Museums & the Mentally Ill: Barriers for the Integration of Art Therapy

for Depression in Museum Education

By

Electra Moulakaki

A thesis presented to

in fulfillment of

the thesis requirement for the degree of

Master of Arts

in Arts and Heritage: Management, Policy and Education

Supervisor: Emilie Sitzia

Maastricht, the Netherlands

August 2014

ID: 6074866 Academic year: 2013-2014 Course code: AHE4800 Assignment number: 00 Word count: 19.303 REGULAR

TABLE OF CONTENTS Table of Figures ............................................................................................................. 3 Abstract .......................................................................................................................... 4 CHAPTER ONE: Introduction .................................................................................. 5

CHAPTER TWO: Modern Role of Museums .......................................................... 8 2.1. Social Inclusion Model ................................................................................................... 8

2.1.1. Historical Overview ................................................................................................ 8 2.1.2. Underlying Forces ................................................................................................... 9 2.1.3. Definition .............................................................................................................. 10 2.1.4. Issues Raised/Importance of Partnerships ............................................................. 12

2.2. Therapeutic Role of Museums ...................................................................................... 13 2.2.1. The Therapeutic Potentials of Museums by Andrée Salom and Alain de Botton . 14 2.2.2. Examples of Museums Embracing their Therapeutic Role ................................... 16 2.2.3. Therapeutic Role of Museums for the Mentally Ill ............................................... 17 2.2.4. Successful Examples of Museum Programs for the Mentally Ill .......................... 19

CHAPTER THREE: Art Therapy ........................................................................... 21 3.1. Historical Overview ...................................................................................................... 21 3.2. Definition ...................................................................................................................... 22 3.3. Benefits of Art Therapy ................................................................................................ 25 3.4. Art Therapy & Depression ............................................................................................ 27 3.5. Art Therapy in Museums .............................................................................................. 28

CHAPTER FOUR: Barriers for the Incorporation of Art Therapy for Depression in Museums ............................................................................................ 29

4.1. Problems in the Museum Sector ................................................................................... 30 4.1.1. Time ...................................................................................................................... 30 4.1.2. Resources .............................................................................................................. 32 4.1.3. Space ..................................................................................................................... 33 4.1.4. Bureaucratic Structure ........................................................................................... 34 4.1.5. Attitude towards Museums .................................................................................... 35 4.1.6. Exclusion of Museums from Partnerships with Agencies .................................... 39

4.2. Problems in Art Therapy .............................................................................................. 40 4.2.1. Lack of Credibility of the Profession .................................................................... 40 4.2.2. Short History of the Profession ............................................................................. 41 4.2.3. Polarization between Art Therapists ..................................................................... 42 4.2.4. Limited Research on the Effectiveness of Art Therapy as a Treatment ................ 43 4.2.5. Complexity of Art Therapy as a Discipline .......................................................... 44

4.3. Conservative Nature of the Mental Health Sector ........................................................ 44 4.4. Lack of Proper Education about Mental Illnesses ........................................................ 46

CHAPTER FIVE: Museums & Therapy ................................................................ 47 5.1. Social Role over the Therapeutic Role of Museums .................................................... 47 5.2. Therapeutic Role as Viewed by the Stakeholders ........................................................ 49

CHAPTER SIX: Conclusion .................................................................................... 53

Bibliography ................................................................................................................ 56 Appendix ..................................................................................................................... 60

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Table of Figures

1.  Programs  for  the  special  interest  groups  ......................................................................................  6  

2.  Triangular  relationship  of  art  therapy  .........................................................................................  24    

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Abstract The aim of this thesis is to find out why integrating art therapy for depression in

museums is in its infancy stage despite its relevance to the social inclusion model in

museum education and the therapeutic role of the modern museum. The research

explores the different types of barriers for the incorporation of art therapy for people

with depression, classified in four areas: museums, art therapy, mental health and

education. Moreover, the potential relationship between museums and therapy, as

identified by the key stakeholders, is presented.

Keywords: museums, art therapy, depression, mental health, social inclusion, education

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CHAPTER ONE

Introduction

From February until April 2014, as an intern at the Stavros Niarchos Foundation1,

one of the world's leading international philanthropic organizations, I conducted

research on Cultural Education. The aim of the research was to serve as a successful

tool for future grants and collaborations of the Foundation in the Arts and Culture and

support the proactive work of the Program Officers by defining which museums and

cultural institutions are currently the most educationally active, digitally advanced

and sensitive to issues linked to the notion of social inclusion for special interest

groups.

The database, employed in the research, included 76 cultural institutions, mainly

museums, in 11 European countries (Europe being the Monte-Carlo (MC) office

action region). The research conducted was based on online findings available in the

official websites of the institutions, in English, French, Italian, Spanish or Greek.

The institutions were selected according to their number of visitors and interesting

programs offered, in order to give a clear and representative idea of the European

cultural sector and demonstrate its strengths and weaknesses.

As far as programs for special interest groups are concerned, the research included

mainly programs for the disabled, the blind and visually impaired, the deaf and

hearing impaired, Alzheimer’s patients, people with mental illnesses, hospitalized

children, people with dementia and the elderly. Even though several such programs

were reported, most of them focused on the blind and deaf, thus not including many

groups that are undoubtedly among the socially excluded population, such as people

with mental health issues.

More specifically, 40% of the institutions offer programs for the blind and visually

impaired, whereas only 6,5% offer programs for the mentally ill.

                                                                                                               1 Official Website of Stavros Niarchos Foundation 2014: http://www.snf.org/

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1. Programs for Special Interest Groups

This statistical fact is quite striking, given that the presence of the special interest

groups in question is reversely proportional in society. In 2012, approximately 285

million people were visually impaired, 246 million suffered from low vision while 39

million people were totally blind (World Health Organization, 2013). On the other

hand, only one form of mental illness, depression, is affecting more than 350 million

people, according to the World Health Organization (World Health Organization,

2012, p.6). Moreover, it is estimated that by 2020 depression will be the second most

disabling illness worldwide after ischemic heart disease (Zubala, Macintyre, Gleeson,

& Karkou, 2013, p.458).

Undoubtedly, visual impairment affects a significant percentage of the world

population, but why is there such discrepancy between the number of programs

offered for the visually impaired and the corresponding number of programs for the

mentally ill?

This thesis will explore the reasons for this discrepancy as well as why art therapy is

not usually included in museum programming. In order to achieve this goal, the thesis

will identify the barriers for the incorporation of art therapy for depression in

museum education.

40%  

6,5%  

Programs  for  Special  Interest  Groups  

Blind  and  visually  impaired  

Mentally  ill  

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While our ultimate goal is to examine the barriers for a museum to incorporate art

therapy for people with depression, it is imperative that we first establish a conceptual

framework by which we may comprehend them in full. To begin this exploration,

conceptualizing the modern role of the museum and understanding the social

inclusion model and its therapeutic role in the second chapter will prove of key

importance. Further, a brief overview of art therapy and an analysis of its concept and

its potential benefits within the museum space in the third chapter are similarly

important. Having set the foundations to the research, chapter four will subsequently

discuss and try to identify the barriers behind the absence of art therapy programs in

museum education, as perceived from the major stakeholders. Indeed, this chapter

serves as the crux of this thesis in understanding the discrepancy between theory and

practice, and can also provide us with an outlook on why, despite its relevance to the

social inclusion model and the therapeutic role of museums as well as the benefits of

art therapy, incorporating art therapy for depression into museum programming is

still in its infancy stage. The fifth chapter will then explore the relationship that,

according to the stakeholders, could be established between museums and therapy,

and the importance placed on the social rather than the therapeutic role of museums.

It is with this in mind that we can then conclude with our sixth and final chapter,

where we may consider a broader perspective on the current state of museum

education and art therapy and engage in a critical evaluation of the sum total of our

research.

Since the limited number of art therapy programs for depression in museum

education has not been clearly defined yet as a problem and there are no previous

studies on the topic, an exploratory research was vital to this study. Since exploratory

research is broad in focus, it was considered to be the most suitable so as to identify

key issues. The research relies on qualitative research led through in-depth

interviews. Specifically, the main goal was to conduct focus group interviews of the

major stakeholders: patients, psychiatrists, art therapists, museum professionals and

artists. Due to time limitations, the number of interviews was limited but an effort

was made so as to select a wide range of people to discuss about the barriers

preventing integration of art therapy for depression in museum education. At this

point it should be clarified that exploring how art therapy could be practically

incorporated in museum programming is beyond the scope of this research. The main

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focus is to identify why integrating art therapy for depression into museums is in its

infancy level, and which exactly are the barriers responsible for the limited number of

these kinds of programs in museums.

Reviewing relevant literature was of utmost importance for the conceptual chapters

but also for the thesis core. The second chapter (detailing the social inclusion model)

was based on scholars analyzing the model such as Richard Sandell, Karen Peacock,

David Beel and Eilean Hooper-Greenhill. The therapeutic role of the modern

museum, presented in the same chapter, is mainly grounded on primary and

secondary sources from Andrée Salom, Alain de Botton, Eleonora Belfiore and

Oliver Bennett among others. For the art therapy chapter, the referenced published

research articles were selected from journals spanning from The Arts in

Psychotherapy, Museum Management and Curatorship and the Journal of the

American Art Therapy Association. Last but not least, the fourth and fifth chapters

containing the identification and analysis of the barriers explaining the limited

number of art therapy programs for depression in museums, apart from literature

findings, were mostly based on the stakeholders’ interviews.

CHAPTER TWO

Modern Role of Museums

2.1. Social Inclusion Model

2.1.1. Historical Overview In the late 1970’s and 1980’s, the ideology of New Right, the ethos of economic

rationalism and the successive reductions in public funding resulted in museums

facing great pressure to justify their actions and, more importantly, their spending,

thus becoming even more focused on managerial and economic issues. In response to

that, as Richard Sandell states, many museums started introducing admission charges,

resulting to the exclusion of underprivileged social groups due to financial barriers

(Sandell, 1998, p.402). At the same time however, many museums, especially those

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managed by local authorities, continued to offer free admission and started

developing, if not increasing, their role and leverage within the community.

In 1999, “Museums for the Many”, produced by the Department for Culture, Media

and Sport (DCMS) in the United Kingdom, was the first policy document linked to

the notion of social inclusion in museums. The document underlined the importance

of access to museums and suggested that all public museums should offer free access

to their audience, or at least to children and the elderly.

The following year, the same department published another document entitled

“Centers for Social Change: Museums Galleries Archives for All”. This document

aimed to provide museums with clear policy guidelines on how to demonstrate their

social value and their capability to promote social inclusion and act as a catalyst for

positive social change (Beel, 2011, pp.49-50).

2.1.2. Underlying Forces

But which are the forces underlying museums’ new focus on audiences and social

inclusion? First of all, self-preservation. As David Fleming, director of National

Museums Liverpool, stated, the publicly funded museums of the past era did not pay

much attention in attracting new audiences (Fleming, 2005, p.1). However, during the

1980’s, in the face of the stringent economic policy of the Thatcher administration, an

ever increasing number of British politicians raised indignant questions as to why

should museums be allowed to maintain their existing funding. Especially during the

last decade, due to reduction of state funds, there has been an increasing competition

among museums for scarce public resources. In order to safeguard financial

sustainability, museums should now have to justify their role and value to society,

clarify and demonstrate their social purpose, and commit themselves to serving broad

audiences. This force is well described by the Group for Large Local Authority

Museums (GLLAM) report:

Attitudes of local authorities and other agencies towards museums can change when they see the museum doing a good job, see that museums can deliver the social inclusion agenda and stimulate interest in topics of contemporary concern. With this appreciation more funding can become available. (Group for Large Local Authority Museums, 2000, p.15)

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The insightful GLLAM report also stated that another force underlying museums’

new interest on social inclusion agendas was its undeniably perceived feel-good

factor (Group for Large Local Authority Museums, 2000, p.15). Offering educational

programs for diverse audiences and identifying the barriers responsible for excluding

many social groups from museums provide museum professionals with the

opportunity to demonstrate the educational value of museums and connect with the

community. As a museum professional from Aberdeen describes in the GLLAM

report, “socially inclusive work reflects back the realities of life in the community

and makes us more connected” (Group for Large Local Authority Museums, 2000,

p.15). Similarly, a museum professional in Nottingham underlines the importance of

the commitment to social inclusion work: “By embracing the notion of diversity and

engaging more people it becomes a more vibrant, meaningful place for everyone. It

benefits everyone.” (Group for Large Local Authority Museums, 2000, p.15).

Thus, by getting involved in actions that promote democratization and cultural

equality, museums take a step forward towards a more social image, distancing

themselves from the old-fashioned belief that museums exist solely for the viewing

and cultural pleasure of a certain socio-economic elite and represent institutionalized

exclusion.

2.1.3. Definition But what is exactly the social inclusion model? What do we mean by saying that

museums can act as agents of social inclusion? According to Karen Peacock, these

ideally-modeled museums should “fulfill their mission of becoming more relevant

and accessible to all populations” by redefining their role, accepting their social

responsibility and finding new ways of working and developing educational

programs (Peacock, 2012, p.136). Empowering dialogue, activity, interaction and

collaboration within the museum is considered a matter of justice rather than welfare,

a constituted right everyone should enjoy rather than a privilege for the few.

Richard Sandell in his articles “Museums as Agents of Social Inclusion” and “Social

Inclusion, the Museum and the Dynamics of Sectoral Change” presents the typology

of this model. According to him, museums can contribute towards social inclusion at

three different levels: individual, community and societal (Sandell, 2003, p.45).

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Within this ideological framework, museums, by getting involved in social inclusion

initiatives, can improve the quality of life of their visitors on an individual basis. This

goal is achievable since museums, as Sandell claims, can directly encourage the

personal development of individuals and small groups (Sandell, 1998, p.416).

Programs for special interest groups can increase their self-esteem, encourage their

self-determination, and at the same time deliver numerous positive outcomes such as

enhanced aspirations, creativity, skills and confidence. Thus, involvement with

activities in museums could be really important for individuals on a very personal

level, since it could play a key role in their intellectual, psychological, academic and

personal growth.

But Sandell goes a step forward by stating that museums, apart from their impact on

the lives of individuals at risk of social exclusion, can actually regenerate and

empower disadvantaged communities. He asserts that:

At a community level, museums can act as a catalyst for social regeneration, empowering communities to increase their self-determination and develop the confidence to take greater control over their lives and the development of the neighborhoods in which they live. (Sandell, 2003, p.45)

Nevertheless, despite the fact that museums could affect the lives of individuals and

groups at risk of exclusion, Sandell expresses what seems to be a logical question:

To what extent might the museum consider its role in tackling exclusion beyond the cultural dimension? Can museums play some part in directly tackling the symptoms of social exclusion, which are manifest in contemporary social problems such as unemployment, crime, homelessness, poverty, racism and poor health? Are such goals appropriate for museums? (Sandell, 1998, p.411)

According to him, museums -and in general cultural institutions- have the potential

to “contribute directly towards the combatting of the causes and symptoms of social

exclusion” (Sandell, 1998, pp.412-413). By offering safe, non-judgmental

environments and by renegotiating their relationship with communities, museums

could help in the development of mechanisms through which communities can be

empowered to take part in decision-making processes. Thus, in that way, museums

become open to dialogue, help people view their problems in a new context and gain

a socially inclusive reputation.

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Furthermore, Sandell acknowledges another role for socially inclusive museums:

museums as vehicles of broad social change. He argues that museums need to

“exploit their potential to influence society with a view to promoting social inclusion

(or alleviating the symptoms of exclusion) on a macro level” (Sandell, 1998, p.414).

To be more specific, museums could instigate positive social change by challenging

negative attitudes and by promoting inter-community respect and greater tolerance

towards marginalized communities. As far as Sandell is concerned, this can be

achieved through “providing a forum for public debate, education and persuasion”,

which can challenge stereotypes and promote social change through learning

(Sandell, 1998, p.416).

Therefore, according to the social inclusion model, museums need to broaden their

relevance and scope and stop, as Fleming states, regarding their exhibit collections,

“as an end in themselves” (Fleming, 2005, p.5). For Sandell, the recognition of this

role of museums as agents of social inclusion and broad social change reflects and

echoes “interpretations of nineteenth century museums’ roles as civilizing

instruments of the state” (Sandell, 2003, p.45).

All in all, according to the social inclusion model, museums should not only open up

to people in risk of social exclusion, but also understand their potential to change the

lives of precisely these people in need, but also society as a whole. They should

influence society in a positive way by celebrating and representing diversity as well

as promoting cultural equality and democratization.

2.1.4. Issues Raised/Importance of Partnerships Despite the power of museums to act as cultural catalysts, there are still some issues

to deal with. First of all, Sandell acknowledges the need for further research as far as

the social inclusion model is concerned, since “there has been little supporting

analysis or questioning of the concept of social inclusion and its relevance to the

museum sector” (Sandell, 1998, p.401). Moreover, another issue that adds credence

to the lack of said analysis is the inherent resistance of museums to change, a point

also underlined by Fleming. Nevertheless, Fleming supports that “bringing about and

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managing change is a lengthy process which requires clear thinking, determination

and patience” (Fleming, 2005, p.8).

At this point, it should be noted that a very important aspect of the socially inclusive

museum is partnerships. If museums wish to create long-term sustainable projects,

they need to collaborate with several stakeholders in social inclusion initiatives. As

articulated in the GLLAM report, these partners can act in several ways:

“introductory, as a catalyst, as equal partners in a project, as funders, as providers of

advice and information” (Group for Large Local Authority Museums, 2000, p.16).

All the museums included in the GLLAM report recognized the importance of

partnerships, as demonstrated by the usage of catch-phrases such as “it’s the only way

you can do it” or “this approach is vital” (Group for Large Local Authority Museums,

2000, p.16). The necessity for museums to forge partnerships with agencies

promoting social inclusion agendas is well summarized in the words of a Nottingham

museum professional: “The museum should be seen as one of many organizations/

spaces/ venues which are part of a process. We need to be integrated. We can be more

effective when part of joined-up thinking. Partnership is crucial.” (Group for Large

Local Authority Museums, 2000, p.16)

2.2. Therapeutic Role of Museums Apart from the social inclusion model, part of the modern role of museums is their

therapeutic role by embracing the healing powers of art. The arts have long been

viewed as therapeutic. Eleonora Belfiore and Oliver Bennett present the findings of a

3-year research project on the impact of the arts by UK Arts & Humanities Research

Council and Arts Council England (Belfiore & Bennett, 2007). The project is a

historical approach and classification of the claims made within the Western

intellectual tradition for the impact of the arts to people, from Classical Greece to the

present. As demonstrated, people throughout history have acknowledged the positive

role arts can have in healing the human mind and spirit, since there is a long positive

tradition for the benefits and therapeutic functions of art.2 In that way, the report

                                                                                                               2  Aristotle (384/3-322/1 BC) in his Poetics explained that experiencing pity and fear through the plays on stage has a cathartic effect of purification on the audience (Aristotle, 1982). Plato (428/7- 348/347 BC) stated in his Republic that musical training gives harmony to our soul (Plato, 1978). Freud (1928-1961) believed that artworks help us release tension and give us pleasure (Freud, Strachey, & Freud, 1955). Graham Greene (1904-1991) wrote the

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offers a clearer sense of where commonly accepted views on the impact of the arts

originate from. It also aims to reconnect the long-standing tradition of thought in

Western civilization to the very pragmatic need for governments to either fund

directly or regulate the advancement of arts (Belfiore & Bennett, 2007). But if art is

therapeutic and museums do house the works of art, does this not mean beyond a

shred of doubt that museums can have a therapeutic role for their audiences as well?

2.2.1. The Therapeutic Potentials of Museums by Andrée Salom and Alain de Botton Andrée Salom, art therapist and founding member of the Colombian Art Therapy

Association, explores the therapeutic potentials of museums. Her main argument is

that “museums are safe spaces for the objects they hold and for the persons that visit

them, providing environments that can function in therapeutic ways” (Salom, 2008,

p.1). According to Salom, museums offer transpersonal experiences: if we are to

focus on exploring ourselves through the contents found in them, museums can

impact our well-being significantly.

For Salom, the therapeutic role of museums is manifest in many different ways. First

of all, museums offer a safe place to their visitors. As Salom states:

The architectural boundaries of a museum (scale, lighting, temperature, circulation, display, etc.), along with the appraisals visitors make of these elements, mark a clear difference between the museum and the world outside of it. (Salom, 2008, p.1)

Salom supports that this “shift in behavior, cognition and emotion” offers a visual

experience and a spiritual quality that enable visitors to focus on their self-awareness

and insight (Salom, 2008, p.1). This atmosphere of sentimental safety and security

stems also from the fact that museums value and protect every single piece in them.

These protective limits invite visitors to set their minds free and let them expand

beyond the environment of the museum.

                                                                                                                                                                                                                                                                                                                           following: “writing is a form of therapy. Sometimes I wonder how all those who do not write, compose or paint can manage to escape the madness, the melancholia, the panic fear which is inherent in the human situation” (Greene, 1980).  

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Furthermore, by preserving and presenting diverse works of art, museums become

symbols of acknowledgment of uniqueness and tolerance towards differences. This

manifestation of singularity is well described in Salom’s words:

Museums allow guests to see the artistic expressions of others, who, like them, have explored the human experience with all its hues, textures, and tones, and then allowed these experiences to manifest in their work. By creating an atmosphere that houses expressions of all different states of mind, museums become optimal for exploring the concepts of “imparting information”, “universality”, and “installation of hope” that Yalom (1995) has described as therapeutic in his book, The Theory and Practice of Group Psychotherapy. (Salom, 2008, p.2)

But what are the concepts of “imparting information”, “universality”, and “installation

of hope”? To begin with, the concept of “imparting information” refers to the

possibility for museum visitors to acquire information that can give them inspiration

and perspective for their daily obstacles. Many artists have created artworks under

stressful conditions and used art as a way to cope with their problems, and these

pieces of art can thus serve as examples to the visitors so as to cope with their own

problems (Salom, 2008).

According to Salom, the concept of “universality” and “installation of hope” refers to

the fact that visitors can relate to the works of artists in museums, which offer

evidence of human similarities from beyond one’s own time and place (Salom, 2008,

p.3). The realization that humans have many characteristics, feelings and thoughts in

common help the museum visitors combat any feelings of isolation and withdrawal

and restore their faith in the strength of humanity.

Moreover, as Salom suggests, museums can act as “introducers of transpersonal

information” and “kindlers of transpersonal experiences”, since they offer new

opportunities for self-exploration and self-knowledge (Salom, 2008, p.4). The works

of art in museum collections can inspire visitors to “note unnoticed aspects of

themselves” and arouse new emotions, old memories and subconscious thoughts

(Salom, 2008, p.3). Last but not least, another important aspect of museum visits for

Salom is the feeling of “letting go”. Visitors, in order to experience every single piece

exhibited in the museum, develop mechanisms in order to let go of strong emotions

and relax. As he describes:

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Viewing a museum exhibit with this framework in mind can teach this contemplative skill by offering structure within which to watch patterns of mental grasping and judging, and thereby support the process of relaxing the mind into the present. (Salom, 2008, p.4)

Alain de Botton, Swiss-British writer and philosopher, also highlights the therapeutic

role of museums in his book Art as Therapy. The main line of De Botton’s argument

is that “museums should be apothecaries for our deeper selves” (De Botton, 2013).

Thus for him, art has a specific purpose: to engage with our emotions and reach for

our souls. De Botton claims that art could and should aim to impact our lives:

There is nothing wrong with thinking of artworks as tools and asking them to do things for us. They can help our psyches in a variety of ways: rebalance our moods, lend us hope, usher in calm, stretch our sympathies, reignite our senses and reawaken appreciation. But in order to do these things, they need to be better signposted as having the power to do so. Modern galleries should recognize the therapeutic potential of their collections and honor it in the way they display them. (De Botton, 2013)

2.2.2. Examples of Museums Embracing their Therapeutic Role We have therefore demonstrated that the therapeutic role of museums is to be taken

into account seriously. But have there been any programs based on this therapeutic

role? The most characteristic example is the exhibition “Art Is Therapy” in the

Rijksmuseum in Amsterdam, based on Alain de Botton’s book, which will be

analyzed further in the fourth chapter.

Apart from that, many concrete steps have taken place towards therapeutic

applications of the modern museum. For example, many museums have programs for

hospitalized children such as “Take Art” in the National Gallery of London3,

“Hospital outreach” in Victoria & Albert Museum of Childhood4, “Activities for

Hospitals” in Guggenheim Bilbao5 and “My Superheroes” in the National Portrait

Gallery6. All of these outreach programs wish to use art as a stimulus for the children

                                                                                                               3 More information about the program online at http://www.nationalgallery.org.uk/learning/outreach-projects/take-art 4 More information about the program online at http://www.museumofchildhood.org.uk/learning/schools/hospital-outreach 5 More information about the program online at http://www.guggenheim-bilbao.es/en/learn/general-public/activities-for-hospitals/ 6 More information about the program online at http://www.npg.org.uk/learning/access/hospital-schools.php

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and act as a therapeutic tool through engaging them in fun, creative art-related

activities.

Another program with a clear therapeutic target is “Inside Art” for young offenders

by the National Gallery7, developed in partnership with the juvenile prison HMYOI

Feltham and Young Offenders Institution for young men aged 15-21. As mentioned

in its description, the program aims to “reduce the risk of reoffending” (National

Gallery, 2012). Moreover, many museums have initiated programs for specific

diseases such as Alzheimer’s. “Meet Me” at MOMA8 and “Onvergetelijk Stedelijk”

at the Stedelijk Museum9 in Amsterdam wish to open up to patients with Alzheimer’s

disease, since they believe that visiting a museum and engaging in art-related

activities can not only act as direct brain stimulants but also have a positive effect on

overall patient health.

2.2.3. Therapeutic Role of Museums for the Mentally Ill

Having overviewed the most representational beliefs on the therapeutic role of the

modern museum, and briefly documented some programs related to it, it would be

useful at this point to look further into our main focus, i.e. the therapeutic role of

museums for the mentally ill. The questions this thesis aims to address could take the

following forms: Why provide activities in the museums to people with mental

illnesses? What substantive gain can these programs offer them? Could creative

engagement programs offer to such patients the chance to develop as individuals?

It should be noted that, quite often, people with mental illnesses are unnecessarily

isolated from their social surroundings. Participating in museum activities can help

them feel more socially supported since works of art can act as means for

communicating and connecting with others in many levels: through touch, talking or

even through the simplest eye contact. According to Susan Spaniol, art therapist, and

Gayle Bluebird, Director of Peer Services at the Delaware Psychiatric Centre in New

                                                                                                               7 More information about the program online at http://www.nationalgallery.org.uk/learning/outreach-projects/inside-art 8 More information about the program online at http://www.moma.org/meetme/ 9 More information about the program online at http://www.stedelijk.nl/educatie/volwassenen/onvergetelijk-stedelijk    

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Castle, art-based activities have the power to “encourage participants to bypass

customary barriers and relate more openly and honestly” (Spaniol & Bluebird, 2002,

p.109). Thus, engaging with art in museums could play a key role for people with

mental illnesses to strengthen their relationships with their families or caregivers but

also to foster new ones with other participants and the museum staff.

Another benefit of creative engagement programs in museums for people with mental

illnesses is distraction. As Susannah Colbert, research psychologist specialising in

psychosis, argues, “art galleries and museums, unlike hospitals and clinics, tend to be

non-stigmatizing environments and they are most often publically accessible sites

available in many locations throughout the world” (Colbert, Cooke, Camic, &

Springham, 2013, p.251). Museums, being completely unrelated to sites of mental

problems, can offer a very welcome change in the personal routine of people with

mental illnesses, help them delve into new conditions, ease their resistance to change

and thus open up to new experiences and emotions. A participant in one such

program that has experienced psychosis suggests that it helped him get distracted

from distressing thoughts. As he explains, “you don’t have to consistently and

constantly be consumed with your own inner world, you can be distracted nicely,

don’t have to be a bad reflection all the time” (Colbert et al., 2013, p.254).

Therefore, engaging with art in museums can prompt reflection. Works of art invite

the curiosity of people with mental illnesses and allow them to articulate emotions.

They can reflect on paintings and discover connections between artworks and their

daily lives and life experiences. In that way, as Leisa Gray, former leader of the

health and wellbeing program at Manchester Art Gallery and currently Deputy

Director at Open Art in Huddersfield, suggests, museums can help them “better

understand themselves, others and the world around them”, which can be utterly

beneficial for their mental wellbeing (Gray, 2012).

Last but not least, creative activities for people with mental illnesses in museums can

be beneficial for them in terms of motivation and confidence. As stated by the music

therapist Anne Lipe, “arts interventions have been shown to improve motivation, to

increase personal empowerment and to relieve negative symptoms associated with

mental illness” (Lipe et al., 2012, p.25). In the same article, Lipe concludes that all

  19  

the participants interviewed acknowledged the relaxation these activities offered to

them and explained how much it improved their self-esteem (Lipe et al., 2012).

2.2.4. Successful Examples of Museum Programs for the Mentally Ill

Hence, it is clear that creative engagement opportunities in museums are not only

beneficial for people with mental illnesses but can actually benefit them even more

than regular visitors. Several museums have initiated programs for these people, but

in comparison with other special interest groups, there are many steps to be taken, as

clearly demonstrated in the introduction. The following two examples, amongst the

most representative and well-structured concerning the case in point, will be

presented herewith.

The first example is that of the Reina Sofia Museum in Madrid, which explored the

function of art in therapeutic fields with the project “From Hospital to Museum” in

partnership with the Psychiatric Day Hospital Puerta de Hierro Majadahonda. As

explained in the Reina Sofia museum website, this program sought “to expand the

diversity of audiences to which it is addressed and explore the potential of art as a

way to improve the quality of life for people with some kind of serious mental

illness” (Reina Sofia, 2013). The planning, implementation and evaluation of the

project is in collaboration with museum educators, art therapists and psychiatrists.

The starting point of “From Hospital to Museum”, as stated in its description, is “the

realization that chronic and severe mental illnesses have cognitive, affective and

relational deficits that severely limit the functionality and social adaptation of

sufferers” (Reina Sofia, 2013).

The program successfully embraced the therapeutic role of museums and defined

methodologies and tools so as to optimize art therapy interventions to combat with

cognitive or relational disadvantages of the mentally ill. The Museum achieved this

goal by developing skills and resources through artistic creations inspired by the

original artworks exhibited at the Museum, in order to promote emotional, cognitive,

sensory and interpersonal qualities in patients with severe mental health issues.

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Another museum that has developed a program aiming to have a therapeutic impact

on participants suffering from mental illnesses is the National Gallery of Australia.

The project “Arts for Health” identified three basic needs people with mental health

problems have that can be addressed by the Museum: belonginess, ego/self-esteem,

and self-actualization. As described, it was “a gallery-based art-therapy program

designed to assist people with chronic illnesses, raise awareness of the link between

lifestyle and health, and develop appreciation of their strengths and resources through

creative expression and learning” (Treadon, Rosal, & Wylder, 2006, p.290). Thus,

this example acts as a perfect case in point for proving the theory behind the

therapeutic role of museums, as well as embracing concepts-such as the concept of

“letting go” mentioned previously, as explored by Salom.

Nevertheless, it should be highlighted at this point that both examples of the Reina

Sofia and of the National Gallery of Australia are pilot programs that ran their

scheduled course and are no longer implemented. Thus, they both demonstrate one of

the major issues as far as museum programs for the mentally ill are concerned: the

lack of long-term sustainability, to be further analyzed in the fifth chapter.

  21  

CHAPTER THREE

Art Therapy

Art therapy is undoubtedly a way for museums to implement their therapeutic role.

Thus, it is of utmost importance to analyze the concept of art therapy as well as its

principles and target groups, before exploring art therapy as a tool for museums to

serve people with mental health issues. As described by Lili de Petrillo and Ellen

Winner in their study about whether art making improves mood, “the assumption that

the arts serve a therapeutic function underlies the practice of art therapy in which art

making is considered not only a diagnostic tool but also a means of improving

depressed mood and reducing stress” (De Petrillo & Winner, 2005, p.205). This is

why in this chapter we will not only explore art therapy but also identify its benefits

for the mentally ill, and more specifically, for patients with depression, the main

focus of this thesis after all.

3.1. Historical Overview

But what is art therapy and how did it start? Art therapy is applied to more than 50

countries around the world and uses the creative potential of people with a

therapeutic purpose. It is one of the disciplines of therapy via arts media that is based

on visual arts. The other three disciplines are: Music Therapy, Dance Movement

Psychotherapy and Drama Therapy (Zubala, MacIntyre, Gleeson, & Karkou, 2013,

p.458).

Healing through the arts, internationally known as art therapy, was founded in the

1940’s and was officially recognized for the first time as a profession in the 1960’s.

The 20th century highlights the importance of art created during childhood, which

was considered in the past just an immature and clumsy version of adult art. As

described in an article in the Arts in Psychotherapy journal, “historically, the

emergence of art therapy has been closely linked with developments in art and

modern art in particular” (Karkou, Martinsoneb, Nazarova, & Vaverniec, 2011, p.87).

  22  

After the Surrealists, the Dadaists and the Fluxus movement, the realization that any

material beyond markers, oil pastels and tempera, can become a means of expression

released the field of art therapy for experimentation and exploration, in effect

allowing it to embrace a wide range of expression and communication. Moreover,

postmodernism played an important role in the development of art therapy. As argued

in the same article in the Arts in Psychotherapy journal, this is due to the fact that

“postmodernism has promoted the use of the arts within diverse contexts such as

healthcare and science”, in which “the arts are not seen merely as an aesthetic

experience” (Karkou et al., 2011, p.87).

3.2. Definition Art therapy refers to the beneficial coexistence of art with science and in particular

with psychology and psychiatry. The imperative of expressing negative emotions, the

redemptive power of art known since ancient times and the dynamic features of

visual arts such as shape, color, symbols and surfaces are among the parameters that

led to the birth of this hybrid science; hybrid since it combines the disciplines of

psychology, psychiatry and art. There are currently four major art therapy

organizations: the American Art Therapy Association (AATA) 10 , the British

Association of Art Therapists (BAAT)11, the Canadian Art Therapy Association

(CATA)12 and the Australia/New Zealand Arts Therapy Association (ANZATA)13.

Let us briefly present at this point an overview of art therapy definitions by each of

these organizations, so as to identify their common elements. According to the

American Art Therapy Association, art therapy is “the therapeutic use of art making,

within a professional relationship, by people who experience illness, trauma, or

challenges in living, and by people who seek personal development” (Edwards, 2004,

p.3). For the British Association of Art Therapists, “art therapy is the use of art

materials for self-expression and reflection in the presence of a trained art therapist”

                                                                                                               10 Official Website of the American Art Therapy Association: http://www.arttherapy.org/ 11 Official Website of the British Association of Art Therapists: http://www.baat.org/ 12 Official Website of the Canadian Art Therapy Association: http://canadianarttherapy.org/ 13 Official Website of the Australian/New Zealand Arts Therapy Association: https://www.anzata.org/  

  23  

(Edwards, 2004, p.2). The Australian and New Zealand Arts Therapy Association

focuses more on the psychotherapeutic nature of art therapy by defining it as “a form

of psychotherapy, [that] is an interdisciplinary practice across health and medicine

using various visual art forms such as drawing, painting, sculpture and collage”

(Edwards, 2004, p.3). Last but not least, the Canadian Art Therapy Association,

similarly to the Australian and New Zealand Association, describes art therapy as “a

form of psychotherapy that allows for emotional expression and healing through

nonverbal means” (Edwards, 2004, p.3).

Therefore, artistic creation, psychotherapy and the art therapist are among the most

important elements of art therapy. In his book Art Therapy, David Edward, art

therapist and professor at the University of Sheffield, aims to combine these different

definitions and include their common elements by defining art therapy as “a form of

therapy in which creating images and objects plays a central role in the

psychotherapeutic relationship established between the art therapist and client”

(Edwards, 2004, p.2). Andrée Salom, art therapist and founding member of the

Colombian Art Therapy Association, uses the definition by Geoffrey Thompson as

most representational: “a contemporary art practice that strives to restore the primacy

of art and to achieve a balance between artistic practice and psychotherapy” (Salom,

2011, p.81).

From the very definition of art therapy, it becomes apparent what Diane Waller

underlines in her book Group interactive art therapy: Its use in training and

treatment: that art therapy has developed along “two parallel strands: art as therapy

and art psychotherapy” (Waller, 1993, p.8). The first approach stresses the healing

power of art, whereas the second one focuses on the therapeutic relationship between

the client, the art therapist and the artwork. This relationship, known in art therapy as

the triangular relationship, is depicted in the following image:

  24  

2. Triangular Relationship of Art Therapy

Art psychotherapists, Andrea Gilroy and Gerry McNeilly, similarly to Diane Waller,

describe the complexity of art therapy as a discipline. For them, there are three

different types of art therapy: art therapy, art psychotherapy and analytical art

psychotherapy (Gilroy & McNeilly, 2011, p.61). As they clarify, each form of art

therapy is based on a different axis. In art therapy the therapeutic relationship is

grounded in the form created by the clients. Thus, the axis is ‘client-picture-client’

while the therapist plays a more peripheral role, acting mainly as a witness during the

artistic process. On the other hand, in art psychotherapy, given that the axis is ‘client-

therapist’, the main focus is on the person-to-person transference and counter-

transference relationship. In the third form of art therapy, the analytical art

psychotherapy, each segment of the axis ‘client-picture-therapist’ is of equal status

and the pictures interrelate with the person-to-person transference and counter-

transference.

Nevertheless, regardless of the different approaches, as Emily Nolan, art

psychotherapist and co-owner of Bloom Centre for Art and Integrated Therapies in

Milwaukee, points out, all art therapy has the same basis:

The common ground where all art therapy overlaps is that people in any setting can experience a personal change through artistic expression, can interact with images and art objects, and can negotiate relationships to the therapist, others, and the environment through art experiences. (Nolan, 2013, p.178)

  25  

3.3. Benefits of Art Therapy But what can art therapy offer? As Vija Lusebrink, art therapist and Honorary Life

Member of the American Art Therapy Association, explains, the areas, which are

primarily benefited from art therapy, are: “[a] reconstitution and rehabilitation of

physical impairments [b] promotion of mental, emotional, and physical healing [c]

enhancement of cognitive and emotional growth” (Lusebrink, 2011, p.129). An active

involvement in an expressive activity can contribute to the psychological insight and

well being of individuals, especially those with some kind of mental illness.

For all art therapists, the healing power of the emerging art-form made by patients

constitutes a foundation of self-awareness and self-knowledge. Enabling a creative

self in a “holding environment”, as the environment of art therapy is often described,

offers a new space of existence beyond the boundary of diagnosis and disability and

consists a haven for everyone towards losses, difficulties and upheavals. As Athens-

based art therapist Gianna Kilimi points out, “art therapy, by embracing the concepts

of compassion, solidarity and empathy, is a hymn to the uplifting power of symbolic,

non-verbal expression and communication via the arts” (Kilimi, 2014).

According to Kilimi, the basic power of art therapy is the use of the symbolic non-

verbal language of art within the therapeutic process (Kilimi, 2014). Art therapy, by

building on something inherent in human nature -the creative expression that is- with

no gift or talent needed, facilitates, calms, soothes, balances and offers realizations

beyond the boundary of words, since certain feelings -particularly negative feelings,

such as anger, hatred, shame- usually cannot be expressed with words. The

expression of the unknown and unseen seems to provide relief and inner peace.

Expressing negative feelings through the act of creating images allows these feelings

to be discharged and in this way also helps in the improvement of mood and

psychological healing. Expressing these emotions through artistic creations is far

easier for patients than expressing them verbally. This is aptly described in an article

at the Arts in Psychotherapy journal, which points out the importance of symbolic

expression:

The greater use of symbolic rather than verbal language provides a more appropriate path for arriving at patients’ interiority while protecting and containing, bypassing rather than breaking down their defense

  26  

mechanisms, activating their creative resources and their self-awareness at the same time. (Gatta, Gallo, & Vianello, 2014, p.1)

Thus, getting in touch with the creative self eliminates the boundary of diagnosis and

disability and greatly assists in gradually shedding away negative feelings of

helplessness, abandonment and alienation. But the pleasure and excitement of getting

involved in creative activities are beneficial not only in this sense. The creative

activities during art therapy engage the tactile, haptic, visual, sensory and perceptual

channels and affect the cognitive and verbal channels. As Lusebrink points out, by

involving all these different channels, art therapists can use the interaction with art

media to activate internal imagery, neurophysiological processes and brain structures

of the patients, which can be of utmost importance in their development and

understanding of their selves and others (Lusebrink, 2011, p.125). Therefore, the

creative process itself, regardless the artistic product, is viewed as having the power

to heal.

Art therapy with its applications in dozens of contexts and populations confirms the

redemptive and healing power of art. Using the creativity of individuals is considered

to be one of the greatest strengths of art therapists. As Harriet Wadeson, pioneer in

the art therapy profession and director of the Art Therapy Graduate Program at the

University of Illinois at Chicago as well as the Art Therapy Certificate Program

at Northwestern University, argues, this creativity enables art therapists to “minister

to a large diversity of populations in many different kinds of settings” (Wadeson,

2002, p.83). As Elena Tonikidi, an art therapist based in Thessaloniki, points out, art

therapy is suitable for everyone: from the mentally ill, AIDS patients and older adults

with Alzheimer’s to people that have experienced sexual abuse or domestic violence

(Tonikidi, 2014). For Tonikidi, art therapy can be a very effective means of treatment

for these groups despite their heterogeneity because, “linking with the arts is easy”,

given that creativity is among the basic human needs and constitutes part of

numerous societal structures such as schools (Tonikidi, 2014).

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3.4. Art Therapy & Depression As mentioned above, among the target groups of art therapy are the mentally ill.

Given that depression is a largely common disease worldwide and patients with

depression are one of the most common groups of art therapists, the thesis will focus,

as stated in the introduction, on art therapy for depression.

But what is depression? And how can art therapy help people with depression? As

stated in an article in the Arts in Psychotherapy journal, depression is “a broad and

heterogeneous diagnosis and a multifactorial illness with often complex aetiology,

characterized by biological, social and psychological factors” (Zubala et al., 2013,

p.458). According to the World Health Organization, patients with depression

commonly present decreased energy, depressed mood, symptoms of anxiety, low

self-esteem, increased fatigability, poor concentration and disturbed sleep or appetite

(World Health Organization, 2012). The same Organization reports that depression

can even lead to suicide and almost one million patients with depression decease

because of suicide (World Health Organization, 2012).

The American Psychiatric Association uses DSM-IV codes in order to classify the

severity of mental disorders. DSM-IV for depression classifies the disease into four

types: subthreshold depressive symptoms, mild depression, moderate depression and

severe depression (National Institute for Health and Clinical Excellence, 2009, p.11).

At this point, it should be noted that depending on if the patients have a history of

manic episodes or not, depression could consist part of a distinct clinical entity in

psychiatry called bipolar disease (World Health Organization, 2012).

Antidepressant medication and psychotherapy are among the most preferable

treatment options for depression. Thus, art therapy as a form of psychotherapy can be

an effective way to treat patients with depression, who, as mentioned previously, are

among the most usual patients of art therapists.

The question therefore arises: how can art therapy help people combat depression? As

stated in the research conducted by Ania Zubala, art therapist in Edinburgh, and her

colleagues, “by considering non-verbal communication in the therapeutic process arts

  28  

therapies may offer a valuable alternative to talking therapies especially for those,

who may find it difficult or impossible to engage on a verbal level” (Zubala et al.,

2013, p.458). Thus, art therapy can be very useful in helping patients with depression

express themselves and deal with behavioral problems or inadequate social skills they

may have. Moreover, for Amy Ponteri, art therapist in Portland, art therapy can also

be effective in “reducing anxious and depressive symptoms” as well as “decreasing

psychosomatic symptoms” linked with depression (Ponteri, 2001, p.149). Last but not

least, low self-esteem can be addressed in art therapy, since art therapy sessions are

based on achievement, distraction and personal expression through art making.

3.5. Art Therapy in Museums

As mentioned earlier in this chapter, the therapeutic role of the modern museum is

closely related to the principles of art therapy. But how can museums, their settings

and their objects be effective allies in art therapy treatment? Andrée Salom, in her

article “Reinventing the setting: Art therapy in museums”, explores how museum

experiences could be brought into the domain of art therapy. Salom’s main line of

argument is that museums can play four metaphorical roles so as to facilitate the

treatment goals of art therapy.

The first role is that of the museum as co-leader. As Salom argues, “museums can

confront or contain experiences, allow different pacing rhythms, and offer or restrain

choices according to the population being served” (Salom, 2011, p.82). Art therapists

by emphasizing on certain subjects in the museum or by facilitating free associations

can serve their groups and accomplish their therapeutic goals.

Another role the museum can serve is that of the group. Similarly to the way a group

can be used, a museum can offer information about the human experience, since it

houses a diversity of art pieces that represent collective imagery. In that way,

museums can play a key role in relieving any feelings of isolation the art therapy

groups may have. The groups have the opportunity while being in a museum to focus

on the human similarities rather than differences. This understanding of what we all

share as humans sets universality as basic principal and thus can encourage the

members of the art therapy group to share the difficulties, thoughts and emotions to

  29  

which they relate in the museum setting.

According to Salom, museums can act at the same time as a group, but also as self.

As she describes, museums can be used as healthy symbols of the self since they

“reference all aspects of human drive within an orderly environment” (Salom, 2011,

p.84). Museum as self enables visitors to use its contents in order to learn about

themselves either by identifying or by rejecting them.

Last but not least, museums as environment refer to the possibility to use the art

museum as a place, which, due to its architectural elements, inspires visitors to reflect

upon personal and social relationships and get involved in meaningful social

interactions. As a protected environment from the outside world, the museum with its

objects can become a place for metaphors and thus reinforce the role of art in art

therapy sessions and help art therapists engage in depth with their groups.

CHAPTER FOUR

Barriers for the Incorporation of Art Therapy for Depression in Museums

After presenting the conceptual framework, we can proceed in identifying and

analyzing the barriers due to which art therapy for depression in museums is in its

infancy stage, as described by the major stakeholders. The first part of this chapter

will focus on the problems explaining the limited number of museum programs for

depression, whereas the second part will explore the problems in art therapy itself.

Afterwards, we will explore two other barriers, one related to the mental health sector

and the other related to the current culture about mental illnesses.

  30  

4.1. Problems in the Museum Sector

4.1.1. Time According to museum professionals, one of the firstmost, main barriers for the

limited number of programs for people with depression in museums is the lack of

time. As mentioned in the second chapter about the social inclusion model, due to the

limited number of state funds museums are called, in order to receive state funding

and secure their survival, to justify their role in society, rethink their goals and

promote social inclusion by reaching the widest possible audience. The Department

for Culture, Media and Sport in the United Kingdom, for example, requests museums

to ensure that 12 percent of their visitors are from minorities. As Richard Sandell

states, “such measures may indeed prove problematic for many museums and, it

might be argued, are more likely to encourage tokenism, short term and unsustainable

initiatives rather than effect real change within the sector” (Sandell, 2003, p.58).

Thus, Sandell highlights what seems to be an important issue as far as accessibility

programs are concerned: the problem of time. The current pressure for cultural

institutions to take an active social role can be very often problematic. The social

inclusion model, relatively new as a concept, is still not clearly defined covering all

kinds of special interest groups. Museums are called to offer programs for an endless

list of groups in danger of social exclusion such as the blind, the deaf, people in

rehabilitation, drug addicts, the elderly, the mentally ill, people with intellectual

disabilities and so on.

Despina Kalessopoulou from the Department of Public Relations and Education at

the Archaeological Museum of Athens asserts that it is impossible to deal with all

these groups at the same time, without additional personnel. Even though the

Museum wishes to open up to all kinds of audiences and programs, phrases such as “I

wish I could cover as many different groups as I should”, demonstrate just how

important the time issue is for museum professionals, who are expected to develop

and implement programs for all groups in risk of social exclusion (Kalessopoulou,

2014).

  31  

When asked if a program for people with depression would be of interest for the

Museum, Kalessopoulou responded positively. As she explained, there have already

been some discussions between the Museum and other stakeholders in the mental

health services. Kalessopoulou firmly believed that the museum could open up for

these people as well. As she stated:

It's not that we do not want to or that it scares us to start a program for the mentally ill. It is just that we have a workload and not enough time. These partnerships need us to dedicate time so as to function correctly. When a lot of time is needed to organize educational programs for schools and all different kinds of events, ultimately you never have the time to say that you can now set up a collaboration. (Kalessopoulou, 2014)

Furthermore, Kalessopoulou acknowledged that the mentally ill –and people with

depression in particular- are a very special group, thus it is essential for museums to

be extremely careful if they wish to open up to such groups. As she explained,

museum professionals are not psychologists, thus they should learn from the people

who work with them in order to do their job better: go to their place, discuss about

their needs and talk to the people who live with it everyday (Kalessopoulou, 2014).

Programs like that need a different type of setup, another approach, which requires

plentitude of time and a continuous exchange of knowledge, expertise and experience

between all the stakeholders. For Kalessopoulou, it is preferable for museums not to

get involved in activities that promote social inclusion if they are unable to invest in

them the time and energy they should:

It is easy to start a program like that but the whole point is to build a relationship with these people. This can only be done with a well-structured project after a collaboration of all the people involved. Museums should not do something just because they should. On the contrary, they should respond to their social role with professionalism and responsibility. (Kalessopoulou, 2014)

Thus, it is clear that programs for accessibility have different and more complicated

goals than other educational programs. If a museum wishes to help people at risk of

social exclusion, it needs to modify its programs depending on their needs, in order

to be both ethically correct and achieve the desired outcome as well. Museums start

to embrace their social role and their importance in the social integration of certain

groups but it is acknowledged, as Kalessopoulou explained previously, that this

social role should be taken into account seriously. Programs for special interest

  32  

groups such as people with depression should be developed, only after in depth

research and collaboration between all the stakeholders involved, which of course

require museum professionals to invest sufficient time.

4.1.2. Resources But except time, programs for special interest groups, and thus programs for people

with depression as well, require resources. Marta Miró, co-founder of Susoespai

Association in Barcelona for the mentally ill, when asked about the current projects

of the Association with the National Art Museum of Catalonia (MNAC) and the Miró

Foundation, stated that the museum staff has been really helpful and friendly,

recognizing the importance of the Susoespai workshops for the mentally ill (Miró,

2014). However, both Museums do not support the projects financially but only offer

free admission for the groups that visit the Museums every week for the workshops.

Miró explained that the situation is particularly difficult for the Association as well as

for museums in Spain due to the financial crisis and the reduction of state funds.

Sources of funding include public funds, significantly reduced according to Miró,

from the Ministry of Social Welfare, the Ministry of Culture and the Ministry of

Education of the Provincial Government of Catalonia, as well as private funds,

mostly from non-profit foundations, corporations and banks (Miró, 2014). This is

why, as Miró pointed out, the Association is struggling to adapt to the new situation

and find additional sources of funding, in order to be able to continue to offer its

programs for free (Miró, 2014).

The difficulty to develop accessibility programs for special interest groups without

additional funding was also stressed by Kalessopoulou of the Archaeological

Museum in Athens. This is why she pointed out the important role non-profit

organizations should play as far as programs for special interest groups are

concerned. These organizations have the ability not only to help financially but also

to motivate cultural institutions to participate more in social inclusion initiatives.

Kalessopoulou presented two examples of actions developed by large-scale

organizations that were really useful for the Museum: a program for prisoners

integrated in a European project led by the Aristotle University in Thessaloniki and a

  33  

workshop during 2013 about cultural actions for groups at risk of social exclusion by

the Committee for Education and Cultural Action (CECA) of the International

Council of Museums (ICOM).

4.1.3. Space Another barrier for the integration of art therapy for depression in museums is that art

therapy, as a form of psychotherapy, can be very precise on what kind of environment

and activities are needed so as to work successfully with its groups. Therefore, this

can pose problems to the collaboration of art therapists with museums, since

museums do not have specially designed rooms suitable for art therapy and museum

professionals have their own way to work and implement their programs. As

Valentijn Byvanck, director of Marres, a contemporary art center in Maastricht,

states, for example, he is not willing to work in the space of Marres in order to

“execute the ideas of art therapists” (Byvanck, 2014).

Art therapists themselves acknowledge that museums are not the most suitable spaces

for art therapy for depression. Tonikidi argues that the most suitable place for art

therapy is undoubtedly the office of the art therapist (Tonikidi, 2014). In groups of

five or ten people, the place of art therapy should be a safe space that offers comfort,

in order to inspire artistic creation. Nevertheless, when asked which other places can

be suitable for art therapy sessions, Tonikidi described that hospitals and museums

could become suitable, but only if they create and provide a special room for art

therapy groups. More specifically, museums should have, according to her, a suitable

space, clean and sterile, well equipped, that inspires comfort and expression, far from

the strict and sterile environment usually offered by museums (Tonikidi, 2014). But

even if this space is created, she underlined that museums could never do purely art

psychotherapy because, as she claims, “institutions like museums cannot create

subconsciously an environment that develops the safe, non-judgmental and

therapeutic context necessary for the patients to feel safe to externalize their problems

via psychotherapy” (Tonikidi, 2014).

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4.1.4. Bureaucratic Structure Another issue explaining the limited number of programs for people with depression

in museum education is the bureaucratic structure of museums. As pointed out by

Fleming in “Managing Change in Museums”, due to the bureaucratic system in place,

it is difficult and time-consuming for museums to develop mechanisms so as to

maximize their effectiveness, open up, develop programs for special interest groups

and advocate their value to the society (Fleming, 2005). On the contrary, many

museum professionals tend to remain resistant to change and avoid transforming their

institutions in order to remodel their relationship with the public. For this reason,

Byvanck points out that he wishes to “shake the world of museums up” and states

that a cultural center is a more appropriate and experimental environment to bring

changes and explore the therapeutic and social role of art (Byvanck, 2014).

Panos Tsagaris, an artist based in New York, agrees that museums seem not to fully

embrace their social and therapeutic role, as they should (Tsagaris, 2014). His

explanation for this reluctance, one phrased in very similar terms with that of

Byvanck, is that museums are unwilling to leave their comfort zone and open up to

dialogue. According to Tsagaris, this unwillingness is strongly related to the

bureaucratic way in which museums are organized:

Art museums are like turtles, they move and change very slowly to adjust and catch up with the needs of our times. I believe the problem is mostly bureaucratic. All potential changes in museums have to go through various levels of approvals, meetings, fundraising etc. (Tsagaris, 2014)

Similarly to Byvanck and Tsagaris, Miró points out the need for museums to change

the way they function: “It’s about time museum professionals understood that the

museum is a service to the community and that its bureaucratic structure needs to be

changed. It is that simple.” (Miró, 2014) Miró acknowledges that due to this

“bureaucratic structure”, change in museums is a lengthy, mismanaged, and half-

hearted process.

Nevertheless, Miró does point out that the situation is gradually improving, since

many museums start to engage with issues of social inequality and embrace the social

impact they can have on their audiences. In Spain, as Miró describes, there are

  35  

several museums and cultural institutions that have initiated accessibility programs

for special interest groups and have developed partnerships for the implementation of

these projects with social services, universities, philanthropic organizations and

health care institutions (Miró, 2014).

4.1.5. Attitude towards Museums

Another reason why museums are not including art therapy programs for depression,

highlighted by the stakeholders, is the old-fashioned belief shared by many people -

notwithstanding people with mental health issues- who view museums as cold and

sterile places dedicated only to preserving and displaying to the public artifacts and

treasured mementos.

Mr. N.14, patient with bipolar disorder, expresses this view and describes museums as

“cold buildings that kill artworks” and repel him (N.M., 2014). For Mr. N., art is

relaxing, inspiring and can be “a safe refuge for the misfortunes and difficulties of

life” (N.M., 2014). However, even if he had a positive attitude towards the

therapeutic role of art, Mr. N. made a clear differentiation between art and cultural

institutions, museums in particular. For him, it is unfortunate that art is represented

by museums and as he explained, it has been years since the last time he visited a

museum (N.M., 2014). As he characteristically said: “Museums are not for me. I

avoid going there because I fell like entering a cold environment with artworks

hideously stacked together, which of course cannot help me relax or offer me any

kind of inspiration” (N.M., 2014).

This is why, as he explained, he would not be interested in visiting a museum, let

alone attend an art therapy session hosted in a museum:

I would not be interested at all to participate in an art therapy session in a museum. I would not feel comfortable to be a member of such a group there. I think that museums consist a hostile environment and even more hostile for people like me. It would stress me psychologically. (N.M., 2014)

                                                                                                               14 The full name is not provided for the protection of the identity of the interviewee.

  36  

Thus, Mr. N. believes that museums, regardless of being public institutions, are still

very conservative and cannot contribute in any kind of way to the enjoyment and

psychological wellbeing of their visitors, let alone the mentally ill. This view is

similar to what Sandell points out in his article “Museums as Agents of Social

Inclusion”: that the museum is still viewed by many people as a place that represents

institutionalized exclusion via its practices within the social, economic and political

dimensions (Sandell, 1998, p.407).

Cristina da Milano, president of the European Centre for Cultural Organization and

Management (ECCOM)15, acknowledges three fundamental issues that have led to

this perception of museums as agents of social exclusion: access, representation and

participation (Da Milano, 2014). The term “access” includes both physical and

cultural access- that is to say physical attendance and intellectual methexis as well.

Given that cultural institutions were not initially created as socially sensitive

institutions that engage and interact with all shades of the social spectrum but as by-

products of the high-class elite aggrandizement, being open and inclusive to the

general public was not an important issue for them up until recently. Moreover, as far

as representation is concerned, museums are still Eurocentric institutions, since they

represent dominant European values of the XVIII and XIX century. Furthermore,

exclusion in museums is also manifest in participation. However, the issue of

participation is the only one that is gradually undergoing actual, meaningful

transformation in the form of numerous museums initiating audience development

actions and visitor researches, in order to identify groups traditionally under-

presented in their visitor profiles and foster a “museums for all” idea. This is

undoubtedly an important stepping-stone towards a more socially inclusive model of

the modern museum.

Nevertheless, Sandell expresses what seems to be an important point to be taken into

account by museum professionals as far as programs for special interest groups are

concerned:

A growing body of research into the role and impact of museums suggests that engagement with the concepts of social inclusion and exclusion will

                                                                                                               15 Official Website of the European Centre for Cultural Organization and Management: http://www.eccom.it/

  37  

require museums- and the profession and sector as a whole- to radically rethink their purposes and goals and to renegotiate their relationship to, and role within society. (Sandell, 2003, p.45)

Thus, if museums wish to play a meaningful role in the cultural life of their

communities, they should find ways to connect with their visitors and thus reconsider

being organized around their own traditional values and areas of interest—by date, by

country, by style. A significant percentage of museum visitors struggle to connect

with them and if museums wish to engage a broad audience and offer a

transformative experience, they should open up, find out more about their audience’s

needs and develop exhibitions based on life issues.

An interesting example of an exhibition based on life issues is the exhibition “Art Is

Therapy” at the Rijksmuseum in Amsterdam, briefly discussed in the third chapter.

This exhibition, organized by Alain de Botton and John Armstrong and inspired by

the homonymous book of De Botton, suggests that “art has a clear function: it is a

therapeutic tool to help us lead more fulfilled lives” (De Botton & Armstrong, 2013).

As De Botton argued during his presentation at the exhibition’s opening, museums

exist to inspire a feeling of community and works of art are arenas where ideas are

given a sensory form in order to seduce the audience towards a set of beliefs (De

Botton, 2014).

In the exhibition, De Botton and Armstrong are commenting on 150 artworks on

display in the Rijksmuseum galleries, from the Middle Ages to the 20th century,

according to the seven roles art can have according to them: a corrective of bad

memory, a purveyor of hope, a source of dignified sorrow, a balancing agent, a guide

to self-knowledge, a guide to the extension of experience and a re-sensitization tool

(De Botton & Armstrong, 2013, p.65).

The main line of De Botton’s argument is that art has lost a sizable portion of its

former ambition to act as a didactic force to help people live better, healthier,

fulfilling lives. The question of what art is obviously an impossible to answer in a

graduate thesis with set, strict word-count limitations: it may yet suffice to say that art

matters to us because it encodes values, which are in short supply in the world as we

currently know it. For this reason, De Botton and Armstrong put their theories into

  38  

practice in the exhibition at the Rijksmuseum demonstrating that museums should

embrace the therapeutic potentials of their collections, change their attitude and

convince about the value of the work they do and the impact they can have on the

lives of their audiences.

The need for museums and in general cultural institutions to change their mentality is

also acknowledged by Byvanck. As Byvanck explains, “cultural institutions should

explore and go back to the basics of art such as the sensory aspect, which has been

lost in the last ten years by only focusing in the theoretical discursive meaning of art”

(Byvanck, 2014). Although this “theoretical discursive meaning” is important,

Byvanck fondly believes that it is not the most significant thing and that it certainly

does not constitute the main meaning of art (Byvanck, 2014).

Kalessopoulou as well points out the problems that exist in the attitude of many

people towards museums: “I do not blame the people who believe that museums are

cold and boring” (Kalessopoulou, 2014). Her explanation is that people have to find a

way to develop a relationship with something, in order to consider it close to them. If

museums are focused only on the cognitive or academic aspects, it is more than

understandable that this may indeed seem sterile. If museum professionals wish to

attract people who generally do not visit museums and if they want to show them that

this place exists for them as well, they need to find other ways to connect to them, far

from their comfort academic zone, since, as Sandell points out, “[museums] operate a

host of mechanisms, which may serve to hinder or prevent access to their services by

a range of groups” (Sandell, 1998, p.407).

Hence, the problematic perception of museums as cold and sterile places, a

perception that is acknowledged by art professionals (Alain de Botton, Despina

Kalessopoulou, Valentijn Byvanck), scholars (Richard Sandell, Cristina Da Milano)

and museum visitors (N.M.), demonstrates that there are still many steps to be taken

by museums so as to prevent further damage to their social image: one can only

ponder on the magnitude of the effort that will eventually convince the majority of

the public that museums, far from being exclusive environments, have in fact opened

up and are reaching out to the widest audience possible. And only in that way, will

  39  

museums be able to develop successful programs for the socially excluded, such as

people with depression.

4.1.6. Exclusion of Museums from Partnerships with Agencies

As described in the third chapter and articulated in the GLLAM report, partnerships

are essential for social inclusion initiatives. The common belief labeling museums as

old-fashioned, cold institutions and their bureaucratic structure, as described

previously, certainly explain why many museums “find themselves excluded from

new initiatives and are rarely considered as appropriate partners by social, welfare or

health agencies”, as Sandell points out (Sandell, 2003, p.52).

However, a commonly shared view is that museums should initiate partnerships

themselves in order to respond to their social and therapeutic role. As Miró explains,

if museums wish to become more open and socially inclusive, this could only happen,

“if they recognize the necessity and effectiveness of initiating and further developing

long-term partnerships with a broad time span” (Miró, 2014). David Fleming

supports this line of argument as well when he highlights the need for museums to

initiate partnerships, which involve active consultation for special interest groups,

given that these areas are not in the museum professionals’ expertise. As he

characteristically says:

It is no longer an option [for the modern museum] to remain isolated and aloof, understood by few…. Museums can descend from their Olympian intellectual heights where objects speak for themselves, and engage with people who have different kinds of knowledge, insight and wisdom, to the benefit of all. (Fleming, 2005, p.3)

Sandell acknowledges as well that museums, in order to deliver social inclusion

agendas and develop programs for special interest groups, apart from outward

looking and developing mechanisms to avoid internal bureaucracy and empower

communities in decision-making processes, they should first and foremost start

networking and collaborating with scores of agencies such as health and social

services (Sandell, 2003, p.55).

  40  

Therefore, the exclusion of museums from partnerships with agencies justifies as well

why only 6,5 per cent of the 76 institutions included in the report for Stavros

Niarchos Foundation have developed partnerships with mental health services and

offer programs for the mentally ill.

4.2. Problems in Art Therapy Having explored the problems that plague the museum sector today and are

responsible for the limited number of programs for special interest groups- and thus

programs for people with depression as well- we can herewith take the argument a

step further and try to explore why museums and in general cultural institutions avoid

integrating art therapy for depression in their daily curriculum. As Karen Peacock

argues in her article “Museum Education and Art Therapy: Exploring an Innovative

Partnership”: “museum education and art therapy have more in common than meets

the eye” because both of them as disciplines have art as their main focus and

elaborate on the interpretation and evaluation of human experience (Peacock, 2012,

p.133). So, if that is the case and if people suffering from depression are, as

demonstrated before, one of the groups in risk of social exclusion and thus fit to the

social inclusion model, why is art therapy for depression not usually included in the

museums’ daily curriculum?

4.2.1. Lack of Credibility of the Profession Among the main issues are the challenges in art therapy as a profession and the

minimal understanding that exists for the work of art therapists. As Tonikidi states,

one of the main challenges is that even though many art therapists -herself included-

have struggled extensively to inform people about the concept of art therapy, its main

theories and its benefits, the common belief is that art therapy is not a form of

psychotherapy because it contains the visual arts (Tonikidi, 2014). Similarly,

according to Rudolf Arnheim, art theorist and perceptual psychologist, art therapy is a

profession “received with hesitation and suspicion…[because the art therapist] is

expected to describe the principles by which art claims to be beneficial” (Arnheim,

1980, p.247). Therefore, art therapists often find themselves near the bottom of

hierarchies in medical, service and social settings and are considered only experts in

art, without having the respect and recognition of other mental health professions.

  41  

This correlation of art therapists with art experts tends to repel many patients from

exploring the benefits of art therapy. According to Mr. N., even though he firmly

believes that art can help him with his mental tranquility, art therapy is not something

that would be interesting for him:

Becoming an artist now that I am 60 years old is something that wouldn’t offer me anything. I am not a painter and I do not want to become one. I would not feel comfortable, but rather stressed psychologically, to pretend that I am able to paint and have people judging my paintings. (N.M., 2014)

On the other hand, Mrs. A.16, patient with depression who has attended art therapy

sessions, recognized the positive outcomes of art therapy and explained how it helped

her to keep negative things off her mind:

My mood, even after the first session, was much better. At the beginning, I was afraid that the art therapist and the group would make fun of my creations but after a while I started to feel relaxed, comfortable and more open to talk with the other participants and let my imagination free. (A.V., 2014)

Thus, it is clear that art therapy is not well-defined as a practice, even among its

target groups. It is commonly misbelieved, as expressed by Mr. N. and Mrs. A., that

art therapists focus on the art form created, even though the real focus is on the whole

artistic process and the encouragement of the participants’ creativity, as a way to

relax and express in a way that is not painful and occurs unconsciously. This is

exactly what Nolan states as the main goal of art therapy, presented in the third

chapter of this thesis- that is to make the patients “experience a personal change

through artistic creation” (Nolan, 2013, p.178).

4.2.2. Short History of the Profession Another issue as far as art therapy is concerned is that it is relatively new as a

profession. For example, in the United Kingdom, art therapy was recognized as a

profession by the British government only in 1982 and as an independent profession

next to physiotherapy and language therapy in 1997 (Karkou et al., 2011). In many

countries, art therapy is still seeking governmental recognition and is not yet

officially regulated and recognized as a profession. In Greece, even though art

therapy has begun to be introduced as a concept since 1989, as Tonikidi states, the

                                                                                                               16 The full name is not provided for the protection of the identity of the interviewee.

  42  

recognition of art therapy as a separate profession is still pending (Tonikidi, 2014).

And this is because there is a particular structure for the profession of the therapist in

Greece: any kind of therapist does not belong to a separate, officially recognized,

profession. Only psychologists, psychiatrists and a special position in the public

sector called special therapist have the right to exercise therapy in a psychiatric

context and declare that they are psychotherapists (Tonikidi, 2014). This is the reason

why there are not many art therapists in Greece, but mainly psychologists and

psychiatrists who specialize in some form of psychotherapy.

As Wadeson characteristically points out, “we have had to fight hard for what little

we have: low pay, minimal understanding of our work, slow advancement in our

careers” (Wadeson, 2002, p.83).

4.2.3. Polarization between Art Therapists Another issue in art therapy raised by Wadeson is the polarization between art

therapists:

We have sharpened our claws in the long hard climb to gain recognition. We have had to become assertive, maybe aggressive. Having fought so hard, are we so overly protective of our small pieces of turf that we continue to fight each other for control of our profession? Are we still trying to claw our way up, even gouging each other? (Wadeson, 2002, p.83)

This lack of cohesion in the art therapy profession, combined with the multitude of

other problems art therapists are facing as mentioned above, have lead to a self-

regenerating climate where confusion, anger, distortion of reality and falsity reign

supreme. Many people present themselves as art therapists without having the proper

educational and professional background, thus creating an uncertainty on what art

therapy exactly is. Tonikidi stresses out this problem, explaining that in Greece there

have been many cases like that (Tonikidi, 2014). This problem highlights the

importance of delineation of the common and distinctive practices of art therapists,

as well as the need to clarify what is art therapy and who is certified to practice the

profession.

According to Tonikidi, this can happen only if “professionals in the mental health

sector become more open-minded and understand the benefits of a potential

collaboration with art therapists for the well-being of the patients” (Tonikidi, 2014).

  43  

Moreover, as Kilimi claims, it is of utmost importance that the state recognizes the

profession of art therapy, in order to protect patients from practitioners who call

themselves art therapists without the proper qualifications to practice art therapy

(Kilimi, 2014). Other scholars recognize the same issue as well. In their article in the

Arts in Psychotherapy journal, Jordan Potash, Assistant Professor of the Art Therapy

Graduate Program at The George Washington University, and his colleagues support

that “given that there is a profession called art therapy, practitioners need to be

sensitive to what it means to call themselves art therapists or to call their practice art

therapy” (Potash, Bardot, & Ho, 2012, p.143).

The lack of credibility of art therapy due to, among others, the polarization of art

therapists is also apparent among many psychiatrists. The psychiatrist interviewed

stated that, even though he is familiar with the concept of art therapy, neither does he

know exactly what it is, nor does he wish to learn more about it. Specifically, Dr.

Nick Smirnis, psychiatrist and Associate Professor at the University of Athens,

explained that occasionally, together with pharmacotherapy, he recommends

supportive psychotherapy. As far as art therapy is concerned, he stated that maybe art

therapy could be an additional way to help some patients but it is clearly not suitable

for people with severe depression given that they have low cognitive functions, low

creativity and no desire to do things (Smirnis, 2014). Thus, if they are

underperforming in everything, it is impossible for them to get involved in creative

activities during art therapy sessions.

4.2.4. Limited Research on the Effectiveness of Art Therapy as a Treatment Furthermore, the problems in the standing of the profession of art therapy are also

due to the limited research regarding its effectiveness as a means of patient treatment. 17There is little empirical evidence about the outcomes associated with art therapy

and the majority of the published literature on art therapy does not consist of

controlled studies and trials but is mainly based on theoretical concepts and the

results of case studies. This explains what is described in the article of Potash and his

colleagues on the Arts in Psychotherapy journal: that “even though art therapists can

point to the long-standing practice of art therapy, administrators and government                                                                                                                17 For additional information: Kaplan, 1998; Reynolds, Nabors, & Quinlan, 2000; Slayton, D’Archer, & Kaplan, 2010

  44  

officials often require scientific research to demonstrate efficacy that supports the

claimed benefits of art therapy” (Potash et al., 2012, p.146).

4.2.5. Complexity of Art Therapy as a Discipline The art therapist Gladys Agell connects the problems of the profession of art therapy

around the globe to the complexity of the discipline, since its creation (Agell, 1980).

Art therapy, as demonstrated in the third chapter, is interdisciplinary, since its roots

can be traced on psychoanalysis, psychology and art. Furthermore, art therapy is even

more complex, since, as described in the same chapter, for some scholars such as

Diane Waller, art via the visual arts can be divided into two different types, art as

therapy and art psychotherapy, whereas, according to Gilroy and McNeilly, into

three, since, apart from these two types, there is also analytical art psychotherapy,

based on a different axis in comparison with the other two (Gilroy & McNeilly, 2011,

p.61).

Thus, it is normal that the problems that exist in art therapy (lack of credibility, short

history as a profession, polarization between art therapists, limited research on its

effectiveness and its complexity as a discipline) affect its implementation in

museums. As Peacock argues, the fact that there is limited widespread knowledge,

utilization, and acceptance of art therapy explains why there are not many examples

of art therapy in museums, or even if there are, they are not identified as such

(Peacock, 2012, p.136).

4.3. Conservative Nature of the Mental Health Sector

Another barrier for the incorporation of art therapy programs for depression in

museum education, as stated by the stakeholders interviewed, is related to the mental

health sector and has to do with its conservative nature.

For Byvanck, one of the main reasons why art professionals avoid using the term

therapy in their programs is because there is concern for obtaining the proper consent

from the mental health sector, which tends to be really conservative and unwilling to

open up. As Byvanck says, “as soon as I say that Marres is offering therapy,

everybody in the medical profession will complain and say that this cultural

  45  

institution claims to offer therapy even though it does not, since it is just an art

center” (Byvanck, 2014).

This is why, even though the official aim of the Winter Anti Depression show in

Marres was to boost the senses, the main goal was to show the health care industry

that cultural institutions can offer a way of dealing with depression that is not so

dissimilar to the way they deal with depression themselves. In that way, Byvanck

wishes to facilitate partnerships with the health care system, “a system entirely closed

to impulses from the outside”, as he claims (Byvanck, 2014).

Byvanck explained that he decided to work alone on the project, because all the

people he tried to approach from the health care sector -psychologists, hospital

directors and so on- were mildly interested on the project. Moreover, for Byvanck,

partnerships are even more difficult for institutions like Marres: “If you are as big as

MOMA, you can work with anybody, but what about small institutions? You cannot

imagine how much work it takes me to get into one health institution and be taken

seriously.” (Byvanck, 2014) As he argued, even after managing to approach them, as

soon as he started talking about therapy or ways to develop a project about patients

with mental health issues, the health professionals pulled out and preferred to keep

their distance.

But what do the people in the health care industry believe about therapeutic programs

for depression in museums? As Smirnis explained, in the health care industry, the

rules for developing a project against any kind of disease are difficult and

complicated. Therefore, it is understandable why health professionals tend not to be

so open to partnerships with people outside their sector and to focus more on the

traditional and scientifically approved ways of dealing with depression such as

pharmacotherapy (Smirnis, 2014).

On the contrary to Smirnis, Byvanck maintained that the health care industry should

take advantage of the art sector and understand the importance of a potential

collaboration as far as depression is concerned (Byvanck, 2014). Depression is

undoubtedly a very common disease and thus therapeutic programs for depression

could be very useful for art professionals if they wish to explore their therapeutic and

  46  

social role and open up the cultural sector to the mentally ill. As Byvanck claimed,

none of the research that can de done artistically can be done on a medical basis

without having an enormous amount of money (Byvanck, 2014).

Both art therapists interviewed, Tonikidi and Kilimi, similarly to Byvanck, stated that

partnerships should be established between art therapists, psychiatrists and cultural

institutions as far as patients with depression are concerned. However, they

acknowledged the same problem with Byvanck: the conservative character of the

health care sector, especially as far as mental health is concerned. According to

Tonikidi, psychiatrists need to be open-minded:

Everyone has each role and no one wants to steal the role of the other; there are still many psychiatrists who believe more in the bio part of the treatment and do not support psychotherapy, and thus art therapy as well, despite their effectiveness. (Tonikidi, 2014)

4.4. Lack of proper education about mental illnesses

Another issue explaining the limited number of art therapy programs for depression

in museums is the lack of proper education as far as mental illnesses are concerned.

As Miró argued, museum professionals tend to avoid developing programs because

mental illnesses are purely known and there are still many taboos and bad stereotypes

about them (Miró, 2014).

Tonikidi also acknowledged the same issue supporting that, even if some important

steps have been taken, there is still no proper education about mental health and the

social stigma remains for patients (Tonikidi, 2014). In Greece, over the last twenty

years, the psychiatric community has struggled a lot so as to remove the stigma from

the mentally ill and major reforms have occurred in psychiatry. Nevertheless, despite

all these, as Smirnis acknowledged as well, “people are still afraid of the concept of

madness and the mentally ill are very often considered crazy due to lack of proper

education” (Smirnis, 2014).

Therefore, Miró, Tonikidi and Smirnis, when asked about the reasons behind the

social exclusion of patients with depression and the limited number of programs for

  47  

these people in museums, all three of them underlined, amongst other issues of

course, the same problem: the lack of proper education about mental illnesses.

CHAPTER FIVE

Museums & Therapy

5.1. Social role over the Therapeutic Role of Museums

The majority of the stakeholders interviewed, stressed the need to improve the social

dimension of mental health on a macro level: correct social structures, proper

education and proper information. Even though they were skeptical towards

programs in museums with purely therapeutic purposes for depression, as described

previously, they all acknowledged the important role museums as social institutions

could and should play against the social exclusion in which most of the mentally ill

live in.

For them, art could be therapeutic but in comparison to the steps that need to be taken

so as to improve the lives of people with depression and their place in society, they

all appeared to believe that therapeutic purposes are of minor importance. As

Kalessopoulou explained for example, museums should first and foremost try to

identify the barriers that exist, which exclude groups in risk of social exclusion from

museums. For her, museums should focus on their power to influence society and

promote social inclusion for the mentally ill on a macro level and not so much on

offering them clearly therapeutic programs (Kalessopoulou, 2014).

By opening up to the mentally ill, museums can play a crucial role in the integration

of these people into the cultural and social life of their communities and thus help

them improve their quality of life. This role of museums -that is to help in the social

integration of people into the cultural and social life- and the importance for

museums to embrace their social rather than their therapeutic role is highlighted also

by Miró of the Susoespai Association.

  48  

Susoespai is a non-profit organization based in Barcelona, which aims to promote

cultural and artistic practices among people with mental disorders, promote their

independence and fight social stigma. By stimulating and motivating the production

of visual arts, the association seeks to help these people to discover their own

creativity and have a positive influence against the social exclusion in which they live

(Miró, 2014). Susoespai offers free activities for mental health institutions in the area

of Barcelona and around it. Among the activities is a seminar workshop that includes

visits to museums combined with creative workshops. The workshops operate

autonomously from the museum visits and take place in the cultural center Albareda,

a facility offered by the Government of Catalonia.

As stated in the mission of the Susoespai Association, this promotion of cultural

habits will contribute to the reincorporation of people with mental health issues into

the community, having a positive influence against the social exclusion in which they

live (Susoespai, 2010).

When asked if the Association offers therapy to the participants of the workshops,

Miró was clear:

I have to insist. We are not health professionals. We are not art therapists. The principal objective is the integration of the mentally ill in the cultural and social life, the training of people with mental illnesses as citizens. Everything that makes us feel better can be characterized as therapeutic but we need to be careful with what we call therapy. (Miró, 2014)

Thus, Miró highlights -similarly to Kalessopoulou- the attention that needs to be paid

in the social rather than the therapeutic role of museums. For Miró, even though it is

of utmost importance to draw art museums to the mental health spheres through art

activities, art museums cannot become settings for therapy (Miró, 2014). According

to her, the museum as a cultural and social space is a unique place for someone to

visit in order to feel part of the society and be activated as a citizen. Furthermore,

museums can contribute to the social skills of the mentally ill, since by visiting

museums and by getting involved into group activities, the patients have the

opportunity to meet new people, mingle with other visitors of the museum and

improve their autonomy. Last but not least, a very important contribution of the

  49  

museum to the mentally ill acknowledged by Miró is that it can give them the

opportunity to express themselves in a new context, not related to problems and away

from the mental health institutions, in which the main reference is cultural and

creative and the focus is not on the mental disorder but on their healthy part, their

imagination and their creativity (Miró, 2014).

Therefore, the main purpose of Susoespai is to create a space for creation linked with

cultural visits to museums. Art therapy workshops existed. On the contrary, there

were no activities to unite mental health and museums. This is why the founders of

the association, who mainly come from the disciplines of cultural education, fine arts

and psychology, intended to fill this important gap, as Miró explained (Miró, 2014).

Miró responded positively to a potential collaboration with art therapists, but without

incorporating the label of art therapy in the workshops, since what they want to offer

is different:

By labeling something as therapy, the participants are automatically labeled as ill, as people who need treatment, which is something that we definitely do not want. This is why even though we work with people with mental disorders, we do not know or wish to know their diagnoses⋅ they remain confidential. (Miró, 2014)

In this manner, the association wishes to preserve an environment based on the

healthy part of the patients, providing inspiration for creativity and promoting the

museum as a service to the community.

Therefore, it is clear that many stakeholders seem to point out the importance for

museums to embrace their social rather than their therapeutic role for people with

depression and the mentally ill in general.

5.2. Therapeutic Role as Viewed by the Stakeholders

But apart from their social role, how do the stakeholders believe that museums can

implement their therapeutic role? And how could art therapy programs be

incorporated in the museum setting?

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Byvanck aimed to explore the therapeutic role of cultural institutions with his Winter

Anti Depression show, hosted in Marres from January until March 2014. This show,

as Byvanck explained, was a pilot project so as to comprehend how the audience

would respond to an artistic approach towards mental illnesses, seasonal depression

in particular (Byvanck, 2014). Due to the success of the show, Byvanck has already

been advised to do a second show next year before a full show programmed in 2016

at the Sphinx factory in Maastricht called “Here comes the sun”, which will also be a

show with a sensory approach towards seasonal depression.

As explained during the exhibition opening by Byvanck, the Winter Anti Depression

show aimed to boost the senses of the visitors, through a series of therapeutic rooms,

planned and executed by artists and designers. In the exhibition, visitors were invited

to walk over ribbed floors, feel summer flowers, let the sun caress their skin,

compose landscapes, have tea, play motion games and generally relax and improve

their condition (Byvanck, 2014).

For Byvanck, cultural institutions need to avoid the use of the word therapy, even if

there are some therapeutic aspects, because if the label therapy was to be put in the

show and if it was officially promoted as a show for people with depression, this

would draw people away (Byvanck, 2014). This is why he was trying to elude the

very specific definition of what he was doing in the show.

According to Byvanck, museums and cultural institutions in general, by offering

something fun for lot of people and by creating positive experiences, could plant in

people’s heads the idea that they can offer sensory experiences and thus embrace

their therapeutic role, without using terms like therapy, which can lead to

misinterpretations transforming cultural institutions into mental health centers

(Byvanck, 2014).

Furthermore, Byvanck acknowledged that cultural institutions could contribute to the

psychological well-being of their visitors, even those visitors with some kind of

mental illness, such as depression (Byvanck, 2014). This is why he believes that

cultural institutions should offer programs and exhibitions for less severe forms of

mental illnesses, such as seasonal depression, the main theme of the Winter Anti

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Depression show in Marres. Seasonal depression affects 10 per cent of people in the

Netherlands but given that it is not a serious disease and thus not a heavy term to use,

it is easier for people to relate with and have a positive attitude towards a program or

an exhibition about it.

For Byvanck, designing and promoting a show about a type of depression that

everybody can relate to is a clever technique and an important first step for cultural

institutions to promote their therapeutic role and their potential contribution to the

psychological wellbeing of their audience (Byvanck, 2014). If a program was

promoted as something that would help the mental health of visitors, it would move

people away, since they would have to show themselves to the environment as

depressed, patients or sick. Nevertheless, for Byvanck, it would be much wiser to

attract the general public and have it say how it feels and what it has experienced

within the cultural space (Byvanck, 2014). This is why, as he explained, the Winter

Anti Depression show has drawn a lot of attention: many people wanted to know

about it, came to the show and promoted it through word of mouth (Byvanck, 2014).

Therefore, Marres example clearly demonstrates that a show related to the therapeutic

role of art that dispenses with usage of heavy terms, such as therapy, can be of

interest for the wide audience. As Sintija Lice, an art student who visited the show,

pointed out, it was pleasant to see a cultural institution focusing on sensory aspects

and offering to the public a fun and relaxing experience, far from the traditional

“white cube” stereotypes of galleries and museums (Lice, 2014). When asked if she

believes that an art institution could help people with seasonal depression or any kind

of depression, she responded positively explaining that a cultural way to fight

symptoms of depression is definitely worth exploring but with sensitivity in using

terms such as therapy (Lice, 2014).

Tonikidi as well acknowledged the therapeutic role of museums and cultural

institutions in general. For Tonikidi, museums can be therapeutic places but without

getting into a purely psychotherapeutic context, which requires a safe environment, a

therapeutic trust and confidentiality between patient and therapist (Tonikidi, 2014).

  52  

Furthermore, Tonikidi described another role of museums that can be therapeutic for

visitors and useful for art therapists: museums, as the main art spaces, could help art

therapists use the works of artists exhibited in museums as an inspiration for their

groups (Tonikidi, 2014). Creating art inspired by the artworks exhibited in museums

could be extremely therapeutic for people with depression, in the sense of discharging

emotions and recording fears and thoughts that torment them. By offering inspiration

to patients to create art, museums could contribute significantly to the art therapists’

objective to facilitate, calm, soothe, balance their patients and could offer to these

people realizations beyond the boundary of words. Especially, for patients with

depression, the role of museums can be of utmost importance in the expression of

certain negative, often prohibitive feelings such as anger, hatred and shame.

Moreover, Tonikidi pointed out another therapeutic function of museums. As she

stated, even observing works of art in the museum can be therapeutic for visitors,

especially for visitors with mental health issues such as depression, since it reinforces

the mechanism of projection –that is identifying things that concern the patients in the

works of art- and can be extremely useful in gaining a better insight of their selves

(Tonikidi, 2014).

When asked if exploring the therapeutic role of museums for her groups would be of

interest for her, Tonikidi responded positively. She also explained that she has actual

preparations taking place, in conjunction with other colleagues, for the organization

of a symposium on therapy through the creative arts during which workshops will

take place in museums (Tonikidi, 2014). For Tonikidi, even if the public does not

have a very good relationship with museums, many would still be curious enough to

come to a museum in order to learn more about art therapy and the therapeutic role of

art than in a setting dedicated solely to art therapy (Tonikidi, 2014).

Similarly to Tonikidi, Kilimi acknowledged that museums could be a very interesting

space for art therapists as a place of celebration and exaltation of art, thus moving

beyond the visual dimension of artworks and exploring their therapeutic dimension

(Kilimi, 2014). As she described, she has already successfully applied the principles

of art therapy in a program at the Museum of Greek Children’s Art in Athens and has

  53  

given lectures about art therapy in various museums, utilizing the therapeutic

potentials of the artworks exhibited in them (Kilimi, 2014).

CHAPTER SIX

Conclusion As stated in the introduction, only 6,5% of the cultural institutions included in the

Stavros Niarchos Foundation report offer programs for the mentally ill. The aim of

this master thesis was to find out why incorporating art therapy for depression into

museum programming is in its infancy stage despite its relevance to the social and

therapeutic role of the modern museum and the benefits of art therapy. In order to

achieve this goal and answer to this question, the research focused on identifying

which are the barriers for the incorporation of art therapy for depression in museums.

The key stakeholders gave differentiated answers and distinguished barriers related to

problems in museums, in the profession of art therapy, in the mental health sector and

in education.

First of all, as far as museums are concerned, among the main problems identified

explaining the limited number of art therapy programs for depression were time,

resources and bureaucracy. Museum professionals are expected to develop and

implement programs for an endless list of special interest groups, without additional

personnel or funding -a task that is surely extremely difficult and time-consuming for

them, if not impossible to achieve. Moreover, even current (let alone 100-years old)

museum architectural design is generally considered problematic for the

incorporation of art therapy for depression, since many stakeholders acknowledged

the need for additional, specially designed spaces, exhibition halls and interaction

lounges for art therapy groups. These problems, together with the common perception

of museums as cold and sterile places, were considered to explain the exclusion of

museums from many partnerships with agencies -among them health services- and

thus the limited number of art-therapy programs for depression in museums.

The barriers for the integration of art therapy for depression in museums identified in

  54  

art therapy itself were mostly related to its lack of credibility and its short history as a

profession. Furthermore, the polarization between art therapists, the limited research

on the effectiveness of art therapy as well as its complexity as a discipline were also

identified as barriers of key importance by the stakeholders.

The limited number of art therapy programs for depression in museums was also

linked with the conservative nature of the mental health sector. Mental health

professionals were considered to be rather conservative and unwilling to open up and

collaborate with people and organizations outside their area of expertise. Last but not

least, the lack of proper education about mental illnesses was considered another

barrier for the use of art therapy for depression in museums, explaining the reluctance

of many museum professionals to engage with mental health issues and develop

programs for the mentally ill, such as people with depression.

Furthermore, the majority of the stakeholders interviewed underlined the social rather

than the therapeutic role of museums for people with depression. They acknowledged

the important role museums and cultural institutions in general could play against the

social exclusion patients with depression and most of the mentally ill struggle with on

an everyday basis. According to them, museums have the ability to contribute to the

improvement of the lives of these people, to their reincorporation in the community

and to their training as citizens and thus act on a macro level as vehicles of broad

social change as far as mental illnesses are concerned.

But according to many stakeholders, museums should also explore, apart from the

social, their therapeutic role for the mentally ill. Nevertheless, they stressed the

attention that needs to be paid when terms like “therapy” are used in a cultural

context. Museums, due to the art objects exhibited in them, could address the

psychological and emotional needs of people with depression and help them connect

with each other, improve their mental well-being and thus flourish in the widest

sense.

When asked about how art therapy for depression could be incorporated in museum

education, the majority of stakeholders acknowledged that each discipline could

illuminate the other. Even though museums could not get into purely

  55  

psychotherapeutic goals, they could provide a space of inspiration, not only for

people with depression but for an array of different populations, by giving them the

opportunity to observe the artworks and express themselves similarly to the artists

hosted in the museum.

Findings indicate that there is certainly a shift in the values and attitudes of museums,

but there are still many steps to be taken for museums that will allow them to become

truly inclusive and open to everyone. The key is a conscious and coherent

implementation of art therapy programs for depression in museums, which could only

occur after extensive research. Similarly to programs for all kinds of special interest

groups, sustainable collaborations and deeply-rooted partnerships are essential for the

successful incorporation of art therapy for depression in museums. The formation of

these partnerships could be instigated and motivated by museum on their own, even

without any governmental or entrepreneurial interference or guidance, or could occur

after profound dialogue among the major stakeholders. Either way, the challenge for

museums is thus not just to integrate more art therapy programs for depression in

their education, but to explore the barriers, whether they are attitudinal or physical,

keeping people with depression and in general the mentally ill away from museums.

Stakeholders, policymakers and scholars should explore how art therapy for

depression could be practically integrated in museum education. Moreover, they

should agree on how art therapy for depression could be integrated in museums

internationally and thus identify commonalities and differences between art therapy

and museum education so as to select the best possible strategies for the future.

Moreover, further quantitative research needs to be conducted for the benefits

museum could have not only for people with depression, but for people with mental

health issues in general, since they represent a very important percentage of

populations in risk of social exclusion.

All in all, mental health is everyone’s business. Integrating therefore art therapy in

our established notions of combating mental illness, and promoting, planning and

developing creative engagement activities for people with depression could challenge

social exclusion, further museums’ mission and goals and help them explore further

their social and therapeutic role.

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List of interviews A.V., personal communication, May 29, 2014 D. Kalessopoulou, personal communication, June 17, 2014 E. Tonikidi, personal communication, April 29, 2014

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G. Kilimi, personal communication, July 15, 2014 M. Miró, personal communication, June 19, 2014 N.M., personal communication, May 09, 2014 N. Smirnis, personal communication, July 06, 2014 P. Tsagaris, personal communication, July 03, 2014 S. Lice, personal communication, February 04, 2014 V. Byvanck, personal communication, January 29, 2014

Appendix  

1. Database for Stavros Niarchos Foundation  

 

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