Why use the arts to teach mental health and psychiatry?
Victoria Tischler
INTRODUCTION
Something is lost, as medical students move through their training. I have worked in medical education for the past seven years and have had the privilege of sitting on interview panels to assess entrants to medical school. The process is highly competitive with approximately 800 students interviewed for a possible 260 places each year. All have exemplary academic records. Most have impressive work experience, for example working in healthcare in a developing country, volunteering in a local hospice or working as a care assistant in a nursing home. They also show evidence of a range of artistic, literary, musical and dramatic skills. I was recently presented with a children's book that a potential medical student had written and published. Overall, the students are bright, earnest, passionate and committed to a medical career. Many express an eloquent and clear understanding of empathy even though they are in their late teens. For those who are successful in gaining entry, the commitment and determination remain, yet I witness an erosion in the passion and enthusiasm that brought them to the study and practice of medicine, to the desire to care for and work with others. It may be described as a dulling that sets in almost imperceptibly. Is this a function of the way in which we train our students, the content and volume of the work that they have to digest, a coping mechanism, or something else?
The medical curriculum is densely packed, leaving precious little time for any other type of study or personal development. Students are expected to consume and assimilate huge amounts of information. They must demonstrate a range of clinical skills and they are required to adhere to strict guidelines on personal and professional behaviour. In my institution, apart from protected free time on one afternoon per week, their timetable is full, with students regularly spending 4-6 hours a day in the same lecture theatre.
In addition to my academic role, I am a senior tutor responsible for the pastoral care of students. Many students enthusiastically discuss interests and hobbies outside medicine when they start medical school. As they progress with their studies, I note that these activities are often reduced or stopped altogether, students citing that they have no time, for example to read or play a musical instrument. The initial enthusiasm that students bring to their medical studies also seems to dissipate as they move through their training, being replaced with a coolly dispassionate detachment. This is not to say that students don't care; on the contrary, I am impressed by the maturity, sensitivity and commitment that most demonstrate at a relatively young age.
In a holistic sense, something fades along the way. As educators, we don't nurture the student's whole being as they are trained. This observation could well be generalisable to the training of other health professionals and to higher education as a whole. The erosion in the autonomy of many health professionals, the well- publicised scandals in healthcare, the introduction of student fees and the economic recession, all play their part in creating the current business-like climate. The idea that higher education is a developmental phase in which to 'find yourself7, to explore new ideas, to politicise oneself, to learn about a range of subjects, not just the one you are studying, is perhaps less relevant as students become 'customers' seeking the best possible degree for their investment.
As someone with a passion for the arts, I have always used film, poetry, drama, visual art and literature in my teaching. Student feedback indicates that such teaching is appreciated. Recent research that colleagues and I have undertaken suggests that the arts can bring humanity to medical practice, can help students develop professionally, and can assist in coping with stress.1 One domain that the arts may particularly nurture is the development of empathic skills.2 Empathy has been shown to be of considerable importance in medical practice, for example to aid effective communication. Paintings, novels, films and drama can absorb us and bring us to tears of joy or sorrow. Such media facilitate entry into the worlds of others, to experience it and imagine it. Students with limited life experience can utilise the arts to imagine life from another's perspective. They can do this by engaging with a piece of music about suicidal ideation, a poem from a spurned lover, a story about pathological jealousy, or an autobiographical account of bipolar disorder.
Art highlights, emphasises and explores core elements and human emotions. This provides a relatively safe way for students to engage with difficult and painful emotions that may arise in mental healthcare, for example working with those traumatised by childhood sexual abuse and those who enact their distress through self-harm, suicidal ideas or substance abuse. Literary works can also raise ethical and moral concerns which are commonly encountered in mental healthcare practice, for example detaining someone in hospital against their will. In addition, developing an appreciation for the arts provides a diversion from the demands of study and work and for some, a lifelong passion for creative expression in one or several forms.
This chapter focuses on the experience of establishing a humanities course: The Arts in Psychiatry. Prior to this course, the medical curriculum in my institution contained no formal humanities teaching. A previous module in general practice which had included material on literature had been discontinued.3 I began by seeking out colleagues with similar interests. This was an interesting and affirming process as I found that others shared a similar vision and enthusiasm. I also made links with organisations such as the Association for Medical Humanities and the Madness and Literature Network. This networking and support in establishing humanities teaching has been invaluable. After some years and much persistence 'The Arts in Psychiatry' evolved and has been enthusiastically received by medical students and colleagues alike. The success of the course has led to the development of other humanities projects focusing on art and anatomy and drama and clinical communication, plus a range of associated activities described later in this chapter.
Although this text is primarily aimed at medical educators and their students, much of the material is suitable for students and practitioners of other disciplines; indeed there is much literature that supports the utility of humanities training in other professions, for example nursing and psychology.4,5 Throughout the text the terms 'arts' and 'humanities' are used interchangeably and include visual arts, poetry, literature, music, film, creative writing and drama. This introductory chapter focuses particularly on evidence related to the study of mental health and its practice and includes a 'how to' guide for those contemplating establishing similar courses.
