Mental health dividends of creative pursuits

I express my sincere gratitude for this great honor. It is a lifetime opportunity for any member of the Indian Psychiatric Society. For this presidential address, I have chosen an attribute that distinguishes human beings from the rest of the living world, enables them to change and progress, and imparts color, fragrance, melody, and taste to the lives of one and all. You might have rightly guessed by now, its creativity. To broaden the scope and enhance pertinence, it has been formatted as mental health dividends of creative pursuits.

Let me begin with the reasons for choosing this topic for my address. Obviously, it is a personal choice, but personal choices too have an evolutionary and sociocultural basis, and my choice is also not an exception. There are five reasons for choosing this topic.

1. A poet in me

In hindsight, I realize that I was born to be a poet but entered in science stream because securing good marks used to be a compelling criterion for being there and for almost similar reason joined medicine. After passing the Bachelor of Medicine and Bachelor of Surgery (MBBS), I wanted to become a pediatrician, but due to color-blindness, I was posted in psychiatry as a junior resident, which enabled me for opting psychiatry in postgraduation.

Though I was not writing regularly, but the poet in me remained awake as a wise old man. As a medical student, I never realized that a patient is only a biological entity. I always saw their abrasions and cut marks as a source of pain. I always felt emotions for their miseries and losses. Nobody has been a body for me. I always perceived him or her as somebody coming from some background made of some related–unrelated people who represent a cultural continuum of pristine origin. During practice, I frequently realized that two cases of depression or hypomania coming from two different districts presented differently. This happens despite nearly similar neurobiological language and neurotransmitter scripting. This everyday realization tried to reduce the influence of prevalent reductionism and primed my mind to be more inclusive and to some extent divergent.

I remember a conversation with Prof J S Neki when he shared a teaching room story of his student life at the National Institute of Mental Health and Neuro Sciences (NIMHANS). His professor, Dr Mike Ross, said, “If you know only psychiatry, you don't know even psychiatry.” Intrigued by this statement, Dr Neki asked, “What else we need to know?” The reply was “It's not the question of knowing, it's matter of being.”

Another stalwart behind today's talk is Prof NN Wig. In each meeting, he inspired to find answers for some puzzle unsolved to me. In each conversation, he talked like a practitioner of the bio-psycho-social model and a student of almost every discipline, which touches the faces and facets of ever under construction architecture of psychiatry. His all-seminal works include sociocultural questions. When I was interviewing him for Hindi Mental Magazine Manoveda Digest, I asked “I think, all myths are expressed extension of our inner world. Am I right?” He said “May be, because like psychological illnesses, myths and poetry also originate from the unconscious and express truth in their own way.” I am indebted to him for introducing Joseph Campbell to me, a man from literature who has written the most popular and probably most convincing critique on mythologies across cultures. Campbell had an interest in psychology and was deeply influenced by psychoanalytic geniuses of his time Sigmund Freud and Carl Gustav Jung. After reading his works, I began to understand the metaphorical or poetic nuances of myths better. Probably, this is an opportune time to thank Prof Salman Akhtar who helped me in inculcating the insight, essential for understanding the psychology of poetry and poetry of psyche.

I must admit that during my own literary and creative pursuit, I met hundreds of characters and myriads of creative products, which exposed me to a whole range of simple and complex emotions. TS Eliot was so true, when he said “We read books because we cannot meet so many people.” We must stay indebted to all creative people from the field of literature and art who have given us a huge museum of words, characters, and artifacts capable of interacting with all the strata of our mind.

2. The Journey of civilization

As I said earlier, the reason behind choosing this topic is not only personal. For me, the most important reason is the magnificent historic and on-going role of creativity in the journey of civilization. It is surprising to note that in The Republic, Plato trivializes human creations by calling them imitations.[1] I cannot believe that he was unaware of the fact that he is surviving due to domesticated fire, commuting on manmade wheels, and expressing his thoughts in the language evolved and developed by his creative ancestors. Here, we must thankfully remember the renaissance philosophers who brought innovative human efforts under the umbrella of creativity, which was previously a divine district. Here in India, things were little different because creation was considered the outcome of “Navonmesh Shalini Pragya” (awakened sapience capable of new explorations), which was to some extent attainable for non-divine mortal humans as well.

3. The Digital Era

Man lives in the real world and not in the philosophical one. So, the journey of creativity continued, and apart from literary and artistic achievements, we witnessed two revolutions—industrial and digital. Both revolutions brought ease for body and mind, which is gradually becoming more and more overwhelming and desirable. Now the world has entered a mesmerizing digital era where computers have become intelligent and have already stepped into the sacred space of creativity. Human–computer interaction research groups are creating creativity support tools, and artificial intelligence (AI) researchers are developing computationally creative systems to test cognitive theories of creativity.[2]

It is a fact that AI is trying to outsmart human intelligence with speed and range, and this has become the biggest game changer of the century and probably the biggest danger as well if we think of human mental musculature. Here, I would like to quote a study by Eleanor Maguire et al.[3] In their study, they measured the hippocampal volume of London cab drivers and found an increase in size as compared to the control group. They explained it based on professional training and environmental demands. I am sure that the study with Google age drivers will not yield this finding.

So, here we are left with a few pertinent questions:

1. Will AI be the common final pathway for creative innovation and expression?

2. Will our mental musculature suffer disuse atrophy?

3. What should we do to keep our minds healthy and continuously creative?

People are trying to find answers and reassuring anxious minds that algorithms cannot substitute creative thinking and at best computers and AI can be just a partner.

In this process, a new concept of co-creativity has emerged and is being practiced in the field of science and technology and attempts are being made to create music, art, and poetry. Recently, a large language model program ChatGPT has been launched, which gives you a beautifully written paragraph by typing just a word. According to a very recent (posted online on December 21, 2022) preprint, un-peer-reviewed online publication ChatGPT “performed at or near passing threshold for all three exams of USMLE and demonstrated high levels of concordance and insight in its explanations.” On the basis of result, the authors have predicted its future use in “medical education and clinical decision making.”[4]

Lubert (2005) has classified human–computer co-creation from a human-centric perspective[5]:

1. Computer as a Nanny: It takes care of user's work, time, and tasks and saves the outputs.

2. Computer as a Pen-Pal: It facilitates information flow between the artist and the audience, or other human co-authors.

3. Computer as a Coach: The computer can advise the user of creativity-inducing techniques to stimulate the user's creative process.

4. Computer as a Colleague: The computer can be creative in itself and can contribute new ideas in a dialog with humans.

So, here we are surrounded and skeptical about the future of our innate and highly dependable capability! At this juncture, the biggest reason for optimism is the fact that nobody has been able to match Veda Vyas, Shakespeare, Tulsidas, Kamban, Mozart, and Mirza Ghalib till date, and I am sure that AI cannot create a Kabir or Meera or Karl Marx or Gandhi or Sigmund Freud or Pablo Neruda who responded to the needs of the time creatively and of course from within. AI can do mesmerizing wonders but cannot create a Newton, an Archimedes, an Einstein, not even a Charles Babbage. Another reason for hope lies in the evidence and sociocultural experience that creativity can not only be triggered but also inculcated, induced, learnt, and strengthened, but optimism alone cannot combat the flooding of almost paralyzing ease from the technology side. We must ponder over and find a way out to save and strengthen our forte; otherwise, the synthesis of wisdom will be taken over by the market forces run by greedy money-makers.

4. Education System

The need for strengthening mental musculature can be addressed best by incorporating creativity in school education. JP Guilford in his presidential address at American Psychological Association meeting in 1950 raised the issue by asking two questions.

• - Why are we not producing enough creative persons?

• - Why is there so little apparent correlation between education and creativeness?

These questions are still valid. A 2019 study[6] focuses on creativity in modern education, and the researcher has examined six countries including the USA, China, and India. He finds that only the USA has applied principles of creativity in some schools. Other countries do state creativity in their curriculum but are far from implementation. To talk about other countries, we need references, but all of us are witness to the realities of school education in India where the quantity of marks obtained has become a criteria and growing minds are paying the price by throwing themselves into race, which is resulting in stress, depression, and cases of suicide. The magnitude of the problem is larger than we think, and recent news of back-to-back suicide cases in Kota, Rajasthan, is just the tip of the iceberg.

5. The Coronavirus Disease 2019 (COVID-19) Factor

Last but not least, the on-going COVID-19 pandemic is also a reason for choosing this topic because of the recent taste of uncertainties, loneliness, loss of jobs, despair, depression, and death-related grief.[7] Studies have shown the steep rise of mental illnesses during this period,[8] and through media, we have known the creative happenings in the world in which people resorted to survive through internal and external challenges. Experts too have highlighted the importance and utility of creativity because it gives meaning and purpose along with enjoyment and pleasure, one of the most wanted things during such crisis.[9] Apart from this, we must thankfully acknowledge the stress-induced creative breakthrough, which resulted in different types of vaccines.

UNDERSTANDING CREATIVITY

Creativity is difficult to define due to its complex neuro-psycho-philosophical construct and probably that is the reason we find many definitions on literature search. In a divine sense, it is about creating out of nothing, but scientifically speaking it is about creating something tangible or intangible by somebody with the help of something. Creativity is reflected not only in its products but also in the process and the person who never remains the same after the visible or invisible grind. The outcomes of creativity include inner transformation to problem-solving and the creation of insight and knowledge into innovative and esthetic artefacts.

Classically, it has been considered “artistic Genius” and defined as “an innate capacity to produce works of ‘exemplary originality’ through the free play of the imagination, a process which does not consist in following rules, can neither be learned nor taught, and is mysterious even to geniuses themselves.”

-Immanuel Kant, German Philosopher (1724-1804).

This definition reflects the influence of renaissance and humanism and contributions of polymaths, such as Leonardo Da Vinci and Michelangelo, but due to Industrial Revolution, sociopolitical emphasis on democracy and human rights, and growing psychological understanding, many definitions of creativity came up, which can be divided as follows:

1. Product oriented

2. Person oriented

3. Process oriented

Product-oriented definitions focus on novelty or originality and task appropriateness, or meaningfulness. Later, it was realized that these components cannot be understood without sociocultural and historical contexts. This relationship has been expressed beautifully in the language of mathematics[10]

- C = [O x TA]_Context

Product-oriented definitions of creativity leave person and process perspectives, which are essential for the product because the product needs a person and a process to become something tangible, and it must be kept in mind that the outcome of creativity may be intangible and internal as well.

Process-oriented definitions focus on what is happening in the mind. Pioneer creativity researcher Guilford describes key elements of creativity: fluency, flexibility, originality, awareness, and drive. Of five, originality is the only element that is applicable to the product. His theory of divergent and convergent thinking is also about process.[11] The theory of stages of creation (preparation, incubation, intimation, illumination, and verification) described by Wallas[12] also addresses the process part of creativity.

Creativity leads to the creation of something in the outside world, but simultaneously it also has consequence every time on the inner self, leading to strengthening of self and inner resilience, validation and enhancement of esteem, relief from pain and distress, and restoration of order. Grégoire, J. (2018) beautifully describes it: “The creative person, according to a humanistic perspective, has the consciousness and the abilities to address crisis in transformative ways. Therefore, the creative person can be understood as being in a process to reach self-actualization and to develop characteristics that are related to mental health, such as subjective well-being, resilience, optimism, quality of life, and other aspects emphasized by positive psychology.”[13]

INNATE VS. LEARNT

The nature vs. nurture debate continues to be a puzzle in creativity research. Nancy Andreasen[14] has beautifully discussed this issue in her book “The Creative Brain” by giving examples of born creative geniuses Leonardo da Vinci and Michelangelo and at the same time highlighting the role of renaissance Florence. She also highlights the late nineteenth- and early twentieth-century United States when there were breakthrough innovations by Samuel Morse, Graham Bell, Thomas Edison, and other scientific wizards. She also discusses the role of neuroplasticity in making the brain creative.

Another continuing debate with creativity is magic vs. method. It has been discussed that that creativity is not only a trait seen in gifted minds, but also a state because it is not exhibited routinely. Even gifted minds are not always creative. Apart from trait and state, it is always a process defined by its products. The authors have discussed the four theories—method, memory (innate structures), magic, and mutation—and have concluded that the most important thing is preparedness.[15] They have quoted Pasteur—Chance Comes to Prepared Mind!

Many studies have been conducted to study the neurobiological co-relates and effects of creative pursuits, and almost all have shown the involvement of brain areas related to episodic memory retrieval, free-associative and spontaneous cognition, and semantic integration. Studies have been conducted to see the effects of experience as well. Results inform us that experienced and novice brains are not the same.

Lotze et al.[16] studied resting-state functional connectivity (rFC) between experts and non-experts in creative writing and found reduced connectivity between interhemispheric areas and increased right hemispheric connectivity during rest in highly verbally creative individuals. Increased rFC for experts was observed between the right hemispheric caudate and intraparietal sulcus, and this is indicative of long-term experience with verbal information processing.

Erhard et al.[17] (2014) studied the effect of professional training in a “literary text continuation task.” In this study, they found increased recruitment of caudate nucleus and mPFC and also activation of right cuneus, which helps with increased resources.

CREATIVE PURSUITS

If we go by the classical approach, we may expect domain changing effect from creativity, but when we talk about creative pursuit, we mean a process or an endeavor. To understand this, let us have a look at the most democratic classification of creativity, which accepts the division of class (having high intelligence, divergent thinking, and creative personality) and mass.

Newer definitions have made the boundaries of creativity more permeable and have allowed the majority to enter the zone, which was philosophically reserved for minority elites. Earlier creativity was classified as little-c (everyday creativity) and big-C (breakthrough creativity), but Kaufman and Beghetto[18] introduced and inserted two more Cs in the picture and made a model, which has an entry gate and scope for everybody and proposes that persistent effort helps in reaching at a higher level. The 4-C model of creativity can be summarized as follows:

1. mini-c—These talk about changing oneself by transformative learning and personally meaning interpretation of experiences and insights.

2. little-c—It includes everyday creative thoughts and actions in every aspect of his or her life and its impact can be noticed not only the index person but also his or her zone of influence.

3. pro-c—It includes the majority of creative people who we label experts in the context of organization, discipline, or domain. The pro-c level creativity impacts organizations or systems of practice or domains.

4. Big-C—It is the highest level of creativity and is exhibited by exceptional people who achieve great eminence. As expected, the impact of such creativity crosses all boundaries to become universal and is visible at the level of cultural expressions and societal behaviors.

Creative pursuits include activities resulting in all the Cs of Kaufman and Beghetto. They can be classified as

1. Everyday creativity

2. Scientific experiments/innovations

3. Arts

According to World Health Organization (WHO) Health Network Report 67[19] arts include the following:

1. Performing arts (music, dance, theater, singing, and film)

2. Visual arts (painting, photography, and sculpture), design, and craft

3. Literature (writing, reading, and attending literary festivals)

4. Culture (going to museums, galleries, art exhibitions, concerts, theater, community events, cultural festivals, and fairs)

5. Online, digital, and electronic arts (animations, filmmaking, and computer graphics)

This range is very accommodating, and anybody can indulge in one or other creative pursuit.

MENTAL HEALTH DIVIDENDS

When we are embarking on the journey of understanding mental health dividends, it is important to have a look at WHO definitions of health and mental health.

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

“Mental health is a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community. It is an integral component of health and well-being that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in. Mental health is a basic human right, and it is crucial to personal, community and socio-economic development.”

When we look at the WHO definitions of health and mental health, we find that both are dynamic and rooted in society and culture and include components of illness prevention and health promotion. It must be understood that all creative works have a social component because they are conducted by a social animal, usually with the social animals, and always for the use of social animals. It has been argued that in the presence of chronic diseases complete health and well-being may not be attainable, but one can restore homeostasis by management, adaptation, and resilience. This makes treatment and rehabilitation an integral part of health dynamics. This background is important to chart the mental health dividends of creative pursuits, which is also a dynamic process.

Mental health dividends of creative pursuits can be classified as follows:

1. Mental health promotion prevention of mental illness

2. Developmental effects

3. Therapeutic effects

4. Stigma reduction

5. Rehabilitation

SOME THEORIES AND EVIDENCE

Bharat Muni

Bharat Muni writes in the first chapter of his Natyashastra that Brahma created dance to alleviate stress and negative feelings, such as fear, anger, lust, and jealousy, and to calm the mind. Brahma's new creation was in response to the plea made by Indra and his associates when the whole universe was full of these negative feelings and the people were suffering. If we ignore the mythological way of narration, we stay convinced of Bharat Muni's scientific understanding, and when we see his concept of nine Rasas dealing with almost all emotions we experience, we are forced to admit that probably he was the first psychologist of the world. It is surprising to note that what he said about the world and the mental health effects of performing arts is more than valid even today.

Sigmund Freud

Freud proposes that in the act of creation unconscious plays a major role, and it is made possible by libidinal energy and process of sublimation. By sublimating the sexual desire into a cultural manifestation, creative process makes the thoughts of the unconscious more acceptable, productive, and pleasant. Editing by super-ego refines them further. Based on this, he proposes that the creative process is a defense mechanism protecting against neurosis.

Jacob L Moreno

Another relevant person is Psychodrama fame Jacob L Moreno (1989–1974) who proposed that habitual thinking, the major source of psychopathology, can be best managed by “generating a more flexible capacity for creative thinking in general.” He hypothesizes[20] that creativity is best promoted through an interactive process of improvisation, which includes the involvement of body and mind both. This opens them up to the “delicate sources of intuition and imagination” and induces spontaneity. Moreno values spontaneity not only a key to creativity but also to vitality and deep enjoyment. According to him, it reminds oneself of his or her most authentic part of the self. Spontaneity, according to Moreno, is a physical, mental, and interpersonal process, and creativity can facilitate it. Moreno said, “Spontaneity operates in the present, here and now; it induces the individual to respond adequately to a novel situation or to respond in a novel way to an old situation.” Later, Csikszentmihalyi (1997) described spontaneity as flow, which is more popular today.

Poetry

Creative pursuits involve the clients as participants, stimulate their senses and imagination, and empower them to express their hidden and unnoticed self. Their use of imagination in productive ways leads to self-discovery and positive change.[21,22] In the preface of “Between Hours” (a coaction of poems written by psychoanalysts), the editor of the book Prof. Salman Akhtar writes that poetry is one person's psychoanalysis and psychotherapy is two persons' poetry. Delivering a lecture at the University of Missouri—Kansas City—he highlighted that the healing power of poetry comes from its capability to bridge five duets—“music and prose, phonetic and psychodynamic, right and left brain, known and unknown and separation and fusion.”

Music

Expressive therapies form a unique domain of psychotherapy. Music is considered expression of non-lingual and non-discursive portions of emotions and early childhood and unconscious traumatic experiences.[23] Listening to music is helpful in connecting and bringing out painful memories without pain and anxiety.[24]

According to psychoanalytic theorists, the therapeutic effects of music are mediated through:

1. Emotional catharsis for repressed wishes (Id)

2. Mastering the threats of trauma (Ego)

3. Enjoyable submission to rules (Super-ego)[25]

Nzamie and Tika[26] have beautifully described that music is processed in our nervous system at perceptual, emotional, autonomic, cognitive, and behavioral levels. At neurochemical levels, the effects are mediated through dopamine, endorphins, and oxytocin.

Dance

Body and mind dichotomy is no longer valid. Dance or movement therapy is based on their inter-relatedness and is defined as psychological therapy, which facilitates the integration of emotional and cognitive faculties with physical movements, which leads to positive effects on feelings, cognition, physical functioning, and behavior.[27]

Now, we have a neuroimaging support for dance-based interventions.[28] It has been observed that dance performance has some correlation with gray matter thickness in the superior temporal gyrus and white matter diffusivity in the corpus callosum. This not only indicates the importance of these brain areas in dance performance but also gives a biological basis for the psychotherapeutic use of dance and movement therapy.

Well-being connections

Many studies also tell us about the transformational and positive mental effects of creative pursuits. Researchers have found a positive association between creativity and positive well-being and negative association between creativity and negative well-being.[29]

When creativity is pursued, positive mental health is promoted or maintained through three psychological mechanisms: authentic self, positive focus, and flow.

1. The Authentic Self—All creative pursuits give a purpose and avenue for expressing the self. This process makes life meaningful, a way to express the self and a meaning.

2. Positive Focus—All creative pursuits orient the mind for positive focus. Purposeful creative involvement promotes well-being. Mihalai Czikszentmihaly[30] in his book titled CREATIVITY beautifully explains the difference between entertainment and creativity.

   “Entertainment keeps chaos temporarily at bay, but the attention it absorbs gets wasted. On the other hand, when we learn to enjoy using our latent creative energy so that it generates its own internal force to keep concentration focused, we not only avoid depression but also increase the complexity of our capacities to relate to the world.”

3. Flow—The state of flow is a complete merger of action and awareness. In this state, an individual loses a sense of time. It is achieved when a challenge closely matches a person's capability. This is experienced by individuals not only during creative pursuits, but also physical activities, such as cricket and other sports. According to positive psychologists, the experience of flow enriches life, does away with boredom, and imparts meaning. It is important to note that one can reach the state of flow by continuous engagement.

WHO REPORT ON HEALTH EFFECTS OF ARTS

In the series of health evidence, the WHO has published a very comprehensive report on the health effects of art.[19] This document has been produced using scoping review methodology and has included around 900 global publications covering 200 reviews and meta-analysis covering 3700+ studies, published during the last 2 decades of this century. The authors have found substantial evidence for positive mental health effects and well-being and have given suggestions for inclusion in government policies.

In their review,[19] the authors have identified two sets of components of arts, which have been found health promoting. Psychological components include “Aesthetic engagement, Involvement of the imagination, Sensory activation, Evocation of emotion and Cognitive stimulation.” No artistic activity is without physical involvement and a social interface. They have rightly identified “physical activity, social interaction, engagement with themes for health and interaction with health care settings” as natural and possible components.

The authors have found evidence[19] for the responses elicited by different components of arts and their outcomes. They have classified responses as psychological, physiological, social, and behavioral. Psychological responses include components, such as “enhanced self-efficacy, coping and emotional regulation.” Components of creative pursuits lead to physiological responses, which include “lower stress hormones, enhanced immune function and also higher cardiovascular activity.”

The authors have found evidence for illness prevention and health promotion and the application of arts in management and treatment. In relation to prevention and promotion, the authors found substantial evidence and classified them as follows:[19]

• “1. Arts affect social determinants of health: Promote social cohesion and help in reducing inequalities and inequities.

• 2. Arts support child development: Mother–infant bonding, speech and language acquisition, and educational attainment.

• 3. Arts encourage health-promoting behaviors through promoting healthy living and encouraging engagement with health care, through their role in health communication, reducing health-related stigma and engaging marginalized or hard-to-reach groups.

• 4. Arts help to prevent ill health by enhancing well-being and mental health promotion, reducing the impact of trauma, and reducing the risk of cognitive decline.

• 5. Arts support caregiving by enhancing understanding of health, improving clinical skills and supporting the well-being of formal and informal carers.”

In relation to management and treatment, the authors found substantial evidence and classified them as follows:[19]

1. Arts help people experiencing mental illness: perinatal mental illness, mild–moderate mental illness, severe mental illness, trauma, and abuse.

2. Arts help people with neurodevelopmental and neurological disorders including autistic spectrum disorder (ASD), cerebral palsy, stroke, other acquired brain injuries, degenerative neurological disorders, and dementias.

3. Arts support care for people with acute medical conditions and management of non-communicable diseases (including cancer, respiratory disease, diabetes, and cardiovascular disease (CVD)).

4. Arts support end-of-life care (including palliative care and bereavement).

5. Arts help in fighting the stigma associated with mental illness

SOME HIGHLIGHTS FROM WHO REPORT[19]

Stigma reduction

Creative pursuits facilitate the discovery of the creative self and victory of personhood over patienthood. A huge body of evidence suggests that creative engagements and their exhibition are one of the most effective methods of stigma reduction. Arts improve mental health literacy and empathy and facilitate social inclusion. Art festivals lead to increased positive attitudes toward mental health and abilities of persons with mental illness. Simple activities, such as songwriting in hospitals' inpatient units, have been found to reduce the level experience, self, and total stigma. There are studies that show that watching films on the issue of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) helps in improving parental attitudes toward such children.

Substance use disorders

Creative pursuits help not only in generating awareness but also in getting rid of drug use. Songwriting workshops have been found to reduce craving. The authors suggest that the effect may be due to distraction, engagement, and motivation. It is pleasant to know that “compared to sporting events, arts events are equally effective for promoting antismoking awareness and have twice the effect on individuals' intentions to act.”

Reaching hard-to-reach groups

The authors have found evidence in criminal justice literature. Engagement in the arts helps jail inmates in improving their mental health. It helps in engaging those inmates who refuse to participate in other health-promoting activities. The effects of art projects on juvenile offenders with complex psychological problems have been studied and found that such engagements help not only in improving academic performance but also integration in family. It has been found that those who engage in art projects learn and develop social and coping skills, improve their attention span, experience less stress, exhibit less anger, and express their emotions more effectively. They experience more self-esteem. Art projects help in reducing the incidence of anxiety and depression. Art projects for adult offenders are also beneficial. Studies have shown that they lead to a reduction in the rates of re-offending.

Cognitive effects

Cultural engagements contribute to cognitive reserve and improve the resilience of the aging brain. It has been found that 10 or more years of musical training lowers the risk of cognitive decline and dementia. Even older adults benefit by playing musical instruments. Such activities help in improving or preserving general cognition, processing speed, and memory. Going to museums, art galleries, theater shows, music concerts, or the opera regularly slows down cognitive decline and the risk of developing dementia.

Arts and child development

Motherese or baby talk has musical components. Mother's singing to infants facilitates emotional closeness and mutual bonding. Singing creates a pleasant atmosphere and eases the burden of nurturing. Baby care becomes fun, and this lowers the levels of stress hormones in mothers and their infants.

Music plays an important role in reading, language, and auditory skill development. Several studies have shown that early childhood musical training leads to structural differences in gray matter and white matter. Such changes are not seen in children who do not receive musical training.

The arts facilitate autonomy, competence, and relatedness. Inculcating such qualities lowers the risk of developing maladjustment issues in adolescence.

Therapeutic

Studies have shown that engaging in artistic activities, especially dance and music therapy, helps in reducing anxiety and depression in children and adolescents. In adults and older adults, painting, creative writing, group music, and plays reduce distress, anxiety, and depression. Such engagements are found to enhance individual and social well-being. These benefits are mediated through neurotransmitters. Studies have shown that music improves sleep quality, sleep efficiency, and time to sleep onset, with greater effectiveness than meditation.

Engagement in creative pursuits can be an adjunct to pharmacotherapy and psychological interventions in patients with severe mental illness. Studies have shown their effect in inpatient and community settings both. Researchers have found improvement in global, general, and negative symptoms and also depression and anxiety. Reports suggest that music therapy positively affects psychopathologies.

Bibliotherapy

Books play a role in the development and modifying attitudes. Going to the libraries is beneficial for mental health. Libraries have been used as sites for arts-in-health interventions such as reading for mental health. We have examples from different parts of the world.

Soft evidence

Apart from hard scientific evidence, we have some comparatively softer ones also. I would like to include two soft ones, which do not need to be proved like the existence of air and water. The first is a large volume of mythological literature, which is present in and around us like air. I would like to remember French anthropologist Levi Strauss who lauds the intellect of pristine thinkers and poets who created large volumes of myths. He calls them “uninterested intellectuals” who were more interested in understanding and explaining the relationships between man and the universe. I would like to recall my favorite mythologist Joseph Campbell who wrote “Hero with Thousand Faces,” which is an epic attempt to synthesize and summarize the construct and meaning of myths. In his book of interview, The Power of Myth,[31] he has proposed that myths play a great role in making of our minds by

1. Underlining the mystery of universe and facilitating a relationship

2. Being secret openings through which the inexhaustible energy of cosmos pour in our cultural manifestations.

3. Maintaining social order

4. Teaching how to live under any circumstances

Second evidence comes from folk literature, which is largely unwritten, and forms the part of Shruti tradition. Being a person from a rural background, I have witnessed the supportive and psychotherapeutic roles of singing traditional songs soaked in the salty water of everyday sufferings and fragrant and vibrant colors and smells of flowery islets of happiness and joy.

Before the birth of science of psychiatry, these two manmade treasures and their universal and democratic use and application have taken care of mental health of one and all. They are still playing their role, but due to money and market-driven globalization and globally pervasive postmodernist way of thinking they are being made increasingly redundant. I do not support the blind revivalist approach, but surely recommend judicious and creative use of these time-tested treasures having enormous scope for creative engagement. It is a matter of great satisfaction that the world is looking toward yoga and spirituality for the management.

POLICY CONSIDERATIONS

1. We have substantial evidence for the role of creative pursuits in the prevention of mental illness and promotion of mental health. We must develop a strategy for the implementation of creative interventions.

2. There is a need to create awareness about the health benefits of creative pursuits.

3. WHO report underlines the need to support research in policy-relevant areas.

4. Arts and cultural organizations should be encouraged to make health and well-being an integral and strategic part of their work. They should be involved by mental health professionals because there are examples of prescribing art for mental health reasons.

5. WHO report recognizes the cross-sectorial nature of arts and health fields and calls for a collaborative approach, as mutual cooperation will help both sectors in productive growth. People working in the field of arts can be employed in health settings.

6. The implementation of creative components in education is the need of the time. Today's India badly needs it.

7. WHO report recommends[19] “inclusion of arts and humanities within the training of health care professionals to improve their clinical and personal communication skills.”

CONCLUSION

1. Creativity is unique human attribute that has played very important role not only in advancing the journey of civilization but also taking care of health and mental health needs of people.

2. Newer technologies are extending great help to humanity but at the same time posing a threat to mental musculatures involved creative process by abundance of ease. So, there is a need to engage people, especially younger ones in creative pursuits religiously.

3. We have substantial evidence for the role of creative pursuits not only in prevention of mental illness and promotion of mental health but also therapy and stigma reduction.

4. We must develop strategy for implementation of creative interventions at schools, in families, social centers, and health and mental health establishments.

5. Last but not the least, we need compassionate attitude and clear policies with good intentions from our governments.

(This address is dedicated to the memory of Prof. Narendra Nath Wig.)

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Conflicts of interest

There are no conflicts of interest.