Power Struggle and Critical Encounter: Arts in Health and Medical Humanities

Frances Williams explores some of the tensions to be found in attempting to narrate the history of the Arts in Health movement, a sprawling field encompassing many ‘sub-fields’, including the medical humanities.

When did the field of the Medical Humanities first coalesce? One narrative goes like this: in 1996, the Conservative Minister for Health, Gerry Malone, convened a meeting to discuss the ‘growing interest’ in what was called the ‘humanities in healthcare’. The relationship between “the ‘arts and health’ is a subject whose time has come”, he is quoted as announcing, in a subsequent report by the UK’s Chief Medical Officer, Kenneth Calman (Philipp et al. 2001, 87). A new steering group, the Nuffield Forum, was set up to find ways to ‘take forward the new therapeutic approach’ (9) comprising Dr Robin Philipp and Professor Michael Baum (both eminent physicians), Rev. Andrew Mawson (founder of the Bromley-By-Bow Health Centre) and Professor John Wyn Owen, Secretary of the Nuffield Trust. Dr Jane McNaughton’s expertise, teaching GPs at Glasgow University through ‘philosophy and literature’, was also enrolled, through her involvement as secretary to this group (72).

The Nuffield Forum would go on to set “SMART targets in order to focus action across ‘research, education and policy’”. That is to say: specific, measurable, achievable, realistic and ‘time-based’ targets and goals (87). As well as adopting management-speak, this group’s battle cry also drew inspiration from the words of a revolutionary writer. Victor Hugo was evoked to bolster the Conservative minister’s endorsement: “You can resist the invasion of an army but you cannot resist the invasion of ideas.”

Fast forward nearly 30 years, and Lord Howarth, Chair of the National Centre for Creative Health, echoed Malone’s words almost verbatim, though by way of citing grassroots impetus rather than ministerial blessing. ‘Creative Health’ was the new epithet for the field of practice formerly known as Arts in Health, taken from the title of an All-Party Parliamentary Group report published in 2017. Speaking in 2021, Howarth characterised the ‘creative health movement’ as one that was:

part of a wider movement which demands justice – health justice, racial justice, social justice and climate justice. The power structures that perpetuate such injustices are not to be tolerated. Ultimately the greatest power is the power of ideas and no obstacle can withstand the power of an idea whose time has come (Howarth 2021)

Querying this sense of immanence

The cover of 'When Was Arts in Health?'
Book cover image: Palgrave Macmillan. bit.ly/40RbZ5X

These are some of the recurring temporal motifs that made me want to write a book about the history of Arts in Health – a sprawling, messy field encompassing many sub-fields, with the Medical Humanities one of many so-called ‘strands’: “A typology with four categories: arts in healthcare settings, community arts for health, medical humanities and arts therapies” (Dose 2006). I wanted to query the sense of immanence raised by leading advocates. My book title reverses Howarth’s claim in a different tense to ask: When Was Arts in Health? A History of the Present.

The book grew out of the literature review of my PhD thesis, which tried to pin down this field in history through identifying ‘pre-histories’ and ‘pre-conditions’ whereby distinctive ‘substances’ come into being (Diedrich 2016, 12). I attempt to “plot the some-place and some-time over the everywhere and has-been-forever” (Williams 2023, 17). This contrasts to those who have tried to establish legitimacy through plotting out Neolithic rather than Neoliberal timeframes: “The birth of art was also the birth of arts in health” (Fancourt 2017).

I was also responding more broadly to the need, as identified by a researcher located within the field of Human Geography, not to fix meanings, but “talk afresh about arts-health as a combination of uncertain and contingent things to be explored” (Parr 2017, 18). I drew on literatures within Critical Health Studies that examine health activism with the intention of ‘challenging the naturalization of progress narratives’ (Diedrich 2016,13). I was particularly interested in how political economies had helped shape the field over time, since alignments with certain policy directions have been claimed as helpful spur as well as no-hindrance.

Thriving despite austerity?

In the textbook The Arts, Health and Well-being: A Theoretical Inquiry for Practice, for example, editors note how “This inter-disciplinary field has emerged… over the last 20–30 years” (Stickley & Clift 2017, 1). A single sentence acknowledges the oddness of this growth taking place in a decade marked by austerity and deep cuts to public spending in the UK. A note of surprise, as much as satisfaction, is struck when they note how “despite the challenges of economic cut-backs, the field of practice has thrived”.

The millennium is commonly located as a ‘turning point’ for the field of Arts in Health (Clift et al. 2009, 9), a period when regional groupings agreed to pursue a shared national agenda. Two so-called ‘Windsor Conferences’, large gatherings held at Cumberland in Windsor in 1998 and 1999, provided opportunity for delegates to discuss a range of working papers that would set the field on its course by way of a ‘declaration’ that included a 12-point action plan. It saw those advancing the idea of the Humanities in Healthcare forge explicit links with the esprit du jour represented by the New Labour government. The Windsor Declaration for the Humanities in Healthcare, enthusiastically proposed that “elevating the arts, health and wellbeing into a pivotal role across the spectrum of health care may be the real third way for health” (Philipp et al. 1999, 6).

A photograph of Cumberland Lodge, a large stately home under a bright blue sky
Cumberland Lodge, venue for the Windsor Conferences. Image: Wikimedia Commons

Many new institutions came into being as a result of this drive to ‘make things happen’, refracted across a new ‘national’ landscape that encompassed devolved nations for the first time too. The National Network for Arts in Health (NNAH) was conceived as a ‘federal arrangement’ of equal regional bodies based within England, not an alliance of devolved national bodies working together on an equal basis. There was uncertainly whether “individuals should relate to the umbrella organisation via a federation of centres that reflect their geographical location or their special interests” (Philipp et al. 1999, 53). In the end, the group borrowed a model from UNESCO in order to propose that “the national body should have a federal structure consisting of partner centres with one of these acting as a national co-ordinating centre” (54). Durham University was chosen as the site for a new Centre for Arts and Humanities in Health and Medicine in 2001, with Mike White and Jane McNaughton appointed as co-directors.

Little attention is given in The Windsor Declaration to the way that national or place-based contexts inform population health, despite one contributor noting how “national barriers lose their importance as trade and investment, communication and cultures cross boundaries” (7). There is no mention of devolution at all. Such omissions are notable in retrospect given that measuring differences in mortality rates across areas of the UK had first led researchers to label the study of health inequality by way of place. For example, research undertaken into population health in the late 1980s could find no explanation for the high mortality levels found in Glasgow relative to other UK cities with similar socioeconomic profiles – a mystery dubbed the Glasgow, or ‘Scottish effect’. Though left un-addressed through its own institutional formation, the field of Arts in Health was increasingly underpinned by epidemiological research into inequality and health ‘gaps’ across different populations living in different geographic regions discernible at scale (Wilkinson 1996, Marmot 2015).

Tensions within the movement

These are just some of the interesting tensions held within the pages of the report of Windsor conference proceedings. Others arise out of the different voices that can be heard. While theologians are amongst those calling for the doctors to be given a ‘liberal education’ in order that they might “resist gathering pressures that threaten to reduce their perceived role to that of ‘technician’,” other actors embraced techno-industrial global capitalism uncritically. The Rev Mawson was buoyed-up by the prospect of a “partnership with Coca-Cola who are beginning to get very close to the idea of bringing some of their serious marketing budgets onto this agenda” (Philipp et al. 2001, 48). McNaughton details various ’strategic’ pressures that subsequently split the focus of the Centre for Arts and Humanities in Health and Medicine – those exerted by funding opportunities as well as the strictures of academic discipline – in order to to explain growing ‘divergences’ (Duschinksy 2018).

Perhaps the Windsor Declaration represents a moment when high ideals met head-on deepening inequality in the UK and the emergence of what have since been described as the ‘commercial determinants of health’. The Windsor Conference report presents us with a detailed account of a moment in time, throwing light on “processes and pressures of connection, support, embedding, binding and generation” (Callard & Fitzgerald 2015, 87). It helps reveal how “loose sets of institutions” have taken shape to become “visible and coherent sets of the interventions”, with their own “journals, conferences, centres, funding streams and students” (36).

In closely examining the pressures that shape fields of knowledge, the terms on which shared understandings of the success and failure of the Arts in Health project can be assessed. They are best viewed, I would argue, as sets of practices and institutions produced over time and place, through ‘fields of contention’ (Tilly 2004, Tilly & Tarrow 2015). The guiding metaphors prove instructive. Writing about the influence of the Windsor Declaration, Professor Alan Bleakley charts how various named strands – those that fell under the ‘umbrella’ term of Arts in Health – could not hold together (Bates and Bleakley 2014). New fields emerged across ‘fault lines’ reflective of diverse needs: pedagogic, clinical, creative and academic. It is through critical encounter and power struggle – as much as any sense of consensus – that respective fields have been able to adapt, distinguish and thrive.

About the author

Dr Frances Williams gained a doctoral scholarship at Manchester Metropolitan University where she studied Arts in Health in relation to devolution (2016-2019). She brings long experience of working in this field as an education manager and curator, teaching MA (Arts in Health) at Glyndwr University. Her book, When Was Arts in Health? A History of the Present, was published by Palgrave Macmillan in March 2023. She currently works at QUEERCIRCLE, an LGBTQ+ arts and cultural space based in London.

References

Bates, V, Goodman, S, and Bleakley, A (eds). 2014. Medicine, Health and the Arts: Approaches to the Medical Humanities. London: Routledge.

Callard, F, and Fitzgerald, D. 2015. Rethinking Interdisciplinarity Across the Social Sciences and Neurosciences. London: Palgrave Macmillan.

Clift, S, Camic, P M, Chapman, B, Clayton, G, Daykin, N, Eades, G, Parkinson, C, Secker, J, Stickley, T, and White, M. 2009. “The State of Arts and Health in England”. Arts and Health 1(1), 6–35. 
Diedrich, L. 2016. Indirect Action: Schizophrenia, Epilepsy, AIDS, and the Course of Health Activism. University of Minnesota Press. 

Dose, L. 2006. “National network for the arts in health: Lessons learned from six years of work”. The Journal of the Royal Society for the Promotion of Health, 126(3), 110–112.

Duschinsky, R. 2018. Interview with Jane Macnaughton. BMJhttps://blogs.bmj.com/medical-humanities/2018/09/26/interview-robbie-duschinsky-and-jane-macnaughton-march-2018

Fancourt, D. 2017. Arts in Health. Designing and Researching InterventionsOxford University Press.

Howarth, A. 2021. Online launch of the National Centre for Creative Health. https://www.youtube.com/watch?v=o6DEHuDVCIA

Marmot, M. 2015. The Health Gap: The Challenge of an Unequal World. London: Bloomsbury.

Parr, H. 2017. “Health and Arts: Critical Perspectives” in Arts, Health and Wellbeing: A Theoretical Enquiry for Practice edited by S. Clift and T. Stickley. Cambridge Scholars Publishing.

Philipp, R, Baum, M, MacNaughton, J, and Caiman, K (eds). 2001. Arts, Health and Well-being: from the Windsor I conference to a Nuffield Forum for the Humanities in Medicine. Nuffield Trust Report.

Stickley, T and Clift, S (eds). 2017. Arts, Health and Wellbeing: A Theoretical Inquiry for Practice. Cambridge Scholars Publishing.

Tilly, C. 2004. Contention and Democracy in Europe, 1650-2000. Cambridge University Press.

Tilly, C, & Tarrow, S. 2015. Contentious Politics (2nd Edition). Oxford University Press.

Wilkinson, R. 1996. Unhealthy Societies: The Afflictions of Inequality. London: Routledge.

Williams, F. 2023. When Was Arts in Health? A History of the Present. London: Palgrave Macmillan.

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