MEANING-MAKING IN A PERSON-CENTERED APPROACH
Creating Health is a concept for mental health promotion and -interventions that involves creative, sensory and aesthetic aspects. The concept reflects an understanding of the human body-mind system as part of nature, and the relation with the living world as vital for our well-being. Moreover, EA Creating Health recognizes human creativity as a resourceful part of our inner nature. Creativity is an inherent tool for interacting with our surroundings, for processing thoughts and feelings, generate positive emotions and see new opportunities. This simple framework is supported by research in arts & health, eco-psychology, positive psychology and in theories like Biophilia, Attention Restoration Theory (ART) and The Salutogenic Model of Health. The core-value in all of the EA endevours is meaning-making in a person-centered approach.
EA CREATING HEALTH CONCEPT: MAIN AREAS
- Interventions for therapeutic and social benefits of art- and nature experiences
- Environments and experiences supporting health care services
- Experience-based and creative health communication.
- Situated Creating health interventions.
- Mental health awareness in aesthetic practice and creative professions
- "Health-in-Arts": Health and well-being as origin of design/ art-work
- Environmental aesthetics
Get inspiration and learn more about the research field and interventions that inspired EA´s Creating health concept. These are seven cases of arts&health interventions from around the world. (N.B Not EA´s productions or interventions)
“Globalization, bringing with it the need to embrace the broad cultural diversity around how personal and societal philosophies interoperate, will put a premium on finding more effective ways to create and share meaning and meaningfulness. This need for meaning and relevance in daily experience has long been recognized as one of the fundamental driving forces in artistic creation and engagement”.
(Stuckey, H.L. & Nobel, J. The Connection Between Art, Healing, and Public Health: A Review of Current Literature, American Journal of Public Health, Feb;100(2):254-263, 2010)
Culture-On-Prescription in Region Skåne
An intervention in the Southern region Skåne in Sweden, modelled on programs in UK. The program was running in 2012 – 2014 and had 187 participants. Those were patients, enduring mental conditions like mild depression and stress related symptoms and/or musculoskeletal pain. Physicians referred patients who expressed a wish to participate. The intervention format was a group of 10 members meeting 3 times a week for 10 weeks, and at the meetings the group was introduced to art experiences and participatory art activities at different cultural institutions. The venues were all major establishments in the area; Dunker´s Culture Hall, Fredriksdals Museum, Sofiero Castle Gardens etc. As part of the intervention all participants got a free entrance card to all cultural institutions for the purpose of encouraging future culture experiences. Directly after the intervention 41% of the participants showed clinical improvement along the parameter. 12 months after the intervention the improvement was 29%.
The evaluation study was based on 123 participants and the main research parameter was work capability and health-related quality of life. Methods of measurement on work capability were self-reports by the tool Work ability index (El Fassi et.al, 2013) and questionnaires converted to values on the Functional rating index (Feise & Menke, 2001: 2010). The health-related quality of life was measured by five questions in the EQ-5D questionnaire (Euroqol, 2016). The answers are recalculated into a value (two decimals) between -0,59 and 1,00. Source: Medicinsk utvärdering av Kultur på recept 2.0, 2016, Medical evaluation of Culture-On-Prescription, Stigmar, K., Åström, M., Sarbast, S. & Petersson, I., Centre for epidemiology, Skåne University Hospital
Narrative medicine emerged as a response to the one-sided bio-medical focus in medical education and clinical practice and treatments. The aim is to include personal narratives and a phenomenological standpoint to change and support medical treatment. Both patients and health professionals are involved in the practice, which is about recognizing the importance of seeing the person as a whole person, not reduced to a diagnosis, a symptom, or a professional role. In this allowing environment will stories, feelings and insight emerge. Methods like close reading, reflective writing and bearing witness to suffering are at the heart of narrative medicine.
“Contemplative practices, aesthetic appreciation, and Freud’s evenly hovering attention all have something to teach narrative medicine about the attainment and use of attention. By becoming a recognizing vessel, the doctor can “receive” the patient, acting as a container for a flow of great value or, with a different image, registering a transmitted radio signal from far away.” (Charon, 2007)
Source: Charon, R., What to do with stories, The Journal of Family Physicians in Canada, v.53(8); 1265-1267, 2007
Be A Star, campaign for breast feeding
Be A Star was a social marketing campaign directed towards young mothers (age 18-25) in U.K (2008) and their peers, partners and families. The objective was to inspire them to practice breastfeeding and/or to prolong the breastfeeding period, based on scientific evidence of the unique nutritional values and health outcomes related to the practice. Be A Star was a multimedia campaign including posters, leaflets, role models, radio- and outdoor advertising and the production of newspapers for dads-to-be and a community engagement pack. Those were digitally supported by a website and a blog, where young mothers shared their experiences. The phone number to the National Breastfeeding Helpline was clearly displayed in all materials, and local young mothers were engaged in all stages of the campaign.
A striking characteristic for Be A Star was the use of aesthetic presentation of self as empowerment. Local young mums appeared on posters in shopping malls, bus shelters, libraries, colleges etc. They had professional “star” styling and were pictured as glamorous models, while breastfeeding their baby. The website gives this explanation for that choice of visual expression:
“The Be a Star campaign is dedicated to increasing the number of young mums who choose to breastfeed. We hope to do this by showcasing the beauty, confidence and pride that comes with breastfeeding, as well as highlighting the unique health benefits that it brings to both baby and mum”
The breastfeeding rate within the target group went from 52% to 63% during the first two campaign months, after some fluctuations the result stabilized at 57, 8 %. Breast feeding rates for all mums in the area also increased.
Source: Case report at National Social Marketing (UK) Centre: www.thensmc.com/sites/default/files/Be%20A%20Star%20FULL%20case%20study.pdf
FIA Career Transition Schemes for Dancers
It´s important for EA to do all we can, to ensure that creative professionals that works with us don´t get caught in a situation of delivering health to others, without experiencing healthy work conditions themselves. International Federation of Actors (FIA) focus on fair working conditions and occupational health for performers. FIA is advocating for equality, diversity, and artistic freedom. They work for equal opportunities and balanced representation in media and on stage for men and women, free of sexualization and stereotyping. FIA “affirms that all performers must have full and equal access to all the professional and social advantages obtained by the workers in the sectors in which they are active”. Because of the atypical nature of their work many performers are struggling with tax and law regulations, which doesn´t apply to her/ his work situation. The performer is frequently contracted for a limited period of time covering rehearsals and performances, and to establish job-security, performers enter other professions.
“Precarious work is rising among performers, challenging their ability to make a living and forcing many to embrace other professional options, undermining freedom of expression, cultural diversity and the delivery of quality professional content”
An example is FIA´s interventions for dancers: Dancers is a very exposed professional group, who endure intensive training and hard competition all the way from childhood to an early retirement. Euro FIA has developed funded career transition schemes and have published transition guidelines based on research; “Dancer´s Career Transition, an Euro FIA Handbook” (2011)
Creative Practice as Mutual Recovery for Mental Health and Well-being
Director Paul Crawford tells us in a video, how he once stepped out into a corridor in the hospital, where he worked as a nurse and heard one of his patients play music on an instrument. Dr Crawford experienced great relief from his workload and stress as he listened to the music. He felt much better and started to wonder “who is really treating who? ”. Later he became professor of Health Humanities at the University of Nottingham and director for the program, which invites patients, informal care givers and health professionals into co-creative spaces. The program involves partnerships with several universities, which participates in research teams and projects for patients, informal care givers and staff.
Crawford et.al (2013) emphasize the importance of reciprocal benefits of shared well-being in groups that are otherwise divided; patients, health-, social- and educational staff. Aesthetic expressions allows patients to “become storytellers in order to recover the voices that illness and its treatment often takes away” (Frank, 1995,p xii—xiii). The hypothesis is that these processes can lead to mutual recovery and insight for family members and professionals
“Central to the health humanities is the notion of mutual recovery – the idea that the sharing of creative practice and resources can promote resilience in mental health and well-being among professionals, informal care givers and service users”
Each project/workshop is evaluated by the team behind it. The evaluation below, from an eight-week clay workshop based on statistical analysis of questionnaires proves results like improved social and psychological well-being for participants, particularly due to “aspects of being in a group, the unique features of working with clay, the experience of both the process, and outcome, of art creation, and the potentially sustained and lasting impact of workshop attendance”
Source: Clay Transformations, 2015 http://www.healthhumanities.org/index.php/creative_practice_mutual_recovery
Source: Creative Practice as Mutual Recovery for Mental Health and Well-being, Crawford et.al, 2013
The underlying principle for Biophilic Design is biophilia, meaning “a love of life or living systems” (Greek; bio is life and philia is attraction or positive feeling). The concept was first used by Erich Fromm in Heart of man (1964), and later the Biophilia hypothesis was introduced by Edward O Wilson in Biophilia (1984). The Biophilia hypothesis was defined by him as “the urge to affiliate with other forms of life”. It related dwelling in natural organic environments to our well-being.
Biophilic Design incorporates the sustainable interests and human need to connect with living environments and organic structures. Biophilia is expressed as tvery diverse forms in both interior design and architecture. The Biophilia hypothesis has been linked to research on how environments can reduce stress and increase concentration ability, e.g for children suffering from attention deficit disorders. Convincing research suggests that ADHD symptoms in many cases is a sign of directed attention fatigue (DAF), an exhaustion of our brain´s inhibitory system. Attention Restoration Theory (ART) links DAF to a modern lifestyle, where we are cut off from natural stimuli by the urbanized and technological environments we dwell in (Kaplan, 1995) (Kaplan, R & Kaplan, S., 1989)
Sources: Kaplan, S., 1995, Journal of Environmental Psychology (1995) 15.169-182, Kaplan, R. & Kaplan, S., The Experience of nature: A Psychological perspective, Cambridge University Press, 1989https://en.wikipedia.org/wiki/Biophilia_hypothesis