It’s my pleasure to share this excellent article from one of my students, Eleanor Bones. Eleanor wrote this essay as part of her coursework for the Art Therapy Certificate Course.
Enjoy.
Robert Gray
Director and Senior Lecturer at CECATRegistered Art Therapist and Psychologist
MA A. Th., AThR; B. Soc. Sc. (Psych.) (Hons.), MAPS.; BA. Theol. (Hons), MA Theol.
Cancer & Art Therapy – A Personal Perspective
Choosing a topic for CECAT’s art therapy essay became very personal as I recently went through cancer treatment and now years of monitoring to follow. Added to this is my fine art background and year of pranayama and meditation qualification. These have all informed my decision to explore further the use of art therapy in the oncology field of healthcare.
This area varies greatly in the services it provides to patients. It can change from public to private system, state to state, and from country to country. A patient generally does not know that alternative health support services are available, and I believe they have a valuable role to play. Having personally experienced the full process of treatment and visited various medical practices, I can now share what knowledge I have to help support other people. My choice to reflect on cancer is because it is the dreaded ‘C’ word which immediately causes fear and anxiety. Due to the toxic nature of the treatment, it is situated in a separate area of the hospital. The illness and treatment is a full sensory assault on the human psyche and body. The duration of treatments requires stamina, bravery, and a spirit that has determination and hope. It is interesting to note that some practitioners prefer the word ‘acceptance’ to hope. This may sound defeatist at first but as one may find out – acceptance leads to less anxiety because the body is not using valuable energy fighting the prognosis and this can instead be put towards healing.
Firstly, let us pause to consider more holistically, what helps a patient recover? The outer environment is an important area that is often not considered due to patient relevance and budget. People are composed of mind, body and spirit and this aspect is recognised for children’s wards which in turn are colourful, positive and uplifting. Adult wards tend to be places of sterility, gloominess and austerity. Therefore, my first reflection would be that positive art therapy activities and their outcomes are used to decorate some of the walls and surrounds. If they agree to hang their personal artwork it would be images on paper and sculptures. This is a therapeutic process and the rewards keep giving as present and future patients, carers and staff, can enjoy the outcomes. These are also art images to reflect upon, much like viewing artwork in a gallery.
Knowing that these artworks and areas need to be clean and minimal for hygiene reasons I feel an exercise that could be acceptable is origami crane folding.
This is inspired by Sadako and the 1000 paper cranes (a well-known life story of a young Japanese cancer patient after WW2). The finished hanging mobiles from patients could be displayed for everyone’s enjoyment as they are colourful, and uplifting. This is an individual or group activity that could be done in waiting rooms. It is a much-needed single-point focus activity that helps calm and clear an anxious mind as well as passing the time while waiting for appointments, or during treatment sessions. The cranes can be written on or decorated before or after construction with words of encouragement, love and anything else that the person needs to express. The patients often sit in familiar groups that are going through procedures along the same time frame so it can be a conversation starter. This then has the potential to become a support network. Separate from this, support carers can also participate if appropriate, which I feel is important to consider as they are often also experiencing a lot of fear and anxiety.
This is an external positive environmental approach which would be done in conjunction with more personal individual approaches such as the “early childhood inner resources task”. (Gray, 2019, pg18-24).
Emphasis needs to be placed on the positive memory so clients don’t slip into a negative place which is easily done in this stressful situation. Art ‘in’ therapy is applied to the artwork and hopefully, it will help contribute to inner resilience and an image to focus on when feeling overwhelmed.
“People who are seriously ill often have two explanations for their condition, one spoken and one unspoken. The spoken is a description of their condition based on knowledge of the physical aspects of medical diagnosis and treatment. The other, the unspoken one, is a more personal and often private perception of their illness.” (Malchiodi, 2007, Pg 176).
This explains beautifully the dichotomy of the logical and then the very emotional in regards to a serious illness. The ‘unspoken’ needs to somehow be expressed to deal with the heavy baggage that a patient is silently carrying around. In yoga, we are asked to leave our ‘baggage’ at the door and fully be in the NOW and relax. So too with art therapy – we are given an opportunity to express known and sometimes unknown feelings to help lighten our psychological load.
Another positive approach is to begin an art therapy journal. This allows a private space to monitor and express reactions to invasive treatments and physical discomfort. It can help build an awareness of inner and outer body experiences and often highlights a sense of loss of control of one’s own body. Physiologically, losing the sense of smell and taste and the fear of maintaining weight are all major depression triggers. Individual responses are many and varied. Continual art journaling can be a way of releasing thoughts and emotions that no words can adequately express. In art history, this kind of ‘doodling’ or journaling is an activity called ‘automatic drawing’. Joan Miro, Jackson Pollock and Andre Masson are examples of this.
“They believed that this kind of drawing could reveal levels of awareness and meaning impossible to divine in any other way” (Aimone, 2009, pg 24).
The journal allows you to privately and with no pressure or influence- ‘notice what you notice’. Gazing with contemplation at your artwork can promote harmony and peace. It is a tactile and safe place you can go to enjoy expressing the language of the image world and allow samskaras (past mental impressions) to surface in their own comfortable time- according to the client’s mental strength.
A new understanding of self through continual slow observation, via what seems to be simple daily images can reveal surprising information to the journal maker.
Having been in this situation this is spot-on. It gives the feeling of ‘space’ to not think, to heal and gain inner strength.
As Rubin explains,” …the conscious orientation toward benefit-finding, toward mining our most difficult circumstances for bedrocks of strength and resilience.” (Rubin, 2016, pg 259).
Another option is journaling in the form of mandalas.
“Mandalas images often appear in a person’s expressive work when he or she is undergoing a dramatic change or overcoming a difficult personal situation. People who are experiencing serious illness or a life crisis may spontaneously create mandala images when they are physically or emotionally healing” (Malchiodi, 2007, pg 123).
Using colours, forms, lines and shapes all express things that may not want to be spoken but are revealing themselves as an emotional release – like a kettle boiling, and the whistling is the image that needs to come out to release the client’s internal pressure in the situation.
When having treatment, the personal mandala can also be used as a meditative focus point for the patient to recall in the ‘third eye’ or gaze onto – while in the treatment room. This can give a person an anchor, or you could say, helps them feel grounded. Physiologically it also helps to minimise the overproduction of adrenaline which leads to depression, trouble sleeping and anxiety.
I did a three-month journal of mandalas and found the process to be a mixed bag of reactions. It could be among other feelings – soothing, emotional, and revealing. Upon reflection now I can see that what is left out of a mandala is as telling as what is in it. The negative space can be part of a conversation as well.
The mandala example shown below is another art as therapy experience that I took part in at the Brisbane Botanical Gardens. It was a horticulture class based on drawing and painting plant cells. Each person could choose the plant or image that they were attracted to and then draw their own interpretations.
This is an example of how collaborative and adaptable art therapy can be for any client, and the preferences they may have to help them heal. It is a positive experience as you are expressing yourself as well as socialising and being in a natural environment rather than the hospital. Being amongst nature feels uplifting for most people.
Colour is an element that may become an allegory or symbol for the individual to understand. If the client is doing a daily journal, they can monitor their own expression over a period of time and if a new design element or colour appears this may indicate a shift in thinking, or physical health. The patient’s choice of colour that they intuitively feel they are attracted to each day would be a form of personal data. It is the person witnessing the subtle energy thoughts and emotions of their body being represented by colour. As simple as this sounds it is often a surprising revelation to people who do not often associate with art activities. This is then a source of information for therapist and client to discuss further.
For example, during my treatment and post-recovery the shades of black made me feel very uncomfortable and not a healing, energising colour to have near me. Yellow was a colour I was drawn to and kept wanting to have in my personal environment as a daily ‘pick-me-up’. Further to this, it can be seen each day in daily life as people are drawn to certain works of art or objects and often don’t know why or even that they are doing it. This could be the colour, forms, composition, content, the elements are many. It indicates how the unconscious is drawn to helpful resources to self-heal, and the reasons can be very diverse and changeable.
If a different technique is required due to clients’ reticence to paint or draw, the use of collage, or Schipsel (paper cutting), also opens up the client to unconsciously expressing themselves in a playful, non-demanding way. Added to this is a period of quiet ‘gazing’ or contemplation so they can ‘witness’ what their body, mind, and spirit are trying to communicate. Gazing can also be likened to a form of meditation.
The American artist Mark Rothko, who can be placed in the Colour Field works of art, did this style to show the human spiritual response to colours and to help tap into emotions while focusing on various colours. It is interesting to note that in later years when Rothko suffered from depression the ‘fields of colour’ he painted were blues, greys and blacks.
Whilst I recognise psychological assessment must be done to address the patient’s underlying anxieties, I think this needs to be balanced with sessions of positive art therapy exercises so the outcomes can be used as coping mechanisms for the different treatment phases. This can be many weeks in duration and then the shadow of recovery can be many years. The process is often life-altering and distressing. For example, the immobilisation mask used for radiation and the trauma it may cause.
A further art therapy activity that has proven successful is the end-of-treatment and mask decoration workshop. A mask exhibition has been a successful form of therapy and group participation. Not all people have the same response of course and one mask activity that was enjoyed by one patient was running it over with his tractor several times! Each response is cathartic in its own way.
And lastly an idea that I thought may be helpful for a patient who is very drawing adverse but is perhaps word orientated—a bridge to art therapy artwork may be seen in this presentation given by Lynda Barry at a Graphic Medicine Conference. The YouTube lecture link is in Further Information.
Whilst her books and work may seem naive or ‘odd’ to some, I think she encourages communication in a non-threatening, open and encouraging way that people respond to. This can then merge into art therapy sessions.
Prior to an art therapy activity, a short focused breathing exercise could assist the patient in relaxing mentally, emotionally and physically and therefore getting more enjoyment and clearer expression from the art therapy session. Thoughts, images and emotions can more easily ‘bubble up’ to the conscious mind. Two beneficial forms of relaxation techniques are Nadi Shodhana breath work or Yoga Nidra body relaxation for the very anxious.
Reflecting on my own personal experience and abilities I can say that a collaboration that creates a balance of art therapy, pranayama (the science of the breath) and meditation would be an invaluable support for emotional, physical and spiritual wellbeing.
As Buddhist philosophy suggests, there are many paths up the mountain, and I believe art therapy, in the cancer treatment hospital situation, would be a great option for patients to consider. It is also a resource that an individual can easily learn to use as a tool to draw upon at any further stage in their life.
Sources
Aimone, S. (2009). Expressive Drawing: a practical guide to freeing the artist within. Lark Books, New York: NY.
American Art Therapy Association, (2019, May). The Art of Origami: An Art Therapist Explains its History and Use in Trauma Work. Retrieved from American Art Therapy Association: Arttherapy.org
Barry, L. (2019). Making Comics. Drawn and Quarterly: Malaysia.
Gray, R.P. (2019). Art Therapy and Psychology. New York, Oxon: Routledge.
Hoe, A. (2016, 10 June). Cancer survivor calls for better guidelines to prepare patients for radiation therapy. Retrieved from ABC Radio.
Malchiodi, C.A.(2012). Handbook of Art Therapy. The Guildford Press, New York: NY.
Malchiodi, C.A.(2007). The Art Therapy Sourcebook. McGraw-Hill, New York: NY.
Saraswati, S.N. (2009). Prana and Pranayama. Munger, Bihar. Yoga Publications Trust: India.
Saraswati, S.S. (1976). Yoga Nidra. Munger, Bihar. Yoga Publications Trust: India.
Rubin, J.A. (2016). Approaches to Art Therapy. Routledge: New York: Oxon.
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