Cure by culture therapy


Swedish doctors will soon be able to prescribe singing lessons, pottery classes or art appreciation as part of a new public healthcare initiative

SWEDEN IS testing a new approach – Culture by Prescription – in a state-funded pilot project to reduce sickness benefit, doctors’ visits and the “pill-popping” associated with long-term depression and stress-related illness.

In the same week that the Swedish government proudly announced a taxpayer-funded investment in this less traditional form of rehabilitation, Swedes were shocked to learn that hospitals in their country are increasingly turning to electroshock therapy (ECT) to treat depression.

A Swedish Television Network (SVT) investigation showed that the number of ECT treatments carried out per year in the country has risen sharply since 2000 from 18,000 to 45,000.

With a reputation abroad for sometimes being cold and reserved, some psychologists believe that a national obsession with self-control and getting on with life is taking its toll on the health and wellbeing of Swedes.

The long dark winters when daylight lasts less than six hours as far south as Stockholm and far fewer hours further north, the reliance of some Swedes on alcohol to lift their spirits, and a genetic tendency towards being introverted prevents some of them from seeking help for depression and related illnesses.

Immigrants fleeing wars in the Balkans and Iraq, who were granted residency in Sweden, continue to suffer from post-war trauma without adequate back-up, and are among those most in need of help.

These people will be targeted in the pilot project launched in southwest Sweden, says clinic supervisor Anna Carin Persdotter of Capio Citykliniken, which is about to put it into operation.

“We estimate that it will be 50:50 Swedes and foreigners, and we will have to be very creative so that the non-Swedes feel the cultural cure we offer fits their needs and backgrounds,” she says.

Famed for a generous cradle- to-the-grave social welfare system, Sweden is grappling with an unprecedented rise in those suffering from workplace burnout resulting in depression and a range of other illnesses.

The most recent figures show that one in 10 Swedes in their 40s is currently receiving some type of benefit for being either temporarily or permanently unable to work, due to illness or injury.

New figures from Sweden’s Social Insurance Agency (Försäkringskassan) show that the number of Swedes aged 40-50 receiving sickness compensation has almost doubled since 1991.

As the government searches for ways to reduce the numbers on long-term sick leave, the idea of exploring how cultural activities may help improve people’s health has been supported by the ministries for health and culture.

The new Culture by Prescription (Kultur på Recept) trial will target patients suffering from low- and medium-grade depression, stress and anxiety, as well as those who have had back, shoulder or neck pains lasting more than three or more months.

Initially, doctors in Skåne in southwest Sweden will be able to prescribe a range of cultural activities for patients in conjunction with their traditional treatment and rehabilitation.

“There has been a good reaction from doctors who feel that both body and mind should be stimulated for maximum recovery and we have already done years of research proving that culture is a healing health-promoting part of care,” says Christina Gedeborg-Nilsson, head of culture and healthcare division in the Skåne region.

“A few sceptics have also reacted like the journalist who said he had some neck pain and felt a visit to the cinema might ease it . . . but that’s not what we are all about.”

Gedeborg-Nilsson talks of patients who suffer from “a spiritual anorexia”, people who have withdrawn from society and various help channels, who are lonely, have no social networks and may be suffering physically and mentally, but are unaware of the connection between their needs and the availability of healthcare.

Launching the Culture by Prescription project, Swedish social security minister Cristina Husmark Pehrsson said: “We know that illnesses affect people in different ways and can lead to absences due to sickness of varying lengths of time.

“My hope is that Culture by Prescription can offer new insights into how culture, in a more pronounced way, can be a part of rehabilitation for extended absences due to illness.”

Research by Gedeborg- Nilsson and her team over the past three years shows a positive relationship between participating in cultural activities and an individual’s health.

“We are convinced that different types of cultural stimulation to improve patients’ wellbeing will ultimately bring down the cost of medical consumption and also the cost of drugs from sedatives to laxatives,” she told The Irish Times.

Hospital manager Lisbeth Cederwald told how already some patients with heart problems became more calm, registering reduced pulse rates, after viewing a film about orchids as part of their research programme.

Other healthcare workers involved said patients who were introduced to cultural activities, from dance, music, theatre, art and literature to gardening, needlework, cookery and pottery classes had recovered more quickly from long-term ill-nesses.

“A big problem for those who have been out of work on long-term sick leave is a sense of loneliness and isolation, and often low self-esteem. They find it difficult to relate to other people, their self-confidence is often shattered,” says Gedeborg- Nilsson.

“The cultural activities they will now experience will strengthen their self-confidence and provide continuity and stimulation as a compliment to regular care and help them to return to work and become happy again within their communities.”