Tracing health back to wholeness

An interview with Christopher Bailey

We often define health by a lack of disease. But drawing from his expansive career across arts and sciences, Christopher Bailey says, “To trace its etymology, the word health itself comes from an Anglo-Saxon root, which is a cognate to the word whole. Health is not about the absence of a weakness, but rather about being a complete person.” Now serving as the Arts and Health Lead at the World Health Organization, he creates and shares global initiatives for health and healing. His work, informed by his own experience of losing his sight, also inspires us to broaden our understandings of beauty and perception. Challenging the tendency to over-medicalize health, he says, “It's a positive asset. It's not the lack of a deficit.” And the arts, as you’ll read here, can help us reach that highest quality of being human and alive.

What was your journey to become a leading advocate for arts in health? 

It’s funny looking back on it. If you were to describe my current work to me at any point in my life's journey, I would've laughed and said, no, that's not the plan. But fate had other ideas. As Nietzsche once said with his term amor fati, part of maturing is falling in love with your fate and saying, you know what? I didn't know I was going to be here. But every step of it made sense. Every step of it was leading me to this moment.

Throughout my life, I've toggled back and forth between the arts and the sciences. When I started getting too comfortable in one, I would begin to yearn for the other. When I was a professional actor in my twenties, I did a lot of interesting work, but I also did work that was not particularly compelling. And I just thought, what am I doing with my life? Similarly, when I would get more involved in the sciences, there were times when I felt I wasn’t doing anything for my soul. Unconsciously, I began to lean towards combinations of arts and health to navigate those two interests.

If you study the evolution of humans, arts and sciences were originally combined, and that separation, which happened for some very practical reasons over the millennia, has never been 100% comfortable. There’s something lost when they're not connected. I think they still share some common DNA which informs the best of both sectors. But at any rate, when I joined WHO, I found that in my technical work, which in the early years was often in rural African HIV clinics, I had to use theater techniques to do the work properly. I drew on my knowledge of Augusto Boal and Theater of the Oppressed to figure out a way to not just give communities a sense of ownership over a solution to their public health problem, but actual ownership. Instead of coming in with fully formed solutions or fully formed scripts, I would come in with a half-written script and engage the patients and health care staff to complete it. The result was something that they actually owned, that they had created themselves.

But I couldn't tell anyone that this was a theater technique. There would be an allergic reaction to that. Similarly, on evenings and weekends, I was involved in running a local theater company. I would try as much as I could to invest health messaging themes in the productions that I directed. But again, if I was too obvious about it, people would say, oh, no, no, no, no, this show is not about issues. It’s about escapism from reality. So I would just frame the shows that I directed in a way that would be acceptable.

For example, when I did a production of Crimes of the Heart many years ago, I framed it as a comedy drama about three estranged sisters coming together and finding new meaning in family. And that's an accurate description of it. But I didn’t tell them that it was also about transgenerational trauma and suicide. In the second act, one of the characters attempts suicide on the stage. I used that opportunity to bring in public health experts after the show to have a community conversation about mental health issues. Had I pitched that upfront, I probably wouldn't have gotten the green light to do it.

When Dr. Tedros was first elected as Director-General of WHO, he put out this famous call to staff for crazy ideas. My crazy idea was, well, hey, if I'm trying to sneak arts into my health work and I'm trying to sneak health into my arts work, maybe here's a chance for me to combine the two fully and openly.

So I made my pitch in his office, and in five minutes he agreed. That's the basic journey of how I started the first arts and health program at WHO. I should also add that since its inception, WHO has been very much invested in the arts, but it's usually from the point of view of health messaging, whereas what we're talking about here is the intrinsic healing benefits of engagement with the arts.

When healthcare initiatives often seek measurable impacts, what evidence might you point to that supports sustainable and actionable benefits of the arts? 

In the beginning, I didn't because we hadn't done the research. The pitch was not that this works. The pitch was that people are doing this, and we ought to build up the evidence base.

That's what sold Dr. Tedros. I wasn't saying this was the silver bullet to solve all our health problems. I was saying, people are believing this is it true. Let's find out. And so the result was our 2019 report on the health benefits of the arts. It's a broad survey of the efforts back then to document the published evidence from a variety of artistic genres and health settings.

Examples included studies that showed how adding music to physical therapy after surgery could reduce hospital stays by 50%. Still, that's a rather utilitarian measure. For me, the most powerful measures are not quite so reductionist—it isn’t just about insurance companies or hospitals saving money. It's about when misfortune happens, how do you keep a sense of hope? How do you find an authentic meaning that allows you to endure, to transform and, ideally at some point, to thrive? And that's the healing process, not whether you can reduce your time in the hospital.

Your beautiful monologue The Vanishing Point explores ways of seeing. To loop poetry into the conversation, we think of Jane Hirschfield’s conception of poetry as making “new possibilities of perceiving.” Especially in times of sickness and crisis, how do you understand art’s impact on our individual and collective perceptions? 

When you think about the neurology of poetry, our sense-making ability is not just about gathering as much information as we can and becoming more knowledgeable. It's actually the opposite. Our perceptions are so finely attuned that they gather way more information than we can possibly hope to manage. So to make sense of the world, we have to filter it, even to the point of what they call neural pruning where you bring things back to their essence in order to understand them. How you do that through an aesthetic experience? There are many ways to get there, but oftentimes knowledge is a distillation, not an accumulation. And poetry is in some ways is a manifestation of that. It's like the old Blaise Pascal saying where he apologized for the length of this letter because he didn't have the time to make it short.

What you're saying reminds us of the TS Eliot quote that genuine poetry can communicate before it's understood—which might link back to its roots as the original form of oral storytelling.

Poetry is universal. There isn't a society that doesn't have some form of it. I would also argue from an evolutionary point of view that it's likely humans could sing before they could speak. So poetry in some ways evolved directly from song, not just about the meaning of the words. As Eliot pointed out, it's about the meter, it's about the tone, it's about sound. It's the call and response. And even call and response is a form of spatial triangulation. Even the structure of the sentence itself was subject verb object. It's a geometric triangulation to meaning. You can imagine how our hunter-gatherer ancestors were trying to make sense of the world, going on these long treks to hunt game and bring it back safely to the tribe. How do you not get lost? You have to, in the words of the Aborigines people in Western Australia, sing the world into creation. You have to create a song that allows you to literally navigate the world. So language itself probably began as a very concrete sense-making device: a mountain became a God so that I could understand the characteristics of that particular mountain and make it back to my camp.

Our perceptions create the art too. One of the things I learned in losing my sight is that when I first began to notice that I had a problem, I would be walking in the park next to WHO knowing full well that in Switzerland, that the trees I'm going to see are pine trees. And suddenly there was a palm tree—I was literally hallucinating. I went back to my ophthalmologist and said, am I going mad? What's happening? He said, what's happening is the visual cortex takes information from your perception, from your optic nerve and tries to find a pattern that makes sense. Usually it filters out the extraneous detail to find that pattern. But when your optic nerve fails, as it does in glaucoma, which is what I have, it's not getting enough information. So the visual cortex goes into reverse: it takes that faint pattern and delves into your memory and creativity to find a pattern that makes the most sense with the information that you have. It sensed treeness, but just grabbed the wrong tree.

From that, I learned that the Buddhists were right: what we perceive as the world is one hundred percent illusion. The world is not an illusion, but our perception of it is, and when we have normal perceptions, there is a closer relationship to objective reality than otherwise. But that doesn't mean it's not all still biochemical creation inside your nervous system. Everyone perceives the color blue differently.

As a well-meaning doctor told you “I don’t want you chained to the tyranny of hope.” When medical interventions reach their limits, how can art respond to hopelessness?

What the doctor meant was that oftentimes in our society, hope means clinging to fantasies that aren’t real. And I think what the arts can do is help you take the reality of what's happening, find a personal meaning in it that allows you to endure, and then from that meaning create a pathway to thriving. In my case, I was blinded by a disease rather than despair. I didn't try and wish it away. I didn't use hope as just literally blinding me to the situation. Instead, I tried to adapt. And in that adaptation, I found a personal meaning that transformed me.

That's what the arts can do. They’re not a denial of what's happening, but rather they help us grapple with it from a distance. Whether that magic circle is a stage or a canvas or just musical notes in the ether around you, there's an unwritten contract between the audience and the performers that when we enter that aesthetic world, we have a willing suspension of disbelief. We know that it's false, and that means our circuit breakers don't come in when we start touching on sensitive subjects. We can process them fully because we're in that, dare I say, it's safe space.

Even with aesthetic distance, I would have trouble seeing a play about my loss of sight. But if I saw a play about someone else experiencing a different type of loss, I might find some sympathetic resonance there that could help me get to the next level.

You’ve spoken of injury not as a reduction, but as a transformation. I think to how artists such as Frida Kahlo and Ana Mendieta who reshaped their identity after suffering through self-portraiture—an objectification of one’s own image.  What art forms have you used personally as agents of change?

Music has been a powerful one because if it's not a song, it's often nonverbal and can affect you in a deep way that isn't part of your conscious control mechanism. What's clever about poetry, and this gets back to what Eliot was saying, is that a skilled poet does not tell you outright what they’re talking about. So you're consciously reading words, but it's affecting you more like music at a nonverbal level. In trying to communicate the transformative power of arts in my own work, I actually use the techniques of poetry, of imagery, of empathy to create that deep aesthetic state so that I'm not just describing it, I'm showing it.

For instance, when I talk about having arrived at that transformed state, I don’t say so outright. Instead I say, “Just as you willingly close your eyes to better savor a glass of red wine, just as you willingly close your eyes to better embody a beautiful piece of music, just as you willingly close your eyes to trace the gentle slope of a lover's forearm, so do I accept the closing of my eyes to better share this moment with you?” And that's poetry.

Backtracking to the basics, how do you define health?

I don't have to define it because I work for an organization that already defined it in our 1947 Constitution. WHO defines health as not merely the absence of disease or infirmity, but the attainment to the highest level of physical, mental, and social wellbeing.

What's important about that definition from an arts context is oftentimes, people over-medicalize the arts and start focusing on measures that are based on deficits, the reduction of disease or symptoms. But the real power of the arts is the opposite: the true definition of health. It's raising your physical wellbeing to its highest degree, your mental wellbeing to its highest degree, your social wellbeing to its highest degree. It's a positive asset. It's not the lack of a deficit.

I'm a cancer survivor and yes, medicine lengthened my life. But the question is, was that life worth living? I just addressed a group of Julliard drama students a few weeks ago, and one of them asked about the healing power of the arts. And I said, well, ultimately, the arts are not so much about lengthening your life, but about making sure that you've lived a full life in the first place. And if you've done that, then it doesn't matter how long you live.

What’s next in your work across arts and health?

Through the Jameel Arts & Health Lab, we’ve created a consortium of research centers around the world that are filling out the evidence base, developing robust studies to not only look at arts-based health interventions at the clinical or community level, but also at the fundamental bioscience/neuroscience foundational level. Why does this work? What do we understand about the mechanism?

Within the next few years, I imagine we can present this evidence with recommendations to the member states and maybe even devise with a World Health Assembly resolution on the subject which would call on member states to invest in the arts, not just as preserving cultural identity or supporting the creative economy.

Our work is a shift from looking at the arts as merely a carrier of health messages to an intrinsic part of health. Just as exercise and good nutrition are healthy, being mindful about aesthetics, about making sense of our objectives, and giving ourselves permission to acknowledge moments of beauty and joy help make us healthy. It's not a mechanism to do another health behavior: it is one in itself.

To trace its etymology, the word health itself comes from an Anglo-Saxon root, which is a cognate to the word whole. Health is not about the absence of a weakness, but rather about being a complete person. Health is something that you pay attention to before misfortune strikes, so that when that happens, you can respond to it authentically.