Arts and Humanities in Psychiatry: Beyond Symptom Relief

Psychiatry has always been more than the relief of symptoms. To sit with a patient is to enter not only a medical encounter but also a narrative—a rhythm of life disrupted, a search for coherence. Patients rarely only ask, “Will my anxiety remit?” More often, they want to know, “How can I live with this? How can I carry it?”

Lifestyle psychiatry has emphasized 6 interdependent pillars—physical activity, nutrition, restorative sleep, stress management, avoidance of toxic exposures, and connectedness—each supporting brain health and emotional well-being.^1,2 Yet a dimension remains underdeveloped: the arts and humanities. Literature, music, visual art, and philosophy are not distractions from psychiatry but extensions of its deepest aims. They cultivate empathy, meaning, and coherence—qualities that align most closely with the sixth pillar of connectedness, which encompasses connection to self, others, nature, spirituality, and purpose.³ In this sense, the humanities do not stand apart from lifestyle psychiatry; they complete it.

The evidence is not trivial. Narrative medicine improves empathy and communication.⁴ Arts-based interventions demonstrate benefit across depression, trauma, and dementia.^4-6 Longitudinal research shows that sustained engagement with the arts—not sporadic exposure—predicts higher life satisfaction, autonomy, and purpose in older adults.⁷ In late-life depression, reminiscence therapy has been shown to improve mood, self-esteem, and social connectedness.⁸ Even during crises such as the COVID-19 pandemic, when cultural life was suspended, individuals turned spontaneously to artistic practices—from balcony concerts to digital museum challenges—as collective forms of resilience.⁹ The World Health Organization has since recognized arts engagement as a health resource across prevention, promotion, treatment, and recovery, reinforcing its relevance at both clinical and public health levels.¹⁰

Philosophy and literature in psychiatric training cultivate moral reasoning and tolerance for ambiguity—qualities that directly shape clinical judgment.¹¹ Comparable shifts are evident across health professions: Speech pathology programs now integrate lived experience into training, and virtual reality (VR) simulations are being tested to cultivate empathic communication within lifestyle psychiatry frameworks.^12,13 At the same time, recent work warns of ennui in medicine—the erosion of meaning that breeds cynicism and disengagement—underscoring the urgency of authentic humanities integration as a countermeasure.¹⁵ But beyond data and pedagogy, there is a lived truth: Patients often find healing in forms of expression that precede or exceed the medical idiom.

Evidence and Research Synthesis

Narrative medicine and psychiatry. Narrative-based approaches improve empathy, communication, and patient satisfaction.¹⁴ Within psychiatry, narrative competence fosters connectedness, meaning making, and coherence across the internal and external health domains described in the American Psychological Association’s 6-pillar model.¹ When narrative coherence collapses, clinicians themselves risk ennui—an erosion of meaning linked to cynicism and disengagement.¹⁵ Humanities practices thus sustain patient recovery and clinician vitality by strengthening the connectedness and stress management pillars.

Arts therapies. Cochrane evidence supports music therapy for depression when combined with standard treatment, with gains in social interaction and motivation.⁴ Results of art therapy trials show improved emotional regulation and self-expression, including in complex personality disorders.⁵ Scaled community interventions, such as Project ARTISAN in Singapore, highlight feasibility and intergenerational benefit.⁶ These therapies engage creativity, embodiment, and relationality—pathways that parallel physical activity, stress management, and connectedness—supporting restoration of agency and purpose rather than mere symptom remission.²

Reminiscence and late-life psychiatry. Reminiscence therapies grounded in Eriksonian life review improve depression, self-esteem, and life satisfaction.⁸ Longitudinal research shows that sustained arts participation predicts autonomy and well-being over more than a decade.⁷ Rekindling creativity and memory in late life may strengthen multiple lifestyle domains—particularly connectedness, restorative sleep, and stress modulation—by integrating identity and purpose into ongoing care.

Humanities in training. Integrating the humanities into psychiatric education strengthens reflective capacity and tolerance of ambiguity.¹¹ Lived-experience pedagogy and VR-based empathy training reveal a shared cross-disciplinary insight: Technical expertise alone is insufficient.^12,13 Meaningful practice requires cultivated narrative, relational, and aesthetic skills—the same depth that underpins the connectedness pillar.

The research base. Evidence is promising but methodologically fragile, with small samples and intervention heterogeneity.^6,16 As Holmes, Craske, and Graybiel observe, treatments can be clinically effective even when mechanisms are obscure. Arts and humanities practices demonstrably work; clarifying how—via metaphor, rhythm, or aesthetic resonance—remains a crucial frontier for mechanistic study integrating neuroscience, phenomenology, and clinical outcomes. The following vignette, accompanied by the patient’s own artwork (Figure), illustrates how these principles take shape in clinical practice.

Clinical Vignette: The Bird in Pastel

“Mrs Lee,” a woman in her late 70s with major depressive disorder and catatonic features, required ongoing maintenance electroconvulsive therapy to sustain remission. In the early months, conversation was minimal; she spoke in fragments, often flat or mute, her movements slowed to near immobility. In one brief exchange, she mentioned that she had once enjoyed drawing.

As her symptoms began to lift, she spoke more of color and texture—of how it felt to hold a pencil again. The return of motivation was gradual, almost imperceptible, until one morning she entered the unit carrying a carefully wrapped package. It was the anniversary of her recovery, and she had prepared a gift: an oil pastel of a bird, perched amid pines and palmettos, its red plumage vivid against winter’s green.

The nurses told me she had been excited all morning, waiting to present it. For her, the act was more than art—it was evidence of a life reclaimed, a gesture of gratitude, and a declaration of identity beyond illness. In that moment, the clinical metrics—Hamilton scores, catatonia scales—seemed less central than the return of her aesthetic self. In presenting her bird, she echoed Louise Bourgeois: Art is a guaranty of sanity.⁹ Her recovery underscored a larger lesson: The humanities can be woven into everyday psychiatric care in concrete, practical ways.

Clinical Pearl
In late-life depression, recovery often extends beyond symptom remission. The rekindling of creativity—whether through art, music, or writing—can mark the restoration of identity, autonomy, and meaning. Inviting patients to share these expressions strengthens therapeutic alliance and activates what lifestyle psychiatry terms connectedness—the capacity to relate authentically to self, others, nature, and purpose.³

Clinical Applications: Where to Begin

Entry points can be modest but meaningful (Table). Each can serve as a clinical practice of connectedness—bridging interior and interpersonal domains while complementing established treatments²:

• Narrative invitations: Short reflections between sessions or a text that carries personal resonance.
• Aesthetic listening: Attend not only to what a patient says but to how—tone, metaphor, rhythm.
• Creative modalities: Incorporate drawing, music, or movement; collaborate with art and music therapists.^4,5
• Cultural specificity: Encourage patients to draw on texts, music, or art from their own traditions.¹⁰

Clinical Pearl
Small, authentic steps matter. Asking about a poem, inviting music into a session, or collaborating with an art therapist can deepen engagement without elaborate infrastructure. The humanities amplify—not replace—existing modalities, reminding us that recovery is both clinical and creative, and that meaning itself is therapeutic.

Challenges and Pitfalls

Integrating the humanities into psychiatric care carries risks if done superficially. Patients recognize when art or literature is used as ornament rather than as genuine invitation. A poem read without context or a sketch group offered without continuity can feel tokenistic—what might have been healing becomes trivial.

Systematic reviews underscore the fragility of the evidence base: While promising, arts interventions often suffer from small sample sizes and heterogeneity.^4,6 Without more rigorous frameworks, the field risks remaining marginal. As Holmes, Craske, and Graybiel observe, treatments can be widely practiced even when their mechanisms remain opaque. Humanities-informed care faces the same challenge: We know it helps, but not precisely how. Mechanistic inquiry—how aesthetic engagement modulates affect regulation, connectedness, and neuroplasticity—remains essential for credibility.

Superficial adoption also risks deepening ennui—the erosion of meaning and vitality that afflicts clinicians themselves.¹⁵ In lifestyle psychiatry terms, this represents a breakdown of the connectedness and stress management pillars: an existential “toxic exposure” within the clinician’s own ecology of care.²

Cultural context presents further challenges. A Western canon of “great books” may not resonate with all patients, while culturally specific art or music may evoke recognition that standardized interventions cannot.¹⁰ Authenticity requires both sensitivity and plurality—a willingness to meet meaning where it already lives.

Finally, emerging technologies highlight both promise and pitfalls. VR training for motivational interviewing shows potential as an empathy tool, yet participants often report diminished emotional engagement compared with live encounters.¹³ The lesson is clear: Authenticity and relational depth must not be sacrificed for the sake of innovation.

Future Directions and Take-Home Guidance

Training as core, not peripheral. Narrative competence, reflective writing, and cultural aesthetics should be embedded in psychiatric education.¹¹ Other disciplines already do so, from lived-experience integration in speech pathology to immersive simulation in VR.^12,13 Psychiatry should lead in shaping training that is authentic and humanistic—advancing the connectedness and stress regulation pillars for both clinician and patient.

Research with depth and breadth. Future studies must measure not only symptom reduction but also recovery markers such as restored identity, autonomy, and meaning.^7,8 Mechanistic research on metaphor, rhythm, and creative engagement will further integrate the humanities within the empirical rigor of lifestyle psychiatry.^1,17

Practical entry points. Small, structured practices—such as art, music, or reflective writing in sessions—can amplify rather than replace established treatments.^4,5 Community programs like Project ARTISAN demonstrate feasibility at scale.⁶

From individual to public health. Arts engagement functions as a determinant of population health: It reduces loneliness, improves well-being, and lowers health care utilization.^10,16 Public health strategies that expand cultural participation may prevent illness as effectively as interventions in other lifestyle domains.¹

Guarding against ennui. By preserving coherence and meaning, the humanities safeguard the clinician’s inner ecology. Within the 6-pillar model, they act as a stabilizing force against psychological and existential toxic exposures—sustaining vitality in those who care for others.^2,15

Take-Home Pearl
The humanities are not a luxury in psychiatry—they are essential tools for restoring the texture of a life, sustaining recovery for patients, and preserving meaning for clinicians. They deepen connectedness, regulate stress, and protect against the subtle toxicities of modern practice—bridging lifestyle psychiatry and the art of healing itself.

References

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2. Merlo G, Snellman L, Sugden SG. Connectedness: the updated and expanded pillar of lifestyle psychiatry and lifestyle medicine. Am J Lifestyle Med. Published online June 2, 2025.

3. Merlo G, Sugden SG. The power of lifestyle psychiatry: a new approach to mental health. Am J Lifestyle Med. Published online April 19, 2025.

4. Aalbers S, Fusar-Poli L, Freeman RE, et al. Music therapy for depression. Cochrane Database Syst Rev. 2017;11(11):CD004517.

5. Haeyen S, van Hooren S, van der Veld W, Hutschemaekers G. Efficacy of art therapy in individuals with personality disorders cluster B/C: a randomized controlled trial. J Pers Disord. 2018;32(4):527-542.

6. Ho AHY, Ma SHX, Tan MKB, Bajpai RC. A randomized waitlist-controlled trial of an intergenerational arts and heritage-based intervention in Singapore: Project ARTISAN. Front Psychol. 2021;12:730709.

7. Tymoszuk U, Perkins R, Spiro N, Williamon A, Fancourt D. Longitudinal associations between short-term, repeated, and sustained arts engagement and well-being outcomes in older adults. J Gerontol B Psychol Sci Soc Sci. 2020;75(7):1609-1619.

8. Chen TJ, Li HJ, Li J. The effects of reminiscence therapy on depressive symptoms of Chinese elderly: study protocol of a randomized controlled trial. BMC Psychiatry. 2012;12:189.

9. Courtet P. “Art is a guaranty of sanity,” Louise Bourgeois’ message for the COVID-19 pandemic! Trends Psychiatry Psychother. 2022;44:e20210261

10. Fancourt D, Finn S. What Is the Evidence on the Role of the Arts in Improving Health and Well-Being? A Scoping Review. WHO Regional Office for Europe; 2019. Health Evidence Network synthesis report, No. 67.

11. Bleakley A. Invoking the medical humanities to develop a #MedicineWeCanTrust. Acad Med. 2019;94(10):1422-1424.

12. Glade R, Hussain S, Wilkes C, Hunter C, Mahomed-Asmail F. Integrating lived experience in preprofessional training in speech pathology and audiology. Clin Teach. 2025;22(5):e70183.

13. Verhoeven DJ, Ferenschild FTJ, Verhoeven BH, Bosma EC, Buyne O, van Goor H. Learning motivational interviewing in VR: a feasibility study using self-reported measures. J Med Ext Real. 2025;2(1):290-302.

14. Greenhalgh T, Hurwitz B. Narrative based medicine: why study narrative? BMJ. 1999;318(7175):48-50.

15. Carr B, Ruiz-Menjivar J. Ennui. J Med Ethics. 2025;51(2):144-145.

16. Stuckey HL, Nobel J. The connection between art, healing, and public health: a review of current literature. Am J Public Health. 2010;100(2):254-263.