Art therapy in a patient with bipolor disorder: pictures speak more than a thousand words

Art therapy is defined by the American Art Therapy Association as "a mental health profession in which clients, facilitated by the art therapist, use art media, the creative process, and the resulting artwork to explore their feelings, reconcile emotional conflicts, foster self awareness, manage behavior and addictions, develop social skills, improve reality orientation, reduce anxiety, and increase self-esteem. A goal in art therapy is to improve or restore a client's functioning and his or her sense of personal well-being." (1)

Individuals with mental illnesses may not always be verbally expressive; however, they may display emotions through creative expressions such as music, poetry, or art. The use of art also helps them reflect on their thoughts, desires, and challenges. Vincent Van Gogh projected his turbulent emotional experiences onto the canvas. (2,3) He once said: "What lives in art and is eternally living, is first of all the painter and then the painting." (3) More recently, the work of Mexican artist Martin Ramirez was exhibited at the American Folk Art museum in New York. Ramirez had schizophrenia and spent most of his adult life institutionalized. (4)

We present the case of an elderly woman who had a long history of bipolar disorder who was admitted for aggressive behavior and nonadherence to medications. Art therapy along with pharmacotherapy played a pivotal role in her recovery.

Discussion

The content of the initial drawings highlighted preoccupation with religion and sex, which corresponded with her thought process. All initial drawings used heavy pressure and strokes along with more use of black and red colors, which were also consistent with underlying aggression and anxiety (Figures 1 and 2).

When therapeutic alliance was established in subsequent weeks and medication adherence improved, positive changes appeared in her drawings as evidenced by reduced aggression in themes and line quality, and a less restrictive range of color (Figures 3 and 4).

The act of creating art is connected with sublimation, a secondary defensive process defined as "a creative, healthful, socially acceptable, or beneficial resolution of internal conflicts between primitive urges and inhibiting forces." (5) Using art, Mrs Robinson seemed to sublimate some aspects of her life that she had defined as "perverse" into something socially acceptable, and the combination with pharmacotherapy worked well.

Although not a substitute to pharmacotherapy, art therapy can give a sense of...