Business and Health® Archive
Dec. 1, 1999

Applying lessons from the work of art

A veteran corporate medical director offers intriguing notions of how the work of being an artist can inform and transform the work environment.

By Richard A. Lippin, MD

In an age of technology-based medical miracles, it may be difficult to discern links to the creative arts. Nevertheless, the arts and the effort that goes into them can energize and inform both my field of occupational medicine and the management of the workplace. This is not a radical proposal, but rather a return to enduring values.

Studying the relationships between health and the arts is an attempt to move away from medicine that is focused on illness and fear of death to a paradigm of optimism based on love of life. We study artistic activity--everything from oil painting to figure skating--not only for its capacity to cause injury and illness, but also for its capacity to heal. Properly designed and meaningful work is certainly not pathogenic. It is prerequisite for good health, and empirical studies are beginning to validate this concept.

Three aspects of those studies have special application to the workplace. The first relates to artists as workers. What can we learn from this unique cohort of high-performance workers? Secondly, there is the therapeutic application of the arts, especially for stress management and productivity enhancement. Thirdly, and perhaps most importantly, artistic models address emerging challenges to the dominant models of work organization.

Consider these aspects in the context of two premises. The first is that the miracles of modern biological medicine are yielding to a biopsychosocial model that assumes all stimuli, including the arts, have an impact on human physiology and on health outcomes ranging from illness to wellness, from injury to peak performance.

The natural outgrowth of this holistic approach is a "democratization of psychiatry" that embraces mind-body medicine and expects physicians to be trained in behavioral medicine. The National Institutes of Health offered one good example with its 1996 conclusion that a number of well-defined behavioral and relaxation interventions are effective in the treatment of chronic pain and insomnia.

My second premise is that paternalism in medicine is yielding to consumerism and empowerment. This transition is at the core of the doctor-patient relationship and extraordinarily painful for all concerned. Furthermore, medicine is a bellwether for other paternalistic sectors such as the traditional "command-and-control" management-employee relationship.

A corollary of this transition is that the arts, which emphasize individuality, freedom and creativity, are an effective path toward self-discovery and empowerment. That is why, historically, they have been so feared and repressed by tyrants.

Learning from artists as workers

One important example of how performing-arts medicine has informed occupational medicine is the story of keyboard-induced repetitive strain injury.

Consider the differences between approaching the keyboard of a piano versus that of a computer. What are the overall work demands on the pianist versus the computer operator? What are the performance load demands, the hand-eye coordination requirements and the intellectual effort needed? What about work pace and error tolerance? What are the attitudes and hoped for outcomes that each brings to the keyboard? What are the levels of enthusiasm, boredom and worker motivation? How can we improve measurement of these factors and the impact they have on incidence and severity of injury, duration of disability, return to work, quality of work and long-term worker performance?

Let me mention two examples of how the pianist worker specifically informs the computer keyboard worker. The first relates to the ergonomic issue of keyboard design. It is difficult for a child or a small-statured adult to play a standard 48-inch piano keyboard without harm. Each key is 15/16 of an inch wide, and the octave width is 7 1/2 inches.

Frustrated by her inability to perform the manual gymnastics required by Russian composer Sergi Rachmaninoff, a five-foot tall New York pianist named Hannah Reimann is on a mission. She finally persuaded a German firm that manufactures parts for Steinway pianos to develop a prototype that allows a pianist to slide out a standard keyboard and pop in a slimmer 44-inch version.

Much the same problem applies to the standard QWERTY design of computer keyboards. Fully 15 percent of humans are not anatomically suited for the sustained palms down position of the wrist required of keyboard workers. This has inspired a plethora of alternative designs that minimize or even eliminate the need for pronation at the wrist, and that raises an important question: At what economic level should we reasonably accommodate individuals not just with disabilities but with different physical makeups, especially those in jobs involving repetitive motion?

In 1990, I made a presentation to the National Institute of Occupational Safety & Health (NIOSH) about performing artists as workers. NIOSH was interested in the impact of worker motivation on repetitive strain injury and questioned arguments that most allegedly injured workers were malingering. If higher motivation were linked to lower incidence of these syndromes, one would expect not to see the problem among the unusually motivated, such as concert pianists.

Yet those syndromes do indeed exist among professional musicians. A 1986 survey of seven symphony orchestras, for instance, concluded that half the players had such problems by the age of 30. In another study of 47 U.S. orchestras the following year, three quarters of the musicians reported at least one medical problem that severely affected their performance. At least two world-class pianists, Gary Graffman and Leon Fleisher, had their careers stifled by constant, painful cramps in their left hands.

So worker motivation is clearly not the whole story. Yet here we are in 1999, and the Occupational Safety & Health Administration still does not have an ergonometric standard because of the ongoing controversy surrounding these issues. We need to learn from this small but remarkably high-performance population of professional musician-workers. They provide a window into our understanding of small muscle athletics, fine motor control, hand-eye coordination, much earlier endpoints of pathology, high worker motivation, the limits of human performance, the aging worker and the pursuit of creativity and excellence.

Using the arts as medicine

Can the arts be successfully utilized as therapy for employees, especially as tools for stress management and for productivity and creativity enhancement?

The creative arts­therapy movement dates from the end of World War II. Pioneering professionals incorporated music, art, dance, poetry and drama into therapy. When advances in neuroscience gave us tools to validate their effectiveness, these therapies began to move from primarily psychiatric settings to all medical specialties--including rehabilitation, pediatrics, geriatrics, oncology and hospice--and now to wellness or performance-based medicine. Fundamental premises are that the excesses of pharmacologic and surgical interventions are beginning to bite back and that the arts or objectively measured aesthetic stimuli represent safe and effective alternative or supplemental interventions.

The area that has the most advanced scientific research is the impact of music on the central nervous system. The groundbreaking work by neurologist Frances H. Rauscher and colleagues from the University of California at Irvine demonstrated improvements in spatial reasoning and other CNS tasks among college students after listening to the music of Mozart.

This research, which was extended to infants and toddlers, ultimately became known as "The Mozart Effect" and spawned a veritable industry with much marketing and media fanfare. At least two states enacted legislation. Florida gives child-care centers funds to expose their clients ages birth to five years to classical music. In Georgia, the so-called "Beethoven Bill" would issue classical music tapes or discs to parents of the state's 100,000 newborns each year.

As with any phenomenon, preliminary findings must be validated by additional studies. Other researchers have recently questioned, for example, the range and permanence of some of the effects claimed, especially by those who are aggressively promoting widespread use of the intervention. Suffice it to say, however, that new ground has been broken.

Moving these concepts into adult occupational medicine will be a challenge. Business leaders and third party insurers are skeptics, but they are also pragmatists. Presented with data, they will respond to what works and saves them money. For example, music-paced work is resurgent in new settings. A 1994 study measured the effects of music on heart rate and blood pressure among surgeons and concluded that surgeon-selected music was associated with relaxation and improved performance of a stressful, nonsurgical laboratory task.

Other rigorous studies have demonstrated the impact of music on mood. We need to pay serious attention to this in light of the epidemic of depression among workers and its associated human and economic costs.

The arts also may be able to enhance our percep-tual and creative skills. Certainly the Germans and the Japanese grasp the implications for preparing students for a competitive global workforce. The arts are a mandatory part of their curricula through high school.

(Recognizing that the arts should not be glorified as a panacea for society's ills, I must admit a downside. The U.S. National Safety Council noted a surprising correlation between auto accidents and listening to opera while driving. No correlation was found with music other than opera. This, of course, raises the issues of safe and effective doses of music as well as the importance of where and when the intervention is utilized.)

The arts can also be an effective part of stress management. In this regard, I believe that the Western mind needs practical tools that emphasize activity over passivity. Western man is fundamentally a "creationist" being. A colleague said to me recently that we should call ourselves not "human beings" but rather "human doings."

I am by no means alone in considering arts activity to be the creativity response to stress. Dr. John Diamond, Australian trained as a psychiatrist and now an extraordinary holistic physician, calls engaging in the arts "the supreme meditation or the royal yoga." In England, Dr. Angela Patmore has challenged the relaxation gurus. She suggests that the most effective method of mastering occupational stress is to practice handling pressure, including use of the arts, rather than to practice relaxation and run the risk of learned helplessness.

Transforming the work environment

Our dominant models of work organization are being challenged, just as futurologist Alvin Toffler and others predicted. The command-and-control approaches of large bureaucratic organizations are yielding to individual empowerment and project teams that emphasize rapid results through innovation and creativity. This model embraces the characteristics of work in the arts: freedom, discovery, performance, harmony, discipline, pursuit of excellence and, most importantly, courage.

This, of course, has enormous implications for worker health and productivity and even broader political and economic ramifications for labor-management relationships in a competitive global economy. Productivity guru Peter Drucker says that demands on our creative ability double in every generation and that the 21st century belongs to those companies and countries that can innovate the fastest. Edward DeBono, a British physician and recognized authority on "thinking styles" and corporate creativity, says that ideas and innovation are the currency of success that separates competitors.

That we live in a world where hard capital is in excess and intellectual capital is in short supply is most evident in the booming information technology sector. Thus the human brain is the last frontier in human capital management, as Weston Agor, an expert on intuitive decision making and founder of the Intuition Network, has said.

The realities of these new organizational models and business needs are megatrends that are not going away. At the same time, we are uniquely poised to use medical science to measure, manage and maximize human capital.

As physicians, we must emphasize the centrality of human needs in work. In the arts or in athletic arenas, where the risk of excessive emphasis on performance is great, we must promote the priority of long-term health over short-lived and often dangerous glory. Similarly, we must promote health when it is in competition with work performance.

The arts should serve man, not vice versa, and artists in any form can succeed without destruction of their physical or emotional beings. That concept needs to be applied to all workers. Thus, I tell my business managers that our human assets are precious, that they need to be protected and that we need to emphasize "the marathon over the sprint."

In his wonderful book titled Artful Work, Dick Richards, a corporate consultant, writes about artful leaders who succeed by activating the energy of others, much as a painter activates the energy of paint or a poet energizes words. Leaders must discover how to draw all that very real and measurable energy to a point of focus, to a vision. This, as Richards says, is, indeed, true art. Quoting Peter Drucker once more, "the model for managers in the future workplaces is the symphony conductor, who does not know each musical selection nor play each instrument better than each musician, but leads them all harmoniously through the most effective performance that they can muster."

We must not underestimate the power of these metaphorical models. At this time in western cultural history we need, almost desperately, the powerful and transforming vision that the arts can provide. A vision that, as California artist Ceil Bergman says, provides hope, optimism, affirmation, collaboration and imagination. These are among the best qualities of which we are capable and necessary tools in modern commerce. I predict that as basic human needs are increasingly met around the globe, businesses that understand and supply the human need for beauty or aesthetics will thrive. Thus, we will compete to market and deliver beauty to our customers.

Since 1872, the huge Japanese cosmetics company Shiseido has consistently pursued its vision of "the realization of beauty and health." Shiseido president, Yoshihara Fukuhara, has said his firm has "been fully aware of the values we offer society through our business and products. We can also say that appreciation of beauty can cure social maladies. It also works as a vitamin or hormone for corporate health itself."

Even something as mundane as porcelain toilet bowls can be associated with art. A 25-year-old program at Kohler Company in Wisconsin is probably the most unusual ongoing collaboration between arts and industry in the U.S. Artists spend two to six months creating works of art in Kohler's pottery works, iron and brass foundries and enamel shop. Participants are exposed to a body of technical knowledge, which enables them to explore concepts not possible in their own studios. Perhaps more important than the access to technical materials is the mutual influence between the artists and workers.

Is it naïve or romantic to suggest that this inter-action might mutually benefit both worlds? I think not. Standing outside of Kohler world headquarters in Wisconsin is a large engraving of the words of John Ruskin: "Life without labor is guilt. Labor without art is brutality."

Richard Lippin. Applying lessons from the work of art. Business and Health 1999;12:19-22.

Copyright © 1999 and published by Medical Economics Company at Montvale, NJ 07645-1742. All rights reserved.

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