A 4-year-old was in the hospital and very anxious and afraid. Every time someone new walked in the room he would start crying and ask, “Shot?” However, when the music therapist walked in the door he smiled and asked, “Guitar”?
We all know that fine art is like good medicine. It comforts and elevates the spirit and affirms life and hope. As one of the world’s great medical centers, the Cleveland Clinic has always included arts in its healing environment. Long known for its clinical excellence, in recent years the focus of the clinic began to shift to the emotional experience of the patient and family. In 2008, the Arts & Medicine Institute (AMI) was created with the purpose of integrating visual arts, therapeutic arts, performing arts, and research to promote healing and to enhance the lives of patients, visitors, and employees.
To Dr. Iva Fattorini, chair of the Cleveland Clinic’s Arts & Medicine Institute, the clinic is a very special place because innovative ideas get support from leadership. “Leadership recognized the value of merging arts with medicine, because art approaches the patient and family and passes through the hospital in a completely different way,” she says. “It treats human beings as a whole. This deeply benefits the patients from many different angles.” Fattorini adds, “The leadership is surrounded and supported with the great arts organizations and the community. Without community, you can’t do these programs.”
How does arts in medicine work? Although the effectiveness is difficult to measure, studies with questionnaires employing scales to measure pain and depression are employed, as well as deep brain stimulation, which measures the activity of neurons. “It’s difficult to connect emotions with basic science,” says Fattorini. “It’s not just about art. It’s almost about demystifying the mixture between emotions and the human mind, because the arts are affecting emotions, and emotions are affecting health. So consequently, we believe that arts affects health. It’s a simple equation, but when you try to put the language of arts into the language of medicine it gets a little more complicated, because evidence-based medicine needs a lot of numbers and data. So now, we are basing our research on subjective responses, similar to measuring pain.”
Over 4,500 pieces of contemporary art don the walls and environs of the Cleveland Clinic system. This collection of contemporary art, the largest hospital collection in the world, generates programs in which patient, visitors, and family members can interact with art in many different ways. The Art in the Afternoon Tour employs art ambassadors who host monthly art tours for individuals with memory loss and their care partners. These are specially designed to lift the spirits, engage the mind, and provide an enjoyable social experience. The Cleveland Museum of Art Distance Learning program provides interactive talks via video teleconferencing as a way for patients and families to explore civilizations, artistic movements and styles in the world-renowned Cleveland Museum of Art collection. A patient TV video loop shows over 120 artworks from the Cleveland Clinic collection paired with music on internal, patient-dedicated television channels.
Art therapy is the therapeutic use of artmaking to assist patients in the healing process. Using a variety of visual media for creative self-expression, patients are helped with stress reduction, increased personal insight and strength, increased self-awareness and improved self-esteem. Art therapy can also assist with enhancing cognitive abilities and interpersonal skills.
Pediatric patients are often seen while undergoing treatment for childhood cancers, heart, or bone marrow transplants or gastrointestinal disorders. Art for the Heart and Lungs for Life are two programs for adults who may be dealing with heart and lung transplant and cancer; insight-oriented group therapy helps with drug and alcohol recovery.
The Arts Therapy program is especially effective for patients who are waiting for heart or lung transplants, those Fattorini refers to as “heart waiters.”
“They can be in the hospital for many weeks,” says Fattorini. “Hospitals can be very quiet places in the afternoons. For them it’s extremely important to take their mind off of disease and problems and uncertainty during this waiting period. So they do art therapy. An art therapist comes in and brings tools. They paint and talk about that. They are able to release their thoughts and emotions through this creative process.”
Art as a Path to Wellness groups allow for stress management and the processing of emotions that arise within the hospital setting and are offered to visitors, caregivers, patients, and families.
Music therapy is the systematic clinical application of music to improve a patient’s physical, cognitive, emotional, and social well-being. It combines music and therapeutic techniques and aids in the physiological, psychological, and emotional well-being of the individual during treatment of an illness. AMI’s music program includes music therapy, live music performances, overhead music, a relaxation channel, education, and research. According to Fattorini, “A lot of music therapy patients are neurology patients and recovering from stroke. Very often they can’t speak. Music therapists work with specific methods developed for stroke patients. Melodic intonation and rhythmic stimulatory programs are used to motivate the patient and activate the brain. The human brain can sing a sequence of words that it can’t speak. After the brain sings the sequence, the patient can stop singing and can speak the words. Sometimes after only three sessions, a patient can speak. But they have to first sing the sentence. A simple sentence like ‘Give me a glass of water.’” Music therapy has been active in research for using rhythmic auditory stimulation to improve gait in patients with multiple sclerosis, as well.
The Performing Arts program brings a variety of music, dance, and theater performances to the hospital. Programs are held Monday through Friday, during the lunch hour. There are approximately 370 performances a year.
Professional musicians, as well as community and employee musicians, perform throughout the hospital. Musicians from Cleveland Music School Settlement, Apollo’s Fire, Cleveland Orchestra, Cleveland Pops Orchestra, and Roots of American Music have performed. Dance is an artistic expression that involves the movement of the body. Often done with rhythm and to music, dance expresses ideas, emotions, and energy. The movement itself can be healing and therapeutic, while the observation of dance is uplifting and energizing. AMI has hosted performances of several dance companies, including GroundWorks DanceTheater, a local dance company that collaborates with the clinic to bring in the Dance Exchange, whose Tools for Health include a two-day workshop which put theory into practice for using dance with patients.
Fattorini admits she didn’t recognize the value of the program when it began. “When I started this I really did not know how important it was,” she says. “I am a physician, a doctor, and didn’t know how to shape this, but it’s almost shaping itself because there’s such a need and a passion in people who are receiving and giving. There is a huge passion in employees, who are equally hungry for this type of program. Nurses who work long hours in a very tense and stressful job. They want to prevent burnout. So they call an art therapist and they do a group arts therapy program. It’s really beautiful. They’re all artists; there’s a lot of talent. They just need to be given an opportunity to show it.”
Fattorini also oversaw the establishment of an Arts in Medicine Program at the Cleveland Clinic Abu Dhabi, which opened its doors in 2013. She is excited about the future. “I think we are in a new era where we are restoring the connection between arts and healthcare,” she says. “I think people were so mesmerized by the development of technology the last 50 to 60 years that they forgot about the human soul. When you say that we’re trying to awaken the soul of healthcare and the soul of the hospitals by integration of the arts into the healthcare, people see this sometimes as a soft approach. I don’t think it’s soft. I think it’s realistic. I think we forgot what is important and I think this is now the right moment to awaken the conscience and awareness of the people about the importance of art, almost as a symbol of changing the culture in healthcare.”
Cleveland Clinic was honored at the National Corporate Theatre Fund Chairman’s Awards Gala in New York. The recognition was presented to Dr. Toby Cosgrove, president and CEO, for the clinic’s support of the arts particularly as it relates to the Art and Medicine Institute’s program. In his acceptance speech, Cosgrove said, “We’re proud of our own Arts & Medicine Institute, which brings the power of music, dance, theater, and visual arts to our patients, our visitors and our employees to enrich their experience.” Fattorini hopes that other hospitals will follow Cleveland Clinic’s lead to create a global movement of changing the culture of healthcare.