Anorexia nervosa through the lens of a severe and enduring experience: 'lost in a big world'

BACKGROUND

Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite 'state of the art' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN.

METHOD

A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist's words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience.

FINDINGS

The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the 'SE-AN Kaleidoscope'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist's paintings.

CONCLUSIONS

The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of 'global impoverishment' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN.

Art is Patient: A Museum-Based Experience to Teach Trauma-Sensitive Engagement in Health Care

Psychological trauma is ubiquitous, an often hidden yet influential factor in care across clinical specialties. Interdisciplinary health professions education is mobilizing to address the importance of trauma-sensitive care. Given their attention to complex human realities, the health humanities are well-poised to shape healthcare learners' responses to trauma. Indeed, many such arts and humanities curricula propose narrative exercises to strengthen empathy, self-reflection, and sensitive communication. Trauma, however, is often unwordable, fragmentary, and physically encoded, incompatible with storying methods. This article presents a recent innovation, the Art is Patient seminar series, which focuses on aesthetic exercises to help learners access and share non-verbal, embodied, and relational responses to art. Based in an art museum context, it provides successive experiences of approaching, witnessing, and engaging with visual art as an analogue to developing trauma-sensitive relationships. Reflections on the process locate the seminar vis-à-vis health humanities practices, aesthetics, and trauma-informed approaches.

Cognitive Behavioural and Art-based program (CB-ART): a pilot study in an early parenting centre

BACKGROUND

The period of pregnancy and early motherhood is a substantial life change associated with psychological turbulence. During this period, some women experience symptoms of anxiety and depression of sufficient severity to warrant professional psychological assistance. Psychosocial and psychological interventions are key therapeutic approaches for women at this life stage. There is growing evidence of the value of the arts in the prevention and treatment of mental health problems. Evidence suggests that women prefer psychological interventions that provide social support and shared space for reflection. Cognitive Behavioural and Art-based intervention (CB-ART) is a novel therapy for prevention and treatment of perinatal mental health problems. The aim of this study was to implement and evaluate CB-ART for acceptability, feasibility, safety and preliminary efficacy among women admitted to a residential early parenting unit.

METHODS

The pilot study used a single-centre, mixed-methods pre- and post-test design to evaluate CB-ART among women admitted to a 5-day residential early parenting service in Melbourne, Australia. Participants completed questionnaires before and after attendance at two 1-h CB-ART group sessions on day 2 and day 5 of admission during which field notes were taken. Evaluation interviews were conducted by telephone 1 week after discharge. The Short Profile of Emotional Competence and the Edinburgh Postnatal Depression Scale were used to assess emotional insight and symptoms of depression, respectively. Feasibility, acceptability and safety were assessed using an analysis of field notes, with quantitative data collected by telephone questionnaire and qualitative data by telephone interviews.

RESULTS

Nine participants enrolled in the program; eight provided complete data. Two CB-ART groups were conducted. Before and after comparisons showed that there was an improvement in symptoms of postnatal depression and a marginal improvement in emotional insight. Thematic analysis of qualitative data indicated CB-ART was a feasible and acceptable means of assisting reflection.

CONCLUSION

The preliminary data indicate that the CB-ART program is a feasible, acceptable and safe addition to the 5-day residential program, with potentially therapeutic benefits. A larger randomised study is required to assess the effects of the CB-ART intervention on symptom measures in this and other postnatal settings.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry, ACTRN126220000354785 . Registered 1 January 2022-retrospectively registered.

Humans versus AI: whether and why we prefer human-created compared to AI-created artwork

With the recent proliferation of advanced artificial intelligence (AI) models capable of mimicking human artworks, AI creations might soon replace products of human creativity, although skeptics argue that this outcome is unlikely. One possible reason this may be unlikely is that, independent of the physical properties of art, we place great value on the imbuement of the human experience in art. An interesting question, then, is whether and why people might prefer human-compared to AI-created artworks. To explore these questions, we manipulated the purported creator of pieces of art by randomly assigning a "Human-created" or "AI-created" label to paintings actually created by AI, and then assessed participants' judgements of the artworks across four rating criteria (Liking, Beauty, Profundity, and Worth). Study 1 found increased positive judgements for human- compared to AI-labelled art across all criteria. Study 2 aimed to replicate and extend Study 1 with additional ratings (Emotion, Story, Meaningful, Effort, and Time to create) intended to elucidate why people more-positively appraise Human-labelled artworks. The main findings from Study 1 were replicated, with narrativity (Story) and perceived effort behind artworks (Effort) moderating the label effects ("Human-created" vs. "AI-created"), but only for the sensory-level judgements (Liking, Beauty). Positive personal attitudes toward AI moderated label effects for more-communicative judgements (Profundity, Worth). These studies demonstrate that people tend to be negatively biased against AI-created artworks relative to purportedly human-created artwork, and suggest that knowledge of human engagement in the artistic process contributes positively to appraisals of art.

Can we really 'read' art to see the changing brain? A review and empirical assessment of clinical case reports and published artworks for systematic evidence of quality and style changes linked to damage or neurodegenerative disease

The past three decades have seen multiple reports of people with neurodegenerative disorders, or other forms of changes in their brains, who also show putative changes in how they approach and produce visual art. Authors argue that these cases may provide a unique body of evidence, so-called 'artistic signatures' of neurodegenerative diseases, that might be used to understand disorders, provide diagnoses, be employed in treatment, create patterns of testable hypotheses for causative study, and also provide unique insight into the neurobiological linkages between the mind, brain, body, and the human penchant for art-making itself. However-before we can begin to meaningfully build from such emerging findings, much less formulate applications-not only is such evidence currently quite disparate and in need of systematic review, almost all case reports and artwork ratings are entirely subjective, based on authors' personal observations or a sparse collection of methods that may not best fit underlying research aims. This leads to the very real question of whether we might actually find patterns of systematic change if fit to a rigorous review-Can we really 'read' art to illuminate possible changes in the brain? How might we best approach this topic in future neuroscientific, clinical, and art-related research? This paper presents a review of this field and answer to these questions. We consider the current case reports for seven main disorders-Alzheimer's and Parkinson's disease, frontotemporal and Lewy body dementia, corticobasal degeneration, aphasia, as well as stroke-consolidating arguments for factors and changes related to art-making and critiquing past methods. Taking the published artworks from these papers, we then conduct our own assessment, employing computerized and human-rater-based approaches, which we argue represent best practice to identify stylistic or creativity/quality changes. We suggest, indeed, some evidence for systematic patterns in art-making for specific disorders and also find that case authors showed rather high agreement with our own assessments. More important, through opening this topic and past evidence to a systematic review, we hope to open a discussion and provide a theoretical and empirical foundation for future application and research on the intersection of art-making and the neurotypical, the changed, and the artistic brain.

Visual art-based training in undergraduate medical education: A systematic review

BACKGROUND

Visual art has been increasingly incorporated into medical education and has been shown to enhance important competencies, such as empathy. However, limited evidence on effective visual art program design and evaluation processes remain. This systematic review examines the format, content, and espoused outcomes of visual art-based training programs in undergraduate medical education.

METHODS

A comprehensive literature search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ProQuestERIC on undergraduate medical education and visual arts retrieved 1703 articles published from 2014 to 2020. After reviewing inclusion and exclusion criteria, 23 articles were chosen for full review and synthesis.

RESULTS

Program format and content varied, ranging from 1-day specific competency focused programs to well-structured comprehensive 6-12-week programs. 6 areas of program foci were identified: observation skills, empathy, tolerance to uncertainty, cultural sensitivity, team building and collaboration, and wellness and resiliency. Although several programs used validated measures to assess skills acquisition, they seldom addressed long-term outcomes.

CONCLUSIONS

Our findings indicate that visual art-based education hold a promise to enhance important competencies in medical education, particularly empathy. Clinical observation, in particular, had the strongest evidence of its effectiveness compared to the other competencies. Future programs incorporating visual arts will benefit from a longitudinal (greater than 6 weeks) program which incorporates guided artworks, reflection exercises, and a group discussion to provide a stronger foundation for the development of core competencies. We propose using validated scales to measure outcomes in future studies and follow-up with participants to better assess Kirkpatrick Level 3 and 4 outcomes.

How Artistic Representation Can Inform Current Debates About Chimeras

Researchers have increasingly been creating chimeras - combinations of cells from two species - raising profound ethical, social and scientific controversies. Such research could lead to the creation of animals such as pigs that contain human organs for transplantation, yet public fears have emerged. Scientists have thus called for enhanced public education and discussion, but these efforts require comprehension of the nature of public concerns. While arguments have viewed chimeras as either "good" or "bad," artists have long depicted chimeras in ways that can inform these discussions. Chimeras have a long history - the term itself is from Greek mythology - and have generated complex and ambivalent responses, reflecting deep questions regarding who we are as humans. Images across disparate cultures (such as Sphinxes and minotaurs) suggest how humans have long seen species boundaries as fluid but in differing ways. These images suggest that emotional, not just rational, utilitarian perspectives need to be addressed and that challenges may arise in altering views of all individuals. Nonetheless, public messages could draw on historic examples of positive such combinations. Thus, artistic representations can aid scientists, policymakers, educators and members of the public-at-large recognize and better comprehend and address the discomforts chimeras can foster.

A Forward Bias in Human Profile-Oriented Portraits

The spatial composition of human portraits obeys historically changing cultural norms. We show that it is also affected by cognitive factors that cause greater spontaneous attention to what is in front rather in the back of an agent. Scenes with more space in front of a directed object are both more often produced and judged as more aesthetically pleasant. This leads to the prediction that, in profile-oriented human portraits, compositions with more space in front of depicted agents (a "forward bias") should be over-represented. By analyzing a large dataset (total N of 1,831 paintings by 582 unique identified European painters from the 15th to the 20th century), we found evidence of this forward bias: Painters tended to put more free space in front of, rather than behind, the sitters. Additionally, we found evidence that this forward bias became stronger when cultural norms of spatial composition favoring centering became less stringent.

Seeking the "Beauty Center" in the Brain: A Meta-Analysis of fMRI Studies of Beautiful Human Faces and Visual Art

During the past two decades, cognitive neuroscientists have sought to elucidate the common neural basis of the experience of beauty. Still, empirical evidence for such common neural basis of different forms of beauty is not conclusive. To address this question, we performed an activation likelihood estimation (ALE) meta-analysis on the existing neuroimaging studies of beauty appreciation of faces and visual art by nonexpert adults (49 studies, 982 participants, meta-data are available at https://osf.io/s9xds/ ). We observed that perceiving these two forms of beauty activated distinct brain regions: While the beauty of faces convergently activated the left ventral striatum, the beauty of visual art convergently activated the anterior medial prefrontal cortex (aMPFC). However, a conjunction analysis failed to reveal any common brain regions for the beauty of visual art and faces. The implications of these results are discussed.

An Art-based Case Study: Reflections on End of Life from a Husband, Artist and Caregiver

This study explores the reflective processes of Scottish artist, Norman Gilbert, as he created twenty-five drawings depicting his wife, Pat Gilbert, as she lay dying following an Alzheimer's-related stroke. Norman, ninety-one, had drawn Pat regularly over their sixty-five-year marriage. One week after Pat died, Norman was interviewed by a family friend to chronicle his reflections on the drawings. The drawings along with the interview transcript are analyzed qualitatively as a case study. Norman's Hospital Drawings of Pat transform what was initially a private experience into a shared comprehension of end of life and bereavement.

Keith Haring, Felix Gonzalez-Torres, Wolfgang Tillmans, and the AIDS Epidemic: The Use of Visual Art in a Health Humanities Course

Contemporary art can be a powerful pedagogical tool in the health humanities. Students in an undergraduate course in the health humanities explore the subjective experience of illness and develop their empathy by studying three artists in the context of the AIDS epidemic: Keith Haring, Felix Gonzalez-Torres, and Wolfgang Tillmans. Using assignments based in narrative pedagogy, students expand their empathic response to pain and suffering. The role of visual art in health humanities pedagogy is discussed.

Behavioral and autonomic responses to real and digital reproductions of works of art

Nowadays, works of art can be enjoyed in both their original and reproduced format. The aim of this study was to investigate whether the format of a work of art could influence physiological and cognitive responses in beholders. Two abstract works of art and their digital reproductions were selected as experimental stimuli and displayed for 2min to 60 participants in a museum. HRV, HR, and RMSSD were recorded, while participants observed the works of art. Subsequently, participants provided behavioral ratings of color intensity, emotional intensity, aesthetic evaluation, perceived movement, and desire to touch the works of art. Results demonstrated that the faithful high-quality digital reproduction of works of art could be as arousing as the original works of art, but at the same time, they cannot replace the experience of standing in front of an authentic work of art in terms of explicit hedonic attributed values. Furthermore, specific interactions between individual inclinations to identify with fictional characters and acquired art competences in the context of aesthetic experience were found.

Trusted strangers: social affordances for social cohesion

How could the paradigm shift towards enactive embodied cognitive science have implications for society and politics? Translating insights form enactive embodied cognitive science into ways of dealing with real-life issues is an important challenge. This paper focuses of the urgent societal issue of social cohesion, which is crucial in our increasingly segregated and polarized Western societies. We use Rietveld's (2016) philosophical Skilled Intentionality Framework and work by the multidisciplinary studio RAAAF to extend Lambros Malafouris' Material Engagement Theory (2013) to the social domain. How could a landscape of social affordances generate change in the behavioral patterns of people from different socio-cultural backgrounds? RAAAF is currently imagining and planning an ambitious intervention in the public domain that could really change existing socio-cultural practices and aims to contribute to social cohesion. An animation film it made introduces a landscape of social affordances. We will present and discuss this Trusted Strangers animation film, which is a thinking model for new public domain all over the world. Tha animation film visualizes how a well-designed landscape of social affordances could invite all sorts of interactions between people from different socio-cultural backgrounds.

Neural correlates of viewing paintings: evidence from a quantitative meta-analysis of functional magnetic resonance imaging data

Many studies involving functional magnetic resonance imaging (fMRI) have exposed participants to paintings under varying task demands. To isolate neural systems that are activated reliably across fMRI studies in response to viewing paintings regardless of variation in task demands, a quantitative meta-analysis of fifteen experiments using the activation likelihood estimation (ALE) method was conducted. As predicted, viewing paintings was correlated with activation in a distributed system including the occipital lobes, temporal lobe structures in the ventral stream involved in object (fusiform gyrus) and scene (parahippocampal gyrus) perception, and the anterior insula-a key structure in experience of emotion. In addition, we also observed activation in the posterior cingulate cortex bilaterally-part of the brain's default network. These results suggest that viewing paintings engages not only systems involved in visual representation and object recognition, but also structures underlying emotions and internalized cognitions.