Drawing and healing traditions

 

Wong-Baker faces are meant to be a very clear and useful guide for patients who are having trouble communicating levels of pain to their doctor or other relevant medical professionals. As they are drawings they are supposed to cut through verbal and written language problems and can be used by a wide range of ages and people of different cultural backgrounds. However I suspect they are as ridden with problems as any other supposedly 'objective' language and that what we regard as a fixed set of expressions are still prone to a wide range of interpretations by others. These faces are another example of atomisation, or a need to reduce complex reality to easily understood components. 

Another attempt to visualise pain is the Schmidt pain index,  which has four levels of pain and is targeted at insect bites.

From the Schmidt Pain Index

I have been trying to use drawing to visualise interoceptive experiences for the past three years and although some of the drawings seem to be communicative of basic feelings such as a pain in a particular place, I have been finding that it is very hard to reach a consensus of opinion in regards to more nuanced feelings. However this is perhaps a challenge rather than a disappointment, as it is obvious that we all inhabit very different internal imaginative worlds and therefore one person's image of pain is another person's image of excitement. 

The longer I work in this area the more I become aware of parallel developments in relation to visualised body images in other professions, in particular in psychotherapy. Psychotherapists use the term 'guided imagery' when referring to a situation whereby a patient is helped to recall images from long-term or short term memory. They also work with patients to create imagery from fantasy or to make them from a fusion between imagination and memory. Guided imagery is defined as 'the assisted simulation or re-creation of perceptual experience across sensory modalities'. (I.e. this is not restricted to vision alone)

The use of imagery has been central to world wide rehabilitation traditions and is a critical component of many healing experiences. When we investigate the roles played by the placebo, suggestion or faith in a recovery from illness, it is clear that as well as using modern medicine and its procedures, people often use both positive thoughts and particular imagery that can carry those thoughts, in order to help themselves recover from both mental and physical problems. Those that do, often recover much faster than those that don't. (Robson, 2022) My own work has resulted in a range of imagery that is mainly the product of self analysis, however I am very aware that when I have conducted workshops with other people the nature of the images produced keeps changing. 

In his article, 'Raising Pain Tolerance Using Guided Imagery', David Bresler points out that mental images are formed long before we learn to understand and use words. He states that they 'lie at the core of who we think we are, and what we believe the world is like', His article also raises awareness of how belief systems as a whole can be shaped by our mental images and that therefore they play a very powerful role in our ability to tolerate pain or heal ourselves when ill. He defines a mental image as 'a thought with sensory qualities' and then introduces various types of guided imagery as ways to put into effect an 'active imagination' whereby elements of the unconscious are invited to appear as images that can communicate with the conscious mind. He states that:

'if people can derive not only symptomatic relief, but actual physiologic healing in response     to treatments that primarily work through beliefs and attitudes about an imagined reality, then learning how to better mobilise and amplify this phenomenon in a purposeful, conscious way becomes an important, if not critical, area of investigation for modern medicine'. (Bresler, 2010)

Bresler points out that the body responds to imagery in the same way as any other external experience and in particular the autonomic nervous system easily understands and responds to the language of imagery. Therefore if you imagine you are very ill, or that your pain is hard to bear, you are very likely to find that you become very ill and that your pain will be hard to bear. 

It is Bresler's statement that 'elements of the unconscious are invited to appear as images that can communicate with the conscious mind', that really resonates with myself. This could be something stated by a Surrealist artist back in the 1930s and as I strongly believe that Surrealism is still and always has been, one of our most powerful visual thinking devices, is a central plank of my personal artistic manifesto. 

There is of course a dark side to this, the harsh reality is that the most common way that people develop imagery is by worrying. What we worry about is never happening in the real world, only in our imagination. In my case I have plantar fasciitis in my left foot and heel and I have to get on and do things like write this blog to distract myself from worrying about it and thinking that it will go on forever. The reality is that this is a temporary problem, but I can make it worse by worrying about it. As Bresler puts it, 'people in pain worry all the time. They worry that their pain will never end and that they will remain helplessly immobilised by something they cannot control and cannot endure. As a result, they usually have little difficulty describing an image of their pain at its very worst. Bresler quotes patients as describing their pain as being like, “a swarm of fire ants are chewing on the nerve”, or “a gigantic elephant is sitting on my chest.” If you worry about something its image becomes in effect sharper and more real, and then it can become a major focus of your life experience. In this case we need to beware of self-fulfilling prophecies, for images have the power to create their own reality in the body.  Bresler goes on to state, that if a person has developed really clear images of pain, these images can have profound physiological effects on them that can increase their experience of suffering and interfere with their body’s natural pain relieving abilities. So I have to be careful not to fall into this trap and to find ways of using images to guide myself and others away from wallowing in pain, and to instead provide the imaginative waters that will allow them to swim away from it. 

Getting rid of these images can be a powerful healing tool and this is where my experience of working with votives can make a difference. By making images of people's pain or problem and then ritually removing these pains by either breaking them, burying them, burning them or doing something focused on externalising the feeling that was put into the image, you are in effect also helping them resolve and perhaps remove their association with the 'real' pain or problem. For instance in one case someone I was working with imagined their cancer as a 'little man' that resided inside them, this 'person' was clinging on, and needed to be told to go. 

The 'little man'

Once visualised as an actual drawn and in this case a printed image, its reality was such that it began to overpower the previous mental image they had. The ritual process of tearing it in half and throwing the pieces away, helping to release the grip that a mental image had had on themselves and their own well being. If this area of visual thinking is to be of help to the wider disciplines of medicine and psychotherapy, then it will have to be capable of incorporating these sometimes quite difficult to visualise images that can arise from people's imaginative view of their inner feelings. This is a recognition that the subconscious workings of each person's own healing processes need to be supported and recognised if they are to access and utilise the insights, resources, and solutions that arise from their own interoceptive awareness.

If we are to develop a shared ‘visual’ vocabulary for symptoms and sensations of pain and other interoceptive sensations, we need to stockpile these various representations in order to see if there is indeed a common language or if there is not, to see if this image bank does at least help release the potential of others to visualise their interoceptive experiences. If so, because visual representations have the ability to communicate a wide array of feeling tones or intuited things more efficiently than verbal languages, especially in a situation where medical professionals are linguistically challenged, such as dealing with patients who have no or limited English; images can generate insights that otherwise might be missed and they may also develop possibilities for visually augmenting written information.

When making a more detailed analysis of the images produced, the fact that drawings are stable artefacts that can be returned to and examined in detail, means that we can use them to avoid the problems of image decay that is associated with any mental maintenance of an image in someone's head. 

This issue also relates to the fact that in workshops I have found that people are at their most inventive and sensitive during the first hour or so and that after that their awareness levels drop and very few new visual ideas emerge.  However the time spent in the later half of a workshop can instead be profitably spent adjusting the various images made during the first half of a session and exploring the various visual languages used, and most importantly to test out their communicative possibilities. 

However it is also important to remember that the use of this process in alleviating pain or helping people improve their existing condition, is often associated with using these images to externalise inner feelings and to in doing this help in the removal of these 'bad' feelings or thoughts. 

The drawings and objects made can help enormously in guided image meditation, giving people time to inspect the imagery, and to then move on to a transformation stage whereby they take control of the imagery in some way. 

Once generated and maintained, a mental image and associated drawing can be reflected on interpreted and its understanding transformed and a shift in perspective made. 

With the assistance of a guided imagery practitioner or in this case an artist, a participant can be helped to transform, modify, or alter the imagery, in such a way as to either substitute images that provoke negative feelings, or that reaffirm disability, for those that elicit positive emotion, or to even get rid of the negative imagery by doing something to it, such as breaking it or throwing it away. I.e. they begin to rewrite their own internal stories whilst keeping the essence of what their stories are about. These processes are similar to imagery restructuring or imagery re-scripting, (Holmes et al, 2007), all of which are about people taking control of their own journey. 

Through this process, people can hopefully change their relationship with the images that have been in the past indicative of the distressing, painful, or debilitative nature of a condition, and in taking control of the image making process or sharing it with someone else, develop their capacity for self determination and the ability to cope with life.

Helping people to use their own imagination in this interactive way maintains a focus on the depth of emotional feelings that are central to therapeutic growth. Working with another person that takes them seriously is a wonderful affirmation of them as individuals and by opening doors for them into how visual imagery can carry important information, it can also become a process that leads to the development of a new interest in art itself. 

These approaches acknowledge many other drawing and healing traditions, some of them being disciplines that are thousands of year old. 

Payne, Levine and Crane-Godreau, (2015) point out that somatic experiencing as an aspect of interoception, is a concept that is embedded into ancient embodied wisdom traditions and their more recent offshoots. Listing Yoga, T’ai Chi and Qigong, as well as the Alexander Technique and the Feldenkrais method. When drawing and making we use our bodies to externalise our thoughts and perhaps central to the awareness that we have of the relationship between the body and the mind, is the way we breathe. This connection with breathing can take us back to the traditions of the Ayurveda, considered by many scholars to be the oldest healing science. Ayurvedic healing traditions originated in India more than 5,000 years ago and recognised that mental and physical health come together and that their interrelationship is based on the need for regulated energy flow. This awareness of the deep interconnectivity of all these ideas takes my mind back to older posts, and I don't want to duplicate what I was thinking about then, but I do want to highlight ideas about the use of drawing or image making to externalise thought and how in that externalisation hopefully we are able to have some sort of control over things that might otherwise stay hidden and undermine us from within. 

However drawing and image making is not at its best when trying to illustrate a concept developed via academic research. The research can inform the background out of which an image may emerge but if the image is to be alive to its own emergence into being, it has to feed off whatever it is becoming and that means unpredictability and a certain amount of chaos is always embedded into the process. My own 'medical diagrams' tend to be records of conversations, such as the one immediately below which was made in conversation with someone who was dealing with tinnitus. 

Once the initial conversations have settled down and been assimilated into a visual language, final images become free floating and emerge as a product of their own internal necessity. The further away in time they are from the initial making process, the more I forget what they were initially a response to, and the more they become things in their own right. They operate as a type of animist extension of a thought, a thought that materialised itself and then went its own way. 

Various images that arrived out of a process of visualising interoceptual experiences

Bresler, D. (2010) Raising Pain Tolerance Using Guided Imagery, The Behavioural Medicine Report Dec 4th Available at: https://www.bmedreport.com/archives/18655

De Vignemont, F. (2010). Body schema and body image—Pros and cons. Neuropsychologia, 48(3), 669-680.

Holmes, E. A., Arntz, A., and Smucker, M. R., (2007) Imagery rescripting in cognitive behaviour therapy: Images, treatment techniques and outcomes. Journal of Behaviour Therapy and Experimental Psychiatry, Vol. 38, No. 4, pp. 297–305.

Kosslyn S.M., Ganis G., Thompson W.L. Neural foundations of imagery. Nature Reviews Neuroscience. Vol. 2, No. 9, 2001, pp. 635–642.

Payne, P., Levine, P.A. and Crane-Godreau, M.A., 2015. Somatic experiencing: using interoception and proprioception as core elements of trauma therapy. Frontiers in psychology, 6, p.93.

Pearson D.G. Mental imagery and creative thought. Proceedings of the British Academy. Vol. 147, 2007; pp. 187–212.

Robson, D. (2022) The Expectation Effect London: Cannongate

See also:

Minjeong An

Drawing and healing

Still thinking about what I do

Why interoception

Schmidt pain relief index for insect bites

Ibrahim el Salahi: Pain relief drawings

Drawing and healing

Pseudo-Galen, Claudius

In the West art and anatomy have a long association; they are entangled together, which I suppose was a necessary condition as the ability to render objectively accurate images of the body necessitated artists study anatomy. Dissection of humans however was largely forbidden in the ancient world, but early medical thinkers such as Galen and Vitruvius were still able to come up with theories for how the body worked by dissecting animals, and from the information gathered, they deducted how the inner mechanics of humans worked, often by linking this knowledge to observations of exterior signs of illness such as changes in body colour and condition. This internal / external interrelationship would dominate Western thinking for centuries and in many ways still does. 

Galen' s Tripartite Scheme, explaining how the blood circulated through the body

I love a good diagram and Galen has diagrammatic ideas as to how the body works. He believed in Hippocrates' Humoral ideas, which pointed to the existence of four fluid humors in the human body: blood, black bile, yellow bile and phlegmatic. Humors were divided into the body and a perfect harmony among them resulted in perfect health. Galen also linked the humoral theory to Aristotle’s ideas, which stated that the basis of existence resided in four elements: water, air, earth and fire. Each vital organ would be linked to one type of humor, which in turn, would be related to a natural element. We can see therefore how the body can also be seen as a landscape composed of the same basic elements as the environment that hosts it. The components of the body reflecting the ingredients of the earth. However it is Vitruvius who provides the classic image that we all remember when it comes to the proportions of the body.

Vitruvius

Theory and observation come together in the Renaissance and interestingly in his drawing 'Vitruvian Man', Leonardo did not represent Vitruvius's proportions, instead he used those he found himself after measuring several male models, a sign that things were changing. Vitruvius wrote his 'Ten Books on Architecture', approximately one thousand five hundred years before Leonardo read them. It is the only text on the subject of architecture to survive antiquity, but of far more interest is that it was also one of the first texts in history to draw the connection between the architecture of a human body and that of a building, not only is the bi-lateral symmetry of the body seen as a model for architecture, the interrelationship of body proportion is also seen as something that should be extended into architectural design. This, coupled with the fact that Vitruvius also states that the architect should also have a knowledge of the study of medicine. A building like the humans it is made for can become sick, because climate or air flow can effect the healthiness and unhealthiness of sites, and as Vitruvius goes on to point out, the use of different waters can also lead to illness if not controlled properly. The Romans were very good at building in underfloor heating, channelling water and creating steam baths. By extension an unhealthy body has characteristics similar to an unhealthy building. These characteristics I would argue are similar to those that compose what Henri Bergson in his book 'Creative Evolution' called the ‘élan vital’, an energy that runs through everything, not just living things. The implication of a force such as élan vital is that all materials have the potential to be informed by or formed into others, they just need to be in interaction with each other in some way. So you could describe something like metamorphosis or hybridity as a product of interactions between different energy states. For instance some of the interrelationships between interoception and perception are at their most interesting at the transition or liminal stage, between an external perceptual awareness of lets say a foot and interoceptual messages coming from a foot pain source, such as a bunion. One type of awareness passes into and becomes another type of awareness. This perceptual edge-land is for myself where visual invention conjoins with visual observation.

Image from an interoception awareness workshop

Like Russian dolls, these energy fields can sit one within the other, each one similar to the others, but each one also unique and having its own features. It is in the transition space that sits between the drawing of a man and the drawing of geometry that an idea grows. 

Leonardo: Vitruvian Man

Even though the Catholic Church prohibited dissection, artists and scientists performed it to better understand the body. Renaissance artists wanted knowledge of the inner workings of the human body, which they believed would give them the necessary skills to paint and sculpt it in such a way that body positions represented appeared realistic or natural. 

Andreas Vesalius: On the fabric of the human body in seven books

In the 16th century the physician Vesalius published his influential work, 'On the fabric of the human body in seven books'. He was an anatomist as well as a doctor and in making observations from his actual dissections was able to establish that many of Galen's theories were wrong. As these 'advances' in medicine were undertaken, what they also seemed to do was develop an idea of the body as a 'mechanism' or purely physical organ, advances in representation going alongside advances in medical procedures. 

However there were other traditions. 

Hua Khar Jaintsa 'Course of the Lifespan Principle' (1995–96) Pigment on cloth

In 1991 the 5,000 year old body of what was to be called Ötzi the Iceman was discovered. Entombed in ice shortly after his death, the glacial conditions protected much of his tissue, bones and organs and in particular because his skin was preserved, his tattoos were too.

Ötzi the Iceman with tattoo locations

80% of the tattoos found on the iceman overlap with classical Chinese acupuncture points, in particular those used to treat rheumatism, a medical condition that contemporary forensic archeology tells us the iceman suffered from. Other tattoos were found to be located on or near acupuncture points as well. Various herbs and medicines were also found alongside his remains, all pointing to ancient medical practices, that suggest the iceman belonged to a society with a surprisingly advanced health care system.

It is instructive to compare the Iceman's medical care with Tibetan medicine, a holistic practice with an approach that focuses on the conjunction of mind, body, and spirit. Also known as Sowa-Rigpa medicine, it is an ancient medical system that employs a complex approach to diagnosis, incorporating techniques such as pulse analysis, urinalysis, behaviour and dietary observation to determine what is wrong and uses herbs and minerals alongside acupuncture to treat illness. Hua Khar Jaintsa (active 1990s), created several intriguing images whereby the principles of Tibetan medicine were explained. The image 'Course of the Lifespan Principle' clearly illustrating the relationship between acupuncture points and the way that energy flows through the body. Hua Khar Jaintsa has created a body of work that reflects on many issues related to human development as well as on medicine and it stands comparison to many western European artists who have also attempted to explain the normally hidden aspects of our bodies.

Hua Khar Jaintsa: Early Human development

Hua Khar Jaintsa: Vulnerable points

It is interesting to compare Hua Khar Jaintsa to both Alberto Morroco and Luboš Plný.  Alberto Morroco was the artist who in 1949 created the images for one of the definitive anatomy textbooks. 

Alberto Morroco

Luboš Plný makes anatomical images of the human body, but he is also concerned to depict its functioning, its limitations, and its mortality. Sometimes labelled “anatomical self-portraits”, he combines coloured inks with acrylic paint and collage with organic elements such as blood, hair, the ashes of his dead parents and used medical aids to depict the body.  He makes precise records of skin, musculature, bones, circulatory systems, and organs, embedding his observations into montages consisting of drawings made on the basis of everything from 19th-century anatomical guides, X-ray images, photographs of Madonnas and any other medical or religious items that he comes across. 

Luboš Plný 

Plný seems to have intuitively understood that as in Buddhist influenced health practices such as those practiced in Tibet, India, Nepal Siberia, China and Mongolia, healing is about confronting and transforming suffering and rebalancing the mind and body to equilibrium and not about waiting until someone is sick, so that you can then cure them. This equilibrium is something the body itself is constantly seeking to achieve, using its hormone systems to effect change when it senses things are out of balance. 

Hormone Map

A brief look at a hormone map gives you an idea of the complexity of the body's feedback mechanisms.  It also gives a chemical insight as to why an unhealthy body can affect mental health, and how poor mental health can affect the state of the body. The energy field that moves between the body and mind is called in Tibetan medicine 'duawa' and this is shaped by a combination of environment, diet, history, behaviour and belief system.  For instance it is believed that if we eat the wrong foods, they can accumulate in our bodies and eventually manifest as illness. In terms of my understanding of what my own art practice is and what it could be, it has been important to understand that historically Tibetan artists created powerful images that were used as practical guides for well-being. 

Tibetan Buddhist paintings of medical issues are used to help people understand the relationship between their condition and treatment, these images can combine physical, mental and spiritual conditions as well as illustrate how treatment could help them. This is a step beyond the work of a medical illustrator, and would seem to me to incorporate medical illustration with religious art, conceptualism and expressionism. 

This fusion of various different disciplines offers for an artist such as myself a lot of freedom, whilst at the same time giving me a sense of purpose, especially as I continue my search for a way to visualise various forms of interoception. Here is another image, this time taken from an illustrated handbook of reflexology. The image of feet also has depicted within it images of the various parts of the body that are interconnected to them by energy flows which are themselves stimulated into action by applying pressure onto particular areas of the soles of your feet.

Acupuncture reflexology 

The conjunction of images suggests a fluid liquidity of an embodied understanding, that compresses head, lungs, stomach and heart into a body that can exist within the flattest flatness of flat feet. 

Holbein: Dead Christ

I am interested in a way of making images that combines Holbein's veracity, with an acupuncture reflexology diagram, with a chemical stain, with architectural space, with an emotive mark making system and a conversation between two people whereby they agree that a feeling tone can be not only depicted, but in that depiction captured and therefore externalised and making it available to healing rituals. As I struggle to find the right approach, I as always look around for artists that I think have developed a practice that feels as if it is hitting a spot at least near to where I would like to be. For instance Palden Weinreb, a New York–based artist draws on Buddhist teachings in his art practice, he makes works that help us to regulate our body rhythms. In the work below a pulsing white light brightens and dims in echo with our breathing patterns, encouraging deeper, more thoughtful, slower breaths. These regulated breaths may well have physical, psychological, and emotional benefits. He is essentially making a mandala within a mandala, a cycling light sits in the centre of a series of nested half spheres, the artwork as it pulses operating as an instrument for meditation. 

Palden Weinreb

Weinreb's work is though but an echo of a very old Tibetan tradition, which includes the making of mandalas that have now been produced by anonymous artists for hundreds of years. These artefacts are though rarely to be seen on their own and would normally be accompanied by prayer or some other ritual. 

Tibetan Mandala

There can be constructed between any two things a hybrid, therefore different aspects of the representation of humanity can be brought together, non figurative or more abstract images can be brought together with representation, sometimes to instruct and at other times to provide images that help foster moments of reflection or meditation. These hybrid forms are I believe necessary ones, because they allow imagery to operate across boundaries and to link together previously separate concepts. 

From a series of images developed initially as foot votives

Colour and light would appear to me to be central to the way we develop metaphor, light in particular has often been used to provide a gateway into spiritual reflection. 

Fused glass: memory of rib pain

Fused glass: Lower leg insect bites

I have looked at drawing with light in the past, and I have more recently been made aware of the healing power of both colour and light. 'Colour halls' were used for healing in ancient Egypt, China and India and I still remember first coming across SAD lights in a restaurant in Glasgow some years ago, and finding out then how much a lack of sunlight in winter effected northern people's circadian rhythms. 

The various energy fields that move between the body and mind can all be thought about and reflected upon within the process of image making. Some of these processes will have historically belonged to the realm of religious imagery, others to more general ideas of spirituality but others have now entered the world of contemporary medical practices. Whether these issues are seen as belonging to art as therapy, or to art as a focus for meditation and a doorway into spiritual enlightenment, or simply as a way to use our hands and making skills as route into good mental health, I do think that we ought to be far more aware of art's potential to become once again part of the essential wellbeing of life. 

See also:

Drawing and urban acupuncture 

Drawing bodies

Flesh

Paper and skin

Science and myth

Drawing with light

Working with stained glass

Drawing and quantum theory