سهم بصری هنرسازی برای رفاه ذهنی زنان مبتلا به سرطان: یک مطالعه کیفی

This qualitative study examined accounts of women diagnosed with cancer who engaged regularly in art as a leisure activity. The purpose of the study was to explore participants’ views about the contribution of art-making to their subjective well-being in the context of living with cancer. The study was based on the principles of interpretative phenomenological analysis (IPA). A convenience sample of 12 women aged between 23 and 74 years participated in semi-structured interviews, and their accounts were analysed thematically. Participants described a range of ongoing difficulties associated with cancer such as fear for the future, pain, sleeplessness, role loss, activity restriction, reduced self-confidence and altered social relationships. They described art-making as supporting subjective well-being in four major ways. Creative activities helped participants to focus outwards on positive life experiences relieving debilitating preoccupation with illness. Art-making enhanced self-worth and identity through providing opportunities to demonstrate continuity, challenge and achievement. It also enabled participants to maintain a social identity that resisted definition by cancer. For a minority, art enabled symbolic expression of feelings, especially during chemotherapy. The findings supplement previous case studies and suggest that meaningful creative activity may provide psychosocial resources for living with cancer.

This study explored the meanings of leisure-based art-making for women who were living with cancer. It is increasingly recognised that many people with cancer need to draw upon psychosocial resources such as positive attitudes, spiritual beliefs, information and support in order to cope with their condition (Dunn, Steginga, Rosoman, & Millichap, 2003; Jenkins & Pargament, 1995). Creative art-making during leisure time may offer another resource. Some people identify their diagnosis of cancer as a “wake-up call” to be self-expressive, and turn to art and other creative activities (Predeger, 1996). Most studies of cancer patients undertaking art therapy have focused upon those who are in the relatively early stages after diagnosis, when fear and grief may be particularly intense. Participants at this stage of the cancer trajectory seem to use art to communicate feelings of anxiety, anger and body estrangement, which are difficult to put into words (Borgmann, 2002 and Lynn, 1994). Sibbett (2005) has argued that the creative process may also help those who live with cancer to tolerate the discomforting experience of inhabiting a liminal or threshold space between life and death. Art therapists, particularly those who adopt a psychodynamic perspective, have interpreted the artwork of individuals with cancer as rich in symbolism (Minar, 1999). Imagery of the damaged body has frequently been expressed in the artwork of people living with cancer, as have themes of hope and reintegration (Borgmann, 2002 and Lynn, 1994). Whether art-making has these themes when engaged in as a leisure occupation rather than as therapy is uncertain. Cancer affects many people every year, and few, it seems, have access to art therapy. With better medical treatments, more survive and face the task of coping with the legacy of their diagnosis for many years (Bower et al., 2005). It can be argued therefore that a better understanding of the role of leisure-based art-making in promoting well-being may also help to inform professional interventions and people's own strategies for coping with cancer. Cancer can be profoundly disruptive of personal and social identity (Carpenter, Brockopp, & Andrykowski, 1999; Mathieson & Stam, 1995). Stressful features of cancer such as pain, potentially arduous and disfiguring treatments, and a future perceived as highly uncertain all tend to challenge the previously taken-for-granted relationship with the self. Many describe cancer as bringing about a profound loss of subjective control. In addition to imposing a cognitive and emotional burden, cancer poses threats to subjective well-being through undermining everyday lifestyle and social relationships. About 40% of people report losing their job or taking early retirement after cancer diagnosis and treatment (Spelten, Spranger, & Verbeek, 2002). Cancer still carries a stigma, and from a sociological view imposes an all-defining “master status” upon the person (Charmaz, 1991; Mathieson & Stam, 1995). The person may yearn to establish a sense of normality and an identity that is not totally defined by cancer (Lam & Fielding, 2003; Landmark & Wahl, 2002; Shannon & Shaw, 2005). Some people respond to cancer by placing more emphasis on personally enriching activities (Arman & Rehnsfeldt, 2002). Shannon and Shaw (2005) found that participants re-appraised their leisure habits, wanting “to be actively living and making the most of life” (p. 207). Such re-appraisal may occur soon after a cancer diagnosis. Landmark and Wahl (2002) interviewed women recently diagnosed with breast cancer who reflected on their need to engage with meaningful activities, to provide evidence of their mental and physical strength, to stay actively engaged in daily life, and to distract their thoughts away from cancer. Similar themes were found in the study of women who took up a sport after breast cancer (Tocher, 2002). Link, Robbins, Mancuso, and Charlson (2004) found that 11% of participants who tried to control the psychological impact of their cancer in daily life turned to creative activities such as painting and writing. However, they did not examine in depth how such activities enhanced participants’ subjective well-being. Reynolds and Prior (2003) offered some insights into this issue, albeit from interviews with women who were living with both malignant and non-malignant illnesses. They explored the meanings of art-making guided by the principles of interpretative phenomenological analysis (IPA) as described by Smith, Osborn, and Jarman (1999). Participants’ accounts suggested that art-making offered a way of managing many aspects of long-term illness ranging from unpleasant physical symptoms to loss of roles. Immersion in artistic activities helped to ward off cognitive preoccupation with illness. The participants’ accounts did not focus solely upon coping with the restrictions of illness. They also revealed a more positive project of re-engaging with “normal” life. As one participant with cancer explained: “Art blocks out sad thoughts or frightening thoughts and scary bits… but it also moves you on” ( Reynolds & Prior, 2003, p. 792). Art-making provided some participants with new relationships and generally restored feelings of competence and self-esteem. Present-moment awareness was enhanced, enriching perceptual experiences. Some appreciated that their illness had catalysed a more positive lifestyle. Of the 35 women participating in the study, six were living with cancer. A more detailed examination of the role of art-making in coping with life-threatening illness was recommended. This study sought to understand how visual art-making as a leisure activity contributed to the subjective well-being of women who were living with cancer. An inclusive definition of “art-making” was used, to encompass the practice of any form of visual art or craft resulting in a visible end-product, whether at an amateur or advanced level of expertise.

This phenomenological study sought to understand how visual art-making, as a leisure pursuit rather than as formal psychotherapy, contributed to the subjective well-being of people living with cancer. Participants described many stressful experiences associated with cancer and its treatment, which prompted a search for meaningful activity to help relieve stress. Emotional turmoil and/or early retirement from work prompted most participants to initiate or intensify an interest in art-making after diagnosis. For a minority, a few pieces of artwork enabled expression of feelings about cancer in symbolic or implicit terms, especially in the early stages after initial diagnosis or recurrence, and this was thought to be an emotionally fraught yet valuable experience. Art-making was also valued by participants for encouraging a positive outwards focus, and for limiting their preoccupation with cancer-related fears and physical discomfort. Art-making helped to support continuity of personal identity, an “able” self-image and equality within social relationships, thereby counteracting the ‘master status’ that cancer tends to confer. There are several implications for art therapists. Firstly, cancer creates long-term stress, and art-making later in the cancer trajectory may assist some people to reconnect with aspects of their former identity, to resist the ‘master status’ that cancer can exert, and to experience “vital engagement” with life (Nakamura & Csikszentmihalyi, 2002). However, it must be acknowledged that personal interests and wider psychosocial resources will inevitably influence which leisure occupations are meaningful to individuals. Another implication from this study is that not all of the therapeutic potential of art resides in its symbolic function (although some individuals do need to engage in symbolic self-expression atleast in the early stages of cancer). It is possible, of course, that individuals cannot readily use art to explore deeper feelings symbolically, without the support and containment of a therapist. Yet participants suggested that art-making as a leisure activity promotes subjective well-being in many other ways. Although published studies of artwork by cancer patients emphasise the exploration of darker themes, the sense of re-integration that can be achieved from creating aesthetically pleasing artwork should not be discounted. Participants continued to face distressing experiences in relation to their illness, yet art-making during leisure time offered an important resource for regaining subjective well-being. Helen (50 years old, who had completed treatment for non-Hodgkins lymphoma), explained: “You eventually carry on but in a way, the living afterwards is more of a challenge than actually just getting through your treatment—although you don’t realise it at the time. And actually to live it positively.”