Photo credit: Marina Tsaplina video headshot: Eric Balgley; “trumpet action”: Robert Zimmerman, “puppet 1”: Ben Shepard; Photo of Marina Tsaplina standing with arms raised: Robert Zimmerman; Group photo standing around 4 puppets: Robert Zimmerman; Jack: La MaMa Puppet Slam; Jack and Mr. Williams: La MaMa Puppet Slam

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Dear reader: In this article I have woven together thirteen carefully-selected sources that I hope will begin to transform the conceptual framework for approaching Art and its impact in/for health (broadly conceived). This is my second attempt.

My first attempt was the provocation that Jill Sonke invited me to share with the Art & Public Health gathering in Austin, Texas in October 2018. A dear colleague and friend, Medical Anthropologist Michele Rivkin, wrote in response:

“You eloquently, clearly, with depth of meaning, profoundly moving, and unsentimental imagery, show the flaws of the quantification imperative and its methods for evidence in health.”

But as we are not yet a resounding chorus singing one song in many harmonies, I try again.

The Quantification Imperative

The “quantification imperative” suffocates artistic work by inadvertently denying art’s fundamental offer and path in the world.

Strong claim? Let’s start with this recent study (#1) from the U.K. Arts Council. The short summary of the report says directly: “An evidence review concludes that nuances around the impact of arts interventions are being lost as evaluations take “an overly narrow focus on data and measurement.”

The immediate question should be to ask how and why, in a field called “Arts and Health”, was the error of the quantification imperative recreated ?

A big part of the answer are the hierarchies of knowledge (#2) in our culture:

[There is] an unspoken spectrum of smart in society today:
art < literature < history < economics < biology < math.
Although measurability increases toward the right of the spectrum, complexity increases toward the left.

Importantly, complexity theory shows us that in a complex system, it is not possible to prove (to measure) that event X directly caused effect Y. From the U.K. Arts Council report:

“The ‘burden of proof’ has tended to force arts and cultural projects into a daunting comparison with scientific positivist alternatives. There is a desire to find absolute causality in both the healthcare and criminal justice systems, which poses difficulties for arts projects, where there are so many confounding variables.” (p.66)

It doesn’t just pose difficulties: establishing absolute causality is impossible. It is asking the wrong question entirely.

Furthermore, Arts and Health initiatives, as a means of survival, have made countless attempts to tailor artistic work to the outcomes deemed permissible by a system and culture of medicine that “suppresses and ignores, consciously and subconsciously, the presence of uncertainty.” Tolerating Uncertainty: The Next Medical Revolution? (#3)

Here we arrive at the core of why the quantification imperative for artistic inquiry is suffocation: our medical culture is based on control. But as the great James Baldwin said in 1963: “all Art is here to prove and help one bear the fact that all safety is an illusion.” The Artists Struggle for Integrity (#5)
Art is born from dancing on the balance point of the edge of chaos. (#6)

All Pain has a History

I don’t quote the truth of Baldwin’s key insight on the nature of Art lightly. In our work, we are speaking about life, death, and the in-between. We are doing creative work with communities who suffer entrenched structural violence (#7), or with people who are grappling with their own mortality, dreams, egotism, longing.

Speaking the Unspeakable (#8) is a short New York Times book review of a real-life story of horrific childhood abuse. I include it here because it reveals the necessity of the imagination for survival. And it is this imaginative work that all Art does, in some form or other.

The level of suffering in our failing system of healthcare, and in our communities, is at a tipping point. One must understand the long, deep, roots of the current crisis and continue to radically open the narrow definitions of how “health” “body” “evidence” and life itself are conceived. Why do we always end up here? (#9) provides an excellent framing for understanding the obsessive drive for quantitative evidence at the expense of reason, and in our case, at the expense of art itself.

Rather than placing artistic work in a straitjacket, we might instead ask: what does art accomplish, and more importantly, how? What is the substance of rigorous artistic research, inquiry, and practice?

Art and Perception

Take a look at the Krebs Cycle of Creativity which is “a map for four domains of creative exploration—Science, Engineering, Design and Art. It is an attempt to represent the hypothesis that knowledge can no longer be ascribed to, or produced within, disciplinary boundaries, but is entirely entangled.” The accompanying article Age of Entanglement (#10) proposes that the creative work in one area (Art, Design, Engineering or Science) is inextricably interwoven with the other areas.

But, also notice how the work done in each area has its own unique imprint and way of being in the world. “Art” lives in the domain of Perception & Culture, “Science” in Perception & Nature, and thankfully the article touches on the inextricable link between nature, culture, and perception.

“Art produces new perceptions of the world” writes the author. For this reason, art can be a deeply uncomfortable experience, because the only thing in life that isn’t constantly changing are the frozen perceptions of individuals, communities, and historic structures - structures both internal to the human heart and mind, and those built externally. And it is our perceptions that all of art is always in dialogue with.

Art and Transformation

Back to the U.K. Arts Council report:

“...Many artists … have facilitated and encouraged a kind of epiphany or transformation for the individuals and groups they have been working with. Equally, working in [healthcare and criminal justice] settings can also ... reshape... their own artistic development. As this report has made clear, there is relatively little research examining the creative practice itself…” (p. 66)

The new transformative perceptions that a rigorous artistic work calls forward makes a claim upon us. Aesthetic experiences can be:

“significant because of their capacity to transform our entire horizon of understanding… not as descriptions of experiences but as a call towards a new framework for having experiences whatsoever... [It is] their ability to transform the matrix of meanings and associations which shape our implicit cultural horizons. Here lies a clue to the transformative meaning of aesthetic experience. It is ridiculous to ask for the meaning of such experiences because there is no end to them. None of these experiences point definitively outside of themselves in such a way to say that that is their meaning.” Doubled Reflection: Gadamer, Aesthetics and the Question of Spiritual Experience (#11)

They all point to you, your perception of your entangled life, breath, history, wounds, loves, desires and beyond. This is why the work of the great modernist painter, Paul Cezanne, was attacked when it was first exhibited. The aesthetic claim that it made on the viewer shattered perceptions of how the world was seen! It refused to be tamed into coherence, pushing and pulling on your perception of reality. This is why Mel Chin’s Revival Field was almost rejected by the NEA. Read this interview with the artist (#12) and listen for the struggle for integrity that every single artistic work that is worth its salt contends with, because “through the imagination is the remaking of the world. Not the frivolous imagination, but a very objective definition of this word.” (p. 397)

The Imagination is Not Imaginary

This is what every true artist knows, and though the spaces of the artists work have radically shifted, that which artists are summoning you towards remains unchanged. Where 40,000 years ago the artwork was on the surface of a cave, today some of the most groundbreaking work lives under the somewhat awkward title of “socially engaged art” that is leaving traditional art institutions in order to find new forms of practice in these incredibly challenging, interdisciplinary, community and institutional contexts. The work is no less

rigorous, no less needed, and no less aesthetic. But the definitions of aesthetics are being redefined to meet the needs of this current moment of history.

Art Demands - Beckons - Seduces - Enchants - Whispers - Screams - Pleads for you to release your certainty and controlling mind, your ideas and dogmas and open a space of imaginative breath. Art revels in the ambiguous, playing in the spaces that the dualistic mind cannot pin down, often existing beyond the edges of a given theoretical lens.

Entangling oneself with a work of art is a process of surrender, and to surrender is to allow oneself to be shaped, to release the need, to be the shaper. This is true both in the reception, and in the creation, of artistic work. There is no other way to write this, for I wrote it the way I know it. If what it means to surrender is unknown, then we are back to square one: The art work has made an invitation that is specific to, but not limited by, the conversation it is inviting you into. Can you trust yourself to be open to receive it? Have we created the conditions for high-trust creative work to take place? And, of course, is the quality of the artwork able to carry the conversation it intends?

Questions as Outcomes

The one thing that machines and artificial intelligence cannot do is ask reality-opening questions.(#13) Art needs to be released from obstructive ideologies and allowed to do the work that is its source: awakening the deep, probing questions and revelations of our time within audiences and participants, calling forth reflection on the structures around us, the structures within us, and the entangled ways the two are always, and forever, deeply intertwined.

The funders and researchers who support this work (and goodness knows, we need more of them) should be supporting artists and our artistic inquiry rather then trying to morph our work to fit an agenda that it is not born to fit. I hope to never again hear from an arts and health researcher that a work of art was deemed “too complex” based on the response to poorly-conceptualized evaluation criteria!

Articulation of the entangled complexity of being alive, through the search for the best-suited aesthetic form (whether it be elegant, strange, comedic, “ugly”, or something else), is the work of art.

“This suggests that what is required is a social not a scientific process and that ‘the political will to effect change and the institutional will to deliver it will be as important as evidence’ (p. 67)

If we are talking about public health, we, as a nation, need the imagination and imaginative work to bring us forward into shaping our future reality, to swallow our unspeakable, indigestible history, and foster processes of social healing in and with specific communities. We need creative spaces of radical joy, sorrow, and reckoning. That is the task and urgency of this moment, and we need bold and courageous evaluation and research that will serve the work of social change that births The Moral Imagination (reading #14) rather than supporting existing systems of power.

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Marina Tsaplina is an interdisciplinary performing artist, patient activist with the #insulin4all movement, and a Kienle Scholar in the medical/health humanities. As lead artist of Reimagine Medicine at Duke University, she is developing an embodied pedagogy for health education on the historic and poetic body in health and healing. She is founder of THE BETES® Organization and is an Associate of the Trent Center for Bioethics, Humanities and History of Medicine at Duke University. Her current project is Illness Revelations: The Bodies of History+Medicine+Us.