Going Public
Authors: Bywaters Malcom 
Published: October 2024

This article is developed for the purpose of exploring visual art as a case study of two landscape paintings as trauma management for the male cancer carer. Artists such as Louise Bourgeois, Tracey Emin, Marina Abramovic, and Anselm Kiefer have all worked with the concept of emotional suffering and its aftermath. Surgery, radiation, and chemotherapy can be effective in treating cancer, but these do not cure the mental health effects, which can be just as debilitating to the sufferer and primary carer. Resilience, financial difficulty, the presence of chronic diseases, and the severity of nausea and vomiting significantly influence the quality of life of patients with cancer who were undergoing radiotherapy (Seol et al.). Numerous medical and science-based investigations have explored how we regulate emotion and negative mood (Heintzelman et al.). By doing so they have contributed to a broader quantity of study specific to health management (Carver & Scheier). It can be reasoned from these studies that emotional catharsis enhances positive mood and brings focussed lucidity to mental cognition.
This article argues that creativity originating by cancer trauma, and by exploring the landscape genre in a critical studio practice, can be a significant vehicle for positive health and well-being. The contemporary medical term for this re-emergence of self is Post-Traumatic Growth, a time after trauma that integrates part of the old but significantly a re-invention of the original inner (Joseph et al.). Post-Traumatic Growth integrates sections of the old self, and at the same time reinterprets anew (Pike). The most defined approach to understanding Post-Traumatic Growth is based on five determinants. These include an appreciation of new possibilities, personal strength, spiritual change, and appreciation of life. “Relating to others” means that individuals who experience adversity develop a greater sense of closeness to specific people in their lives and begin to appreciate their family and friends more (O’Donovan & Burke). Post-Traumatic Growth may lead to new life directions, including an understanding of inner strengths not before realised, newfound appreciation of life, or, as in this case study, a creative investigation using landscape painting as health outcome.
Cancer-related fatigue is a common symptom experienced in cancer patients and this includes depression, anxiety, and worrisome stress (Weber, O’Brien). The psychological effects of cancer on the primary (in my case study male) carer can include feelings of helplessness, a sense of personal life forfeiture, and significant emotional distress (Northouse et al.). Caregivers are also involved in the many physical hands-on aspects of cancer patient care. In this case study these included communication with hospital and medical staff, supervision of treatments, dispensing medicine, cooking meals, house cleaning, domestic and family duties, to name only a few (Given et al.). In the early cancer narrative the normal decision-making paradigm of life, for the sufferer and those closest, is ceded to the medical schedule (Lesure & Chongkham-Ang). Life is dominated by hospital and specialist physician appointments and drug regimen. In this case study the artworks enabled a cathartic fecundity to exist in the studio. The exhibition Indeterminate Landscape: A Cancer Carer's Creative Journey (Bywaters) gave a visual public outcome that acknowledged a case study embedded in depression and angst. Such is the “artistic imagination that it can create a world more real and more haunting than that which our family see daily” (Klepac 90). “The decline in quality of life in a cancer caregiver family occurs in almost all domains” (Maziyya et al.). The male primary carer needs to find a way to give voice to the cancer trauma, write it down, talk to the therapist, or as I have, paint (Marchese).
Various researchers have investigated emotion and negative mood (Heintzelman et al.). The scientific study of how we manage negative mood to achieve greater subjective well-being is linked to the growing field of positive psychology, whose goal is to understand how people flourish (Seligman; Csikszentmihalyi). I have deliberately used the display of visual emotion as public awareness for greater understanding of cancer and its impact, both personally and on the broader community. The exhibition (Bywaters) included several detailed artist's statements alongside the displayed paintings. The exhibition was held in a secondary school, with the paintings listed for sale at a price kept affordable for students to buy. All sales were donated to Cancer Council Tasmania, and this was widely promoted by the Examiner newspaper (Bailey). The media coverage aided the message of positive discussion on cancer and its impact on the male carer as case study. As I stated in the Examiner article regarding the research: “the important thing is our journey is no different to any others that have cancer. We’re in the same landscape where you work with the great unknown on a daily basis” (Bailey 3). The paintings depict physical sites specific to our family cancer journey.
The artwork in this case study originates with emotional anxiety produced by the daily life struggle that cancer has generated. Love, desire, and landscape are brought together to promote by public exhibition a discussion that includes male identity and medical trauma. Visual observation can sometimes shift public perception and provide an entryway into a problem that can feel abstract or complex (or both; Yanagihara).

Writing and sculpting, can serve as a powerful tool that allows the person facing death and trauma to work through the painful mourning that comes with loss or with the end stage of life. This occurs in large part because one’s perceptions of time can change while being actively involved in artistic expression. (Dreifuss-Kattan)

Numerous contemporary artists have considered the impact of cancer as creative visual concept. Holis Sigler and Hannah Wilke are two significant historical examples, who both succumbed to cancer. In 1999, Sigler’s Breast Cancer Journal presented a pictorial chronicle of sixty paintings tracing her grappling with breast cancer. Wilke’s posthumously published Intra-Venus (1992–1993) is a photographic record of the physical transformation and deterioration caused by chemotherapy and bone marrow transplant. Perhaps the most famous mainstream image of breast cancer is Beauty Out of Damage (1993), a self-portrait by Matuschka that appeared on the cover of the glossy New York Times weekend magazine. This photograph is widely considered the first example by a daily news publication of a topless woman with surgically removed breast (Vogel). More recently, the 1990s supermodel Linda Evangelista has been photographed with mastectomy scar showing on the cover of Selt Magazin, a sister publication of the German weekly Die Zeit (Ferla).
Australian photographer Carrol Jerrems was diagnosed in 1979 with polycythaemia, a rare blood-related cancer.  While a patient at Hobart Hospital, Jerrems photographed and wrote about her physical decline. She documented the doctors, surgery scarring on her stomach, and the daily physical impact of the cancer treatment. Photography enabled Jerrems to archive and attempt to understand what was happening (King). With the forensic detailed imagery of Jerrems's surgery stitches and bloated stomach reflected by mirror as self-portrait, we are only too aware of the cancer's emotional and physical impact. Jerrems mirror self-portraits offer a reality that coalesces artist, patient, body, and photograph (King).
To review these specific art examples has enabled this case study, a subjective comprehension of the cancer impact upon my partner. As noted in my visual diary entries between February to April 2020, my partner was obviously very concerned about the physical and mental impact of the full mastectomy. It is potent to review these scribbled entries now that time has passed, with the first-hand immediate reflections being valuable research for the two created paintings.
The Paintings
In the first trauma-filled immersive months of cancer, creativity and solitude in the studio enabled exploration of the male self via the landscape metaphor. The paintings give resonance to the male carer as fraught with underlying terror and the potential lost hope of a shared future. Alongside the milieu of life expectations, the carer must manage the emotive unknown impact on life expectancy. There are social changes with a shift from usual participation in life activities to a focus on the challenge of being a caregiver (Schulz & Eden). The greatest fear when caring for somebody you love suffering with cancer is the dread of losing that person. I was able with the studio practice to visualise my subjective male cancer experience. A creative juxtaposition that incorporated the unknown future with the routine management of daily life. The expectation that someone we love will be there for us – whether it’s a caregiver, a romantic partner, a child, or someone else – is a fundamental part of our bond (Seeley & O’Connor).

Fig. 1: Malcom Bywaters, The Western Tiers, from Launceston, 2023. Mixed media on canvas, 122cm x 183cm. Collection: Scotch Oakburn College.
The aftermath of our family cancer judgement has delivered a personal philosophical serenity, as depicted with the bright illuminated sun shape in fig. 1: The Western Tiers, from Launceston, 2023. In the distance from our home backyard, we can see the snow resting across the mountainous Western Tiers, Launceston, Tasmania. The painting gave me an anchor, a physical action to visualise the anger and engulfing distress, the outcome being a tableau landscape of emotional trauma. The terrifying aftermath of trauma can cause both negative and positive psychological outcomes (Romeo et al.). As Hancock articulated regarding the impact of cancer on the patient, carer, and family, and remarkably familiar,

the diagnoses and treatment of cancer mean that the patient and their family have to undergo many adjustments, some very quickly, others over a period of time. A diagnosis of cancer is to many people the realisation that their worst nightmares have come true. (118)

The physical process of painting enabled a personal contemplation of cancer, its negative and, dare I admit, positive impact. In the studio, I was able to disenfranchise from the male cancer carer role using aerosol spray paint, permanent marker Texta colours, charcoal scratched across the canvas surface. All this physical creative milieu enabled me to concentrate on the disease aftermath. This intensity is represented in fig. 1 by the universal sun shape, round, bright, and glowing of positive energy. Here I overlaid several paint colours and then sponged with cloth, giving a speckled sunlike burning orange and red painted luminosity. The foreground whiteness of snow, crisp and generically pure, poetically free of anguish. Lastly the dark foreboding of the blackened horizon line, night is approaching and yet the sun does not relinquish, nor yet admit defeat.
The various prohibitions caused by the cancer and treatment on health and well-being are a toleration that we as a family unit endure, and this will be part of our forever life journey. Even four years after treatment, patients can continue to experience the physical effects of cancer treatment, which may affect their ability to perform typical daily activities. These effects can include pain, neuropathy, sexual dysfunction, incontinence, and fatigue, among others. Some treatments lead to other health risks, such as damage to the heart, bones, or other organs, as well as an increased risk for other cancers (Puzo). As with the cloud-like misty white of fig. 1, the threat of death often renews our appreciation of the importance of life, love, friendship, and all there is to enjoy. We open up to new possibilities and begin taking risks we did not have the courage to take before (Rosenbaum & Rosenbaum). The sky as remembered in fig. 1 will clear, the clarity permitting sight to a future focus and life plan that will to an extent always remain unknown, worrisome, and laden with anxiety. Medical science can by quantitative research predict patient survival percentages, but in reality, much concerning cancer and the long-term impact on the sufferer is still unknown and based within individual health circumstance.
Notwithstanding the aftermath of a cancer judgment, the experience can deliver a consciousness of inner philosophical serenity, and such is reflected with the bright illuminated sun shape in fig. 1. In the distance from our backyard, we can see the snow resting across the Western Tiers. Such a challengingly cold visual is timelessly comforting, and determined evidence we exist as a part of a greater environment.

Fig. 2: Malcom Bywaters, Road to Cradle Mountain, 2023.Mixed media on canvas, 121cm x 121cm. Private Collection.
Cancer and its treatments can affect every aspect of an individual’s life, giving rise to a range of supportive care needs that can include informational, physical, practical, social, spiritual, psychological, and emotional requirements (Krishnasamy et al.). Fig. 2: Road to Cradle Mountain, 2023, attempts to combine the psychological torment of the cancer case study journey with the necessity to maintain emotive control. The bleak landscape that exists alongside the bitumen road to Cradle Mountain provides an eerie moors-like visual. Here spray and oil paint has been merged with the visual, creating a division within the painting. The sun is used as a recognisable round token, scientifically essential for life and sustenance. The greenery of the painting foreground with yellow foliage gives credence to wilderness of the Cradle Mountain's harsh environment. The sensuous, yet unsettling colours, I argue, engage with the nature of place. The foreground green and yellow debris embed this image with signs of remembrance, a gardened floral tribute that tellingly informs the fragility of life. This is a cold, bleak day, where one can sense or feel the wetness of soil underneath. Several studies have demonstrated that caregivers experience more emotional challenges than patients themselves. Combined, patients with advanced cancers and their carers report emotional and psychological needs as the most prevalent unmet supportive care domains requirements (Hassan et al.). Fig. 2 enabled this research to embed a groundmass within the greenery of foliage, moistness of soil, and small twig-like strokes of bark and wood. The challenge visually represented by the landscape of the painting is to understand the scale of community concern, scourge of cancer distress, and disease magnitude.
Fig. 2 locates our family within the journeyed experience of cancer trauma. We have become somewhat stoic, less fearful, more tolerant, and with a focus on family, friendship, and local community as the core. As the Rosenbaums stated regarding mortality and the pleasures of life,

the threat of death often renews our appreciation of the importance of life, love, friendship, and all there is to enjoy. We open up to new possibilities and begin taking risks we didn’t have the courage to take before. Many patients say that facing the uncertainties of living with an illness makes life more meaningful. The smallest pleasures are intensified and much of the hypocrisy in life is eliminated. When bitterness and anger begin to dissipate, there is still a capacity for joy. (Rosenbaum & Rosenbaum)

Conclusions
This case study elaborates on the experience of the primary male cancer carer journey that is filled with anxiety, sleepless nights, emotional grieving, financial stress, loss of future planning, and burdensome medical and domestic chore, all of which can be included in the generic complexity as recognised cancer fatigue. Further, the case study considers the impact of Post-Traumatic Growth, where individual emotional reaction may lead to new personal growth directions and revised appreciation of life's importance. As indicated by scholarship in the field, the way in which trauma and art share a relationship through these paintings has digressed in the same approach that other fields including psychology and sociology interlink post-traumatic growth within contemporary art practice.
The two paintings base the case study in visual creativity. These artworks were publicly displayed in the exhibition Indeterminate Landscape: A Cancer Carer's Creative Journey (Bywaters). The paintings give evidence to the capability of creative output to act as an emotional cathartic vehicle for positive health and well-being. As creative research outputs, the artworks act as physical public credence to the male primary carer's struggle with the everyday dominance of the cancer case study. The paintings have therefore integrated the contextual aspect of this struggle into the two parts of situational events of cancer and the embodiment of self within this experience. The works have demonstrated a way to convey both these fundamental aspects within the artworks themselves, and also the conversations brought forward about the subject.
As a response to trauma, creativity can deliver an accessible mark-making that can be individually or publicly analysed and studied for therapeutically valid engagement. As such, the visual arts can challenge, question, and offer a public physical outcome and emotive product that can assist with the male primary carer maintaining equilibrium during the cancer journey. It is essential for the primary carer to maintain focus, and the visual arts can provide a freedom to ponder, ruminate, and challenge the negative that cancer compels subjectively and in the broader public community. Cancer is a complex disease with multiple causes and outcomes. Without attention to emotional care, no other aspects of cancer care can be fully realised. The arts can in the aftermath of cancer trauma instil confidence, provide a visual supportive release, and enable physical and meaningful discussion. 
References
Anguiano, Linda, Deborah Mayer, Mary Piven, and Donald Rosenstein. “A Literature Review of Suicide in Cancer Patients.” Cancer Nursing: An International Journal for Cancer Research (July / August 2012). <https://journals.lww.com/cancernursingonline/Fulltext/2012/07000/ A_Literature_Review_of_Suicide_in_Cancer_Patients.12.aspx>.
Balammal, Aruna. “Art Creation and the Mental Health: A Qualitative Study among Artists.” Journal of Social Sciences 19 (2020).
Bailey, Duncan. “Cancer Carer Creative Journey.” Examiner, 5 June 2023. 1, 3. 
Bouchner, Frederick. Now and Then: A Memoir of Vocation. San Francisco: Harpers Collins, 1991.
Bywaters, Malcom. Indeterminate Landscape: A Cancer Carers Creative Journey. Space Gallery, Scotch Oakburn College, Launceston, 2023.
Bywaters, Malcom. The Western Tiers, from Launceston. Mixed media on canvas, 2023. Collection: Scotch Oakburn College.
Bywaters, Malcom. Road to Cradle Mountain. Mixed media on canvas. 2023. Private Collection.
Bywaters, Malcom. Diary entries (Feb. – Apr. 2020). Launceston. Private collection.
Carver, C.S., and M.F. Scheier. Self-Regulation of Action and Affect. In K.D. Vohs and R.F. Baumeister (eds.), Handbook of Self-Regulation: Research, Theory, and Applications. 2nd ed. Guilford Press, 2011. 3–21.
Dreifuss-Kattan, Esther. Art and Mourning: The Role of Creativity in Healing Trauma and Loss, London. Taylor & Francis, 2016.
Dalebroux, Anne, Thalia Goldstein, and Ellen Winner. “Short-Term Mood Repair through Art-Making: Positive Emotion Is More Effective than Venting.” Motivation and Emotion 32 (2008). <https://link.springer.com/article/10.1007/s11031-008-9105-1>.
Friedemann, Marie-Louise, and Kathleen Buckwalter. “Family Caregiver Role and Burden Related to Gender and Family Relationships.” Journal of Family Nursing (2014). <https://journals.sagepub.com/doi/full/10.1177/1074840714532715>.
Given, Barbara, Charles Given, and Paula Sherwood. “The Challenge of Quality Cancer Care for Family Caregivers.” Science Direct 28.4 (2012). <https://www.sciencedirect.com/science/article/pii/S0749208112000538>.
Hancock, Barry. Cancer Care in the Community. Oxford: Radcliffe Medical Press, 1996.
Heintzelman, Dieter, Samantha Kushlev, Kostadin Tay, Louis Wirtz, Derrick Lutes, and Oishi Shigehiro. ”Findings All Psychologists Should Know from the New Science on Subjective Well-Being.” Canadian Psychology / Psychologie Canadienne 58.2 (2017): 87-104. <https://psycnet.apa.org/buy/2016-48141-001>.
Joseph, Stephen, David Murphy, and Stephen Regel. “An Affective-Cognitive Processing Model of Post-Traumatic Growth.” Clin Psychol Psychother 19.4 (2012): 316-25. <https://pubmed.ncbi.nlm.nih.gov/22610981/>.
King, Natalie. Up Close Carol Jerrems. Melbourne: Schwartz City, 2010.
Klepac, Lou. Russell Drysdale. Sydney: Murdoch Books, 2009.
Krishnasamy, Meinir, Heidi Hassan, and Carol Tenniel Jewell. “Perspectives on Emotional Care: A Qualitative Study with Cancer Patients, Carers, and Health.” Healthcare (2023). <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9956222/>.
La Ferla, Ruth. “Scars.” The New York Times, 23 Feb. 2023. 20 June 2024 <https://www.nytimes.com/2024/02/23/style/linda-evangelista-ai-fashion.html>.
Lesure, Peeranuch, and Supaporn Chongkham-Ang. “The Experience of Caregivers Living with Cancer Patients: A Systematic Review and Meta-Synthesis.” Journal of Personalised Medicine 19.4 (2015). <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695863/>.
Luchurts, Roger. The Trauma Question. Routledge: New York. 2008. 
Marchese, Amber. “Amber Marchese: My Journey with Cancer: The Real Housewives of New Jersey Star Opens Up about Her Second Battle with Breast Cancer in a New Blog Exclusively for People.” People 2 June 2015. 27 June 2024 <https://people.com/tv/amber-marchese-blogs-about-her-journey-with-cancer/>.
Matuschka. Beauty Out of Damage. 1993. 27 June 2024. <http://www.beautyoutofdamage.com/>.
Maziyya, Nur, Laili Rahayuwat, Ahmad Yamain. “Quality of Life of Family Caregiver of Cancer Patient: A Literature Review.” Journal of Nursing Care 1.3 (2018).
Northouse, Laurel, Maria Katapodi, Ann Schafenacker, and Denise Weiss. “The Impact of Caregiving on the Psychological Well-Being of Family Caregivers and Cancer Patients.” National Library of Medicine (Nov. 2012). 20 June 2024  <https://pubmed.ncbi.nlm.nih.gov/23107181/>.
O’Donovan, Roisin, and Jolanta Burke. “Factors Associated with Post-Traumatic Growth in Healthcare Professionals: A Systematic Review of the Literature.” Healthcare (Dec. 2022). 13 June 2024  <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9777806/>.
Pike, Andrew. “Handling the Heart.” Compass. ABC and Ronin Films, 2022. 27 June 2022 <https://iview.abc.net.au/video/RN2111H014S00>.
Puzo, Victoria. “What Are the Needs of Cancer Survivors 5 Years or More after Treatment?” Oncology Nursing News 13.8 (2019). 12 May 2022 <https://www.oncnursingnews.com/view/what-are-the-needs-of-cancer-survivors-5-years-or-more-after-treatment>.
Rosenbaum, Ernest, and Isadora Rosenbaum. “The Will to Live.” Stanford Medicine, Stanford Centre for Integrative Medicine. (2022). 12 May 2022 <https://med.stanford.edu/survivingcancer/cancers-existential-questions/cancer-will-to-live.html>.
Romeo, Annunziata, Lorys Castelli, and Marialaura Di Tella. “Emotional Functioning and Post-Traumatic Outcomes in the Aftermath of a Traumatic Event.” Frontiers in Psychology, 23 Dec. 2023. 20 June 2024  <https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2022.1116690/full>.
Sedghi, Sarah. “Cancer Risks Cascade through Generations for Some Families: But There Are High Hopes for Precision Medicine.” ABC News 26 June 2022. 29 June 2022 <https://www.abc.net.au/news/health/2022-06-26/cancer-genetics-families-generations-precision-medicine/101175306>.
Seeley, Saren, and Mary-Frances O’Connor. “Seeing Grieving as Process Takes Time.” Psychye, n.d. 27 June 2024  <https://psyche.co/ideas/seeing-grieving-as-learning-explains-why-the-process-takes-time>.
Seligman, Martin. Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment. New York: Simon and Schuster, 2002.
Seol, Ki, Su Bong, Dae Kang, and Jun Kim. “Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy.” Psychiatry Investigation (Jan. 2021). 17 June 2024 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897871/>.
Sigler, Holis. Breast Cancer Journal. Michigan: Hudson Press, 1999.
Vogel, Maria. “Facing Illness with Art: 4 Powerful Artworks That Reveal Artists' Experiences with Breast Cancer.” Artnet, 12 Oct. 2020. 20 June 2024 <https://news.artnet.com/art-world/breast-cancer-art-1912124>.
Weber, Daniel, and Kylie  O’Brien. “Cancer and Cancer-Related Fatigue and the Interrelationships with Depression, Stress, and Inflammation.” Journal of Evidence Integrative Based Medicine (Nov. 2016). 20 June 2024 <https://journals.sagepub.com/doi/10.1177/2156587216676122>.
Wilke, Hannah. Intra-Venus, 1992-93. 27 June 2024 <https://feldmangallery.com/exhibition/164-intra-venus-wilke-1-8-2-19-1994>.
Wincer, Penny. Tender: The Imperfect Art of Caring. London: Coronet, 2020.
Yanagaihra, Hanya. “What Should We Expect of Art?” The New York Times, 18 Aug. 2022. 20 June 2023  <https://www.nytimes.com/2022/08/18/t-magazine/art-activism-social-justice.html>.