







































 Humanities and Social Science Research; Vol. 4, No. 4; 2021 

ISSN 2576-3024   E-ISSN 2576-3032 

https://doi.org/10.30560/hssr.v4n4p42 

 42 Published by IDEAS SPREAD 

 

Mental Health Perceptions from Artwork 

Alexei Sammut1, Paulann Grech1, Michael Galea1, Margaret Mangion2 & Josianne Scerri1 

1 Department of Mental Health, University of Malta, Malta 

2 The Edward de Bono Institute for Creative Thinking and Innovation, University of Malta, Malta 

Correspondence: Alexei Sammut, Department of Mental Health, University of Malta, Malta. Tel: 356-2340-1185. 

E-mail: alexei.sammut um.edu.mt 

 

Received: December 6, 2021; Accepted: December 20, 2021; Published: December 23, 2021 

 

Abstract 

The relationship between artwork and mental health has been the subject of various research endeavours. Whilst 

artwork has been long used as a means of emotional expression, it is also a method of raising mental health 

awareness. In this study, an art collection was presented to depict the challenges faced by many individuals living 

with a mental illness. Through a series of open-ended questions, twenty-nine participants were requested to give 

a title to each piece and to describe the perceived message and emotions related to each painting. The thematic 

analysis process of the participants’ descriptions led to the identification of three themes, namely those of Darkness, 

Solitude and Recovery. Whilst congruence was often observed between the participants themselves and between 

the viewers and the artist, discrepancies were also noted. Artwork can be an important medium in addressing 

stigma and in guiding reflections on mental health topics.  

Keywords: aesthetics, mental health, artwork 

1. Introduction and Background 

1.1 Art and Emotions 

An important characteristic of aesthetic experiences is their capacity to elicit emotions in observers (Paasschen et 

al., 2015). In this view, research effort has been dedicated to understand the exact mechanisms that are involved 

in the process of perceiving and interpreting artwork. One aspect of this research has focused on the composition 

and form of the image itself and their role in the ability to evoke an emotional response. For instance, the colour 

composition and the linear-mark direction of the picture are elements that can trigger specific emotions in the 

viewer (Hodges, 2015). Thus, lighter colours tend to be associated with more positive emotions whilst chaotic 

lines may suggest agitation (Gail, 2017). 

Notably, the tone of artwork does not simply suggest an emotion but often results in bodily changes within the 

perceiver. For instance, in their study, Leder et al. (2012) reported how participants, displayed more frowning 

when viewing images with a negative emotional tone whilst smiling more when being presented with emotionally 

positive work. Furthermore, in another study by Gatti et al. (2018), the study sample experienced greater levels of 

arousal (as indicated by higher skin conductance) when viewing stirring images.  

Whilst research on the emotion-related characteristics of artwork and the viewers’ general experience, is in 

abundance, few studies have delved deeper into the inner affective experience of the observer (Pelowski et al., 

2017). The current study attempts to contribute to this gap. 

1.2 Art and Mental Health 

The link between mental health and artwork has often been described in the literature (Gail, 2017; Rothenberg, 

2015). Commonly this refers either to individuals expressing their mental health distress or professionals who 

utilise art-based interventions as a means of support. Artists' feelings, opinions, ideals, and emotions are 

inextricably reflected in their work – and in some cases, purposefully portrayed (Rustin, 2008). In fact, Mark 

Rothko, Edvard Munch, and Bernard Buffet all claimed that their work represented their dysthymia whilst the 

works of Paul Cézanne, Vincent van Gogh, and Jackson Pollock have been interpreted as portraying aspects of 

mental disturbance (Rustin, 2008; Sahiti, 2017). 

The art collection that features in the current study is part of the series Living with Mental Illness by Anthony 

Calleja, who is an internationally acclaimed Maltese artist. It consisted of 17 paintings depicting the various 

challenges that many individuals living with a mental illness face on a daily basis such as stigma, bullying and 



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inner turmoil (Refer to Figure 1 and Table 1). In this study, we studied affective aspects of art appreciation in 

relation to this collection. Thus, participants were requested to give a title to each piece as well as to explore the 

message that each painting was conveying. Additionally, the viewers were asked to describe the emotions 

perceived in relation to each of the works.  

 
Figure 1. Artwork 



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Table 1. Intended artistic message/topic in relation to each painting (Sammut & Calleja, 2019) 

Painting Artistic message/topic Painting Artistic Message/topic 

1 Thoughts 2 Social Isolation and Loneliness 

3 Stereotyping 4 Technology and mental wellbeing 

5 Obsessions and addictions 6 Financial stability 

7 Eating Disorders 8 Relationships and substance misuse 

9 Bullying 10 Vulnerability 

11 Schizophrenia 12 Struggles with suicidal ideations 

13 Fighting suicidal ideations 14 Death by suicide 

15 Professional support 16 Recovery and rehabilitation 

17 Message open to interpretation  

 

2. Method 

The main research questions guiding this study were:  

- What is the perceived message of each painting, as interpreted by the participants? 

- Which emotions are experienced by the participants upon viewing each painting? 

A cross sectional survey design involving a series of open-ended questions was employed to investigate the 

interpretations of participants to artwork in the series Living with Mental Illness. The self-designed questionnaire 

was distributed by the exhibition curator during an art exhibition. A total of 29 participants were recruited. Ethical 

approval was sought and granted by the University’s Faculty Research Ethics Committee (FREC). The participants’ 

descriptions in relation to the paintings were analysed through a process of thematic analysis. A Comparative 

Analysis process was then undertaken whereby the participant descriptions related to each painting were compared 

in order to explore: 1). similarities and differences in interpretation and emotion perception between the 

participants themselves and; 2). congruence and discrepancy between the participants’ perceptions and the author’s 

intentions (the latter-mentioned were available on the publication that accompanied the collection).  

3. Results 

The thematic analysis process led to the identification of three themes, namely those of Darkness, Solitude and 

Recovery, each of which had a number of subthemes, as presented in Table 2.  

 

Table 2. Themes emerging from the Analysis of the Findings 

Participant interpretations Main paintings contributing to each theme 

Overarching themes  Subthemes 

Darkness Entrapment 

Death 

Pain 

Fear 

2,3,4,6,7,10,11,13,14,16 

Solitude Loneliness 

Lost in Thoughts 

1,2,5,8, 9 

Recovery Freedom 

Support 

12, 15,17 

 

Theme 1: Darkness 

This was the dominant theme that emerged from the findings of the study, with ten of the 17 paintings being 

identified as contributing to it. Darkness refers to reported participant interpretations that touched upon a range of 

emotions related to mental health challneges such as anguish, burden and struggles that frequently characterise 

mental illness: 

“...what struck me the most was the “darkness” and “hollowness” in the person’s eyes. It’s almost as if the 

person is completely empty and hurt, but at the same time I got the sense 

that he/she is also angry.” [Painting 2, Participant 25] 

The sub-themes within this theme are Entrapment, Fatigue, Pain and Fear.  



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Entrapment refers to feelings of being kept hostage by mental illness or by its societal perception, as discussed by 

some of the participants. Fatigue was depicted as that sense of tiredness and unmotivation that can accompany a 

mental illness, rendering every single day a major challenge to go through. The sub-theme of Pain was presented 

through descriptions of the emotional distress that those experiencing mental illness may go through. Fear was the 

final sub-theme that contributed to the Darkness, featuring the multiple terrifying thoughts and experiences that 

those who are living with a mental illness may be engaged in. 

Theme 2: Solitude 

This theme represents those participant interpretations related to the feeling of stillness that emerged from some 

of the paintings. Stillness, which was often described in negative rather than positive terms, can be part of the 

journey of mental illness and recovery: 

“The painting immediately evokes feelings of fear, pensivity and above all despair and  

loneliness. It somehow reaches out to you and makes you want to explain to this  

individual that he is not alone.” [Painting 1, Participant 3] 

Seven paintings were the main contributors for this theme and the sub-themes identified were those of: Loneliness 

and Lost in Thoughts. 

Loneliness referred to that state and associated feelings which result when the person living with a mental illness 

is misunderstood or segregated by society. On the other hand, Lost in Thoughts was presented as that person who, 

because of their inner turmoil, withdraw in themselves, lost in myriads of thoughts that threaten to be 

overwhelming. Here the person opts to be alone in preference of being with others, rather than this state being 

imposed upon them by society.  

Theme 3: Recovery 

This final theme may be seen as akin to the light at the end of the tunnel – a ray of hope. Consisting of the sub-

themes ‘Freedom’ and ‘Support’, the clear participant interpretations show the move towards recovery. A sense 

of freedom was interpreted by the viewers and this was parallel to the heartening indication of support being 

available to those living with a mental illness: 

“A sense of unity and being; belonging to a community, a system of support. Feeling of hope and willingness.” 

[Painting 17, Participant 14] 

4. Discussion 

In his book Camera Lucida, Barthes (1980) introduced a concept that quickly gained interest in the artistic world. 

This centered on the two stages in the relationship between an image and its viewer. Studium is the first process 

that takes place, which involves that which first draws a viewer to an image – this is often the topic of the image 

itself – that which engages or repels the viewer at the first instance (Singh & Ladsaria, 2017). The studium is that 

which affects the logical and intellectual parts of the person who is being exposed to the image. The punctum, 

which is the second step, is that which goes deeper and is able to move the viewer emotionally (Singh & Ladsaria, 

2017) During this current study, the first request that was made to the participants was to provide a title to each of 

the seventeen pictures. Interestingly, upon reflection on the titles provided, it can be noted that in many cases, the 

titles given were based on the studium response of the viewer. To this extent, the titles, which often consisted of 

one word, were mostly focused on the first impression obtained from the painting, commonly involving the pose 

of the depicted figure, the facial expression or the type of movement. Such titles include ‘Waiting’ and ‘Foetal 

position’ for the first painting, ‘Caged’ and ‘Scream’ for the third one, ‘Dance’ and ‘Bullying’ for the ninth picture 

and ‘Come hither’ and ‘Souls’ for the fifteenth image. Contrastingly, when the participants were asked to describe 

the emotions and feelings conveyed by each picture, the progress from studium to punctum could be clearly 

observed in most of the cases. For instance, one of the viewers who had provided the title of ‘Fighting for life’ to 

the fourteenth painting, subsequently described the perceived emotion as: 

“Climbing up steps, trying to reach what you really want to achieve” [Painting 14, Participant 28].  

Similarly, the participant who had named Picture 15 as ‘Transcendence’, shared an in-depth reflection that clearly 

portrays the punctum effect: 

“[The painting] gives me positive feelings like hope and peace. Being aware of one’s mental illness, falling 

down and then rising up once again. Feeling at peace with oneself and accepting the mental illness in oneself. 

Rising up again with the constant support/help of a supernatural being who is constantly with the person.” 

[Painting 15, Participant 18] 



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Jacquette (2014) described that there may be discrepancies between that which the artist wishes to portray and the 

punctum which is perceived by the viewer. This was demonstrated in a study by Markey et al. (2019) who explored 

inconsistencies in the processing of artworks, as recorded via EEG. The findings suggested that there is an art-

related processing mode or schema that influences human perception. Consequently, the researchers concluded 

that this schema, which is active when viewing images, seems to have specific underlying rules, referring to 

individualistic ways of defining structure and meaning. The participant responses in the current study can be noted 

to demonstrate such similarities and inconsistencies, both between the participants themselves as well as between 

the artist and the participant, in view of the same painting - these shall be discussed as follows within each of the 

three themes that emerged.  

Theme 1: Darkness 

The dominant theme that emerged from the analysis of the participants’ interpretations of the paintings in this 

collection, was that of ‘Darkness’. This refers to those emotions which are associated with a heavy and sombre 

ambiance in view of several factors that have given rise to the sub-themes of Entrapment, Fatigue, Pain and Fear. 

The paintings which were associated with this theme through the reflections by the viewers were 2,3,4,6,10,11,13, 

14 and 16.  

One similarity amongst most of the paintings that have been interpreted within the context of Darkness is the 

featuring of the artist’s own face in dark tones. The facial expression in these paintings is mostly one that 

communicates the experience of agony, despair and confusion. For example, the second painting shows a shrouded 

dark figure wearing a white cloak. The artist’s message related to this work emphasises the fact that it is not only 

the illness itself that may cause an individual to withdraw from society but the stigma which is commonly 

experienced in the face of mental health pathology (Sammut & Calleja, 2019). In this picture, the perception of 

‘darkness’ by the participants can perhaps be attributed to the contrasting colour scheme between the dark reddish-

brown tones that are used in the facial composition of the figure and the white veil and shirt that he is wearing – a 

technique that emphasises the figure’s face especially the “dark and hollow eyes” [Painting 2, Participant 25]. This 

is complementary to the description provided by one of the participants who explained how “a sense of darkness 

and evil is conjured” as soon as one looks at the picture. This perception is similar to a finding which emerged 

from a study by Kirkham et al. (2015), who engaged individuals with chronic pain in the production of pictures 

that portrayed their hardship. Interestingly, the colours red and black were ones which featured most in the 

production, showing that these colours are linked to an element of darkness, in this case, brought about by pain.  

The same theme extends to the third painting which depicts a figure who is holding a cage over their head. Cages 

are synonymous with freedom or the lack of it and in this case, it represents the freedom that should belong to 

every individual (Sammut & Calleja, 2019) The symbolic use of objects in order to convey emotions and meanings 

through art is no novelty and constitutes one of the clearest ways of communication by artists (Kingslan & 

Gibilisco, 2011). In this picture, a dark nature has been created by several factors. For instance, the figure’s open 

mouth, as if in a permanent scream, may be one contributor. The cage and the vertical dark red streaks may be 

consciously or subconsciously associated with blood – two other elements which add to the perceived dark nature 

of this painting. In fact, one may compare the hues in this painting and the one after it to The Scream – the famous 

piece by Edvard Munch - a painting which is known for its red hues and its intended ability to stir overwhelming 

anxiety and darkness in the viewer (Beams, 2019) 

The same technique echoes in the fourth painting. The fact that the figure in Painting 4 is wearing a crown of 

thorns has strong connotations to the Passion of Jesus Christ – a message which was captured by some of the 

viewers. This perceived message is understandable since the exhibition was held in a country which is 

predominantly Roman Catholic. Once again, the figure’s mouth is open in a scream – a feature which, along with 

the crown of thorns and the use of red colour around the figure’s head may have contributed to the perception of 

darkness, brought about by pain. In the history of art, the use of ‘screams’ has been commonly linked to feelings 

of anxiety and discomfort. Whilst Munch’s The Scream would be the obvious example, another painting by this 

same artist – Self-Portrait with the Spanish Flu – uses the same concept (Goldstein, 2020) 

Interestingly, in view of Painting 4, none of the participants commented on the wires and pieces of net that are 

entangled in the crown of thorns – crucial items which are linked to the artist’s intended meaning - that of the 

potential effect of technology on mental health. This automatic assumption may be due to the crown of thorns’ 

ability to influence the viewers’ perception in its totality. Taylor et al. (2019) termed this as ‘meaning-maintenance’, 

referring to the processes by which pre-existing cultural objects persist across space and time to perpetuate 

meaning. 



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On a different level, the sub-theme of pain also emerged from the participants’ perceptions in relation to the tenth 

picture. In this case, the pain is a result of “going round in circles” (Painting 10, Participant 20) in an endless search 

for meaning and/or identity. In this view, many of the participants commented on the struggle, shame and 

helplessness linked to the painful realisation attributed to being emotionally stuck in a rut: 

“Sense of being stuck. Moving, but unable to move forward” [Painting 10, Participant 23] 

“Gives me feeling of internal struggle leading to person not looking after self. Helpless, hopeless feeling” [Painting 

10, Participant 18] 

The artist’s original message in relation to this painting was that of vulnerability. This is exhibited by the use of 

nudity and the circular motion of the figure in the painting, which is meant to indicate a loss of direction and 

stability. The perception of vulnerability was similarly evident in the respondents’ replies, indicating congruence 

with the artist’s intention. The use of nudity in the portrayal of vulnerability has been explored in the literature and 

a study by Gerge et al. (2020) clearly presents the use of naked figures in drawings made by gynaecological cancer 

survivors in order to suggest the pain and vulnerability associated with this illness. 

Moving on to Painting 11, it can be noted that this work is the epitome of darkness, as interpreted by most of the 

participants. The dark smoke surrounding the figure is probably that which sets the emotion of the picture. The 

effect of colour tones and saturation in images on the emotional response of the viewer is an area that has been 

studied extensively (Alracao, 2014; De Melo & Gratch, 2010; Gbehounou et al., 2012; Pos & Green-Armytage, 

2007). In this view, the use of dark and dull colours, such as those which constitute this painting, have been 

consistently found to create a gloomy mood (Alracao, 2014). The heavy aura surrounding this work is perpetuated 

by the features of a male face emerging from the smoke, being caught in the middle of a scream that emerges from 

a slightly deviated mouth. Only one of the figure’s eyes is visible - a fiery red eye which is a stark contrast to the 

dullness of the black smoke and possibly contributes to the dark nature of the painting. Notably, the use of highly 

chromatic colours such as red have often been associated with aggression (Pos & Green-Armytage, 2007) - this 

could explain why one of the participants perceived a feeling of anger in view of this painting: 

“The dictating man. The man who seeks power through aggression. It makes me think of a man shouting out 

power.” [Painting 11, Participant 7] 

Only one participant mentioned schizophrenia, which was the artist’s intended meaning. In fact, the smoke refers 

to the distortion of reality that is the prime marker of this mental illness. 

As a personal and social phenomenon, death has often been the main topic that featured in popular works such as 

The Third of May 1808 by Francisco Goya and Judith Beheading Holofernes by Caravaggio. In this collection, 

death was also the creative drive behind the thirteenth and fourteenth paintings. Interestingly, these two works 

clearly present the artist’s struggle with the notion of death which, in both cases, is represented by a skeletal figure. 

This struggle may be seen as being more evident in the thirteenth painting with the artist and death being seemingly 

caught up in a direct physical encounter.  

The use of skulls in artwork is well documented. For instance, there are the vanitas skull paintings which are often 

understood as showing the narcissistic indulgencies of the human against a backdrop of the passing aspect of time 

(impermanence). Philippe de Champaigne’s Vanitas (1671) is one such example. On the other hand, Marinus van 

Reymerswaele’s Saint Jerome (1541) painting is one that uses a skull in a memento mori fashion – a reminder to 

be a good person and live life to the fullest due to the inevitability of death (Charney, 2016) More recent works 

that feature skulls are Gabriel Orozco’s Black Kites (1997) and Damien Hirst’s For the Love of God (2007). Both 

of these paintings, albeit in different ways, illustrate the dark beauty of death – feared but mysteriously intriguing, 

as reported by viewers of these works (Smart, 2011) as well as by some of the participants in the current study, in 

relation to Paintings 13 and 14. 

In a similar way to other paintings that were explored within this theme of Darkness, the human face in the 

thirteenth painting, features a scream, possibly due to the fear or fury that are being conjured by the struggle – 

emotions that were perceived and well-described by a number of participants: 

“Feeling of fear when facing experiences which could have led to own death” [Painting 13, Participant 2] 

“At first glance it’s as if the person is trying to defeat death, as if he/she is not ready to let go of this life. 

However, it could also mean that the fear of dying and the fear of the unknown is actually very vivid.” 

[Painting 13, Participant 25] 

The emotions that were perceived by the participants were congruent with the artist’s intended meaning, thus 

focusing on the emotional turmoil linked to suicide. The suicide theme is also reflected in the fourteenth painting, 



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which is a self-portrait of the artist at his most vulnerable state, as he embraces death. The clear message here is 

that Death is enjoying its victory so fervently that is looks as if it is engulfing the artist’s whole body. At the same 

instance, the victim surrenders and lets himself to be embraced by his opponent, as he passes on. These heavy 

emotions were aptly described by one participant as:  

“…in the picture the person has either surrendered or accepted the concept of death. while in a way I feel that 

there is a connection to Christ’s crucifixion; symbolizing pain and discomfort for some reason” [Painting 14, 

Participant 25] 

As seen from the last quote, once again, the religious theme comes to the forefront. Notably, death paintings in 

which the figures assume postures that have been traditionally associated with Jesus Christ, such as that seen in 

Painting 14, have been reported to bring religious recollections in the viewers (Hershfield et al., 2011). In fact, the 

figure’s pose in Painting 14 can be likened to that in the painting Dead Christ with the Angels by Edouard Manet 

(1864).  

Surprisingly, some of the participants also linked the sixteenth painting to the theme of Darkness. In this painting, 

the artist presented a semi-naked female figure as she emerged from a dark background. The intention was to 

portray possible recovery and so the message was intended to be one of hope. Contrastingly, many of the 

participants wrote about vulnerability, fatigue, pain and sadness when asked to interpret the painting. This glaring 

gap between the artist’s intended message and that perceived by the participating audience is intriguing and one 

that can perhaps be explained by the use of technique in the painting. On these lines, it can be noticed that although 

there is a clear contrast between the light-coloured human figure and the dark background, there may be a perceived 

imbalance, with the darkness taking over the lighter elements in the painting. The vertical black streaks that the 

figure has seemingly pushed through may also be adding an element of sharpness and pain which is even more 

pronounced by the incorporation of the red colour within the upper fifth sector of the figure. This may have been 

interpreted as sharp objects cutting through the figure’s body, leading to bloodshed and the somewhat sad 

expression on the face.  

Theme 2: Solitude 

The second theme that emerged from the analysis of the participants’ reflections was that of ‘Solitude’. This 

included the subthemes of Loneliness and Lost in Thoughts. This theme and its subthemes were related to multiple 

paintings, particularly to Paintings 1,2,5,8 and 9. 

In the first painting, the artist’s intended message was related to ‘thinking’. The use of light and dark shades of red 

and purple portrays an analogous use of colour, which is commonly incorporated as a means of adding an element 

of balance and serenity to a picture (Lewis, 2018) This can perhaps explain why this painting contributed to the 

sub-theme ‘Lost in thoughts’ – a state that suggest solitude and perhaps, stillness. The same simple technique and 

hues are visible in the ninth painting, which was also interpreted by many of the participants as being an image of 

solitude, depicting individuals who have withdrawn into themselves – ‘lost in thoughts’ - perhaps in a quest to 

search for meaning or as an act or despair in reaction to wrongdoing by society or by the symptoms of the mental 

illness itself: 

“Being alone – with yourself – you have to start somewhere – But you have to find yourself first.” [Painting 

1, Participant 5] 

This interpreted meaning has contrasting elements with the artist’s intended message, which revolves on the topic 

of substance misuse. The female figure in the painting is the symbol of care and support. The male figure seems 

to be going through a process, possibly related to an internal struggle. This figure is always assuming a subdued 

and thoughtful expression and posture, which may have contributed to the projection of solitude to the viewers. 

The fact that the female figure’s body language differs considerably was not really intercepted by the participants. 

This lack of attention to the female may be partly explained by the ratio of the figures in this piece of work – on 

inspection, the male figure is taking up the larger area whilst the female one occupies less than a third of the space, 

almost guaranteeing that one’s gaze falls onto the male: 

The solitude theme also emerged from the analysis of the participants’ descriptions related to the second and fifth 

paintings. Yet these two works feature different techniques than the ones seen in the two paintings that have just 

been discussed. Perhaps the most obvious difference is the use of darker colours as opposed to the light sketches 

in Paintings 1 and 9. These are paintings that portray a male figure’s face and hands, each in a specific position 

that is intended to deploy a message to the viewer. As described in the previous theme, in the second painting, the 

artist reflected upon the social isolation and loneliness that can result from mental illness. The fifth painting is one 

intended to portray the hardships of living with an addiction or an obsession. The dark colours used set the tone 



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for the heavy and serious subject addressed by this painting – a typical emotional effect brought about by the use 

of dull colours from the darker side of the spectrum (Elliot, 2015; Sutton & Altarriba, 2016). However, the 

individual’s disturbing look of despair and his hands, which are placed firmly on his forehead, are the main features 

that may have guided some of the participants to relate this to ‘loneliness’. This main figure is so prominent that 

the viewers may have missed noticing the background figures which are engaged in several sexual gestures. In 

fact, these were the main clue to the artist’s specific intention – the portrayal of sexual obsessions. The relation to 

sexuality was reported by just one participant. The fact that the sexual figures are cleverly camouflaged in the 

background beneath the dominant figure may have made it even more challenging to capture the viewer’s attention.  

The sub-theme of loneliness also emerged from the participants’ findings in relation to the ninth painting, which 

features a male figure standing next to four female ones who are in a pose that suggests verbal abuse targeted at 

the male. The artist’s intention was to depict the social phenomenon of bullying and most of the participating 

audience picked up these vibes and delved further into the loneliness that often results as a consequence of bullying.  

“Unacceptance, isolation, us against them/you.” [Painting 9, Participant 22] 

“I feel that this painting perfectly conveys segregation. To me, the person on the left looks somewhat different 

then the people on the right of the painting. Seeing that he/she might be different they secluded him/her which 

unfortunately portrays most of today’s society, especially when it comes to Malta and some Maltese when handling 

refugees.” [Painting 9, Participant 25] 

The congruence amongst the participants’ perceptions and between these and the artist’s intended meaning is 

striking and possibly brought about by the clear poses of the figures in the picture. Moreover, the facial expression 

of the female figure adjacent to the male one shows the haughty superior and self-righteous attitude that has often 

been presented in similar research concerning art and emotions, such as that by Groman (2019) and Andreou & 

Bonoti (2010) .  

Theme 3: Recovery 

The final theme that emerged from the findings was termed as ‘Recovery’, which was further sub-themed into 

‘Freedom’ and ‘Support’. The paintings that were mostly associated with this theme were 12, 15 and 17. The 

fifteenth paining has strong connotations with the Roman Catholic religion by depicting an ethereal male figure 

dressed in a white robe and cloak in a welcoming embrace towards two nude figures. In this view, some of the 

participants compared this figure to Christ as he shows his love to mankind. Interestingly, main figures in white 

have often featured in other art works and they are commonly used as representations of Christ. For instance, 

Goya’s The Third of May 1808 painting, presents the main figure as a man in a white shirt with his arms stretched 

out in a pose that has been interpreted by viewers as being reminiscent of Christ (Arn, 2019). Additionally, in 

Western cultures (Sammut & Calleja, 2019), white is often associated with feelings of purity and peace (Cherry, 

2021) – this may have given rise to the reported feelings related to the theme of ‘Recovery’ in this study. 

Whilst the artist’s intended meaning was also related to recovery, he used the figure in white in a symbolic attempt 

to present the importance of health care professionals. Whilst none of the participants specifically mentioned health 

carers, many referred to a sense of support and relief: 

“Feeling of comfort and safety. Perhaps even forgiveness.” [Painting 15, Participant 23] 

On similar lines, the final painting of the collection is the pure representation of recovery, with the image of clasped 

hands – the traditional symbol of support. Many of the participants interpreted this image as being one of hope and 

peace together with love and care. However, only three of the respondents mentioned a rope that is seen intertwined 

with the hands in the painting. Interestingly, two of these participants compared the rope to the knots in one’s life 

that are caused by a mental illness: 

“Depression can tie us in knots, make us feel trapped, full of despair, hopeless, helpless, not understanding, 

fearing nothing, then we gradually untie the knots and release the burden. There is always hope and help and 

love.” [Painting 17, Participant 11] 

Another participant intercepted a dark meaning and referred to ending one’s life using a rope. This is a painting, 

the meaning of which has been left open to interpretation by the public, with no description being provided by the 

artist. Hands in different positions have often featured in famous works such as the masterpiece The Creation of 

Adam by Michelangelo and Albrecht Durer’s Praying Hands. Audiences of these pieces have often reported 

feeling strong emotions by the image of hands since the hand is often symbolic of life itself (Katzin, 2016).  

As already indicated, the twelfth painting has also contributed to the theme of recovery. This is an image of a nude 

female figure standing on edge with her soul leaning in a leap position towards the opposite direction. This work 



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is mainly composed of shades of red – a colour that has often been linked to aggression and pain rather than to 

aspects of recovery. Findings and explanations related to the research work by Pope et al. (2012) may add clarity 

to this apparent contradiction in the current study. In their study, they reported that in addition to the colour itself, 

the hue, value (brightness) and chroma (saturation) are other variables which can affect the emotional impact of a 

painting. In fact, in their findings, ‘happy’ colours had higher ratings in value and chroma. With this explanation 

in mind, reflecting upon the twelfth picture in the current study leads to the realisation that it has brighter tones 

than the pieces which gave rise to the theme of Darkness such as Paintings 4,5 and 11. This could be what gave 

rise to participant interpretations centred on a sense of freedom and relief. Additionally, the figure’s pose, with 

specific reference to the positioning of the arms and the hair strands, which lie in a parallel to the figure’s back, 

introduce an element of motion, which may have led to participant descriptions such as the following: 

“Somehow this painting made me think the person in the painting is about to take a leap. Somehow I got the 

feeling of freedom and a sense of relief. It is as if the person is now ready to let go and take a chance into the 

unknown...” [Painting 12, Participant 25] 

“Fly away – Leaping behind your worries.” [Painting 12, Participant 28] 

Only one participant mentioned the possibility of suicide, which was in fact the artist’s intending meaning in 

relation to this painting. In comparison to the other works which gave rise to the theme of Darkness, this painting 

differs greatly, especially in terms of the lack of use of dark colours, sharp lines, expressions and postures that 

may have communicated a sense of despair and heaviness in the other works. These could be some of the factors 

that led to the discrepancy between the artist’s dark message and the recovery perceptions reported by many of 

the participants. 

5. Conclusion 

This study explored the affective aspects of art appreciation in relation to an art collection depicting the experience 

of mental illness. Three dominant themes emerged from the findings namely those of Darkness, Solitude and 

Recovery. Whilst congruence was often observed between the participants themselves and between the viewers 

and the artist, a number of discrepancies were also noted. These were attributed to the element of subjectivity that 

characterises art pieces, the use of technique by the artist and the multi-tangential aspect of mental illness and its 

understandings. In view of the outcomes of the study, a number of recommendations and applications can be 

postulated. Primarily, it is felt that artwork can be an important medium in the raising of awareness about the 

stigma related to mental illness – as seen in this study, an image often has a striking and immediate impact and so 

it can be as powerful, and possibly more so, as verbal or written information. Another area that merits exploration 

is the use of artistic paintings to broaden healthcare students’ understanding of different mental health states in a 

more creative learning initiative. Our final recommendation is to teach health carers about the fundamentals of art 

appreciation, interpretation and application especially with regards to 1). hues and tones that can instil certain types 

of emotions in any particular environment 2). art-based interventions. Conclusively, this study has shown that the 

link between art and mental health can be exploited to encourage reflection and acknowledgment of mental illness 

and the challenges that it often presents with.  

Acknowledgements 

We would like to thank the artist, Mr. Anthony Calleja, for his work in the compilation of the art collection and 

for his co-operation and support during this project. 

Disclosure of interest: The authors report no conflict of interest 

Funding source: None 

Data availability: Data available on request due to privacy/ethical restrictions 

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