Wings to Fly:

Art and Pain through the Lens of Psychology and Medicine

“Feet, what do I need you for when I have wings to fly?” asked Frida Kahlo, whose tremendous artistic career was shaped by a life of profound physical challenges. Twelve years after surviving a polio infection at the age of six, which left her with a stunted and weak right leg, Kahlo was caught in a horrific bus crash in Mexico City. The impact caused fractures in her spine, collarbone, ribs, and pelvis, and a handrail from the bus impaled her abdomen, leading to further complications and surgeries. This event would mark the beginning of a long and arduous journey of physical pain and medical procedures. Through her art, Kahlo found a powerful outlet for her suffering, allowing her to confront it and transform it into emotionally charged artworks that continue to inspire generations of artists across disciplines.

While this type of creative catharsis—the idea that art can help us manage pain—may seem intuitive, a growing body of medical research supports the concept from an empirical perspective. Below I join three experts in the field of arts in medicine—Tamara Shella, PhD, director of the art therapy program at the Cleveland Clinic, Cleveland; Dr. Matthew Doll, PhD, a director at the SSM Health Treffert Studios in Fond du Lac, Wisconsin, the world’s leading institution in the study of acquired savant syndrome (the emergence of unusual skills after traumatic brain injury); and artist David John Marchi—to discuss the measurable psychological and physiological impact of art on our experience of physical trauma.

—Ashley Overbeek

Ashley OverbeekIt’s exciting to get so many brilliant minds together in one place. I wanted to start with understanding how each of you has seen art used as a tool to confront physical pain. What examples have you seen in your lives and practices?

Tamara ShellaI’ve been working at Cleveland Clinic for more than twenty-five years. I started in behavioral health, and then about fifteen years ago I started working with the Arts & Medicine department, creating the medical art-therapy program. Arts & Medicine is more than just art therapy, though; people are creative in a lot of different ways. From a medical perspective, art therapy often addresses anxiety and mood, both of which can impact pain. So we look at those as a group and try to work on, “Can we improve your mood, can we lessen your anxiety, and hopefully then lessen the pain?” And one of the ways artmaking can do that is getting the person into flow state. Flow state is a theory of the positive psychologist Mihaly Csikszentmihalyi, who talked about it as a state of optimal attention, being mindfully immersed in what you’re doing. That immersion, that mindfulness, is part of why making art helps. The other part of it is, art becomes a visual way to discuss things that maybe you don’t have the words for.

Matthew DollI love your answer, Tammy. And I think there are individual differences, right? We all have different sensory issues, we all have different types of anxiety, physical pain, emotional pain. I’ve seen it with art therapists working with Vietnam vets and the intervention was asking them to create masks, because many of them feel they wear a mask, having to hide their emotional pain or their posttraumatic symptoms or even physical pain. Some feel they need to be tough for the family, or have other reasons they can’t show or talk about the pain they experience. It seemed to be one of the functions of the task that through the arts, they were able to express things without necessarily having to be verbal about it. Our brains store pain information, trauma, in a different way, and depending on how we were impacted and what state we were in when we were harmed, we have these different access points. Some of them are really unconscious, stored in our bodies, even nonverbal. Art is often able to tap into that, so that we can express unvoiced or unvoiceable emotions, feelings, and thoughts.

Then there’s the sensory nature of things, being able to use your hands to smear things or to create in any tactile way, and I’ve seen that be very, very helpful for folks, because it gets them out of their head in a way that’s not their thinking brain but their creative brain. That really frees them up and gives them a sense of accomplishment and success.

It’s curative for all of us to be in relationship, and many of us feel isolated or absent in relationship. So art is also a way of connecting, individually creating and then sharing work. That cohesion, that sense of belonging, is another way to manage both physical and emotional pain.

AOSo art can be a pathway of communicating and connecting nonverbally with each other.

MDYes, but also internally, for ourselves, because we can sometimes create things that we weren’t aware of.

David J. MarchiI was never really good in art class; stick figures were about as far as I could go. I was very creative, however, so conceptually I could come up with ideas, but I couldn’t translate them into something visual. Then in 2015 I was in a severe boat accident that led to the onset of acquired savant syndrome, which is the emergence of skills after an individual suffers a traumatic injury. These are usually in art, music, math, calendar calculating, and spatial skills. After the accident, I began dreaming every night in structured images. In my mind I was mixing, blending, creating new colors, and eventually seeing complete or near complete paintings. I found the ability to take those ideas from memory and put them down on something—canvas, paper, a wall.

So as far as what art has done to me and for me, and what I’ve been through—well, I have chronic pain every single day. I’ve had chronic pain with over eight surgeries since the accident in 2015. I tell people, I don’t know what a day is like without pain. I don’t take pain pills but the moment I get into my studio, and it’s hard to explain this, but in my studio I feel no pain. I can reach high, I can get on the floor and move around, and so it’s definitely something that is now in me.

And it’s almost uncontrollable at this point. I remember a conversation early on with Dr. Darold Treffert, who diagnosed my condition. I said to him, “It’s almost like I’m going crazy. There’s so much in my head and in my mind, and I can’t compartmentalize it. It’s just coming out.” And he said, “This is part of it. You need to try to figure out how to manage it and control it; it’s now part of you and not going away.” I think I’ve done that, but I don’t think there’s a night that’s gone by that I don’t dream of the completion of a painting or the creation of a new one. Ashley, you saw my studio: my mind doesn’t show small images. The dreams are so visual and so large, I just finished a twenty-eight-foot painting. Most of my paintings are six, eight, and ten feet, but I’m now very comfortable painting sixty by forty inches.

What’s interesting is, the larger the painting, the more time I have where I’m kind of inside the painting looking out, which allows me to subconsciously prepare for night, because I’ll dream about the next step on the painting. And it’s frustrating, because, for example, I was in the studio this morning at 4:30am because I had to put “it” down, and it’s a twenty-minute drive; I was in my pajamas and went to the studio and did it. But it’s been a pretty dramatic thing in my life. I tell people, I think it saved me mentally, and also got me through all the surgeries and rehabilitation so far.

MDThere can be a sense of compulsion, this sense of needing to do something, and then it sort of goes into its own world, hours go by, and people aren’t aware of it. I think the similarity of that pattern is pretty striking and consistent across the folks we’ve talked to that have acquired savant syndrome.

TSAnd beyond the compulsion to do it, everything you were describing is flow state—the loss of time, the loss of need, bodily sensations, not feeling thirst, hunger, pain. Those kind of go away to the side and you realize hours later, “Oh, I haven’t had anything to eat, I should stop and have something to eat.” What you were just describing is that mindful immersion. If we could get all patients to just kind of pick the colors and go with them and not overthink it, not be self-conscious—because loss of self-consciousness is part of flow as well—that would be wonderful. A lot of times, people overthink, and that’s one of the obstacles to getting them to engage in art therapy or artmaking: the fear of the wrong.

DJMTo that point, once again, when I come into my studio, it’s almost like everything shuts off. Not only is my phone off, but everything shuts off, the sounds around me shut off, and it brings me to a mental space that is totally safe, with no boundaries. I paint on average six hours a day, sometimes twelve hours a day, and I paint every single day. I forget to eat. And yes, it’s this state of—I don’t know, it’s a pleasant state, because once I leave my studio I feel like everything explodes. It’s a blessing for me, to experience that type of peace when I’m here.

AOThat mindfulness, the flow state you describe, David, I feel like there are so many ways to describe that feeling of everything else falling away. Matt, in an earlier conversation we had, you used the phrase “releasing the tyranny of the left side of the brain.” Is that related to this feeling of everything falling away? Could you speak a little bit more about what that means?

MDI think of it in relation to what Tammy was talking about in terms of that self-consciousness, self-awareness, the limits we put on ourselves. We’ve all experienced the anxiety of not being able to recall something we know, or find something that’s right in front of us—different processes, but accessing information that we have can change based on our emotional state or situation. We’ve seen that with individuals gaining access to skills that they didn’t have access to prior to traumatic brain injury. It appears that in some cases, if particular areas of the brain that have restricting effects on other areas of the brain are damaged, access to formerly restricted areas becomes possible. In some forms of dementia, and in some individuals who have had a brain injury impacting the left anterior temporal lobe, you may see increased artistic skills that were not evident before the disease or injury. The theory is that our left hemisphere may suppress other areas of the brain, potentially for efficiency’s sake, but once damaged, that suppression is removed, and you may see a shift from a left- to right-hemisphere mode of functioning.

There are a great many variables and individual differences to consider, of course, but that process in general is the “tyranny” that Dr. Treffert would talk about: we don’t have access because our left hemisphere is rational and we’re thinking about things logically, whereas if it’s altered, we may now have access to our more creative side, which is typically associated with the right side of the brain. There have also been studies, with varied results, looking at trying to suppress left-hemisphere areas artificially so as to allow greater access to right-hemisphere areas.

AOHow do you give people the tools to continue using art for healing even after they finish treatment? How do you ensure that art is something they can engage with forever?

DJMFor context, I started teaching an art class for fourteen-year-olds at the new SSM Health Treffert Studios, which opened recently in Fond du Lac, Wisconsin. This new addition has expanded the services of the Treffert Center to focus on the strengths and neurodiversity of young adults. It provides the space and facilities to create and perform, whether in the form of visual art, music, videos, video-game streaming, talk shows, or other art forms. My biggest mission is to spread the word on how I believe art heals at certain levels, and it’s not on the quantitative or qualitative level but from my own personal level, where I can talk with some degree of credibility. And I felt that participating with these kids would give me the opportunity to start the process with people who are young and might experience this and be inspired in some way.

The inspiration for starting this class with Dr. Doll and his team was meeting Max, the son of one of my neighbors, who has autism. Max had never painted before. I asked his dad if I could come over and paint with him and his brother Sam. It took almost forty-five minutes for him to pick up a brush and start putting paint on the canvas. It was the most rewarding thing I experienced in my “art world,” more rewarding than selling a painting or being in a show. Max’s family ended up moving, but his father called me a month later to thank me and said, “I need to tell you that Max has not stopped painting since you were at our house. Every day when he comes home, he pulls out his paints.” So for me, if one person can carry that on. . . . I’ll be curious if any of the students in my class do the same thing.

TSOne of the issues with medical art therapy is that it’s brief. We’re at a huge hospital, so we’ve got 1,000 inpatient adult beds, 250 pediatric beds, and very few art therapists to serve all those people. Patients are consulted for an art-therapy session based on a need. We’re working on the crisis of hospitalization. So we really try to introduce art that the patients can take home. The sad part is, we don’t always know if they do. We may see a person once and never see them again. Many times we see patients who come back every other month—they’re here for another reason, like treatments for transplant issues or cancer. So as I was listening to David speak, I thought, I wish I knew. And I love that an art therapist who works with outpatients has that opportunity to see the art that the patient made when they first came in and the art made months later. We don’t get to see that. You come in to work in the hospital knowing that you’re going to do what you can with this person in the maybe one time you see them.

We had a young cancer patient who was already interested in art and began creating these fantastical pieces. He was worried he was going to be forgotten when he died, because he was going to die young. And because of that, we were inspired to do an art show with him and with other patients. So sometimes those things happen within our environment to show how the art is helping, to hopefully let other people see it, and hopefully we’re engaging people with art that is easy enough for them to pick up when they go home and continue in some way. But unfortunately we don’t always know.

MDAs we mentioned earlier, art connects people, and it’s a universal language, being both personal and interpersonal. So when you think about healing, medicine, and art, it’s not just in that singular person; healing happens in relationship. And yes, it’s the flow state, and it helps us heal and it helps us express emotions that we otherwise couldn’t, but there’s a lot of emerging research that says we actually coregulate each other. Our heart rates go into sync, and we have oxytocin [hormone] levels that influence each other. So art must do that for people too, right? We’re all internally connected in unique ways based on individual differences, and yet we are also interconnected with each other. One of the things we miss at times, being focused on individual access to skills and our measurement of outcomes on an individual basis, is really that collective connection and the influence we have on each other. Art speaks many languages. I think we have these silos in our brains and in our society that say “Art isn’t medicine, relationship isn’t medicine,” but the emerging evidence is, “Oh, relationship is very much medicine.” Art connects us in a unique way.

TSI think that arts and medicine is broadening as a concept. The Arts & Medicine program at Cleveland Clinic started fifteen years ago, which is not long, that’s pretty emerging. But now I’m seeing more and more hospitals have it. We just went to the National Organization for Arts in Health conference here in Cleveland. So we’re seeing more awareness of it, and then social prescribing, which started in the United Kingdom before the pandemic, where it’s basically prescribing arts activities for patients, a lot of it to lessen loneliness, to add to people’s lives.

And we know that it does. We know that one of the interesting things that happened during the pandemic was that people who had hobbies that got them into flow state did better than people who didn’t. Toward the end of the pandemic there was a whole issue of languishing, where people had no energy, they just lost it. But if you were already doing a flow-state activity—art, music, dance, whatever you liked to do—your wellbeing was probably better than someone who was not engaging in those kinds of things. So that kind of information is interesting, and the fact that people are studying it—it’s going to keep growing.

DJMWhen I went to the Helen Frankenthaler exhibition at Gagosian in Chelsea last spring, it was one of the most emotional exhibitions I’d been to, and I don’t know what it was—I mean, I love her, she’s a huge influence on my work, but a couple of paintings brought tears to my eyes and I couldn’t figure out why I became emotionally attached to them. Then when I was looking around, I saw I wasn’t the only one—a few people were emotional, and one person was staring in front of a painting called Western Roadmap [1991]. They were there from the time we got there to the time we left.

AOWhere do we go next? What’s the frontier, Tammy, for art therapy? What do you want to research, study, expand upon in your program? David, Matt, what’s next for you? How do we continue to push the envelope in thinking about art and medicine?

TSI think continuing research, looking at different things. Sometimes newer research surprises you. Along with art therapist Sarah Brown, I did a research study looking at how patients with epilepsy and nonepileptic seizures would make a head sculpture to represent their seizures. These patients created their sculptures in vastly different and unexpected ways. The people who had epilepsy did this electronic kind of stuff; the patients who had conversion disorder, which is basically taking one’s traumas and converting it into what looks like a seizure but is not actually a seizure, all of their sculptures were turned in toward the head. All patients were given the same directions and materials to work with; the only difference was their diagnosis. These remarkable differences in the art they created were an exciting find, and we’re going to do more research on that. So I really think it’s just doing research. Art therapists didn’t do enough of it in the past, and we need to do more to show the impact even in small areas.

DJMThe opportunity for the academic side should be the first point of inflection and exposure. As a member of the Art Students League in New York, I’ve had meaningful discussions with Executive Director Michael Hall and President Robin Frank on this subject and the potential impact for the League. I’ve also spoken with Eric Shiner, president of Powerhouse Arts in Gowanus, about getting involved in the intersection of art and medicine, as Powerhouse focuses on an artist’s complete journey. Everyone is very receptive and wants to learn more. The opportunity for galleries and museums is to take the first step, start the conversation, and develop a strategic roadmap.

Think how many of the artists whom curators select or critics critique have had some type of mental or physical trauma in their lives. By virtue of who they are and what they do, they’re surrounded every single day with art and this healing phenomenon. I think change starts with education, communication, and credibility. Dr. Doll, Dr. Shella, and I know about the powerful benefits of engaging art because we’ve each experienced them on certain levels, with people we work with, the research we do on them, and what we create from them. I think there’s a responsibility for the art world to look at this in a very, very serious way and understand what impact it could really have. Many well-known and often exhibited artists had severe mental and physical disabilities: Vasily Kandinsky, Frida Kahlo, Henri Matisse, Jackson Pollock, Francis Bacon, and on and on. The galleries already have a huge advantage because the art is on their walls and in their halls. They can be the catalyst to create, educate, and inform the public quicker than anyone else.

MDFor us, it’s helping individuals across the globe, and also research. We have a lot of information about individuals who have come forward, such as David, and shared their experiences very generously with us. We have so much to learn; the brain is such a fascinating organ, and is tied to our other organs in ways we have only begun to understand. Our heart sends more information to our brain than our brain sends to our heart. We’re also using electroencephalograms to better understand the connections in different parts of our brains, and how different brain waves are tied to brain states such as “being in the zone.”

We also continue to provide connection to individuals across the globe who have been born with or acquire unique abilities. I want to share a story about a primarily nonverbal eighteen-year-old boy who visits the Treffert Center from a different country. He starts drawing his horses and a group of preschool children join him, also drawing horses. A little girl goes up and gets in his space, and for the first time outside of his family, he begins to share attention with another person; his mother is brought to tears. He’s looking at her, they’re making eye contact, they’re looking at the drawings together. It’s that connectivity, I think, that is really what we want to magnify and elevate. How do we have art heal through relationships, through the obvious chemical interactions we all share, to heal ourselves and each other?