E. Davis

Arts-In-Medicine, Spring 2009

Moving from Creative Expressions to Creative Encounters

This semester I have taken a long journey with the concept of pain. At first my goal was to understand how it works. Then I became interested in how it has been understood over time. My interest then morphed into the individual’s concept of pain and how it is expressed. I have not gained a cohesive answer to any of these questions, but I have become more convinced of the potential of creative expressions to help transform pain.  While the individual’s expression of pain through the arts can have a role in healing, the impact of that creative expression is multiplied when experienced as an encounter with others or within a caring community.

The manner in which we learn to express or hide our experiences of physical and emotional pain is quite complex. Ridell et al. (2007) studied pain behaviors in babies and found that babies’ expressions of pain or discomfort become adapted to the degree to which their parents respond: those with parents more likely to comfort the baby cry more than those whose caretakers show less concern (Craig 27). Much of one’s individual reaction to painful stimuli is based upon her personal history of painful events as well as her socialization process, which is influenced by the modeling of peers or family members (Craig 4).

In human evolution, the hiding of a physical weakness plays an important role, as ancient people would not want to show vulnerability to potential foes for fear of being taken advantage of. In modern times, it is still true that there is a wide range of potential responses from others to one’s expression of pain, among which might be apathy, fear, or compassion. In experiencing these negative responses, children learn to be cautious about indicating discomfort to others (Craig 26-7). Badali (2008) found that individuals who were alone tended to be more expressive about their pain and more obvious in exhibiting pain behaviors than were individuals in the presence of strangers (Craig 28). Judy Zeman and Judy Garber studied pain expression in boys and girls in first, third and fifth grades. They found that older participants had developed more internalized rules about what type of expression of pain, anger, or sadness was appropriate in different contexts with different audiences (968). They also found that girls were more likely than boys to ask for support when confronted with pain or an emotion-laden situation (969).

            If a patient’s verbal and non-verbal expressions of pain do not accurately reflect her experience of pain, the patient’s diagnosis and treatment become problematic. Kenneth D. Craig notes that many health care professionals rely mainly on verbal or written self-reports about patients’ experience of pain (2). The ability to discuss pain is highly based upon social learning and dependent upon culture. This reliance on the self-report has led to the under-treatment of those who have cognitive disorders or who lack adequate skills in vocalizing their pain (Craig 23).

            In the decades since pain research came into vogue, there has been continual experimentation into alternative means of measuring pain in patients. Two individuals worked in the 1970’s and 80’s on pain scales consisting of colors. Stewart (1977) was interested in the colors most often identified with peoples’ pain. Most of the subjects selected red. Stewart then developed a scale involving different sizes of red circles to represent the strength of the pain. An additional set of black circles were offered to subjects to identify the emotional impact of the pain (McGrath 63).

            Eland (1974) tested some of Stewart’s ideas in children. Those studied commonly identified purple, red, or black as representing pain. Eland’s later work asked children to build their own scale of colors representing pain. These were then used to fill in a figure of the human body, identifying intensity in different areas with the colors from their scale (McGrath 63). Several additional studies have been conducted of children’s expressions of pain in drawings. Jeans and Gordon (1981) found that the overwhelming majority of children in their study drew representations of physical pain (Craig 63). There has been no reliable way developed to consistently utilize the information in children’s drawings to develop a plan of treatment (Craig 63).

Having seen the process of children visualizing their pain through drawings, I have come to the conclusion that I could not interpret their experience based upon their drawing. My own view of what they painted or sculpted must be colored by my own life. There may be some common points in the depictions, and in the experiences from which they were drawn, but each individual’s viewpoint is totally unique. While they may not be a good diagnostic tool, artistic expressions of pain done by children can be valuable in the healing process.

The value of these art works seems to lie in the expression of a difficult experience and its accompanying emotions. Michael Lerner states that the act of expressing an emotion allows a person to see it for what it is, bringing it into consciousness and at the same time stepping away from it, and changing the relationships with that aspect of the self (334). Perhaps this was what I discovered through my service learning project. I asked the children to recall a painful experience. Some of them called that into being in front of the group, giving it new life in words. Then in creating a visual representation of it, they really could step back and think about the experience in a new way. In turning the pain into an object and thinking about how to represent it, one can reclaim, refashion, or reorganize the experience and its connected emotions. As Michael Lerner writes, “When you’re able to express the fear and the pain and the sorrow and the anger, then there’s room for the lightness and the joy as well” (332-334).

While it is not something that we are often asked to do, drawing a picture of pain may be easier to do than to talk about what pain is. Morris writes that pain defies definition, yet we still seek to try to understand what it means (12). McGrath asked child participants in a pain survey to write about what it meant for them. Some of the responses were, “something very bad and unuseful” (Age 7), “a feeling of hurt physically or mentally by someone or something” (Age 14), and, “a feeling, but what I don’t understand is why it is so bad and why sometimes you cry. It’s just like any other feeling. I think the reason why you cry is because it looks bad and it’s mostly all in your head” (Age 10) (McGrath 5-6).  Again, the pain experience is different for everyone.

Much of the writing on pain emphasizes its isolating aspects. Rachel Remen speaks about illness as a factor that can separate a person from those around him or her. It makes one feel alone and can scare others away (345). David Morris also emphasizes the isolating, solitary experience of pain, as it is felt only in the individual’s body and mind (14). Yet when a wounded person joins with someone with a similar wound, a trust can be developed, and the two individuals can more easily unite in their vulnerability. This ability to be vulnerable can allow one to open the self to the world, to others, and to love (Remen 344, 346) as well as to healing. This connection in woundedness facilitates communication about the pain and its accompanying emotions. Lerner mentions Temoshek’s study which links the expression of feelings in women living with cancer to increased evidence of physical healing at cancer sites (332). In my service learning project, I asked the participants to deal with pain as a group. In discussing some of their experiences and responses to it together and viewing one another’s representations of pain, they learned something about each another. By creating a forum for group expression, we altered the nature of the pain, making it more communal than individual.

Pain may be impossible to grasp or define, but the idea of what pain does to each of us can be instructive in thinking about how to counteract its effects. As mentioned, pain serves to isolate. It is a solitary experience. Because it resides entirely within one individual, no one else can grasp what it means or feels like to that person. This turns one inward. When I visualize myself in pain, I see myself in the fetal position, curling up to protect myself from further painful stimuli. The pain acts upon the individual, so that the person becomes the receptor, making the pain experience a passive one. Pain can be a debilitating experience. It results from harm to one’s body or psyche, and can result in limitations in one’s ability to function at an optimal level, by limiting physical movement or social interaction. Pain, then, is an inherently isolating, inward, passive, debilitating experience.

The process of healing must involve counteracting some of the effects pain has. In my service learning project we discussed the idea of an “opposite” of pain. The words mentioned were “happy,” “healed,” and “excited” (Reginald Chavez Elementary). “sadness,” “affection,” “warm fuzzies,” “not hurting,” “excitement,” and “feels good” (Whittier Elementary), and “freedom,” “joy,” “bliss,” “vitality,” “openness,” “wholeness,” and “love” (Arts-In-Medicine Class). Just as pain is experienced differently by everyone, pain’s opposite takes a different form for each person.

In coming to see pain as isolating, inward, passive, and debilitating, I am learning that for me, healing must involve opposing characteristics. This disintegration of the person that happens through the process of suffering must be counteracted for healing to begin. Lerner states that the process of learning to reintegrate these hidden parts or ourselves is a long one (332).  Remen notes that, “Healing may not be so much about getting better as about letting go of everything that isn’t you—all of the expectations, all of the beliefs—and becoming who you are. Not a better you, but a realer you” (354). My process of healing must unite, focus outward, be active, and be a regenerative force in order to begin reversing the effects of pain.

            Throughout our course, a strong connection between artistic expression and the healing process has been emphasized. Rollo May also makes this connection in describing creativity and the creative process. While early analysis of creative people focused on their deficiencies or deviations from the norm, May sees the creative process as evidence of wellness and a part of the process of self-actualization, or reaching ones highest potential as a human being (40).  May further emphasizes that creativity must necessarily involve an encounter—this must unite the individual with his or her world (50) while also unifying different aspects of the person herself, such as the rational and the expressive or emotional (May 49). This encounter is “powerful and alive” (May 52) and results in an expression of joy (May 45). Creativity, then, can be seen as a force that unifies: the individual with herself, with others, and with her world. While much of the process may take place internally, it is ultimately focused outward. It is inherently an active process, involving bringing something new into being, generating rather than destroying.          

If creativity combines many of the opposite characteristics of pain, it makes perfect sense that creativity can be vital to the healing process. In dealing with a lengthy spiritual crisis and a collapse of my world view ten years ago, I was intuitively drawn towards expressive, creative activities like drumming, dancing, poetry and the visual arts despite the fact that they had played no role in my life prior to that point. My involvement with these creative activities was mostly in isolation. When faced with pain, I succumbed to the need to turn inward, isolating myself from others. While I was opening new doors for my life, my expression, and my future, the healing process was stalled. There was no encounter, no unifying happening through the expression of my creative self.

            It was not until I relocated and found myself in the arms of a loving, caring group of like-minded individuals that the healing process really began for me. With this new community I felt comfortable sharing my battles and pains, and was also able to be present for others in their own struggles. I continued experimenting with creative expressions, but now I had others to journey along with me. With this new community, my creative expressions turned outward and became creative encounters, providing the healing effects I needed. In the years since then I have not been consistent in cultivating my community of support. I may continue to express myself partially through my art, but unless that is experienced as an encounter with others, the healing process cannot be fully realized.

            This is one aspect of my service learning project that I did not consider, but which had the biggest impact on me. If I had worked individually with each child to develop his or her image of pain, the project would have had less long-term value. Yes, the child would have an alternative way to express a difficult experience, but the connection with the group and the realization that we all have these traumas would not have occurred. In the same way Alison in the Arts-In-Medicine program at UNMH extends the value of the arts in healing. In offering art materials to patients or caregivers and providing them with the opportunity to express themselves artistically, she is offering them a creative experience. She goes beyond this, however, sitting down to talk about the artwork with the artists and giving them an opportunity to share.  When this happens, the experience becomes an encounter, and the healing possibilities are broadened.

            As I move forward in my life there remain pains and emotions that I have yet to deal with. In my service learning project I was willing to ask children and my classmates to recall and creatively express some of the pains they have experienced, but I have not been able to do so for myself. This time, after looking inward, I need to turn outward, inviting others along on my journey. It is in this outward, active expression of pain with a caring community that the creative encounter can reach its fullest potential as a healing force.


Works Cited

 

Arts-in Medicine Class. Service Learning Presentation Group Discussion. 30 Apr. 2009.

Craig, Kenneth D. “The Social Communication Model of Pain.” Canadian Psychology 50.1

(2009): 22-32.

Lerner, Michael. “Healing.” Healing and the Mind Ed. Bill Moyers. New York: Anchor, 1995,

323-342

McGrath, Patricia A. Pain in Children: Nature, Assessment, and Treatment. New York: The

Guilford Press, 1990.

May, Rollo. The Courage to Create. New York: Norton, 1975.

Morris, David B. The Culture of Pain. Berkeley: University of California Press, 1991.

Reginald Chavez Elementary. Group Discussion. 16 Apr. 2009.

Remen, Rachel Naomi. “Wholeness.”  Healing and the Mind. Ed. Bill Moyers. New York:

Anchor, 1995, 343-364.

Whittier Elementary. Group Discussion. 23 Apr. 2009.

Zeman, Janice and Judy Garber. “Display Rules for Anger, Sadness, and Pain: It Depends on

Who is Watching.” Child Development 67.3, (1996): 957-973.