Some Thoughts on Social Prescription and the ArtsSocial prescription (SP) is a model of care where health practitioners prescribe non-medical interventions such as time in nature, volunteering, painting, or dance. While there is understandably immense excitement surrounding this model [1], some reports suggest caution around SP programs, the main reason being that they do not address the socioeconomic determinants of health [2]. Arts-based SP programs include, but are not limited to singing, drawing, mosaics, painting, photography, and pottery, and overall they have shown a positive impact on psychosocial well-being [1]. I am a practitioner of Bharatanatyam, an approximately 2,000-year-old Indian dance form that consists of a vocabulary of hand gestures, percussive movements, emotions, and melody to narrate a story or convey a mood. The dance form is characterized by its immediacy, universality, and relevance to contemporary issues. I am also a neuroscientist; my doctoral and postdoctoral work focused on epilepsy, and currently, I work as a scientist and science educator. Despite its rootedness in Southeast Asian culture and mythology, Bharatanatyam can be used outside of its historical and cultural context. For example, I have used this dance form to communicate science and have created the foundation to use Bharatanatyam for creative aging in New York City [3,4]. I suggest that arts-based SP practices may warrant a deeper look when traditional art forms such as Bharatanatyam are considered. In this article, I pose some questions inviting discourse by practitioners and prescribers and discuss some complications that may arise when considering traditional art forms outside their original cultural context. It might be reasonably said that many, if not most cultures have been practicing SP without explicitly giving it that label. Navratri is a festival celebrated in my home state of Gujarat and consists of nine nights of communal dancing; though it is referred to more as a community ritual and celebration, rather than a prescribed activity. Sikhs – a community in India - are known for their spirit of voluntarism and generosity, but this activity is understood to be part of the cultural and societal fabric, not something prescribed for a particular outcome. The points I explore below represent three points of caution with respect to arts-based SP: 1. A transactional, exploitative relationship with the arts and artists; 2. Appropriation of traditional art forms; 3. The evaluation of arts-based SP programs. This article represents an evolution of the ideas put forth in an article in the BMJ Medical Humanities blog in March 2023, where I suggest that SP could be a way to expand the reach of Bharatanatyam for older adults. Arts-based SP programs can promote a transactional relationship with the arts: “I sang for half an hour, when can I expect benefits?” was what a participant asked me when I shared a basic foundation of Carnatic music. A headline in the New York Times “When the prescription is a dance class, not a pill ” was making the rounds, suggesting how useful arts-based SP programs can be. While the arts can have therapeutic effects, and while it is known that these effects can be directed by trained practitioners, there are many issues when we think of the arts as therapy itself - if it were, artists would not be depressed. One session may or may not help, and the “dose” prescribed is arbitrary. Depending on the choice of music and the kind of facilitation, the dance-based programming may even be harmful and could trigger negative emotions and traumatic memories. Do we have evidence to support the efficacy of this kind of treatment? Do we have a sufficiently reliable understanding of how the benefits of dance during a session carry over to the life of the individual outside of the session? By using the arts as a “health resource”, we are using the arts as a means to an end, and not as an end in themselves Appropriation of traditional art forms: Practice of the arts requires a lifetime of training and study. For my work in Bharatanatyam, I bring 30 years’ lived experience of Indian culture, knowledge of several Indian languages, music training, and mythology. I continue learning from gurus still and carry on the lineage of the guru and disciple. But consider by way of a counterexample the state of yoga in the West. In its original social context in India, yoga is an intensely spiritual discipline, whose practitioners spend lifetimes in its study, and where enlightenment and mastery over the spirit are attained by mastery over the body. But in the West, the required training is essentially non-existent, the emphasis is on physicality and merchandising, and there is typically no distinction made between stretching and enlightenment. Traditional art forms very often are not taught by a person from the culture, or even familiar with the culture, and are exoticized and fetishized. How can we treat art forms like Bharatanatyam and yoga that are steeped in culture and history outside their cultural and geographical context? How can we consider the changes in the art form impacted by the forces of colonization? What training should practitioners of the art form get to work with diverse populations? Should practitioners be required to learn about the language, culture, mythology, and tradition of the art form they hope to teach to others? Do practitioners of traditional art forms wanting to teach others have a responsibility to correct overly simplistic and paternalistic colonial-based stereotypes? As more and more art forms will be used as SP, how do we guard against simplifying, cheapening, and appropriation? Evaluation of arts-based SP programs: As a scientist, I love data, charts, graphs, and statistics. However, as a practitioner of Bharatanatyam, I am aware of the nuances of evaluation of any art form, especially one that has been shaped by the disruptive forces of colonization, plunder, and invasions. Formalizing arts-based SP will lead to the generation of metrics and dashboards; but the procedure of defining metrics is antithetical to the artistic approach, which is holistic and anti-reductionist. Besides, it is likely true that the aspects of the arts that are therapeutic are probably not ones that are easily measured, resulting in a difficult paradox. How can arts-based SP programs be evaluated? The conceptual frameworks capable of understanding Western art and its impacts may not be capable of understanding art from another culture. In an SP system that is dependent on quantified metrics, how do we decide who is qualified to rate the efficacy of traditional art forms? While SP holds great promise, we need to be sure to respect the integrity of the arts and the traditions that produced them. We also need to be careful as to how we determine ‘success” especially when traditional forms such as Bharatanatyam are involved. References:
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AuthorMy name is Sloka. I am a neuroscientist and dancer; you can find more about me here. Archives
February 2025
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