Evidence-Based Art

EVIDENCE

BASED ART

G K ROWE , XD Cited by the U.S. National Library of Medicine

Many of us Gen Xers are at the cusp of caring for our community in a time when our healthcare system is at the edge of a major breakthrough or on the verge of a major breakdown. As a result, there are multiple concepts gaining progress related to aesthetics in the healthcare environment. One of these earliest concepts is Evidence-based Design or Evidence-based Art. “Evidence-based Art is the process of basing decisions about art in healthcare on credible research to achieve the best possible outcomes.” The question should be what is the credible research? Artist and physician, Henry Domke, MD has an article on his blog titled Where’s the Beef? The Evidence for Evidence-based Art and Dr. Ruth Brent Tofle suggests “designers are embracing it without realizing that this is such a new field that we don’t know much [about] yet.”

While Evidence-based Art has elevated the importance art plays in the enhanced care of patients, I think much of the research lacks the inclusion and credentials from fine art professionals. Within my studies of Evidence-based art, there is little attention given to art educators, artist, curators or historians; yet, when you compare the studies done in neuroscience with art history, it is apparent that science is behind the times when it comes to understanding the relationship between woman or man and art. With the advancement of technology and neuroscience, scientists are rapidly gaining more information about the master “minds” of artists. Most of the findings in Evidence-based Art today are done through controlledgroup questionnaires developed from healthcare professionals, academics and art consultants. While their findings are significant, I think it is dangerously premature to begin establishing standardized processes used in patient-focused aesthetics. Making such claims as “abstract art is the worst” is inconsistent with our cultural evolution with visual images.

Furthermore, there is power in both knowledge and fear and I would suggest that many art consultants will be eager to own a piece of this conceptual pie.

Formulating guidelines for Evidence-based Art is problematic because it attempts to define measurable outcomes based on a fraction of information gathered under diverse situations. According to studies reported by the Center for Health Design: A Guide to Evidencebased Art by Kathy Hathorn, MA, and Upali Nanda, Phd., reports “In the Biological Origins of Art, Aiken (1998) makes a scientific as well as philosophical argument for the emotional impact of art and its importance to humankind’s survival as a species.” Art has been an integral component of human evolution, both as a species and as a society. The report presents that images of nature are more appropriate in healing art based on the concept of “biophilia,” which was coined by Edward O. Wilson. Dr. Roger Ulrich, Ph.D., EDAC, further interprets this by explaining that “humankind’s evolutionary survival skills in a natural world have hardwired humans to find nature calming and restorative.” Furthermore, it is suggested that as modern humans we have an inherent connection to nature derived through our ancestors.

The research presented fails to comprehensively examine the evolutionary process of art and its impact on modern societies to more specifically enhance patients’ recovery through a process inclusive of nueroaesthetic concepts and experience design practices.

Taking a look back 30,000 years ago to the time when Nomadic people started making statues and images of the human body, we can begin to understand our connection to abstract art. The Venus of Willendorf, a relic of our ancient past, provides the first clue as to why our modern world is so dominated by unrealistic images. The Venus of Willendorf’s features are grotesquely exaggerated with the breast, stomach, hips, and thighs prominently enhanced. Carved with great care, the statue has no arms and the face is nonexistent. The statue would have been easy to carry and may have served as a symbol of fertility or motherhood. These features provide clues as to what was most important to the Nomadic peoples that lived in the harsh ice-age environment where fertility and fattiness would have been highly desired. In our modern society, we live in a world of abundance and can see examples all around us where we have continued to emphasize those features we most desire that are extremely contradictory to the environments in prehistoric times which was mostly defined by scarcity.

It would be unrealistic to claim that modern people respond to the same types of images that were important to their ancestors particularly if the images reflect our relationship to the environment in which we live. While early hunter-gatherers valued and emphasized fertility and fattiness in their culture, our modern knowledge-worker culture values are expressed in vastly different ways than those defining the Venus of Willendorf. “Over 10.2 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2008. The overall number of cosmetic procedures has increased 162 percent since the collection of the statistics began in 1997. The most frequently performed nonsurgical procedure was Botox injections and the most popular surgical procedure was breast augmentation.� This statistic alone reflects the values most important to our modern culture and the ways in which we have embraced aesthetics. As our modern society became more culturally diverse, what we chose to exaggerate changed even further. Similar historic references to the use of visual images are evident in the advancement of societies from gatherer-hunter to the conceptual age.

As one of the first settled civilizations, the Egyptians relied heavily on agricultural means of survival and adopted behaviors that led to the investigation and exploration of mathematics as it related to the human body. Their visual communication reflected that which was most fundamental to the civilization’s survival which thrived through structures, organization, and order. The images created consistently depict the values of their culture for more than 3,000 years until Egyptians started trading with the Greeks by way of the Mediterranean Sea. The ancient Greeks were preoccupied with mathematics and philosophy and with a fixation on perfection and beauty of the human body, inspired by their belief that Gods took human form. Similar to the Nomadic ancestors approach and purpose, the Greeks developed a highly skilled athletic body – filling their temples with life-like statues of their Gods and Goddesses to achieve an exaggerated reality; thus, exemplifying the values most important to their culture.

It wasn’t until the Renaissance period, late 14th to early 15th century, that art became Art and the creative thinkers gained the ranks of the elite and established themselves as Artists. Simultaneously, the influence of religion and humanism integrated with power and authority, gave way to narrative imagery with allegoric references throughout the Renaissance. Italy would experience the bubonic plague or the “Black Death” which would affect the economy, cause rapid expansion of hospitals and stimulate commissioned work of religious images.

Most of the theories developed for Evidence-based Art encourage the use of natural images derived from evolutionary concepts that support human connection to shelter and protection instilled from our ancestors; and, through emotional congruence or moodcongruence processing which implies that in a stressful situation negative emotions are likely to be projected on to the surrounding environment by a patient, which explains the adverse reaction to abstract or ambiguous art.

The Guide for Evidence-based Art reports, “Visual art can be traced as far back as the Paleolithic man’s cave art and continues to be an integral part of people’s live[s]. It’s a small wonder then, that the use of art in hospitals dates back to the 14th century, when they were church operated.” While it is apparent that Prehistoric humans had an affinity to their environment especially as it pertained to shelter and protection, it is more important to evaluate the relationship between artist and woman or man. It is also important to note that viewing appropriate nature images can reduce stress and reduce pain as reported through psychological testing and selfreporting surveys. So, why have we spent years producing abstract images that reflect our most fundamental values when they are reportedly inappropriate for enhancing our connection to our recovery process in a healthcare setting? Jeff Hawkins, founder of Redwood Center for Theoretical Neuroscience suggests, “Modern art, in its tendency toward abstraction, does not depict anything less realistic than art that depicts a human form or any other place or object in a more photo-realistic manner.

Rather, it is just depicting a different place in our brain: a place between the invariant (photo-realist) representations at the top of hierarchies, and the essential, raw sensory data of incoming input.”

Applying science to the arts expands the “evidence” in Evidence-based Art principles by identifying more acutely the impact art can have on clinical and behavioral outcomes for patient focused aesthetics.

V.S. Ramachandran, Director of the Center for Brain and Cognition and Professor with the Psychology Department and Neurosciences Program at the University of California, San Diego, is best known for his work in behavioral neurology. Ramachandran has explored the connection between the brain and art and has begun the investigative journey with the fourinch oolitic limestone sculpture Venus of Willendorf to better understand the “human artistic experience and the neural mechanisms that mediate it.”

Ramchandran uses the Peak Shift Theory to explain the behavioral response to images as they relate to life’s most fundamental necessities.

The Peak-Shift theory, a principle in animal discrimination, helps explain human pattern recognition and aesthetic preference. This is a fundamental resource to consider when practicing Evidence-based Art to fully understand human experiences with works of “art” from the Paleolithic period to modern day culture. This theory gives insight to behavioral responses to an aesthetic environment as it relates to survival. The study, using herring gulls, was demonstrated to explain neuro responses to abstraction. Adult herring gulls have large yellow beaks with a red dot that is significant to the visual response from herring gull chicks as it relates to their survival. The process of how young chicks respond to their mother’s beak for food is an important principle in understanding the evocativeness of much of visual art. When an adult herring gull has a grub in its beak, young chicks respond by opening their mouths wide and cheeping excitedly. This might seem like intelligent behavior on the part of a hungry youngster seeing food, but herring gull chicks are not very intelligent. If the red spot was painted yellow, the chicks ignore the food. Show them an empty beak with a red spot and they gape and cheep as before. In fact a bright red dot on a vivid yellow pencil elicits extra strong gaping and when presented with the option of large yellow stick with three red bands, the chicks favored the more abstract over the mother’s beak.

The peak shift effect can be applied to human recognition and aesthetic preference throughout the history of man creating images. Consider the way a skilled cartoonist produces a caricature of a famous face. The cartoonist takes the average of all faces, subtracts it from the subject’s face and then amplifies the differences to produce a caricature. The final result is a drawing that is even more like the original. The cartoonist uses the same fundamental principles learned and used by the Nomadic peoples to create the Venus of Willendorf. In our modern culture, we respond to caricatures in much the same way sea gull chicks responded to the exaggerated abstraction of their mother’s beak. It can be argued that a Picasso portrait is nothing more than a caricature - when you compare the subjects to the paintings, their similarities become obvious.

“Despite all that has been said, there might appear to be an important disanalogy between science and art.

Scientific understanding has an object – the natural world or physical universe. This is what the scientists’ theories are about. But we have yet to state clearly what artistic understanding is about. In terms of focus, an artistic process is concerned with issues of look-andfeel, whereas a scientific approach focuses on deeper, more systematic issues like underlying architecture. In terms of methodology, art relies on intuition and experience, whereas science depends on rigorous investigation and analysis. In terms of validation, an artled process often rests on subjective or personal evaluation, whereas a process that’s grounded in science relies on rigorous testing using quantitative metrics.”

I don’t disagree with the concept of nature-based art and being sensitive to subject matter that will potentially enhance a patient’s recovery process; however, I’m not convinced by the data presented that “ambiguous or detrimental visual elements (including art) may have emotionally, and even physiologically, harmful effects.” Most of the data collected has been through focus groups, questionnaires and surveys, which are poor tools for learning about behavior since they are documented by actual use; and, what people actually do can be different from how they think they do or what they say.

There needs to be more quantitative data collected through neuroscience to make these types of judgments; that said, since we all judge the world through our own experiences it may be that we will never be able to properly define what artwork is appropriate for a patient other than the patients themselves. For now, it is important to continue the dialogue between artists and scientists about the possibilities and limitations surrounding aesthetics in healthcare. Reports indicate that less than two percent of design decisions are based off of solid evidence. Evidence-based Art is significant to the role art will have in the future development of healthcare facilities. Having the best research is not enough. It is imperative to the process that observations, insights and practices carry over to advance aesthetic decisions. At the end of the day, I think all art consultants that work in the healthcare industry should be participating in the practices of Evidencebased Art by continuing to learn as much as possible about the field by implementing, evaluating and questioning the research to improve and enhance the aesthetic environment in healthcare.

There needs to be more quantitative data collected through neuroscience to make these types of judgments; that said, since we all judge the world through our own experiences it may be that we will never be able to properly define what artwork is appropriate for a patient other than the patients themselves. For now, it is important to continue the dialogue between artists and scientists about the possibilities and limitations surrounding aesthetics in healthcare. Reports indicate that less than two percent of design decisions are based off of solid evidence. Evidence-based Art is significant to the role art will have in the future development of healthcare facilities. Having the best research is not enough. It is imperative to the process that observations, insights and practices carry over to advance aesthetic decisions. At the end of the day, I think all art consultants that work in the healthcare industry should be participating in the practices of Evidencebased Art by continuing to learn as much as possible about the field by implementing, evaluating and questioning the research to improve and enhance the aesthetic environment in healthcare.

GK ROWE, XD is an Experience Designer and Principal Partner, Director of Creative Development for Q7 Associates a multimedia marketing and design firm located in Indianapolis Indiana. GK has formal education in Fine Arts, Design, Natural Wellness and Education including studies abroad in Italy, London and Paris. He continues to infuse creative solutions and experience design concepts into the business world through multidiscipline mediums applying neuroaesthetics in the healthcare, hospitality and corporate industries.

Committed to a higher level of aesthetics, GK serves as the President for the Indianapolis Museum of Contemporary Art Society, co-developed the art program for the InterContinental Chicago-O’hare hotel and continues to support art education as a faculty member at the Art Institute of Indianapolis and is a member of the National Arts Education Association.

REFERENCES Domke, Henry. "Where's the Beef? The Evidence for Evidence-based Art". Health Care Fine Art. May 2006 <http://www.healthcarefineart.com>.

Gordon, Graham. Philosophy of the Arts: An Introduction to Aesthetics. New York: Routledge Taylor and Francis Group, 2005.

Jeff , Hawkins. "The Cellular Architecture of Abstract Art".

The Beuatiful Brain. 2009 <http://www.thebeautifulbrain.com>.

Kathy, Hathorn. "A Guide to Evidence-based Art".

The Center for Health Design 2008: 1-20.

"Liposuction No Longer the Most Popular Surgical Procedure According to New Statistics". American Society for Aesthetic Plastic Surgery. 2008 <http://www.surgery.org>.

Peck, Richard. "Emerging trends in healthcare". Health Care Design Magazine March 30, 2010.

V.S., Ramachandran. "The Cellular Architecture of Abstract Art". The Journal of Consciousness Studies. 1999 <http://www.imprint.co.uk/rama/art.pdf>.