Drawing on death งานศิลปะบำบัดกับผู้ป่วยระยะสุดท้าย - Bangkok Post


One doctor is using art to help young people suffering from life-threatening illnesses deal with the uncomfortable reality of death

Eight months ago, a 16-year-old girl was drawing furiously on a blank sheet of paper. The images she drew - her school, her family or her holiday on the beach - were hardly of consequence to her; the only thing in her mind was that she was seriously sick and that she had only a few months left to live.

Three months later the girl passed away, her body ravaged by cancer. But art had already prepared her to leave her loved ones behind as well helped her deal with the cancer.

"Doing artwork is like to explore one's mind. Art enables us to see our past, our present and our future to help us better understand what we want to do with our life," said Dr Pacharin Sughondhabirom, 36, now working as an art therapist for children with special needs at the Centre of Healing and Enriching Arts for Life (Heal), Arsom Silp Institute of Arts and Development.

Dr Pacharin has also been working with patients who suffer from life-threatening illnesses at Chulalongkorn Hospital. To these patients, facing death is a horrible reality, one filled with fear and uncertainty. But to the doctor, art is probably the best way to cope with such fear.

In most people, artistic and scientific aptitudes are controlled by two different sides of the brain. But for Dr Pacharin, her ability to balance both fields equally has paved way for her current career as an art therapist.

The right side of her brain, thought to be responsible for more creative and artistic ways of thinking, played an important role when she was very young, as art was one of her favourite subjects in primary school. However, the turning point came when she decided to study medicine at Chiang Mai University. After completing her bachelor's degree, she furthered her studies in psychiatry at Chulalongkorn University. It was then that she first realised that most of the patients needed more than medical treatment to cure their disorders.

"I know there is lot of medicine available at the hospital. But is that what patients really want? Sometimes technology is not enough. Patients also need emotional support," Dr Pacharin remarked. During her psychiatric studies, Dr Pacharin treated a number of terminally ill patients including those in the final stages of their disease.

From then on, she felt a need to dedicate her life to these patients. She also discovered that there was a need for trained personnel to look after these patients as some medical staff felt uncomfortable or ill-equipped to deal with patients with chronic life-threatening illnesses.

"I started thinking about what patients might want to do if they realised that they had only a short time left on Earth. Was there anything they still wanted to accomplish before they left this world? Therefore I started to look deep into my mind, asking myself the same question. And the answer seemed so clear."

Her childhood passion for art suddenly reappeared. Without hesitation, Dr Pacharin quit her psychiatric studies and took up visual arts at Yale University in the US. There, she studied all kinds of art, from drawing, painting to sculpting, not only to fulfil her own passion but also to possibly apply the knowledge to her patients' therapy. After five years in the US, Dr Pacharin returned to Thailand in January last year.

The therapist first volunteered her service at the Department of Paediatrics, Chulalongkorn Hospital, where she was responsible for arranging art workshops for a number of children in the final stages of cancer or other incurable chronic diseases.

For these patients, art was probably the last thing they expected during their ordeal. However, after being properly exposed to it, they found they could cope with their feelings better through creating art.

"Most patients who realise they are dying have no idea how to manage the rest of their time," said the art therapist. "They are shaken and overwhelmed by feelings of anger, sadness and hopelessness. Some of them express their feelings in an aggressive way. Some beat their parents, speak rudely to nurses or reject treatment."

To treat these patients, Dr Pacharin asks them to freely express themselves and their illness through art.

"This is purely the work of imagination," Dr Pacharin noted.

When patients become more comfortable with whatever artistic medium they choose, art then becomes a stimulus for them to carefully explore their inner self.

"This second phase of art rehabilitation is the longest one," explained Dr Pacharin. "It's the period where patients reflect on their lives and begin expressing their thoughts, again, through art. Some are still feeling despondent but they are now readying themselves to die."

After this period, patients will enter the last phase in which they are prepared for death and ready to accomplish any personal goals before their
time is up.

The 16-year-old girl mentioned earlier went through the art therapy programme before she passed away cancer in January. The girl had been diagnosed as having cancer of the eye muscle and surgery was needed to remove one of her eyeballs.

To cope with stress brought on by the surgery and illness, she was asked to gradually express her feelings through drawings.

Five months after the girl had her eye removed, she came back to the hospital with a severe headache. The doctor examined her and finally found that she was suffering from cancer in an advanced stage that had spread to her lungs and bones. She felt numb with shock, then broke down in tears.

Dr Pacharin approached her again and asked her to use art to focus on the aspect of life she considered important. It took her another two weeks to think about what she wanted to do. In the meantime, she never stopped drawing and painting.

"She chose to focus on her family. That's the reason why she selected her home as a place where she would leave this world. During her three-month hospitalisation, she was still drawing until she was calm enough to leave. Later we talked more about religion, about this life and the next," explained Dr Pacharin.

According to the doctor, there is no quantifiable formula as to how long each phrase takes or what kind of output she expects from her patients. It depends on the patients' state of mind and their attitudes toward life. If a patient requires extra support, Dr Pacharin will conduct individual therapy while others undergo group therapy.

To the doctor, her attempt to make these patients accept death as an inevitable fact of life is no simple task. Some patients are difficult to approach as they are initially aggressive and angry about their situation.

An 11-year-old girl suffering from diabetes and renal disease was one such example of defiance to art therapy. The girl felt angry and uncomfortable about her long stay in the hospital, her inability to go to school and her dietary restrictions. Being upset, she adopted some erratic behaviours such as spitting on the floor and being uncooperative during her medical treatments.

"During the first two art sessions I arranged for her, the girl did not say a word to me," said Dr Pacharin. "But I had to be very patient. In our third meeting, she walked to me herself and asked me for a piece of paper and crayon so that she could draw with other children.

"The last time I met her, she even sang while she was painting."

Dr Pacharin said each method of art therapy is carefully selected for each patient, depending on their illness. "For example, I would never ask a patient suffering from paralysis in the hand to hold a pencil and write something on a piece of paper. Instead I'd ask her to make a sculpture in order to stimulate muscle growth and subsequently the growth of the brain cells too."

The art therapist also helps the families of the patients maintain their strength and cope with the sadness of losing their loved one.

"The families are important because they are the ones who stay with the patients during their final moments. Therefore it is necessary that families are emotionally stable and have the strength to get through such an ordeal."

The method of therapy for family members is similar to that offered to patients. Parents or relatives are asked to create art in order to reflect on what they think and how they feel. Art workshops, according to Dr Pacharin, should be done along with counselling sessions.

"For children to see their parents do art is an uplifting experience, too. It's also a way for them to communicate with one another."

One of the most obvious obstacles for Dr Pacharin is time. In many cases, there is too little time for her to help her patients. In some cases, she has only met the patient once before learning that he or she has passed away.

Saying farewell to her patients is one of the most agonising aspects of the job. "I just tell them that we are going to meet again, probably in the
next life.

"Death is a part of life, just like birth. People are born and then one day they die. It's like going back to Mother Nature. They should spend the
rest of their time on Earth doing whatever they would like to do. And after they do it, they'll leave this world with peace and contentment."


Bangkok Post 2006