September 2022 saw the most extraordinary outpourings of grief, public and personal, across the UK and many other parts of the world, triggered by the death of a beloved Queen.
Media commentary repeatedly underlined that this death marks the end of an era – coming on top of all the other things that mark the end of old certainties (the pandemic, the war and Russia’s nuclear threats, the vivid presence of climate change, the economic crisis).
Is the loss of the Queen the straw that breaks the camel’s back? Will it exacerbate already high levels (Ford et al, 2021; Commission on Young Lives, 2022) of mental health problems in the young (and everyone else), or will this huge expression of grief prove to have been cathartic, a healing release of all the stressed emotions we have tried to manage and control in recent years?
The notion that the expression of strong emotions provides release and healing from stress is part of our folklore: “A damn good cry makes you feel better.”
The idea has a long history. Tragic plays in ancient Greece (Sophocles’ Oedipus Rex, for example) aimed to first build powerful emotions and then trigger release from those emotions, a cathartic release and healing.
Around 2,000 years ago, writers such as Pythagoras explicitly explored catharsis as a means of fostering both physical and mental health, and similar ideas are present in much older Chinese medical writing.
Religious rituals in the face of disasters and griefs offer catharsis various ways to provide healing (Jacobs, 1992). Psychology and psychiatry have long explored catharsis as a basis for therapy, for example, in psychoanalysis (Breuer, 2009) or in Cognitive Behavioural Therapy (Nichols & Efran, 1985). And catharsis is suggested to be a key element in the healing arsenal of art therapy (Petrillo & Winner, 2005).
Does making art (drawing, painting, clay modelling and the like) to express our feelings about the many sources of stress in our current world provide a cathartic healing?
Might art classes in school offer such support? In a world where so many of our young are experiencing emotional problems, depression, anxiety, where medical intervention is neither on offer in sufficient quantity (Commission on Young Lives, 2022) nor necessarily the optimal response (Fielding, 2021; Keyes 2002; Thornton, 2022), it is worth exploring every possible means of supporting wellbeing in the young. Do art classes have a role to play in countering mental health problems? If so, how can we make the most of any such potential?
Music, arts and sports and their links to good mental health
- Music and mental health: A powerful way to destress? Published November 14, 2022.
- Art and mental health: Catharsis or distraction? Published November 21, 2022.
- Sports and mental health: Is exercise better than mindfulness? This article.
Making art, catharsis, and healing
Numerous websites – including those supported by influential agencies such as MIND (2021) or Harvard Medical School (2017) – claim that making art has many benefits for mental health and wellbeing.
Among these is the claim that making art provides a medium for the expression of difficult emotions that are otherwise hard to articulate, allowing individuals to explore those emotions, identifying the ways of thinking that cause distress and reframing these in healthier ways – a form of catharsis.
This is the thinking behind using drawing to express emotions after trauma, in hope of a cathartic relief and healing. This form of art therapy is most often applied in the context of post-traumatic stress disorder. PTSD, or mild versions of it, may be a common strand in the emotional problems of our young now: a recent study suggesting that up to 25% of youth exposed to trauma would develop PTSD (Danese et al, 2020).
Does cathartic drawing to relieve stress work? A striking thing about websites making such claims is that very few cite any empirical research.
Published papers arguing for the benefits of art in mental health tend to focus on the theoretical bases for such expectations, rather than presenting empirical data testing those theories (Stuckey & Nobel, 2010). Or else they cite research that confounds the effect of art-making on mental health with other factors. For example, is an improvement in wellbeing after art therapy produced by the art-making per se, or by the therapeutic interactions surrounding the activity?
Overall, there is remarkably little well-designed research evaluating the effectiveness of art-making, cathartic or not, in relieving stress after trauma in the young. What we have is equivocal. For example, Chapman et al (2001) found that an art therapy specifically designed to reduce PTSD in children was no more effective in reducing symptoms of PTSD than offering no intervention at all. However, the art therapy did reduce signs of acute stress.
Studies with adults further muddy the waters over the benefits of drawing traumatic events as a means of improving wellbeing, suggesting that art may offer healing more through distraction than catharsis. For example: a series of experimental studies, where participants were shown tragic images or distressing film clips and then asked to make drawings of one kind or another found that making drawings that expressed feelings improved mood more than copying random shapes, or other forms of distraction (Petrillo & Winner, 2005).
This seems at first to support some notion of cathartic healing. However, Petrillo and Winner also reported that mood improved equally whether an individual drew positive or negative images, which suggests that it was the activity of drawing, perhaps the creativity of the activity, rather than the release of negative emotions that was effective in improving mood.
A later study (Drake & Winner, 2012) concurs: distraction (drawing something emotionally neutral) is generally more beneficial to mood and wellbeing than catharsis (drawing to express negative feelings triggered by a distressing film clip). How relevant are these results for traumas personally experienced rather than stress experimentally induced? The jury is still out.
Making art, creativity and distraction
Of course, catharsis is not the only mechanism postulated to underlie the healing potential of art-making. Indeed, the power of distraction in reducing stress is not to be discounted. Art as distraction is often claimed to lower stress and promote calm, to foster self-esteem, to mitigate feelings of woe and pain. Experimental studies support this idea (for example, Drake & Winner, 2012). “Real world” data are more equivocal.
Results from studies of the effectiveness of art in fostering mental health in stressed populations are surprisingly inconsistent and contradictory. Meta-reviews of research find that while there are many studies reporting reductions in depression and anxiety and improvements in wellbeing from making art (De Witte, 2021; Reynolds et al, 2000; Stuckey & Nobel, 2010), there are other studies reporting no benefit (Reynolds et al, 2000).
This mixed pattern of results is hard to interpret. Studies vary in exactly what art-making was involved, how it was supervised, how wellbeing was assessed (generally subjective self-report), and in the populations studied. Few studies include control groups which would allow the effectiveness of art-making to be disentangled from other factors.
The most interesting research in this area comes from studies using physiological rather than only subjective self-report measures of the effects of making art on wellbeing. Here, there is strong support for the claim that art-making can reduce stress. For example, Kaimal et al (2016) demonstrated that after a 45-minute session of art-making, college students and staff not only reported reduced tension, but showed significant reductions in levels of salivary cortisol, a hormone widely used as a marker for stress.
Though the participants here were adult, there are no obvious reasons to suppose that such results would not also apply to teenagers. This study is particularly interesting, since the participants were from a normal population (much research on art therapy focuses on hospitalised groups such as cancer patients), and the art-making was informal rather than directed by a trained therapist – hence this study is more relevant than most to the question of whether making art might reduce stress in a school context.
More, if tangential, support for the possible utility of art-making in fostering mental health comes from series of studies of visual imagery (Holmes et al, 2009; Lyadurai et al, 2018). The formation of the intrusive visual imagery characteristic of stress reactions including PTSD can be reduced by a visual distraction such as playing Tetris shortly after a trauma is experienced. The benefit (reduction of the imagery that fuels stress) extends well beyond the intervention.
Could distracting visual art-making similarly stop stress from accumulating in the young, heading off mental health problems before they become entrenched? We do not yet have the research to answer that question, though it is an interesting possibility.
Practical suggestions from research
Even short sessions of art-making are likely to reduce stress: Even short periods of relief from stress would be valuable, in these troubled times. A reduction in cortisol might well carry forward beyond the art class, alleviating stress well beyond the session.
Art-making in school is better construed as distraction than as offering catharsis: Quite apart from the data showing that distraction can improve mood more than catharsis, triggering strong emotions in a school setting where there is likely no trained therapist on hand to offer support if an individual becomes seriously distressed is obviously ill-advised. Furthermore, releasing strong emotion does not always have constructive results: for example, intervention encouraging the expression of anger is associate with increased feelings of anger and increased hostile action (Bushman, 2002).
- Dr Stephanie Thornton is a chartered psychologist, author and lecturer in psychology and child development. She is the co-author of Understanding Developmental Psychology (Macmillan International/Red Globe, 2021). To read her previous articles for SecEd, visit http://bit.ly/seced-thornton
Further information & references
- Breuer: Freud S: Studies on Hysteria. The Standard Edition of the Complete Psychological Works of Sigmund Freud, 2, 1893-1895, 2009.
- Bushman: Does venting anger feed or extinguish the flame? Catharsis, rumination, distraction, anger, and aggressive responding, Personality and Social Psychology Bulletin (28), 2002.
- Chapman et al: The effectiveness of art therapy interventions in reducing PTSD symptoms in pediatric trauma patients, Journal of the American Art Therapy Association (18,2), 2001.
- Commission on Young Lives: Heads up: Rethinking mental health services for vulnerable young people, thematic report 4, July 2022: https://bit.ly/3BR4P6y
- Danese et al: Psychopathology in children exposed to trauma: Detection and intervention needed to reduce downstream burden, BMJ (19,371), 2020.
- De Witte et al: From therapeutic factors to mechanisms of change in the creative arts therapies, Frontiers in Psychology, 2021.
- Drake & Winner: Confronting sadness through art-making: Distraction is more beneficial than venting, Psychology of Aesthetics Creativity and the Arts (6), 2012.
- Fielding: Languishing is the mood of 2021, how to identify it and how to cope, Mental Health News, 2021: https://bit.ly/2RBfgIv
- Ford et al: Mental health of children and young people during pandemic, BMJ (10:372), 2021.
- Harvard Medical School: The healing power of art, 2017: https://bit.ly/3raEawJ
- Holmes et al: Can playing the computer game Tetris reduce the build-up of flashbacks for trauma? A proposal from Cognitive Science Plos One, 2009.
- Kaimal, Ray & Miniz: Reduction of cortisol levels and participant’s responses following art-making, Journal of the American Art Therapy Association (33,2), 2016: http://bit.ly/3XE8dfi
- Keyes: The mental health continuum: From languishing to flourishing in life, Journal of Health and Social Research (43), 2002.
- Lyadurai et al: Preventing intrusive memories after trauma via brief intervention involving Tetris computer game play in the emergency department: A proof-of-concept randomised controlled trial, Mol Psychiatry (23), 2018.
- MIND: Arts and creative therapies, 2021: https://bit.ly/3xQzsrR
- Jacobs: Religious ritual and mental health. In Religion and Mental Health, Schumaker (ed), Oxford University Press, 1992.
- Nichols & Efran: Catharsis in psychotherapy: A new perspective, Psychotherapy: Theory, Research, Practice, Training (22), 1985.
- Reynolds, Nabors & Quinlan: The effectiveness of art therapy: Does it work? Journal of the American Art Therapy Association (17, 3), 2000.
- Petrillo & Winner: Does art improve mood? A test of a key assumption underlying art therapy, Art therapy: Journal of the American Art Therapy Association (22), 2005.
- Stuckey & Nobel: The connection between art, healing and public health: A review of current literature, American Journal of Public Health (100), 2010.
- Thornton: How will the bad news cycle of recent years affect young people? British Journal of Child Health (3), 2022.