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 hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 43 Published by IDEAS SPREAD 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 hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 44 Published by IDEAS SPREAD 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. hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 45 Published by IDEAS SPREAD 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] hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 46 Published by IDEAS SPREAD 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. hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 47 Published by IDEAS SPREAD 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, hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 48 Published by IDEAS SPREAD 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 hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 49 Published by IDEAS SPREAD 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 hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 50 Published by IDEAS SPREAD 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 References Alracao, S. (2014). EmoPhoto: Identification of Emotions in Photos (MSc). https://doi.org/10.13140/RG.2.1.2915.6969 Andreou, E., & Bonoti, F. (2010). Children’s Bullying Experiences Expressed Through Drawings and Self-Reports. School Psychology International, 31(2), 164-177. https://doi.org/10.1177/0143034309352421 Arn, J. (2019). How Goya’s “Third of May” Forever Changed the Way We Look at War. Retrieved from https://www.artsy.net/series/stories-10-art-historys-iconic-works/artsy-editorial-goyas-third-may-forever- changed-way-war Barthes, R. (1980). Camera Lucida. Hill and Wang. hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 51 Published by IDEAS SPREAD Beams, S. (2019). The Scream: A Deeper Analysis of Edvard Munch’s Anxiety-Wrought Piece. Retrieved from https://medium.com/everything-art/the-scream-a-deeper-analysis-of-edvard-munchs-anxiety-wrought-piece- c36d9bbbb4cd Charney, N. (2016). How the Skull Is an Ally in Art. Retrieved from https://blogs.getty.edu/iris/how-the-skull-is- an-ally-in-art/ Cherry, K. (2021). The Color Psychology of White. Retrieved from https://www.verywellmind.com/color- psychology-white-2795822 De Melo, C., & Gratch, J. (2010). Evolving expression of emotions through color in virtual humans using genetic algorithms. Paper presented at the 1st International Conference on Computational Creativity, ICCC-X. Elliot, A. (2015). Color and psychological functioning: a review of theoretical and empirical work. Frontiers in Psychology, 6, 368. https://doi.org/10.3389/fpsyg.2015.00368 Gail, S. (2017). To remove the stigma of mental illness, we need to accept how complex—and sometimes beautiful—it is. Retrieved from https://qz.com/author/drgailsaltz/ Gatti, E., Calzolari, E., Maggioni, E., & Obrist, M. (2018). Emotional ratings and skin conductance response to visual, auditory and haptic stimuli. Scientific Data, 5(180120). https://doi.org/10.1038/sdata.2018.120 Gbehounou, S., Lecellier, F., Fernandez-Maloigne, C., & Cnrs, U. (2012). Extraction of emotional impact in colour images. Paper presented at the 6th European Conference on Colour in Graphics, Imaging and Vision, Gerge, A., Pederson, I., Gattino, G., & Warja, M. (2020). The body in the mind – Assessing the phenomenal self through paintings created by gynaecological cancer survivors. The Arts in Psychotherapy, 71. https://doi.org/10.1016/j.aip.2020.101691 Goldstein, J. L. (2020). The Spanish 1918 Flu and the COVID-19 Disease: The Art of Remembering and Foreshadowing Pandemics. Cell, 183(2), 285-289. https://doi.org/10.1016/j.cell.2020.09.030 Groman, J. (2019). The Bully’s Face: Using Art to Understand Bullying in Gifted Children. Gifted Child Today, 42(1), 12-18. https://doi.org/10.1177/1076217518804852 Hershfield, H. E., Goldstein, D. G., Sharpe, W. F., Fox, J., Yeykelis, L., Carstensen, L. L., & Bailenson, J. N. (2011). Increasing Saving Behavior Through Age-Progressed Renderings of the Future Self. Journal of Marketing Research, 48, S23-S37. https://doi.org/10.1509/jmkr.48.SPL.S23 Hodges, S. (2015). How to Look at Art. Tate. Jacquette, D. (2014). Art, Expression, Perception and Intentionality. Journal of Aesthetics and Phenomenology, 1(1), 63-90. https://doi.org/10.2752/20539339XX14005942183973 Katzin, M. (2016). Exploring Personal Symbolism and Visual Metaphors through Artistic Inquiry (MA). Kingslan, A., & Gibilisco, M. (2011). History and Meaning of Objects in Painting. Retrieved from https://kingslan.com/newsletters/Symbols_in_Art.pdf Kirkham, J., Smith, J., & Havsteen-Franklin, D. (2015). Painting pain: an interpretative phenomenological analysis of representations of living with chronic pain. Health Psychology, 34(4), 398-406. https://doi.org/10.1037/hea0000139 Leder, H., Gerger, G., Dressler, S., & Schabmann, A. (2012). How art is appreciated. Psychology of Aesthetics, 6(1), 2-10. https://https://doi.org/10.1037/a0026396 Lewis, M. (2018). 10 ways to convey emotion in your artwork. Retrieved from https://www.creativebloq.com/features/10-ways-to-convey-emotion-in-your-artwork Markey, P. S., Jakesch, M., & Leder, H. (2019). Art looks different – Semantic and syntactic processing of paintings and associated neurophysiological brain responses. Brain and Cognition, 134, 58-66. https://doi.org/10.1016/j.bandc.2019.05.008 Paasschen, J., Bacci, F., & Mlecer, D. (2015). The Influence of Art Expertise and Training on Emotion and Preference Ratings for Representational and Abstract Artworks. Plos One, 10(8), e0134241. https://https://doi.org/10.1371/journal.pone.0134241 Pelowski, M., Forster, M., & Tinio, P. (2017). Beyond the Lab: An Examination of Key Factors Influencing Interaction with ‘Real’ and Museum-based Art. Psychology of Aesthetics Creativity and the Arts, 11(3). https://doi.org/10.1037/aca0000141 hssr.ideasspread.org Humanities and Social Science Research Vol. 4, No. 4; 2021 52 Published by IDEAS SPREAD Pope, D., Butler, H., & Qualter, P. (2012). Emotional Understanding and Color-Emotion Associations in Children Aged 7-8 Years. Child Development Research, https://https://doi.org/10.1155/2012/975670 Pos, O., & Green-Armytage, P. (2007). Facial expressions, colours and basic emotions. Journal of the International Colour Association, 1, 1-20. Rothenberg, A. (2015). Creativity and Mental Illness. Retrieved from https://www.psychologytoday.com/us/blog/creative-explorations/201503/creativity-and-mental-illness Rustin, T. (2008). Using artwork to understand the experience of mental illness: Mainstream artists and Outsider artists. Psychosocial Medicine, 5. Retrieved from https://PMCID:PMC2736519 Sahiti, G. (2017). Mentally ill artists and their impact on the world. Retrieved from https://mccsoapbox.wordpress.com/2017/08/06/mentally-ill-artists-and-their-impact-on-the-world/ Sammut, A., & Calleja, A. (2019). Living with mental illness. Sammut & Calleja. Singh, R., & Ladsaria, S. (2017). Reading 'Studium' and 'Punctum' in Steve Mccurry and Raghu Rai's photography. Trames, 21(71/66), 33-50. https://doi.org/10.3176/tr.2017.1.03 Smart, A. (2011). Damien Hirst and Gabriel Orozco, two conceptual artists, create two very different skulls. Retrieved from https://blogs.getty.edu/iris/how-the-skull-is-an-ally-in-art/ Sutton, T., & Altarriba, J. (2016). Color associations to emotion and emotion-laden words: A collection of norms for stimulus construction and selection. Behaviour Research Methods, 48, 686-728. https://doi.org/10.3758/s13428-015-0598-8 Taylor, M., Stoltz, D., & McDonnell, T. (2019). Binding significance to form: Cultural objects, neural binding, and cultural change. Poetics, 73, 1-16. https://doi.org/10.1016/j.poetic.2019.01.005 Copyrights Copyright for this article is retained by the author(s), with first publication rights granted to the journal. This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/4.0/).