In 1999, artist Mark Gilbert bumped into surgeon Iain Hutchison at a railway station in Glasgow. Hutchison’s wife had previously bought artworks from Gilbert, and they began discussing art and medicine. Not long after their chance meeting, Hutchison contacted Gilbert to offer him a position as artist in residence at the Dept. Oral and Maxillofacial Surgery Unit of St Bartholemew’s and the Royal London Hospital.
So began Gilbert’s career exploring the experience of patients and caregivers in portraiture.
During his residency, Gilbert spent two years following patients who were undergoing facial surgery. In collaboration with the patients, he created portraits before, after (and sometimes during) surgery. What evolved was a masterful project called “Saving Faces”, a tribute in portraiture, to each patient’s journey.
Following a tour of the resultant “Saving Faces” exhibition to North America, Gilbert went on to carry out a further 2 year residency at the University of Nebraska Medical Centre (UNMC). His research predominantly focused on the relationship between art and medicine and explored the utility of using art as a research method to explore notions of care and caregiving. During this time, he completed over 100 portraits of patients and their caregivers. The resulting works were collated into a moving exhibition entitled “Here I am and Nowhere Else: Portraits of Care”.
After the residency was completed, he stayed on at (UNMC) to carry out his PhD in the Medical Sciences Interdepartmental Area (MSIA). His final project centred on a deep analysis of the artist/sitter relationship and was entitled “The Experience of Portraiture in a Clinical Setting”.
“It hit me like a thunderbolt- I realised we are all going to patients and caregivers at some point in our lives. That was both terrifying and reassuring”
He currently holds a position as Research Associate with the Medical Humanities (HEALS) program at Dalhousie University, Nova Scotia, Canada where he teaches medical students to use art to promote critical thinking and engagement with patients.
Here, Mark Gilbert reflects on his career in the medical humanities and what it has taught him about life, death and the human experience of illness.
Can you tell us about your early career as an artist and how you came to work in a clinical environment?
I came from a family of painters. Both my parents were painters. My dad is still a painter and my mum was an art teacher. She was actually my art teacher during high school. I had grown up in a house with a studio, so it wasn’t surprising that I ended up at art school. After high school, I attended Glasgow School of Art where I studied drawing and painting for four years.
Following art school, I worked as a self employed portrait artist for ten years. I was working in a very limited and traditional way, I wasn’t using photographs and I was working mostly from models. I guess I working in a really laboured way. I’d spend up to nine months on one painting. I loved the luxury of it but it wasn’t really conducive to making a living. My focus was becoming narrower and narrower. At the same time I watched what other people were doing with their art, people who were able to use their art to make more social commentary. I started to feel as though I was at a dead end. At that point I bumped into Ian Hutchison at a train station in Glasgow.
What was the intention behind ‘Saving Faces’?
For Ian Hutchison, I think he had a hunch that this process would be therapeutic and cathartic for his patients. He also thought it could show what is and isn’t possible with modern facial surgery. He wanted to show that people who have had facial surgery or who have facial disfigurement could still lead active, fulfilled lives.
For example, the first person I met was a man who was a barrister. He had massive facial disfigurement. He’d had up to fifteen different operations, which left him awfully disfigured and with a speech impairment. Yet after five minutes with him I came to recognise he was the most charismatic and generous person I had ever met. I worked with him for a year and half, we became good pals.
There is research that shows that people with facial disfigurement are deemed as less attractive, less trustworthy and more prone to violence. All kinds of things. We are all guilty to a greater or lesser extent of these prejudices. Hopefully the paintings contribute to limiting such notions.
What do you think the patients took from being involved in this project?
Some patients would tell me that they used the paintings as a way to engage people who might be staring at them on trains or buses. They would pull out a photograph of the painting and tell people their stories. This engaged people in a way that all of the pictures do. Whether the painting was on the wall or a photograph of one in their wallet, the images were used as a fulcrum to facilitate discussions that otherwise wouldn’t happen.
The patients may not have liked looking in the mirror or looking at photographs, but there was something about looking at the paintings that they did find positive and constructive and authentic. I was surprised to find that they thought the paintings represented their personality more than a photograph could.
How did you feel about creating portraits of patients undergoing such dramatic surgery?
Initially, it was a subject matter that made me deeply uncomfortable. It made me incredibly anxious and worried. But at the same time I was intrigued to know if I could create pictures in collaboration with people experiencing illness. I realised I was going to be working with people in the most dramatic moments of their lives.
I’d never been in hospital. I’d never had to care for anyone who was ill and I hadn’t been really sick myself. I didn’t know how to approach people with facial disfigurement or injury and I didn’t know how to talk to people who had cancer. I didn’t want anyone to feel as though they were being taken advantage of. Could the pictures be seen as voyeuristic? Could the pictures be focusing on parts of these peoples lives or appearance that they felt very self-conscious about? But the amazing thing about meeting and working with these patients is that they held my hand and guided me through the process as much as I held theirs. I remember thinking at the time that everyone I was working with was far stronger than anyone had given them credit for. There was an incredible generosity of spirit. It is something that I aspire to all the time. It is probably a good thing for physicians to aspire to as well.
“I remember thinking at the time that everyone I was working with was far stronger than anyone had given them credit for. There was an incredible generosity of spirit.”
You spent a lot of time with these patients over the course of their treatment. Was there anything that they revealed to you about their health care experience that you think would be worthwhile for medical professionals to know?
Tonnes. I can give tonnes of examples. For example, there was Roland, who wanted to be painted wearing his radiotherapy mask. He’d had surgeries to remove the roof of his mouth and the whole of his cheekbone. These were massive surgeries, but he felt a positive sense of achievement for getting through that. But the radiotherapy was awful. It made a a mild mannered man into someone who cussed, someone was aggressive with nurses and deeply depressed and anxious. The mask represented to him, the worst thing in his life. But the interesting thing was that he would tell this all to me, but had never told it to his surgeon. It left me in a sort of position where I became the go-between him and the surgeon. Which leads me to question why he didn’t feel as though he could raise it with the surgeon in the first place. Was it because there wasn’t enough time? Was it because he didn’t think it was important enough?
(For medical professionals) I think there are benefits in slowing down and realising that as a physician, only a small part of the journey is curing and the rest is caring. It is easy to become obsessed with a hunt for a cure. Remembering that by slowing down you can also be more effective. Approach the patient with attentiveness and mindfulness. Fundamentally, take time to listen to the patient. With that attentive listening comes everything else- more compassion, more understanding.
Are there any other subjects who have had a strong impact on you and what did you learn from working with them?
There are some really strong examples. Later, when I was working on a project in the United States (Portraits of Care), there was one patient called Roger who had very advanced ALS (Amyotrophic Lateral Sclerosis). The experience of working with him was remarkable. He was unable to communicate verbally. But by spending time drawing him, I became accustomed to the nuances of his facial expression. I would begin drawing and he would noticeably relax.
He could use his eyes to move a cursor to write what he wanted to say. After he died, his wife told me that he had said that sitting for the portrait was the most purposeful thing he felt he had been able to do in a long time. Everything needed to be done for him in that time. But this, this was him doing a job. The resulting painting was a visual testament to him, but at the time he was also acutely aware of how it could speak to others in a similar situation.
“After he died, his wife told me that he had said that sitting for the portrait was the most purposeful thing he felt he had been able to do in a long time.”
I had all of these anxieties about communicating in the right way, for knowing what to say, especially when the news wasn’t good. Working with people who had limited verbal communication made me realise that silence was meaningful in itself. It wasn’t an empty void.
What mediums do you use and how do you choose them?
Really, it is based on what I feel like doing that day. And it depends on the setting. When I was working in clinics I would use pastel rather than paint, because of the painting fumes. I was really just experimenting and seeing what I felt like. Although now I find that I’m not as comfortable with painting as I am with drawing. Painting can sometimes become a preconceived technique-driven thing, whereas with drawing I find I can experiment a bit more, there is more analysis and more curiosity. Although this is just a personal preference.
How has this career changed your perception of illness and death?
It’s been huge.When I was working with patients and care givers in the US, I was drawing patients who were sitting with me and literally planning their funerals, other times I was drawing in a delivery room while women were giving birth. One of the things that hit me when I started working in America- it hit me like a thunderbolt- I realised we are all going to patients and caregivers at some point in our lives. That was both terrifying and reassuring. Although I still have an element of hypochondria, I have a better attitude to my own wellbeing.
What has your career taught you about the relationship between medicine and the arts?
“The integration of these disciplines is much more powerful if both parties come into it with an openness to be changed.”
When I first started, I didn’t see the parallels between the doctor-patient relationship and that of the sitter and artist. But the patients did. I still get nervous when I see new patient for the first time. Which I now know doctors feel that as well. Both the artist and a doctor have to find the balance between the objective and subjective. Art requires a lot of empirical observation. Medicine and science both contain an element of artistry and subjectiveness.
Art is a form of communication. A form of collecting information and a way of articulating an experience. These are all things that science does in it’s own way. If you realise that you are still dealing with the same thing (humanity) as people with test tubes and bunsen burners, then it becomes completely reasonable to include the arts as a research method in traditional academia.
There is also a tendency to think that sole the purpose of art in relation to medicine, is to bring a sense of humanity back to medicine that is lacking. But artists can be deeply cynical as well. I feel like I am a far more compassionate person because of my interactions with medicine. The integration of these disciplines is much more powerful if both parties come into it with an openness to be changed.
Mark Gilbert’s work has been featured at the National Portrait Gallery in London and has toured Europe, North America and the UK.
Further information about his work can be found here.