Medical Matters/Dr Muiris Houston: I want to write this week about health and the arts. Or should that be the arts and health?
For those in the arts world, healthcare is yet another milieu in which they can practise art. For those in medicine and health, the arts are a reminder that before the advent of science and technology, medicine was an art, firmly based on the ability to listen and to transform a patient's story into a diagnosis.
My musings are prompted by a recent Arts Council publication, The Arts & Health Handbook. It defines the phrase "arts and health" as a reference to "the emerging area where the arts sector and the health sector intersect". It makes a clear distinction between "art practices", where the primary goal is the experience or production of art, and "arts therapy", whose primary function is therapeutic.
The handbook is a practical guide to managing an arts-and-healthcare project, such as a writer-in-residence at a hospital or the use of an artistic installation within a primary-healthcare centre.
One of the more radical approaches to transforming an environment has been the introduction of clowns. Clown Care, in the US, and Le Rire Médicin, in France, use specially trained clowns to work with children in hospitals. Despite the potential for anarchy, both projects report great success.
A general practice in Britain has also demonstrated the effectiveness of arts-and-health projects. Malcolm Rigler, a doctor in Brierley Hill, near Birmingham, turned his surgery into a cultural centre. It has hosted artists and writers-in-residence, run art classes in the waiting room and staged plays.
Rigler's comments are instructive: "People's lives have changed. Some of us can see the arts having a dramatic effect, as strong as penicillin, in getting patients where they need to be . . . . It's also kept the staff very buoyant and morale high; there's always a project to look forward to. It balances up having to cope with so much distress."
The Arts Council says the core purpose of arts-and-health projects is to improve the quality of life of everyone in healthcare settings. Its arts development director, Mary Cloake, is keen to support the arts community in developing a greater role in the health sector. It is an excellent initiative, and one that will be celebrated at the third International Arts and Healthcare Conference, to be held at Dublin Castle next June.
What of the other side of the arts-and-health coin? With the buzz surrounding the science of evidence-based medicine, is there any room for artistic narrative within healthcare itself?
The good news is that a discipline called narrative-based medicine is emerging. There is a growing recognition that narrative is important in medicine, because it performs a "bridging" function. Doctors (and other healthcare professionals) travel across this bridge, taking the patient's story of illness and repackaging it in the form of a case history.
The risk associated with the process, however, is that the patient may be dehumanised, becoming an object rather than a person. So it is important that the narrative continually travel back and forth across the bridge, so the patient's story is kept alive.
To this way of thinking, patients tell short stories, or anecdotes, in a consultation. This is especially true in general practice, where the patient's account of his problems is generally unmedicalised. Typically, a person might offer the following: "The reason I am here is that I was playing table tennis the other evening with my usual cronies and I began to feel funny in my chest. Eventually the feeling went away. I'm pretty sure it's nothing, but I thought I should come for a check-up."
In fact, this 50-year-old man ended up with a stent bypass - when a splint is placed inside a blood vessel - to relieve a single-vessel coronary artery blockage.
Patient anecdotes can also show how well they understand - or how badly they misunderstand - their illnesses or how their illnesses are affecting their lives. An attentive doctor will pick up and build on them to create a shared understanding of the illness and future priorities as defined by the patient.
Patients' stories are also important to other patients with similar illnesses. Perhaps the Arts Council might look to formalising a collection of these narratives as part of its initiative.
You can e-mail Dr Muiris Houston at mhouston@irish-times.ie. He regrets he cannot answer individual queries