The healing arts

Any discussion of the arts in healthcare requires a leap of faith and imagination.  Medical care is not simply the treatment of physical ailments – the ancient Romans spoke of mens sana in corpore sano, a sound mind in a sound body; and the word 'hospital' shares the same root as the word 'hospitality'.
    
The idea of the arts as part of the healing process is not new. In Western mythology, Apollo - god of music, sun and light – is father of Aesculapius, god of medicine. The ancient Greeks used drama as part of the healing process at Epidaurus, as did the ancient Egyptians at Sakkara.

Art in hospitals
Art has been used in hospitals in the western world since at least the 15th century: in Brunelleschi’s Foundling Hospital in Florence and Thomas Coram’s Foundling Hospital in London (which, intriguingly, led to the foundation of the Royal Academy of Arts – but that’s another story); William Hogarth’s first great public commissions were two vast paintings for St Bartholomew’s Hospital, London, hanging to this day; when, in 1959, Sheridan Russell, almoner at the Hospital for Nervous Diseases, founded Paintings in Hospitals, the organisation that lends original paintings to hospitals and healthcare facilities at minimal cost, it was a continuation of an ancient tradition.
    
From 1993-2003, as director of the ambitious arts programme at Chelsea and Westminster hospital, I pioneered the integration of the visual and performing arts in new ways in London's newest NHS teaching hospital. I'm not talking the odd Monet reproduction hung crookedly and too high, or carols at Christmas, but the world's first full-length operas in a hospital; music festivals; an orchestra and Indian dancers in residence; and workshops by actors, singers, poets and puppeteers. Performances were free and, in public areas, open to all.
    
I hung 2,000 original works of art in the vast spaces of the stunning atrial building, on anaesthetic-room ceilings, in treatment and changing rooms - everywhere a picture could take patients' minds off medical procedures. The sound of music was introduced to make chemotherapy endurable, if not pleasurable.
    
My three governing criteria were appropriateness for the hospital setting; artistic excellence and cost. As an art historian, passionate about the arts and architecture, I was determined to be bold, to go beyond visual and aural wallpaper of any kind, mere tasteful hotel-based interior decoration, to invigorate patients, provoke discussion, challenge expectations. After all, in the 21st century hospitals are more than just places to in which to be born or die. I passionately believe in breaking down the traditional barriers between illness and health so that the hospital is, rather like cathedrals in the Middle Ages, a real community centre.
    
Why do this? I’m not only an art historian but a perpetual patient (polio at the age of four, two hip replacements, five back operations, a heart attack, breast cancer), so I speak with authority about the power of art to make people get better faster, go home sooner. But until recently, although the benefits of a pleasant environment with art and music to take patients’ minds off medical procedures were acknowledged by doctors and nurses, the evidence was purely anecdotal: although Florence Nightingale recognised as long ago as 1859 that ‘variety of form and brilliancy of colour in the objects presented to patients have a powerful effect’ and are ‘actual means of recovery’, there were few controlled studies that went beyond Ulrich’s 1984 comparison of views from hospital windows; and although reams have been written about the power of music to reach the sick, the comatose and the dying, there was, until recently, no real clinical evidence or scientific measurement of the effects of live music.
    
It was not just intellectual curiosity that made me seek proof for what I as a patient and nurses and doctors had long observed: that a pleasant environment, with art and music to engage the eye and ear, can measurably speed the process of recovery and wellbeing. Although Britain is the fifth richest country in the world, unlike colleagues in Europe, the United States, Japan and Australia, I had to raise every penny for all hospital arts activities. And, in our evidence-based society, I needed to be able to provide proof to cautious funders, to convince them that their money would be as well spent on murals or music as beds or bedpans.
    
Anaesthetists and nurses had told me that patients’ stress levels were markedly reduced by paintings on the ceilings and walls of anaesthetic and recovery rooms: I wanted to be able to say that they were measurably reduced; and, in the culture we live in, where there is no spare money for the arts, and where the NHS is desperately under-funded, I realised that the only way to convince hard-nosed businessmen or women was to approach the trial in exactly the same way as a drug trial. I determined to prove what was regarded as immeasurable and unquantifiable, and, in 1999, the inspiration came in a music workshop with the City of London Sinfonia when a cardiotachograph was linked to a pregnant mother and two quite different heartbeats of the baby in utero were distinctly audible when first Bach, then Bizet, was played. This, I realised in an epiphanic moment, was a measurable involuntary physiological response.
     
The ‘Study of the Effects of the Visual and Performing Arts in Healthcare’ – which I conceived, instigated and supervised over four years – funded by the King's Fund and carried out by a scientist using rigorous scientific methodology and controlled studies, proved categorically that art and music improve patient outcomes, including significant reductions in the need for medication, in stress and anxiety levels, and in length of hospital stay. Art and music measurably improved staff recruitment and retention; and, since the NHS is the largest employer in Europe, and the fourth largest in the world, this information was of particular significance to the bean counters.

New policy
Indeed, once this fact became public, with prompting from the Commission for Architecture and the Built Environment (CABE), NHS Estates policy directed that the cost of every new capital build should include a percentage for some form of artistic enhancement. (Unlike in other civilised countries, where there is a mandatory per cent for art in all public buildings, the percentage was unspecified; and, sadly, NHS Estates no longer exists.)
    
All this has won recognition: Special Commendation from the National Art Collections Fund Prize (1996), cited for ‘innovative and imaginative approach to hospital healthcare which enhances the experience of patients, staff and visitors’ and ‘for promoting enjoyment of the visual arts’; Londoner of the Year Award (1998); Creative Britons Award (2000); and European Woman of Achievement Award (2004) with particular mention of the research. In July 2000 I was invited to address a specially convened meeting of the Parliamentary Arts and Heritage Committee at the House of Lords on the arts in healthcare, the first time the subject was discussed in those august portals; and in March this year, the 60th anniversary of the founding of the NHS, Lord Howarth again broached the subject in the Lords, saying “There is much to celebrate in the contribution of the arts to healthcare across the country,” and noting that “the brilliant tradition established by Susan Loppert continues.”
    
I’m delighted that the seed I planted has burgeoned and flourished: it is a passion and a privilege for me to have achieved what ‘they’ said couldn’t be done in a hospital; but I am proudest of all at having been able to initiate the world’s first ever scientific study evaluating the arts in healthcare.

For more information
E-mail susan.loppert@blueyonder.co.uk