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Museums, Health and
Well-Being

Helen Chatterjee and Guy Noble

Museums, Health and Well-Being
Museums, Health and
Well-Being
Helen Chatterjee
University College London, UK
guy Noble
University College London Hospitals, UK
© Helen Chatterjee and Guy Noble 2013

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording
or otherwise, without the prior permission of the publisher.

Helen Chatterjee and Guy Noble have asserted their right under the Copyright, Designs and
Patents Act, 1988, to be identified as the authors of this work.

Published by
Ashgate Publishing Limited Ashgate Publishing Company
Wey Court East 110 Cherry Street
Union Road Suite 3-1
Farnham Burlington, VT 05401-3818
Surrey, GU9 7PT USA
England

www.ashgatepublishing.com

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloging-in-Publication Data

Chatterjee, Helen.
Museums, health and well-being / by Helen Chatterjee and Guy Noble.
pages cm
Includes bibliographical references and index.
ISBN 978-1-4094-2581-6 (hardback) -- ISBN 978-1-4094-2582-3 (ebook) -- ISBN
978-1-4724-0211-0 (epub) 1. Art therapy. 2. Museums--Therapeutic use. 3. Imagery
(Psychology)--Therapeutic use. 4. Clinical health psychology. I. Noble, Guy. II. Title.
RC489.A7C478 2013
615.8'5156074--dc23
2013004546
ISBN 9781409425816 (hbk)
ISBN 9781409425823 (ebk – PDF)
ISBN 9781472402110 (ebk – ePUB)

III
 Contents

Figures and Tables vii

Foreword ix
Acknowledgements xi

1 Museums, Health and Well-being 1

2 The Role of Arts in Health 15

3 The Link between Museums and Health and Well-being 31

4 Museums and Health in Practice 53

5 Measuring Health and Well-being 93

6 Moving Forward and Final Conclusions 107

Bibliography 125
Index 139
This page has been left blank intentionally
 Figures and Tables

Figures

4.1 Museums, Health and Well-being survey form 54

4.2 Schematic of museums, health and well-being provision by type 55

Tables

2.1 World Health Organization Quality of Life domains:

WHOQOL-BREF 23
3.1 Health and well-being outcomes derived from cultural encounters 50
5.1 Ander et al.’s generic well-being outcomes framework with
possible museum contributions  96
6.1 Public Health, Adult Social Care and NHS domains as defined
under the Health and Social Care Act 2012 121
This page has been left blank intentionally
 Foreword

This book could not be more timely. The challenges to health and well-being have
never been greater as we journey into the second decade of the new millennium. The
so-called ‘lifestyle’ diseases of developed countries are now increasingly afflicting
the developing world. In this very real sense, globalisation means the exportation
of poor health from rich countries to less well-off nations. Inequalities in health
are growing, both between countries and among social groups in individual nation
states. Economic prosperity is not evenly distributed. The old adage that it is the
health of your state more than the state of your health that counts could not be more
true when it comes to health and well-being. Health and illness are rooted in society
and culture plays a major role in determining our capacity for well-being.

In addition to the plethora of potentially avoidable non-communicable diseases,

ranging from cardiovascular ill health and cancers to depression and dementia, we
also face the ever-present challenge of communicable disease. New and re-emerging
diseases travel with increasing impunity across the globe and we can never be certain
what is just round the corner – perhaps a new strain of pandemic influenza or another
SARS-type infection.

At its heart, public health is about the organised efforts of society in preventing
disease, encouraging well-being and building resilience for when ill health strikes.
All sectors have a role to play in creating the context for better health and museums
can contribute significantly to our ‘social capital’ for better health.

Recent years have seen a rapid growth in our understanding of the role that the arts play
in health and well-being. The relationship between culture and health is indivisible and
the arts reflect the very essence of that culture. They provide a window into our values,
beliefs and behaviours. They contribute to health literacy and our understanding of
society and its impact on the way we live our daily lives. They provide an essential
conduit between the environment and our inner selves, highlighting the interrelationship
between the individual and the wider determinants of health.

Museums have not always been considered a resource for health and well-being,
despite their obvious potential. As we move from a world where populations have
x Museums, Health and Well-Being

been defined almost entirely by their disease profile to a focus on community assets,
museums must surely be one of the key ‘tools in the toolbox’ for well-being in the
future. On the one hand, museums are observatories on history and culture, providing
a lens on the relationship between health and society over time. On the other hand,
from a more contemporary perspective, they offer an interactive environment that can
contribute positively to present day well-being. Gone are the days when museums
were viewed as static and inert. Many museums these days make the most of the latest
communications media, providing engaging environments that contribute to a positive
state of psychological and physiological health. Modern-day museums are multi-
dimensional and multi-sensory in their approach, increasingly tactile and ‘hands on’.

Museums not only allow us to reflect on our heritage and the relationship between
health and society in the past, they are also part of our modern-day social capital,
contributing positively to health in the future. For the present, museums offer a truly
therapeutic environment with consequential emotional and physiological benefits.

The Marmot Review highlighted the social determinants of health and illness. The
findings strengthened the case for an ‘assets’-based approach to building capacity
for better health and well-being. Health and Well-being Boards, now established in
local authorities across the country, are looking at the assets in their communities as
they build their capacity for health in the future. We know that health is determined
largely outside of the health sector; it is not primarily a medical construct. Health,
well-being and our resilience at times of stress are functions of the many formative
influences upon us at every stage of the life course, and the arts in their various
manifestations have so much to offer. The most significant improvements in
human health have come from public health interventions, such as better nutrition
and improved sanitation, not from medical care, important though it is. Of course,
more evidence about the potential contribution of museums is needed, but this
book sets out what we already know and understand, and provides a building block
for future planning and evaluation.

The interrelationship between health, society and culture is complex. Health is part of
our human capital, a resource for economic prosperity and social development. In turn,
our social circumstances and environment determine in large measure our capacity for
health and well-being, and we must exploit all of our assets if we are to achieve our
health potential and reduce inequalities between different social groups. What better
asset can there be than the most fundamental of all windows on society – museums?
They allow us as individuals and communities to connect with our cultures and it is
these very cultures, past and present, that set the context for health in the future.

Professor Richard Parish, CBiol, FSB, FFPH, FRSPH,

Chief Executive, Royal Society for Public Health and Chair,
National Pharmacy and Public Health Forum, UK
 Acknowledgements

We are extremely grateful to numerous collaborators and colleagues who helped

make this book possible. First, we thank Dr Linda Thomson who has worked with
us as a Postdoctoral Research Associate over the past five years on various research
projects associated with museums, health and well-being. Linda’s depth and breadth
of knowledge, and her commitment and dedication to our research programme have
significantly contributed to the field of museums, health and well-being, and have
helped to inform the content and direction of the book. We are deeply indebted to her.

We are very grateful to the Arts and Humanities Research Council, which has sponsored
several research projects discussed in this book, including the Heritage in Hospitals
research project. We gratefully acknowledge the following awards (PI: HJ Chatterjee):
AH/G000506/1; AH/J500700; AH/J008524/1.

We are also grateful to several collaborators with whom we have enjoyed many lively
and informative discussions: Dr Anne Lanceley; Professor Usha Menon; Professor
Paul Camic; Jocelyn Dodd; Erica Wheeler; Hannah Paddon; and Nic Vogelpoel. We
especially acknowledge Paul Camic for his support, encouragement and help during
the writing of this book. We are also very grateful to Raquel Pinto, Mary Gillespie
and Lindsay Bontoft, MA Museum Studies students, who assisted in the collation of a
database comprising details of museums, health and well-being projects; much of their
hard work is evident in the chapters, providing information about current health and
well-being provision in the UK and beyond.

Colleagues at UCL, UCL Museums and Public Engagement and UCL Hospitals NHS
Foundation Trust have been extremely supportive, and we thank in particular: Sally
MacDonald; Michael Worton; Hannah Umar; Lauren Sadler; and Annie Lindsay. We
are especially grateful to those museum staff that provided access to their collections
for use in our research: Jack Ashby; Nick Booth; Mark Carnall; Ian Carroll; Subhadra
Das; Jayne Dunn; Andrea Fredericksen; Wendy Kirk; Susi Pancaldo; Nina Pearlman;
Stephen Quirke; and Rachel Sparks.

We are also grateful to Damian Hebron, Director of the London Arts and Health Forum
for his support.
xii Museums, Health and Well-Being

Numerous colleagues from museums, galleries and other organisations across the
UK and internationally contributed information for this book, for which we are
very grateful. The following colleagues generously donated case study and other
supplementary material: Manchester Museums and Galleries (Wendy Gallagher,
Myna Trustram and Emma Anderson), Nottingham City Museums & Galleries
(Annabel Elliott); Bethlem Art and History Collections Trust (Annabel Elliott);
Bethlem Royal Hospital Archives and Museum (Victoria Northwood); Beamish
Museum (Michelle Ball and Helen Barker); the Museum of Oxford (Helen Fountain);
Salford Museum and Art Gallery (Naomi Lewis); the British Museum (Harvinder
Bahra and Laura Phillips); Thackray Museum and the UK Medical Collections Group
(Joanne Bartholomew and Alison Bodley); Colchester and Ipswich Museums (John
Pollard and Lynette Burgess); Healing Arts: Isle of Wight (Guy Eades); Tyne & Wear
Archives & Museums (John Hentley); the Lightbox (Rib Davis); Glasgow Museums
(Claire Coia, Chris Jamieson, Mary Johnson, John-Paul Sumner and Caroline Currie);
Leicestershire’s Open Museum (Nikki Clayton); the Museum of Hartlepool (Sandra
Brauer); Sudley House, National Museums Liverpool (Justine Karpusheff and Mandy
Chivers, Assistant Chief Executive, Mersey Care NHS Trust); National Museums
Liverpool (Claire Benjamin); Acces3Ability (Colette Neal); Waterford Healing Arts
Trust (Mary Grehan); the Irish Museums Association (Gina O’Kelly); Heritage
Council Ireland (Geni Murphy); the Museum Standards Programme for Ireland
(Lesley-Ann Hayden); Macquarie University Art Gallery (Rhonda Davis and Sara
Smyth-King); the History Trust of South Australia, Government of South Australia
(Pauline Cockrill and Allison Russell); Arts in Health at Flinders Medical Centre (Sally
Francis); Helping Hand Aged Care (Susan Emerson); Helsinki Metropolia University
of Applied Sciences (Pia Strandman); Medical Museion, University of Copenhagen
(Professor Thomas Söderqvist); American Alliance of Museums (Ariana Carella); and
many other colleagues from museums and arts organisations. We also thank all of the
participants in the projects and programmes discussed in this book; their feedback and
input has been invaluable.

We gratefully acknowledge the kind words provided by Professor Richard Parish,

Chief Executive, Royal Society for Public Health and Chair, National Pharmacy and
Public Health Forum, for writing the Foreword to this book. We are also very grateful
to Lois Silverman, Constance Classen and Mark O’Neil for reading and reviewing the
manuscript.

Finally, we thank our families and friends for their enduring support.
 Chapter 1

Museums, Health and Well-being

Introduction

Many populations are facing an unprecedented socio-economic challenge.

Individuals are living longer but with unhealthier lifestyles, with a significant rise
in age- and lifestyle-related diseases, such as Alzheimer’s and diabetes. A key
consequence of these trends is considerable pressure on health services (including
the National Health Service (NHS) in the UK) and social services. In addition,
evidence reveals that there is a ‘social gradient’ in relation to health, whereby
individuals from poorer socio-economic backgrounds experience reduced health,
well-being and social resilience (the Marmot Review: Marmot et al. 2010; GCPH
2010). The Marmot Review recognises that a range of social factors must be taken
into account in order to alleviate health inequalities and that services such as the
NHS alone cannot reduce health inequalities. It goes on to suggest that social
networks and local communities strongly influence individual health and well-
being, and, further, that the extent to which people are able to participate in society
and control their own lives makes a ‘critical contribution to psychosocial well-
being and health’ (Marmot et al. 2010).

Health reforms in the UK as part of the Health and Social Care Act 2012 are
also placing greater emphasis on the role of communities through the notion
of a Big Society, which seeks to create an environment that empowers local
communities and people to take collective responsibility for their environment,
communities and public health. A key focus of these health reforms sees a shift
towards ‘prevention is better than cure’, within a model which will require a multi-
agency approach with an increased reliance on third-sector organisations such as
charities, voluntary and community organisations. Not without controversy and
opposition, these radical health reforms will change the way in which health and
social care services are delivered; this may create not only new challenges but
also opportunities for organisations such as museums, which have traditionally
not been part of the ‘public health offer’. The inclusion of museums under the
Arts Council England umbrella is also likely to encourage a museum sector shift
which recognises the value of creative experiences and access to knowledge and
information in relation to health and well-being (ACE 2011).
2 Museums, Health and Well-Being

This book seeks to define a new field of study and practice in museology, namely
Museums in Health. The field is grounded in Arts in Health and draws heavily from
research stemming from this field of study and associated good practice (Chapter
2). The book aims to encourage heritage professionals to promote museums as
assets for enhancing health and well-being. It brings together a breadth of literature
pertinent to the debate around the value of museums and cultural encounters in
relation to tangible health and well-being outcomes, and explores the underlying
psychological and physiological mechanisms which explain the value of Museums
in Health (Chapter 3). Practice-based examples are explored in detail, including
several case studies written by museum professionals, exemplifying the diversity
of current Museums in Health practices (Chapter 4). The evaluation methods
and approaches for measuring health and well-being in relation to cultural
encounters are critically examined (Chapter 5) and recommendations for the future
development of the field are offered (Chapter 6).

Background

It is widely acknowledged that the environment has a significant effect on

individual health and well-being. Roger Ulrich’s seminal study from 1984, for
example, provided some of the first quantitative evidence to show that patients
with views of nature recover more quickly after surgery compared to those with
no view of nature (Ulrich 1984). The idea that objects may have therapeutic value
is also not new. Florence Nightingale noted the effects that objects could have on
patient recovery, suggesting that the ‘variety of form and brilliancy of colour in the
objects presented to patients are actual means of recovery’ (Nightingale 1860: 58).
It is well established that museums are custodians of objects of historical, scientific
or other significance, and are concerned with collecting, cataloguing, displaying
and providing interpretations of objects for the benefit of furthering knowledge
and encouraging the public to engage with, and learn about, their own and others’
heritage. However, museums and galleries are now beginning to articulate a less
paternalistic approach to engaging with their public by recognising the therapeutic
and health benefits that their collections and resources can offer.

Not surprisingly for some, this raises the question of why should museums be
involved in the business of delivering health benefits to their audiences in the
first place? The same argument has been directed at the arts more generally.
Belfiore, for example, has questioned the impact that museums and galleries have
made to social outcomes. She explores the ‘instrumental’ aspects of government
policy and public arts organisations in using the arts as a means to tackle social
inclusion, drawing attention to a shift towards ‘an instrumental cultural policy,
which justifies public expenditure in the arts on the grounds of the advantages that
they bring to the nation’ (2002: 92). This stance focuses on the policy implications
for the future funding of subsidised arts and arts organisations as agents of social
 Museums, Health and Well-being 3

change, arguing that if social benefits cannot be demonstrated, funding will be

lost to those organisations that are better set up to deal with social issues. Whilst
this may be a worthwhile debate, rather than justify the wider role and funding
for museums and the cultural heritage sector, this book primarily seeks to explore
the evidence base for museums’ role in healthcare and does not set out to make a
case for instrumentalism in museums. However, it does recognise that individual
and community health and well-being is complex and fluid, and as such the health
services offered should reflect this. The increasing pressures on health services and
governments on personal choice in healthcare do provide potential opportunities
for museums to use their collections in a more altruistic way. Notwithstanding this,
we are in agreement with Belfiore and others who recognise the importance of
gathering a strong evidence base which is grounded in a critical evaluation of the
social impact of the arts (Belfiore 2002; Staricoff 2006; Belfiore and Bennett 2007).
It is vital that Museums in Health is supported by robust and reliable evidence, not
only to justify public expenditure in this area, but crucially to ensure that museums
and their partners deliver effective and efficient services which meet the needs of
their audiences. Thus, the debate as to whether museums should consider health
and well-being outcomes at all is largely beyond the remit of this book, as the
same argument could be levelled at virtually any area of museum programming;
for example, why should museums focus on the intrinsic educational value of their
collections? Does this imply that the intrinsic value of objects is more important
than the instrumental value of using them for societal benefit, whether that be for
educational or well-being objectives? We argue that it is not a case of ‘either/or’
and that museums can be viewed in their widest sense as more than simply places
where objects are kept for posterity:

Museums and galleries have always served a number of purposes other than
the evident one of enabling visitors to appreciate their collections of art and
artefacts. They are a site for social interaction and for acquiring and conveying
an air of cultural authority. They may provide a cool place on a hot day or a
quiet retreat. (Classen 2007: 897)

Many authors have described the social role of museums (e.g. Sandell 2002;
Classen 2005; Silverman 2010) and the link between health and socio-economic
status is well understood, as discussed above (e.g. Marmot et al. 2010; GCPH
2010). Most Western approaches to healthcare are firmly rooted within the
medical profession, despite increasing awareness of the negative health outcomes
associated with low income, poor housing and other socio-economic factors (Dodd
et al. 2002). As Dodd describes, ‘medical expertise can diagnose disease, treat
individuals’ symptoms but do little or nothing to prevent the cause of depression,
stress and chronic disease resulting from unemployment, the disintegration of
stable relationships, poor housing and poverty’ (Dodd et al. 2002: 183). The
concept of preventative versus remedial medicine is also not new, but for many
people preventative approaches to medicine are shrouded in doubt and disbelief.
4 Museums, Health and Well-Being

This is for good reason in many cases; as with remedial healthcare, preventative
healthcare requires a robust evidence base gathered using standardised, reliable
and repeatable techniques. Sadly the latter is lacking for many preventative
approaches to healthcare, but with museums’ expertise in evaluation, albeit often
geared towards educational outcomes, the transition to securing health and well-
being outcomes should not, in theory, be too onerous. Furthermore, given the
forthcoming health and social care reforms in the UK, it is extremely timely for
the museum sector to reposition itself as a core asset in the new framework, the
central tenet of which will see a focus on ‘prevention is better than cure’.

One of the biggest challenges for museums is understanding, demonstrating

and articulating their value (both preventative and remedial) to individual and
societal health (both physical and psychological) and well-being. These three
challenges form the focus of this book, which seeks to define a new field of
Museums in Health.

The Therapeutic Potential of Museums

Lois Silverman has described the museum as a promising tool for therapy and,
further, that ‘through their therapeutic potential, museums have a means to social
inclusion of individuals who are often overlooked by cultural institutions’ (2002:
70). She advocates that one pathway to expanding the social role of museums
is to recognise their therapeutic potential. By acknowledging that museums
assume a healthy visitor population and that those facing health challenges,
such as people with depression, adjusting to older age and associated loss of
function, those with terminal illness or those dealing with substance abuse, are
often excluded from museums, Silverman proposes that museums could play a
valuable therapeutic role.

In her recent book The Social Work of Museums, Silverman suggests that museums
contribute to the pursuit of health in five major ways: promoting relaxation; an
immediate intervention of beneficial change in physiology, emotions or both;
museums encourage introspection which can be beneficial for mental health;
museums foster health education; and museums are public health advocates and
enhance healthcare environments (Silverman 2010: 43). The role of museums as
agencies which encourage social cohesion and interaction, affording enhanced
psychosocial well-being, might also be added to this list. These are, by necessity,
generalisations and not all museums are working to address these agendas, but
they highlight the potential contribution that museums can make to individual
psychological and physiological health, and public health.

Silverman (2002) describes a collaborative project from 1997 at Indiana

University (MATA: Museums as Therapeutic Agents) which brought together
 Museums, Health and Well-being 5

museum staff, social/mental health programmes, researchers and students. The

aim of this innovative project was to study a set of pilot museum programmes
with explicitly therapeutic goals and to develop a better understanding of the
therapeutic potential of museums. The study resulted in the identification of
eight concepts pertaining to the theory and practice of museums as therapeutic
agents; four of these concepts relate to mental healthcare and four to the unique
environment of museums (Silverman 2002: 71). Regarding the latter, Silverman
identified the following concepts as fundamental to the therapeutic role of
museums: 1) people’s response to artefacts in museums, where she explores the
power of objects to elicit responses from people; 2) interpretive media, where
she advocates that a wide variety of media can be harnessed towards therapeutic
outcomes; 3) the social roles possible in museums, where museums can help
reinforce a sense of self and connection to others, which is particularly important
for those experiencing decreased health or function; and 4) the need for ongoing
evaluation.

Many of these themes plus new ideas pertinent to the emerging Museums in
Health field will be developed throughout this book. The themes are helpful as
a vehicle for exploring not only the therapeutic potential of museums but also
the underlying theoretical and conceptual basis for understanding the value of
museums for enhancing health and well-being. A wider exploration of these
issues is crucial in order to clearly articulate the therapeutic value of museums
across the cultural sector and beyond, particularly to the health sector.

Silverman advocates a focus on outcomes since this provides a framework to

acknowledge and support the varied aspects of a museum encounter (2002).
This is a valuable approach as it is also the framework for evaluating individual
health and well-being. Outcome measures in healthcare are the key criteria
for assessing the impact of a particular intervention (be it pharmacological or
otherwise) and for assessing change in patients over time. For Silverman, lessons
from the field of mental healthcare can enrich our understanding of what sorts
of therapeutic outcomes that museums might facilitate, since ‘mental health can
remind museums of the range of goals that are essential for a health society’
(2002: 75). Whilst this is undoubtedly valuable, we advocate incorporating a
wider spectrum of healthcare outcomes, including physical and psychological,
into the planning, design, evaluation and communication of the therapeutic value
museums. Healthcare outcomes are the main currency and language used by
healthcare professionals, and if museums are to clearly articulate their therapeutic
potential, it is essential to communicate and define a system which is understood
and valued by both sectors. Practitioners need to think strategically, focusing first
on health priorities and how they in turn can support heritage priorities. Through
establishing better links with health organisations, practitioners can begin to
understand the business and management of health which is essential if this field
of work is to be sustained.
6 Museums, Health and Well-Being

Some Definitions

Since the study of the role of Museums in Health is relatively new, it is appropriate
to attempt to define some recurring terms. The focus of this book is museums (to
include galleries) and the cultural heritage collections (see Article 1, UNESCO
1972) such institutions house or represent. The word ‘culture’ is used as a catch-
all term in this and comparable contexts (e.g. Ruiz 2004) to include museums,
galleries, libraries, literature, theatre, dance, festivals and celebration, music,
crafts, film and art. ‘The arts’ is often referred to as a separate entity, but includes
not only the people and places producing and experiencing art but also artworks
and art collections. Davies et al. (2012) recently sought to define arts engagement
via art forms, activities and level (magnitude) of engagement, and proposed that
arts engagement can be defined by five art forms: performing arts; visual arts,
design and craft; community/cultural festivals, fairs and events; literature; and
online, digital and electronic arts. Interestingly, this study and other literature refer
to visiting a museum or gallery as arts engagement. In other words, there is some
overlap between the use of the terms ‘culture’ and ‘the arts’, but suffice to say
that although the focus of this book is on the cultural heritage sector (museums,
galleries and heritage sites), examples, evidence and ideas from the broader cultural
sphere will, through necessity, be drawn upon. The term ‘cultural encounter’ is
used here to define any interaction with a cultural heritage organisation and its
collections, including: visiting museums, galleries and heritage sites; exhibition
and gallery tours; talks and lectures; and participatory and creative sessions such
as art workshops, object handling and reminiscence activities. The term ‘museum
encounter’ is likewise used to refer to any interaction with a museum (or gallery),
its collections, its staff or its spaces.

Health and well-being are two of the top agenda items for most developed and
developing countries, and are often used in combination with each other. The
World Health Organization (WHO) defined health as ‘a state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity’
(WHO 1946: 100). There is relatively little dispute about the definition of health,
but the same cannot be said for well-being. Well-being is an ambiguous term which
has little agreement among disciplines on its definition or measurement and is
often conflated with ‘health’, ‘quality of life’ and ‘happiness’ (Galloway and Bell
2006; Ander et al. 2011; Thomson et al. 2011). Ereaut and Whiting, writing for
the Department for Children, Schools and Families, suggest that ‘well-being is no
less than what a group or groups of people collectively agree makes “a good life”’
(2011: 1). A useful definition is that by the UK Think Tank the New Economics
Foundation (NEF). NEF defines well-being as ‘most usefully thought of as the
dynamic process that gives people a sense of how their lives are going, through the
interaction between their circumstances, activities and psychological resources or
“mental capital”’ (NEF 2009: 3). NEF suggests that in order to achieve well-being,
people need:
 Museums, Health and Well-being 7

a sense of individual vitality to undertake activities which are meaningful,

engaging, and which make them feel competent and autonomous, a stock of
inner resources to help them cope when things go wrong and be resilient to
changes beyond their immediate control. It is also crucial that people feel
a sense of relatedness to other people, so that in addition to the personal,
internally focused elements, people’s social experiences – the degree to which
they have supportive relationships and a sense of connection with others –
form a vital aspect of well-being. (NEF 2009: 9)

The Conceptual Basis for Museums in Health

In Chapter 2 we explore the role of Arts in Health, what it means and how
Museums in Health has emerged from the Arts in Health field. Within the chapter,
there is description of the five main domains (Dose 2006) of Arts in Health and
an exploration of some of the challenges facing both the Arts in Health and the
Museums in Health sectors in measuring impact and in particular the health and
well-being benefits that the arts can bring to society. Chapter 2 touches on some
of the academic literature and references, including the most recent reviews of
Arts in Health activity across the UK, in order to provide a picture of practice and
how that might inform museum professionals embarking on Museums in Health
projects. For practical reasons, it does not review all the academic literature in
the field; however, it is worth noting here some of the most influential studies that
evidence culture’s impact on health and well-being.

Although anecdotal, observations by Florence Nightingale made over 150 years

ago are still powerful today when expressing the possible power that museum
objects could have on the health of a population. Nightingale’s Notes on Nursing
highlights the importance of variety in patient’s environment, noting that views
out of a window or of different objects are actual means of recovery (Nightingale
1860). It is easy to dismiss Nightingale’s observations, particularly in the light
of healthcare practitioners’ requirements of a robust, systematically derived,
evidence base which is founded on a standardised experimental approach (which is
important in the validation of the evidence base). However, anecdotal observations
such as Nightingale’s are useful in combining both the quantitative and qualitative
evidence base when presenting a more approachable face to research.

There has been significant effort by some in the Arts in Health sector to move
away from a purely anecdotal approach to one which is more rigorous and
respected within both the health and academic communities of healthcare. This has
created some tensions within the sector over the suitability and appropriateness of
evaluating arts-based activities within a medical evaluation framework (which is
touched on in Chapter 2), not least because of the inherent difficulties facing Arts
in Health researchers (Raw et al. 2012). These difficulties stem from the breadth,
8 Museums, Health and Well-Being

depth and variety of art forms and delivery methods, the varying healthcare contexts
in which projects operate, and the numerous health needs of the participants and
how these needs might be addressed. Despite this, the sector has been rewarded
with an ever-increasing evidence base.

Clift et al. (2009) provide a current picture of this provision as well as the practice,
policy and research in England today. This review, coupled with Rosalia Staricoff’s
literature review (2004), is an excellent starting point for Museums in Health
professionals wishing to delve deeper into the evidence base. Below are a number
of other noteworthy studies concentrating on particular health issues, including
dementia, cancer and mental health.

Dementia

Several studies highlight the value of Arts in Health for older adults and older
adults with various forms of dementia, including Alzheimer’s disease (Cohen
2009; Cutler 2009; Zeisel 2009). It has been suggested, for instance, that the actual
aesthetic response of viewing and making art within an art gallery has a positive
effect on people with dementia (Eekelaar et al. 2012). Furthermore, Cohen (2009)
reviews several studies which show that the arts and music contribute to healthy
ageing.

Cancer

Within cancer care, increasing numbers of arts-focused interventions have

employed quantitative methods to assess health and well-being. These are
summarised in Thomson et al. (2012a) as follows:

• Weekly live-music and art exhibitions for patients receiving chemotherapy

were assessed over two months. The Hospital Anxiety and Depression Scale
(HADS; Zigmond and Snaith 1983) demonstrated lowered anxiety and
depression compared with non-intervention controls, though differences
were non-significant (Staricoff and Loppert 2003).
• A pre-test post-test, six-month trial with caregivers of cancer patients tested
the effectiveness of a caregiver-delivered, creative arts intervention. The Mini
Profile of Mood States (Mini-POMS; McNair et al. 1992) showed significant
decreases in caregiver stress (patients were not assessed) (Walsh et al. 2004).
• A pre-test post-test trial employing one-hour art therapy sessions for
patients with cancer was used to explore symptom control. The Edmonton
Symptom Assessment Scale (ESAS; Bruera et al. 1991) and State-Trait
Anxiety Index (STAI-S; Spielberger and Sydeman 1994) demonstrated
significant reductions in post-intervention symptoms (Nainis et al. 2006).
 Museums, Health and Well-being 9

• A randomised controlled trial (RCT) piloting four, weekly creative arts

interventions was conducted with participants with newly diagnosed
breast cancer. The Short Profile of Mood States (POMS-SF; Shacham
1983) showed enhanced psychological well-being where positive emotions
increased and negative emotions decreased (Puig et al. 2006).
• An RCT was used to evaluate a dance-and-movement programme for breast
cancer survivors. The Functional Assessment of Cancer Therapy-Breast
(FACT-B; Brady et al. 1997) showed significant improvements in quality
of life after 12 weeks (Sandel et al. 2005).

The studies exemplify the diversity of Arts in Health interventions used with
cancer patients as well as the range of health measures used to assess outcomes.

Mental/General Health

Cuypers et al. (2012) conducted a large population study in Norway involving over
50,000 adult participants to assess the role of cultural activities on perceptions of
health, anxiety, depression and satisfaction with life. Questionnaires were used to
ascertain that participation in both receptive and creative cultural activities was
significantly associated with good health, good satisfaction with life, low anxiety
and depression, even when the data was adjusted for confounding factors. More
specifically, the effects of singing on mental health and other aspects of health have
also been widely studied. Cohen et al. (2006) outline a study comprising 166 healthy
older adults based on a singing (choral) intervention. Using a quasi-experimental
approach, approximately half of the participants joined a singing group (intervention
group) and the rest continued activity as usual (comparison group); groups were
assessed at baseline and after 12 months. Results revealed that the intervention
group reported a higher overall rating of physical health, fewer doctor visits, less
medication use, fewer instances of falls, fewer other health problems, increased
morale and less loneliness than the comparison group. Clift et al. (2010a) review
a number of research reports investigating the link between singing and health and
well-being in non-clinical samples, and subsequently a large-scale study led by Clift
involving over 600 choral singers from English choirs resulted in the identification
of a series of positive benefits affecting happiness, a sense of social support and
friendship which ameliorate feelings of isolation and loneliness, and keeping the
mind and body active (Clift et al. 2010b). Devlin (2010) also highlights how the arts
contribute to good health, as opposed to how the arts are used to combat ill health.

The above draws attention to a range of studies which examine the effects of
Arts in Health on different aspects of health and well-being; further studies are
discussed in Chapter 2. Froggett et al. (2011) point out that despite a diversity
of studies that seek to address the impact of arts participation on health and
well-being, the absence of a common framework to evaluate these effects
10 Museums, Health and Well-Being

is problematic. Clift is in agreement, stating that ‘progress in the field of arts

and heath is crucially dependent upon the development of coherent theoretical
frameworks for understanding how involvement in the arts can result in benefits
for well-being and health’ (Clift et al. 2009: 17). The same is also true regarding
the effects of museum engagement.

Cultural Participation: The Evidence

Matarasso (1997) reports one of the most comprehensive and widely cited studies
to date regarding the wider impact of participation in arts, although it should
be noted that this work is not without its critics (Merli 2002). The research
draws from a diverse range of participatory arts programmes including cultural
festivals, museum outreach programmes and community arts projects. A total of
60 projects were looked at in detail, with a further 30 used more peripherally;
513 participant questionnaires were completed and data from a further 500
participants were included from case studies. The study employed a range of social
science methodologies including questionnaires, interviews, formal and informal
discussion groups, participant observation and other survey techniques. During the
planning stages, the study team developed six key themes against which to assess
and organise response material. These are outlined below, including the statistics
derived from the more quantitative aspects of the study.

Personal Development

• 84 per cent felt more confident about what they can do.
• 37 per cent decided to take up training or a course.
• 80 per cent learnt new skills by being involved.

Social Cohesion

• 91 per cent made new friends.

• 54 per cent learnt about other people’s cultures.
• 84 per cent became interested in something new.

Community Empowerment and Self-determination

• 86 per cent wanted to be involved in further projects.

• 21 per cent had a new sense of their rights.

Local Image and Identity

• 40 per cent felt more positive about where they live.

• 63 per cent became keen to help in local projects.
 Museums, Health and Well-being 11

Imagination and Vision

• 86 per cent tried things they had not done before.

• 49 per cent thought taking part had changed their ideas.
• 81 per cent said being creative was important to them.

Health and Well-being

• 52 per cent felt better or healthier.

• 73 per cent were happier since being involved.

Matarasso identified a series of generic findings regarding health and well-being

which suggest that participation in the arts can have a positive impact on how
people feel, be an effective means of health education, contribute to a more relaxed
atmosphere in health centres, help improve the quality of life of people with poor
health and can provide a unique and deep source of enjoyment (1997: 64). Again,
due to the lack of studies focused on heritage and health, these outcomes pertain
to projects and programmes focused on broader cultural and arts participation,
such as community arts projects with health education aims. The full spectrum of
outcomes from Matarasso’s research cannot be done justice here, but of particular
significance is a set of 50 social impacts of participation in the arts which have
been widely cited across the arts/culture and health literature (1997: VI):

1. Increase people’s confidence and sense of self-worth.

2. Extend involvement in social activity.
3. Give people influence over how they are seen by others.
4. Stimulate interest and confidence in the arts.
5. Provide a forum to explore personal rights and responsibilities.
6. Contribute to the educational development of children.
7. Encourage adults to take up education and training opportunities.
8. Help build new skills and work experience.
9. Contribute to people’s employability.
10. Help people take up or develop careers in the arts.
11. Reduce isolation by helping people to make friends.
12. Develop community networks and sociability.
13. Promote tolerance and contribute to conflict resolution.
14. Provide a forum for intercultural understanding and friendship.
15. Help validate the contribution of a whole community.
16. Promote intercultural contact and cooperation.
17. Develop contact between the generations.
18. Help offenders and victims address issues of crime.
19. Provide a route to rehabilitation and integration for offenders.
20. Build community organisational capacity.
21. Encourage local self-reliance and project management.
12 Museums, Health and Well-Being

22. Help people extend control over their own lives.

23. Be a means of gaining insight into political and social ideas.
24. Facilitate effective public consultation and participation.
25. Help involve local people in the regeneration process.
26. Facilitate the development of partnership.
27. Build support for community projects.
28. Strengthen community cooperation and networking.
29. Develop pride in local traditions and cultures.
30. Help people feel a sense of belonging and involvement.
31. Create community traditions in new towns or neighbourhoods.
32. Involve residents in environmental improvements.
33. Provide reasons for people to develop community activities.
34. Improve perceptions of marginalised groups.
35. Help transform the image of public bodies.
36. Make people feel better about where they live.
37. Help people develop their creativity.
38. Erode the distinction between consumer and creator.
39. Allow people to explore their values, meanings and dreams.
40. Enrich the practice of professionals in the public and voluntary sectors.
41. Transform the responsiveness of public service organisations.
42. Encourage people to accept risk positively.
43. Help community groups raise their vision beyond the immediate.
44. Challenge conventional service delivery.
45. Raise expectations about what is possible and desirable.
46. Have a positive impact on how people feel.
47. Be an effective means of health education.
48. Contribute to a more relaxed atmosphere in health centres.
49. Help improve the quality of life of people with poor health.
50. Provide a unique and deep source of enjoyment.

The outcomes derived from Matarasso’s study are unavoidably broad due to
the nature of the research and diversity of projects included, so it is difficult to
draw more direct and tangible outcomes. There is also an issue regarding the
transparency of the correlation between the questionnaire responses and the
outcomes discussed above, which is in part due to the limited details provided
about the research methods employed to derive the outcomes. This was highlighted
by Merli (2002) in a critical review of the Matarasso study (for a rebuttal, see
Matarasso 2003). Merli’s review proposes several methodological shortcomings,
including questions that are leading and may have encouraged respondent bias.
For example, as Merli points out, questions such as ‘Since being involved,
have you felt better or healthier?’ (where the permissible answer was: ‘yes/no/I
don’t know’) allowed the respondent to express either no change or a positive
improvement but no negative change, which means the respondent was unable
to state if he or she felt worse. This positivist approach is not uncommon in the
 Museums, Health and Well-being 13

evaluation of social and cultural activities, including museum evaluation, and this
highlights the value in adopting more objective and transparent methods, even
when subjective data forms the basis of the evaluation, and here qualitative and
quantitative methods used within a mixed-methods, interdisciplinary framework
may be of benefit (Pope and Mays 2006; Staricoff 2006; Raw et al. 2012). Further
criticisms levelled at the Matarasso study include the fact that the research design
had no control groups, so confounding variables could not be accounted for, and
the study was not longitudinal (Merli 2002). Again this is not uncommon in many
areas of research, but the ‘causal’ relationship is a common issue in this area of
study, and determining whether a cultural activity and health is correlational or
causal is problematic (Davenport and Corner 2011). Even when a study is able
to show statistically significant results which indicate a correlation between the
tested variables, proving that the effects are caused by a particular intervention
or activity is challenging, and again it is here that the use of mixed methods may
be advantageous. Finally, there is also a distinction between active and passive
engagement in the arts and the need for a common terminology from which
research can be developed, as discussed by Davies et al. (2012) and Raw et al.
(2012). This, in turn, highlights the need for focused heritage-specific research,
and in the decade or so since the Matarasso study, this has been forthcoming,
albeit on a small scale and often largely restricted to case studies. This is not to say
that case studies and reviews are not of value; indeed, the opposite is true as these
contributions give life to an otherwise largely inaccessible (to the non-academic
community) and often hard-to-navigate landscape. Some of the most significant
studies and reports are discussed in this book, but this is by no means all of the
literature that is relevant to this debate.

Ruiz (2004) reviewed a range of literature regarding the benefits of participating

in culture and sport in order to inform Scottish policy development and future
investment in culture, the arts and sport. The report examines a variety of evidence
that demonstrates both social and economic benefits from wider participation in
culture and sport, and highlights an important and recurring challenge, namely
that there is no consistent approach to evaluating or measuring the impact of
participation or those programmes and organisations (such as museums) offering
such programmes. This will be discussed in further detail in Chapter 5, but it is a
common problem faced by many reviews, and this book is no exception.

Of the studies reviewed by Ruiz pertaining to museums, she concluded that:

‘Innovative and creative outreach work in museums can reach socially excluded
groups and develop new skills, increase self-esteem and confidence and enhance
formal and informal learning’ (Ruiz 2004: Chapter 2) and, furthermore, that whilst
minority groups recognise that museums and galleries play a valuable role, they
view them as ‘elitist and not for them’ (Ruiz 2004: Chapter 3). There are plenty
of examples from museums where this is not the case, however. Work undertaken
at the Manchester Museum with diaspora communities highlights the unique
14 Museums, Health and Well-Being

social role that museums can play in helping to overcome the many challenges
faced by individuals from such communities; including tackling issues such as
social isolation, exclusion, anxiety, insecurity, sadness, loss, fear, intimidation
and sometimes confusion. This is eloquently explored by Lynch (2008) following
sustained work with several diaspora groups, with a particular focus around using
museum objects to provide a sensory process for exploring emotions, stories,
knowledge and experiences. The work highlights the value of touch and the
sensory experience, which is the theme of other chapters from the same book
(Chatterjee 2008), showing that objects can provide a route to recovery and
enhanced understanding about emotional states.

O’Neill (2009, 2010) provides a useful review of studies which have sought to
capture the impact of cultural participation (referred to by O’Neill as ‘general
cultural participation’, including visiting museums and galleries, going to the
cinema, attending music events, singing in a choir and reading books) on health
and well-being. The studies ranged in scope, size and the target population
demographic, but the large-scale studies in particular are compelling. For example,
in a study comprising 10,600 Swedish adults, Konlaan et al. (2000) found higher
mortality risk for those people who rarely engaged in cultural activities (visiting
cinemas, concerts, museums and art exhibitions) compared to those who engaged
in such activities more frequently, when the study cohort were followed up after 14
years. The authors controlled for variables such as age, sex, educational standard
and smoking. Another Swedish study assessed the effects of cultural attendance on
cancer-related mortality (Bygren et al. 2009) and determined that from a cohort of
9,000 cancer-free adults, death from cancer was 3.23 and 2.92 times more likely
among rare and moderate attendees respectively, compared to frequent attendees.
Other studies report that increased cultural participation leads to increased self-
reported health status (Johansson et al. 2001; Wilkinson et al. 2007). Furthermore,
a study of 1,200 mothers in Lebanon revealed that maternal cultural participation
was a significant predictor of child health (Khawaja et al. 2007).

Summary

In summary, there is considerable evidence regarding the health and well-being

benefits of cultural/arts participation and this is extremely beneficial in helping to
define the emerging field of Museums in Health, but navigating this literature and
understanding the discrete role of museums and cultural heritage is challenging for
two reasons: first, few studies have been carried out to explicitly understand the
value of museums to health and well-being, despite numerous examples of good
practice; and, second, a problem highlighted earlier, is the lack of a unified, agreed
evaluation or measurement approach for assessing the contribution of museums to
individual and/or community health and well-being. These two challenges will be
explored in the following chapters of this book.
 Chapter 2

The Role of Arts in Health

It is crucial to stress that Museums in Health is grounded in the field of Arts

in Health and it is this sector that currently provides the majority of literature
demonstrating arts contribution to health. Whilst there is not space here to do
justice to the full scope of literature covering Arts in Health, it is useful to explore
its background and in so doing provide the context in which Museums in Health
work has developed. This chapter will offer insights into some of the political
challenges and practical issues of working in the health sector that may well be
pertinent to museum professionals.

In the summer of 2005, University College London Hospitals NHS Foundation

Trust opened its new flagship hospital on Euston Road: University College
Hospital. Surprisingly it was not the state-of-the-art facilities offered by the hospital
that caught the attention of the press, but the art within it, notably a sculpture by
John Aiken entitled Monolith and Shadow, which sits on the steps just outside
the main entrance to the hospital. The sculpture, a beautifully polished composite
granite sourced from a prehistoric river bed in Brazil, was quickly nicknamed the
‘Pebble’ by tabloid newspapers and became the centre of a wider press furore over
NHS spending on art. The press had great fun, with headlines such as: ‘Taking
the Picasso – £9 million NHS Art Bill’ – and – ‘Off Their Rockers, Hospital
Spends £70,=000 on Giant Pebble’. Despite the vast majority of money spent on
the arts coming from charitable sources – the ‘pebble’, for example, was funded
charitably by the Kings Fund’s Enhancing the Healing Environment programme1
– the tabloids did not let this get in the way of a good story and buried the facts at the
end of their articles. For some NHS boards, who were sensitive to media criticism,
this created a lasting nervousness around the use of the arts within healthcare, and
consequently the need to justify the arts role has never been stronger. However, in
spite of this negative coverage around spending on art, it served to open a debate
around the role of arts in health and in so doing demonstrated to the public the

1 The King’s Fund’s Enhancing the Healing Environment Programme encourages and
enables nurse-led teams to work in partnership with patients to improve the environment in
which to deliver care. See http://www.kingsfund.org.uk/publications/ehe_care_environment.
html.
16 Museums, Health and Well-Being

breadth and depth of the sector. The media spotlight energised the Arts in Health
sector to lobby the Department of Health (DH) and Arts Council England (ACE) to
publish the case for the role of arts in health. The result was the publication of two
documents: Report of the Review of Arts and Health Working Group (2007);2 and
A Prospectus for Arts and Health (2007).3 These documents draw on evidence such
as Dr Rosalia Staricoff’s medical literature review in 2004, which cites 385 papers
that explicitly link the benefits of the arts on a wide range of health and well-being
outcomes. Within the Report of the Review of Arts and Health Working Group, the
DH made a clear statement in support of the role of the arts in health: ‘The Arts are,
and should be firmly recognised as being integral to health, healthcare provision and
healthcare environments’ (2007: 3).

But what do we mean when we talk about Arts in Health and exactly how are the
arts integral to health, healthcare provision and healthcare environments? In their
illuminating article, Clift et al. (2009) offer an overview of Arts in Health work
in the UK and Ireland today, focusing on policy, practice and research as well as
highlighting the various descriptions and definitions of what Arts in Health work is
all about. The Waterford Healing Arts4 programme based in Ireland, for example,
sees it as ‘arts practice with clear artistic vision, goals and outcomes that seeks to
enhance individual and community health and well-being’. Mike White defines Arts
in Health work as ‘creative activities that aim to improve individual or community
health using arts-based approaches, and that seek to enhance healthcare delivery
through provision of artworks or performances’ (White 2009: 2).

It was Aristotle who wrote that ‘the quality of life is determined by its activities’, and
it is tantalising to imagine that one of the activities to which Aristotle is referring is
indeed the arts and the active engagement and participation with them determining
the quality of one’s life. This in essence is what Arts in Health work is all about; the
aspiration to improve and maintain individuals’ and communities’ quality of life or
health through the arts. The commonality threading through these definitions is that
Arts in Health practice transforms the quality of individuals’ and communities’ lives.

Arts in Health work is as varied as the communities and individuals its serves, and not
surprisingly this has led to various attempts at categorising the work (Angus 2002;
Macnaughton et al. 2005; Dose 2006; Sonke et al. 2009; Davies et al. 2012). For the
purposes of this chapter, Dose’s four-strand typography is a useful model that can
be used to explore the various components that make up Arts in Health work. These
are: 1) Arts in the Healthcare Settings; 2) Community Arts for Health; 3) Medical

2 Report of the Review of Arts and Health Working Group, 2007, DH: http://www.dh.gov.uk/
prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_073589.pdf.
3 A Prospectus for Arts and Health, 2007, Arts Council England: http://www.artscouncil.
org.uk/publication_archive/a-prospectus-for-arts-and-health.
4 http://www.waterfordhealingarts.com.
 The Role of Arts in Health 17

Training and Medical Humanities; and 4) Arts Therapy. This chapter will narrow its
focus further on the first three of these, which are the Arts in Health activities that
have the most bearing on Museums in Health’s development as a practice.

The justification for the exclusion of arts therapies within this discussion is based
not only on expediency but also because it is important to make the distinction
that art therapy is a treatment based on ‘therapeutic intervention informed by the
practice of psychology, psychotherapy and psychiatry’ (Broderick 2011: 96) with
a set code of ethics and practice run by a professional body. The work undertaken
by the wider Arts in Health sector (Museums in Health included) is concerned
with a wider spectrum of potential benefits. This is not to say that museums and
galleries have nothing to offer qualified art therapists who use objects, paintings
and creative activity (making, craft, painting, singing, performing, etc.) with
patients as a psychotherapeutic tool, usually to deliver medical outcomes on a
one-to-one basis.

Arts in the Healthcare Settings

This encompasses a broad spectrum of activity, including architectural design and

the full gamut of art forms within healthcare environments. It is based on the
idea, and indeed a considerable amount of evidence that, the arts have a huge
impact on humanising healthcare facilities as well as contributing to improved
clinical outcomes for patients. The arts transform sterile, inhospitable clinical
environments into more welcoming, uplifting environments offering patients
comfort when they are sick, addressing their suffering and isolation, and providing
them with solace in their time of need. Participatory art projects within healthcare
environments also offer patients, staff and carers the opportunity to be creative and
expressive, and so improve their mental health (Windsor 2005). The art historian
Richard Cork writes that:

Across the world, there is an ever-increasing awareness that art can do an

immense amount to humanise our hospitals, alleviate their clinical harshness
and leave a profound, lasting impression on patients, staff and visitors.
Hospitals can undoubtedly do more to look after the whole person, not just
the patient’s bodily ailment. Many critical moments in our lives occur there,
from birth through to death, and they deserve to take place in surroundings
that honour their true significance. (2012: 5)

Whilst painting, site-specific commissions, gardens, music, lighting, proper

signage, interior design and even the view afforded to patients in hospital can all
contribute to making an environment that improves the patient’s experience, the
artist Grayson Perry argues for art in hospitals that challenges us and helps us face
up to the significant moments in our lives:
18 Museums, Health and Well-Being

Hospitals are places of extreme drama: death, injury, birth and the saving of
life are hourly occurrences. This is not reflected in the hospital art that ends up
in them … If hospitals want to use art, please can they treat us as adults? Part
of healing might be facing up to the realities of being stuck in a fallible body.
I don’t want the last thing I see from my deathbed to be a jaunty painting of
fishing boats.5

Interestingly, looking back at the early history of art in hospitals, patients were
confronted with exactly the kind of art that Perry calls for. For example, from
medieval times, visual art played a part in the healing process. During this period,
caring for the sick (and poor) was generally the domain of the church. Being
physically ill was often seen as a sign of spiritual weakness, and so monasteries
and churches were, not surprisingly, embellished with spiritual and devotional
works of art often portraying images of the sick and the dying receiving treatment
at the hands of a saint, which in turn conveyed a spiritual message to the sick in an
attempt to offer them solace and to heal the soul. The art also served to reinforce
the powerful status of the church and emphasised its charitable practices in order
to encourage rich patrons to donate funds. A fine example of this can be seen in
Europe’s – and possibly the world’s – earliest hospital, Santa Maria della Scala
in Sienna, which was founded in 1090. Within the Pellegrinaio (pilgrim) halls
in Santa Maria della Scala, where patients were treated until 1983, there are a
number of fourteenth-century frescoes commissioned by the then rector Giovanni
Buzzichelli. Buzzichelli commissioned the finest Siennese painters of the time
to create frescoes that celebrated the hospital’s glorious past, whilst creating
an environment that showed the healing, caring and charitable activities of the
hospital (Baron 1990). Domenico di Bartolo’s The Care and Healing of the Sick
(1440/1441) is probably the most famous of these frescos.

The link between arts and healthcare environments can be traced back even earlier
to ancient Greece and the town of Epidaurus, when people from all over Greece
went to visit the Temple of Asklepios, who was the god of healing. As part of the
healing process, they were prescribed walks to ‘the amphitheatre (which is still
in use today) to attend performances of tragedies or comedies’ (Senior and Croall
1993: 3). The arts were part of the everyday life and environment, part of the
process of living and healing.

In England, hospitals followed Santa Maria della Scala’s example by using art not
to only beautify the surroundings of hospitals but also as a device for propaganda,
highlighting the greatness of the institution and its patrons and the charitable acts
that were performed within it. Vast sums of money were spent on these important
civic buildings and rich patrons came forward to pay for them, commissioning the
great artists of the day in order to establish their name amongst the great and the

5 Grayson Perry, The Times, 12 September 2007.

 The Role of Arts in Health 19

good of society, and in so doing securing their place in heaven. Perhaps one of
the most impressive examples of this can be seen in St Bartholomew’s Hospital in
Spitalfields, London, where one of the most competitive artists of his generation,
William Hogarth, painted two enormous murals, The Pool of Bethesda (1735–6)
and The Good Samaritan (1737), in the staircases of the great hall to the Hospital.
Hogarth may not have had completely altruistic motives in painting the works;
he was made governor of the Hospital and he donated and painted many more
pictures for St Bartholomew’s, the Foundling Hospital and the London Hospital.
According to the doctor and hospital art historian Hugh Baron, he was also the first
to recognise the potential of hospitals as gallery spaces. He organised exhibitions
within the Foundling Hospital, recognising the opportunity not only to provide
his friends with an exhibition space but also to encourage the public to see new
artwork and the foundlings simultaneously (Baron 1987).

It remained fashionable to furnish the walls of hospitals with paintings of the

great patrons and physicians of the day throughout Queen Victoria’s reign.
However, there were a number of instances where hospitals recognised the arts’
more instrumental impact. For example, etchings in the collection of the National
Hospital for Neurology and Neurosurgery in London (previously the National
Hospital for Nervous Diseases) show it to be full of ornate furniture, with plants,
books and pictures present. The archives also reveal that the founders of the
Hospital, Louisa, Johanna and Edward Chandler, organised music and poetry
recitals for the amusement of the patients. This may in part be due to Florence
Nightingale’s comments in Notes on Nursing, where she noted the effect that a
considered environment could have on patients’ recovery (Nightingale 1860).

In 1915 Edmund Davis, a South African mining magnate, banker and the Vice
President of Middlesex Hospital, commissioned four enormous murals for the
entrance hall from the artist Frederick Cayley Robinson. The paintings adorned
the main foyer entrance of the Hospital until it was knocked down in 2005 and they
are now housed in the Wellcome Library and the UCH Macmillan Cancer Centre.
The subject matter of the paintings was again in the tradition of great hospital
art: the depiction of charitable deeds and the healing of the sick. The paintings,
entitled Acts of Mercy, are essentially two pairs: The Orphans and The Doctors.
The Doctors portrays soldiers returning from the Great War receiving treatment on
the steps of a medical institution and The Orphans shows a number of girls seated
at a table receiving sustenance. Davis’ motives for commissioning the works were
also perhaps not completely altruistic, as he certainly recognised the role that
art played in creating an impressive and perhaps awe-inspiring environment for
patients, which reflected well on the patron.

Sheridan Russell, an Almoner (chaplain) at London’s National Hospital for

Neurology and Neurosurgery, was passionate about art’s effect on the patient’s
environment and he energised his artist friends and gallery contacts to donate
20 Museums, Health and Well-Being

works of art to the hospital’s corridors and waiting rooms. Russell’s passion for
art in hospitals was infectious and he persuaded the Nuffield Foundation to help
him establish a unique paintings library that loaned artworks to other hospitals.
This marked the founding of the charity Paintings in Hospitals in 1959. Today
the Paintings in Hospitals collection contains over 4,000 artworks for loan to all
healthcare environments.

In his book The Healing Presence of Art (2012), Richard Cork provides a detailed
historical account of the presence of arts in Western hospitals up to 1975. The case
study below provides a contemporary account of the role of arts in the healthcare
environment. For alternative case studies, see Clift et al. (2009).

UCLH Arts: A Case Study

UCLH Arts is the hospital arts project that serves University College London
Hospitals NHS Foundation Trust and its surrounding community. It is funded by
charitable donations and fundraising. It aims to provide a welcoming, uplifting
environment for all patients, visitors and staff through the use of a varied and
stimulating arts programme that reflects the diversity of all users of the Trust and
in so doing improves patient well-being, boosts staff morale and widens access to
the arts. The programme was established in September 2005 and since then has
developed a reputation for programming innovative, challenging art events and
projects committed to raising the standard of the arts within the health sector.

The UCLH Arts core programme of work includes:

• running three exhibition spaces, including the Street Gallery in University

College Hospital (UCH), hosting some 12 exhibitions a year;
• hosting eight music concerts per month in the public areas across the
University College London Hospitals NHS Foundation Trust;
• providing musicians to perform by patients’ bedsides;
• running projects with museums and galleries to bring their collections to
patients and the public;
• commissioning artists to create artworks for the Trust;
• hosting dance and other performing arts events within wards and public
areas;
• running professional development projects for staff;
• instigating research into the impact of arts and heritage interventions on
patient well-being;
• providing advice on interior design and wayfinding;

Since 2005, UCLH Arts has been gathering evidence to demonstrate the impact that
the arts have on the patient experience, the hospital environment and staff morale.
 The Role of Arts in Health 21

The arts programme has received some impressive feedback that demonstrates that
the arts have a real impact on patients’ experience of the Trust. Patients across the
Trust are convinced of the benefit of the arts to them, as some of the comments taken
from an evaluation carried out by the University of Central Lancashire suggest:

‘What is fantastic about the arts programme is how often it changes, it is a

very vibrant programme, the gallery is noticeable from the road and people
do look at it.’
‘It’s music. I love music, it’s the second time I’ve been to the hospital as an
in-patient, I normally don’t come here, it’s nice to know that someone takes
an interest in art.’
‘I enjoyed it, the little moment they were here I enjoyed it, I saw that there
is kind of life somewhere, you see, even though I am sick, there is still life.’
‘Funny little things, that you don’t expect to register, really came out with a
bang … these musicians; they hit a chord that puts you on the stroke of life.’
‘The arts programme in UCLH is vibrant, diverse and engages fully with all
stakeholders. The numerical data demonstrates that there are high levels of
engagement with the programme.’
‘The new environment is calculated to lift the spirits of the sick and must
contribute to helping them on their way to health, as well as to encourage the
staff in their efforts.’
‘I am very impressed both from an architectural point of view and as a user. The
building is very inviting and welcoming.’ (Froggett and Little 2008: 16–19).

Stakeholders report that they find the programme a source of interest, enjoyment
and relaxation. The independent evaluation carried out by the University of
Central Lancashire revealed some interesting data around the active engagement
of patients with the arts programme. Their initial evaluation detailed types and
levels of engagement with the arts programme. It established that the long-term
value of the programme lies in its ability to awaken or nourish sensory faculties,
give pleasure and stimulate curiosity (Froggett and Little 2008). The second report
found that ‘the programme continued to exhibit high quality artworks that were
appreciated by service users, visitors and staff, and which added instrumental,
institutional and intrinsic value to the setting. Significantly, the diversity of
the programme, which includes live music, visual art in a variety of media and
handling of museum objects, builds high levels of interest that are crucial to its
success’ (Froggett and Little 2008: 2).

This case study highlights some of the anecdotal evidence gathered through patient
questionnaires and interviews at UCLH, but it is worth noting the substantial
and ever-growing evidence base now in place demonstrating the role of arts in
healthcare environments. Staricoff’s review (2004) highlights examples of the
impact of arts on patient outcomes, including reduction of stress, depression and
anxiety, reduced blood pressure, reduced pain intensity and the reduced need for
22 Museums, Health and Well-Being

medication. For example, an evaluation of 425 patients, 181 staff and 395 visitors
at Chelsea and Westminster Hospital showed that the presence of the visual and
performing arts in hospitals can bring down stress levels and help take patients’
minds off medical problems (Staricoff et al. 2001).

Music also plays a major role in healthcare environments and has been shown to:
reduce levels of anxiety (Frandsen 1990; Wang et al. 2002; Staricoff and Loppert
2003) and stress (Miluk-Kolasa et al. 1994) prior to surgery; lower blood pressure
among pregnant women at antenatal clinics (Staricoff 2003) and patients with heart
conditions (Elliot 1994); reduce pain intensity and improve sleep after coronary
bypass surgery (Zimmerman et al. 1996); reduce perceptions of pain among
people with rheumatoid arthritis (Schorr 1993); and reduce the need for sedatives
after urological (Koch et al. 1998), orthopaedic or plastic surgery (Walther-Larsen
et al. 1998) and analgesics following gynaecological surgery (Good et al. 2002).
The effect of listening to music was also found to be of significant relevance in
activating the immune system and decreasing the levels of the hormone cortisol,
an indicator of stress, in cancer patients (Burns et al. 2001).

The arts have also been shown to have an impact on the staff working within the
healthcare organisation, and art and design interventions have been shown to have
an impact on staff satisfaction, which in turn could contribute to the recruitment
and retention of staff (Ulrich 1992). Furthermore, a study of the impact of an
active arts programme integrated into the healthcare environment showed that it
is a major consideration for staff when applying for a job or remaining in their
current positions (Staricoff et al. 2001; Staricoff and Loppert 2003).

Community Arts for Health

Community arts for health activity operates in a variety of contexts, such as primary
care settings (GP surgeries, mental health outpatient services, care homes, respite
care facilities, rehab centres, etc.) and more informal community groups (schools,
museums, galleries and art groups). This area of work aims to encourage people to
come together in creative endeavour to address particular health issues or enhance
individuals’ sense of well-being. It serves a range of people, including those
with disabilities, mental health problems, terminal illnesses and long-term health
conditions, older adults, carers, and diaspora communities. Research shows that the
physical act of participating in the creating and making of art and the engagement
within cultural activity improves well-being and reduces stress (Windsor 2005;
Devlin 2010). Often the environment created by the communal act of creating and
experiencing culture assists in shaping a safe environment where people can form
friendships and acquire new life skills (Stickley and Hui 2012a). As touched on
earlier within Chapter 1, Francisco Matarasso, in his research investigating the
impact of participatory arts, notes a number of benefits, including the following:
 The Role of Arts in Health 23

Table 2.1 World Health Organization Quality of Life domains:

WHOQOL-BREF

Domain Facets incorporated within the domains

1. Physical health Energy and fatigue
Pain and discomfort
Sleep and rest
2. Psychological Bodily image and appearance
Negative feelings
Positive feelings
Self-esteem
Thinking, learning, memory and concentration
3. Levels of independence Mobility
Activities of daily living
Dependence on medicinal substances and
medical aids
Work capacity
4. Social relationships Personal relationships
Social support
Sexual activity
5. Environment Financial resources
Freedom, physical safety and security
Health and social care: accessibility and quality
Home environment
Opportunities for acquiring new information and
skills
Participation in and opportunities for recreation/
leisure activities
Physical environment (pollution/noise/traffic/
climate)
Transport
6. Spirituality/ Religion/spirituality/personal beliefs
religion/personal
beliefs

Note: http://www.who.int/mental_health/media/68.pdf.

• Participation in the arts is an effective route for personal growth, leading to

enhanced confidence, skill-building and educational developments that can
improve people’s social contacts and employability.
• It can contribute to social cohesion by developing networks and understanding,
and building local capacity for organisation and self-determination.
• It brings benefits in other areas such as environmental renewal and health
24 Museums, Health and Well-Being

promotion, and injects an element of creativity into organisational planning.

• It produces social change which can be seen, evaluated and broadly planned.
• It represents a flexible, responsive and cost-effective element of a community
development strategy.
• It strengthens rather than dilutes Britain’s cultural life and forms a vital factor
of success rather than a soft option in social policy (Matarasso 1997: vi).

The above can also be seen to be contributors to improved well-being (see Table
2.1 above) and it is not a big jump to recognise museums’ potential in delivering
similar benefits through participatory activity. In terms of specific health benefits,
Matarrasso also recorded the following anecdotal benefits from his research in the
area of mental health:

• positive impact on how people feel;

• effective means of health education;
• contributing to a more relaxed atmosphere in health centres;
• helping to improve the quality of life of people with poor health;
• providing a unique and deep source of enjoyment. (1997: 68).

Mike White, a leader in managing and researching arts projects addressing

community health issues, provides a detailed account of the development of
community arts practice in his book Arts Development in Community Health: A
Social Tonic (2009). In it he traces arts and community work back to the community
arts movement of the 1960s in terms of both the techniques and approaches that
have been developed (2009: 13). He reflects on Owen Kelly’s work Community,
Art and the State, which expressed community arts as a type of cultural activism
that enabled people to gain control over their lives. He discusses the importance of
SHAPE6 as a driver of community health in the 1970s and 1980s, ‘which bought
arts access issues into the health and social services domain from the perspective
of service users themselves’ (2009: 15). He goes on to discuss additional projects
such as START,7 which provided arts activity for mental health service users in
a non-institutional setting. White’s own personal journey with community Arts
in Health is an interesting one, particularly his collaboration with Dr Malcolm
Riggler, a GP based in Withymoor in the West Midlands, who recognised that
patients required more than a merely medicalised approach to their care. Riggler
understood that good health came from the idea of a healthy community and
striving for this is part of the common good:

6 SHAPE, an organisation established by Gina Levete which now provides art

opportunities for disabled artists: http://www.shapearts.org.uk/aboutshape.aspx.
7 START, an art initiative for mental health service users to experience arts in a non-
institutional setting. This was set up as part of the Manchester Hospital Arts Project established
by Peter Senior in 1973.
 The Role of Arts in Health 25

I always wanted to do all I could to help patients to fully appreciate and

understand the fragility and complexity of their own bodies, but I wanted
this to go beyond biological facts and simple health education. I believe we
could sow the seed of total enchantment with the human, help us all to find a
meaning in life and so to value ourselves, our neighbours and the community
in which we live. (White 2009: 18)

Riggler identified with the arts’ role in achieving this and collaborated with White
to create a project tackling some of the psychosocial conditions that were presented
to him at the surgery. Working with a range of people suffering from depression,
anxiety, and isolation, White teamed up with the artist Alison Jones to develop a
project that truly unified the community by establishing a lantern procession that
grew from strength to strength, with over 1,000 people participating in its tenth
anniversary procession (White 2009: 20). White lists the goals achieved through
the programme, which bear some resemblance to Matarasso’s findings above:

Increased access to information, increased understanding of health

issues, development of and access to lay referral systems, development
of communications skills and confidence, reduction in social isolation,
development of a sense of community, increased confidence to tackle causes
of ill health, reduced anxiety associated with visiting the surgery, patients’
involvement in their own care plans, and improved understanding of patients’
own and their communities’ health needs. (White 2009: 20)

For many working in the Arts in Health sector in the 1990s, the two Windsor
Seminars organised by the Nuffield Trust, chaired by the then Chief Medical
Officer Kenneth Calman, marked a unification in the Arts in Health sector. The
seminars were important because they resulted in a statement arguing that ‘the
link between art and health is now recognised to be a social process requiring new
and fundamental research’.8 This resulted in a concerted effort to gather evidence
and commission research into the field. Academic institutions such as Anglia Ruskin
University, the University of Central Lancashire, University College London,
Manchester Metropolitan University, Durham University and Canterbury Christ
Church University have all since set up research groups dedicated to investigating
culture’s relationship to health. A website9 set up by the National Alliance for Arts
Health and Well-being provides information about the impact of creativity on health
and well-being. It also includes a database of research on the ways in which the arts
benefit health, examples of Arts in Health projects from across England and links to
organisations working in this area.

8 See Calman (2002), http://www.nuffieldtrust.org.uk.

9 http://www.artshealthandwellbeing.org.uk.
26 Museums, Health and Well-Being

Medical Training and Medical Humanities

As previously touched upon, the relationship of the arts with medicine goes back
many thousands of years, so it is no surprise that the arts have a huge amount to offer
in the training of medical students in terms of developing the practice of medicine
and assisting in the understanding of well-being. Many medical schools, nursing
colleges and professional development programmes for clinicians now use the arts
and humanities in medical training, including: assisting in the development of
better communication skills; improving empathy and thus humanising the medical
experience of patients; and improving observational skills, which in turn assist in
the better understanding of patient conditions and patient diversity. This area of
Arts in Health practice offers great potential for cross-disciplinary working which
brings scientists, patients, clinicians, patients and their carers onto a level playing
field to explore issues around medicine, culture and scientific research, and in so
doing engages with the public in a more accessible manner.

The fact that the arts have so much to offer medical training – and indeed health
generally – indicates that science does not hold all the answers to, or about,
health, both in terms of its language and its tools of treatment. White refers to
Michael Wilson’s book Health is for People (1975), in which Wilson alludes to the
alternative perspective that the arts can bring:

Factors which make for health are concerned with a sense of personal and
social identity, human worth, communication, participation in the making of
political decisions, celebration and responsibility. The language of science
alone is insufficient to describe health; the languages of story, myth and poetry
also disclose its truth. (White 2009: 17)

The arts then provide the physician, surgeon, nurse and health practitioner with
an avenue to explore these factors of health, and projects across the country have
been established to complement medical education. Suzy Wilson, Artistic Director
of the theatre company Clod Ensemble and an Honorary Senior Lecturer at Bart’s
and the School of Medicine and Dentistry at Queen Mary, University of London,
runs a programme entitled Performing Medicine aimed specifically at medical
students and healthcare professionals. Wilson believes that the ‘arts can have a role
in medical education in three ways: practical skills; examination of cultural and
ethical issues through the arts; and introduction to artists working in health’ (2006:
368). It seems that central to Wilson’s approach to working within this domain is
the ability of the arts to cross boundaries, challenge the status quo and encourage
cross-disciplinary working. Today, theatre is commonly used in medical education
and UCLH Education Centre employs actors to play the role of patients in order
to act out different scenarios for students to respond to in a safe environment.
Wilson is in no doubt of the benefits that performance can bring to students: ‘An
understanding of the practical skills of voice, body language and use of space can
 The Role of Arts in Health 27

make a huge difference to the way doctors communicate and perhaps even to the
way they diagnose’ (2006: 368).

Healthcare operates in a variety of contexts within diverse populations and

healthcare professionals need to be equipped to deal with this heady mix. For
example, how can a young medical student be expected to relate appropriately
or know how to communicate with an elderly patient when he or she has no
understanding of what it is to be old? Theatre and, indeed, museum and gallery
collections have a lot to offer the medical profession in the consideration of the
cultural and ethical heritage of the population they serve, and good communication
is essential to this. Some of the findings from a research project set up by UCL
using medical students (as part of their SSM)10 to deliver and run handling sessions
of museum objects with patients demonstrated this, emphasising the importance of
providing medical students with opportunities to communicate with patients in a
non-clinical way, encouraging them to consider the whole person and not just the
illness (Chatterjee and Noble 2009). This project demonstrated that challenging
students’ perceptions of what patient care can be leads to improvements in student
communication skills and consequently an improved patient experience.

Medical schools use a variety of approaches in developing their students’ skills

and a number of studies have revealed that the arts can be used to enhance the
observational skills of healthcare professionals to better understand the human body
from a biological, biomechanical, relational and ethical perspective (Dolev et al.
2001; Shapiro et al. 2006; Kirklin et al. 2007; Naghshineh et al. 2008; Fougner and
Kordahl 2012). In particular, life drawing, and looking at art within a gallery setting,
has been shown to improve (albeit short-term) observational skills. For example,
first-year medical students taking part in art appreciation classes which involved
describing dermatological lesions significantly improved their observational skills
(Dolev et al. 2001). Furthermore, a cluster design controlled trial of arts-based
observational skills training in primary care also demonstrated statistically significant
improvements in the observational skills of doctors and nurses (Kirklin et al. 2007).

The actual process of looking at, discussing and deciphering paintings also has
a lot to offer the healthcare professional and, indeed, patients and their carers.
Rembrandt’s Anatomy Lesson of Dr Nicolaes Tulp (1632) and Anatomy Lesson of Dr
Joan Deyman (1656) depict physicians in the process of understanding the workings
of the human body and perhaps placing those physicians closer to God. As Cork
explained, ‘the Dutch believed that dissection engendered a greater awareness of

10 SSMs are defined by the UK’s General Medical Council as: ‘that part of the course
which goes beyond the limits of the core, that allows students to study in depth in areas
of particular interest to them, that provides them with insights into scientific method and
the discipline of research and that engenders an approach to medicine that is constantly
questioning and self-critical’.
28 Museums, Health and Well-Being

God’s identity, an examination of brain tissues was tantamount to probing the very
workings of His mind’ (2012: 122). These paintings provide an ideal scaffold for
discussions around dissection and the role of the physician, his or her perceived
power and the position of the patient within this dynamic (Wilson 2006). A painting
such as Extreme Unction by Poussin again allows exploration and discussion around
issues of death and the last rites. Students who are encouraged to reflect on their role
as caregiver will gain greater insights into the patient/carer/doctor relationship. The
use of creative art has also been shown to be effective in enhancing the counselling
skills of hospice professionals working with the bereaved (Zamierowski and Gordon
1995).

Artists working alongside healthcare professionals can also offer further stimulus
to clinicians to reflect on the patients’ own experience of their illness and care.
The artist Deborah Padfield11 worked within the Eastman Dental Hospital,
UCLH, using photography to help patients visualise their perception of facial
pain. Clinicians normally have a standardised scoring chart for pain that merely
describes the amount of pain a patient is in, as opposed to the type of pain a
patient might be feeling (heavy constant pain, electric pulsating pain, etc.). The
description of pain does not necessarily provide the clinician with the relevant
information needed to treat the patient and Padfield was able to develop a visual
dictionary of cards which patients were able to hold up to illustrate how they were
feeling. This obviously has uses for patients whose first language is not English.
This is but one of many possible examples of how artists and the arts can provide a
valuable insight into the human condition and reinforce the need for holistic care.

For many medical professionals, the present available research and case studies
touched on here do little to justify the inclusion of arts in an already-packed core
medical curriculum. The arts operate on the periphery of the curriculum, and Dr
Helen Smith, Professor of General Practice at Brighton and Sussex Medical School,
writes that the position of arts in the medical curriculum is a precarious one and
one that can only be resolved with a solid evidence base: ‘One way of sustaining
art/medicine initiatives in the medical curriculum is to orchestrate a shift from the
peripheral to the core curriculum. This desirable scenario can only be achieved if
there is sound evidence that prescribed learning objectives, for example, fostering
critical thinking, self-reflection or understanding the meaning of illness, can be
acquired more efficiently and effectively by the additional study of art and the
humanities’ (Smith 2012: 107). Where art does feature in the curriculum, it is
part of the student-selected component that the General Medical Council (GMC)
currently suggests should make up a minimum of 10 per cent of the curriculum (it
stood at 25 per cent in 2003).

11 The artist Deborah Padfield was artist in resident at UCLH NHS Foundation Trust from
2008 to 2011. An exhibition entitled face2face was shown in the Street Gallery, UCH and is
still available to see through UCH.
 The Role of Arts in Health 29

Arts in Health: The Future

In spite of the already-extensive evidence available, some of which has been

referred to within this book, the Arts in Health sector is conscious of the need
to continue to build on the evidence base in a way that demonstrates impact
and thus contributes to the case in persuading funders to make policy decisions
that encourage engagement with the arts. For some academics, however, it
seems that this preoccupation with evidence gathering is a cause for concern
that creates instability within the sector. Raw et al. argue that resistance to
definitions, disagreements over what constitutes a valid evidence base and a lack
of consideration of the practice and theory of Arts in Health detrimentally affect
the academic status of the field. Without a more concentrated effort away from
evidence gathering ‘towards analysing and theorising the practice in question, the
basis for understanding and accepting the findings of impact studies will remain
insubstantial’ (2012: 98). Raw et al. suggest that developing an interdisciplinary
theoretical framework exploring key themes and concepts that have emerged from
participatory arts practice will best serve the sector in ensuring ‘a healthy and
robust arts and health debate’ (2012: 105).

Susan Potter also identifies with this interdisciplinary approach and stresses that in
our ambition to find appropriate means to measure the impact of the arts, we must
still seek to find a common language in which to communicate. Artists working
in healthcare settings, or indeed within the community, are in a unique and often
ambiguous position, and questions remain as to whether it is even appropriate
(or ethical) to apply an evidence-based methodology to contemporary art practice
within clinical practice (Broderick 2011; Potter 2012). Potter reminds us that to
achieve improvements in public health, a range of approaches are necessary, and
argues that if the Arts in Health sectors are to truly work together, there has to be a
consensus, a sharing and a mutual respect of values. She argues for a progressive
research programme to be implemented to generate ‘hypotheses, while remaining
sensitive and flexible to the unique “nuanced and intangible” nature of the art’
(2012: 18).

As this discussion within academia goes on, the grassroots work of Arts in Health
continues and it is important not to understate the important place of anecdotal
evidence: the informal stories of the ability of the arts to impact on people’s
lives are still worth recording and celebrating. Lord Howarth of Newport writes
thatr ‘the real energy however will always come from the grass roots – from the
practitioners and the artists … Arts are the index of the health of a nation and not
the ill health of society, and the process of creating art is healing for the individual
artist as much as it is for all of us collectively. It’s not just about a remedy to
certain ailments but it is certainly about maintaining a good life balance’.12

12 Extract from Voluntary Arts Network paper, p. 14.

30 Museums, Health and Well-Being

As important as the evidence is, so too is a sector’s ability to support and celebrate
good practice, lobby opinion formers and disseminate the evidence. The recent
establishment of an International Journal of Arts & Health has done much to
achieve this, as has the work of a number of networking organisations such as
the London Arts and Health Forum who have been instrumental in attracting
funding from the Arts Council to establish a website for the sector, as well as to
support the formation of a National Alliance for Arts Health and Well-being. It is
clear that this is a vital service bringing together all the professions and evidence
assisting the sector in speaking with one unified voice. With the pressures of
funding requirements and the museum sector’s own need to demonstrate wider
social impact, it would be astute to not only look within its own sector for shared
expertise and resources but also to take note of the existing models, arguments and
examples presented within this chapter when expounding the value of Museums
in Health activities.

Summary

This chapter has provided a summary of the numerous ways in which the arts
permeate health and well-being. Art projects up and down the country continue
to practice with the aim of transforming the quality of life of individuals and
communities. Arts in the healthcare settings, community arts for health, and the
arts in medical training and medical humanities have all been discussed. The case
studies and evidence that have been presented here give an idea of the enormous
breadth of the sector in which Museums in Health is grounded. The chapter has
offered a synopsis of the ongoing discussions within the Arts in Health sector
around what should be measured, what the appropriate measurement methods
should consist of, what the appropriate frameworks for evaluation should be,
the need for a common language across the art and health sectors, and how the
evidence of impact should be disseminated. These discussions are all relevant to
the Museum in Health professional.
 Chapter 3

The Link between Museums and

Health and Well-being

The museum sector has become increasingly aware of the value that their
collections and resources can bring to individual and community health and well-
being. This chapter first discusses some of the best-known examples pertaining to
this work, some of which broadly fit under the therapeutic arts umbrella, whilst
other work can be considered part of the sector’s wider contribution to social
engagement and cohesion. In addition, some of the key health and well-being
outcomes derived from such encounters are explored in the context of defining a
lexicon of museum-specific health and well-being outcomes. Second, this chapter
examines the underlying mechanisms which help to explain why and how cultural
encounters contribute to improvements in health and well-being, and in so doing
defines the conceptual framework for Museums in Health. Evidence from a broad
spectrum of disciplines (including psychology (psychosocial, psychoneurology,
psychophysical and psychoneuroimmunology), neuroscience and physiology) is
reviewed in order to begin to understand why and how museum encounters can
enhance health and well-being.

Museums in Health: The Evidence Base

Perhaps one of the best-known and most widely cited Museums in Health examples
is the Museum of Modern Art’s (MoMA, New York) Meet Me project. This initiative
offers guided tours for small groups of around eight people with dementia plus their
family members and carers, providing facilitated tours which take in four or five
artworks related to specific themes. Research undertaken at MoMA by New York
University across nine months employed a psychosocial framework using a variety
of scales to assess participants’ responses to the sessions. The measurement scales
included self-rating scales, which sought to capture the emotional state of participants,
and observer-related scales, which allowed researchers and museum staff to record
their observations of participants and group dynamics. The research found improved
relationships with carers, and improved interaction and happiness for adults with
dementia after viewing and discussing artworks (Rosenburg et al. 2009). MoMA’s
32 Museums, Health and Well-Being

Meet Me project was part of an international initiative involving other organisations

in the USA (including the Harvard Museum of Natural History and the Lexington
Museum of National Heritage), France and Australia (Zeisel 2009).

The Good Times programme run by the Dulwich Picture Gallery in London has
received considerable attention in the media and won a variety of awards and
commendations, including a Royal Society for Public Health award for excellence
and innovation, in 2011. The programme provides a range of activities, including
creative workshops, art appreciation talks and gallery tours for older adults, targeting
socially isolated members of the community. The Gallery also offers a Prescription
for Art service in association with local doctors’ surgeries, where nurses with
special responsibilities for older adults invite patients to creative workshops run by
the gallery. A retrospective qualitative evaluation of the Good Times programme,
undertaken by the Oxford Institute of Ageing at the University of Oxford, used
existing post-session questionnaires, diaries and personal testaments, selected
interviews with participants and observations from creative workshops to evaluate
the impact of the programme. The research determined that the programme enhances
the lives of local people, helps combat social isolation and improves the efficacy of
conventional medical treatment (Harper and Hamblin 2010).

The Open Museum is the outreach service run by Glasgow Museum which seeks
to take the museum’s collections to hard-to-reach audiences and non-traditional
users. Dodd et al. (2002) showed that creative activities gave participants a means
of self-expression that was effective in countering mental health issues and
enabling new skills. More recently, Balshaw et al. (2012) describe eight projects
carried out in seven museums across the north-west of England. These projects
ranged in scope, size and target audience, but all were organised under a ‘health
and culture’ banner. Healthy walks organised by Bolton Museum and Archive and
the People’s History Museum (Manchester) targeted mental health service users
and socially isolated older adults (aged between 60 and 80) respectively. These
sessions combined in-house museum activities such as museum object-handling
and creative and reminiscence activities with opportunities to explore social history
through guided walks in the local areas. Outreach activities run by Manchester
Museum and Salford Museums and Art Gallery focused on providing opportunities
for reminiscence through handling museum objects in hospital wards, care homes
and day centres. Other museums used their collections for public health education,
such as the Fit for Life exhibition at Portland Basin Museum (Ashton-under-Lyne)
and a programme to encourage breastfeeding in north Manchester developed by
Manchester Art Gallery. Another project at Manchester Art Gallery, delivered by
Wigan Child and Adolescent Mental Health Services, sought to enhance recovery
and build self-esteem in young people with eating disorders and a history of
self-harm. Two psychiatrists, employed as part of the project team, encouraged
participants to explore issues such as relationships, identity or bullying through
gallery visits and creative art sessions.
Discovering Diverse Content Through
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The Project Gutenberg eBook of Stellar
Showboat
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Title: Stellar Showboat

Author: Malcolm Jameson

Illustrator: Alexander Leydenfrost

Release date: May 28, 2020 [eBook #62255]

Most recently updated: October 18, 2024

Language: English

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*** START OF THE PROJECT GUTENBERG EBOOK STELLAR

SHOWBOAT ***
STELLAR SHOWBOAT
 By MALCOLM JAMESON

A drama more fantastic than any the stage

had ever produced was being plotted behind
the curtains of the Showboat of Space. And
between its presentation and inter-world
disaster, waiting for his cue, stood only
the lone figure of Investigator Neville.

[Transcriber's Note: This etext was produced from

Planet Stories Fall 1942.
Extensive research did not uncover any evidence that
the U.S. copyright on this publication was renewed.]
Special Investigator Billy Neville was annoyed, and for more reasons
than one. He had just done a tedious year in the jungles of Venus
stamping out the gooroo racket and then, on his way home to a
well-deserved leave and rest, had been diverted to Mars for a swift
clean-up of the diamond-mine robbery ring. And now, when he
again thought he would be free for a while, he found himself
shunted to little Pallas, capital of the Asteroid Confederation. But
clever, patient Colonel Frawley, commandant of all the Interplanetary
Police in the belt, merely smiled indulgently while Neville blew off his
steam.
"You say," said Neville, still ruffled, "that there has been a growing
wave of blackmail and extortion all over the System, coupled with a
dozen or so instances of well-to-do, respectable persons
disappearing without a trace. And you say that that has been going
on for a couple of years and several hundred of our crack operatives
have been working on it, directed by the best brains of the force,
and yet haven't got anywhere. And that up to now there have been
no such cases develop in the asteroids. Well, what do you want me
for? What's the emergency?"
The colonel laughed and dropped the ash from his cigar, preparatory
to lying back in his chair and taking another long, soothing drag. The
office of the Chief Inspector of the A.C. division of the I.P. was not
only well equipped for the work it had to do, but for comfort.
"I am astonished," he remarked, "to hear an experienced policeman
indulge in such loose talk. Who said anything about having had the
best brains on the job? Or that no progress had been made? Or that
there was no emergency? Any bad crime situation is always an
emergency, no matter how long it lasts. Which is all the more reason
why we have to break it up, and quickly. I tell you, things are
becoming very serious. Lifelong partners in business are becoming
suspicious and secretive toward each other; husbands and wives are
getting jittery and jealous. Nobody knows whom to trust. The most
sacred confidences have a way of leaking out. Then they are in the
market for the highest bidder. No boy, this thing is a headache. I
never had a worse."
"All right, all right," growled Neville, resignedly. "I'm stuck. Shoot!
How did it begin, and what do you know?"

The colonel reached into a drawer and pulled out a fat jacket bulging
with papers, photostats, and interdepartmental reports.
"It began," he said, "about two years ago, on Io and Callisto. It
spread all over the Jovian System and soured Ganymede and
Europa. The symptoms were first the disappearances of several
prominent citizens, followed by a wave of bankruptcies and suicides
on both planetoids. Nobody complained to the police. Then a squad
of our New York men picked up a petty chiseler who was trying to
gouge the Jovian Corporation's Tellurian office out of a large sum of
money on the strength of some damaging documents he possessed
relating to a hidden scandal in the life of the New York manager.
From that lead, they picked up a half-dozen other small fry
extortionists and even managed to grab their higher-up—a sort of
middleman who specialized in exploiting secret commercial
information and scandalous material about individuals. There the
trail stopped. They put him through the mill, but all he would say is
that a man approached him with the portfolio, sold him on its value
for extortion purposes, and collected in advance. There could be no
follow up for the reason that after the first transaction what profits
the local gang could make out of the dirty work would be their own."
"Yes," said Neville, "I know the racket. When they handle it that way
it's hard to beat. You get any amount of minnows, but the whales
get away."
"Right. The disturbing thing about the contents of the portfolio was
the immense variety of secrets it contained and that it was evidently
prepared by one man. There were, for example, secret industrial
formulas evidently stolen for sale to a competitor. The bulk of it was
other commercial items, such as secret credit reports, business
volume, and the like. But there was a good deal of rather nasty
personal stuff, too. It was a gold mine of information for an
unscrupulous blackmailer, and every bit of it originated on Callisto.
Now, whom do you think, could have been in a position to compile
it?"
"The biggest corporation lawyer there, I should guess," said Neville.
"Priests and doctors know a lot of personal secrets, but a good
lawyer manages to learn most everything."
"Right. Very right. We sent men to Callisto and learned that some
months earlier the most prominent lawyer of the place had
announced one day he must go over to Io to arrange some
contracts. He went to Io, all right, but was never seen again after he
stepped out of the ship. It was shortly after, that the wave of
Callistan suicides and business failures took place."
"All right," agreed Neville, "so what? It has happened before. Even
the big ones go wrong now and then."
"Yes, but wait. That fellow had nothing to go wrong about. He was
tremendously successful, rich, happily married, and highly respected
for his outstanding integrity. Yet he could hardly have been
kidnaped, as there has never been a ransom demand. Nor has there
ever been such a demand in any of the other cases similar to it.
"The next case to be partially explained was that of the
disappearance of the president of the Jupiter Trust Company at
Ionopolis. All the most vital secrets of that bank turned up later in all
parts of the civilized system. We nabbed some peddlers, but it was
the same story as with the first gang. The facts are all here in this
jacket. After a little you can read the whole thing in detail."
"Uh, huh," grunted Neville, "I'm beginning to see. But why me, and
why at Pallas?"
"Because you've never worked in the asteroids and are not known
here to any but the higher officers. Among other secrets this ring
has, are a number of police secrets. That is why setting traps for
them is so difficult. I haven't told you that one of their victims seems
to have been one of us. That was Jack Sarkins, who was district
commander at Patroclus. He received an apparently genuine
ethergram one day—and it was in our most secret code—telling him
to report to Mars at once. He went off, alone, in his police rocket. He
never got there. As to Pallas, the reason you are here is because the
place so far is clean. Their system is to work a place just once and
never come back. They milk it dry the first time and there is no need
to. Since we have no luck tracing them after the crime, we are going
to try a plant and wait for the crime to come to it. You are the
plant."
"I see," said Neville slowly. He was interested, but not enthusiastic.
"Some day, somehow, someone is coming here and in some manner
force someone to yield up all the local dirt and then arrange his
disappearance. My role is to break it up before it happens. Sweet!"
"You have such a way of putting things, Neville," chuckled the
colonel, "but you do get the point."
He rose and pushed the heavy folder toward his new aide.
"Bone this the rest of the afternoon. I'll be back."

It was quite late when Colonel Frawley returned and asked Neville
cheerily how he was getting on.
"I have the history," Neville answered, slamming the folder shut,
"and a glimmering of what you are shooting at. This guy Simeon
Carstairs, I take it, is the local man you have picked as the most
likely prospect for your Master Mind crook to work on?"
"He is. He is perfect bait. He is the sole owner of the Radiation
Extraction Company which has a secret process that Tellurian
Radiant Corporation has made a standing offer of five millions for. He
controls the local bank and often sits as magistrate. In addition, he
has substantial interests in Vesta and Juno industries. He probably
knows more about the asteroids and the people on them than any
other living man. Moreover, his present wife is a woman with an
unhappy past and who happens also to be related to an extremely
wealthy Argentine family. Any ring of extortionists who could worm
old Simeon's secrets out of him could write their own ticket."
"So I am to be a sort of private shadow."
"Not a bit of it. I am his bodyguard. We are close friends and lately I
have made it a rule to be with him part of the time every day. No,
your role is that of observer from the sidelines. I shall introduce you
as the traveling representative of the London uniform house that has
the police contract. That will explain your presence here and your
occasional calls at headquarters. You might sell a few suits of clothes
on the side, or at least solicit them. Work that out for yourself."
Neville grimaced. He was not fond of plainclothes work.
"But come, fellow. You've worked hard enough for one day. Go up to
my room and get into cits. Then I'll take you over to the town and
introduce you around. After that we'll go to a show. The showboat
landed about an hour ago."
"Showboat? What the hell is a showboat?"
"I forget," said the colonel, "that your work has been mostly on the
heavy planets where they have plenty of good playhouses in the
cities. Out here among these little rocks the diversions are brought
around periodically and peddled for the night. The showboat, my
boy, is a floating theater—a space ship with a stage and an
auditorium in it, a troupe of good actors and a cracking fine chorus.
This one has been making the rounds quite a while, though it never
stopped here before until last year. They say the show this year is
even better. It is the "Lunar Follies of 2326," featuring a chorus of
two hundred androids and with Lilly Fitzpatrick and Lionel Dustan in
the lead. Tonight, for a change, you can relax and enjoy yourself. We
can get down to brass tacks tomorrow."
"Thanks, chief," said Neville, grinning from ear to ear. The
description of the showboat was music to his ears, for it had been a
long time since he had seen a good comedy and he felt the need of
relief from his sordid workaday life.
"When you're in your makeup," the colonel added, "come on down
and I'll take you over in my copter."

It did not take Billy Neville long to make his transformation to the
personality of a clothing drummer. Every special cop had to be an
expert at the art of quick shifts of disguise and Neville was rather
better than most. Nor did it take long for the little blue copter to
whisk them halfway around the knobby little planetoid of Pallas. It
eased itself through an airlock into a doomed town, and there the
colonel left it with his orderly.
The town itself possessed little interest for Neville though his trained
photographic eye missed few of its details. It was much like the
smaller doomed settlements on the Moon. He was more interested in
meeting the local magnate, whom they found in his office in the
Carstairs Building. The colonel made the introductions, during which
Neville sized up the man. He was of fair height, stockily built, and
had remarkably frank and friendly eyes for a self-made man of the
asteroids. Not that there was not a certain hardness about him and a
considerable degree of shrewdness, but he lacked the cynical
cunning so often displayed by the pioneers of the outer system.
Neville noted other details as well—the beginning of a set of triple
chins, a little brown mole with three hairs on it alongside his nose,
and the way a stray lock of hair kept falling over his left eye.
"Let's go," said the colonel, as soon as the formalities were over.
Neville had to borrow a breathing helmet from Mr. Carstairs, for he
had not one of his own and they had to walk from the far portal of
the dome across the field to where the showboat lay parked. He
thought wryly, as he put it on, that he went from one extreme to
another—from Venus, where the air was over-moist, heavy and
oppressive from its stagnation, to windy, blustery Mars, and then
here, where there was no air at all.
As they approached the grounded ship they saw it was all lit up and
throngs of people were approaching from all sides. Flood lamps
threw great letters on the side of the silvery hull reading, "Greatest
Show of the Void—Come One, Come All—Your Money Back if Not
Absolutely Satisfied." They went ahead of the queue, thanks to the
prestige of the colonel and the local tycoon, and were instantly
admitted. It took but a moment to check their breathers at the
helmet room and then the ushers had them in tow.
"See you after the show, Mr. Allington," said the colonel to Neville, "I
will be in Mr. Carstairs box."

Neville sank into a seat and watched them go. Then he began to
take stock of the playhouse. The seats were comfortable and
commodious, evidently having been designed to hold patrons clad in
heavy-dust space-suits. The auditorium was almost circular, one
semi-circle being taken up by the stage, the other by the tiers of
seats. Overhead ranged a row of boxes jutting out above the
spectators below. Neville puzzled for a long time over the curtain
that shut off the stage. It seemed very unreal, like the shimmer of
the aurora, but it affected vision to the extent that the beholder
could not say with any certainty what was behind it. It was like
looking through a waterfall. Then there was eerie music, too, from
an unseen source, flooding the air with queer melodies. People
continued to pour in. The house gradually darkened and as it did the
volume and wildness of the music rose. Then there was a deep
bong, and lights went completely out for a full second. The show
was on.
Neville sat back and enjoyed it. He could not have done otherwise,
for the sign on the hull had not been an empty plug. It was the best
show in the void—or anywhere else, for that matter. A spectral voice
that seemed to come from everywhere in the house announced the
first number—The Dance of the Wood-sprites of Venus. Instantly
little flickers of light appeared throughout the house—a mass of vari-
colored fireflies blinking off and on and swirling in dizzy spirals. They
steadied and grew, coalesced into blobs of living fire—ruby, dazzling
green, ethereal blue and yellow. They swelled and shrank, took on
human forms only to abandon them; purple serpentine figures
writhed among them, paling to silvery smoke and then expiring as a
shower of violet sparks. And throughout was the steady, maddening
rhythm of the dance tune, unutterably savage and haunting—a folk
dance of the hill tribes of Venus. At last, when the sheer beauty of it
began to lull the viewers into a hypnotic trance, there came the shrill
blare of massed trumpets and the throb of mighty tom-toms
culminating in an ear-shattering discord that broke the spell.
The lights were on. The stage was bare. Neville sat up straighter and
looked, blinking. It was as if he were in an abandoned warehouse.
And then the scenery began to grow. Yes, grow. Almost
imperceptible it was, at first, then more distinct. Nebulous bodies
appeared, wisps of smoke. They wavered, took on shape, took on
color, took on the appearance of solidity. The scent began to have
meaning. Part of the background was a gray cliff undercut with a
yawning cave. It was a scene from the Moon, a hangout of the
cliffdwellers, those refugees from civilization who chose to live the
wild life of the undomed Moon rather than submit to the demands of
a more ordered life.
Characters came on. There was a little drama, well conceived and
well acted. When it was over, the scene vanished as it had come. A
comedy team came out next and this time the appropriate scenery
materialized at once as one of them stumbled over an imaginary log
and fell on his face. The log was not there when he tripped, but it
was there by the time his nose hit the stage, neatly turning the joke
on his companion who had started to laugh at his unreasonable fall.
On the show went, one scene swiftly succeeding the next. A song
that took the fancy of the crowd was a plaintive ballad. It ran:

They tell me you did not treat me right,

Nor are grateful for all I've done.
I fear you're fickle as a meteorite
Though my love's constant as the Sun.

There was a ballet in which a witch rode a comet up into the sky,
only to turn suddenly into a housewife and sweep all the cobwebs
away. The featured stars came on with the chorus, and Lilly
Fitzpatrick sang the big hit song, "You're a Big, Bad Nova to Burn Me
Up This Way!" Then a novelty quartet appeared, to play on the
curious Callistan bourdelangs, those reeds of that planet that grow
in bundles. When dried and cut properly, they make multiple-
barreled flutes with a tonal quality that makes the senses quiver. The
show closed with a grand finale and flooded the house with the
Nova song.
It was over. The stage was bare and the shimmering curtain that
was not a curtain was back in place. People began to rise and
stream into the aisles.

"La-deez and gen-tul-men!"

The voice boomed out and people stopped where they stood. A man
in evening clothes had stepped through the curtain and was calling
for attention.
"You have seen our regular performance. We hope it has pleased
you and you will come again next year. But if you will kindly remain
in your seats, the ushers will pass around with tickets for the after-
show. We have prepared for your especial delectation a little farce
entitled, 'It Happens on Pallas.' Now, ladeez and gen'men, I assure
you that this sketch was prepared solely for your entertainment and
any resemblance of any character in it to any real person is purely
coincidental. It is all in fun, and no offense intended. I thank you."
Billy Neville was bolt upright in his seat by then and his eyes glinted
hard through narrow slits. Something had rung the bell in his
memory, but he did not know what. He would have sworn he had
never seen that announcer before, and yet....
The man stepped backward into the curtain and appeared to vanish.
The audience were grinning widely and resuming their seats.
"This is going to be good," said the man next to him as he dug for
the required fee. "It is their specialty. It beats the regular show, I
think."
Neville paid the usher, too, and sat where he was. He shot a glance
upward at the box and saw Mr. Carstairs and the colonel in animated
conversation and apparently having a grand time. Presently the
ushers had done their work. The hall began to darken and the
scenery come up. The scene was the main street of New Athens, as
some called Pallas' principal town. Neville relaxed and forgot his
recent sudden tension for a moment.
But it was only for a moment. For an instant later he was sitting up
straight again, watching the development of the act with cold
intentness. For the two main characters were comedy parodies of
Mr. Carstairs and Colonel Frawley. At first glance they were Mr.
Carstairs and the colonel, but a second look showed it was only an
impression. The police inspector's strutting walk was overdone, as
were his other mannerisms, and the same was true of the magnate's
character. Their makeup was also exaggerated, Mr. Carstair's mole
being much enlarged and a great deal made of his plumpness. Yet
the takeoff was deliriously funny and the audience rolled with
laughter. Neville stole another look upward and could make out that
both the subjects of the sketch were grinning broadly.
It was a silly, frothy skit about a dog, a lost dog. It seems that Mr.
Carstairs had a dog and it strayed. He asked the police to help him
find it and they helped. The inspector brought out the whole force.
It was excruciatingly funny, and Neville roared at times along with
the rest, though there were many local references that he did not
understand, nor did he know some of the minor characters were so
splittingly entertaining. The man next to him writhed in spasms of
delight and almost strangled at one episode.
"Oh, dear," he managed to gasp, "what a scream ... ho, ho, ho, ho,
... gup! It happened ... just like that ... he did lose a dog and all the
cops on Pallas couldn't find it ... oh me, oh my...." Peals of laughter
drowned out the rest.
The postlude came to its merry end. This time, the show was over
for keeps and the audience began trooping out. Neville got up and
looked around for his friend, but the box was empty. So he strolled
down the aisle and had a closer look at the illusion of a curtain. He
understood some of the effects achieved that night, but the curtain
was a new one to him. After standing there a moment he discovered
that he could hear voices through it. One was Colonel Frawley's. He
was saying:
"Certainly I am not offended. I enjoyed it. I would like to meet the
man and congratulate him on the takeoff."
Neville climbed up onto the stage and walked boldly through the
curtain. There was a brief tingly feeling, and then he was backstage.
Most of the actors had gone to their dressing rooms, but several
stood about chatting with the colonel and Mr. Carstairs.
At that moment the man who had made the announcement came on
the stage and spoke to Colonel Frawley.
"I dislike interrupting you, Inspector," he said obsequiously, "but one
of our patrons is making trouble in the wash-room. She claims her
pocket was picked. Would you come?"
"Nonsense!" exclaimed the colonel. "I stationed an operative there
to prevent that very thing. No doubt it is a mistake. However, I'll do
what I can."
He excused himself and hurried off. Then the man in black turned to
Neville and said in an icy voice, "And you, sir—what is it you wish?"

Neville's mind worked instantly. He did not want to express interest

in Mr. Carstairs, nor did he care to reveal to the showman his
acquaintance with the colonel. So he said quickly:
"The curtain ... I was curious as to how it worked ... you see, once
I...."
"Joe," called the man, wheeling, "explain the curtain to the
gentleman."
Joe came. He led the way to the switchboard and began a spiel
about its intricacies. Neville looked on, understanding it only in the
high spots, for the board was a jumble of gadgets and doodads, and
it was not long before he began to suspect that the long-winded
explanation was a unique variety of double-talk.
"See?" finished the man, "it's as simple as that. Clever, eh?"
"Yes, indeed. Thanks."
Neville started back to the stage, but the announcer barred his way.
"The exit is right behind you, sir," he said in a chilly voice. The words
and intonation were polite, but the voice had that iron-hand-in-
velvet-glove quality used by tough bouncers in night clubs when
handling obstreperous members of the idle rich. They were
accompanied as well by a glance so uncanny and so charged with
malignancy that Neville was hard put to keep on looking him in the
eye and murmur another "Thank you."
But before Neville reached the exit, Colonel Frawley came through.
"Oh, hello. Where is Carstairs?"
Neville shook his head.
"A moment ago he was talking with his impersonator," offered the
announcer, seeming to lose all interest in Neville's departure. "I'll see
if he is still here. He may have gone into the actor's dressing room."
But as he spoke a dressing room door opened and Carstairs came
out of it, smiling contentedly. He turned and called back to the actor
inside:
"Thanks again for an enjoyable evening. You bet I'll see you next
year." Then he came straight over to Frawley and hooked his arm in
his. "All right, Colonel, shall we go? And Mr. Allington, too?"
Neville nodded, luckily recognizing his latest assumed name. Out of
the corner of his eye he saw the dressing-room door slammed shut
by the actor inside of it.
"I hate to hurry you, gentlemen," said the announcer, "but we blast
out at once."
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