9781529935530

Diet. Sleep. Exercise. Nature. Art? Discover why the arts are the forgotten fifth pillar of our health.

‘Art Cure elegantly distils the evidence for what we have always intuitively felt; that music, literature, cinema and art are powerful universal remedies. Best of all, it shows us how to utilise the arts to make simple, health-enhancing changes in our own lives. A glorious read.’

Gillian Anderson

Daisy Fancourt is Professor of Psychobiology and Epidemiology at University College London, where she heads the Social Biobehavioural Research Group, and Director of the World Health Organization Collaborating Centre for Arts and Health.

She has published 300 scientific papers, won over two dozen academic prizes, and is listed as one of the most highly cited scientists in the world. Daisy is also a multi-award-winning science communicator and has been named a World Economic Forum Global Shaper and BBC New Generation Thinker.

‘This rigorously researched, scientifically informed book offers hard evidence of the value of participation in the arts for everyone . . . It could not be more timely, nor make a stronger, more urgent case for placing the arts at the centre of our communities.’

Melvyn Bragg ‘Every day we are overwhelmed by advice on how to live better: diets, gadgets, supplements, exercises and a million other things. Art Cure is an amazing antidote to the deluge of nonsense. Its evidenced-based advice is for joyful, meaningful things that will expand our lives and our minds and help us take charge of our health.’

Xand van Tulleken ‘Thoughtful and carefully argued, Art Cure consistently speaks good sense. It offers a comprehensive, reasoned case that will resonate.’

Philippa Perry ‘Imagine a dinner conversation with the smartest, most compassionate person you know, talking until the wee hours on science and beauty, and you will have some idea of what it is like to read this book.

Fascinating, comprehensive, compelling, inspiring.’

Dr Christopher Bailey, World Health Organization

Cornerstone Press Penguin Random House One Embassy Gardens 8 Viaduct Gardens London SW11 7BW

www.penguin.co.uk

Jacket design by Luke Bird Images by Adobe Stock Author photo © Tom Burton ISBN: 978 1 529 93553 0

Art Cure Daisy Fancourt

‘A book for our times’ Gillian Anderson

Art Cure Daisy Fancourt

‘Everyone should read this’ Xand van Tulleken

‘A revelation’ Melvyn Bragg

The Science of How the Arts Transform Our Health

Many of us consider making and consuming art to be a hobby, or even a luxury. But what if arts engagement – from classical music to salsa, poetry to pop concerts, galleries to graffiti – was in fact one of our most powerful tools for unlocking health and happiness? What if the arts could help you live longer – and even save your life?

In Art Cure, Professor Daisy Fancourt reveals the life-changing power of the arts: Songs support the architectural development of children’s brains. Creative hobbies help our brains to stay resilient against dementia.

Visual art and music act just like drugs to reduce depression, stress and pain. Dance builds new neural pathways for people with brain injuries. Going to live music events, museums, exhibitions and the theatre decreases our risk of future loneliness and frailty. In her work as Professor of Psychobiology and Epidemiology at University College London, Fancourt has seen how engaging in the arts improves the functioning of every major organ system in the body. Art helps us not only to survive, but to thrive and flourish.

Informed by the results of decades of scientific studies, Art Cure explains why the arts – alongside diet, sleep, exercise and nature – are the forgotten fifth pillar of health, and gives you the tools to write your own ‘arts prescription’.

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781529 935530

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CORNERSTONE PRESS UK | USA | Canada | Ireland | Australia India | New Zealand | South Africa Cornerstone Press is part of the Penguin Random House group of companies whose addresses can be found at global.penguinrandomhouse.com Penguin Random House UK, One Embassy Gardens, 8 Viaduct Gardens, London SW11 7BW penguin.co.uk

First published 2026 001 Copyright © Daisy Fancourt, 2026 The moral right of the author has been asserted p. 33: Double Portrait of Van Gogh, Oleg Shupliak, 2011, used with permission. p. 34: M.C. Escher’s Relativity © 2025 The M.C. Escher Company-The Netherlands.

All rights reserved. www.mcescher.com p. 93: William Utermohlen images, Self-Portrait, 1967, Self-Portrait (with easel – yellow and green), 1996, Self-Portrait (with easel), 1998, Head I, 2000, courtesy of Chris Boïcos Fine Arts, Paris.

No part of this book may be used or reproduced in any manner for the purpose of training artificial intelligence technologies or systems. In accordance with Article 4(3) of the DSM Directive 2019/790, Penguin Random House expressly reserves this work from the text and data mining exception.

Set in 12/14.75pt Dante MT Pro Typeset by Six Red Marbles UK, Thetford, Norfolk Printed and bound in Great Britain by Clays Ltd, Elcograf S.p.A. The authorised representative in the EEA is Penguin Random House Ireland, Morrison Chambers, 32 Nassau Street, Dublin D02 YH68 A CIP catalogue record for this book is available from the British Library ISBN: ​­978–​­1–​­529–93553–​­0 (hardback) ISBN: ​­978–​­1–​­529–​­93554–​­7 (trade paperback) Penguin Random House is committed to a sustainable future for our business, our readers and our planet. This book is made from Forest Stewardship Council® certified paper.

For Tom, Adeline & Daphne

Contents prelude Do we need art? 3 What even is art? 14 mind, brain, body, behaviour 1. ‘A thing of beauty is a joy for ever’: Arts for ​­well-​­being 29 2. ‘Help me if you can, I’m feeling down’: Arts for mental health 55 3. ‘A muscle that can move the world’: Arts for brain health 79 4. ‘Get into the groove’: Arts for movement 113 5. ‘I will try to fix you’: Arts for stress and pain 135 6. ‘Ain’t misbehavin’’: Arts for health behaviours 160 7. ‘I will survive’: Arts for longevity 190 coda Why aren’t we doing more arts? 217 How do we fix things? 228 Acknowledgements 245 Notes 247 Index 329

Prelude

Do we need art?

Russell stood with his hand on the door, wondering whether to go in. It just wasn’t his scene. He was only here because his doctor had told him to come.

It had started with a stroke. He’d been walking home from work when the blood supply to the base of his brain became blocked and the world careened sideways. He’d had to relearn to walk, to talk. There had been months lying in bed staring at the ceiling and panicking about his future. He’d developed back pain so bad he couldn’t sit up. He’d lost his job, his relationship with his partner fell apart, he couldn’t play with his son any more, he put on weight, he couldn’t sleep. When he did sleep, his breathing kept stopping, so he had to wear a mask over his head at night, blowing air into his lungs to keep his airways open. His doctors prescribed dozens of pills, but new problems kept accumulating. He felt himself spiralling down into depression.

When his doctor first wrote the prescription for eight weeks of art classes, Russell thought for a moment it was some sort of joke.

How was art supposed to help? But he didn’t feel he had anything to lose any more, so he opened the door.

The first class wasn’t as bad as he’d expected. He didn’t paint, just watched the others in the class. But somehow just being around the paints, the colours, and the calming atmosphere had an impact, and on his way home he noticed his breathing was slower and deeper and he felt a bit calmer than he had walking in. The next week wasn’t as daunting. He recognised a few of the other people. Again, he didn’t do any art. But that night he couldn’t sleep, so he snuck outside and sat in the shed in the garden, doodling little caricatures of the 3

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people in the art group. In the third class, he picked up a paintbrush.

Russell’s still not sure how things escalated so rapidly after that, but a few weeks later, he found himself standing in front of the art group to announce an idea he’d had: to paint portraits of them all.

I first met Russell at 6 a.m. in the basement cafeteria of a Premier Inn in Manchester. We were both waiting to go on television for the BBC Breakfast news show to talk about a new proposal to roll ‘arts on prescription’ across the National Health Service. Over cups of instant coffee, I tried to grasp the magnitude of the experience he was telling me about.

At the next ​­check-​­up, Russell explained, his doctor was pleased with his progress. His mood had improved and his pain levels were lower. Even his blood pressure was better. The art class gave structure to his week, and he found himself looking forward to it.

At the following ​­check-​­up they started to review his ​­medications – ​ the doctor didn’t feel he needed as many. His sleep was better too.

As his portraits neared completion, Russell approached the Museum of Gloucester to ask if they would allow him to host an exhibition of the paintings in their café. He called the exhibition ‘We’re All Mad Here’. His classmates and his doctor were amongst those who attended. He received his first commission shortly​ ­afterwards – ​a nurse who had come to the exhibition wanted him to paint her children. That was just the beginning.

In the decade since, Russell Haines has exhibited his artwork all around the UK, from Gloucester Cathedral to the Tower of London. His pieces sell for thousands of pounds (if you can get your hands on one fast enough). He’s been leading his own classes back in the community too, and his doctor has been referring more patients to him. He doesn’t take any pills nowadays. He hasn’t even had to visit his doctor in over a year.

I asked him, ‘How great a change do you think those art classes actually made for you? How big of an impact are we talking?’

He didn’t miss a beat.

‘They saved my life.’ * 4

Prelude

Do you remember the first album you bought? The photograph you loved so much you framed it? The show that you spent hours queuing to get tickets to? The poster you had above your bed when you were growing up? I probably don’t have to try too hard to convince you that we are ​­all – ​in some way or ​­another – ​consumers of the arts. Our tastes may differ: your music may be my noise, my street art your graffiti. But we all engage. In fact, we do more than that. Have you ever hummed a ​­made-​­up tune in the shower? Doodled in your notebook when you should have been working? Taken a photo on your phone? Danced (however awkwardly) at a party?

Improvised a bawdy limerick? However much you might resist the labelling, protest that you’re not ‘artistic’ or ‘creative’, the evidence is to the contrary. We are also all producers of art. We are a planet of 8 billion artists.

Tangible evidence of our artistic prowess as a species can be traced back 40,000 years. Around this time, a remarkable evolutionary development meant that Homo sapiens became capable of performing three advanced cognitive processes at the same time: mentally conceiving an image, intentionally communicating this image, and attributing meaning to it. This resulted in the first physical examples of art that still survive today: stone figurines, bone flutes, ​­animal-​ ­skin drums, cave paintings, heel prints in rhythmic patterns. Art subsequently accompanied human beings as they spread across the globe. Every culture and society has art. We use it to express every emotion, every experience: love, hatred, war, politics, peace. Art awakens our passions, causing public outcries, protests and riots.

Humans idolise artists as demigods, make pilgrimages to see them perform. Artworks are preserved for thousands of years to enshrine their beauty, bought for more than their weight in gold, and sent for preservation on the moon. Art is so incomprehensibly beautiful it has inspired more art about itself. On average, we read 700 books in our lifetime, watch 5,000 films and listen to 1.3 million songs. Over 300 million of us attend a live music event each year. The global cultural sector provides nearly 30 million jobs worldwide and has an estimated worth of $4.3 trillion a year. As a species, we are obsessed.

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Yet despite this obsession, for most of the past 40,000 years we have failed to reach a consensus and provide a coherent scientific answer to a fundamental question: is art good for us? Not in the vague sense of being positive and pleasant, but actually having tangible, meaningful effects on our health?

It’s a question that has bewitched some of the greatest thinkers in history. Among the Greek and Roman philosophers, Aristotle argued that theatre could restore balance to the heart, Pythagoras is credited with using music to purify the soul, and Boethius believed music could rebalance fluids in the ​­body – ​all actions thought to make people ‘well’. Persian philosopher Ibn Sina referred to the arts more than 150 times in his encyclopaedia of medicine. And Italian philosopher Marsilio Ficino argued music could cure melan­ cholia. We also find the arts embedded in every medical tradition.

The ancient Egyptians believed engraved gems, bone statues and drawings could dismiss evil spirits responsible for illness. The indig­ enous Indian medical system of Ayurveda promoted the use of soft sounds and pleasant sights to aid digestion. In Arabic medicine, the arts were prescribed to improve sleep. In fact, anecdotes of the healing powers of the arts across the past two millennia abound. Music, dance and art have stopped wounds, quelled plagues, restored the ability to walk, cured tarantula bites and even awakened patients from the dead.

The problem with all of this, as you may have surmised, is sepa­ rating the wheat from the chaff ​­ – ​identifying the credible reports of genuine health benefits amidst the myth, magic and superstition.

But in the past few decades, science has come to the rescue with an explosion of research ​­studies – ​over 30,000 empirical papers published to date, cataloguing a remarkable body of evidence.

My own journey to discovering this evidence arose when I found myself unable to choose between arts and science. We often talk about the two as though they’re strangers, but in fact many of the most famous scientists and medics across history have also been artists, and vice versa. The distinction between art and science would 6

Prelude

barely have been comprehensible to the likes of Leonardo da Vinci or Robert Hooke. But the pursuits of such lauded figures as these were little consolation to me at the age of seventeen when I was deciding what to study at university.

I plumped for the arts and went to read music at Oxford University, performing in my spare time as a pianist for the radio station Classic FM. But I couldn’t shake the science. I attempted to analyse pieces of music using mathematical formulae, wrote essays comparing the structure of music to biological cells, and dug up obscure archival records about the use of music in medical contexts.

In my second year, when an opportunity arose to do an internship delivering arts workshops in a paediatric hospital as part of a new programme called ‘Singing Medicine’, I couldn’t have signed up any faster. In my postings, first at Birmingham Children’s Hospital and then at Oxford’s John Radcliffe Hospital, I worked on neurology, cardiology, oncology, and palliative care wards, singing with the children to distract them during injections and dressing changes, cheer them during examinations, connect them with their life outside the hospital and give brief moments of respite to their exhausted parents. I absorbed every detail I could about the inner workings of a ​­hospital – ​the science of how care was delivered, the rhythm of ward rounds, the rigours of infection control, and the careful dance of ​­staff–​­patient interactions.

When I left university, I fell into my dream job: designing and implementing a performing arts programme at the Chelsea and Westminster Hospital in London. For three years, I ricocheted bet­­ ween wards, setting up weekly concerts in the atrium, recorded music in surgical waiting areas, dance classes for stroke patients, concerts on the HIV ward and singalongs for dementia patients, and developing partnerships for the hospital with arts organisations from the Royal College of Music to the Chickenshed theatre company to Rambert Dance Company. But I felt an increasing frustration.

What I was doing was seen by many of the staff and patients as ‘entertainment’ staged between long periods of television watching. Yet what I was seeing was quite different: the surgical patient 7

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whose panic attack stopped when she saw the digital arts light box we installed; the child with burns who was so distracted by the dance performance he didn’t need the morphine; the patient in intensive care whose blood pressure decreased when we played his favourite music. I wanted to know why this was ​­happening – ​to analyse the processes occurring in the brains and the bodies of these patients that might explain the effects I was seeing.

So I left the hospital to pursue science. For the next few years, I immersed myself in psychology, immunology and statistics. I spent my time completing psychiatric questionnaires with patients; learn­ ing to collect saliva samples and process them in the lab to identify levels of stress hormones and immune markers; and writing reams of statistical code on my laptop. I covered the walls of my room with diagrams of the brain, classifications of immune cells and anatomi­ cal drawings of hormone glands. I eventually graduated with a PhD from University College London (UCL) in psychoneuroimmunol­ ogy, my thesis charting the effects of music on stress hormones and inflammatory markers in different patient groups. Over the years since then, I have worked in universities and hospitals, running clinical trials (just like those carried out for drugs) on the medical impact of the arts, conducting lab experiments to ‘zoom in’ on the psychological and biological mechanisms behind these health benefits, and analysing dizzying amounts of data from hundreds of thousands of people tracked over decades of their lives to quantify the impact of the arts on the health of societies as a whole. I now lead the Social Biobehavioural Research Group at UCL, where I am Professor of Psychobiology and Epidemiology, and my team and I spend our days discovering the incredible ways that the arts (and other social behaviours in our lives) impact on our health. In 2021, the World Health Organization designated us the first-​­ ​­ ever WHO Collaborating Centre for Arts and Health.

Over the next few hundred pages, I will share with you the science that has mesmerised me for the past fifteen years. I’ll be taking you on a journey through the astonishing scientific evidence for how 8

Prelude

arts can improve your health, stave off illness and disease and help you live a longer and fuller life. We’ll be sampling every flavour of arts activity that can affect our ​­health – ​from the ​­micro-​­moments of creativity we engage in, sometimes unnoticed, in our daily lives, to bespoke arts programmes and creative arts therapies delivered for specific patient groups, to the gigs we go to on our weekends and the cultural festivals we take part in. When I say ‘the arts’, we really will be taking in all of the arts, from classical music to hip hop, ballet to salsa, galleries to graffiti, as well as pottery, soundscapes, interior design, heritage sites, photography, museums, animations, books and films.

We’ll begin our exploration in the mind, uncovering some of the stunning findings about how our mental health and well-​­ ​­ being can be improved through arts engagement. Like how people with depression experience nearly twice the improvement in symptoms if arts therapies are added to standard approaches such as medication and psychotherapy. And how regularly going to the theatre, live music events, museums and galleries could nearly halve your risk of developing depression over the next ten years. It’s natural to be sceptical about all this. We wonder whether improvements take place merely because we want them to happen ​­ – ​the consequences of wishing ourselves better or enjoying the ​­short-​­term high of a placebo. But our biological markers tell a different story: one of reward circuits, stress hormones and neurotransmitters.

Diving deeper into the brain, we will uncover another host of remarkable effects. We are innately artistic, and in our early years the arts shape the architecture of our brains, nurturing core cognitive skills like language and fundamentally altering the size and functioning of different brain regions. The arts build the resilience of the brain against the ravages of diseases like dementia, helping us to preserve our cognition for longer and unlock forgotten mem­ ories. Art activates brain regions involved in diverse functions like movement and builds new neural pathways around brain injuries.

Participating in the arts, whether through dance, music or magic tricks, can help all our movements be faster and more efficient, 9

Art Cure

whether we’re exercising or doing motor therapies for brain inju­ ries or disease.

Zooming out to look more widely at the body, we will discover the role the arts can play in hospitals, from helping babies in intensive care gain weight and leave hospital sooner to reducing the need for sedatives and anti-​­ ​­ anxiety meds in surgery. Arts even reduce the amount of opioids we need for acute and chronic pain. In fact, there is no physiological system art does not affect. When we breathe deeply for activities like singing, we improve the strength of our respiratory muscles and increase our exercise capacity. When we dance, we experience decreases in blood pressure, glucose levels and stiffness in our arteries. Arts engagement even improves immune activity and affects the expression of our genes, as well as helping us stay physically fit and functioning, free from disease, for​ ­longer – e​ xtending what we call our ‘healthspan’.

Health also isn’t something that just happens to us. It’s performative. Our behaviours can have dramatic influences on our health. If children engage in art workshops, choirs, book clubs, dance classes, drama groups or bands, they’re less likely to be lonely or develop behavioural problems, to commit crimes or use marijuana or tobacco. Arts build vital life skills, from self-​­ ​­ control to self-​­ ​­ esteem, empathy and motivation. They keep us more socially connected and less sedentary, all of which add up to affect our future health. Art helps us not only to survive but to thrive and flourish. In fact, it’s not actually any exaggeration to say the arts could save your life. From preventing suicides to helping stop epidemics to even increasing our life expectancy, the arts can be the difference between life and death.

But we’re not ready to talk about life and death yet. You’ll say I’m being sensationalist. And this book isn’t about sensationalism ​­ – ​it’s about science.

And I want to be ​­clear – ​the arts are most definitely not a panacea. In fact, there are examples of the arts doing far more harm than good, even deliberately being used to cause damage to health. Sur­ realist artwork, death metal music and K-​­ ​­ pop have all been used as horrendous means of torture. The arts can also inadvertently cause 10

Prelude

harm, from loud music exposure accelerating hearing loss, to arts perpetuating stereotypes or stigma surrounding certain health conditions, to stories encouraging harmful behaviours. Used in the wrong way, the arts can even become a tool for excluding some people within society and for wielding social power. We must also challenge the ​­hype – ​I’ll be dismantling absurd stories about music killing cancer cells, increasing the IQ of babies and curing terminal illness. The science I will be sharing is a sharp divergence from such fiction, but the findings are no less ​­awe-​­inspiring.

Yet there is something I find quite baffling. Despite this enormous body of research, surprisingly little has made its way into public conversation. Instead, the evidence has remained a bizarrely ​­well-​ ­kept secret. We’re bombarded with information about how to live longer, healthier lives ​­ – ​cut your sugar, eat your vegetables, elimin­ ate ​­ultra-​­processed foods, quit smoking, moderate your alcohol, go for your health screening, get your daily exercise, take supplements, don’t stress, go to sleep. But how often have you seen dance, go to an art gallery or read a book included in this list? These are probably the most enjoyable pieces of health advice we could follow, but they are rarely given. In fact, the idea that the arts might have a practical purpose for our health is looked upon suspiciously, a sign of a decreased appreciation of art for its own ​­value – ‘art for art’s sake’.

At the same time, we as societies are becoming increasingly disengaged from the arts. If you look back just a few centuries ago, everyone, all around the world, told stories, sang and danced as a natural part of everyday life. But we have taken this ubiquitous human behaviour and commodified it ​­ – ​turned it into a luxury. Folk arts practices are disappearing, and in many societies the traditions that used to bring us together to participate in the arts as communities are fading from memory. It is eighty years since the United Nations declared access to the arts a human right, but arts engagement in many societies is heavily imbalanced, with the wealthiest (and healthiest) participating the most. Every time we face periods 11

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of austerity, funding for the arts is the first thing to go. We haven’t considered the health ramifications of these ​­ decisions – ​ every pound we cut in investment in the arts has consequences for health and healthcare systems.

So this book is a vehement challenge to this way of thinking. The arts are not a luxury; they are an essential. Instead, I will outline my vision for a different ​­society – ​one that values and supports the arts and artists.

But my real focus of this book is you. My goal is to fundamentally change the way you value and engage with the arts in your daily life. Over the past decade, I’ve been working with governments all around the world on schemes to ‘prescribe’ the arts to ​­people – ​to give people a written prescription, like we would a drug, to go to a choir or join a dance class or listen to music, just like the scheme Russell took part in. The health benefits of the arts are really that strong. But I don’t want you to have to visit a doctor before you discover these health benefits. So I’m going to share them with you here.

In each chapter of this book, we’ll explore a different aspect of health: ​­well-​­being, mental health, brain health, movement, stress and pain, healthy behaviours and longevity. I’ll take you through the science of the benefits the arts can have, whether you’re healthy or dealing with illness. Often, it’s the extreme ​­stories – ​the studies involving people going through personal crisis, undergoing surgery or in intensive ​­care – ​that actually teach us the most about how we can benefit from the arts in our ​­day-​­to-​­day lives. And I won’t just tell you what the arts do to us, but how. Because the more you understand about the ways different flavours of arts experiences affect your mind, brain, body and behaviour, the more you’ll know how to apply the arts in your own life to maximise your health. Yes, doctors can ‘prescribe’ the ​­arts – ​I’ll share a ‘daily dose’ of my recommendations at the end of each chapter. But the whole point is that the arts are not a simple pill. They’re one of the most diverse, complex and personal behaviours we can engage i​­ n – ​one of the crowning glories 12

Prelude

of our species’ evolution. Ultimately, you need the knowledge of the incredible science to write your own arts prescription.

Some of what I suggest may sound daunting, and both tangible and invisible barriers might be holding you back. In the final chapters, we’ll examine these barriers and the ways to dismantle them.

I’ll take you on a tour of the science of behaviour change and help you explore why it is you might not be making the most of the arts in your life. I’ll share some simple principles that could help us all increase our healthy ‘dose’ of the arts and reap more benefits. We’ll see why we should all pursue as many aesthetic experiences of as great a diversity as we can. Why we should allow art to make us feel exhilarated, intoxicated, elated. Because it is fundamentally, measurably good for us. ​­Art – ​as you’ll ​­see – ​alongside diet, sleep, exercise and nature, is the forgotten fifth pillar of health.

13

What even is art?

I don’t remember where I was, or even how old I was, when I came ​­face-​­to-​­face with the sheep. I must have been quite young, as I remember standing nearly ​­nose-​­to-​­nose and looking right into her eyes. She was floating, suspended in blue liquid inside a large white box. I’d seen plenty of sheep before, but never for enough time to actually look. She had a little black nose and a freckled white face bent quizzically upwards towards me, and the light in the room bouncing off her fluffy white coat made her shimmer. She was beautiful, and I was mesmerised. I still remember the feeling of calm and happiness I felt standing and staring at her.

It was only years later, reading a review in the newspaper of a new art exhibition in London, that I realised I’d been looking at a work of art by the English artist Damien Hirst. Except that was the problem. To the reviewer whose critique I was reading, this wasn’t art. It wasn’t beautiful. It was just an animal pickled in formaldehyde.

Hirst’s work might be towards the more controversial end of ‘art’. But his sheep pushes us to consider some critical ​­questions – ​ questions we need to answer before we go any further in this book.

Like what do we mean by ‘art’? How do we know which kinds of activities or experiences count as the ‘arts’ and which don’t? What is it about the arts that can affect us so deeply? And how is it that people can respond so differently to the same arts experience? These kinds of questions are important to scientists like me because they provide the foundation for researching the effects that arts experiences have on ​­us – ​on our health.

14

Prelude

Identifying ingredients Think back on the last time you had a headache or other annoying pain. You may have taken a painkiller like ibuprofen. Ibuprofen is made of a core ‘ingredient’ called propionic acid, which enables it to have its pain-​­ ​­ relieving effects. Pharmacology is about identifying chemical agents that can form these ingredients in drugs to achieve desired health outcomes. But what if we apply this approach as a metaphor to think about what the main ‘ingredients’ of arts are?

‘The arts’ actually involve hundreds of ingredients. The sheep I saw was a set of ingredients herself ​­ – ​a physical object comprising different shapes, colours, reflected light, and the faint smell of wood varnish. Standing in front of her, I received all these ingredients in the form of stimulation to my senses. Other arts experiences can bring other types of ingredients, like auditory stimuli when we hear music or soundscapes, or physical stimuli when we dance or act out stories or feel the textures of clay or fabrics. Every arts experience we have is a combination of these different ingredients.

Thinking about the arts in this way, they arguably share many features with other objects or activities in our lives ​­ – ​a Grecian urn on display in a museum has many practical similarities to my​ ­washing-​­up bucket, and practising my plié isn’t a million miles away from reaching up to hang washing on the line. But for something to be really considered ‘art’, we typically expect there to be some additional ingredients present ​­ – ​like imagination, creativity, novelty, emotional expression, maybe even beauty. It’s these core ‘artistic’ ingredients that help the arts to stand elevated from other more prosaic objects or experiences. These ‘artistic’ ingredients arguably constitute the central ‘essence’ of art.

Some activities in our lives quite clearly have these artistic​ ­ingredients – ​dancing, singing, painting, acting, writing – ​whether we do them for leisure, work, ritual or worship. But artistic ingredients are also present in activities we might not initially think of as ‘arts’, like baking and decorating cakes, growing arrangements of flowers in an allotment, performing choreographed ice-​­ ​­ skating 15

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routines, whittling and carving wood, or devising and performing magic tricks. So when I talk about ‘arts’ in this book, I mean all of these activities and more. There is subjectivity here. To me, the sheep had ‘artistic’ ingredients. To the critic in the newspaper, she did not. Only you will know whether an experience contains those crucial ‘artistic’ ingredients for you. If on Friday night I quickly boil a bowl of pasta for dinner, I’m likely not activating those ‘artistic’​ ­ingredients – ​it has been a somewhat utilitarian cooking experience.

But if on Saturday night I lovingly bake a pie from a new recipe I’ve created myself, fill it with a rainbow of autumn fruits and aromatic spices and serve it on a beautiful platter with a sprinkling of icing sugar, I would appreciate my dinner guests calling it ‘a work of art’.

So thinking about the ‘artistic’ ingredients can help you decide what is ‘in’ and ‘out’ as ‘arts’.

Thinking about ingredients also helps us select or design our arts experiences to be as beneficial to our health as possible. For some health outcomes, we might need a particular ​­ingredient – ​we can’t expect to change a physical outcome like mobility without using an art form with physical ingredients, such as dance. But for other health outcomes, art forms may be more interchangeable. Our mood can be improved through essentially any type of art (more on this later). To achieve ​­short-​­term health outcomes, a small ‘dose’ of arts may be sufficient, but for ​­longer-​­term health benefits, we might need more sustained engagement.

It’s also not just the art itself we need to think about when we consider our ingredients list. If we engage with other people, dozens more ingredients are ​­added – ​who those other people are and how we socialise and communicate with them. And if an activity is led by a professional, that facilitator brings more ingredients, depending on their training, approach, experience, practice and style. Variations in these ingredients can profoundly affect our engagement with the arts activity. Think back to your school music ​­teacher – ​ did they fill you with their passion and inspire you to engage more, or put you off for life? Either way, they may have been a crucial 16

Prelude

ingredient in whether the arts benefited your health then or since.

Our environments, too, have their role to play. Picture seeing the same abstract artwork in a school classroom, professional gallery and ​­church – ​would you value it the same in each location, or feel the same inner emotions? So when we’re selecting an arts activity to engage with, we can also fine-​­ ​­ tune these broader social and contextual ingredients to make it as enjoyable and beneficial to us as possible.

The philosophers amongst you may be raising eyebrows at thinking about the arts as this constellation of ‘ingredients’. Identifying every single ingredient in an arts experience would probably be a​ ­never-​­ending task. And trying to do so would be extremely reductive. But we’re actually only interested in identifying the ingredients that are likely to have any impact on our ​­health – ​what pharmacology calls the ‘active ingredients’. Ibuprofen also contains various ‘inactive ingredients’ like cornstarch, preservatives and colourings, which make it a pill you can swallow but don’t play a role in pain relief. So, too, there were plenty of other ingredients in the sheep that made no difference to my e​­ xperience – ​I have no idea how much she weighed or what type of wood made up her box. And thinking about ‘ingredients’ is an ‘approach’ rather than a ‘formula’. A way of thinking rather than what to think. It may be a challenge or a foil to how you’ve previously thought about the arts. So I urge you not to berate or give up on me quite yet. Because if we’re starting to think about if and how the arts are good for us, we have to be clear about what is the catalyst.

In the chapters to come, we will be discussing different arts experiences, all with different combinations of ingredients. We’ll be exploring how we are affected differently by the ‘background’ arts experiences we all have in our daily lives, like hearing music in a shop or lift or walking past a poster at a bus stop, compared to arts experiences we deliberately choose to give our attention to, like going to a folk music night or an art fair. We’ll be contrasting the little activities we do at home to fill idle minutes, like doodling or playing a song on our phone, with ​­decades-​­long immersion in 17

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learning specific artistic skills, from virtuosic violin playing to the complexities of tap dance. We’ll have to compare solo versus social arts; amateur versus professional; participating versus watching. As we’ll see, all of these activities can have profoundly different effects on us, and we need to be able to say why. Thinking about ingredients gives us this language. By the end of this book, you’ll be an expert on which ingredient combination you need for which health outcome.

So what happens to us when we’re presented with arts experiences comprising all these different ingredients? How do we process them?

Experiencing the arts I’m sure you remember learning at school about the five senses: visual (eyes), auditory (ears), tactile (skin), olfactory (nose) and gustatory (tongue). Each of these sensory systems involves receptors that translate the events we experience into electrical signals in the brain. This process is called ‘sensory transduction’. When I saw the sheep, the ingredients I experienced from the artwork itself (shapes, colours, smells) as well as the social and contextual ingredients (the warmth of the room, the smell of other bodies around me, the taste of the snack I was nibbling, etc.) were all received by these sensory systems. Over 100 million receptors on my retina received the visual stimuli, converting them at a rate of 10 million bits per second (roughly the speed of an Ethernet connection) to electrical signals that travelled through 1 million retinal ganglion cells in my optic nerve to my brain. Meanwhile, my ears converted the frequency and amplitude of the sound waves of the noises around me, vibrating the 12,000 hair cells in each of my cochleae and causing the release of chemicals that created an electrical signal that was carried from the auditory nerve to my brain. In my nasal passages, two small patches of around 10 million to 20 million olfactory receptor cells detected the smells in the room around me, while in my mouth, around 2,000 18

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to 4,000 taste buds (each containing 10–​­ ​­ 50 sensory cells) tasted the sweetness of the biscuit I’d just eaten. As I reached out to touch the glass in front of me, my skin converted information from 250,000 tactile fibres that respond to touch, temperature and pain.

Via these multiple sensory systems, the dozens of ingredients in our arts experiences are broken down into billions of nerve signals in our brains. These nerve signals operate in binaries, meaning, theoretically, that we could capture and write down all of these signals flashing across all of these nerves as code, producing insanely long lists of 1s and 0s. We could use these to compare the codified differences between watching a performance of Tchaikovsky’s Swan Lake by the English National Ballet in the Royal Albert Hall to watching a samba parade through the streets of Rio as part of the Carnival.

Every arts experience is comprised of this colossal collision of sensory ingredients.

But if engagement with the arts is reducible to a series of such basic constituent ingredients ​­ – ​a binary code flashing across billions of ​­neurons – ​how is it that the newspaper critic and I saw the same sheep, probably in very similar galleries, and I was deeply moved while he was left stone cold?

There are two reasons.

The first is we actually have more than five senses. There is indeed a sixth sense, and a seventh and eighth. (Depending on how we categorise, there may be even more.) These senses are focused reflectively on ourselves. Vestibular receptors in the inner ear that process movement and balance sensed that I had leaned forwards and tilted my head to the side to see the sheep better. Interoception receptors fed back about the experiences of my internal organs and noted that my heart was beating faster as I locked eyes with the sheep. Proprioception receptors in my muscles and joints told me where my body was in space, sensing how far my nose was from the glass in front of me. As I watched the sheep, my senses gave me unique binary codes, different to the ones the critic received. These differences might have been subtle and we might have shared a very similar sensory experience. But sometimes the information we 19

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receive from senses six to eight can override the arts ​­experience – ​ we’ve all been to events where we’ve felt too hot, too tired, have spent the entire evening craning our necks to see and haven’t been able to focus properly on what senses one to five have been telling us. Did the newspaper critic see the sheep in a room that was too crowded or too noisy, where they couldn’t get close enough to see the sheep properly? Perhaps.

I’m more inclined to think the difference in our experiences was down to another explanation. Sensing the arts is only one half of the process. When our sensory systems detect the incoming nerve signals, they are conveyed to the brain. But here we rely on a sepa­ rate system to interpret these inputs: our perceptual system. While our sensory system is ‘data-​­driven’, our perceptual system is what we call ‘concept-​­driven’ – ​it depends on our emotions, memories and expectations. This perceptual system essentially acts ‘top-​­down’ to interpret and moderate the information that is being provided ‘bottom-​­up’ from our sensory systems. Think about the book Where’s Wally? You can spend hours searching through the pictures, completely oblivious to the little stripy man. But once your brain has found him, you can’t believe you hadn’t spotted him before and you can’t ‘unsee’ him again. From then on, because of your memory, your perceptual system highlights Wally as an important feature in the complicated picture you’re looking at and extracts sensory data pertaining specifically to him.

This intersection between what we sense and what we perceive is arguably where the ‘magic’ of the arts occurs ​­ – ​the moderation of our sensory system in action. We’ll return to this concept of moderation throughout the book, because while there are some ingredients in arts engagement that produce universal responses in us (like synchronising to a beat, which we’ll cover later), there are many, many other ingredients that are modified based on our personal ​­experiences – ​those perceptions, emotions, memories and expectations. As a child approaching the sheep during one of my first times in a gallery, I had very few ​­preconceptions – ​everything I saw was new and exciting. Perhaps the newspaper critic, reviewing 20

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their hundredth exhibition, had more gallery experiences to benchmark this one with or different e​­ xpectations – ​maybe even a different set of feelings about sheep.

It is this intersection between the artwork and the human that, for me, makes the scientific study of the arts so fascinating and has kept me captivated across my career. The arts marry objective and subjective experiences, such that we never have the same experience twice. Our perceptual systems are constantly updating. So even if we view the same piece of art or read the same poem a second time, we perceive it differently and spot things we didn’t the first time around. When we return to a song or film we loved as a child, we reflect on it differently with the experiences we’ve had in the intervening years.

This is why my ‘ingredients’-​­based way of looking at the arts doesn’t take away any of the magic. Instead, my enjoyment of the arts is enhanced by thinking about their ingredients, because I can appreciate how phenomenally complex they are.

So how do these ingredients, now sensed and perceived inside us, translate into tangible changes to our health?

Mapping mechanisms Our health is both ​­multifaceted – ​consisting of mental and physi­ cal ​­components – ​and layered: changing constantly over time, from small, transient aches, pains and emotions, to ​­short-​­term infections or periods of anxiety that are here and gone within a few days, to longer mental and physical illnesses that could take weeks, months or years to recover from, to chronic conditions that stay with us.

Health is also not just about avoiding mental or physical illness but also attaining what the World Health Organization describes as ‘a state of complete physical, mental, and social ​­well-​­being’. Illness and​ ­well-​­being are not polar opposites but actually different constructs.

You might not have anything wrong with your health, but you may feel unhappy or unfulfilled. Or you might have a long-​­ ​­ standing 21

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illness or disability but you possess all the tools you need to cope with it, find meaning and purpose, and flourish. In this book, we’ll be considering health in all these different ways.

If we imagine the concepts of ‘arts’ and ‘health’ standing on two cliffs with a chasm in between, the bridge that links the two constructs is what scientists like me describe as ‘causal mechanisms’.

These mechanisms are activated by the ingredients we explored ear­ lier. They’re essentially ‘processes’. If ingredients are the what about arts, the mechanisms are the how. If we return to our headache and that ibuprofen we took, the active ingredient of propionic acid in it reduces our pain through the mechanism of blocking chemicals in the body called prostaglandins that trigger pain and inflammation. To put it simply, active ingredients → mechanisms of action → health outcomes.

Hundreds of mechanisms linking arts to health have been identified. Some mechanisms are psychological (how the arts interact with our mental states, thoughts and emotions), while others are biological (how the arts affect the functioning of our brains and bodies), social (how the arts affect the way we interact with others) or behavioural (how the arts affect our decision-​­ ​­ making and actions). In the following chapters, we’re going to see these mechanisms in action ​­ – ​take journeys inside our brains and our cells to uncover the magic that occurs when we are exposed to arts ingredients. We will add sensors, monitors and alarms to people to track their thoughts, feelings and behaviours. We’ll dive into reams of data on hundreds of thousands of individuals and interview people who have been changed for ever by arts encounters.

But it’s here that we have to bid farewell to our ibuprofen anal­ ogy, because the arts are actually far more complex than any pill.

Whereas many drugs have only a couple of ingredients that trigger a few core mechanisms, the arts can trigger dozens of mechanisms at any one point. It’s not so much a bridge between two chasms as a web. And the strands of the web interlock with one another in complex patterns.

Some mechanisms go directly and fairly immediately to improved 22

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health outcomes. If you sing, the ingredient of deep breathing activates the mechanism of increased oxygen intake, which leads to the outcome of feeling less breathless. Some mechanisms emerge over time. If you increase the ingredient of ‘dosage’, such as singing every day, you can additionally activate the mechanism of increasing the strength of your respiratory muscles. Sustained for long enough, this could enable you to exercise more, leading to deeper health outcomes being achieved, like improved physical fitness.

Some mechanisms lead to positive feedback ​­loops – ​if the singing makes you feel happier, you might feel like singing more, creating an upward spiral. Other times, mechanisms can work ​­backwards – ​ if you are feeling ill one day, it might decrease your energy levels, which could stop you singing. And mechanisms can add together and lead to disproportionate outcomes relative to the ingredients that went in (like a case of 2 + 2 = 5). For example, adding the ingredient of ‘other people’ to your singing (like joining a choir) could build your confidence, self-​­ ​­ esteem and support networks, all of which could help you feel more capable of attempting bigger changes in your life, like joining a programme to help you quit smoking. Suddenly, singing has been part of a process that leads to a major change in your life, and in your health. And it might not be affecting just you. When you go to your choir rehearsal, you as an individual can experience the mechanism of reduced loneliness.

But, at a group level, the choir is also triggering the mechanism of group bonding. If you have enough choirs or arts groups in a community, you could start to have increased social cohesion.

If this sounds complex, that’s actually part and parcel of it. This field of work mapping the intersection between such ingredients, mechanisms and outcomes is called complexity science. In my view, it’s what is so exhilarating about the question ‘how do the arts affect our health?’ There’s not one simple answer. Instead, there are hundreds of answers, each with its own fascinating story.

We’re nearly at the point of telling these ​­stories – ​crossing the bridge (or crawling through the web) between those two cliffs. We just have one final thing to consider.

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Researching complexity When I’m lecturing to students at UCL, I often show them graphs of some incredible relationships. For example, in the US, there is a​ ­near-​­perfect correlation between divorce rates in the state of Maine and per capita consumption of margarine. The number of Disney films released annually aligns with the number of car thefts. And each year, the rate of drownings in swimming pools is predicted by the number of films Nicolas Cage appears in.

As you may have guessed, there is in fact no causal relationship between these factors. Nicolas Cage can ease his conscience. These are what are known as ‘spurious associations’. Sometimes, spurious associations are down to pure chance. Other times, they are due to ‘confounding’ – ​the presence of third factors that actually explain both outcomes. I’d hazard a guess there is a correlation between​ ­ice-​­cream sales and shark ​­attacks – ​not because of any causal relationship, but because when it’s hot, people are more likely to both indulge in a cooling treat and go swimming in the sea. Sunny weather is the confounder. Other times, spurious associations are due to ‘reverse causality’ – ​it isn’t the first thing that causes the second, but the second that causes the first. Opening an umbrella is correlated with rain, not because umbrellas cause rain but because rain causes umbrellas. It’s easy to see how these effects could translate across to the arts and health. Plenty of things affect both our capacity to engage in the arts and our health outcomes: individual characteristics, wealth, lifestyle and other behaviours. It’s probably going to come as no surprise to hear that people who are healthier often engage in the arts more.

One way around this is to conduct randomised controlled trials (RCTs). RCTs are the gold standard for assessing causality because people aren’t able to choose if they get arts or not. They’re allocated at random by the scientists into an experimental group (i.e. those who receive arts) versus a control group (i.e. those who don’t). But RCTs aren’t without their limitations – the people who agree to take part in experiments aren’t always representative of the rest 24