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Healing by art.

As we are firmly engaged in a better understanding of the relation between "life and medicine," we are trying to create new knowledge and competencies by developing better abilities in innovation, differentiation, branding and patient-driven health care service, while reconsidering the essential role of communication in an adequate offer of the right answers in accordance with the changes in medical care, quality of life being one benefit (Purcarea 2008). There is clear evidence that medical schools have become more innovative (Glatter 2013), and that in contemporary digital, image-based world of medicine there is a real chance for both students (with more "right-brain" qualities related to imagery, visual and drawing skills), and educators (to develop new ways of focusing on skills in diagnosis and observation, to understand a patient's needs by combining art and medicine).

On the other hand, there is this growing acceptance of alternative medicine and holistic healing practices, while marketing is challenged to provide the opportunity to expand the network of connecting with more people and spreading the healing further, by dealing with customer's needs and coming to their aid (Remington 2014). There is no doubt that healthcare customers, the patients, are in an entirely different stratosphere of expectations and interactions, a more comprehensive approach being necessary, providing compassion and empathy in any interaction. (Vennum et al 2015)

Stabilizing the subjective life-quality of the patient

The following is a documentation of effects by art therapy while stabilizing the subjective life-quality of a 40 yearold patient suffering from ALS (amyotrophic lateral schlerosis). On considering to have her artificial respiration cut off in December 2014, she requested art therapy for her two young children (4 and 11 year-olds) wanting to watch them painting while herself being fixed in her bed/wheelchair. In addition to her muscle atrophy, she was no more able to speak due to the medical treatment of her main disease. Communication was possible for her by nodding with her head, "yes" or "no."

Taken home from the hospital for her last phase of her life-cycle (Kuebler-Ross 1969; Jonen Thielemann 2012: 990 ff) in order to meet with her desire to be surrounded by her family groupsettings, art-therapy started with her two children and the children of her sister who supported the family together (Forgey&Bursch 2014: 331 ff) in a Palliative Care Team (photo: "Group-setting").

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In late January 2015 attempts were already made to involve the patient in art-work, for example by putting her hand between the hands of her two children for a colored hand-print (photo: "Hand prints").

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In order to keep up the "dialogue" with the patient an alphanumerical chart was developed (photo: "Chart"), in which she was asked for a "key-word" for a picture she wanted to be painted.

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The finger of the therapist goes to "A" and then step by step to the next letters: waiting for the nodding patient to connote "yes." By this method, the basic work about "dictates of pictures by patients" (Herborn 2011) was enlarged and in early March 2015 the picture "Birch-Trees" could be painted by the therapist although the patient was not able to speak anymore (photo: "Birch-trees").

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For the interpretation of this picture it is important to know an intercultural context: the patient is Russian, her husband is from Kazakhstan, both of them living in Germany now. Birch-trees are symbols for their homelands! The two trees symbolize the married couple! The topic of birch-trees continued with the painting "wood," a wood of tall birch-trees covering three X-mas trees to symbolize the "great family of parents, aunt and uncle, grandparents all coming from the East," and bring to the fore the two youngest and their elder brother (the three of them born in Germany)--(photo: "Wood").

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In early May an aquarell-picture shows the family again. The black/brown background represents the mother while the colored points are the three children and the father: all of the "flowers" painted from above inviting the interpretation of "seen from Heaven." Parallel to the floating colors of the picture tears were running across the face of the patient (photo: "Feelings").

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Another "bye-bye" is the picture "Marriage" (photo). It shows the couple on its wedding-day, but from the back and at sunset! The patient desired to have that picture framed and meant as a present for her husband on the anniversary of their wedding-day.

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A third picture "Tulips" (photo) shows her three children waving "good bye," with a smiling attitude.

Psychologically speaking, the patient meant to have the agreement from her children to pass away. All three pictures show that the patient just wanted to "empty her soul"--she was looking for relief.

But suddenly the patient's mood changed. Whilst before refusing sunshine in her pictures in mid-May the title of the painting was "Beach with Sunshine" (photo).

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In early June she started a picture "Playground" in the unusual format of DIN A3: which was already a challenge for its size, because the patient needed concentrating, so as to explain all the details to be painted, all of this being quite time-consuming (photo).

The standard situation was to paint one picture in one session; the playground took six sessions covering all of June and July. Another remarkable thing is that all the persons in the pictures were not related to family-members. The patient started to focus her expressions to the outcome of art, no longer being fixed onto her situation and negative family-feelings. The same for the painting of "lilac" (photo), a sign of spring, the colors being symbols of non-evil.

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Further on, one could say that blue, standing for the dark side of the soul, mixes with the red of the life/body for violet. Another interesting fact with that painting is that the patient asked the therapist to sign it and wanted it to be hanged on the wall as a memory for the art-sessions. But only a patient who thinks of the future will ask for a physical piece of remembrance! Last but not least, it is remarkable that the patient no longer constricted the pharmaceuticals to the absolute minimum like in December 2014, but asked for full medical treatment again.

Testing a "well-being barometer"

For the academic part of this case-study, a "well-being barometer" was tested as early as May 2015. Five questions regarding the topics of general well-being, wellbeing focused on health, emotional level, impacts from facts on that day, the perception of feeling by the home-environment/Care Team. Each question has a scale of 10 points: Zero stands for low, and 10 for very well. Each question was asked at the beginning and at the end of each art-session. By getting 100 values from May till August the evaluation in the meantime can give a first hint about the development in general (Graphics).

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The Quantitative Test was done by measuring the mood of the patient: 5 questions per session at the beginning--being repeated at the end, the scale of 0-10 reflecting very negative feeling up to feeling very well.

It is also possible to cross-check each point comparing it with data from the other four categories and the daily report of the sessions. One could thus see that for example the painting "Feelings" caused the patient's tears to run, but after that session she was feeling better. On the other hand she was touched negatively in the course of the session because one of her kids had to see a doctor. In so far the indices of that barometer do not fully explain but just give a hint and suggest deeper research into all of the background.

Those interdependences can be indicated by the graphic "Holistic Approach." The patients' medical well-being could be influenced by direct art therapy, also indirectly by the art therapy for the children. Seeing her family more relaxed can/ could improve her feelings--and vice versa, can leave its imprint on the mood of the family: a spiral of positive (or negative) developments can influence the overall situation.

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Acknowledgements An earlier version of this article was initially published in 2015, in the Holistic Marketing Management 6(3): 32-41.

Marie-Christin Hallier

Alanus University

Correspondence concerning this article should be addressed to b.hallier@gmx.net.

References

Forgey M, Bursch B (2014) Psychopharmacology in Palliative Care and Oncology: Childhood and Adolescence. Psychopharmacology in Oncology and Palliative Care. Grassi E, ed. Berlin.

Glatter R (2013) Can Studying Art Help Medical Students Become Better Doctors? Retrieved from: http://www.forbes.com/sites/robertglatter/2013/ 10/20/can-studying-art-help-medical-studentsbecome-better --doctors/, 9/9/2015.

Herborn E (2011) Kunsttherapie Forshung mit Sterbenden. Forschungsmethoden Kunstlerische Therapien. Petersen P, ed. Wiesbaden.

Ionen-Thielemann I (2012) Sterbephasen in der Palliativmedizin. Lehrbuch der Palliativmedizin, Aulert E, ed. Stuttgart.

Kuebler-Ross E (1969) On death and dying. London: Routledge.

Purcarea T (2008) Why is now the best time for approaching the significant relation between "life and medicine?" Journal of Medical Life 1(1): 7-12.

Remington C (2014) Marketing a holistic healing or alternative medicine business. Retrieved from: http://shunksanweb.com/marketing-a-holistichealing-or-alternative-medicine-business, 9/9/ 2015.

Vennum K, Ditmer R, Oldenburg J (2015) Learning from the healthcare customer experience. Retrieved from: http:// managedhealthcareexecutive.modernmedicine.com/ managed-healthcare-executive/news/learninghealthcare-customer-experience?page=full, 9/9/ 2015.
Primary raw data--Mood Barometer

Date                     before lesson/after lesson

                            1                 2

                        How do you       How do you
                        feel today      feel today at
                       in general ?   this very moment
                                      (the real truth?)

1. Les.: 15.04.2015         --               --
2. Les.: 29.04.2015         --               --
3. Les.: 06.05.2015        8/8               1/4
4. Les.: 13.05.2015        8/8               5/6
5. Les.: 27.05.2015        8/9               6/6
6. Les.: 03.06.2015        8/7               5/5
7. Les.: 10.06.2015        8/9               7/6
8. Les.: 01.07.2015        9/10              8/9
9. Les.: 08.07.2015        7/5               5/4
9. Les.: 08.07.2015        8/9               5/5
11. Les.: 24.07.2015       8/8               3/4
12. Les.: 12.08.2015      10/10              8/6

Date                            before lesson/after lesson

                             3                4               5

                         How do you       How do you        Do you
                       feel emotional   feel rational     feel well
                       impacts today?   impacts today?    understood
                                                           by your
                                                         environment?

1. Les.: 15.04.2015          --               --              --
2. Les.: 29.04.2015          --               --              --
3. Les.: 06.05.2015         0/1              2/4             3/3
4. Les.: 13.05.2015         2/2              4/4             6/6
5. Les.: 27.05.2015         5/8              5/6             7/8
6. Les.: 03.06.2015         3/4              4/3             5/5
7. Les.: 10.06.2015         8/8              6/7             7/8
8. Les.: 01.07.2015         8/8              7/7             9/9
9. Les.: 08.07.2015         2/3              2/2             5/5
9. Les.: 08.07.2015         4/5              4/4             5/6
11. Les.: 24.07.2015        5/3              5/4             7/3
12. Les.: 12.08.2015        5/5              6/5             8/8
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Author:Hallier, Marie-Christin
Publication:Romanian Journal of Artistic Creativity
Geographic Code:4EUGE
Date:Dec 22, 2015
Words:1829
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