There is accumulated evidence that art through many mediums has an intrinsic value in modern healthcare provision (Staricoff 2004). McNiff (1981) endorses the position that all art forms are valid and a variety of creative expression that stimulates all the senses is therapeutically beneficial. Warren (2007) argues that such meaningful avenues of expression build resilience, support recovery and are unlimited in therapeutic value. He argues that individuals can be empowered through the creative process in the creation of an image, word, sound or movement which gives an individual affirmation to the ontologically secure position that ‘I exist. I have meaning’.
Photography provides vast opportunities within mental health care for therapeutic interventions (Bach 2001; Glover-Graf and Miller 2006; Smith and Grant 2014; Weiser 2014 accessed 1 June 2014). Throughout this essay I will explore the value of photography as a public art form and its benefits within mental health care. I will draw evidence from both literature, personal experience and practice, in using photography as a therapeutic tool.
Photography as public art
Photos are everywhere; with the digitalisation of the 21st Century there has been a change in in the accessibility of photography. Previous to the appearance of modern technology, photography was a highly technical medium that was not accessible to all. Nowadays advances in technology mean that photography is much more widely accessible; rather than requiring expensive equipment and a darkroom, taking pictures only requires a disposable camera or mobile phone. The tradition of family photo albums has largely been replaced through social network sites and cyber storage, and the rise in accessibility of the Internet means that visual images captured through photography can be shared with wider audiences (PhotoVoice accessed 1 June 2014).
Photography in healthcare
The use of photography in healthcare can be dated back to the work of Dr Hugh Diamond who used photography with psychiatric patients in the mid-nineteenth century, and by the mid-twentieth century ‘phototherapy’ was used for both physical and psychological health care (Wheeler 2012). The works of Jo Spence (Fig.1), further strengthened the impact of photography as a therapeutic intervention. Her controversial works in the 1980s used photography as a medium to explore and make sense of her own experience in healthcare whilst undergoing cancer treatment (Dennett and Spence accessed 1 June 2014).
The formal use of ‘Phototherapy’, which aims to improve people’s social and empathic sensitivity, requires some minimal training (Smith and Grant 2014; Weiser 1999; Weiser accessed June 2014). However the use of less specific therapeutic interventions in healthcare using photography requires no formalised training. The benefits of photography within healthcare are extensive due to the variety of processes involved, such as taking and processing photos, looking at old personal photos and exploring photographic images taken by others. The ensuing therapeutic advantages include providing support for individuals to: explore self identity, better understand and explore the social context behind images, aid memory, use as a tool to communicate and creatively express emotions through creativity (Bach 2001; Fryrear 1980; Glover-Graf and Miller 2006; Weiser accessed 1 June 2014; Wheeler 2012).
The use of photography as a therapeutic tool within mental health care holds particular value in the exploration of self and self-identity. A significant factor amongst high proportions of individuals who have experienced mental health issues is a ‘negative self–image’ is (Glover-Graf and Miller 2006). The use of photography in exploring self-image can support an individual to develop self-knowledge and create a positive self-image, which in turn impacts on confidence and self-esteem (Weiser 2014 at). In addition, using photography to explore self-identity induces conversations that allow an individual to control how they tell their story and validates their own experience (Bach 2001, PhotoVoice accessed 1 June 2014).
Photography can provide a transformative narrative to enable people experiencing mental distress to engage in dialogue and explore meanings and their significance (PhotoVoice accessed 1 June 2014) – to, in short enable people to make sense of their worlds (Martin 1999). Furthermore, photography can provide a medium to communicate and express what cannot be verbalised. For people who are experiencing mental distress this can be of particular value. This is particularly well demonstrated through John Keedy’s (2012, accessed 1 June 2014) ‘it’s hardly noticeable’ exhibition (Fig.2). Keedy uses photography to express experiences of, in his terms, ‘unspecified general anxiety’. His images provide an insight into this experience.
My use of photography in the Allsorts youth project
I have used photography in my own life as a therapeutic intervention in a number of settings and have observed the benefits of photography in others. For the past nine years I have worked both on a voluntary and employed basis at Allsorts youth project, based in Brighton. Allsorts supports young people aged 13 to 26 who identify as lesbian, gay, bisexual, transgender or unsure of their sexuality or gender orientation (LGBTU). Although identifying as LGBTU is not a mental health issue, people who do so are at greater risk and are more likely to experience mental health issues due to discrimination in the context of a long history of LGBTU oppression within social structures (Mental Health Foundation accessed 2 June 2014; NHS choice accessed 1 June 2014).
Allsorts, places great importance on the use of art in its mental health and well-being programmes, through media such as music, creative writing and visual arts. Photography has been used extensively within Allsorts to affirm identity, build confidence, raise self-esteem, and challenge social constructs and normative notions such as heteronormativity cisgender bias. In addition to the individual therapeutic benefits of using photography as an art form, the images produced are very often published and used in campaigns to raise awareness of the LGBTU issues in the wider community. This adds a further dimension to the therapeutic benefit of photography for the young people involved, in the way that it helps them build on their confidence and self-esteem.
Identity is a key issue for LGBTU young people who attend Allsorts as this often conflicts with heteronormative and cisgendered biased social structures, causing oppression and isolation (Butler 1993; Mayberry 2013). Inevitably, an LGBTU identity can become the focus of a person’s identification. The social power of heterosexual cisgenderd identity is normalised, and LGBTB people are ‘othered’ through social discourses, for example ‘the gay doctor’ (Beasley 2005). In order to support young people to recognise that they do not have to be solely defined by their sexual orientation or gender identity, Allsorts worked collaboratively with Star Peers to produce a photo campaign that recognised that LGBTU people were defined by more than their sexuality or gender (Fig 3, accessed 1 June 2014). The project used self-portraits and words with the phrase ‘I am…’ that defined individuals in terms other than that of their LGBT status.
Whilst working with young people and taking photos of their portraits using words to define themselves, I noticed that they initially struggled to find phrases or words that were separate from their LGBTU identity. This offered opportunities for open dialogue with young people around their identity and what it meant to them.
Further, this was the basis of a further project using photography, to explore with young people what Brighton meant to them. During the ‘what Brighton means to me’ (photos unpublished) project, I supported young people in creating photos that told a story about their relationship with Brighton as their home. Throughout this project I observed the multifaceted benefits of photography as an art form. The process of taking the photos provided young people with an opportunity to support and encourage each other, strengthening their relationships. Whereas other art forms such as drawing or painting can initially be quite daunting for people who feel they have no creative ability, photography essentially simply requires capturing images. Them realising that they were able to create images through the use of cameras this boosted the confidence of the young people involved in creative expression. Furthermore the opportunity to explore Brighton rather than staying at the youth centre created a fun and enjoyable experience and the dialogue of telling their story initiated a vast range of conversational subjects. For some, Brighton meant excitement, community and home. For others, Brighton was place of safety and sanctuary in its diversity and acceptance of the LGBT community. Through sharing their experiencesof the images they created, the young people were able to add context to their identity and those experiences.
A significant photography project produced by Allsorts was ‘HumanBeing:BeingHuman’, (Allsorts 2014, accessed 1 June 2014) in which young Transgender people used photography with autoethnographical text to tell their own stories, in an exploration of self-identity. Whilst I was not directly involved in the production of this project it did serve as a tool to have a meaningful discussion with a young person through exploration of the photos.
During one of Allsorts drop-in sessions I was looking through HumanBeing:BeingHuman’ ‘with a transgendered female, Emma aged 19 (pseudonym used to protect confidentiality). Emma commented on one of the ‘non-recognisable self-portraits’, saying that she wished she could be ‘non-recognisable’. I asked Emma to expand on this, which gave her opportunity to tell her story. Emma has only recently joined Allsorts and had not disclosed her gender identity anyone outside of the facility. While Allsorts provided her with a safe space in which she could wear makeup, be known as ‘Emma’ and referred to with the pronoun ‘she’, outside of Allsorts Emma is known by her birth name and referred to as male.
We had a long discussion exploring Emma’s two conflicting identities. This discussion in itself was therapeutic for her, as she had not had the opportunity to discuss this before. In addition Emma said that HumanBeing:BeingHuman gave her hope, insight into the fact that she is not alone and a determination to pursue her identified gender as a female. This experience highlighted to me the importance of sharing stories and experiences in order to support individuals in the wider community. Photography provides a medium through which oppressed minority groups such as LGBTU communities become visible:
Without the visual identity we have no community, no support network, no movement. Making ourselves visible is a continual process.
(Joan Biren 1983, Cited in Muholi 2010, 5)
Photography, heteronormativity and me
I personally enjoy photography; I find the process of capturing an image that creates meaning for me and induces an emotion or meaning for others therapeutic. I realised the significance of my own therapeutic relationship with photography through creating visual images for a photo essay earlier this year. Identifying as a lesbian and having active involvement in challenging heteronormative concepts in the last decade, I chose to write my essay on challenging stigma within mental healthcare through the experience of the LGBT community. It wasn’t until I created the photo ‘Bottled Up’ (fig.4) (Naish 2014) that I realised I had not been able to express the impact that hetronormative discourses within society had had and continues to have on me as an individual. Until that moment the notion that my sexual orientation had been oppressed, was a metaphorical concept that had no validity other than what was ‘felt’ by me. In producing the image it created a ‘concrete’ visual expression, which I have not been able to verbalise previously.
My use of photography in nursing placements
My experience in using photography is predominantly related to my work with LGBTU young people. However I have also used photography in my nursing placements, including while working in the community mental health team when my mentor and I were supporting a 52-year-old man, John (pseudonym to protect confidentiality) who had a diagnosis of generalized anxiety disorder. One of John’s coping strategies wass to visualise places where he felt safe and secure if he becomes anxious in public. However recently he had been finding it difficult to retain such an image in his mind. We discussed both what the causes of this may be and the value of a number of different techniques to support his visualization, one of which was to use photographs of images that invoked feelings of safety, to support his visualization.
When I next saw John he reported that he had had an experience of becoming anxious whilst out shopping. He had used visualisation and mindfulness as a coping strategy to get himself home, although he still found it difficult to manage his anxiety. However he did remember the suggestion of looking at photographs and picked up an old family holiday album. John was surprised to realise he had spent an hour looking through photos, enjoying and laughing at memories of him and his brothers having fun on the beach. This served as a valuable distraction tool for him. Furthermore he showed me a photo of himself and his brothers as children on the beach, which he had saved onto his phone, and said ‘this is my favorite photo – it takes me to a place where I have no worries’.
Photography provides vast opportunities within mental health care for therapeutic interventions. Its overall significance should be understood is in the context of how using the arts generally can benefit healthcare, since Other media such as literature, movement and dance, music and myriad other art forms also have significant value in both the mental and physical Healthcare arena. In nursing there is the opportunity to utilise art to add another, counterbalancing dimension to the dominant medical model. Photography is a relatively cheap and simple to use medium in which health care users can explore self-identity, and express emotions through visual creativity.
Jaime Naish, Mental Health Nursing BSc (Hons) student
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