Can art therapy help address the mental health pandemic?

Amid the ever-rising wave of Covid-19 cases around, anecdotal evidence has pointed to the deep impact of the pandemic not just on physical health but also the mental health of thousands, manifesting through depression, anxiety, stress-induced trauma and more.

In a study published in PLOS ONE from earlier this year, researchers concluded that a whopping 1 in 3 adults globally are depressed or anxious due to Covid-19, after performing a meta-analysis of 68 studies surveying 288,830 participants from 19 countries, all conducted during the pandemic.

Unfortunately, India is more than vulnerable. Not so long ago, the World Health Organisation (WHO) labelled the country as ‘the most depressed in the world’ — and the prevalent low public awareness and high level of stigma attached to mental illness has rendered systems capable of addressing the issue to be both powerless and unwilling to act.

Amid these alarming developments, psychotherapy remains an avenue that is not engaged to its fullest capacity, both for and by mental health patients. This, however, has also left room for alternative modes of therapy to come to the fore and inhabit a much-needed microcosm for those seeking relief not just from severe mental illnesses, but also milder or chronic cognitive challenges. Enter: art therapy.

Abir Pothi hears about it from Dr Drona Sharma, an accomplished UK-based consultant psychiatrist/clinical director, who has worked extensively with both the government and private agencies in the field of psychiatry of intellectual disability, and offers art therapy sessions as part of a holistic treatment plan.

Art therapy is a richly flexible mechanism that works across classes and cultures. All cultures have some inherent link to arts of all types, as do social classes. Art therapy is not about learning art or teaching art — but about using art as a medium of expression; it’s important to note that the benefits from art therapy are not linked to level of achievement in delivering the art form. And so, the applicability of art therapy is universal.

Art therapy has been known to add substantially to the treatment and healing of serious mental illnesses, including depression, personality disorders, anxiety, post-traumatic stress disorder (PTSD) and schizophrenia.

The creative process of art-making activates multiple areas of the brain, and by doing so, art therapy provides a means to exercise the whole brain, supporting integration, brain plasticity and healthy brain functioning.

Cutting across modalities, art therapy also finds age to be no bar. In fact, aside from the post-pandemic perspective on this antidote, art therapy also goes leagues ahead to address learning disabilities and mental troubles in children at an early stage, aiming to give them a healing means of expression to focus their energies on. I have also worked substantially with adults who have learning disabilities, including those who have committed major crimes, in the UK.

The brain is stimulated by creating art, and produces higher levels of dopamine. This is especially important for Attention Deficit Hyperactivity Disorder (ADHD) as increased dopamine levels improve concentration. Expressing creativity through art also elevates serotonin and reduces stress levels. Used therapeutically, art-making can also improve the symptoms of executive function in children and adults with ADHD, and the motor skills of specific children with learning disabilities or dyslexic children. In a variety of ways, this therapy can be highly beneficial in addressing the daily challenges they face.

For instance, children with ADHD and types of learning disabilities often have intense emotions. Some suffer from poor social skills and/or low self-esteem as well. Art therapy is a tool that provides a non-verbal approach to communication and expressing emotions.

Art therapy also means, in most cases, a zone that is relatively free of judgment to communicate one’s thoughts. It bestows an opportunity for self-expression, especially for those who find it hard to express their thoughts and feelings verbally. Art therapy in schools offers a creative (and enjoyable) way to communicate without restrictions, as there is no such thing as failing when you create art. This process gives them a sense of accomplishment and builds their self-confidence.”

There are many ways in which art therapy can benefit participants, such as by building self-esteem, supporting mentalization processes (the capacity to read and understand one’s own and other people’s emotions and motivations), developing coping skills, working through trauma in a safe, non-intrusive way, developing interpersonal skills and reciprocity, building frustration tolerance, supporting sensory integration, promoting internal locus of control (developing the child’s capacity to identify choice and exercise appropriate levels of control in their life), teaching and supporting self-regulation, and directly affecting levels of hormones like serotonin, dopamine and cortisol.

As for the integration of art therapy into education/rehabilitation systems in India — the country has a rich heritage that links arts in all its forms to day-to-day life, rangoli being a common example, song and music being another. We are surrounded by sculptures and many of us have grown up with clay utensils like surahi and ghada. So, the psychological substrate to engage in such a medium exists. India’s challenge is in delivering some succour to the mentally disturbed in the context of very limited resources for both training professionals and treating patients. If we combine the two elements, India could benefit from using art therapy to engage with the mentally disturbed and those who have limited communication means, such as people with learning disabilities, ASD, acquired brain injury , dementia, and of course, the mentally ill.

Dr Drona Sharma (MBBS, DPM, DCP, DPM, FRCPsych, LLM) has been a consultant psychiatrist in psychiatry of intellectual disability since 2002, in both the public and private sector in the UK, Ireland and Gibraltar, and has held additional positions as clinical director and medical director. He has also used telepsychiatry to deliver remote mental health care and support in India. He has developed specialist clinical pathways for people with learning disability, autistic spectrum disorders, Prader-Willie Syndrome, intellectually disabled sex offenders and those with ADHD. He is trained in behaviour management techniques and brief solution focused therapy, and endeavours to create a holistic treatment plan for his patients incorporating art therapy.

Team Pothi\’s Take: Recent instances of art therapy in India

Existing evidence supports the success of art therapy in myriad ways. For instance, take Chennai-based 24-year-old Rupak Munje, who was diagnosed with autism spectrum disorder (ASD) when just three years old. In a recent news report, his parents professed that as a school student, he took part in a year-long programme conducted by an American art therapist, which not just helped him channel his non-verbal and hyperactive tendencies, but also had the offshoot of recognising a genuine aptitude and passion for art. In 2018, Rupak’s painting was selected for exhibition by the Kochi Biennale Foundation, and later, also by Geneva Centre for Autism’s International Virtual Symposium-2020.

Before the onset of the pandemic, a handful of places in India offered art therapy sessions, workshops and/or courses. These include Sankalpa in Auroville, Pondicherry, where therapy sessions took place in individuals and in groups, with those partaking encouraged to create without judgment of their own art or that of others. Abhyaantar Healing Arts in New Delhi used a combination of visual art, dance, drama and creative writing, while Mumbai reported at least three options for art therapy counselling/exercises.