In addition to making, I have an interest in interactions between art, mental health, creativity, and art therapies, with an emphasis on how art therapies may be better understood and funded to be more effective in the future.  In exploring these issues, my background in engineering and quantitative sciences steers me to take a systems approach that may provide a good foundation for better shared understanding in the future between art therapy stakeholders with disparate viewpoints.  In what follows, I briefly review art, mental health, creativity, and art therapies via a small number of recent references.  After noting linkages between these topics resulting in a small network, I suggest that all have gaps concerning language, knowledge and emotions, that can be addressed through inclusion of additional topics within the network.  I further suggest that this enhanced network could provide a basis for developing better quality evidence for art therapy efficacy and funding through better sharing of knowledge and understanding between stakeholders.

In what follows, I use ‘viewpoint’ in a specific way - a viewpoint is held by anyone who interacts with- or participates in a system.  A viewpoint has two parts – a model and a narrative.  The model is those parts of the system that the viewpoint interacts with.  The narrative describes how the viewpoint uses its model to provide the interaction or participation.  For example, the following ART section identifies at least 10 different viewpoints.

ART

Amongst other things, the philosophy of art is concerned with its origin and reason.  Davis [1] considers two alternative theories - biological evolution and cultural invention.  The biological approach claims that art is a consequence of evolution driven by intrinsic value to makers and viewers.  This is evidenced by its occurrence in many forms throughout the world, over tens of thousands of years.  Alternatively, cultural invention claims that art arose in 18^th & 19^th century western society, driven by technological and social change, along with emergence of philosophical theories concerning aesthetics largely recycled from ancient Greece.

Another philosophical issue concerns what art is or may be.  Aesthetic functionalism suggests that something is art if it generates an emotional response in the viewer that makes them feel that it is art.  Institutional theory focuses on social factors suggesting that something is art if it is created by an artist using processes accepted as valid in the artworld.  Alternatively, Historicism suggests that something is art if it can be related to artistic predecessors, perhaps through the art making process or through emotional response of the viewer.  Whilst each has elements of truth, each also has caveats.  Each is a model associated with a different viewpoint.

Formulation of art philosophy and associated definitions typically takes place through observation and interpretation outside of the art making process.  Interpretation of the artist’s efforts has ebbed and flowed over several centuries between manual labourer and inspired genius. As discussed in [2], the rise of Modern Art in the 19^th century saw artists taking the initiative and emphasising the technical and intellectual complexities of the art making process.  This introduces the need to consider the psychology of art making and how individuals engage with its results [3].  In art making, cognitive psychology addresses the basis for development of artists’ knowledge, experience and skill, whilst emotion plays a significant role in steering their application, aiming to achieve the artist’s creative intent.  Art making is rarely linear, needing continued interaction between creativity and practical work to keep on track or recognise the need or opportunity to take the work in a direction that feels more important to the artist.  Of particular relevance to art therapy, as discussed in [4], much of this, starting with the initial creative idea or insight, has been explained from a psychoanalytical viewpoint.  As with any other viewpoint, this involves a model that provides valuable insights, but does not tell the whole story [5].

MENTAL HEALTH

For several decades mental illnesses have been defined by Chapter 5 of the WHO International Classification of Diseases (ICD) [6] and the Diagnostic and Statistical Manual of Mental Disorders (DSM) [7].  Most clients arrive in art therapy as a consequence of practitioner decision making guided by these documents.  Revision of DSM from edition 4 to 5 met with significant wide-ranging criticism [8].  Many of the criticisms relate to the specification of arbitrary classification boundaries that are open to manipulation by commercial, political and cultural influences.  This also includes the difference between mental illness and normality.  In contrast, Gallon [9] proposes that mental problems arise from interactions between our biology, psychological experience and social environment and that these problems fall more naturally along nine dimensions, or types, rather than within discrete categories.  Along with problem states, each dimension includes the concept of ‘normal’.  This approach appears to offer a more fundamental and robust conceptual framework for evidence-based practice, consensus between practitioners and reliability of interventions.

CREATIVITY

[10] provides a very broad starting point for exploring creativity with good links to deeper material.  I have particular experience of creativity in engineering and sculpture. Creativity in engineering is concerned with problem solving, aiming to achieve novelty and value in terms of cost, efficiency and market share.  Strong focus is placed on divergent and convergent thinking, along with the need for appropriate emotions and a conducive environment [11]. From a neurological viewpoint, divergent and convergent thinking take place via networks of different brain regions [3], with divergent thinking exploring novelty and convergent thinking assessing the value of this novelty.  In contrast to relatively formulaic approaches in engineering, creativity in art making is concerned with interpretation and can take many forms [4], but also relies on emotions and the interplay between divergent and convergent thinking, hence reliance on similar neurological activity.

The value of creativity in engineering is easy to perceive, e.g. availability of new consumer products, consequently, value can be measured in technological and financial terms.  Value of creativity in art is more subtle.  “isms” are clear indicators of creative pulses, typically spawning new artistic communities.  Also, as shown in [12] it is possible to calculate creativity networks spanning centuries amongst individual artists that demonstrate longer term value through influences on personal technique and practice.  In art therapy, creativity is required of both the client in producing their artwork and practitioner in its interpretation.

ART THERAPY

Jones [13] provides a recent comprehensive review of arts-based therapies using many examples of current practice to demonstrate its benefits.  He also highlights the significant lack of good quality statistical evidence of these benefits needed by national funders to establish arts-based therapies as a mainstream treatment option.  This is supported, for example, by particular investigations such as [14, 15] and an over-arching review [16] which provides valuable insight into various reasons for current evidence quality, including the use of multiple terminology for techniques and processes.  Such linguistic issues - semantic and syntactic problems – are symptomatic of unmediated knowledge silos or schools of thought and multiple viewpoints.  Allied to Jones’s review of practice,  Huss [17] provides a viewpoint in which practice is situated in a categorisation of psychoanalysis themes.  This appears to be a valuable starting point for establishing a coherent knowledge base from which investigations can be designed to deliver statistically valid evidence of art therapy efficacy.

OBSERVATIONS CONCERNING ART THERAPY

Art therapy has significant potential for growth as a community-based treatment option, with a growing body of evidence indicating that it provides beneficial results for many.  However, from the viewpoint of potential funding bodies, this evidence is of scientifically poor quality.  Many of the topics reviewed in previous sections have a bearing on this and may potentially contribute to improved progress based on several common factors.  Each topic:

• Contributes various forms of value to society
• Has a relationship with the others, forming a small network as shown in fig.1
• Has a body of research at the conscious and neurological levels but lacks some form of mediating middle ground.
• Has an emotional element but lacks a coherent or structured approach for documenting how emotions arise and their influence.
• Can be considered as a viewpoint on being human.
• Has multiple viewpoints within it, associated with a wide range of differences, including interests, perceived importance, processes and terminology.