CONTRIBUTION OF VISUAL ART-MAKING TO THE SUBJECTIVE WELL-

BEING OF WOMEN LIVING WITH CANCER: A QUALITATIVE STUDY.

Abstract

This qualitative study examined accounts of women

diagnosed with cancer who engaged regularly in art as a

leisure activity. The objective was to explore

participants’ experiences of cancer and their views about

the contribution of art-making to their subjective well-

being. The study was based on the principles of

interpretative phenomenological analysis (IPA). A

convenience sample of twelve women aged between 23-74

years participated in semi-structured interviews, and

their accounts were analysed thematically. Participants

described a range of ongoing difficulties associated with

cancer such as fear for the future, pain, sleeplessness,

role loss, activity restriction, reduced self-confidence

and altered social relationships. They described art-

making as supporting subjective well-being in four major

ways. Creative activities helped participants to focus

outwards on positive life experiences relieving

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debilitating preoccupation with illness. Art-making

enhanced self-worth and identity through providing

opportunities to demonstrate continuity, challenge and

achievement. It also enabled participants to maintain a

social identity that resisted definition by cancer. For a

minority, art enabled symbolic expression of feelings,

especially during chemotherapy. The findings supplement

previous case studies and suggest that meaningful

creative activity may provide psychosocial resources for

living with cancer.

186 words.

Keywords: Cancer, well-being, identity, art, creativity,

leisure

CONTRIBUTION OF VISUAL ART-MAKING TO THE SUBJECTIVE WELL-

BEING OF WOMEN LIVING WITH CANCER: A QUALITATIVE STUDY.

INTRODUCTION

The meaning of leisure activity for people with cancer

may at first sight seem to be a trivial issue, given the

degree of stress that is associated with this illness.

2

Perhaps reflecting such an attitude, there has been

little research from a social science perspective. Yet

more than a decade ago, Lahey (1993), a recreation

specialist, suggested that “Since the threat of death

poses the greatest possible challenge to one’s sense of

identity, those leisure pursuits which have contributed

powerfully to self-identification will be particularly

meaningful at this time” (p. xvi). This study explored

the meanings of art-making for women who were living with

cancer, to gain insights into the influence of creative

leisure activity on subjective well-being. It is

increasingly recognised that many people with cancer need

to draw upon psychosocial resources such as positive

attitudes, spiritual beliefs, information and support in

order to cope with their condition (e.g. Jenkins &

Pargament 1995; Dunn et al 2003). A better understanding

of the role of meaningful leisure activity in promoting

well-being may also help to inform professional

interventions and people’s own strategies for coping with

cancer.

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Cancer can be profoundly disruptive of personal and

social identity (e.g. Carpenter et al. 1999; Mathieson &

Stam 1995). Stressful features of cancer such as pain,

potentially arduous and disfiguring treatments, and a

future perceived as highly uncertain all tend to

challenge the previously taken-for-granted relationship

with the self. Many describe cancer as bringing about a

profound loss of subjective control (Taylor 1983). In

addition to imposing a cognitive and emotional burden,

cancer poses threats to subjective well-being through

undermining everyday lifestyle and social relationships.

About 40% of number of people report losing their job or

taking early retirement after cancer diagnosis and

treatment (Spelten et al. 2002). Cancer still carries

stigma, and from a sociological view imposes an all-

defining ‘master status’ upon the person (Charmaz 1991;

Mathieson & Stam 1995). The person may yearn to establish

a sense of normality and an identity that is not totally

defined by cancer (Lam & Fielding 2003; Landmark & Wahl

2002; Shannon & Shaw 2005).

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Some people respond to cancer by placing more emphasis on

personally enriching activities (e.g. Arman et al. 2001;

Arman & Rehnsfeldt 2002). Yet relatively few studies

have enquired in depth into the meanings of specific

leisure activities for people living with cancer. One

exception is the study by Tocher (2002). She interviewed

22 women with breast cancer who participated with other

survivors in dragon boat racing. Participants regarded

their leisure activity as enabling them to ‘live well’

rather than merely ‘coping’ with cancer. Shannon and Shaw

(2005) detected a similar theme in the interviews of

women with breast cancer. They found that participants

had re-appraised their leisure habits as they now ‘wanted

to be actively living and making the most of life’

(p207). Such re-appraisal may occur soon after a cancer

diagnosis. Landmark and Wahl (2002) interviewed women

recently diagnosed with breast cancer who reflected on

their need to engage with meaningful activities, to

provide evidence of their mental and physical strength,

to stay actively engaged in daily life, and to distract

their thoughts away from cancer.

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Link et al. (2004) found that 11% of participants who tried

to control the psychological impact of their cancer in

daily life turned to creative activities such as painting

and writing. However, they did not examine in depth how

such activities enhanced participants’ subjective well-

being. Reynolds & Prior (2003) offered some insights

into this issue, albeit from interviews with women who

were living with both malignant and non-malignant

illnesses. They explored the meanings of art-making

guided by the principles of interpretative

phenomenological analysis (IPA) as described by Smith et al.

(1999). Participants’ accounts suggested that art-making

offered a way of managing many aspects of long-term

illness ranging from unpleasant physical symptoms to loss

of roles. Immersion in artistic activities helped to ward

off cognitive preoccupation with illness. The

participants’ accounts did not focus solely upon coping

with the restrictions of illness. They also revealed a

more positive project of re-engaging with ‘normal’ life.

As one participant explained: ‘Art blocks out sad thoughts or

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frightening thoughts and scary bits…but it also moves you on.’ (Reynolds

& Prior 2003; p. 792). Art-making provided some

participants with new relationships and generally

restored feelings of competence and self-esteem. Present-

moment awareness was enhanced, enriching perceptual

experiences. Some appreciated that their illness had

catalysed a more positive lifestyle. Of the 35 women

participating in the study, six were living with cancer.

A more detailed examination of the role of art-making in

coping with life-threatening illness was recommended. In

response, a recent paper has presented three case studies

of people living with cancer to explore in detail the

role of art as a leisure activity in maintaining a

familiar, positive identity (Author, in press).

The purpose of this study was to supplement the findings

from individual case studies, and to identify recurring

themes in the accounts of a larger sample of women living

with cancer. The study sought to understand how visual

art-making as a leisure activity contributed to their

subjective well-being. An inclusive definition of ‘art-

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making’ was used, to encompass the practice of any form

of visual art or craft resulting in a visible end-

product, whether at an amateur or advanced level of

expertise.

METHOD

Methodology:

This research aimed to gather rich ‘insider’ descriptions

of the creative process, and was guided by the principles

of interpretative phenomenological analysis, IPA (Smith et

al. 1999).

Ethical approval

The interviews were carried out following ethical

approval by the University Research Ethics Committee.

Participants were recruited through invitations placed in

national UK arts magazines. Those expressing interest

were given full information including the main interview

questions prior to giving consent. They were assured of

confidentiality and their right to withdraw from the

8

study at any time. In the quotations below, participants

are identified by pseudonyms.

Sample

Twelve women participated. The age range was 23-74 years,

with the majority aged in their late 40’s to 50’s. They

resided in many areas of England. All were White. Nine had

a professional work background but had discontinued

regular paid work since becoming ill. The others had

mainly been homemakers. Ten disclosed that they were

married or living with partners and most of these had

adult children living away from home. Participants had all

lived with cancer for at least a year, therefore gaining

some emotional distance from the initial trauma of

diagnosis. Six had been diagnosed with breast cancer and

the remaining participants reported other types of

cancer. Seven were currently receiving treatment for

cancer. Participants varied in time since diagnosis. Five

considered that they were facing terminal illness, five

expressed uncertainty and two were optimistic about their

longer-term health. It was considered acceptable to

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include women living at different stages of the cancer

trajectory in this exploratory study. This is because the

stress of cancer is not confined to those engaged in

medical treatment. Long after treatment has ended, people

report remaining vigilant and fearful about recurrence or

metastasis (Bower et al. 2005.).

Procedure

Semi-structured interviews lasted between 1 to 2 hours.

All were carried out by the first author, audiotaped and

fully transcribed. Ten interviews were carried out in

participants’ homes, and two were conducted by telephone

according to participants’ preferences. Participants

reflected on their experience of cancer, initial reasons

for taking up art-making, and the ways in which visual

art-making as a leisure occupation contributed to their

subjective well-being. In relation to the last topic,

questions included:

1. Can you describe what is satisfying about creative

activity?

2. Do you think that your artwork has helped you to

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express your feelings about your illness - or not?

3. In what ways has your artistic work helped you to

manage/ live with your health problems?

These questions were not asked in a rigid way but were

modified and probed, as needed, to guide a flowing

conversation.

Data analysis

Data analysis was carried out jointly with the second

author, focusing on the meanings of engaging in the

process of art-making (rather than interpreting content

or imagery). The authors’ different professional

backgrounds in psychology and occupational therapy helped

to limit the influence of a priori concepts upon the data

analysis. The authors spent a considerable period of

immersion in the transcripts. Based on the guidelines for

IPA (Smith et al., 1999), one lengthy interview transcript

was initially coded for microthemes. This list expanded

as subsequent transcripts were analysed. Gradually, the

‘micro-themes’ initially identified were clustered into

larger meaningful themes as the process of analysis

11

unfolded, aided by concepts recorded in a memo book and

discussion between the authors. The focus of this paper

is on the major recurring themes in participants’

accounts. An audit trail supported the confirmability,

and hence rigour, of the analysis.

FINDINGS:

Summarising the stressful aspects of cancer

Before examining the contribution of art-making to well-

being, it is important to acknowledge that participants

had faced many cancer-related problems. Indeed, they

referred to most of the stressful experiences that have

been reported in previous qualitative research (e.g.

Mathieson & Stam 1995). There is insufficient space to

give details but their descriptions included the initial

shock of diagnosis, the discomforts of treatment, feeling

out of control, fears for the future, negative changes in

some of their social relationships, early retirement from

work, and loss of self or identity. One participant

(Jean, aged 50) summed up her difficulties after

diagnosis of breast cancer: “That was a horrendous year.

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Mastectomy, chemotherapy, radiotherapy…that was months of treatment. At

that stage I was feeling really battered”.

Patterns of art-making: brief outline

Most participants had engaged in considerable lifestyle

change since the beginnings of their illness. Half of the

sample had taken up art after their cancer diagnosis,

generally during the crisis of initial treatment; five of

the others had substantially intensified their

involvement. Only the youngest participant, a student

aged 23 years, had enjoyed creative art as a leisure

activity quite steadily throughout her life. Participants

engaged in many different types of visual art, including

textile art, card-making, collage, watercolour and

acrylic painting, and pottery.

Art and subjective well-being: Themes within the

interview data

Whilst the rich interview data provided testament to a

wide variety of subjective benefits of engaging in art

after cancer diagnosis, these were clustered into four

13

distinct themes, reported in Table 1. One theme was only

seen in the interview data of five participants. However,

because of its subjective importance for this group it is

included here. The remaining three major themes were

present in all of the interview data.

Insert Table 1 here************************

Although presented in linear fashion, it is important to

emphasise that the subjective benefits of art-making were

highly interconnected. For example, with the achievement

of better self-worth, participants described feeling more

confident in social relationships. Reciprocating care

(through hand-made gifts, for example) had individual and

social benefits, in building self-esteem, and warding off

pity from others. When participants focused attention

upon planning or creating artwork rather than dwelling on

their worries about cancer, they re-connected with a

familiar self-image as an effective, capable person.

Participants also felt that their social interactions

were normalised rather than dominated by the stigma of

cancer and ‘cancer talk’.

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Art symbolised the cancer experience

Five of the twelve participants described their art-

making as enabling symbolic self-expression. However,

only one or two pieces of their artwork had this

function. Four of the five referred to a ‘chemotherapy

piece’, which generally had a symbolism that was

perceived only at a later stage. One participant (Carol,

aged 57, with breast cancer) recollected her first piece

of art: “I did a sort of collage …a deep dark ravine, all greens and dark

colours…the dark ravine was obviously where I was…that was the only one

that seemed to be symbolic. And I threw it away.” Symbolic expression

was not confined to fear or grief. Another participant

(Jean) interpreted some of her early artwork as obliquely

expressing her psychological strength during treatment

for breast cancer: “[The art] was something I could manage, I was

sure to get it right, right enough to say ‘I’ve done that, that’s fine, I’ll frame it’.

It stands for something in my life now …I keep it somewhere and I think it

says ‘that’s a stage in my life that I went through’”.

15

Although infrequently constructed, symbolic pieces

appeared to have great psychological significance,

enabling participants to express feelings about the

cancer, including hopes and vulnerability, that were

almost out of reach of conscious awareness at that

particular time.

Art-making focused attention on life experiences other

than cancer

Art-making was highly valued by all participants for

providing a strong cognitive and emotional involvement

with aspects of life other than cancer, thereby relieving

some of the stress associated with the condition. Deep

immersion in art-making was described as reducing

perceptions of pain, alleviating ruminations and worry

about cancer. For two participants whose pain was

difficult to control, art-making helped participants to

cope with long sleepless nights. Many participants

considered that their time-consuming projects had a wider

benefit, in helping them to retain positive plans and

hope for the future, even within the context of life-

16

limiting disease. These different sub-themes will be

further explored with selected quotations.

Many participants spent a substantial part of the

interview reflecting on their inspirations for artwork,

including the work of recognised artists, and the natural

and man-made environment. This emphasised their outwards

focus. For example, Marie (aged 55, with a life-limiting

blood condition) constructed fragile textiles out of silk

thread that she dyed herself. She explained how was one

piece was developed ‘from a combination of inspirations. I went to

Venice and was totally struck by the verdigris on the bellies of the horses in St

Mark’s Square... the fabulous, fabulous greeny gold rivulets going down the

belly of the horse…The other thing that struck me was all sorts of old doors

around the fish market. They were kind of really beaten up …it was so

textural.” With this degree of attention to her

surroundings, Marie felt able to give less attention to

her life-limiting illness. She explained: “I suppose my whole

approach to the whole problem with my health is put it on one side and do

the best I can with it. Otherwise, it can consume you. And it will”. This

strategy of re-focusing did not seem to reflect denial or

17

other defensive strategies. Rather, re-focusing outwards

enhanced the quality of subjective experience and reduced

unproductive and emotionally debilitating rumination upon

illness.

Many other participants referred to their outward focus

on art-making and the benefits of this strategy for

living with cancer. One participant (Carol, 57 with

breast cancer and lung disease) explained: “Four or five hours

can go by without your realising. It’s wonderful. You thought of nothing else. I

mean that’s the beauty of it”. Such complete mental absorption was

seen as helpful for managing the discomforts of treatment

and illness.

As well as reducing preoccupation with illness, art

(including the focus on outside inspirations, design,

texture, colour and the process of making) offered a

coping strategy for pain, nausea and sleeplessness.

Several had discovered that the more they focused upon

their bodies, the more unpleasant their symptoms became.

They had learned to break what they regarded as a vicious

18

circle. One participant described coping with pain during

sleepless nights: “It might sound strange, but it [art] is a way of… not

thinking of the pain. Or at least you’re thinking of something to take the pain

away, rather than the pain itself. So you’re not getting into a vicious circle of

saying, ‘I’ve got pain, I must be getting worse’ and then the next minute it is

worse.”

In most cases, participants’ outward focus also included

planning many future art projects. This strategy helped

to ward off negative preoccupations with mortality, and

maintained hope. Jessica (47, with breast cancer) was

perhaps the most articulate about this strategy: “I’ve got

notebooks of things that I want to do. If I lived until I was 107, I wouldn’t

finish everything and I think that’s a good thing. I mean especially when

you’re looking at a shorter life span, rather than concentrate on that, you

think, I’ve got to get this finished, I’ve got to do this and that, I think that

helps a lot”. Louise, aged 66 and currently receiving

treatment for breast cancer, was also adamant about the

subjective importance of having future goals: “While you’re

doing something, you’re not dying. Literally”.

19

Art-making maintained personal identity and self-worth

Physical and functional losses have deleterious effects

on self-worth and identity, and so do social role

changes. Participants described many ways in which art-

making was helping them to maintain or restore a positive

sense of identity, and to resist being overly defined by

cancer. Feelings of accomplishment through meeting the

challenges involved, ongoing learning and personal

growth, experiencing continuity through involvement in

long-standing interests, and enhanced choice and control

were all important benefits derived from creative

activity that helped to sustain identity and thereby

helped participants to live more positively with cancer.

Most participants used the word ‘challenge’ at least once

during the interview. One participant (Dorothy, aged 74),

who was paraplegic from a spinal tumour, welcomed the

challenges inherent in her art-making, explaining: “ I

haven’t got many challenges, so doing a difficult piece of [art]work is helpful”.

Another (Marie) enrolled on a City and Guilds textile art

course after her early retirement. “It was a massive learning

20

curve, but very challenging, which was just great…You know, unless you shift

your comfort zone, you just carry on being what you are”. She considered

that her new-found lifestyle helped to provide the level

of challenge and on-going development that she used to

enjoy in her former academic work.

Participants did not necessarily require the challenge of

an advanced course to feel achievement. For example,

Louise (aged 66, with breast cancer) enjoyed making hand-

made cards. “It’s a sense of achievement, you know. It beats anything. For

me, anyway”. That this could be helpful for living with

cancer became very clear later in her interview: “I don’t see

the sense of sort of going to bed and waiting to die, or sitting in a chair and

waiting. I would rather be doing something that I enjoyed and have

something at the end to show for it… It’s the sense of achievement more than

anything”.

During interviews, many participants focused at length

upon their inspirations, courses, internet contacts and

other sources of learning and skill development.

Participants emphasised the enjoyment and personal growth

21

associated with gaining new skills. They referred to

themselves as “blossoming” and “having something to knock me off

course”. As well as developing new skills, art during

leisure time also afforded opportunities for participants

to express some of their pre-cancer interests, even

within a context of diminishing physical function. This

outcome also can be interpreted as helping to maintain

personal, or biographical, continuity. For example, Eve

(48, with metastasised breast cancer) emphasised how

continuity of creative interests contributed to

‘normality’ within her life, and hence subjective well-

being: “Well, I think really it’s [important] doing normal things … Obviously

with all these sort of toxic drugs some days are less normal than others and

some days are more normal than others…I think really that by doing these

things [arts and crafts], I’m doing the things that I always did do, so those

always were my hobbies and I suppose I’ve just added a new interest or, like,

taken the interest into a different dimension”.

In many ways, participants had suffered a profound loss

of control over their lives. Some recounted difficulties

in gaining a correct diagnosis, and their sense of

22

vulnerability in entrusting their lives to medical

practitioners. Treatments sometimes had unexpected side-

effects, and the progress of the illness continued, for

many, to be uncertain. As disabled people, some faced

barriers to accessing taken-for-granted resources such as

transport and so on. Whilst many difficulties remained in

relation to cancer treatment and prognosis, art-making

was experienced as a haven of choice and control in

everyday life. Marie made this point clearly: “It is quite

hard to discover that you’re not going to live forever and your body’s gone a

bit cranky…Having a disorder of some sort makes you very aware of your own

vulnerability, you know. You used to be immortal and now you’re not, and if

you do creative things, they’re entirely within your control and it gives you a

sense of something that you can do something about. Because it’s coming

from within you and then you’re expressing it outwardly and you know, you’re

not vulnerable. You’re growing a little bit.”

Another participant (Jill, aged 50, who had finished

treatment for a pituitary tumour) agreed that art-making

gave her more power in relation to her cancer: “I don’t feel

I’ve been defeated…if I can do things like this”.

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Art-making preserved an ‘able’ social identity

As discussed in the introduction, cancer tends to have a

powerful ‘master status’ that can radically re-shape

social relationships and interactions. Several

participants had suffered social difficulties as a result

of their illness. Louise recounted: “That’s the saddest part

about it. I had a friend, a really close friend, we worked together for years…I

tried to meet up with her but as soon as I mentioned the word that I’d got

cancer, I haven’t heard from her anymore. I’ve not heard from her since that

day.”

Jessica’s experience was similar: “I’ve known people hide…

because they don’t know what to say to you and you get comments. Someone

came up to me and said, ‘Oh, if I had to have a mastectomy, I’d kill myself.’

Very helpful! And what I actually said is, ‘Oh, it’s a good job I don’t feel like

that, isn’t it?’ But people are ridiculous about what they say and I think that’s

another reason for doing something that they can talk to you about, that’s

not cancer, because people are scared of cancer, aren’t they?”

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Art-making provided a shared interest with others that

had nothing to do with cancer. With the cancer rendered

less dominant, a better quality of social life was

achieved, and stigma was resisted. Participants felt able

to retain active roles in their social circles rather

than feeling totally defined by the cancer diagnosis or

pitied as a ‘tragic victim’.

Art-making also provided a shared focus of social

activity for many participants. Those who joined courses

or set up arts and crafts groups of their own (e.g. for

painting, cross-stitch, patchwork, or charity fund-

raising) belonged on their own terms, rather than being

defined by their illness. Jessica said: “I think one of the

biggest factors in that is that your disability or your ill health or whatever isn’t

the most important thing in your life. I don’t think about it when I’m out and

about at all. I keep that for family. I think it’s boring listening to someone

else’s health problems and I think by having the art and the craft and

everything, it gives you that interest that you can talk about. I mean what do

people talk about? They talk about their work, their family, their hobbies, their

health”.

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Some participants regarded their art-making as helping

family and friends to feel less concern about their well-

being. For example, Jean described wishing to protect

her young adult children from distress by having a

positive focus in her life during treatment for breast

cancer: “I’d still got three kids at home, early 20’s, old enough to be helpful

but in other ways I needed to protect them a bit. I wanted something so they’d

feel their mum was riding above this…so I joined the Embroiders’ Guild”.

Eve described sometimes sparing her friends details about

her breast cancer treatment. With her hand-made cards,

she took care to avoid focusing on her illness or

treatment: “If you sometimes include nice photos or you send a [pink]

ribbon or whatever and maybe that’s not so depressing for the people

receiving. Better than saying ‘Oh, this week I’ve been to the hospital again and

I’ve had another scan’ …Because people have been very good and they do

want to know what’s going on, but I don’t always want to be the bearer of bad

tidings. It’s nice sometimes to send something just a bit more cheerful”. She

not only exercised control over disclosure of her

illness; she also maintained her status as an equal

26

partner in her social relationships, giving as well as

receiving emotional care.

Making hand-made gifts was popular among the

participants. As well as spending enjoyable time in

making the gift, the act of giving also helped to

maintain or restore the status of the person with cancer.

Gifts helped to reciprocate care. The youngest

participant (Susie, aged 23, who was receiving treatment

for a brain tumour) explained: “I like to make things for people

who have done stuff for me or looked after me or been kind to me”.

Participants appreciated that hand-made gifts also

encouraged others focus on their positive talents, not

simply their cancer diagnosis. Gifts were sometimes given

as a strategy to ward off pity and to emphasise

personhood instead of cancer. For example, one

participant (Carol) returned to work after weeks of

chemotherapy with a set of embroidered waistcoats that

she had made for all of her colleagues.

27

For some participants with life-limiting illness, gifts

were viewed as a legacy, helping to preserve their

memory. Louise thought that she was unlikely to live long

enough to see her young grand-daughters marry, yet she

described embroidering wedding presents, ‘something to

remember me by’.

DISCUSSION

None of the participants ascribed any mystical healing

powers to their creative activities. Although art

therapists emphasis the symbolic functions of art (e.g.

Minar, 1999), art as a leisure activity rather rarely had

this purpose. Nevertheless, the artwork that did

communicate fear and hope in the early stages of

treatment had great psychological significance. Art-

making generally provided other sources of well-being.

Participants emphasised that they gained a sense of

vitality from ongoing engagement with the beauty and

creative inspirations of the physical environment;

participation in active planning and problem-solving; and

28

from observing development of their own artistic skills.

Art-making also offered opportunities to re-focus

attention away from distressing symptoms. Art-making also

offered a means of preserving a familiar personal and

social identity, maintaining personal continuity, control

and reciprocal relationships, in face of the physically

and social disruptive nature of cancer.

The themes that emerged were broadly consistent with the

themes derived from a wider sample of people living with

chronic illness (Reynolds & Prior 2003). However, the

intensity of emotional turmoil, awareness of limited

time, and degree of physical pain among participants with

cancer may have been responsible for the greater emphasis

reported here on managing the negative aspects of

illness. Compared with the previous study, participants

with cancer made fewer references to art as a catalyst

for other positive lifestyle choices (such as travel,

exhibitions, or courses). Art-making provided

opportunities to experience continuity, agency and self-

esteem, recognised as defining features of identity which

29

are readily threatened by cancer (Gillies & Johnston

2004). Art-making also helped participants to move beyond

preoccupations with self and mortality. It offered a re-

vitalising experience, preserving a healthy and vigorous

engagement with life. For at least short periods,

participants were able to escape from the liminal zone

between life and death that has been described by Sibbett

(2005).

Previous research has found that social support and

spiritual beliefs provide resources for living with

cancer (e.g. Gall and Cornblat, 2002). This study

provides fresh insights by revealing how a personally

meaningful leisure activity such as art-making helps to

re-establish a familiar, ‘normal’ and positive identity

during cancer and a sense of re-engagement with life.

Findings are consistent with previously reviewed evidence

about people’s needs to preserve an able social identity,

free from the labelling imposed by cancer.

30

The findings support previous qualitative research (e.g.

Luoma & Hakamies-Blomqvist , 2004; Luker et al., 1996) that

has documented how some people cope with cancer by

getting on with their lives (‘living well’) rather than

dwelling on their illness. However, Luoma & Hakamies-

Blomqvist (2004) interpreted participants’ desire to

focus on experiences other than cancer as a form of

conscious denial or reality distortion. They used this

term to describe participants’ strategy of trying not to

think about their illness, instead seeking absorbing

pastimes such as watching films. Yet denial occurs when

people reduce their anxieties by refusing, consciously or

unconsciously, to accept or believe a threatening event.

In the current study, there was no evidence of denial, as

participants were quite open about their fears for the

future and they talked quite explicitly about their

harrowing experiences of diagnosis and treatment. Yet

when engaged in creative activity, they were able to

withdraw attention from their cancer. Such a strategy can

be understood as emotion-focused in relieving

participants from worry and stress at least temporarily

31

during creative activity, or as problem-focused in

managing the intrusive cognitive burden of cancer. This

strategy of deliberate immersion in activity may be a

form of self-distraction, a strategy that was noted by

Kershaw et al (2004) to be unrelated either to avoidant or

active coping. Its relationship with subjective well-

being requires further examination.

Previous research (e.g. by Tocher, 2002) has focused on

the meanings of physical leisure activity for breast

cancer survivors. In this study, participants’ accounts

of art-making emphasised certain similar psychological

and social benefits. These included enhanced control, the

experience of living more intensely in the present

moment, a commitment to future projects and making use of

precious time, as well as social relationships built upon

shared leisure interests rather than cancer.

Participants, through their art-making, appeared to be

practising a form of resistance to the all-defining power

of cancer. Narratives have been understood as a means of

32

resistance to the life disruption that cancer brings

about (Dreifuss-Kattan, 1990; Mathieson & Stam 1995).

This study seems to demonstrate many ways in which

creative leisure activities confer psychological

resistance to the potentially overwhelming psychological

and social power of this condition. Other studies have

emphasised that cancer disrupts identity (e.g. Gillies &

Johnston 2004). This study has revealed that personally

meaningful creative activity can offer a powerful means

of maintaining identity and therefore subjective well-

being during and after cancer treatment.

From a critical perspective, this qualitative study has a

number of limitations. In interview-based research, there

is inevitable doubt as to whether the interviewer is

gaining a transparent window on to participants’ thoughts

and feelings, or is faced with complex strategies of

self-presentation, or social ‘masks’. People with cancer

are bombarded with exhortations to be ‘positive’ and

these may influence their decisions to volunteer for

research and also encourage ‘heroic’ accounts during an

33

interview (Wilkinson & Kitzinger 2000). Such social norms

cannot be discounted in the present study. Yet on

balance, we argue that the interviewees’ responses should

not be treated simply as artificially positive self-

presentational strategies. Participants clearly engaged

in art-making outside of the interview and had certain

reasons for choosing creative activity, even if they

could not fully articulate their motives in the

interview.

The sample size was small though typical for a

phenomenological study using IPA, but transferability of

the findings remains debateable. Culture influences the

cancer experience (Lam & Fielding 2003), but this could

not be explored as all participants were White. The

sample was diverse in terms of diagnosis. A few regarded

themselves as cancer ‘survivors’; some were uncertain

about future health, and some regarded themselves as

terminally ill. For an exploratory study it was

considered helpful to have participants in various stages

of the cancer trajectory. It should be noted that more

34

than a year had elapsed since diagnosis. Participants’

concerns would possibly have been different had the

interview taken place earlier in the process of emotional

adjustment.

CONCLUSION:

This phenomenological study sought to understand how

visual art-making, as a leisure pursuit rather than as

psychotherapy, contributed to the subjective well-being

of people living with cancer. Participants described many

stressful experiences associated with cancer and its

treatment. Emotional turmoil and/or early retirement from

work had led most participants to take up or intensify an

interest in art after diagnosis. Art-making provided

participants with a positive outwards focus, limiting

their preoccupation with cancer-related fears and

physical discomfort. Their art-making helped to support

continuity of personal identity, an ‘able’ self-image and

equality within social relationships, thereby

counteracting the ‘master status’ that cancer tends to

confer. For a minority, art enabled expression of

35

feelings about cancer in symbolic or implicit terms,

especially in the early stages after initial diagnosis or

recurrence. Participants continued to face distressing

experiences in relation to their illness, yet art-making

during leisure time offered an important resource for

enhancing subjective well-being. Helen (50 years old,

who had completed treatment for non-Hodgkins lymphoma),

explained: “You eventually carry on but in a way, the living afterwards is

more of a challenge than actually just getting through your treatment -

although you don't realise it at the time. And to actually live it positively”.

ACKNOWLEDGEMENTS

The authors would like to thank participants for sharing

their experiences and the Arts & Humanities Research

Council (UK) for its financial support.

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Table 1: How did art-making enhance participants’

subjective well-being after a cancer diagnosis?

1. Art symbolised the cancer experience

41

Fear and grief

Hope and strength

2. Art-making focused attention on life experiences

other than cancer

Encouraged an outwards focus

Relieved worry, pain, sleeplessness

Provided a future hopeful orientation

3. Art-making maintained personal identity and self-

worth

Provided experiences of challenge and

achievement

Promoted learning and self-development

Enabled expression of self-defining interests

Increased subjective control

4. Art-making preserved an ‘able’ social identity

Offered a mutual social interest unrelated to

cancer

Provided a non-cancer source of social identity

Relieved family from concerns about well-being

Enabled reciprocal care through hand-made gifts

Provided a legacy or memorial

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