Drawing a picture of your diagnosis


Part of my latest mandala (a work in progress)

by Carolyn Thomas   @HeartSisters    January 27, 2019

The late Madeleine Shields was a gifted artist and teacher here on the west coast of Canada. But more importantly to me, she was MY teacher. Her artistic expression of choice was the mandala, a Sanskrit word for “circle”. The mandala practice of Madeleine Shields was not what you might see in adult colouring books or on painted rocks at craft fairs. Hers was based on an ancient spiritual and meditative practice that she compared to “painting a mirror”. I can sometimes still hear her distinctive voice in my ear asking pointedly, “Did you do it well, or did you do it fast?”

A recent study supports what Madeleine had already figured out 20 years before her death, that art can intuitively reflect our deepest emotions in a surprisingly accurate fashion – and that’s especially true when we become patients.

Dr. Christian Jarrett, editor of the journal, British Psychological Society Research, suggests that art is an approach that can help patients heal.

Broadbent et al, 2018

He cites new research by Dr. Elizabeth Broadbent at the University of Auckland in which patient drawings offer insights that are often missed by healthcare professionals.(1)  These insights can help to improve and personalize psychological interventions intended to help patients understand and cope with their illness, treatment and prognosis.  For example:

“When patients draw the parts of their body affected by illness, this can reveal how people think about their diagnosis and/or the seriousness of their condition, and may even be able to predict how well they are likely to cope.”

Dr. Broadbent and her colleagues believe that psychologists can use patients’ drawings to improve understanding of the illness experience and to inform the clinical interventions they offer. They can do this through:

  • observing the drawing size
  • identifying themes in drawings
  • looking for distortions or omissions
  • studying drawing styles and use of colour
  • analyzing facial expressions

The Broadbent research cited a number of studies on what patients’ drawings reveal about many diagnoses. For example:

  •   brain injury survivors who drew greater damage on their brain tended to experience a longer recovery time and a worse quality of life
  •   kidney transplant patients who drew their kidneys larger tended to have higher anxiety and lower feelings of control
  •   research comparing the drawings of healthy and sick children  found that sick children’s drawings featured fewer human figures
  •   AIDS-affected children featured more bed-ridden people, less beauty and more distress
  •   people diagnosed with mental health conditions like depression used fewer colours and more empty space compared to other diagnostic groups

“Where emotions have been drawn,” adds Dr. Jarrett, “the drawing could be a good starting point for a discussion about how the patient has been emotionally affected by the illness.”

This study’s findings immediately reminded me of Alaska’s Dr. Stephen Parker, a cardiac psychologist and a heart patient himself for almost 20 years. 

Despite having no art training, Dr. Steve felt compelled one day to start painting a series of 27 images that reflected how surviving a massive heart attack had affected him emotionally.

He called this series, Heart Attack and Soul.

And after he was done, Dr. Steve came to an unusual decision:

“Something in me decided to spend the next 40 days reviewing these paintings and posting a daily comment about them on a new blog.

“Each day I wrestled with how to express how the heart attack had affected me, and then finally posted an illustrative image and a short commentary.

“In that intense process of thinking, painting and writing, a profound spiritual awareness slowly emerged, transforming my perception of myself and the world around me.”

This response to creating art is not unique to Dr. Steve. (A 2016 study, for example, found that 45 minutes of art-making can lower stress hormone levels).

His Heart Attack and Soul project began as a series of these 27 original paintings, then morphed into a blog, then a public art exhibit, and finally a book (sadly, out of print now).

With Dr. Steve’s permission, here’s painting #19 of his heart, along with his thoughtful description of how this painting reflected his own cardiac experience:

© Stephen Parker 2007

“We connect with each other through our wounds.”

~ Rachel Naomi Remen

Emotions of the Wounded Heart

“I experienced so many swirling emotions after surviving this heart attack:

–Relief at survival

–Disbelief and anger that it happened

–Grief for everything that was and will be lost

–Gratitude to those who helped

–Extreme vulnerability in a previously safe world

–Fear of what the future might bring

“I had taken my vitality for granted and assumed that I would have many long and healthy years of life ahead of me. Now, I had no solid ground on which to stand. I was profoundly weak from the injury. I never knew whether or not I would wake up the next morning. I doubted that I would ever be able to return to any kind of normal life again.

“It is as if I had crossed the River Styx to the Underworld and was allowed to return to the Land of the Living, temporarily, for an unspecified period of time.

While the journey has certainly been hellish, at the same time it has given me something important and valuable: I now have an increased compassion for the wounded, a compassion for all those who must cross the River Styx.

“Although the heart attack has broken my heart, it has also opened my heart.”

We’ve known for many years that professional art therapists help people explore and express thoughts and feelings through creativity and art materials.

Creating art can make patients feel better, but emerging research has also suggested it’s not just about making nice pictures, but more importantly – and as patients like me and Dr. Steve have discovered – it can be a form of healing therapy.

Here’s the conclusion from Italian researchers, for example, who were specifically studying heart patients:(2)

Through the creation of a tangible product, psychologists can better evaluate the emotional and psychological troubles of patients, and provide them and their families with more focused and personalized support.”

It’s important to remember that, unlike most art classes that focus on what art looks like when it’s finished, the focus of art therapy is on the art-making process itself, particularly on the thoughts and feelings that come up for the person creating the art. No artistic talent required!

In that way, it reminds me of my early mandala painting lessons with Madeleine Shields. The only rule was to start with a carefully measured pencil outline, from the first concentric circle of the ring of fire (known as “the outer wall of the world, beyond which lies chaos”) down to the quiet central square of four gates (portals).

But after that simple outline of circles and squares was done, it’s all freehand painting, attention focused only on the tip of the brush, without purpose or even knowing what comes next. The mandala essentially paints itself, as Madeleine used to tell me whenever I started thinking too hard about how the finished painting would turn out, or if I were doing it “right”.  (My monkey mind tended to go straight to planning which wall of which room in the house I’m going to hang this thing when it’s done!)

But you don’t need paints or an art teacher to explore this kind of therapeutic expression. Grab a pencil or a felt pen and a clean sheet of paper, and just start drawing what you are feeling today. Don’t think, just feel.

Even without access to an art therapist, you may discover that, as I have found through the mandala, and as Dr. Stephen Parker found after his own heart attack, art can be a powerful creative outlet in support of healing.

1. Elizabeth Broadbent et al. A systematic review of patients’ drawing of illness: implications for research using the Common Sense Model”,  Health Psychology Review 27 December, 2018.
2. E. Quadri et al. “Art therapy for hospitalised congenital heart disease patients”. Pediatr Med Chir. 2012 Nov-Dec;34(6):292-6.

ART UPDATE:  Did you know that January 31st is Inspire Your Heart With Art Day? Me neither!  I learned about this from Alexia Aspri, a cath lab nurse in Cyprus, who shared this heart drawing:

Screen Shot 2019-02-02 at 12.15.38 PM

NOTE FROM CAROLYN: I wrote much more about how we adjust to a serious diagnosis in Chapter 5 of my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon.  Or if you order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN, you’ll save 20% off the list price when you order).

Q: Have you used art to express the effect your own cardiac event has had on your life?

See also:

17 thoughts on “Drawing a picture of your diagnosis

  1. I absolutely love this, Carolyn…I worked with a wonderful artist for a few years, and we used mandalas with cancer patients and women searching for creative expression…

    I am inspired to try this for myself–a mandala expressing my heart…hobbling along as it is.

    Liked by 1 person

    1. Thanks so much for this, Sharon. You never know how working with just one special person can inspire us to do years afterwards. A mandala expressing your heart – good luck with that project!


  2. Did you know that picking up a pencil to doodle or making a figure out of clay can help you to relieve stress, depression and fear, and can even help diminish pain or other physical symptoms?

    Art therapy uses simple art activities to help people express themselves and develop a sense of well-being through the creative process. Expressing oneself through a drawing, painting, sculpture, or collage makes our thoughts, feelings, and ideas tangible and communicates what we sometimes cannot say through words alone.

    Through working with art materials, learning new skills, and developing ideas through visual media, often people feel a sense of self-satisfaction, personal achievement, and accomplishment….


    Liked by 1 person

  3. Years ago, during my nurse training, I took part in an Art Therapy session – it was a real eye and mind opener! I am forever grateful to the wonderful art therapist who led the session – I was not one of the “patients” but that session has influenced my life for over 30yrs in a positive way – it showed me that I could express my deepest concerns creatively and safely. Many years later I stitch, sometimes just for pleasure but sometimes to work through troubles, emotions and experiences. I don’t have to share what I do, but simply doing it is cathartic and soothing.

    I wish creative expression could be prescribed by medics, it can be so much more helpful than many drugs – now that so many of us have to learn to live with ongoing health issues, which are managed rather than cured, it really is more appropriate and necessary to have a therapeutic toolkit which include a wide range of approaches for the body and mind.

    Thank you for this post.

    Liked by 1 person

  4. LOVED this post Carolyn! So glad to see that you are an artist! Thank you for sharing your latest work in process with us, it’s beautiful. I’ve wondered for awhile where you get the artwork on your blog — did you make some of that?

    I have a college degree in Art History (I love analyzing artworks!) and have taught Art for over 25 years. Art can be very therapeutic but it doesn’t have to be drawing, which I have found most people are afraid to try. (“Oh, I’m not an artistic person, I can’t draw” — I’ve heard this over and over again.)

    There are so many ways to visually express your creativity — besides drawing and painting and sculpture, you could try knitting, crocheting, sewing, woodworking, jewelry-making, floral arranging, gardening, etc etc — even cake decorating. My favorite media are watercolor pencils, which are super easy to use, and collages, especially using yarn and weavings.

    After my first stent in 2015 (of two), I painted a good-sized canvas in a warm orangey-red color and sewed warp threads in the shape of a heart through the fabric (a Valentine’s type of heart, not realistic). Then I wove the heart on top of the canvas with a bulky weight yarn that formed a striped pattern. The yarn was in shades of cooler red and maroon and had a subtle blue thread that wove through it, which I wanted to suggest the blue of blood vessels like you see under your skin. On top of the weaving I crisscrossed thread lines of sparkly silvery beads to form a short diagonal oversized “stent” along one side of the heart. Then around the heart in small black letters I wrote “Thank you for my” and under the heart I stenciled the word “STENT” in large black lettering (unless you look up close all you really see is the heart and the stenciled word). It came out looking like folk art and I’m calling it “Heartfelt Thanks.” I had originally planned to give it away to the doctor who did the cath but after it was done I could not part with it. It’s too personal for me — too close to my heart, if you will.

    I’ve also done some smaller heart weavings (many 4×4″ canvases in all kinds of different color combinations) and a couple of watercolor pencil pieces with hearts too. One of them is of stenciled hearts completely filling the picture space and overlapping each other, colored in with watercolors (pencils) that blend together where they overlap, and then embellished with pointillistic dots of permanent marker. I call it “Cardiac Connections” and it was inspired by the heart patient support group I lead of the same name.

    “Heart art” is my current focus these days. I do encourage anyone with cardiac issues to find a way to use your creativity to express your feelings. It is really healing.

    Liked by 1 person

    1. Thanks Meghan for the important reminder that art is not just DRAWING (which is why, according to some experts, many adults still do ‘stick men’ when asked to draw because their art practice long ago in childhood is likely the last time most of us actually drew something!)

      Your list of alternative forms of creative art expression is a really good one. To that list, I’d add paper crafts (scrapbooking, making personalized greeting cards, etc). And I think mixed media collage is a really effective way to get those who insist “I’m not an artistic person!” to see how much fun art can actually be. Some of us need to be introduced to expanding our experiences like this by signing up for a workshop, but even just sitting down with scissors, glue and little stack of interesting twigs, leaves, and papers can be a good start.

      Your 2015 heart project sounds amazing!


  5. Carolyn, I love this post. I’ve had decades of expressing feelings through both visual arts and one-on-one interactive guided imagery both personally and professionally.

    Personally: I’ve kept a visual journal using collage and smearing paint on the pages – I do it spontaneously without thinking it through and invariably when I look at what I did a week, month, year later what I did was reflective of what I was going through at the time. I did 3 non-representational paintings (just smeared paint on the canvas with sponges) just before being Dx’d with atrial fib, and lo and behold the painting are my heart beating regularly and irregularly – it blew me away when I realized that.

    Professionally, I facilitated, (probably 100’s of hours) of creative expression workshops using collage, paint, masks for both clients and the general public. The mask workshop was one of my favorites where participants painted the outside of the mask to represent the face they showed to the world and painted the inside what they felt. Many of the workshops were specifically for chronic medical conditions/pain and the work was incredibly powerful.

    The key, I believe, is not interpreting but allowing the creator to describe and explain. They always know their truth. It sometimes takes some instruction to help people explain their work but once they get it . . . they get it.

    Research has shown for a long time that it isn’t even necessary to “understand” but just the act alone of journaling or painting, or scribbling is therapeutic.

    Creative expression of any kind is, I believe, God given – spiritually emotionally and physically therapeutic

    Liked by 1 person

    1. Thank you, Judy-Judith for weighing in with your opinions here. I thought of you (because of your background as both a psychotherapist and an artist) – so am really happy to read your informed comments.

      I feel particularly moved by that “mask” workshop you teach (“outside of the mask represents the face they SHOWED to the world, and the inside what they FELT”). Oh my goodness – I’ve become a world expert in that duality! When I think of how I have clung to denial during the worst times, pasting on that little happy face smile, even putting my own life in peril (!) so as not to be perceived as “making a fuss”, it’s just downright embarrassing….

      I agree with your interpretation of ‘interpreting’, too: just the very act of doing the drawing or painting or journaling seems to be able to shift our perspectives – even if we can’t quite figure out how it works!

      Liked by 1 person

  6. Dr Steve’s expression of “taking his vitality for granted” … ” feeling unsafe” in a previously safe world … and his other post heart attack feelings are all truths that happen not just after a heart attack but after an accident, a new diagnosis, a chronic illness…. even death of a loved one.

    All of which are events in human life that remind us that our body is a temporary dwelling…..And if we have not developed solid ground in a framework that is based on our soul and our spiritual nature …. we will feel lost, totally lost.

    After being a nurse for 30 years and watching this process in my patients over and over again….I left ICU nursing and began my work and study in Spirituality and Health. I am grateful that by the time I was having open heart surgery I had developed a strong sense of who I am …. with or without a physical body. We all suffer way more than we need to….

    Art, expressing beauty for beauty’s sake, focusing on color and beauty quiets the mind and allows our true, spiritual selves to shine through ushering in Peace and understanding.

    Liked by 1 person

    1. Hello Jill – thanks for this unique perspective. I agree that, because it focuses on color and beauty, art helps to quiet the mind in an important and perhaps unappreciated way. And I also believe that art can help to express grief and confusion and sorrow in order to work those emotions out, too.

      Liked by 1 person

  7. I logged on to the internet and read this blog post just after drawing in my journal–drawing my bruised heart held by my hands.

    This was the first time I’ve made a drawing of my heart. This post was really helpful as I wander between fear of what the future might bring and acceptance of a changed capacity.

    Liked by 1 person

  8. Carolyn, as always, I was interested in what you were saying. When I got to Stephen Parker’s words, I felt I had to reply. He expresses so well the whole-being change that occurs when we lose the innocence of counting on our bodies to work.

    After open-heart surgeries in 2000 and 2011 to replace valves then cardiac microvascular disease diagnosed in 2014, I was doing well in 2018. Until October, when I had the shocking diagnosis of cancer in one eye. Surgery to remove the eye and everything in the socket followed and once again I am feeling

    “–Relief at survival

    –Disbelief and anger that it happened

    –Grief for everything that was and will be lost

    –Gratitude to those who helped

    –Extreme vulnerability in a previously safe world

    –Fear of what the future might bring”

    Actually, I don’t feel anger that it happened, but disbelief! More women die of heart disease than cancer. I was in the heart disease column: cancer couldn’t happen to me!

    Liked by 1 person

    1. Hello Jenn – I too loved Dr. Steve’s list of those “swirling emotions”. No wonder you are feeling so many of them, especially since you are in relatively early days of your new devastating diagnosis in October.

      It often seems to me that some people get far more than their fair share of awful things, which just proves my theory that there really is no ‘fair fairy‘ in life.

      Once you’d already been through such serious cardiac events, it must have been a shocking blow to hear that cancer diagnosis. One more thing??!?! Many breast cancer patients now share that same disbelief, given that we know that certain forms of cancer treatments can result in heart damage (often years later), which has given way to the specialty field of cardiology called cardio-oncology. Thanks so much for sharing your perspective here…


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