Twentieth century exploration
The start of the twentieth century saw divided opinion on arts in health. The horrors of World War I led to two schools of thought. One of these saw even the most reverential artworks in hospitals as a waste of public money. Instead, simpler and cleaner designs were adopted in some hospitals and the ‘clinical’ emphasized. This move was reinforced by a number of factors. A growing awareness of infection and the focus on cleanliness and hygiene encouraged white hospitals so that dirt could be spotted more easily. Second, there were moves in architecture towards functionalism and rationalism at the start of the twentieth century that foregrounded the purpose of a building and saw decoration as unnecessary.(47) This had a profound impact on the design of some hospitals, with a prime example being the starkly functional Bata’s Hospital in the town of Zlin in what was Czechoslovakia in 1927.(48) Third, in the 1920s there arose a professional opinion that Greek temples and Romanesque and Gothic cathedrals had been all white; a belief that persisted until the 1960s when further evidence came out showing their rich colourful decorations. It has been hypothesized that these architectural moves were instrumental in the shift away from artistic hospitals to more clinical designs.
However, the war also provided an outpouring of art.(49) Some artworks arose directly in response to the war as people struggled to represent the unprecedented and epoch-defining events. Artists such as Gilbert Rogers graphically depicted the scenes they had witnessed. Others shrank from the energy and violence towards a more abstract and less raw depiction, such as English painter Percy Wyndham Lewis. For others still, art was used for escapism, with nostalgic impressions of landscapes, such as in the work of British painter Gilbert Spencer. Not just visual art, but also performing arts became a mode of escapism, with plays, books, poetry, and music flourishing both during and after the war. This attitude seeped into hospitals and healthcare too. In contrast to the simpler, functional hospitals preferred by some, others looked for beauty. So alongside clinical designs, increasingly elaborate hospitals were also built, and a range of countries, including Norway, the Netherlands, the USA, Canada, France, and Italy also introduced ‘percentage laws’, by which the expenditure of a certain percentage of the building cost for major new public buildings (including hospitals) had to be spent on art. One of the beautiful hospitals to emerge from this scheme is the Academisch Ziekenhuis at the University of Amsterdam built in 1974, which has a separate unit for each of the post-war movements in the arts in the Netherlands, from Zero to Neo-Expressionism, totalling 5,000 pictures. Alongside visual arts, performing arts were reinvigorated within healthcare, with entertainments services that had provided support for people during the war, such as the Entertainments National Services Association (ENSA), which had brought live music to wounded servicemen in military hospitals, transitioning their efforts into healthcare and leading new movements to provide holistic support to patients (see Chapter 4).
However, what this divided approach highlighted was that the relative significance and prominence of arts in health was very much dependent on factors such as individual opinion and societal fashions. Arts in health had relatively little autonomy or authority in its own right. But by the mid-twentieth century, this was all changing. Inspired by specific medical traditions or theories, off-shoots of arts in health activity began to emerge, taking root in different countries and developing into the leading fields of activity within arts in health that are active today, including arts therapies, arts-based learning, and targeted patient programmes. In Chapter 4, we will explore how this development occurred and how the first national and international organizations formed. However, underpinning these practical developments was a broader shift in mind-set regarding how medicine was viewed, which has provided further opportunities for the arts.
Discussions about the ‘art’ of medicine are traced throughout history. But the prominence of these discussions has varied, with core advances in science often temporarily casting aside discussions about the ‘art’. However, in the twentieth century, the ‘art’ of medicine has been brought back into the mainstream as a concept. Sir William Osler, a Canadian physician widely considered to be the Father Modern Medicine, wrote in an essay entitled Aequanimitas, ‘The practice of medicine is an art, based on science’,(50) highlighting distinctions between the ‘science’ of knowing medical facts and the ‘art’ of drawing on individual observations, experience, and personal judgement in putting this knowledge into practice. The ‘art’ of medicine is also used to describe other aspects of patient care, such as treating people with respect, compassion, empathy, and humanity as well as trying to optimize patient experience, which is now seen as a priority within many healthcare systems.(51) Although this might seem peripheral to the more important prescription of medications or undertaking of procedures, research suggests that patients who feel personally involved in their own care are more likely to following treatment guidelines and lead the lifestyles needed to ensure their own health. This will be discussed more in Chapter 2. There are also specific areas of medicine in which aesthetics are recognized as integral to the medicine itself, broadening further discussions around the ‘art’ of medicine. For example, cosmetic surgery and some branches of plastic surgery centre around artistic principles of beauty.
Of course, ‘art’ in relation to the ‘art of medicine’ is very different to the application of the arts in health. But what the rising prominence of the ‘art’ of medicine is doing is normalizing discussions around creativity alongside discussions of medicine, bringing theoretical considerations of the worlds of ‘art’ and ‘science’ closer together and emphasizing the importance of a holistic approach to health. This all helps to foster a more receptive mind-set among healthcare professionals, funders, and policy-makers for proposals of arts in health interventions. Indeed, it is probably no coincidence that the greatest flourishing of arts in health over the last 100 years has occurred alongside the rise again of the acceptance that medicine is both an art and a science.
For a further discussion and history covering 2,000 years on the topic of the art of medicine, the illustrated book by Julie Anderson, Emma Shackleton, and Emm Barnes is a wonderful resource.(52)