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Art and Medicine

By Dr Jim Chambliss

It is often said that a picture speaks a thousand words.

Contemporary medical technology provides incredibly intricate pictures of external and internal human anatomy.

However, technology does not communicate holistic representations of the social, behavioural and psychosocial impacts associated with illness and the healing process.

Studies have shown that increased reliance on reports from expensive laboratory tests, radiology and specialised diagnostic technology has resulted in inadequacy of physical examination skills; decline in patient empathy, and less effective doctor/patient communication.

Having commenced in May this year and continuing until July 8, continuing professional development workshops which explore and promote the value of art expression in the development of observation skills, human sensitivity and relevant healthcare insights will be presented at the National Gallery of Victoria exhibition of the original works of Vincent van Gogh.

The program will incorporate empirical research to illustrate the way neuropsychological conditions can influence art and creativity. The objectives of the workshops are to:

 • advance understanding of the impact of medical, psychological and social issues on the health and wellbeing of all people;

 • promote deeper empathy and compassion among a wide variety of professionals;

 • enhance visual observation and communication skills; and

 • heighten creative thinking.

Over the last 15 years, the observation and discussion of visual art has emerged in medical education, as a significantly effective approach to improving visual observation skills, patient communication and empathy.

Pilot studies of implementing visual art to teach visual diagnostic skills and communication were so greatly effective that now more than 48 of the top medical schools in the USA integrate visual arts into their curriculum and professional development courses are conducted in many of the most prestigious art galleries and hospitals.

The work of Vincent van Gogh profoundly illustrates the revelations of what it means to be uniquely human in light of neurological characteristics, behavioural changes and creative expression through an educated, respectful and empathic perspective.

The exact cause of a possible brain injury, psychological illness and/or epilepsy of van Gogh is unknown.

It is speculated by numerous prominent neurologists that Vincent suffered a brain lesion at birth or in childhood while others opine that it is absinthe consumption that caused seizures.

Two doctors – Felix Rey and Théopile Peyron – diagnosed van Gogh with epilepsy during his lifetime.

Paul-Ferdinand Gachet also treated van Gogh for epilepsy, depression and mania until his death in 1890 at the age of 37.

After the epilepsy diagnosis by Dr Rey, van Gogh stated in a letter to his brother Theo, dated 28 January 1989: “I well knew that one could break one’s arms and legs before, and that then afterwards that could get better but I didn’t know that one could break one’s brain and that afterwards that got better too.”

Vincent did not, by any account, demonstrate artistic genius in his youth. He started painting at the age of 28 in 1881.

In fact, his erratic line quality, compositional skills and sloppiness with paint were judged in his February 1886 examinations at the Royale Academy of Fine Arts, Antwerp to be worthy of demotion to the beginners’ painting class. His original drawings and paintings were copies from others’ art, while his sketches in drawing class showed remarkably different characteristics.

Increased symptoms of epilepsy and exposure to seizure triggers (absinthe and sleep deprivation) ran parallel with van Gogh’s most innovative artistic techniques and inspirations following his move to Paris in 1886 to 1888.

These symptoms increased, accompanied by breathtaking innovation following his move to Arles, France in 1888 and his further decline in mental and physical health.

In Paris he was exposed to the works of many of the most famous impressionistic and post impressionistic painters, but so much of his new techniques and imagery were distinctly innovative in detail without traceable influences from others.

While in Paris his work transitioned from drab, sombre and realistic images to the vibrant colours and bold lines.

His ebb-and-flow of creative activity and episodes of seizures, depression and mania were at their most intense in the last two years of his life when he produced the greatest number of paintings.

His works are among the most emotionally and monetarily valued of all time. Vincent’s painting of Dr Gachet (1890) in a melancholy pose with digitalis flowers – used in the treatment of epilepsy at that time – sold for $US82.5 million in May, 1990, which at the time set a new record price for a painting bought at auction.

Healthcare professionals and art historians have written from many perspectives of other medical and/or psychological conditions that impacted van Gogh’s art and life with theories involving bipolar disorder, migraines, Meniere’s decease, syphilis, schizophrenia, alcoholism, emotional trauma and the layman concept of ‘madness’.

What was missing as a basis to best resolve disputes over which mental or medical condition(s) had significant impact on his life was a comprehensive foundation of how epilepsy or mental illness can influence art and possibly enhance creativity based on insights from a large group of contemporary artists.

Following a brain injury and acquired epilepsy I gained personal insight into what may have affected the brain, mind and creativity of van Gogh and others who experience neurological and/or psychological conditions.

The experience opened my eyes to the medical, cognitive, behavioural and social aspects of two of the most complex and widely misunderstood human conditions.

Despite having no prior experience or recognisable talent, I discovered that my brain injury/epilepsy had sparked a creative mindset that resulted in a passion for producing award-winning visual art.

I enrolled in art classes and began to recognise common topics, styles and characteristics in the art of contemporary and famous artists who are speculated or known to have had epilepsy, such as Vincent van Gogh, Lewis Carroll, Edward Lear and Giorgio de Chirico.

Curiosity for solving the complex puzzle of how epilepsy could influence art led me to pursue a Masters in Visual Art which included a full course exclusively about Vincent van Gogh.

I subsequently obtained the world’s first dual PhD combining Visual Arts, Medicine and Art Curation at the University of Melbourne.

The PhD Creative Sparks: Epilepsy and enhanced creativity in visual arts (2014) was based on the visual, written and verbal insights from more than 100 contemporary artists with epilepsy and provided:

 • objective and subjective proof that epilepsy can sometimes enhance creativity – supported by brain imaging illustrating how that can occur;

 • a comprehensive inventory of the signature traits of neurological and psychological conditions that have significant interpretive value in healthcare practice and consideration in art history;

 • the largest collection of images of the visual narratives from people with epilepsy;

 • comparative data to distinguish epilepsy from other medical and mental conditions; and

 • the Creative Sparks Art Collection and Website – artandepilepsy.com.

Interest in these research discoveries and art exhibitions provided opportunities for me to deliver presentations at national and international universities, hospitals and conferences. Melbourne University Medical School sponsored an innovative series of workshops through which to teach neurology and empathy by an intriguing new approach.

 Jim Chambliss has a dual PhD in Creative Arts and Medicine and has explored the ways epilepsy and other health conditions can influence art and enhance creativity.

Information about his Art and Medicine Workshops involving Vincent van Gogh can be obtained by visiting artforinsight.com or artandepliepsy.com

 

Increasing funding to improve outcomes for eating disorders

The Federal Budget allocated $80 million for Australians with a mental illness such as severe depression, eating disorders, schizophrenia and post-natal depression resulting in a psychosocial disability, including those who had been at risk of losing their services during the transition to the NDIS.

The Government also announced it will provide $9.1 million over four years to improve access to psychological services through telehealth in regional, rural and remote Australia.

Health Minister Greg Hunt has also freshly announced that eating disorders will be included in the 5th Mental Health Plan and that the current Medicare Benefits Schedule Review Taskforce investigate Medicare coverage for the treatment of those with an eating disorder.

The National Mental Health Commission described the funding announcement as timely.

“Timely that eating disorders will be recognised officially as serious and complex mental illnesses with serious physical consequences,” said the Commission’s chief executive Peggy Brown.

The Butterfly Foundation, which is the country’s peak support organisation for people with conditions such as anorexia and bulimia, says that the current health system is failing people with an eating disorder.

Its chief executive, David Murray, said: “Too many times in the past 12 months Butterfly staff have sat vigil with families as the health system has failed.”

“When suicide is up to 31 times more likely to occur for someone with an eating disorder, clearly the Government should address this problem with a dedicated focus.”

According to the National Eating Disorders Collaboration (NEDC), an initiative of the Australian Government Department of Health, more than 1 million Australians suffer from eating disorders and represent the third most common chronic illness for young females.

The NEDC also cites research that shows anorexia has the highest death rate of any mental illness and carry a very high rates of mortality with one in 10 people who suffer from an eating disorder dead within 10 years.

Deaths associated with eating disorders are typically caused by medical complications (such as cardiovascular issues and multiple organ failure), suicide or complications relating to substance use.

A 2012 Deloitte Access Economics report examined the economic and social impact of eating disorders in Australia and found the total socio economic cost of eating disorders to be $69.7 billion per year.  These costs can be reduced with early detection.

The Australian Medical Association believes that a greater focus is needed on ensuring appropriate access to early intervention and treatment services for young people especially in rural and remote locations.  The AMA also believes that a nationally coordinated approach is necessary in order to develop effective and consistent practices in preventing and addressing the incidence of unhealthy body image and eating disorders. 

If this article has raised concerns about eating disorders, please contact the Butterfly Foundation national hotline on 1800 33 4673; or visit www.thebutterflyfoundation.org.au for support and resources for eating disorder sufferers and their families and carers.

Meredith Horne

[Comment] Respiratory medicine and critical care: a call for papers for ERS

The Lancet and The Lancet Respiratory Medicine would like to hear from authors of research papers in the fields of respiratory medicine and critical care, as the two journals are planning special issues to coincide with the 2017 European Respiratory Society (ERS) International Congress that will take place in Milan, Italy, on Sept 9–13, 2017.

[Editorial] Purdah and the gagging of science

The UK’s National Institute for Health Research (NIHR) has issued guidance discouraging publication of—and commentary on—NIHR-funded research for the remainder of the country’s General Election purdah. Purdah is a controlled period restricting public-facing activity, intended to prevent influence on election outcomes (currently enforced from April 22 to June 8). Using purdah to control science communication is an abuse of its intended purpose, and is not part of the original code. The guidance prevents dissemination and commentary on all NIHR-funded research covering public health, social care, health-system finance and workforce, and “any other areas where there is a risk of political interpretation”.

PM shares the love

Prime Minister Malcolm Turnbull put down his script while addressing the AMA’s National Conference to express his appreciation for the medical profession.

After telling conference delegates that his Government was committed to delivering good health policy – and after outlining what he considered to be the best bits of what the Federal Budget had delivered for the health sector – he said doctors were committed to love.

“I know that all you – all of your years of academic training, all of your years of clinical experience, all of the science and studying that’s dominated your lives – above all else what drives you is love for your fellow men and women. Love for your patients,” he said.

“You’ve committed yourselves to a life of service – undiluted. A commitment. A compassion. We thank you for it.”

The Prime Minister continued to leave his notes aside as he wound up his speech praising the state of Australia’s medical workforce.

“Our health system is the envy of the world,” Mr Turnbull said.

“Our skilled doctors, our nurses, all your allied professionals, work tirelessly to give the best possible care and your Government thanks you for that.

“Thank you for your dedication, thank you for your professionalism, thank you for your compassion.

“We will match you with a commitment to ensure that you have the resources at every level to continue to deliver the practical love that keeps Australians well.”

The Prime Minister’s speech was warmly received by a receptive audience. AMA President Dr Michael Gannon said it was indicative of the respect and influence the AMA has that the PM eagerly accepted an invitation to address the conference.

Peanut allergies in children

Earlier in his speech, Mr Turnbull committed a $10 million investment towards a research project for a new treatment for children with peanut allergies.

“That has the potential to benefit the people who deserve the highest level of support – our children,” he said.

“The research will help develop a new therapy for our children with peanut allergies to help incorporate peanut products as a regular part of their diet.

“What a difference that will make to children everywhere. It’s an example of innovative projects the Government is backing.”

Chris Johnson

 

 

Funding to help tackle resistant bugs

Health Minister Greg Hunt used his address to the AMA’s National Conference to announce a $5.9 million investment from the Medical Research Future Fund (MRFF) to help address the growing threat of superbugs.

With the number of microorganisms such as bacteria, viruses or parasites becoming increasingly resistant to standard medical treatments such an investment was warranted, the Minister said.

Resistance results in standard medical treatments such as antibiotics, antivirals or anti-malarials becoming ineffective, allowing infections to persist and possibly spread.

“Infections are becoming increasingly difficult to treat, leaving healthcare professionals with limited – or in some instances zero – treatment options,” Mr Hunt told conference delegates.

“Australia has one of the highest rates of antibiotic use in the world and rates of resistance to some common antibiotics are increasing globally.

“Commercial returns on the discovery and development of new antibiotics is relatively low, so it is an area of research that doesn’t attract sufficient private sector investment.

“The research will be consistent with the achievement of the objectives of the National Antimicrobial Resistance Strategy 2015-2019, which was developed by the Australian Government in partnership with states and territories, academics, research organisations and industry.”

The strategy will include a focus on knowledge gaps in relation to the development and spread of resistance; and the development of new products, including diagnostic technologies and therapies, policies and approaches to prevent, detect and respond to resistance.

“The Coalition’s $20 billion MRFF provides a long-term sustainable source of funding for research that aims to improve health outcomes, quality of life and health system sustainability,” the Minister said.

“This investment in critical antimicrobial resistance research is part of the $65.9 million in MRFF disbursements announced in the Budget.

“The Turnbull Government is committed to supporting Australia’s talented researchers to find solutions to challenges that make a difference to patients’ lives.”

Chris Johnson

[Perspectives] Brain Diaries: two hemispheres of interest

“Understanding the brain and its diseases is one of the key challenges of the 21st century”, said Professor of Clinical Neurology Christopher Kennard at the launch of Oxford University Museum of Natural History’s Brain Diaries. “I’ve said that is like climbing Everest, but I don’t even think we’ve got to base camp”, Kennard explained, citing the growing “problem of dementia: the longer we live, the more likely we are to develop Alzheimer’s”. Incorporating research from more than 50 neuroscientists, Brain Diaries explores the passage of a healthy brain from conception to old age.

Malaria expert to head up WHO

Internationally recognised malaria researcher, Dr Tedros Adhanom Ghebreyesus from Ethiopia, will be the next Director-General of the World Health Organisation (WHO).

He will be the first African to lead the United Nations agency and will replace Dr Margaret Chan who steps down from the role at the end of June.

He will also be the first non-physician to lead WHO – holding a PhD in community health. His leadership of WHO is for a five-year term.

Dr Tedros, aged 52, was previously the Ethiopian Health Minister and the Foreign Affairs Minister, and was also the chairman of the Global Fund to Fights Aids, Tuberculosis and Malaria.

He has been elected to the Director-General’s post after winning the most votes from WHO’s 194 Member States during three rounds of secret ballots that began in January and culminated on May 23.

In a three-way face-off during the final vote, he first knocked off Pakistan’s Dr Sania Nishtar then defeated Britain’s Dr David Nabarro 133 votes to 50 (with some abstentions).

The agency has been criticised for its response to the Ebola epidemic in West Africa – particularly for missing warning signs of just how bad 2013 outbreak that went on to  kill more 11,000 would be.

Before being elected, Dr Tedros committed WHO to responding to future emergencies more rapidly and effectively.

And he has promised to champion the health rights of the world’s poor. 

“All roads should lead to universal health coverage. I will not rest until we have met this,” he said while campaigning for the role.

“(My vision as the new Director-General is of a) world in which everyone can lead health and productive lives, regardless of who they are or where they live.

“I promise I will get up every day, determined to make a difference. I am ready to serve.”

The campaign was controversial at times, with Dr Tedros being accused of covering up cholera epidemics in Ethiopia – accusations that have been vigorously denied.

His candidacy was also greeted by Ethiopian opposition groups as an attempt to improve the country’s profile and smooth over accusations of human rights abuses by its government.

Dr Tedros has listed his top priorities in the new role as: advancing universal health coverage; ensuring WHO responds rapidly and effectively to disease outbreaks and emergencies; putting the wellbeing of women, children and adolescents at the centre of global health and development; helping nations address the effects of climate change on health; and making the agency transparent and accountable

Chris Johnson

[Comment] Offline: Israel and Palestine—a joint search for the truth

In July, 2014, amid the tragedy of a war between Israel and Hamas-controlled Gaza—a conflict in which thousands of rockets and missiles were fired, leaving hundreds of children and women dead—The Lancet published a letter by Paola Manduca and colleagues. We had been working with Palestinian health professionals since 2007 to help advance their health and health care through research collaboration. The intention of publishing the letter from Manduca et al was to signal a cry of anguish for a people we had come to know well.

[Correspondence] Health economics – Authors’ reply

As Theodore Papaioannou and colleagues point out, projecting long-term health spending is challenging.1 Our Article2 and extensions of this research3 made health spending projections for 184 countries and extends through 2040. Many factors—environmental, epidemiological, demographic, cultural, political, economic, and scientific—influenced the creation and evolution of complex health systems, and have coalesced to determine current health spending levels. These same factors will undoubtedly also influence health spending in the future, although how these factors will interact and determine precise spending is difficult to predict.