Sketching the Human Experience
Authors: Kruti Hawkins, Casey L. O'Brien, Justin L. Dwyer
Journal: Journal of Clinical Oncology (2014)

DOI: 10.1200/JCO.2013.54.7323 “I’ve always wanted to draw the human body. Can you teach me?” Paul asked before I had the chance to put down my sketchbook and pencils. “It’s the most difficult thing to draw” he continued, leaving me to hurriedly introduce myself as the art therapy student in the psycho-oncology department. The psychologist in our department had referred Paul in the hope that art therapy might offer him a way to express how he felt about his recent paralysis, feelings that he had only hinted at during their sessions. Art therapy is a powerful process that uses visual symbols created in the therapy to work through feeling states and experiences not easily articulated. It is especially helpful for those limited by language or held back by the ferocity of their distress. A growing body of evidence in cancer care reveals improvements in symptoms such as depression, anxiety, pain and fatigue, the benefits particularly apparent where the treatment is delivered by a qualified art therapist. Moreover, art therapy can reestablish a connection with oneself as coherent and enduring, a process described in the qualitative literature as “meaning making” and of special importance in cancer care where a disorienting sense of personal disintegration frequently accompanies diagnosis. My position in the psycho-oncology service acknowledged these benefits to patient care, and I was keen to meet Paul after I heard his story. Paul was a single man in his fifties who worked as a health professional. He had a strongwilled and resilient personality bolstered by his athletic physique, which he had mobilized in his battle against lymphoma 9 years earlier. After many years of good health, he had been admitted to the hospital with relapsed lymphoma complicated by lower limb paralysis. In keeping with his usual coping strategy, he threw himself into his rehabilitation, insisting on “double doses” of physical therapy. He similarly embraced a psycho-oncology referral when his treating team anticipated he might need support adjusting to his paralysis. At our first meeting, Paul struck me as friendly and approachable. His casual clothes and collegial manner suggested that he saw himself as a fellow professional rather than a patient. The process of art therapy privileges the patient’s voice in guiding the work and understanding the symbols created. At Paul’s bidding we began with technical aspects, using light and shadow to sketch real-life objects (Fig 1). After several quite structured sessions in which little emotionally salient material surfaced, Paul admitted to some frustration that his drawings did not emerge as he imagined. This dissatisfaction with the work he produced was apparent in his repetitive titling of each piece with “practice.” Our first sessions coincided with a plateau in his physical progress where his paralysis seemed permanent. In team discussion it became clear that Paul greatly valued achievement and saw himself as able to overcome any adversity with enough effort. This led him to become anxious with tasks he could not easily master, and now, confronted with an apparent stalemate in the presence of fellow health professionals, his attitude was one of self-reproach. To address Paul’s frustration with artistic realism, I led him towards more abstract and spontaneous art making using less constraining materials. During our eighth art therapy session, Paul experimented with acrylic paints and took pleasure in the ensuing mess, a process that can bring people into contact with the child-like aspects of themselves where emotions are less guarded. The colors and shapes evoked childhood memories of earning his place among his older brothers through his sporting prowess, and he lamented the loss of this physical connection through the cancer. Another piece observed from a distance symbolized a shield (Fig 2), and Paul quietly admitted “I want this shield to protect me from my illness, but......I think that I may just have to live with it.” Holding this protective visual metaphor in mind, Paul was able to safely explore his feelings about the irreversible nature of his illness, a process Moon described as “arting out” that empowers the patient to reframe their story by altering or even painting over certain aspects. Paul’s art helped to connect the cancer to his life story while offering a buffer against intolerable feelings that his body, and thus he himself, had failed in some way. JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 32 NUMBER 19 JULY 1 2014