The Arts and Humanities in Psychiatry . . . A Debut

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A psychiatry resident meets regularly for coffee with a friend studying architecture. They begin a dialogue on what makes for a healing environment on a mental health ward. An ER psychiatrist listens to Mahler’s Second Symphony after a particularly difficult shift fraught with violent outbursts by a couple of distressed patients. A supervisor in psychotherapy asks her residents if they would like to read and discuss a poem about death together instead of pursuing the scheduled talk on bereavement. They choose the poem.

If you were to ask these physicians what role the arts and medical humanities played in their working lives, they might answer they were simply doing something they liked. But if you were to press them to go deeper, it would become apparent they were creating a space for creative reflection-for thinking and feeling “outside the [medical] box.”

Doctors at all levels of experience struggle at times to find meaning in their work. With sub-sub-specialization, dwindling resources, insurance squabbles, and burnout, physicians yearn for deeper connection with peers and patients.

For some, psychiatry is about receptors in the brain, but for many that is not enough. The brain is also the locus of the mind, and the human mind insists on making meaning. Evidence-based medicine has fallen short of its promise and has taken the focus away from subjective experience in working with patients. Instinct, intuition, and imagination cannot easily be measured and, perhaps for this reason, are not typically seen as “belonging” in the science of medicine. Ironically, as psychiatry has sought out credibility within medicine, it has placed less importance on narrative competence or the ability to work with and interpret patient stories. Even more ironic, the field of narrative medicine appears to have emerged and found more welcome in other medical specialties than in psychiatry.

The health humanities offer a formidable remedy for what ails contemporary psychiatry.

Until fairly recently, “medical humanists” in psychiatry have worked in splendid isolation within their communities and even in their academic faculties, often because their fascinations and pursuits seemed “fluffy” to their fellow practitioners. Residents often viewed their own creative pursuits as “add-ons” or completely dispensable.

Why did a faculty member take students to the art gallery to work on their visual literacy and perception of non-verbal cues? Why did a psychiatrist write a paper about the history of wine? Why did a psychiatry fellow invite an actor to help trainees be more physically embodied and fully present when seeing patients? Why has a child psychiatry resident started exploring bibliotherapy and comics with children or begun to use music as a way to reach non-verbal patients? These are questions that should be considered integral to conversations regarding what makes a well-rounded psychiatrist.

We* see the value in such unexpected unconventional undertakings. These pursuits not only place a high value on curiosity and the role of aesthetics in both personal and professional life, they enhance many of the competencies expected from trainees-communication, professionalism, reflective capacity, and collaboration. An artistic or intellectual passion can provide a new focus for appreciating and recharging one’s daily work and learning. Creativity should not be seen as “optional” in psychiatry. Rather, it helps us to approach clinical problems in new ways, allows us to pull together disparate ideas, and sustains us in the face of uncertainty

The health humanities offer a formidable remedy for what ails contemporary psychiatry because it expressly explores the human side of medicine. Increasingly, research demonstrates that exposure to literature, music, the fine arts, theology, medical history, philosophy, critical studies, and anthropology broadens a resident’s cultural competence and encourages the linking of both cognitive and affective approaches to the physician’s task. The arts and humanities also validate the importance of the doctor’s subjective, personal experience with a patient, which, balanced with caution against stereotyped judgment, has long been a critical source of clinical information in psychiatry.

Reflective practitioners take better care of their patients and themselves. Ongoing dialogue with colleagues from the arts and sciences both complements and stretches one’s views of health, disease, and healing. These conversations can help challenge assumptions and illuminate blind spots, while inviting us to articulate why we do what we do. Poets, musicians, and artists have been contemplating suffering for longer than psychiatrists and have much to teach. They also give permission to rediscover the Art in what we do and to fully imagine what makes our work beautiful. If psychiatry is about the brain, why not use both sides of it?

*The members of the Committee on Arts and Humanities at the Group for the Advancement of Psychiatry are David Sasso, MD (Chair), Aparna Atluru, MD, (fellow), John Cahill, MD, Joseph Carmody, MD, Anish Dube, MD, Don Fidler, MD, Alan Gruenberg, MD, Andrew Lustbader, MD, Allan Peterkin, MD, Anna Skorzewska, MD, John Tamerin, MD, and Ken Weiss, MD.

Disclosures:

Dr. Peterkin is Professor of Psychiatry and Family Medicine and Director of the Program in Health, Arts and Humanities, University of Toronto. Dr. Sasso is Assistant Clinical Professor at the Yale Child Study Center, New Haven, Connecticut and Medical Director, Child Guidance Center of Mid-Fairfield County, Norwalk, Connecticut. Dr. Skorzewska is Assistant Professor at the University of Toronto Faculty of Medicine and Director of the Psychiatric Intensive Care Unit at University Health Network in Toronto.