums being seen as places to lock people up, their segregated environments came to be seen as an advantage as they offered the opportunity to reshape the mind and behaviour of people affected. Although some, such as Foucault, have questioned whether this new approach was in fact more humane than the previous, or whether it merely replaced one form of control with another (one that isolated patients and focused on their ‘correction’), this new approach did provide an opportunity for the arts.(42)
In Germany, one of the leading asylums was the Cure and Nursing Home Illenau. Notably, Illenau was renowned for promoting sensory stimulation over pharmaceutics or restraints, not only employing the arts, but positively depending on them. It maintained a house choir, marching band, chamber orchestra, concert series featuring 140 performances a year, and a full-time music instructor who worked closely with the physicians. The team at Illenau believed that only certain music was appropriate for its patients, so each piece to be performed had to receive medical approval, and any that were deemed too aesthetically demanding were rewritten. In fact, the asylum published the Illenauer Liederbuch, which featured specially composed hymns that became standard in asylums throughout Germany. Illenau also had its own gymnastics hall and gymnastics instructor, and classes were accompanied by guitar. Within these classes, choreographed dance sequences were developed to aid patients in synchronizing with others around them.(43) In addition, in England, Ticehurst Private Asylum had a list of permitted recreational activities which included writing, drawing, spinning, sewing, and playing the violin or harpsichord. Worcester City and County Lunatic Asylum employed English composer Edward Elgar as bandmaster to compose dance sets for patients. While in France, the psychiatrist Wilhelm Horn reported that the bath house of an asylum which contained eight stone baths had also been fitted with a loud organ, drum, and cymbals in an unusual form of shock therapy. In other asylums and hospitals, the visual and fine arts were actively encouraged. For example, at Crichton Royal Hospital in Scotland, doctor William Browne appointed artists to work with patients in 1847. He found that patients who engaged in drawing experienced improvements in their condition. Similarly, in 1901 Royal Montrose Mental Hospital in Scotland gave an art studio to one of its patients, Adam Christie, where he worked making over 200 pieces of sculpture using broken bottles rather than conventional tools and carving wood with a nail.(44)
However, the arts were not always seen as positive for health. Madness was considered in some quarters to be the result of an overindulgence of the imagination exacerbated by the arts. For example, the Romantic author Alexander Sternberg reported that when the pianist Franz Liszt performed in public, women were overtaken by an ‘insane stupor’, referring to them as ‘die Electrisierten’ (the mesmerized ones).(34) And women themselves were portrayed as victims of madness in nineteenth-century opera, with their madness attributed to a weakness of their gender and their inability to process dramatic emotional events; Donizetti’s Lucia di Lammermoor of 1835 is one example, in which a mad turn from the protagonist Lucia leads her to kill her own bridegroom. But men were not exempt. The poetry of British poet Alfred, Lord Tennyson, epitomizes the obsessive intrigue with madness yet fear of its encroachment on society. And the Romantic British poet John Clare became famous for suffering delusions which eventually led to him being committed to an asylum, which only furthered concerns around excessive engagement with the arts.(45)
Nevertheless, the eighteenth and nineteenth centuries marked turning points in the history of the arts in health. Not only did these two centuries see the rise of a more scientific and rational approach to the field, but they also saw the arts become a core part of the new field of psychiatry, paving the way for the emergence of new areas of arts in health practice in the following century.
Mary De Young’s Encyclopedia of Asylum Therapeutics, 1750-1950s explores a wide range of expressive therapies that were used to treat people with mental health conditions including photography therapy.(43) Penelope Gouk’s Musical Healing in Cultural Contexts provides more on the theoretical attitudes to the arts and science during the Enlightenment.(46)