The border between art and medicine by Roy Ziegelstein

There’s a lot of attention being paid these days to borders, and a lot of debate about whether a wall should be built to make sure that people from different cultures don’t mix. The people in the world of art and the people in the world of medicine and biomedical science have generally lived separately from the beginning, with few people crossing the border except for some notable exceptions like William Carlos Williams, John Keats, and even Leonardo da Vinci. To a large extent, a wall between medical science and the arts hasn’t been necessary. There have been very few who have crossed the border even without one. 

I was an artist from the time I was a young boy. I had the opportunity to study with the surrealist master, Gene Scarpantoni, at an early age. When I was only 12, he allowed me to join his Thursday evening class of about a dozen adults, charging my parents only $3 for each lesson. When I was 16, I attended a summer program at Rhode Island School of Design, and then studied painting after I completed high school. I was exposed to a fascinating culture and I learned an extraordinary amount, not only about color and composition, but about passion and creativity as well. Eventually, in a series of events that amounted to the metaphorical scaling of a wall, crossed the border and found my way to medicine. However, my early experiences have stayed with me and influenced my approach to medicine and science. 

We are fortunate here in Baltimore to have the Cone Collection at the Baltimore Museum of Art. One of the most magnificent paintings and well-known works in the Cone Collection is the iconic Blue Nude by Henri Matisse. This painting teaches us a lot about creativity and innovation, which are as important to medicine and science as they are to art. Matisse and his followers were known as Fauvists. It was 1905, and people entered a room at the Salon d’Automne and saw a sculpture by the Renaissance artist Donatello surrounded by the work of Matisse and his followers. The critic Louis Vauxcelles famously expressed his disapproval of their work by noting that there was “a Donatello amongst les fauves” which in English means, “a Donatello amongst the wild beasts.” Two years later when he saw the Blue Nudewhich Matisse painted in 1907, Vauxcelles commented, “I admit to not understanding. An ugly nude woman is stretched out upon grass of an opaque blue under the palm trees… This is an artistic effect tending toward the abstract that escapes me completely.”  

Fauvism is a lot like innovation in medicine. It is a disruptive force that initially may not be understood or appreciated by others. That is the essence of discovery, whether that occurs in the research laboratory or the clinical environment. It starts with curiosity, with a willingness to question the accepted understanding or paradigm, and with a desire to generate new knowledge to improve fundamental science or medical care and thereby improve human health. It requires an ability to be bold and to accept the criticism of others, much as Matisse didDr. Michel Morowski, a physician-scientist at Sinai Hospital and Johns Hopkins, developed the implantable cardiac defibrillator in the early 1970s, eventually implanted in a human for the first time in 1980 by Dr. Levi Watkins at Johns Hopkins Hospital. Imagine being Dr. Mirowski and reading an Editorial commenting on your device in the well-known cardiology journal Circulation by the renowned cardiologist and expert in ventricular arrhythmias, Dr. Bernard Lown. Dr. Lown noted, “… the implanted defibrillator system represents an imperfect solution in search of a plausible and practical application.” He concluded the article with some very dismissive commentary, “The rationale for some current bioelectronic development is best exemplified by Edmund Hillary’s reasons for climbing Mt. Everest, ‘Because it was there.’ The same holds for some electronic gadget manufacture: ‘It was developed because it was possible.” (Lown B and Axelrod P. Circulation 1972; 46:637-639). Lown’s lack of understanding of Mirowski’s invention and Vauxcelles’ lack of understanding of Matisse’s amazing work are similar in many ways. One can almost imagine Morowski being called a wild beast.  

In this article as I focus on the border between art and medicine, and about the importance of tearing down the border wall, I would like to highlight three things: (1) the way an artist sees, (2) squinting, and (3) gesture drawing.  

First, the way an artist sees – There is no such thing as a typical personality type of an artist. You will not find a typical personality type for painters or artists  artists come in all shapes, sizes and personalities. And while much is made of the artist’s vision and the artist’s ability to see things more clearly or perhaps better than others, it turns out that artists have no unique or characteristic visionIndeed, I think that attempts to have medical students and practicing physicians better appreciate the artist’s vision in order to make them better doctors may be misguided. Instead, artists might say that rather than seeing things better, they see things differently or, more accurately, thethink things differently. In fact, Picasso famously said, “I don’t pain things the way I see them, but the way I think them.” 

Second, squinting – One of the things you learn as an artist is the importance of squinting. When you paint, you are often asked to look at your subject and squint. As you read this, I suggest you take a moment and look around the room you are in and do that now. When you squint, you’ll notice that the shadows get darker and the highlights get lighter, and this helps to better define shapes. From a visual perspective, when you narrow your view, you see the contrasts. I think this is also true when we listen. When we narrow or restrict the groups of people we associate with or the people we listen to, everything appears black and white. Issues are polarized. People are good or bad. We won’t see the subtleties in the issues that confront us or the humanity in all the people we care for.  As a doctor, and as a person, I try to surround myself with people who widen my perspective and who will prevent me from the equivalent of squinting so I see the subtleties of the people I associate with and care for. 

Finally, gesture drawing – Artists are very familiar with something known as gesture drawing. In gesture drawing, the model changes pose every 3 minutes or so. It’s an exercise that in art is similar to what happens in the Three Minute Thesis Competition, when doctoral students deliver an engaging presentation on their scientific research in three minutes and with only a single PowerPoint slide to a non-specialist audience (of note, this year’s fourth annual Three Minute Thesis Competition at Johns Hopkins takes place on April 17, 2019 from 2-4 PM in the Mountcastle Auditorium). As an artist, you can’t possibly draw or paint the details in three minutes, but you can capture the position of the figure in space. I equate this with improvisation, like what jazz musicians do. One of our former faculty, Dr. Charles Limb, has studied the process of improvisation by having jazz musicians play music from rote memory and then having them improvise while in a special type of MRI scanner that is not only able to image the anatomy of the brain but also its function. The purpose of Dr. Limb’s work was to study creativity, and in particular to better understand how the brain creates art. I encourage you to view a TEDTalk on the topic entitled, “Hip-hop, creativity and the brain: Q&A with Dr. Charles Limb” at: https://blog.ted.com/hip-hop-creativity-and-the-brain-qa-with-dr-charles-limb/comment-page-2/. What Dr. Limb found is that interactive improvisation between two musicians is characterized by activation of specific areas of the brain and deactivation of brain structures that are implicated in the semantic processing of language. What Dr. Limb says is that, when we are speaking in front of a group of people, for example, we are constantly vigilant and aware of what we are saying because a certain processing part of the brain is active. In improvisation, that part of the brain is turned off. As doctors, I think we process a lot. We “learn” as part of training that we have to constantly check our emotions. Showing emotion is often considered weak, and after all when you are inundated with emotional and stressful situations, it may be protective to shut all that off. I think doctors therefore often seem unfeeling. Insensitive. Even arrogant. When I’m with patients, I often think of gesture drawing or improvisation and try to shut the processor off and be natural and more myself. I think patients appreciate it. 

In summary, I think that all too often people think of artists and physicians or scientists as being from different walks of life, almost as if there is a border wall between them. In fact, there are many similarities between the way these groups of individuals think and their view of life. The border should be opened; our world would be the better for it.