Cunningham Dax Collection

The purpose of psychiatric art is not to assist the elaboration of classification but to lead to better understanding of the experiences of psychiatric disorders and to give emotional relief to the individuals concerned.

Eric Cunningham Dax^1(p6)

In 1946, Dr Eric Cunningham Dax, superintendent of Netherne Hospital in Surrey, England, invited a professional artist, Edward Adamson, to initiate and facilitate art programs for patients hospitalized at this pioneering psychiatric hospital. This quiet beginning was the first formal introduction of art into mainstream psychiatry. Under Adamson, Netherne Hospital became a national center for art therapy in the United Kingdom, and Adamson the founder of British art therapy. In 1952, Dax left the United Kingdom and took up the position of Chairman of the Mental Health Authority in Melbourne, Australia, a position he held until 1968. As he had done at Netherne Hospital, Dax modernized inpatient and community psychiatric services and introduced and established art therapy in psychiatric hospitals in Australia. As was done at Netherne Hospital, an art master served as a resource to encourage creative expression by patients but did not interpret their works. Art created by patients was reviewed by treating staff members and became part of the each patient’s medical record. In 1953, Dax published Experimental Studies in Psychiatric Art,² which is based on his work with Adamson at Netherne Hospital.

Over the ensuing years in Melbourne and later in Tasmania after 1968, Dax shepherded creative art from people with mental disorders to create a unique collection of artwork in Australia. The Dax Centre houses more than 15 000 creative works on paper and has a permanent home in the Melbourne Brain Centre Building on the campus of the University of Melbourne; it features its own art gallery. Its mission is to promote mental health and well-being by fostering a greater understanding of the mind, mental illness, and psychological trauma through art and creativity. It serves as a resource to study human psychological experience through art and other related creative endeavors. There are only 2 other collections of similar size and stature: the Prinzhorn Collection in Heidelberg, Germany, and the Bethlem South London and Maudsley Collection in England, both of which have been the subject of commentaries in this journal.^3-5

The Cunningham Dax Collection is unique because of Dax’s (1908-2008) personal involvement with it. He continued to work with the art collection throughout his lifetime, only surrendering directorship of the collection when he was in his early 90s. Since its inception, the Cunningham Dax Collection has emphasized 3 approaches to the uses of artwork by people with mental disorders: clinical, therapeutic, and educational.⁶ The clinical approach focuses on artwork as a longitudinal record of changes in symptoms over time. The therapeutic approach emphasizes how art programs help people to cope with their illness and to communicate with others. The public education approach uses public displays of art to educate people about mental illness. It addresses the stigma of mental illness and emphasizes each individual’s creative capacity. Respectful of people with mental disorders, the Cunningham Dax Collection does not use the term psychiatric art but, instead, uses the term artwork by people who have experienced mental disorders or psychological trauma.

Ten thousand visitors to the Cunningham Dax Collection were surveyed after viewing exhibits to determine the impact of its programs.⁷ More than 90% of respondents agreed that the exhibits helped them to gain a better understanding of mental illness and to appreciate the ability and creativity of people with mental illness. This survey demonstrates that such exhibits can help promote mental health awareness and suicide prevention programs and facilitate positive attitudes.

The Cunningham Dax Collection has long emphasized the ethical issues involved in the public display of art by people with psychiatric disorders. Those represented in this collection must provide consent before their work is displayed in public. Graeme Doyle and Joan Rodriguez, both of whom are represented in the collection, have granted permission. Graeme Doyle is an artist, poet, musician, and performer from Melbourne, Australia, with a diploma in fine art. Doyle discovered that he had an interest in art when he was a child. When he was 18 years of age, he received a diagnosis of schizophrenia and now describes himself as a “grim survivor with extraordinary courage.”⁸ He is determined to live a full life despite his illness: “I’ve taken more of schizophrenia than it’s taken from me.”⁸ The National Gallery in Australia and a number of other collections hold some of his artwork.

Doyle’s untitled painting (Figure 1) depicts a quiet everyday garden scene whose calm is shattered by the frightening specter that looms in the background. This painting provides insight into Doyle’s inner world.⁹ He describes it as haunted, that the face is like a huge demon. It reminds him of the psyche and of death. Doyle’s work is central to his mental health; it is important to him and therapeutic. He says that “[i]t’s nervous, it’s electric, I put my kilowatts of suffering into it.”⁹

Joan Rodriguez found comfort in drawing during a solitary childhood. She completed a course in art, worked as a graphic artist, was married, and had 2 children. She was ill for 4 years following postpartum depression. She took medication for anxiety but found that art was a powerful tool for coping.⁸ She found that the creative process allowed her to have some control over her mental state and to find balance in her life. Her artwork represents “the silent cries of her depression.”¹⁰

Influenced by Jungian psychology, Rodriguez paints underwater scenes to represent the unconscious and examine her depression. In them, she metaphorically blows into the drowned lungs to revive the expired “feminine.” Her painting If Only Alcyone Would Wake (Figure 2) is a call to wake up and take charge of her life, and it draws on Greek mythology.

Alcyone and her husband Ceyx were deeply in love. Ceyx offended Zeus, and in revenge Zeus sunk his ship. Seeing Alcyone’s despondency in not hearing from her husband, the gods sent Morpheus in disguise as the dying Ceyx in an apparition that revealed his plight. The bereaved Alcyone threw herself into the sea. Out of compassion, the gods took pity on her and, as she sank into the sea, transformed her into a kingfisher bird of the genus Halcyon (Figure 2). Relenting, Zeus prevented the winds from blowing for 7 days before and after the winter solstice, the time of the breeding season of the halcyon birds. The saying “halcyon days” (a time of peace and tranquility) derives from the myth of this fabled bird with the seeming power to calm the wind and waves when it nested on the sea during the winter solstice. Rodriguez shows the devoted Alcyone (Figure 2) sinking into the gentle sea. As she descends, her flowing hair transforms into wings to illustrate her transformation into a halcyon bird. The transformation and reawakening of Alcyone as a halcyon bird symbolizes the reestablishment of calm, as when depressive moods remit. The Cunningham Dax Collection and similar collections in other countries illustrate the importance of encouraging creative expression in people who have experienced mental disorders and remind us that encouraging such expression enhances their lives, facilitates the therapeutic alliance, and is mutually rewarding.

Corresponding Author: James C. Harris, MD, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287 (jharri10@jhmi.edu).

Conflict of Interest Disclosures: None reported.

Note to the reader: This will be the last Art and Images in Psychiatry article in JAMA Psychiatry. It has been a unique and gratifying collaboration between the editor Dr Joseph T. Coyle and me. The 144 commentaries will remain a topic collection on the JAMA Psychiatry website and continue to serve as an educational resource for the humanities in psychiatry. I am grateful for the positive responses that I have received from readers and hope these commentaries will be a continuing reminder of the importance of creative expression in our patients’ lives.