A Ten-Step Art-Based Program to Mitigate Exhaustion among Students and Teachers—What Would Our Ancestors Say? ()
1. Introduction
Research has established that engaging with the arts and creative activities can be beneficial for both mental and physical health ( Bojner Horwitz et al., 2017 ; Theorell & Bojner Horwitz, 2023 ; Bojner Horwitz & Thyrén, 2022 , Thyrén & Bojner Horwitz, 2022 ; Grape Viding et al., 2015, 2017 ). There is robust evidence that the arts can be used to support mental health and well-being ( Culture for Health Report, 2022 ; Zbranca et al., 2022 ). However, there has been little exploration of the history of these types of activities. We posit that it can be important to examine history to learn how we can best cope with and support those suffering from poor mental and physical health today. In recent research, statistics show an increase in mental and psychological ill health among young academics and students in particular ( WHO, 2022 ) and there is a significant demand from industry leaders to prevent ill health and find methods that may be useful for mitigating ill health among today’s youth.
1.1. Background
A clinically tested program in arts and health for exhausted students and patients, which comprises ten steps, has been developed over the course of twenty years of clinical practice: “Culture for Your Health” ( Bojner Horwitz, 2011 ) and “Cultural Health Box” ( Bojner Horwitz, 2014 ). According to research, the arts can support students coping strategies for stress and anxiety ( Bojner Horwitz & Thyrén, 2022 ) and therefore we set out to adapt this 10-step program to a new setting. This article discusses the variation of the original program ( Bojner Horwitz, 2011 ), adjusted to fit the needs of students and teachers in higher academic programs. During an Erasmus Plus international research program taking place in 2023, the program was evaluated and tested by researchers from Finland, Greece, England, Sweden, and Ireland. The program was created through a “learning by doing” concept, in which embodied knowledge was gained by participants undertaking “guided” bodily experiences. We found that this led to an increase in conscious awareness of well-being among students and teachers, as presented in the report “Towards Creative Well-being” ( Laitinen et al., 2023 ).
1.2. Practical Data Motivating the Use of the 10-Step Program
The effects of students’ burnout, overwork and negative stress are well documented in the research literature ( Culture for Health Report, 2022 ). Indeed, students’ mental stress is documented not only as a major issue for their quality of life, but also for the educational system as a whole ( Bojner Horwitz & Thyrén, 2022 ; Thyrén & Bojner Horwitz, 2022 ). Short-term exposure to distress and work overload can cause depressive symptoms, elevated blood pressure and anxiety, among other things ( Figley, 2002 ). In the long term, these symptoms may lead to early sick leave and a range of possible physical, emotional, and psychological problems ( Grant & Kinman 2014 ). Therefore, clinically tested preventive programs could be of uttermost importance for students and teachers.
1.3. Historical Work in Relation to a Modern 10-Step Program
In this article, we construct a bridge between past and present, by conducting a historical literature review. By doing this, we bring to light knowledge that our ancestors held about the signs and signals that we today could interpret as indicators of stress. The lived experiences of our ancestors and how with regards to how they handled situations of stress and ill health in their youth will be discussed in relation to this modern 10-step program. Historical work also contributes to the 10-step program, wherein we discuss the development of how we view the relationship between health and the arts. Through this, our intention is to encourage broader perspective-taking and knowledge-building.
Examining in ancient writings, from periods over more than 5000 years ago, there is evidence that our ancestors coped with life’s endeavors by using artistic works ( Fancourt, 2017 ). The word “stress”, as we know it, was not used. Based on the knowledge of the hardship of life in the past, we can assume—although the words may not have been used—that the feelings of burnout, overwork, and negative stress were part of former daily experiences. Efforts to reduce stress and mitigate exhaustion early on, before the onset of symptoms, were perhaps routine practice then.
The purpose of this article is to discuss an arts-based 10-step program designed for students and teachers ( Bojner Horwitz, 2011 ) in the light of what we know about how the arts were used in relation to health in earlier eras. We present both similarities and differences between historical approaches and the approaches taken today during this discussion and draw on these comparisons to inform our thinking about future practice.
2. Purpose
The overall aim of this project is to present a 10-step arts-based program as a method to mitigate mental and physical ill-health. To do this, we explore how the arts have been used throughout history for health purposes and meaning-making.
3. Methodology
The 10-step program (presented below) consists of five meetings, as two steps are combined in each session. The duration of each meeting is about 90 minutes and a couple of days between each meeting are recommended. In addition to these, the program includes homework, to write notes and reading of research literature ( Grape Viding, 2021 ; Bojner Horwitz, 2014 ; Bojner Horwitz et al., 2021b ). It is a flexible program that can be embedded into the curriculum (for example a 1 - 5 ECTS). It can be used both individually and group-oriented. Self-chosen music is used in the program but can be omitted if needed for access purposes. It has been found, however, that the use of personal music can help the participants to feel safer and more motivated ( Bojner Horwitz et al., 2021a, 2022 ; Theorell & Bojner Horwitz, 2023 ). Boosting the wellbeing of students and teachers by supporting their bodily needs’ is an important part of the ten-step program. Each step is guided, and participants can use movements to express the different tasks. It is voluntary if the participants want to verbalize their experiences. The students and teachers engage in supporting each other by sharing self-figure drawings (see below) after each session and after the whole program (after step number 10).
Self-figure drawing
The self-figure drawing is used before and after each step in the program ( Bojner Horwitz et al., 2006 ; Bojner Horwitz & Thyrén, 2022 ). The drawing of a figure (in 2 minutes) representing the feeling in the body “right now” represents a way of processing and externalizing the feelings that could be involved in a stressful situation for the student/teacher.
4. Results
The ten steps of the program are described below. The quotes are taken from the original guidance of the program ( Bojner Horwitz, 2011 ) and tested by researchers from the Erasmus plus program in 2022 ( Laitinen et al., 2023 ).
4.1. The Ten-Step Art-Based Program
4.1.1. The Body Journey
The body journey is based on paying attention and developing one’s body awareness. A guided body journey involves noticing each body part, starting from the feet, and travelling up to the head, is the preparatory phase of the program. “When you travel across all body parts, you try to maintain contact with the whole body at the same time. Note if there is any body part or parts that you have poor contact with. Pay extra attention to these body parts.”
4.1.2. Levels of Consciousness
The guided body journey continues with the five levels of consciousness:
“By paying attention to the five different levels of consciousness with movements, you can train yourself to increase your perception connected to yourself and the world around you.”
The five levels of consciousness are the following:
1) The bodily/motor;
2) The emotional;
3) The figurative;
4) The perceptual;
5) The verbal/cognitive.
4.1.3. Body Movement Qualities
The third step involves body movements:
“Movements can be divided into different qualities such as:
open-closed;
straight-crossed;
Light-heavy;
Fast-slow.
By varying your personal movement qualities, you can get an experience of increased awareness of emotions.”
4.1.4. Emotional Differentiation
The fourth step engages with nine basic affects: joy, interest, surprise, anger, fear, worry, shame, disgust, and hatred. These are expressed with body movements on an imaginary line on the floor, representing a continuum. By using body language and the continuum line, affects that are felt in the moment can be expressed as more or less strong in intensity. By exploring and piloting on emotions, it can become easier to connect with them.
4.1.5. Positive Self-Values
The fifth step involves a focus on positive self-values:
“Write a list of some of your positive self-values. Reflect on your own values and try to express some of these using body movement. Think about which values emanate from the body with an outward direction, and which of the movements that are directed inward, towards your own body. Which of the embodied self-values do you feel are directed at you and not at someone else, i.e. are self-worth enhancing? Reflect with someone.”
4.1.6. The Organ Map
Next step is about body organs: “Draw a sketch of your body where you try to place some of your body organs: Heart, lungs, stomach, intestines, and bladder. You don’t have to draw exactly, but the point is to draw your experience of the body organ. Then let a body organ initiate a movement. What inhibits, what movement gives life to the chosen organ? Reflect with someone watching”.
4.1.7. Visiting Life Events
The next step is about positive life events: “Focus on some strong positive life memories, from about 10 years ago. Briefly write down the memories on a piece of paper. Select a movement that you start moving in the direction of that memory. Paint a picture or a symbol to that memory. The image helps you visualize new experiences linked to the memory and brings positive memories to life”.
4.1.8. Journey into the Future
“Put yourself in a room where you can move freely. Imagine an imaginary line that represents the time axis you want to move within, for example, from today’s date to the end of the line, five years into the future. You decide the time-axis yourself. The task is for you to clear the line connected to your future. Consider possible symbolic body expressions that the body signals. How did you choose to start? How do you choose to quit?”
4.1.9. Relaxation and Breathing
Relaxation is an active process based on an awareness of wanting to relax.
“You can choose between sitting or lying down during the exercise. Four moments are part of the relaxation.
1) Contact with breathing.
2) Contact with all your different body parts, a body scanning.
3) Counting down from 300 and stopping at 295, where every number is in the mind’s eye.
4) Visualization of a place that gives you warm and cozy feelings throughout your body.
When you have completed the four different steps, take your time in coming back to the here and now. Take a deep breath and slowly blow the air out again.”
4.1.10. Looking Back via Self- Figure Drawing
“This final stage is all about placing your self-portraits/self-figure drawings in a circle so you can look back on the entire 10-step program. If you only have made drawings for some of the steps, you may still lay these out in a circle. Sit in the center of the circle and look from the outside at what you have drawn. Feel free to comment on your findings together with someone you feel safe with.”
4.2. Historical Perspectives of the 10-Step Program
Throughout history and in various cultures, there are examples of body awareness exercises and “body journeys”. In prehistoric times our ancestors gathered in caves to take shelter from the elements and from dangerous animals. Life expectancy was short, and it was essential to stay together and cooperate for the benefit of the group. Rituals—including music, dance, drawings on the walls and flickering of torches to create the illusion of moving images—were essential to regulate emotions and prevent anxiety and exhaustion. In the ambience of the caves, singing developed simultaneous to speech and the human voice was the primary instrument and tool of the shaman who used it in rituals and for healing. Today, rituals such as these are still being performed, notably by the Venda, a Southern African Bantu people, living near the South African-Zimbabwean border ( Thyrén & Bojner Horwitz, 2022 ).
It was discovered in prehistoric times that rhythms and sounds could transform people’s levels of consciousness and add to their sense of well-being and trust. Shamans could aid the passing from consciousness to unconsciousness by using music, spoken words, singing and dance. This phenomenon can for example be studied in the Northern parts of Sweden, where jojk was being performed by local shamans known as nåjder (i.e. “the wise”). They transferred their knowledge and wisdom to the next generation orally by jojking (a singing style), often with a ceremonial drum accompaniment. The music is based on repetition with focus on rhythm, tempi and timbre ( Lüderwaldt & Köhn, 2001 ). Another example is found in Islamic music and dance movements with the Dervishes and other Sufi ascetics who reach a state of religious ecstasy through the combination of chants, percussive rhythms, and dance. The Dervishes whirl around in an accelerating tempo, dancing to the haunting sounds created by accompanying musicians ( Blenkinsop et al., 2013 ). Today, in film music, great emphasis is often made on strengthening the narrative by having the musical score influence and emotionally affect the audience subconsciously, without them being consciously aware of it. This phenomenon is known as “unheard melodies” ( Gorbman, 1987 ).
The body is always involved in making music. Music is generated by body movements: to make a sound, for example by a string, to make it vibrate and resonate hence moving air, it must be set in motion by some kind of energy, usually accomplished by bodily movements from a musician, plucking the string, controlling in detail exactly when and how and with just the right amount of energy to create the desired sound. This is and has been the case throughout history. In prehistoric times, the human voice was explored as a musical instrument, distributing regulated quantities of air from the lungs to create the energy necessary to make the vocal cords vibrate and sing. The human voice is extraordinarily expressive and a great tool, which we can use to project words and sounds, and to express emotions. Other sounds generated by bodily movements, such as hand clapping and the stamping of feet, were created by our prehistoric ancestors to further develop music using body movements alone. In prehistoric times, music and dancing were closely interlinked and of equal importance in rituals. However, through the invention of writing and arithmetic’s in more complex civilizations, music and dance became more specialized as separate professions. This division later accelerated with the invention of musical notation in medieval Europe. However, with the recent invention of electronic music and film production tools and popularization of music videos, music and dance have become strongly interlinked again. Research indicates that the combination of music and dance or other kinds of kinesthetic movements, as used by our ancestors thousands of years ago, has great health benefits and helps reduce stress and mitigate exhaustion ( Valkare, 2016 ).
In ancient Greece, the philosopher and polymath Aristole (384 - 322 BC) laid the foundation of a field we might now consider as music aesthetics. He was a disciple of Plato’s Academy, and on special request from King Philip II of Macedon, the private tutor of Alexander the Great. Aristole argued that the value of music and movement was not only ethic, as a mean to create a more civilized society, but he also recognized music’s aesthetic power. His philosophy on music and movement included two key concepts: catharsis and mimesis. Catharsis is involved in emotional regulation, with the idea that mankind can be refined and healed through the experience of art. The ancient Greeks believed that to experience a simulated crisis, artistically performed on stage in a Greek Tragedy, can be as powerful as the experience of a real-life crisis ( Horden, 2000 ).
The concept of self-value per se was not defined in the same way as we think about it today. Self-value was previously related more strongly to a person’s profession or social power. Background factors, status, hierarchical position, and what you do increased the self-value of a person or family ( Valkare, 2016 ).
The sound produced by one’s internal organs and the energy that an organ needs to be able to function has been of interest especially in Asian cultures and in South America ( Reichbart, 2019 ). Shamans could listen to inner organs and diagnose what was missing in your body and there is a literature upon which this practice was founded ( Reichbart, 2019 ). In recent times, the creator of musique concrète, Pierre Schaeffer (1910-1995) and his assistant, co-researcher and studio technician Pierre Henry, debuted Symphonie pour un homme seul (Symphony for One Man Alone). The Symphonie explored sounds that originate from the human body to elaborate on the concept that mankind can create music by being his or her own instrument. It demonstrates that a human being can possess many more ways of making music with bodily sounds than by just using the voice to intonate and to sing various pitches within the octave. The sounds from the human body that Schaeffer and Henry explored and turned into musique concrète were cries, whistles, laughter, groaning, spoken words, breathing and accelerating breathing, heart beats, footsteps, etc. ( Manning, 2013 ). Schaeffer established a syntax for musique concrète, Solfége de l’objet Sonore. It included a hierarchical organization of sounds in four layers, where living elements such as voices were considered most important, followed by noises, prepared instruments and lastly conventional instruments ( Manning, 2013 ). This organization of sounds is very different from how symphony orchestras are organized in the tradition of Western art music. It is more in line with the way our predecessor’s made music in prehistoric and ancient times ( Thyrén & Bojner Horwitz, 2022 ).
Music has the ability to function as a powerful mediating tool that can help us reconnect and revisit life events through our memories. Viper et al. (2020) have examined the importance of music as consolation, when employed in funeral rituals and practices of mourning, where relatives conduct farewell ceremonies for their recently deceased loved ones. The findings indicate that the role of music in farewell rituals is very important for the grieving process, and in various ways. It was associated with positive memories of loved ones and gave rise to experiences of recognition. Music and dance also facilitated active participation in the grieving process through choosing farewell music together with the loved one in advance. Selecting music together, before the funeral, is a sensitive and delicate thing to initiate, but it was experienced as hopeful, comforting and consoling, not only during the actual funeral rite but also before—and not the least—long after the bereavement. It is interesting to note that there was also a difference between how live and recorded music were perceived. Music that was performed live at the funeral was experienced by the grieving relatives as significantly more powerful in helping them to reconnect and revisit life events with their deceased loved ones, in comparison to recorded versions of the music being played back ( Viper et al., 2020 ).
In relation to the step “Journey into the future”, questions about your future were often put in the hands of God, regardless of religion ( Valkare, 2016 ). In many of the petroglyphs found all over the worlds, worship and hope were reflected in symbolic expressions that we today can decipher thanks to new technology ( Valkare, 2016 ).
5. Discussion
It has been an exciting process to understand how a ten-step art-based program can be thought about in relation to the practices of ancient times. Music, dance, visual arts, verbal and non-verbal communication, rituals, shamans as guides to the subconscious, emphasis on the here and now in the moment, a performance only happens once in real time and could never be recorded or recreated in the same way again. Close relationship to deceased ancestors and to constantly bring forth the next generation and closer relationship to the animals that were seen as sacred and treated with reverence and great respect. All this was embodied multimodally in rituals with music, dance, and visual arts in previous times ( Thyrén & Bojner Horwitz, 2022 ).
Contemplative exercises have been an important part of previous societies everyday life and in many philosophical traditions, stillness of the mind was part of the daily routine ( Ricard et al., 2014 ; Stenfors et al., 2018 ). Enabling the mind to reflect via contemplation was a way to be able to handle stress and to relieve the mind from suffering. Today we probably would have defined these activities as mindfulness or exercises in increasing conscious awareness.
Body movements and its qualities are an important part of what we often refer to as embodiment ( Bojner Horwitz et al., 2013 ). In all our perception of the world, embodied knowledge ( Bojner Horwitz et al., 2021b ), the experience of our bodies cannot be underestimated. To be able to fully understand ourselves and our mental functions, we need a reference to our physical body ( Varela et al., 1992 ).
Difficulty in differentiating emotions is part of several health issues such as high blood pressure and chronic pain ( Lennartsson et al., 2017 ). This is common in the personality trait of Alexithymia (an inability to discriminate emotion in others and self) ( Bojner Horwitz et al., 2003, 2015 ). By differentiating movements, creating nuances, shapes, and patterns via embodied dance movements, seen in the ten-step program, we can stimulate emotions and thereby stimulate parts of our brain that is linking body movements to emotions. Emotional regulation seems to be an important vital function both in our ancestor’s life and in our wellness programs.
As seen in a historical perspective, different reactions may be evoked when viewing art. When viewing an abstract painting, it tends to evoke different stress reactions among patients in health care settings, while paintings of natural landscape induce calmness and harmony ( Lankston et al., 2010 ). This may be related to the soothing effect of viewing fractals of a certain dimension, frequently seen in nature and in some art-styles ( Taylor et al., 2011 ). The self-figure drawings seen in the ten-step program are often referring to nature related symbols and thereby also part of something bigger.
In group settings, using music generates a cohesiveness which we know is one of the survival values of a group ( Valkare, 2016 ). Music can stimulate energy but also trigger calming effects ( Bojner Horwitz et al., 2021c ; Theorell & Bojner Horwitz, 2023 ). So, music has possible health-promoting effects, alongside nature and the arts more generally which have been historically regarded as having important healing effects for many thousands of years.
So, how might our ancestors regard our 10-step program? As we have seen from the literature, the content of our 10-step program has connections to our ancestors’ lives and beliefs at various points in history, and in different cultures, even though for them, the steps may have employed vocabulary and concepts of spiritual energy, religion and acts of higher power. Some elements of the mythology of shaman healing power could be interpreted as today’s counselor or student health guidance (Studenhälsan). There is a rich range of health apps that students use today, providing everything from mindfulness and contemplation exercises guided by health-conscious gurus to idle speculation. In our postmodern time, we may rely too much on technology and may become alienated from our own embodied experiences. It is therefore important to practice awareness regularly during the school or working day, alongside knowledge acquisition on other subjects. We argue that we have not made time for this important type of knowledge in our modern lives, and that this impedes us from being able to take care of one’s health within academia. The surfacing of historical perspectives on arts and aesthetics in relation to health can help us in navigating our academic institutions and ensure that we attend to the needs of our health and the importance of meaning-making, learning and social cohesion ( Bojner Horwitz & Thyrén, 2022 ).
If we have unhealthy teachers, this will affect our students. By noticing the warning signs of stress in good time, we can costly sick leave. The 10-step program can be used in academic workplaces, academic programs and other fields. We can have healthier students, better student retention, and increase the motivation for students to engage in the development of new artistic skills. The 10-step program can prevent students from future burnout and perhaps unnecessary stress in their future workplaces. The 10-step program is a preventive strategy and could be especially valuable during periods of transformations and high work intensity. In the future, the results from our clinical and academic use and experience of the program could be further tested in other academic contexts, and we could be part of ‘their’ ancestors’ experiences.
6. Conclusion
The presented 10-step art-based program has led to an increased awareness of health and well-being among students and teachers in higher academic programs. Through music and movements as powerful mediating tools, we can reconnect and revisit life events through our memories in the same way as our ancestors. Contextualizing health and well-being in relation to art through a historical overview encourages broader perspectives and knowledge-building. This suggests that learning from our ancestors can be beneficial to interpret and managing indicators of stress.