THE world鈥檚 largest indoor sculpture is a monumental steel figure called The Acrobat. But you won鈥檛 find it in a museum or art gallery. It鈥檚 in London鈥檚 Chelsea and Westminster Hospital. Just walk past the reception desk鈥攜ou can鈥檛 miss it.
The 18-metre-high sculpture by Allen Jones, worth 拢100,000, is not some corporate status symbol. It is part of the hospital鈥檚 strategy for healing the sick with arts and music. The walls of the hospital are studded with drawings and paintings as well as sculptures. Some are works by students and some are by established artists such as Patrick Heron and Maggi Hambling. The hospital chapel has a painting by the 16th-century Italian master Paolo Veronese. And on most days you鈥檒l also hear live music at the hospital, anything from the chamber music of the Medici String Quartet to the traditional jazz of Dick Laurie鈥檚 Elastic Band.
Taking part in music and art classes is a well-established form of therapy. It can benefit patients socially, emotionally and physically. But researchers at the Chelsea and Westminster are exploring a different premise鈥攖hat simply pleasing the eyes and the ears will help people recover. It鈥檚 not a new idea. Back in 1860, Florence Nightingale wrote in her Notes on Nursing that brightly coloured flowers and art helped patients recover more quickly. 鈥淭his is no fancy. People say the effect is all on the mind. It is no such thing. The effect is on the body too.鈥� But the truth is that no one knows exactly why patients who listen to music or see paintings should recover quicker, or how to maximise the effect. That鈥檚 what the new research is hoping to show.
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Over the years, a trickle of results has suggested a link between the arts and well-being. But there have been few strictly controlled randomised trials like those that test the effectiveness of a new drug. One classic American study, which shows that architecture can affect recovery times and that patients do respond to their surroundings, is nearly 20 years old. It looked at 46 people who鈥檇 had their gall bladders removed. Half of them were kept in hospital rooms with a pleasant view over some trees. The other half had rooms looking out onto a brick wall. The patients who had a room with a view needed smaller doses of painkillers on average and left hospital almost a day earlier: a 10 per cent shorter hospital stay than those faced with the brick wall (Science, vol 224, p 420). But it isn鈥檛 so clear whether looking at pleasing pictures will have the same kind of effect.
More research has been done into the effect of music, and this year David Evans of the Royal Adelaide Hospital in South Australia reanalysed data from 19 earlier studies. He concluded that music was a cheap and effective way of relieving patients鈥� anxiety (Journal of Advanced Nursing, vol 37, p 8). Some of the studies seemed to suggest that music could also lower blood pressure and reduce the need for painkillers. But these studies were too small to tell for sure.
At the Chelsea and Westminster, all the money for the hospital鈥檚 arts is raised from charities, which often ask for proof that this is money well spent. Susan Loppert, director of the arts programme, set up the research to have something more solid to show them. 鈥淭he literature is full of anecdotal evidence,鈥� says Rosalia Lelchuk Staricoff, who heads the hospital鈥檚 research into the clinical effect of art. 鈥淏ut we wanted to go beyond that.鈥� They have analysed the results from studies of nearly 300 patients so far, and they are turning up some interesting effects. 鈥淔or the first time we have established physical and biological evidence for the influence of art on healthcare,鈥� says Staricoff.
The three-year research programme began in 1999. The first phase established that 80 per cent of patients in the hospital found art and music helped distract them from their medical problems and raised their spirits. Then in June 2000 the research moved up a gear when the King鈥檚 Fund, a British charitable foundation, put up 拢70,000 to measure the clinical effect. The final stages of the research won鈥檛 be made public for a while, but the results so far are almost all positive, says Staricoff.
One of the early studies looked at cancer patients who were being given chemotherapy at the hospital. Many are anxious about their treatment and depressed about the possible outcome. 鈥淚f you can relieve stress then it can help patients to make the most of the time they have to live,鈥� says Debbie Fenlon of Cancer Research UK.
But Fenlon thinks that easing anxiety and depression has physical effects too. For example, it relieves pain and reduces nausea from chemotherapy. 鈥淚f you鈥檙e tense you鈥檙e more likely to feel pain. It鈥檚 a fairly straightforward physical thing,鈥� she says. Although the effect is controversial, she thinks that reducing anxiety and depression could spur the body鈥檚 immune system to fight cancer too.
The 83 patients in this study were divided into three groups. One group listened to a 45-minute performance by live musicians during their treatment. A second group was treated in a room that had a selection of pictures hung on the walls. These were changed every week so that patients wouldn鈥檛 see the same ones week after week. Finally, a control group was treated in a standard hospital ward, without any music or art.
Staricoff and her colleague Jane Duncan used a standard psychological questionnaire to assess anxiety and clinical depression in the patients. They found that both the paintings and the music lowered depression by about a third. However, music was more effective at lowering anxiety than art. On average, the art group had an anxiety score that was 18 per cent lower, and the music group had a score 32 per cent lower than the controls.
The researchers have so far gathered results from four other studies. In the antenatal clinic they found that live music also helped to reduce anxiety and depression. A short 30-minute recital of music had a similar effect on mothers attending the postnatal clinic.
Music also has the added bonus of helping doctors monitor the health of unborn babies. Britain鈥檚 National Institute for Clinical Excellence says that a healthy baby鈥檚 heart should beat between 110 and 160 times a minute. Brief accelerations of around 15 beats per minute are a good sign of the unborn child鈥檚 basic health. 鈥淚t鈥檚 the most promising sign that one looks for,鈥� says Peter Bowen-Simpkins of the Royal College of Obstetricians and Gynaecologists in London. If the fetus is reacting to external stimuli, such as music, it shows it is healthy. The researchers found that live music increased the number of accelerations in the baby鈥檚 heart rate by a factor of four, without having any effect on the mother鈥檚 pulse. This could make it easier and quicker to spot any potential health problems.
Great expectations
An attempt to measure the effect of music on the blood pressure of high-risk expectant mothers was less conclusive. Compared with a control group, the systolic pressure of mothers who listened to music dropped by 3.5 millimetres of mercury, and the diastolic pressure dropped by 2.3 millimetres. 鈥淭here was a clear trend towards a reduction of levels of blood pressure,鈥� says Staricoff. However, problems with unpleasant resonance around the ward forced them to cut short the experiment and the group of 54 mothers tested is too small for the result to be statistically significant.
If art and music really are helping patients to get better, what鈥檚 going on? It could be something similar to the placebo effect: if you think it鈥檚 doing you good then it does. Or maybe it鈥檚 displacement. 鈥淚t distracts them from their worries,鈥� Staricoff believes. Evans agrees. He thinks that music helps patients escape from their predicament into their imagination. 鈥淚 can certainly relate to this and recall how much easier it is sitting in a dentist鈥檚 chair while listening to music,鈥� he says.
Staricoff鈥檚 assessment programme has now moved onto the orthopaedic unit. Most patients are in for hip operations, and they stay for around 10 to 14 days. The researchers have been testing the effects of live music by putting on half-hour recitals on the ward, and the effects of art by hanging paintings on the walls, removing them and returning them. They want to see whether exposure to visual art or music cuts down on the need for painkillers after operations, and reduces the length of time patients stay in hospital.
Frances Brewer, a tourist from New York state, is in hospital for a hip operation鈥攁fter falling off the platform of a London bus. Her ward is listening to the guitarist Jerry Haglund perform a set of jazz standards. As the strains of his final number, the George Gershwin classic Summertime, fade away, all the patients are appreciative. 鈥淚 like it,鈥� says Brewer. 鈥淚t鈥檚 very soothing.鈥� The charge nurse on the ward, Aidan Mulcahy, underlines the staff鈥檚 support too. 鈥淚t鈥檚 lovely music today,鈥� says Mulcahy. 鈥淧atients and staff like it. It cheers them up.鈥�
At the end of the day, such feelings might be just as vital as hard statistics on blood pressures or anxiety scores. A persistent problem in Britain鈥檚 cash-strapped National Health Service is attracting and keeping good nurses and doctors. High staff turnover makes for poor patient care. As part of their research Staricoff and Duncan carried out a survey of staff attitudes. They found that the staff felt the paintings and music reduced their stress and made them more likely to stay at the hospital. 鈥淲e know there鈥檚 a tendency for the Chelsea and Westminster to have lower staff turnover than other London hospitals,鈥� says Loppert.
Is it trivial to worry about what鈥檚 hanging on ward walls when there are bed and staff shortages and growing waiting lists to deal with? Staricoff hopes their work will convince funding bodies otherwise. After all, if music or paintings can take the place of a course of antidepressants, it has to be better for everyone.