Culture prescribed

Les Kurbas Theatre, Lviv, Ukraine, 2022. Photo: Adriano Miranda

Attending performances of ancient Greek plays in ancient Greek theatres is an experience that always gets me thinking. I find particularly moving the stream of people heading towards the theatre to watch for the umpteenth time the same stories that tell us of love, hate, respect, arrogance, thirst for power, war, justice, revenge. Stories written many centuries ago about human nature and all that is good and bad about it. And then, once I look around me at all the people filling up the theatre, and also seeing them leave after the performance, I often wonder “So what? What now?”. To what extent people use the “food for thought” provided by the play to think about contemporary life, about themselves and others, their place in the world and what could be their contribution towards a better world? When I consider contemporary Greek society (and other societies), the way we take care (or don’t take care) of each other, I am reminded that the power does not lie in the play alone, but also, and perhaps even more, in the individual and what that person will (or will not) do with what was given to them.

I value culture and the arts; I value creativity and the way it questions our certainties and feeds our imagination; I enjoy and cherish the way we, humans, create communities based on all sorts of cultural participation. My daily work is to contribute towards a society where, through culture and the arts, everyone can have opportunities to participate and to grow, to dream and to contribute towards a better, more humane, world. But I also know that this is as far as I can go. The rest, lies with each individual. This is why, years ago, I started questioning statements made by all sorts of cultural organisations that they contribute towards social cohesion, individual and collective wellbeing, intercultural understanding, tolerance, etc. etc., when we see no sign that anything of the kind is actually happening at a larger scale – starting from the way these cultural organisations are managed from within. Some cultural organisations (not all, perhaps not even the majority) make the “tools” available. I am talking about those organisations which are aware of human diversity and their role in serving communities on the principles of access, inclusion and equity. They form part of a broader cultural, educational and social network, though, one whose “success” lies on collaboration and interconnections and not only on Culture.

The way culture and the arts have often been pictured as “remedies” that will solve all kinds of ills in societies (injustices, inequalities, wars and other social conflicts) normally leaves me uncomfortable, for two main reasons: because it seems to ignore the broader cultural, educational and social network, that must see itself as such and become functional, serving a common vision for a future society; and also because it gives culture and the arts a purpose that is not theirs in the first place.

Early November, I attended a conference in Portugal where our colleague Mariana Mata Passos, of the cultural association Pó de Vir a Ser, talked about a pilot programme of “cultural prescription” in the region of Central Alentejo. In her brief presentation, culture and the arts were mentioned associated to “mental health”, “isolation”, “health centres”, “doctors“, “prescriptions”. Given that time for questioning was rather scarce, some of us left the room feeling puzzled and troubled. Days later, I came across an article in a Greek newspaper entitled “At the theatre and the museum with a doctor’s prescription”. The title sounded the alarm for me. The article itself described something similar to the Portuguese experience: a pilot programme of cultural prescription and the ambition that, by 2025, every private psychiatrist will be able to prescribe art therapies, with the goal to include cultural prescribing in the National Health System. What may be prescribed is three-month-long artistic activities or attending performances, films or concerts at least three times a month, which the beneficiaries may then discuss, expressing thoughts and feelings. All this made me comment on Facebook, in a rather ironic mood: “If the patient doesn't improve, will the performance be to blame or will they increase the dose?”. Colleagues closer to these initiatives or involved in similar activities offered to talk about it. I truly look forward to it. But before, I did a bit of homework.

My main concerns, as my comment on Facebook pointed out, have to do with the criteria used by doctors to prescribe a specific activity or attendance and, most of all, how the results might be interpreted regarding the quality or “healing capacity” of the activities prescribed and, taking it a bit further, the impact this might have (is it supposed to?) on the evaluation and perhaps also funding of culture and the arts.

Dodoni Theatre, Ioannina, Greece, 2023. Photo: Maria Vlachou

The article in the Greek newspaper mentioned that “parametres such as how much improvement the patients saw, which intervention (i.e. watching a theatre performance or participating in a drama therapy group) proved more effective, how many patients left, for what reasons and what their characteristics will be evaluated with scientific criteria.” Considering my main concerns, everything still sounded too absurd for me, but, after all, this was only a brief newspaper article. Reading the document that presents the Portuguese pilot programme, written by Mariana Mata Passos and Patrícia Deus Claudino of the cultural association Pó de Vir a Ser, I found no specific references to evaluation – not so much regarding the patients’ progress, but mainly as to what a positive or negative development for each one of them would tell us about the “remedy” itself. This is the part that sounds more problematic to me regarding the “use” of culture and the arts in this context.

In this document, one reads (p.11) that “International scientific research on Cultural Prescription illustrates improvements in mental health and well-being across different parametres: increased energy level; greater vitality, joy and pleasure in life; improvement in the establishment of interpersonal relationships and skills; better self-esteem; increase in motivation; better ability to understand your needs; better self-care capacity; greater proximity to the job market.” Apart from these benefits, another document, Libraries on Prescription, written by Greek colleagues Lida Tsene and Dina Ntziora, also refers that (pp.4-5):

• Social and cultural referral programs can help individuals build social connections and support networks, which are crucial for mental well-being.
• According to “Art, Culture and the Brain” (2022), participation in cultural activities is associated with well-being, a sense of cohesion and mobilisation, while the mental health of people living in developing areas can be improved through exposure to creative and artistic activities.
• Moreover, according to Katherine Cotter, a researcher at the University of Pennsylvania, "museums and art spaces have the potential to positively affect people, reducing stress, creating positive emotional experiences, and helping them feel less alone and more connected.

This is not exactly a surprise for cultural professionals and many of us have got this kind of empirical/personal evidence. It is also useful to have scientific data supporting it. But can we actually say that this is a kind of “recipe”, a “rule”? Something beyond and independent of each individual’s willingness, capacity, agency and context? In an article entitled “Could visiting a museum be the secret to a healthy life?”, Emma Dupuy refers that Mikaela Law, a psychology researcher at the University of Auckland in New Zealand, and her colleagues reviewed the scientific literature for studies on the physiological response to the visual arts and its effect on self-reported stress. “Some of the studies listed in her work show that contact with artwork can lower blood pressure, heart rate and the cortisol secreted in saliva. Such changes reflect a reduction in the body’s state of guardedness, also called stress. This change appears to be perceived by the individual, reflected by the reduction in the stress he or she feels after exposure. Other studies, on the other hand, have observed no effects.” This isn’t a surprise either, is it?

Alexandra Wilson, writing for The Critic about the English National Opera’s forced move from London to Manchester, criticised the organisation’s press releases focusing repeatedly and intensely on the contribution this move will have towards the wellbeing and public health of the locals. First of all, she commented on the irony of such a statement, considering the damage that has already been done to the mental state of highly skilled musicians, who are fearing for their livelihoods, as a result of this change. “Of course, classical music undoubtedly has many benefits for people’s health and happiness. At the most basic level, attending a beautiful performance will probably lift the spirits of most audience members”, but Wilson calls this “a happy by-product”. She also quotes academic Eliane Glaser, who in her book Elitism: A progressive Defence, writes that “By making culture, education and journalism into public relations arenas for tackling inequality, politics has given up on trying to improve society in any kind of organised way”. 

And this is also my point.

As I have already stated, I don’t doubt the physical, emotional and intellectual benefits culture and the arts may have on individuals and also on the diverse communities they form. Participants in Libraries on Prescription reported that the programme offered them the opportunity to find a creative way to express themselves, to socialise and promote their wellbeing and mental health; to creatively enrich their day; to feel part of team and have the opportunity to work in groups; to enhance their confidence and to contribute towards their self-improvement (pp. 14-15). As a cultural professional, though, my main focus is not to use culture and the arts to tackle (and to prove to be able to tackle) issues such as “the recovery and well-being of patients with chronic illnesses (hypertension, diabetes), neurological conditions, cognitive disorders or mental health problems” (as mentioned in Emma Dupuy’s article regarding museum prescription in Canada). My main focus is neither tackling the causes of mental health issues, referred by our Portuguese colleagues as “the social determinants of health” (p.15: disposable income and social protection; education; unemployment and job insecurity; living conditions at work; food insecurity; housing, basic amenities and the environment; early childhood development; social inclusion and non-discrimination; structural conflict; access to affordable health services of decent quality); or failures in the health system, such as “pharmacological overprescription, the lack of human resources in health centres for psychological intervention or the hyper-utilisation of the services” (p.9).

As a cultural professional, I am very happy about all the by-products. But I am also very aware of my place and contribution to the broader cultural, educational and social network I am part of. And I expect each professional (doctors, nurses, therapists, social workers, teachers, judges, police officers, as well as politicians) to do their part to achieve this network’s goals.

Since governments and professionals of different sectors seem to acknowledge culture’s contribution, I believe we need to be clear about the nature of that contribution and the specific role of cultural professionals. Thus, the questions in my mind at this point are the following:

• Should cultural professionals be investing time, effort and money in leading pilot programmes that will confirm scientific evidence on “happy by-products”?
• Aren’t we concerned that, by focusing the by-products, we shall be asked to provide evidence on our effectiveness in dealing with issues and goals which are anything but cultural and artistic
• Considering the apparent consensus on culture’s contribution, shouldn’t we be fighting against the disinvestment from arts and humanities, and their systemic disappearance from school and university curricula?
• If culture and the arts give us tools to become more creative and imaginative, to feed our critical spirit, to envision a better world and our place in it, shouldn’t we be focusing on access and inclusion, in order to guarantee opportunities of attendance and participation for different people?
• Shouldn’t we be working on making cultural organisations more relevant and welcoming for different people, both those with and without health issues and other issues?
• Shouldn’t we concentrate on building capacity among cultural professionals in order to better understand concepts such as access, inclusion, equity, cultural democracy and the way these concepts may affect how we do our work?
• Shouldn’t we be striving to guarantee that cultural professionals (including artists and mediators) have got adequate conditions to do their work?
• Shouldn’t we be caring for cultural professionals mental health?
• Shouldn’t we all (citizens, professionals in different sectors and politicians) be more aware of the need to build a vision for the future and to better understand the role and contribution of each sector in the broader cultural, educational and social network we have formed?

 

I believe that, being able to imagine and to build a better world should be the shared task of the sectors forming the network. Achieving our common goals will be the result of collaboration, acknowledging the specific nature of each one’s contribution and their expertise. Cultural prescription, its reasons and goals, raise serious concerns for me. Now that I have been able to express them in a more organised way, I look forward to discussing them with the colleagues involved.