AHSW's Director, Trustees, and Members reflect on various aspects of arts, health and wellbeing.

Beauty, excellence and quality in arts and health

Alex Coulter, Thursday, 6 November 2014

My starting point for these musings is Professor Semir Zeki’s research into perceptions of beauty and the effect it has on our brain and feelings of wellbeing. We heard Professor Zeki speak about his work at our 2012 Arts & Health South West Awards event. Sara Houston’s research into Beauty in Dance for Parkinson’s with the English National Ballet2 and Lynn Froggett’s work on Aesthetics and health: why quality matters were both presented at the Culture, Health and Wellbeing international conference 2013. Grayson Perry talked about beauty in relation to contemporary art in this year’s Reith Lectures. Lastly, François Matarasso recently wrote about quality in participatory arts.

I wondered whether I could use these references to make some sense of the experience of beauty, excellence and quality in relation to arts and health. I venture into this territory with some caution. The backdrop to any discussion of beauty is a vast literature in philosophy and aesthetics from Plato on. I won’t attempt to summarise that history and you, the reader, will bring to bear any knowledge you already have. This is an attempt to bring some of the perennial questions into present day focus for our mutual benefit.

Matarasso highlights some muddled thinking about the word quality, which is an objective term frequently used instead of the subjective term ‘good’. He says: ‘In philosophy..quality is a characteristic of things: it does not determine their value’ and quotes the literary critic John Carey: ‘Value not intrinsic in objects, but attributed to them by whoever is doing the valuing’. He articulates the political dimension to this debate: ‘The use of phrases such as ‘high quality art’ is dangerous because it makes it harder to discuss and determine the value of arts practice, while also tending to exclude those who believe themselves less able than professionals to recognize quality in art.’ The Arts Council uses the word ‘excellent’. We are about to embark on our next funding application to Arts Council England, as are many others, and we all have to contribute to ensuring ‘excellent art happens’. What is excellent art and how do we measure it?

In the dictionary ‘beautiful’ is equated with ‘excellent’. This may be semantics but if I were to say something is ‘excellent’ it would signify a level of detachment from the source of the experience, a detachment into analytical judgement. Whereas to describe something as ‘beautiful’ implicates me emotionally in the experience, I feel more vulnerable for having exposed my feelings – it seems less of an objective assessment. Surely good art should affect us emotionally as well as stimulate us intellectually? I am therefore focusing on the word ‘beautiful’ in this discussion rather than ‘excellent’ as it feels more authentic.

Professor Zeki generally focuses on visual perception, he works with visual artworks in his research and shows how viewing an image of an Ingres nude to his research subjects caused ‘feelgood’ hormones to be released. It may be significant that he selected people that had not had an art education. The implication is that we can be educated out of our instinctive responses to the visual arts. When I am viewing paintings my brain uses a series of codes and shortcuts to read and locate what I am seeing, which can result in me not giving time and space for a spontaneous emotional response, but I am not sure that I can control my physical response to music in the same way, which may be because my understanding and knowledge of music is less sophisticated. Although the majority of Professor Zeki’s writing focuses on visual stimulus his recent article on ‘Clive Bell’s “Significant Form” and the neurobiology of aesthetics’ takes as its starting point Clive Bell’s ‘aesthetic emotion’, which can be aroused by all that is experienced as beautiful. Zeki asks ‘is there a common mechanism in the brain that underlies the experience of beauty, regardless of source and regardless also of culture and experience?’ Experiments which aim to determine the activity in the brain that correlates with the experience of beauty have repeatedly shown that there is one area, located in a part of the emotional brain known as the medial orbito-frontal cortex (mOFC), that is consistently active when subjects, irrespective of race or culture, report having had an experience of the beautiful, regardless of whether the source is visual, musical or mathematical. This is not the only area of the brain to be active but it is the part of the brain, which is consistently active across a range of stimuli (music, visual art etc). It is also the part of the brain found to be
consistently active in the experience of reward and pleasure and it is active during aesthetic judgements. Zeki goes on to say that: ‘the strength of activity in the mOFC is proportional to the declared intensity of the experience, the more intense the declared experience, the more intense the activity.’ Alan Yentob had an MRI scan while listening to his favourite Strauss last song, sung by Jessye Norman. On the screen it showed that his whole brain rapidly filled with blood. The Neurologist thought the scanner had broken, in fact it was the body’s response to the music.

It is best not to get hooked on neuroscience and be seduced by the idea of knowing The Truth. The main point about all this is that beauty is in the eye of the beholder, it is what we perceive as beauty that provokes the response in our brain, and it would take a lot of brain scans to prove that any given thing or experience had provoked the same response in enough people for us to say categorically that thing or experience is objectively beautiful. Change the word beautiful to excellent and we have to assert that the power to claim excellence is in those experiencing it, not embodied in some authority. In fact perhaps some of the tensions and anxiety about who decides what is good, come from the fact that we quite frequently look at or experience art that we are told is excellent but our mOFC is not responding. So we don’t know why other people think it excellent, and consequently might feel excluded if we lack confidence, or might just think those telling us are talking rubbish if we are confident in our own judgements. When it comes to participatory arts, as Matarasso says in his piece: ‘unless the people who are supposed to benefit from an activity can participate in defining the criteria of its success, then control remains firmly with the professional organisations and any claim of empowerment must be open to question’.

My recent experience of listening to the performance of ‘Bewitched’ at the international conference in June was what I would call a ‘beautiful’ experience. Ian Wilson was composer in residence in the stroke unit at Tallaght Hospital in Dublin and created Bewitched in response to that experience and with the words from conversations he had with patients, relatives and staff. As a result of feedback from patients, to the music he
was composing, he decided to combine the new compositions with old favourites based on a Doris Day CD that was frequently played in the Stroke Unit. He talked to a young woman who had had a stroke after the birth of her first child, and to her husband who was very distressed. I can describe quite literally my experience. The piece, when sung by the soprano Deirdre Moynihan, took you into the head of the young woman, struggling to speak and to say the word ‘water’. You are trapped with her inside unable to communicate, feeling frustration and fear, and then the song moves seamlessly into ‘Fly me to the Moon’ and with her your imagination soars, you escape and feel free from the physical constraints of the world. So, as an audience member, I experienced a physical response that no doubt would have shown up on an MRI scan. Maybe my brain was flooded with blood as I experienced the tingling on the back of my neck or perhaps it was just the mOFC bit that would have gone red on the screen.

When it comes to participating in making the beautiful experience oneself, Sarah Houston’s research into the Dance for Parkinson’s work with English National Ballet is helpful. Her presentation at the Culture, Health and Wellbeing international conference was called: Feeling Lovely: an examination of the value of beauty for people dancing with Parkinson’s. She says that the consequences of feeling beautiful takes the discussion beyond instrumental benefit and that dancing is not only something ‘nice’ to do but a core activity upon which participants confer value. She quotes a participant in a Dance for Parkinson’s session as having said ‘I feel beautiful again’ after taking part.

François Matarasso begins by talking about the fact that any self- respecting artist can be trusted to judge the quality of their own work. That may not relate to the critics, the market or the audience consensus of course, but I would agree that it is part of the process of artistic development to be constantly interrogating your own practice and striving to achieve ever greater ‘effect’. As he clearly articulates this is a different issue when we look at quality in relation to participatory arts practice. He uses the case study of Creative Progression, a project by Helix Arts, for which the principal goal was to support the progress of the homeless participants with chronic mental health problems towards health, wellbeing and independent living. Matarasso identifies five stages in the life of a project and analyses each in relation to quality. The first stage is the theoretical context for the conception of the work. He identifies this as the weakest area in contemporary participatory arts practice due to the lack of critical writing on the subject, an observation that chimes with one of my current concerns in relation to good practice in arts and health. We need to be working from a clearer and better articulated theoretical base, to draw on research evidence and past experience to define and justify the work when advocating for it, and also to make sure that we are delivering the best work we can, informed by learning from others. There are academics working on this and I would point you to the writings of Mike White at the Centre for Medical Humanities at Durham University.

Returning to the issue of the beautiful experience. We talk about the transformatory power of the arts. Transformation could suggest an intense and perhaps shortlived experience that has lasting impact, for example the experience of immersive theatre or that of listening to Bewitched as described above, or it could suggest a longer term transformation of our lives and our health for instance through the weekly participatory arts workshop. They are both of value of course but perhaps we need to think about them differently. The weekly workshop better mirrors patterns of health services, is more likely to fit a health model of service delivery, funding and outcomes measurement, but could fall foul of the ‘instrumental’ derogative description. Whether it is true or not, in the world of arts and health we can feel relegated to a second class status associated with the instrumental use of the arts for the benefit of participants. The elevation of the artist from craftsman through a hierarchy to visionary genius was a gradual process from the Renaissance on but the polarisation of the instrumental and the intrinsic is a relatively recent phenomenon. Until the rise in art for art’s sake promoted by the late 19th C and early 20th C Romantic and Aesthetic movements, surely art was always seen to serve a purpose within society?

Lynn Froggett’s research into the ‘aesthetic third’ relates to the transformative effects of the arts and whether the distinctive qualities of the artwork matter. She writes: ‘It is commonly claimed that the arts contribute to mental health and well-being through the processes of transformation that they stimulate in individuals and communities. At the same time concern is often expressed in the arts sector that while the arts may ‘do you good’ the instrumentalisation of the arts for social purposes renders irrelevant the quality and integrity of the artwork.’ As Lynn Froggett clearly articulates: ‘For communities the artistic process acts as a provocation whereby people begin to re-imagine themselves in terms of the otherness within, a profound experience of psychosocial transformation.’ It accounts for the possibility of transformation via the artwork’s potential to act as a ‘symbolic’ or ‘aesthetic third’. The aesthetic third is a point of articulation between artwork and community which brings together the distinctively personal dispositions of the individuals involved in its production or reception and elements of a shared culture. Lynn Froggett’s paper shows how for individuals the transformative effects of engaging in art projects depend on both recognition of exclusion and the invitation to participate in a collectively held creative illusion.

Grayson Perry, in his Reith Lectures, confronts the issue of beauty in contemporary art. His is the beauty of craft, delicate and decorative surfaces, drawing and design, colours and shapes. The content of his work is obviously conceptually challenging and it gets to us by stealth. Not his the Jake and Dinos Chapman route of punch your audience in the face with gross illustrations of horrific acts. This connects to the fact that ‘beautiful’ art needs to move us emotionally as well as challenge us intellectually. So much contemporary visual art dissociates itself from emotional authenticity and tries to impress us with self-conscious cleverness.

One suggestion I have is that we need to change the ‘future narrative’ of arts and health work by arguing the case for the importance to the artist of engagement in participatory arts and health practice. What could be more stimulating, moving, revelatory even, than working with people whose life experiences go well beyond our own comfort zone and encompass life and death issues? It is not that the artist thereby uses other people’s experience to feed their own practice but rather that the reciprocal process of co-production is an equal exchange of experiences and creative processes that is fascinating for both sides.

Finally a more mundane aspect of transformation but one that would endear us to health professionals and funders is proving the effectiveness of the arts in changing behaviour. Self-efficacy, the individual’s impression of their own ability to perform a demanding or challenging task, is the basis for many behavioural change theories. Learning theories tell us that complex behaviour is learned gradually and social cognitive theory that behavioural change is determined by environmental, personal and behavioural elements which all interact. In recent years there has been an increase in interest in energy consumption reduction based on behavioural change, which supports the criticism of a too narrow focus on individual behaviour and a broadening to include social interaction, lifestyles, norms and values as well as technologies and policies – all enabling or constraining behavioural change. This is the landscape in which we need to consider the purpose of the arts. Their role in empowerment and endowing self-efficacy; their complex relation to lifestyles, norms and values; their intellectual as well as their emotional potential. It is not behaviour change imposed because of some statistical evidence of the resulting reduction in costs to the NHS that we are after, but rather inspiring participants to pursue more imaginative and fulfilling paths in their lives through their own volition.

This article is intended to provoke a response. If we consider ourselves to be cultural leaders we also need to be thought leaders for the field. I would like to invite you to write a piece in response to this, which we can include on the Arts & Health South West website and in one of our monthly newsletters to 600 members.


Alex Coulter

AHSW Director

February 2014

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