Over the weekend, I was honored to get to share some of my thinking about healing art in hospital environments with an delightfully engaged audience at Healing Arts Houston: Innovation in Arts and Health. I also attended compelling presentations by scholars and arts leaders who have made tremendous contributions to the field of Arts in Health, often without having considering themselves as part of what was being described by the conference hosts as a “movement.”
I came away from the weekend with a couple of useful ideas that I think will help to clarify our thinking about visual art in hospitals.
The first has to do with – and helpfully complicates - the concept of “positive distraction,” which is often the primary desired purpose of a work of art in the Environment of Care. We are starting to see the utility of other purposes, but this first purpose supports patients and family by distracting them from their circumstance, from their feelings of pain or distress, from thinking about or focusing on their ailing bodies. Positive distraction lays a claim on our attention, and can even lay our attention to rest for a period. According to “attention restoration theory” – originally associated with exposure to nature, and then extended to exposure to art depictions of nature – positive distraction alleviates mental fatigue and stress and can return to us to our ability to focus. These outcomes are important in the inherently stressful hospital environment, where people may be feeling worried or alone, but are still required to think and talk about their condition and their plans of action with their doctors and family.
A comment from the audience very helpfully clarified the concept by way of recognizing the contrary value placed on efficiency in the healthcare system. Offering the patient a distraction would seem to lay an obstacle in the way of efficiency, would it not? Inefficient systems, or inefficient patients, are just not as cost-effective, wasting time and attention, soaking up the system’s resources.
In my presentation I had briefly evoked a poorly design healthcare environment as part of the basic story of EBD, as what came “before” design practices were improved with empirical findings.
The difference is plain when you think of what most hospitals used to look and feel like, or what they still look and feel like in under-resourced communities: impersonal, confusing to get around in, noisy, and privileging the comfort and status of the physician over the patient. It may seem like a no-brainer than that the built environment has direct effects on the health and well-being of its users, but that insight has only in recent decades made a difference to how hospitals are planned, designed, and built.
I will usually describe the work of design as a process of making decisions, and call for consideration of how the decision was made to, say, hang this picture in that location. And I will usually assume that these decisions are made deliberately so that it is possible to inquire into their meaning and purpose. Accordingly, bad design should be attributed to poor decisions.
Knowledge born of experience will tell of healthcare spaces today where bodies are processed efficiently that no resources can be spared for other considerations, including the consideration of the human need for culture and connection, including visual art. Such considerations would introduce costly inefficiency to moving bodies through the healthcare system. This is a picture of the under-resourced hospital.
Framing the concept of “distraction” in opposition to “efficiency” tellingly illuminates how design choices are made when certain bodies are routinely subject to the rule of efficiency at the cost of other considerations.
It may be true that no individual person decided to withdraw access to art because resources could not be afforded to it. It may be true that no one willfully intended to deny anyone the dignity of coherency and self-identification that are possibly afforded by access to nature and art. In matters of design, neglect and inattention are decisions too.
It may be true that cash-strapped hospital systems have few, if any, resources to spend even on cheap posters and faded, second-hand prints. But the allocation of those resources to begin with exposes the flawed design choices of our policymakers and our medical, insurance, and legislative systems.
We can make better choices.