Art therapy is defined by the American Art Therapy Association as “a mental health profession in which clients, facilitated by the art therapist, use art media, the creative process, and the resulting artwork to explore their feelings, reconcile emotional conflicts, foster self awareness, manage behavior and addictions, develop social skills, improve reality orientation, reduce anxiety, and increase self-esteem. A goal in art therapy is to improve or restore a client’s functioning and his or her sense of personal well-being.”1
Individuals with mental illnesses may not always be verbally expressive; however, they may display emotions through creative expressions such as music, poetry, or art. The use of art also helps them reflect on their thoughts, desires, and challenges. Vincent Van Gogh projected his turbulent emotional experiences onto the canvas.2,3 He once said: “What lives in art and is eternally living, is first of all the painter and then the painting.”3 More recently, the work of Mexican artist Martin Ramirez was exhibited at the American Folk Art museum in New York. Ramirez had schizophrenia and spent most of his adult life institutionalized.4
We present the case of an elderly woman who had a long history of bipolar disorder who was admitted for aggressive behavior and nonadherence to medications. Art therapy along with pharmacotherapy played a pivotal role in her recovery.
Mrs Robinson, a 78-year-old white nursing home resident with bipolar I disorder, is admitted for agitation. Her psychiatric history is complicated; she had multiple exacerbations and hospitalizations and is nonadherent to her medications.
During the first week, she is agitated, abusive, and preoccupied with religious and sexual perseverations, specifically about homosexuality (Figure 1). While in the hospital, the medications she had been taking at home are continued, although her risperidone dosage is increased. She shows some improvement, but by the second week, she becomes more agitated and intermittently refuses medications. She draws a picture of herself in a bathtub (Figure 2). Valproic acid for further mood stabilization is added.
In spite of her agitation, she participates in art therapy. Her artwork is closely observed and interpreted by a trained art therapist. Mrs Robinson does not engage in any conversation with the treatment team; however, her drawings frequently demonstrate the fluctuations in her mood. With symptom improvement, she joins other structured art activities, such as painting boxes and decorating charts with feathers and other embellishments. She plays the piano and enjoys watching the news and talk shows. She makes a portrait of a famous comedian in the second week (Figure 3).
Mrs Robinson gradually improves, she becomes noticeably cheerful and polite, and her drawings seem to reflect more positive themes (Figure 4). She is discharged after 4 weeks.
The content of the initial drawings highlighted preoccupation with religion and sex, which corresponded with her thought process. All initial drawings used heavy pressure and strokes along with more use of black and red colors, which were also consistent with underlying aggression and anxiety (Figures 1 and 2).
When therapeutic alliance was established in subsequent weeks and medication adherence improved, positive changes appeared in her drawings as evidenced by reduced aggression in themes and line quality, and a less restrictive range of color (Figures 3 and 4).
Dr Maheshwari is a Psychiatry Resident at the Einstein Medical Center in Philadelphia. Ms Ordner is an art therapist at Indiana University-Purdue University Indianapolis and Community Health Network. Dr Agarwal is a Psychiatric Resident at the Einstein Medical Center. Dr Retamero is the Associate Program Director at the Einstein Medical Center. The authors report no conflicts of interest concerning the subject matter of this article.
1. American Art Therapy Association. What is art therapy? 2013. http://www.arttherapy.org/aata-aboutus.html. Accessed October 9, 2014.
2. Butterfield B. The Troubled Life of Vincent Van Gogh. http://bonniebutterfield.com/VincentVanGogh.htm. Accessed October 9, 2014.
3. Blumer D. The illness of Vincent van Gogh. Am J Psychiatry. 2002;159:519-526.
4. Parker-Pope T. Art and mental illness. December 11, 2008. http://well.blogs.nytimes.com/2008/12/11/art-and-mental-illness/?_r=0. Accessed October 9, 2014.
5. McWilliams N. Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process. New York: Guilford Press; 1994.
6. White M, Angus J. Arts and adult mental health literature review 2. April 2003. https://www.dur.ac.uk/resources/cahhm/reports/Arts%20and%
20Mental%20Health%20Report%20MW%202003.pdf. Accessed October 9, 2014.
7. Forzoni S, Perez M, Martignetti A, Crispino S. Art therapy in cancer patients during chemotherapy sessions: an analysis of patients’ perception of helpfulness. Palliat Support Care. 2010;8:41-48.
8. Wallace J, Yorgin PD, Carolan R, et al. The use of art therapy to detect depression and post-traumatic stress disorder in pediatric and young adult renal transplant recipients. Pediatr Transplant. 2004;8:52-59.
9. Betts DJ. A Systematic Analysis of Art Therapy Assessment and Rating Instrument Literature. April 11, 2005. http://diginole.lib.fsu.edu/etd/1396. Accessed October 9, 2014.
10. Cohen BM, Hammer JS, Singer S. The Diagnostic Drawing Series: a systematic approach to art therapy evaluation and research. Arts Psychother. 1988;15:11-21.
11. Gantt L. A Validity Study of the Formal Elements Art Therapy Scale (FEATS) for Diagnostic Information in Patients’ Drawings [dissertation]. Pittsburgh: University of Pittsburgh; 1990.