A veteran corporate medical director offers
intriguing notions of how the work of being an artist can inform
and transform the work environment.
By Richard A. Lippin, MD
an age of technology-based medical miracles, it may be difficult
to discern links to the creative arts. Nevertheless, the arts
and the effort that goes into them can energize and inform both
my field of occupational medicine and the management of the workplace.
This is not a radical proposal, but rather a return to enduring
the relationships between health and the arts is an attempt to
move away from medicine that is focused on illness and fear of
death to a paradigm of optimism based on love of life. We study
artistic activity--everything from oil painting to figure skating--not
only for its capacity to cause injury and illness, but also for
its capacity to heal. Properly designed and meaningful work is
certainly not pathogenic. It is prerequisite for good health,
and empirical studies are beginning to validate this concept.
aspects of those studies have special application to the workplace.
The first relates to artists as workers. What can we learn from
this unique cohort of high-performance workers? Secondly, there
is the therapeutic application of the arts, especially for stress
management and productivity enhancement. Thirdly, and perhaps
most importantly, artistic models address emerging challenges
to the dominant models of work organization.
these aspects in the context of two premises. The first is that
the miracles of modern biological medicine are yielding to a biopsychosocial
model that assumes all stimuli, including the arts, have an impact
on human physiology and on health outcomes ranging from illness
to wellness, from injury to peak performance.
natural outgrowth of this holistic approach is a "democratization
of psychiatry" that embraces mind-body medicine and expects physicians
to be trained in behavioral medicine. The National Institutes
of Health offered one good example with its 1996 conclusion that
a number of well-defined behavioral and relaxation interventions
are effective in the treatment of chronic pain and insomnia.
second premise is that paternalism in medicine is yielding to
consumerism and empowerment. This transition is at the core of
the doctor-patient relationship and extraordinarily painful for
all concerned. Furthermore, medicine is a bellwether for other
paternalistic sectors such as the traditional "command-and-control"
corollary of this transition is that the arts, which emphasize
individuality, freedom and creativity, are an effective path toward
self-discovery and empowerment. That is why, historically, they
have been so feared and repressed by tyrants.
Learning from artists as
important example of how performing-arts medicine has informed
occupational medicine is the story of keyboard-induced repetitive
the differences between approaching the keyboard of a piano versus
that of a computer. What are the overall work demands on the pianist
versus the computer operator? What are the performance load demands,
the hand-eye coordination requirements and the intellectual effort
needed? What about work pace and error tolerance? What are the
attitudes and hoped for outcomes that each brings to the keyboard?
What are the levels of enthusiasm, boredom and worker motivation?
How can we improve measurement of these factors and the impact
they have on incidence and severity of injury, duration of disability,
return to work, quality of work and long-term worker performance?
me mention two examples of how the pianist worker specifically
informs the computer keyboard worker. The first relates to the
ergonomic issue of keyboard design. It is difficult for a child
or a small-statured adult to play a standard 48-inch piano keyboard
without harm. Each key is 15/16 of an inch wide, and the octave
width is 7 1/2 inches.
by her inability to perform the manual gymnastics required by
Russian composer Sergi Rachmaninoff, a five-foot tall New
York pianist named Hannah Reimann is on
a mission. She finally persuaded a German firm that manufactures
parts for Steinway pianos to develop a prototype that allows a
pianist to slide out a standard keyboard and pop in a slimmer
the same problem applies to the standard QWERTY design of computer
keyboards. Fully 15 percent of humans are not anatomically suited
for the sustained palms down position of the wrist required of
keyboard workers. This has inspired a plethora of alternative
designs that minimize or even eliminate the need for pronation
at the wrist, and that raises an important question: At what economic
level should we reasonably accommodate individuals not just with
disabilities but with different physical makeups, especially those
in jobs involving repetitive motion?
1990, I made a presentation to the National Institute of Occupational
Safety & Health (NIOSH) about performing artists as workers.
NIOSH was interested in the impact of worker motivation on repetitive
strain injury and questioned arguments that most allegedly injured
workers were malingering. If higher motivation were linked to
lower incidence of these syndromes, one would expect not to see
the problem among the unusually motivated, such as concert pianists.
those syndromes do indeed exist among professional musicians.
A 1986 survey of seven symphony orchestras, for instance, concluded
that half the players had such problems by the age of 30. In another
study of 47 U.S.
orchestras the following year, three quarters of the musicians
reported at least one medical problem that severely affected their
performance. At least two world-class pianists, Gary Graffman
and Leon Fleisher, had their careers stifled by constant, painful
cramps in their left hands.
worker motivation is clearly not the whole story. Yet here we
are in 1999, and the Occupational Safety & Health Administration
still does not have an ergonometric standard because of the ongoing
controversy surrounding these issues. We need to learn from this
small but remarkably high-performance population of professional
musician-workers. They provide a window into our understanding
of small muscle athletics, fine motor control, hand-eye coordination,
much earlier endpoints of pathology, high worker motivation, the
limits of human performance, the aging worker and the pursuit
of creativity and excellence.
Using the arts as medicine
the arts be successfully utilized as therapy for employees, especially
as tools for stress management and for productivity and creativity
creative artstherapy movement dates from the end of World
War II. Pioneering professionals incorporated music, art, dance,
poetry and drama into therapy. When advances in neuroscience gave
us tools to validate their effectiveness, these therapies began
to move from primarily psychiatric settings to all medical specialties--including
rehabilitation, pediatrics, geriatrics, oncology and hospice--and
now to wellness or performance-based medicine. Fundamental premises
are that the excesses of pharmacologic and surgical interventions
are beginning to bite back and that the arts or objectively measured
aesthetic stimuli represent safe and effective alternative or
area that has the most advanced scientific research is the impact
of music on the central nervous system. The groundbreaking work
by neurologist Frances H. Rauscher and colleagues from the University
of California at Irvine
demonstrated improvements in spatial reasoning and other CNS tasks
among college students after listening to the music of Mozart.
research, which was extended to infants and toddlers, ultimately
became known as "The Mozart Effect" and spawned a veritable industry
with much marketing and media fanfare. At least two states enacted
gives child-care centers funds to expose their clients ages birth
to five years to classical music. In Georgia,
the so-called "Beethoven Bill" would issue classical music tapes
or discs to parents of the state's 100,000 newborns each year.
with any phenomenon, preliminary findings must be validated by
additional studies. Other researchers have recently questioned,
for example, the range and permanence of some of the effects claimed,
especially by those who are aggressively promoting widespread
use of the intervention. Suffice it to say, however, that new
ground has been broken.
these concepts into adult occupational medicine will be a challenge.
Business leaders and third party insurers are skeptics, but they
are also pragmatists. Presented with data, they will respond to
what works and saves them money. For example, music-paced work
is resurgent in new settings. A 1994 study measured the effects
of music on heart rate and blood pressure among surgeons and concluded
that surgeon-selected music was associated with relaxation and
improved performance of a stressful, nonsurgical laboratory task.
rigorous studies have demonstrated the impact of music on mood.
We need to pay serious attention to this in light of the epidemic
of depression among workers and its associated human and economic
arts also may be able to enhance our percep-tual and creative
skills. Certainly the Germans and the Japanese grasp the implications
for preparing students for a competitive global workforce. The
arts are a mandatory part of their curricula through high school.
that the arts should not be glorified as a panacea for society's
ills, I must admit a downside. The U.S. National Safety Council
noted a surprising correlation between auto accidents and listening
to opera while driving. No correlation was found with music other
than opera. This, of course, raises the issues of safe and effective
doses of music as well as the importance of where and when the
intervention is utilized.)
arts can also be an effective part of stress management. In this
regard, I believe that the Western mind needs practical tools
that emphasize activity over passivity. Western man is fundamentally
a "creationist" being. A colleague said to me recently that we
should call ourselves not "human beings" but rather "human doings."
am by no means alone in considering arts activity to be the creativity
response to stress. Dr. John Diamond, Australian trained as a
psychiatrist and now an extraordinary holistic physician, calls
engaging in the arts "the supreme meditation or the royal yoga."
Dr. Angela Patmore has challenged the relaxation gurus. She suggests
that the most effective method of mastering occupational stress
is to practice handling pressure, including use of the arts, rather
than to practice relaxation and run the risk of learned helplessness.
Transforming the work environment
dominant models of work organization are being challenged, just
as futurologist Alvin Toffler and others predicted. The command-and-control
approaches of large bureaucratic organizations are yielding to
individual empowerment and project teams that emphasize rapid
results through innovation and creativity. This model embraces
the characteristics of work in the arts: freedom, discovery, performance,
harmony, discipline, pursuit of excellence and, most importantly,
of course, has enormous implications for worker health and productivity
and even broader political and economic ramifications for labor-management
relationships in a competitive global economy. Productivity guru
Peter Drucker says that demands on our creative ability double
in every generation and that the 21st century belongs to those
companies and countries that can innovate the fastest. Edward
DeBono, a British physician and recognized authority on "thinking
styles" and corporate creativity, says that ideas and innovation
are the currency of success that separates competitors.
we live in a world where hard capital is in excess and intellectual
capital is in short supply is most evident in the booming information
technology sector. Thus the human brain is the last frontier in
human capital management, as Weston Agor, an expert on intuitive
decision making and founder of the Intuition Network, has said.
realities of these new organizational models and business needs
are megatrends that are not going away. At the same time, we are
uniquely poised to use medical science to measure, manage and
maximize human capital.
physicians, we must emphasize the centrality of human needs in
work. In the arts or in athletic arenas, where the risk of excessive
emphasis on performance is great, we must promote the priority
of long-term health over short-lived and often dangerous glory.
Similarly, we must promote health when it is in competition with
arts should serve man, not vice versa, and artists in any form
can succeed without destruction of their physical or emotional
beings. That concept needs to be applied to all workers. Thus,
I tell my business managers that our human assets are precious,
that they need to be protected and that we need to emphasize "the
marathon over the sprint."
his wonderful book titled Artful Work, Dick Richards, a
corporate consultant, writes about artful leaders who succeed
by activating the energy of others, much as a painter activates
the energy of paint or a poet energizes words. Leaders must discover
how to draw all that very real and measurable energy to a point
of focus, to a vision. This, as Richards says, is, indeed, true
art. Quoting Peter Drucker once more, "the model for managers
in the future workplaces is the symphony conductor, who does not
know each musical selection nor play each instrument better than
each musician, but leads them all harmoniously through the most
effective performance that they can muster."
must not underestimate the power of these metaphorical models.
At this time in western cultural history we need, almost desperately,
the powerful and transforming vision that the arts can provide.
A vision that, as California
artist Ceil Bergman says, provides hope, optimism, affirmation,
collaboration and imagination. These are among the best qualities
of which we are capable and necessary tools in modern commerce.
I predict that as basic human needs are increasingly met around
the globe, businesses that understand and supply the human need
for beauty or aesthetics will thrive. Thus, we will compete to
market and deliver beauty to our customers.
1872, the huge Japanese cosmetics company Shiseido has consistently
pursued its vision of "the realization of beauty and health."
Shiseido president, Yoshihara Fukuhara, has said his firm has
"been fully aware of the values we offer society through our business
and products. We can also say that appreciation of beauty can
cure social maladies. It also works as a vitamin or hormone for
corporate health itself."
something as mundane as porcelain toilet bowls can be associated
with art. A 25-year-old program at Kohler Company in Wisconsin
is probably the most unusual ongoing collaboration between arts
and industry in the U.S. Artists spend two to six months creating
works of art in Kohler's pottery works, iron and brass foundries
and enamel shop. Participants are exposed to a body of technical
knowledge, which enables them to explore concepts not possible
in their own studios. Perhaps more important than the access to
technical materials is the mutual influence between the artists
it naļve or romantic to suggest that this inter-action might mutually
benefit both worlds? I think not. Standing outside of Kohler world
headquarters in Wisconsin
is a large engraving of the words of John Ruskin: "Life without
labor is guilt. Labor without art is brutality."
Richard Lippin. Applying lessons
from the work of art. Business and Health 1999;-22.