The psychopathology of everyday art: a quantitative Study - World ...

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Acknowledgements, thanks and foreword This thesis comes as a culmination of questions that have arisen, mostly unformulated, over many years of involvement in art, which started casually through community projects, continued during a degree in Fine Art, and subsequent professional involvement with mental health groups. During the last decade, I touched on the same sort of question under the auspices of academic psychology during my MA., but finally the opportunity to research through psychiatry has led me to approach the subject from a far different angle than I had originally envisiaged. I have not become a multidisciplinary expert, I have tried to understand what I have applied, but no doubt shortcomings can be found in it. The course of this research, however, has changed me. It has given me new and useful skills, and thought structures, but it has also taken away some aspects I was not fully aware of; I am still synthesising the widely different contexts it covered. I am aware this thesis may read as an attack on the profession of art therapists, although this is far from the intention. It is a sad picture of art therapy research that emerges, and I have related its failings rather than the clinical achievements of this dedicated profession for which I have the greatest respect and whose research work is often constrained by lack of funding and low status. This research was made possible by the interest and generous help and encouragement I have received from some who gave their valuable time and went out of their way to assist this novice. I should like to record outstanding debts of gratitude to Dr. David Martin Foreman, Senior Lecturer, Psychiatry Dept. School of Postgraduate Medicine at the University of Keele, who supervised this research through the depths of depression to its highlights and whose unfailing encouragement, useful comments, criticism and suggestions most motivated me over the six years it took. I would like to specially thank also Mike Fletcher, Head of Dept., School of Computing, Staffordshire University, who provided specialist knowledge and supervised the application of the discriminant analysis technique and who kindly checked over the first draft of the results section. I thank these Consultant psychiatrists from N. Staffs. Hospitals, who allowed me access to their patients: Dr. K. Bloore, Dr. K. Barrett, Dr. F. MacMillan, Dr. J. Crisp, Dr. Ward, D. Gee, Dr. Slade, Dr. J. Boardman, Dr. Myers and special thanks to Dr. K. Barrett, Clinical Director, Bucknall Hospital and Senior Lecturer in Psychiatry, Post Graduate School of Medicine, Keele University whose interest, encouragement and supervision of the initial stages for the first DAPA study was instrumental in development of the test theory. John Belcher of the Dept. of Mathematics, Keele University did his best to instruct me in basic statistics in the early stages of this research; Professor Terry Shave, of the Dept. of Fine Art at Staffordshire University allowed me to recruit his students as test-raters; Dr. Linda Gantt, of Alexandria sent me her Ph.D thesis from the USA and provided some useful contacts. Finally, without the unceasing support and encouragement of my partner David, I should never have been able to finish what has seemed at times an impossible task, 14
especially since the birth of our daughter Ellie 3 years ago. His support, love and understanding is my greatest resource. Chapter One: Introduction Organisation of thesis: The first three chapters introduce the background to the study, the need for systematic assessment of painted artwork and the development of a novel approach to the assessment of drawing categories. Chapter one provides an overview, points out that conventional interpretive evaluative methods do not identify what is specifically psychiatric about artwork produced by patients and reveals the neglect of formal measures. Chapter two reviews the development of assessment of psychiatric artwork over the past 20 years in two sections. Section 1 introduces a number of popular views about how art therapy works and Section 2 concentrates on the information from case studies and controlled studies; common findings, conclusions and changes in assessment methods. These results are then critically discussed with particular reference to methodology. In chapter three a meta-analysis is performed on studies from the review to identify which groups of variables are central to reliable and systematic assessments of psychiatric paintings. The summary gathers the knowledge from the literature review to show the kinds of measurement which have the best repeatability and validity for new instruments. Chapter 4 describes the development of a novel instrument, the Descriptive Assessment for Psychiatric Art (the DAPA) and introduces the steps taken to validate it: the main experiment, inter-rater reliability and the initial study. Chapters 5 presents the results of the main study. Chapter 6 considers the support for and discrepancies from the DAPA results with previous work. Finally, Chapter seven summarises and 15
Page 1: The psychopathology of everyday art
Page 4 and 5: Table of Contents Page Number Chapt
Page 6 and 7: List of Illustrations, Figures and
Page 8 and 9: quality. 113 Table 5: Reliability s
Page 10 and 11: Table, boxplot and spreadplot 1e (b
Page 12 and 13: Table 19: Correlation for DAPA vari
Page 16 and 17: concludes on the effectiveness of t
Page 18 and 19: or drawing progresses, relationship
Page 20 and 21: The link between genius as a produc
Page 22 and 23: again by a multidisciplinary team w
Page 24 and 25: theoretical foundation relating art
Page 26 and 27: the content of which was seemingly
Page 28 and 29: approach. Some of the major critici
Page 30 and 31: Gestalt Analysis Rudolph Arnheim ha
Page 32 and 33: molar level and not by individual e
Page 34 and 35: Attempts to lists characteristics o
Page 36 and 37: tests are still popular in assessme
Page 38 and 39: investigation of artwork, but few h
Page 40 and 41: expressions of a disordered psyche.
Page 42 and 43: own paintings, or on interpretation
Page 44 and 45: pointing to integrative or global j
Page 46 and 47: Chapter Two: Review of the recent l
Page 48 and 49: etrieved from the Psychlit, which p
Page 50 and 51: a major proportion of the study mat
Page 52 and 53: psychopathology, something which is
Page 54 and 55: 3 13 5 5 5 1 3 2 10 0 0 2 11 0 0 3
Page 56 and 57: social/developmental energy theorie
Page 58 and 59: advanced from all types of papers b
Page 60 and 61: Art therapists begin their career f
Page 62 and 63: talent and therefore do not fit in
Page 64 and 65:
2. Research studies There were two
Page 66 and 67:
Method of study or description of t
Page 68 and 69:
olds and only 2 with over 60s. The
Page 70 and 71:
form of this expression and how it
Page 72 and 73:
Content: 16 studies reported change
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Pictures by bipolar depressives sho
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This section does not deal strictly
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correlation of art elements with de
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of form 154 . The formal elements w
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ecognise and work through the situa
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Conclusion The use of art was not i
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Thematic interpretation varied with
Page 88 and 89:
(2) to find out how the art relates
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There were 7 demographic variables:
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No. 1 judges 2 3 4 60 No. 2 Study 3
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satisfactory classification as it i
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or non-art tests which were not see
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favoured (12% n=6) over post measur
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procedures, or publishing bias, sin
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Table 8b. Analysis of variance perf
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spread between subjective and objec
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are linked to those artistic charac
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3 Demographic variables were used f
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Table 2. Diagnostic groups for 70 s
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However, there were few tests which
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include recognisable or identifiabl
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and emotional indicators in drawing
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The DDS (1988) study was an explora
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which were not significant - and I
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eliability studies or studies which
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Thematic variables Table 1: reliabi
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etween grades of the same diagnosis
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personally expressive images than '
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to trees (52); size of figure (75);
Page 132 and 133:
Table 4: reliability statistics and
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Line Table 5: reliability statistic
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Purpose or use of line contained on
Page 138 and 139:
Shape variables (study no.) (o) obj
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Colour Table 7: reliability statist
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number of colours. Furthermore with
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subcategories were congruous and al
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(35, 46, 36, 38, 33); and indicator
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Summary: There are unresolved defin
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Summary: The effect which distingui
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Summary: Striking variation in glob
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Reliability: Perseveration is a non
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(including schizophrenics) against
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The studies are difficult to sum up
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indicate greater agreement (even th
Page 162 and 163:
Two weaknesses lie in the simple ca
Page 164 and 165:
of drawing areas and to quantify wh
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Is Meta Analysis appropriate for th
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techniques which compensate for unr
Page 170 and 171:
drawing evaluation with comments fr
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There are few answers to this criti
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attention to overall effect sizes t
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The 'File Drawer Problem' (refer ba
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Table 2. All variables for 11 studi
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Less than a third of the drawing ar
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Case study and controlled research
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potential for psychiatric populatio
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only are discussed (indicators whic
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specific areas of positivity could
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Rating Guide (Hacking & Foreman 199
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Table 2: Summary table of expected
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Previous methods of assessing atomi
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cases as to whether informed consen
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It was decided to use a large mixed
Page 200 and 201:
paintings was not reliable enough t
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computed on any of these levels. Gr
Page 204 and 205:
The DAPA (Descriptive Assessment fo
Page 206 and 207:
The extremes of the distribution fo
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The difficulty with using t-tests i
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addition it leaves out other variab
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nebulous for reasonable conclusions
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identified were included in the stu
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DISCUSSION • The validity of the
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and the test used terminology which
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How the data were structured Althou
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How well does the method agree? Tab
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- 76% - of the scales were rated wi
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Green Blue Brown White Black Intens
Page 228 and 229:
All of the scales were understood b
Page 230 and 231:
Table 1: Demographics for experimen
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classify, even as in and out patien
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score for each subject was a ratio
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each participant received the same
Page 238 and 239:
Results Interaction effects: The me
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was no evidence of impoverishment f
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Chapter 5. Results This chapter pre
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appendix 2) and these were left in
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fairly small, less than 0.1, indica
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Red, Green, Black, Drawn Line, Emot
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1. Neither schizophrenics nor depre
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schizophrenia was indistinguishable
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Black: Black is the darkest colour
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the other groups since no confidenc
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Drawn line: The normal distribution
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proportions of empty space in the p
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1. Depressives showed significantly
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function contributed significantly
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the discriminant analysis. It will
Page 268 and 269:
Subordinate Analyses Interaction ef
Page 270 and 271:
Table 15: showing correlations betw
Page 272 and 273:
2. Intensity showed a correlation o
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quality and reliability of their me
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as being unreliable, would be metho
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There would be a correlation betwee
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Figures 3. Map of Associations betw
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Schizophrenic pictures showed corre
Page 284 and 285:
The DAPA results for depression are
Page 286 and 287:
abusers 308 , but not the schizophr
Page 288 and 289:
Control pictures showed the only as
Page 290 and 291:
yellow Structural variables Figures
Page 292 and 293:
directly, to answer this question.
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yellow and green, its removal would
Page 296 and 297:
Schizophrenics used little colour e
Page 298 and 299:
directly to the environment; assess
Page 300 and 301:
influence on apparent negativity. W
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ather than for schizophrenia 335 .
Page 304 and 305:
Supporting this point, the focus ar
Page 306 and 307:
Several kinds of difficulties were
Page 308 and 309:
portraiture, so it is difficult to
Page 310 and 311:
1, as generally the scores for schi
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numbers resulted in differentiation
Page 314 and 315:
at or above the usual level. Person
Page 316 and 317:
size (_=0.36) which contrasts wildl
Page 318 and 319:
sets had all the identified high ef
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hospital; the mean of up to 10 pain
Page 322 and 323:
eliability of the test and shows th
Page 324 and 325:
Chapter 7. Conclusion This thesis r
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probably because the form variables
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etween different groups of patients
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previously unexplored, which comple
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statistical tests and missing data
Page 334 and 335:
psychopathology in clinical diagnos
Page 336 and 337:
6 scales to categorise commonalitie
Page 338 and 339:
Orientation of the researcher, what
Page 340 and 341:
Validity Analysis of controlled stu
Page 342 and 343:
_ 2 _ _ _ _ 2 _ .3_ 1 1 _ B _ 2 1 2
Page 344 and 345:
6j. Standard differences from mean
Page 346 and 347:
Correlation table 16 for DAPA varia
Page 348 and 349:
Page 350 and 351:
Page 352 and 353:
eliefs to depression. cannot be mat
Page 354 and 355:
Table 4: summarising changes or sig
Page 356 and 357:
Table 6: summarising changes or sig
Page 358 and 359:
13 22y. male Violence and substance
Page 360 and 361:
Crosstabulations 1-6: contingency t
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Crosstabulation 3: ORIENTATION By B
Page 364 and 365:
Crosstabulation 5: FORM OF EXPRESSI
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Reliability Study Chapter 4 - Metho
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Raters R1-7 score for ORANGE, pics
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-4_ _ R-A _________________________
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e _ _ -4_ _ R-A ___________________
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c _ _ e _ _ -4_ _ R-A _____________
Page 376 and 377:
Appendix 3 Table of Authorities 1.
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connection from victim to victimize
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Hodnett, M.L. (1973), A broader vie
Page 382 and 383:
Muller-Braunschweig, H. (1975), Psy
Page 384 and 385:
Siegel, L. (1988), The use of mural
Page 386 and 387:
Psycho-Analysis , V.6(2):183-200. 3
Page 388 and 389:
10 Fagin, I. (1983), Images of grow
Page 390 and 391:
Institute Creative Arts Therapy Rev
Page 392 and 393:
psychotics, Perceptual and Motor Sk
Page 394 and 395:
Appendix 4 Development of the Descr
Page 396 and 397:
D.A.P.A. DESCRIPTIVE ASSESSMENT OF
Page 398 and 399:
INTENSITY DEFINITION: Firstly, the
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SPACE >10% >25% >55% >80% >100% DEF
Page 402 and 403:
Part 2 Rating Sheet for DAPA: Hacki
Page 404 and 405:
Rating Sheet for Casenotes DAPA ver
Page 406 and 407:
D.A.P.A. DESCRIPTIVE ASSESSMENT OF
Page 408 and 409:
Intensity DEFINITION: The brightnes
Page 410 and 411:
Form sheet for Artists. Side 2. DAP
Page 412 and 413:
Appendix 5 Permission for study, in
Page 414 and 415:
North Staffordshire Health Authorit
Page 416 and 417:
Psychiatry Dept., School P.G. Medic
Page 418 and 419:
Bibliography 418
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Psychiatry, 152(suppl.1): 33-57. Ca
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V.11: 139-143. Kaplan, F.F. (1996),
Page 424 and 425:
Reuven, S.K. (1998), Reversal of a
Page 426 and 427:
Blackwell. Arrington, D. (1992), Ar
Page 428 and 429:
MacGregor, J.D. (1989), The Discove
Page 430 and 431:
Research (ICD-10 DCR), Geneva: Auth
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