Tracy Reinhardt, a self-taught artist, has talked frankly in an interview about how the gradual development of her identity as an artist had first served as a way of coming to terms with her disorder:
I started drawing constantly several months prior to being diagnosed. The drawings weren’t art—they were about getting as many thoughts on the outside as I could. As I put each thought on paper I gave it a place to live. I did one drawing after another, and when each was done there was a sense of relief. Seeing the drawings was like seeing evidence of a burden I no longer had to carry. At the time, I wouldn’t have called what I was doing creative in an artistic sense but I do think it was a creative coping strategy.4
Initially, the process of artistic creation helped her communicate with the cultural context and, through it, establish an inner dialogue. Over time, as she discovered her creative abilities, explored her style, and developed new techniques, her artwork moved beyond a solely therapeutic function: the dialogue expanded to include outside viewers.
I’ve changed a lot in the last ten years, and so has my artistic style. What I want to do now, why I want to do it. . . . What I need out of it—it’s all different. I don’t need so much emotionally from the artwork. I want to do it very much, I enjoy it. . . . It calms me, satisfies me. . . . Makes me happy. . . . But the doing isn’t about spilling. It’s a more peaceful giving process. And the art is more peaceful and reflective.4
In the same interview, Ms Reinhardt talks poignantly of the value of audience input:
I’ve received many comments from people who saw my work on the internet—not necessarily people who bought it, simply those looking—saying that it expresses just what they feel, and that it was a relief to see their own feelings articulated. Writing is a very good way to deal with stigma but so is art. Art of all kinds. I think creativity is something that is deeply ingrained in people . . . albeit something that gets squashed quickly.
The artworks attracted the attention of outside viewers, who often found them relevant to their own experience by expressing an insight into the human condition that is no longer reducible to the personal history of an individual artist. The marker was effaced. In this way, the creative process bolstered the artist’s self-esteem and resilience, helping counteract both social stigma and self-stigmatization. Public exhibitions of psychiatric art may also be an effective tool in anti-stigma campaigns, as promoted by the World Psychiatric Association and its Section on Art and Psychiatry.5 Such exhibitions counteract negative social stereotypes of mental illness and undermine the cultural mechanisms for stigma.
Any culturally active artwork has the potential to change the structural self-orientation of the viewer’s or reader’s personality, to transform both that personality and the degree to which it is connected to metacultural constructions. In the words of Joseph Brodsky,6 a Nobel Prize Laureate for Literature, “the more substantial an individual’s aesthetic experience is . . . the freer . . . he is.” This is even more true in the case of patients who struggle with mental illness, who often find themselves constrained by both the reality of their medical condition and the social stigma that surrounds it. To help visualize the potential of art for combating stigma and promoting inclusion, we can turn to the conceptual model of “vicious circles” of stigmatization as formulated by Sartorius (Figure 1).7,8
According to this formulation, a marker that allows a person to be identified with it can be loaded with negative content by association with existing stereotypes and prejudices. Once a marker is negatively loaded, it becomes stigma, and the individual who bears it will inevitably be stigmatized. The experience of discrimination leads to impaired functioning and reinforces stigma, establishing a vicious circle.
Art can counteract stigma by weakening or breaking this vicious circle in 2 ways (Figure 2). The dialogical mechanisms of art may be built on to prevent a marker from becoming associated with stigma. Stigmatization has at its root the objectification of the other, that is, denying the right to be an independent agent in the communication process. It also involves rejection of any new information that may lead to the alteration of existing constructs. In sum, stigmatization is a breakdown of communication. Art affords a viable alternative: a model of dialogue in which the other is accepted as an equal partner in the communication process. This explains the potential of art to promote the acceptance of a person in his or her full subjective being, “In his or her totality,” to use an expression of Jean Delay.
The visual arts and literature have long been recognized as valuable sources for describing psychological states. Freud9 famously quipped: “The creative writer cannot evade the psychiatrist nor the psychiatrist the creative writer.” Art needs to be acknowledged as a social force that can shape dominant cultural values that underpin the functional concepts of health and disease.
Many higher-education institutions are considering ways to incorporate humanities into their medical curricula, recognizing the role played by social constructs in health care policies. A number of hospitals in the US and Canada offer workshops to their staff aimed at enhancing cultural competence and communication skills as well as decreasing staff burnout. The role assigned to art in modern psychiatry has been evolving. It was first seen almost exclusively as a diagnostic tool; later, art started being used for its therapeutic properties. Art is now gradually being tapped for its social function in anti-stigma interventions. Seizing the dialogical potential of art, we can change the context in which mental illness is experienced and work toward a greater acceptance and integration.