Part front matter for Section VII Aesthetic Experience in the Clinic

The field of medicine is replete with evocative images and processes. These occur in everyday clinical practice, in small actions as well as pronounced issues of life and death. Healthcare practitioners can be moved in aesthetic ways. However, the capacity for awareness of aesthetic experience may be suppressed in clinical practice where the positivist objective evidence base has primacy. Bureaucracy, technology, financial restraints, and high workloads may also detract from space to notice the aesthetic dimension in the human encounter in care. Aesthetic experience has been linked with values in different contemporary fields and could also be important in health care.

Whilst the word ‘aesthetics’ has several meanings, in this section it is taken from its Greek origins and will relate to sense perception. The imaginative dimension that arises during immersive participation will also be included. ‘Aesthetic experience’ also embraces human sensibilities, emotions, the tacit, haptic, pre-reflective, and the embodied. Awareness and articulation of this complexity may extend beyond words and only be fully realized during experiential practice itself.

Thus, these nine chapters take a ‘practice first’ approach. Rather than being limited by the boundaries of any one tradition, theory, or concept of philosophical thought, the focus is on noticing aesthetic experience as it arises in clinical practice. Authors offer perspectives and reflections from their practice within health care and other disciplines. They also weave in links with existing practices and theory that they feel resonate.

These chapters reach into a developing area of practice in innovative ways. They contribute examples that reveal facets of aesthetic experience in clinic work and aim to stimulate new and exciting cross-disciplinary connections, thinking, and creative synthesis of practice-based processes. Awareness of such experience may bring benefits related to values and quality in the clinical encounter. This section offers a platform for an expansion of ideas.

The first chapter (A. Cribb and G. Pullin) proposes that aesthetic considerations are relevant and important for healthcare quality and improvement in everyday practice. Written from combined perspectives of applied philosophy and design, the authors particularly draw on the sensibility in Saito’s ‘everyday aesthetics’ (Saito, 2007, 2017). They regard aesthetic experience as an intrinsic part of the experience of everyday clinical life, upholding that such awareness can contribute to enhancing quality alongside more technical issues. For example, in relation to interpersonal connection, inclusivity, equality, co-production, the environment, and design. This chapter provides an important opening for this section as it links core concerns in this Handbook with issues of quality and improvement in the world of healthcare practice and policy. ‘Practice-facing’ questions and examples are presented along with a resource of references from different disciplines. The authors wish to encourage discussion between scholars and practitioners across disciplines.

The second chapter (L. Younie) draws on the author’s practice-based clinical experience as a General Practitioner (GP) and medical educator. This included innovating, pioneering, and establishing a ‘Creative Enquiry’ pedagogy that employs expressive arts strategies to facilitate engagement with, and reflection on the human dimension in clinical practice for medical students in GP placements.

The author discusses how Creative Enquiry is a way to activate and become aware of aesthetic experience to gain deeper insights that enrich meaningful interpersonal human connection between patient and doctor or medical student. This can be embraced alongside objective biomedical facts. The author upholds that by being present to aesthetic experience in this encounter, fresh perspectives and new learning for the clinician become possible that may nurture patient and clinician alike. This chapter also draws on concepts of ‘everyday aesthetics’ amongst other literature and shows how awareness of aesthetic experience is relevant in the clinical encounter.

The third chapter (H. Fox) offers an empirical description of the nature of aesthetic experience built through a research inquiry in relation to the everyday work of healthcare practitioners. An innovative arts, practice-based methodology, called ‘Connective Aesthetics in Medicine’, was designed to explore and articulate the rich complexity of everyday aesthetic experience. New participatory processes combined familiar everyday clinical actions with poetic twists to activate aesthetic experience for healthcare participants to observe and describe.

The author’s background experience in clinical medicine, psychiatry, and the arts was combined in research inspired by ‘connective aesthetic’ arts practices from Social Sculpture, aspects of phenomenology, contemporary aesthetics, informal mindfulness, and functioning of the imagination. These were adapted and synthesized into new practice-based methods.

The nature of aesthetic experience in this study is given with examples. Awareness of aesthetic experience coupled with reflective practice may bring new insights and deeper understandings related to values and issues in quality in humane care. The human capacity for awareness of this type of aesthetic experience may offer an important resource in healthcare work.

The fourth chapter (S. Stuart-Smith) is written from the author’s experience in clinical psychiatry, psychotherapy, and horticulture. The author has recently developed a community garden in the UK aimed at helping transform people’s health and well-being through spending time in nature.

An overview of the history of the therapeutic benefits of horticulture on mental health and well-being sheds light on the complex nature of aesthetic experience that may arise. The author discusses how engaging in gardening, being in gardens and nature can activate all the senses together with emotional, physical, social, vocational, and spiritual aspects of life and how people may also experience feeling empowered and creative. In addition, deep existential meanings can emerge through working with the cycle of life in the garden. This chapter reveals the interrelated connective aesthetic engagement of the mind-body-environment complex rather than the objectified view of a disconnected spectator in horticultural practice.

The fifth chapter (C. Blowers) describes the ‘Moving Pieces Approach’ (MPA) in which sensory awareness of personal embodied experience and the intersubjective space with others in a group process are key components. The author developed this innovative practice-based approach to facilitate therapeutic understanding and amelioration of stress and trauma often held as medically unexplained symptoms in the body. The aim is to achieve sensorimotor integration through awareness of tacit knowledge and more unconscious embodied experience as these emerge and are expressed through different art forms. The approach draws on aspects of practice from the arts, psychotherapy, body-based approaches to working with trauma, somatic movement education, particularly the Feldenkrais Method and Le Coq-based physical theatre approaches.

Six core concepts of MPA are described. This model offers a therapeutic example of ways of working in an aesthetic mode to raise awareness of broader experiential knowledge than through words alone.

The sixth chapter (F. Oyebode) is written from practical experience as a psychiatrist and medical educator. The author uses literature to expand the awareness of medical students’ experiential knowledge. Examples in this chapter are used to explore characteristics of aesthetic values in the clinical encounter between doctor and patient.

The author touches briefly on evolutionary and scientific theories that uphold that aesthetic appreciation is hardwired and influences all social encounter. However, this chapter also reflects on how further factors may be involved in the role of aesthetics in the clinical consultation and setting to transform this into a more humane and connected interrelationship. In health care where the predominant value system is objectivity with doctor and patient cast in expected roles, this chapter proposes that awareness of aesthetic considerations may implicitly influence the nature and quality of care.

Sartre’s ideas of ‘perfect’ and ‘privileged’ moments are proffered as a way of thinking about attention and attunement between patient and doctor as is Martin Buber’s ‘I-Thou’ relationship. The use of language in the clinic is discussed. Prose, poetic usage, sharing of subjective descriptions and analogy are considered in comparison with clinical words that maintain distanced objectivity. Examples from various authors are cited, illustrating how this could offer a more connected, sensitive interaction for sharing of meaning beyond technical words alone and offer a more aesthetically satisfying consultation.

The seventh chapter (A. West) explores and reflects on how close attention paid to each moment in free musical improvisation (FMI) requires an aesthetic attitude and may offer a model for understanding pivotal moments in the therapeutic encounter. The author discusses commonalities between these two settings from the perspective of experience in both clinical psychiatry and as a musician. By drawing on the aesthetic experience that may arise in immersive practice of FMI, this chapter reflects on how a parallel nature of such aesthetic experience may also arise and be noticed in the therapeutic encounter. This includes attention to the intrinsic qualities of the moment, awareness of relational process, and responsivity in unique and unscripted moments that may contribute opportunities for developmental and therapeutic change. The author proposes that a better understanding of improvisational process thus becomes an ethical responsibility, given the uniqueness of individual experience. Lived experiences and imagined clinical examples are provided alongside relevant literature from psychotherapeutic theory and musical improvisation to illustrate this view.

The eighth chapter (J. Tan et al.) describes how rich aesthetic experience may come into play in the field of eating disorders alongside the objective evidence base in treatment and outcomes. The authors focus on exploring how engagement with the arts can offer a way of exploring the domain of aesthetic experience that is ‘felt’ as embodied experience, allowing it to be expressed, for emotion to be accessed, and for meaning to unfurl that may be hard to express through spoken words. They illustrate this with a range of examples from research quotes, song lyrics, poetry, creative art, and practice. They suggest that acknowledging aesthetic experience in the field of eating disorders is important in understanding and exploring these disorders, for both people who have eating disorders and also for those to seek to treat them.

The ninth chapter (A. Dempsey) offers reflections combined from the author’s practice-based experience in aerial dance; as a doctor leading a trauma group; from teaching medical students, and aspects of doctoral research in theological aesthetics.

The author considers how disparate concepts can be held in mind conjointly. Parallels are drawn between the immediacy of connection between technical and experiential knowledge required in ariel dance with components required in facilitating a trauma healing group. The latter similarly combines factual knowledge balanced with felt sense and awareness of being present to to others as a participant. Further analogies for holding disparate concepts in mind, such as earthly and spiritual, are explored in relation to theological imagination and aesthetic experience. The first relates to Kierkegaard’s dancer especially in the landing back to earth. The second, arises as the author perceives the priest’s movements in the Eucharist which are sensed as a way of uniting spirituality with everyday lives in the human world.

The author considers how these examples including aesthetic experience may reveal how awareness of different realms of knowing may be united and drawn upon in teaching for reflection on offering more holistic and compassionate care.