What Should Hang on the Walls of a Hospital, The New Yorker, July 2021
“Patient advocates agree on the palliative effects of art. But they differ on what that art should look like.”
An article exploring the thinking behind art selection in hospitals, with a particular focus on the UK charity Hospital Rooms
Extract
Mid-pandemic, while undergoing a much-delayed Pap smear at a London hospital, and encountering a poster of some tulips that neither uplifted nor offended me, I thought of a scene in Ben Lerner’s novel “10:04,” throughout which the protagonist undergoes various vaguely degrading medical experiences. “There was a poster of Picasso’s dove in the first neurologist’s waiting room, watercolors of Manhattan sunsets where they sent him for bloodwork, photographs of orchids where he waited for his CAT scan,” Lerner writes. The protagonist ponders asking his doctor, “Do you choose this stuff or does the hospital buy it in bulk?” He theorizes, irritably, “I understand the desire to have some decorations that indicate this isn’t just a hospital room, that a patient isn’t just a pathologized body. . . . it nods blandly to established cultural modes, the medium of painting and the cliched instance of it. They are images of art, not art.”
In her recent book, “ ‘Purpose-built’ Art in Hospitals: Art with Intent,” the nurse, artist, and academic Judy Rollins asks what the function and style of art in hospitals are and should be. Soothing or challenging? Figurative or abstract? Some advocate for the calming power of nature scenes, while others push for works of gallery quality: rousing, conceptual, complex. Rollins writes about the importance of curating differently depending on location—art selected for a maternity corridor may not be appropriate for an emergency waiting room. It is unfeasible, though, to attempt to control all responses. An image of a quiet landscape may comfort one patient, but for another, Rollins observes, “the scene might trigger an unpleasant memory (e.g., for a combat Veteran with posttraumatic stress disorder, an enemy awaiting behind the trees or barn).”
Rollins cites fifteen different “intents” for hospital art, including “art for empathy,” “art for inspiration and hope,” and “art for transcendence.” She argues that on some occasions—such as in cases where artists have chronicled their own illnesses—abstract work, or even art with dark or negative subject matter, can be instructional or enriching. Tools for collecting evidence about art can also be expanded, Rollins writes, thanks to brain-research techniques such as functional magnetic resonance imaging (fMRI), which maps neural activity. “Art is sensitive, so every method of measurement you use should be sensitive, too,” she told me via Zoom.
A handful of early adopters argued for the medical role of art. In “Notes on Nursing,” published in 1859, Florence Nightingale wrote, “The effect in sickness of beautiful objects, of variety of objects, and especially of brilliancy of colour is hardly at all appreciated.” Yet much of the Western medical establishment took little interest in the physical environments of hospitals until the late nineteen-seventies and early nineteen-eighties, when some researchers began arguing for the palliative potential of interiors and art work. One pioneer was Angelica Thieriot, who, after suffering from a viral infection, left a San Francisco hospital in 1978 outraged by the experience: the limited access for visitors, the lack of clarity about different procedures that her body would undergo, the general banality of the surroundings. In 1985, she established the Planetree model of “patient-centered” care, which advocates for hospital designs and treatment plans that offer more autonomy and empathy. Today, the Planetree organization advises hundreds of hospitals and governmental bodies, including the U.S. Department of Veterans Affairs, in twenty-five countries. It has introduced dimmer switches to tone down harsh lighting in hospital rooms, offered sculpture classes to patients and clowning classes to staff, and, at Griffin Hospital in Derby, Connecticut, installed a grand piano in the front lobby. Such innovations remain relatively rare, but most hospitals today will at least hang a pointedly inspirational mural of sunshine and blooming buds in the front hall. Perhaps there’s an art cart, from which patients can select works for their rooms.
Much of what we see in contemporary hospitals, including the tulips at my gynecology appointment, can be traced back to Roger Ulrich, the author of a small study conducted in a suburban Pennsylvania hospital, between 1972 and 1981. His research is cited, to this day, in nearly every article on hospital aesthetics. Twenty-three surgical patients were assigned rooms with windows looking out onto a small stand of trees, and twenty-three others were given rooms facing a brick wall. The former group had shorter hospital stays and took fewer painkillers than those with less verdant views, and nurses gave them more upbeat reports. Ulrich has referred to these findings to support a lush, green ideal for health-care art. According to him, works should be chosen only on the basis of whether they improve patient outcomes, and not because they receive praise from critics and artists, or approach gallery standards. His argument set a norm. It explains why covid patients across the world have convalesced before images of landscapes, night skies, lush vegetables, and flowers, endless flowers—pictures that feel more like the backgrounds on corporate PowerPoint presentations than the result of an artist’s vision.
According to the nature-art advocates, other kinds of art work, particularly abstract paintings, can disturb patients. Ann Sloan Devlin, the author of “Transforming the Doctor’s Office: Principles from Evidence-based Design,” told me that she would advise staying away from anything that leaves patients unsure of what they are looking at. “If people are ill and already being challenged, I don’t think that’s where you want to challenge people,” she said. The goal seems to be, as Lerner wrote in “10:04,” the suggestion of art—the inference that work has been done to break from the generic “sick person’s environment,” as Devlin called it, but without shattering expectations to the point that patients lose faith in where they are, the procedures they’re facing, or the people in charge around them. Along this line of thinking, a stock photo of a night sky, framed and hung as if precious, would be preferable to a print of Van Gogh’s “The Starry Night,” with its mesmerizing swirls and undulating curves. The inclusion of either would evince thoughtfulness and care, but the former would be less likely to excite, confuse, or rile patients. The presence of “art” could be registered with a brief glance, without demanding that they overthink the content.