Imagine this: you’re in your doctor’s office, getting checked out. You’ve noticed you’re not yourself. After an exam and some discussion, you’re expecting the next step to involve medication, a specialist visit, or even a procedure. Instead, your doc hands you a prescription for… an art class? What’s going on here and where’s the real remedy, you wonder—after all, you’re likely paying a lot of money into the medical system. But what if that is the real treatment, or at least an important part of a broader course of treatment? Certainly Béralde, in Molière’s The Imaginary Invalid believed in this possibility. His voice stands alone in the play when he tells his brother Argan to dismiss all his doctors and just go see a comedy at the theatre. Béralde’s voice is believed by many to reflect that of Molière himself, who, even while suffering from tuberculosis, was known in his day as the “god of laughter.”
Healing arts in history.
Throughout history many people and cultures have believed in the healing power of the arts and their value to one’s overall health and wellbeing. In her book Art Cure: The Science of How the Arts Saves Lives, award-winning scientist Daisy Fancourt notes that Aristotle believed the theatre could “restore balance to the heart.” In The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging, author and journalist Julia Hotz also addresses art as medicine through history: Indigenous groups have, for generations, connected personal health to the health of one’s relationships to others and to nature; African, Chinese, and Indian medicinal traditions have a long history of believing in the connection between body and its environment; Buddha “connected health to the harmony a person feels with their environment, and in their social relationships;” Rhazes, a 9th century CE chemist and physician from Iran, bucked his contemporaries and attributed the cause of sickness not to supernatural forces, but rather to “unmet social needs;” and Hippocrates, 4th century BCE, was the first physician to actually write a prescription for exercise.
Further, according to Olympia Museum, Ancient Greek physicians believed so strongly that stress impacted physical health that they established an entire theatre, the Theater of Epidaurus, inside the sanctuary of Asclepius, the god of medicine, to offer the public an opportunity to experience catharsis—emotional purging. They believed that tragedies offered a psychological outlet for audiences, enabling each person to work through their own grief, fear, and trauma because these stressors impacted physical health. Therefore, going to the theatre was a critical element of getting and staying healthy physically as well as psychologically; one was just as important as the other in living a healthy life. The idea was that catharsis, therapy-like, allowed for the processing and release of these stressors before they led to sickness of the body.
What really makes us sick.
Our modern-day medical community has begun to return to a more holistic philosophy around health and wellness even as it continues to be guided by evidence and research. Research shows that a huge percentage of what is making us unwell may be determined by our environment rather than by germs or genetic predispositions. According to Julia Hotz in Scientific American: “Rigorous research and a critical public health fact [is that] . . . 80 percent of our health outcomes are driven by social factors in our environments, while only 16 percent are related to clinical care.” What this means is that our health and wellness is impacted way more often by social factors than by clinical reasons alone. Hotz considers social factors to include “. . . access to basic resources—clean air, nutritious food, stable housing, freedom from violence and discrimination, and psychological resources—outlets that help us cope with stress, activities that give us a sense of purpose…” These all make up what she calls the “social determinants of health.” It is these social determinants of health that today are getting more attention, especially now that an explosion of research is revealing data that supports just how impactful social determinants are. In her Scientific American article Hotz says the estimation is that one in five patients in the UK are visiting doctors due to “purely social reasons.” Even doctors are recognizing the importance of social factors—Hotz cites the fact that “an American Academy of Family Physicians survey of more than 1,500 physicians found 95 percent agreed their patients’ health outcomes were affected by at least one social determinant of health, and 87 percent wish they had both more time and ability to address social needs.”
Research & evidence.
Today there are multiple research labs and organizations dedicated to studying the impact of social determinants on health. In fact, several organizations exist solely for the specific study of art’s impact on health, and they are reporting extraordinary discoveries. A 2019 World Health Organization report, “What is the evidence on the role of the arts in improving health and well-being? A scoping review,” has captured more than 3000 separate studies compiling the evidence and championing creativity as having a major impact on health and wellness. Among many others, two research groups—Frontiers in Public Health and EpiArts Lab, a partnership between the University of Florida’s Center for Arts and Medicine (UFCAM) and University College London (UCL) — are dedicated to the study of art’s impact on health and wellbeing. A multi-year EpiArts Lab study found that, for older adults, those “who did creative hobbies once monthly were 20% less likely to be depressed” and that being engaged in the arts also led to “reduced inpatient care and hospital stays” while “doing 1-3 hours of arts activities per week helps prevent cognitive decline.” The study also found that for youth under 25, those “who take part in arts and cultural activities are less likely to engage in antisocial or criminalized behavior” and engagement with the arts was found to be a direct predictor of “future flourishing… particularly social wellbeing.” And for adults 25-65, loneliness, a major epidemic today, is connected to higher inflammation, and it was found that social engagements such as those offered by the arts may lower levels of inflammation. Based on the results of this EpiArts Lab study, Julia Hotz tells the Observer that the research not only validates the healing property of art because of how it “promotes empathy, facilitates meaning-making, and encourages self-expression and self-efficacy” but that the “research suggests arts and cultural engagement can be used to help treat symptoms of several conditions, including Parkinson’s, chronic pain, depression and addiction.” In fact, its success in treating these conditions along with hypertension, PTSD, anxiety, dementia, and many others, is well documented, measurable, and significant. In Art Cure Daisy Fancourt explores how the arts impacts several elements of health: “well-being, mental health, brain health, movement, stress and pain, healthy behaviors, and longevity.” She believes it is critical that we return to engaging with art daily—which at one time was more accessible for all and infused regularly in daily life—and stop thinking of the arts as a non-essential extravagance. She tells us to “experience art as you experience food.” There is much more research to do, but the evidence is overwhelmingly supportive of the arts as a critical element in any strategy to achieve and maintain health and wellness.
Social prescribing.
Enter social prescribing. While there isn’t a single codified definition, social prescribing describes nonclinical, community-based activities to improve health and wellbeing recommended by a doctor as part of a broader treatment to support a patient’s health. These prescriptions “… aim to improve health and well-being by connecting people with nonclinical activities that address underlying problems, such as isolation, social stress and lack of nutritious food” says Christina Caron in her The New York Times article “When the Prescription Is for a Dance Class, not a Pill.” Prescriptions may be written for exercise or biking groups, garden and park memberships, volunteering, or, of course, for art engagement—museum visits, creative writing, dance, music, theatre, etc. These prescriptions can be for participating in a group, class, or workshop, or may be simply for viewing performances or artwork (though according to Daisy Fancourt, there is a marked difference in the benefits to passive art receiving in the background versus whole-person, intentional art engagement and practice). Arts prescribing is not a clinical treatment, nor is it a formalized and evidence-based individualized intervention. In The Connection Cure, Julia Hotz describes social prescribing this way:
Instead of replacing other kinds of medicine, social prescriptions complement them. Instead of just treating symptoms of sickness, social prescriptions re-connect us to our sources of wellness… that’s what social prescribing is all about; instead of ‘what’s the matter with you’—a fixed list of symptoms—it focuses on ‘what matters to you’—a set of inherently unique interests, needs, and life events.”
EClinical Medicine Journal states that, as “non-medical interventions which aim to reduce the burden of health-care concerns” social prescriptions are a widely respected and critical element of care in the UK where the practice of social prescribing began and has been thriving as a proven strategy for over 30 years. Research in the UK has shown that “83% of patients [who receive social prescribing] had experienced improved wellbeing as determined by a number of validated outcome measures.” The Journal also notes that the current demand for services in the UK has outgrown the originally established structures.
Social prescribing in the US.
Since the UK originated social prescribing, about 30 countries have instituted the practice. In the US, approximately 250 providers are now taking part. The first statewide arts on prescription program in the US, CultureRx Initiative, was launched in Massachusetts in 2020. Its subsequent three-year pilot program, created by the Mass Cultural Council, gave health professionals the power to prescribe trips to museums, performances, zoos, parks, and art studios, linking hospitals and health providers to over 300 arts and cultural organizations. The program was evaluated in 2023 and, as reported by John Hopkins’ International Art + Mind Lab, “showed that patients had overwhelmingly positive responses, often wanting to repeat the experience. Meanwhile, providers themselves reported that the program boosted their own joy and efficacy.”
Inspired by the successful Massachusetts model, the New Jersey Performing Arts Center (NJPAC) created the first partnership between an arts organization and health insurers, partnering with Horizon Blue Cross Blue Shield of New Jersey and RWJBarnabas Health. Named ArtsRx, the program connects arts experiences including performances at NJPAC, offerings at the Montclair Art Museum (including art classes, lectures, family programs, exhibitions), as well as glass blowing, dance, and music concerts, all free of charge to patients and their family and caregivers as well.
Looking ahead.
Research continues to be done to understand and explain the qualitative outcomes of social prescribing. In their book Your Brain on Art: How the Arts Transform Us, Susan Magsamen and Ivy Ross lay out the compelling evidence as to how exactly art can powerfully transform physical and mental health. The emerging field of neuroaesthetics, or neuroarts—how the arts impact us—is made possible by new technologies that give us a more complete understanding of human physiology. Magsamen and Ross offer a basic explanation: “As sensations of light, sound, smell, taste and touch enter the brain, they set off a complex cascade of neurobiological effects, sculpting and shaping neurological functions and structures. Interacting with the arts, as maker or beholder, sparks a dynamic interplay of neurotransmitters, triggering billions of changes that shape the way we feel, think and behave.”
There continues to be structural and societal barriers that may pose challenges to the wider adoption of arts prescribing. These barriers include inequities in access to cultural institutions, a lack of parity in research across different conditions, and absence of infrastructure to meet the demands of this movement. However, there exist organizations and partnerships currently striving to reduce all these barriers and others. Dr. Tasha Golden, former singer-songwriter and now behavioral scientist, was the first Director of Research for the International Arts + Mind Lab at Johns Hopkins School of Medicine. She created the “Arts On Prescription: A Field Guide for US Communities” as a roadmap for developing arts on prescription programs at the community level with the goal of expanding social prescribing and to advance its infrastructure in the US. Her words quoted on this NEA blog offer a rallying cry and a challenge for us all:
We ignore the effects of the arts, and the presence of the arts, the impacts of the arts to our detriment and, sometimes, at our peril. We all are influenced and impacted by the arts to various degrees. It’s just a question of whether that’s an impact that we can really use to support what we want for our lives and for the people that we love… [and] not exclude the arts from your sense of what is meaningful, what matters, what it means to be human.