Volume 15, No. 1, Art. 10 – January 2014

Interrogating Ourselves: Reflections on Arts-Based Health Research

Michael Hodgins & Katherine M. Boydell

Abstract: This article is deliberately unconventional in style and reflects a conversation between us—Katherine, senior scientist/principal investigator and Michael, research coordinator—as we embark on an arts-based health research study to explore the theoretical, methodological and ethical challenges faced by scientists, artists and trainees who are "doing" arts-based health research (ABHR)1). Our narrative is based on reflexive and observational field notes that we kept during the research process. We draw on ELLIS and BOCHNER's (2000) autoethnographic practices of writing reflexively about the ways in which the self informs one's work as a researcher. As a beginning, we each reflect upon our own perspectives on the importance of the arts in our lives. We then move to a conversation between us regarding using the arts in the process of both doing research and disseminating research that illustrates some of the key issues in the field.

Key words: reflexivity; narrative; arts-based; health research; field notes

Table of Contents

1. Reflections

2. Our Narrative

3. Concluding Comments







1. Reflections2)

I remember very clearly when I discovered the power of art. I use the phrase "the power of art" at the risk of sounding cheesy for want of a better expression. I was 13. I had always enjoyed music. My parents had always played good3) music on long car trips and it was not uncommon to hear Paul Simon's "Graceland" or various film soundtracks blaring and distorted from our Toyota Tarago speakers. I had had a few piano lessons because either my parents thought it would be good for me or I had whimsically asked them to after seeing a piano for the first time. My friends at school would talk about the music they were listening to and I remember very vividly being laughed at when I didn't know whom Eiffle 65 or Chumbawumba were. I bought their CDs to try and fit in. But it wasn't until I had reached puberty that I truly "found" and connected with a piece of music. [1]

It was at my friend's house and we were listening to his dad's antiquated music collection. Actual records from the 1960s and 1970s from bands like The Beatles, David Bowie, Cream and Queen with funny pictures on the covers like men with make-up dressed all in leather. It was all quite a novelty. All until he played one song for me and from the moment the guitars, strings and drums exploded out of the speakers with their terrible, amazing, powerful, hypnotic riff I was dumbfounded. [2]

"Kashmir" by Led Zeppelin had ripped me from a passive, complacent, "background-noise" relationship with music and thrust me violently into a world where I was utterly feeling every beat, note, melody, harmony and rhythm. It was as if a new nervous system had turned itself on inside my brain, heart and soul and the catalyst was this one simple piece of music. From then until this day my insatiable appetite and appreciation for music has only grown stronger. [3]

I took up the drums and then learned to play the guitar and the bass before I was 16. I started taking more notice of the things I had learned in those tiresome piano lessons when I was 10. I went through school in various bands, playing various instruments wanting desperately to make music for a living. By the end of high school I was a highly capable bass guitarist and had scored 94% in my final exams for music (a considerably higher mark than in any other subject) earning a place on the state merit list. It is safe to say that that first "experience" had an overwhelming effect on me. [4]

I studied education at university because my parents and I both decided that if the "rock star" dream fell through, it would be good to have a backup. I became a teacher. After four years as a professional teacher I became disenchanted with many of the aspects of the education system and I opened myself to the possibilities around me. Thankfully one of those possibilities happened to be Katherine inviting me to work on this very project. [5]

Having the opportunity to speak to the amazingly brilliant people creating innovative arts-based health research has been remarkable. It has enabled me to begin to truly understand and acknowledge what impact art has had on me and the potential beneficial impact it could have on many other people, both in the health care field and beyond. [6]

I am a scientist whose roots are (were) firmly planted in a positivist tradition—training in a faculty of medicine and particularly in community health and epidemiology provided the basis for my research career. However, I strayed from those roots very early on—when I discovered that the answers to the research questions I was interested in asking were not found within the quantitative realm. I was far more interested in the lived experience of health and illness, the reasons why people may fail to take prescribed medication, their perspectives on treatment and support, and the impact of the social context within which they live their lives. [7]

This led me to branch out and embrace qualitative inquiry as a way of doing research. But even this proved to be inadequate. I recognized the limitations of the traditional boundaries of health and social scientific research and wanted to be able to share our research findings with a far broader audience than that targeted by peer-reviewed articles and scientific conference presentations. How could this be done in a manner that was engaging and could effectively communicate key research findings? Could this be done in an artful way? As a mother, immersed in the dance world via three daughters, I found myself continuously moved by the power of dance to communicate a story. As a qualitative methodologist interested in narrative and storytelling, I wondered about using dance to share research results. This led to a partnership with a dance choreographer to co-produce a research based performance on access to health care—which allowed us to access other parts of human consciousness, to pay attention to reality in a different way, and to make the ordinary extraordinary4). [8]

More recently, I was incredibly moved by a powerful installation in the Art Gallery of Manchester. It was a curious collection of many different types of suitcases from old worn leather baggage trunks to more modern sleek and shiny luggage sets. On each luggage handle was a brown paper tag that held a hand written message by other art gallery viewers. Their responses were replies to the question "if you could be anywhere in the world right now where would it be?" I was with my eldest daughter at the time and I remember that she wrote, "right here, right now-with my entire family" and I felt exactly the same way. Upon reading the other baggage tags I was moved to tears as they were so poignant—one memorable one stated, "in heaven with my mother if only for one minute." I spent a great deal of time reading all of the baggage tags and thought about the power of the installation in terms of sharing elements of the human experience. I returned one year later and found that the messages on the luggage had all changed. This installation has stayed with me as an example of a powerful way that the arts can communicate lived experience, hopes, wishes, and dreams. [9]

I think that such artful approaches can offer an alterative means to the achievement of one main purpose in qualitative research—understanding the context-specific collection and interpretation of the meanings people attach to their behavior, how they interpret situations and their perspectives on particular issues. The inclusion of visceral, emotional and visual elements in research creation and dissemination, which rely on alternate expressive possibilities, can allow us to access and represent different levels or types of experience. [10]

Yet there remains a struggle as I recently realized—I have not entirely escaped from the scientific model I was trained in. I tend to hide behind the cloak of science, sometimes finding it difficult to stray too far from the expectations of a linear, evidence-based tradition of writing and presenting research results. [11]

2. Our Narrative

I think it is so important to conduct this research we are embarking on in order to establish a foundation for pursuing ABHR5). There is so much written descriptively about the content and form of such research but very little critical thought focused on the theoretical, methodological and ethical challenges encountered by the scientists, artists and trainees engaged in conducting these projects. [12]

The arts have such a significant role in portraying issues that are critical to our understanding of health, illness and the body. We know that many health researchers are using the arts creatively, as a method of doing research and as a method of disseminating study findings. A range of artistic genres are employed; usually photography and other visual arts, theater and less frequently music, poetry and dance. Some benefits of using the arts in research include increased attention to the meaning and experience of health and illness, inclusion of disenfranchised and marginalized communities and the heightened ability to convey research findings in a way that engages target audiences and facilitates change in health care knowledge, attitudes and practice. [13]

In Canada and indeed worldwide, there has been a continual increase in the number and variety of arts-based health research projects adopting an arts-based approach to conducting research and/or disseminating research findings (COX et al., 2010; SONKE, ROLLINS, BRANDMAN & GRAHAM-POLE, 2010; WREFORD, 2010). Three recent review articles on the arts and health described the scope and significance of this work, one written by our own team (BOYDELL, GLADSTONE, VOLPE, ALLEMANG & STASIULIS, 2012) and the other two by Canadian colleagues (COX et al., 2010; FRASER & AL SAYAH, 2011). In our scoping review (BOYDELL et al., 2012), we found that there was little in the way of guidelines about ethical issues specific to ABHR and identified a need to focus on how the quality or trustworthiness of ABHR is "measured." COX and her colleagues (2010) provided an overview of arts-based work conducted in areas of health policy, healthcare practice, individual and community health promotion, and health professional education in Canada. They noted the rapid increase in knowledge about the methodology involved in ABHR and noted the need for further scrutiny of the ethical aspects involved in and unique to this work. FRASER and AL SAYAH's (2011) systematic review also identified little critical examination of the use of arts in research. [14]

Katherine …

All reviews identified ethical issues as an important area for development—especially regarding data ownership, appropriate ways to analyze arts-based data, and participant anonymity. [15]

Katherine …

Another recent article by George BELLIVEAU, one of our co-investigators on this project (WHITE & BELLIVEAU, 2010) examined ethical considerations, the need for researchers to maintain a critical awareness of surfacing ethical dilemmas throughout the process and to explicitly acknowledge issues with performers and audience as an integral part of the research. [16]



What are you doing?

I'm describing our research project and giving you some background regarding the scholarly work in the ABHR realm. [17]

But we're here not only to discuss our project but also to add to the discussion around the ways in which arts-based methods can contribute to the creation and dissemination of knowledge. To me, part of that involves using new, more evocative and provocative methods to pass on knowledge. Don't you think you're undermining that stance a little by adhering to more "traditional" forms of academic writing above? You are straying toward that cloak of science that you mentioned earlier. [18]

You're absolutely right but, and this reflects my concern to remain "legitimate" within the field of medicine, to do so means to fall back upon the common academic currency—peer-reviewed publications and scientific presentations. I have to find a way to let go of this. [19]

Now might be that time, Katherine. [20]

But remember though, we are talking about arts-based health research, so we can't do away with the research part. [21]

I agree. As one interviewee informed me "there is no way you can really have a methodology that is purely arts-based. There needs to be some traditional methods or some traditional components to include." [22]

Let's talk a bit about our study and why we think it's important to lay the foundational groundwork in the field of arts-based health research—the "traditional" components if you like. [23]

Well, as I understand it, arts-based health research is a positive development but it also raises unique challenges for researchers, artists, patients and other participants. [24]

Yes, current research demonstrates the potential for arts-based methodologies to create and share new knowledge, yet further work remains. Despite the prolific work in the field that focuses on the form, content and legitimacy of arts-based methods, there are many gaps. Arts-based research is under-theorized and the methodological challenges and benefits are rarely addressed. Our in-depth interviews with 36 artists, scientists and trainees represents an essential first step in identifying the theoretical, methodological, ethical, and practical issues for those doing this work, thus establishing the groundwork to identify research priorities and pave the way for future research in this emerging field. [25]

I've been thinking that qualitative research and arts-based research share some similarities. Didn't you start out doing qualitative research when it was less accepted and fairly "new" in the medical field? [26]

Yes, there are many parallels in terms of the struggle to gain legitimacy for qualitative inquiry in a world where the positivist viewpoint is so prevalent. In the early 1990s when we were drawing on qualitative inquiry to answer the key sociological questions we were asking in the adult mental health field, many of us qualitative methodologists encountered skepticism. We encountered this doubt from colleagues about the legitimacy of our epistemologies, theories, methodologies, and procedures. Fortunately, qualitative inquiry has gained a lot of ground since that time and is now largely regarded as legitimate within disciplines where the hegemony of the quantitative positivist paradigm generally prevails. However, I think that arts-based researchers are now facing some of this same skepticism. [27]

Judging by my field notes, so far this skepticism has had an impact on the funding of ABHR projects. There is disappointment and disenfranchisement regarding the current funding climate, particularly for projects involving new and innovative research approaches such as arts-based methods. Participants lament a general lack of funding for qualitative and arts-based research in health by the majority of health-related funding bodies. [28]

I also hear that a great deal, however, that's not been my experience. My team and I have been successful in garnering the funds to be able to do this work. I think it is because the proposals are very solidly academic. I have also reviewed recent databases for our major funder, the Canadian Institutes for Health Research (CIHR), and discovered that they are funding this work to the tune of millions of dollars. [29]

Yes and everyone I spoke to had also received funding for their projects and/or had published their ABHR in peer-reviewed journals—although, that was part of the criteria to be eligible for the study. I think you and most of the participants who are being allocated funds all have strong views regarding consistency and rigor in all forms of research, including arts-based. [30]

I think the problem here is that there's little in the way of formal policy recognition and funding available in all areas of the arts and health. So, tell me a little bit about what you are hearing from the many participants you have interviewed so far. What are some of the issues they're facing when using the arts in the research process? [31]

I think there are challenges around many different aspects of their work, such as the ethics involved with keeping anonymity and associated issues of ownership, the differing processes and epistemologies of artists and researchers, ideas around (re)presentation, quality and "goodness" and the ability to measure the impact of arts-based research. Even some of the researchers I spoke to had their own doubts about the legitimacy of this kind of work and consider many of the projects they have seen to be "not very good at all." There is a concern that the "sexy" and "fun" image of ABHR means that people are undertaking projects without maintaining a strong commitment to both the research and the art components. [32]

I agree. One of the critical issues we wanted this project to help illuminate were some of these challenges. Let's try to unpack each of them a bit. Why don't we begin with the ethical issues associated with anonymity and ownership of the work, be it a dramatic script, a film or photographic installation. [33]

Many participants spoke about the issues surrounding anonymity including ownership and confidentiality. They explained how they overcame these issues themselves, but also elaborated on the possible negative consequences that could have, or did, arise. [34]

I know from my research experience that the issue of confidentiality in arts-based work is complex. There is the preference of many participants to be acknowledged as artists when they participate in ABHR. On the other hand, there is the expectation that anonymity be preserved. I think we need to focus on the longer-term consequences of participant identification in ABHR. Do research participants understand the future consequences of what it means to be identified? For example, in our research in the mental health field, there is a tension between the goals of anonymity and protecting vulnerable participants on the one side, and the desired goal of stigma reduction strategies that promote speaking out and putting a name to mental illness on the other. [35]

You can understand participants in a study of a potentially stigmatizing illness or health issue would be much more inclined to identify themselves as an artist, rather than as the participant of a study or not at all. What comes first? Are they an artist or a research participant? [36]

I'm not sure. I think that, ultimately, it comes down to a matter of individual preference. As you know, we faced the same ethical dilemma in our research process for this study. Just last week, one of our research participants e-mailed me to state that she wanted to be associated with her work and thus desired acknowledgment rather than anonymity. Many other interviewees also indicated their desire to be associated with their work in the context of this project. How did we overlook this? We were victims of following the "procedural" Research Ethics Board (REB) rules of assuring confidentiality and anonymity without thoughtfully considering the specific context of our study. This is one of the issues that we explicitly talked about in our opening article to the special issue of the International Journal of the Creative Arts in Interdisciplinary Practice published last year (BOYDELL et al., 2012). [37]

I also wonder about those who do wish to remain anonymous. Is this even possible given the nature of their work? Once we identify the art genre, discipline and health issue, most people in the arts and health community would know exactly who the participant is. Will we have to modify the facts in order to protect confidentiality? [38]

I believe that there is a need for an explicit discussion about when and for whom it is appropriate for a research participant to be identified and that this discussion should include the academic and artistic community as well as participants. In our case, they are one and the same. [39]

Staying with the ethical issues associated with the work, authorship/ownership issues were encountered in the use of various art genres. Who ultimately "owns" the work that is produced in a collaborative effort? [40]

There are many instances where we have questioned who the product—be it a research-based dance, dramatic script or photographic installation—ultimately belongs to. Is it the research participant, the artist, or the researcher? It is in this area that I think we have much to gain from our conversations across the country with artists and researchers and trainees who are dealing with these questions on a day-to-day basis. I am aware of legal contracts being developed to deal with such ownership issues, with a focus on co-ownership and what that means on a practical basis. There are also other situations that lend themselves to additional questions such as, have participants consented to the use of interview material by artists to create an artistic piece? [41]

Through my preliminary observations I found that researchers that successfully mitigated ownership issues were those who developed contracts or agreements towards the beginning of the project that negotiated the difficult terrain surrounding this dilemma. These agreements were generally developed in consensus with the artists or the participants involved. It will be interesting to examine our data more closely to create a greater understanding around this issue. [42]

I suspect though, like me, participants in the study have faced many other challenges engaging in this work. I'm very interested to see how they've dealt with them. Are there lessons learned that could be applied to the field in general? Can representing research outcomes in, with and through an art form serve as an effective way of reaching multiple and diverse audiences? [43]

I think it is, based on your extensive experiences, not only witnessing the impact of the products of your ABHR, but also the impact of art generally on multiple and diverse audiences. Then there are those words that belong in the artist lexicon like "intuition" and "feeling" that are generally ignored in the hard data driven research world. How can there be rigor if what you are saying or thinking is based on a feeling? How can you be sure your data is communicated effectively if the tool used to transfer knowledge is based on emotion and can be misinterpreted? One of the key areas I have been reflecting on during my experience is how researchers and artists try to avoid misinterpretation in their (re)representation of research by adapting their artworks or research products. [44]

When you say (re)representation, you mean the layers of interpretation that occur when engaging in arts-based work. As a qualitative researcher, the text is always subjected to interpretation and then in using the arts, there is yet another interpretive process. The potential for (mis)representation as we move further and further from the actual data can make me feel uncomfortable—and I am sure it does so for many others as well. The issue of (mis)representation looms large for me—what are the dangers? I hope that the results of this project can address this issue. [45]

There were many researchers and artists who were also uncomfortable with this and consciously sought to limit, or at least acknowledge, an artwork moving further away from data through (re)representation. One participant involved in the creation of a drama to depict her research results was in a position where being a full-time professor had brought job security; she spoke about allowing the playwright and the actors to (re)represent the research data through the play freely. She was enthusiastic about "letting go of the reigns," but I think in a sense she really didn't identify it as being her work—it was someone else's work but it just had a grounding in her research. It didn't represent all of the perspectives and ideas that the research had uncovered. Through the reinterpretation, certain ideas—generally the more emotive or those capable of fitting nicely into a narrative—were highlighted and the product became extremely figurative. [46]

I faced this representational issue when using dance to share our research findings on pathways to care for young people experiencing psychosis. I questioned what might have been sacrificed for the sake of performance and the choreographer questioned what might have been sacrificed for the sake of the research (BOYDELL, 2011a, 2011b). For example, would leaving the performance open to a greater level of interpretation result in a product that was less true to the research? Would too much of an emphasis on the research findings affect the artistic qualities of the dance? We arrived at a mutual agreement that it was essential to maintain the integrity of the key features of the data and hence the lived experience; however, the ways in which to do so were frequently ambiguous. I think that such collaborations open up a space for meaningful dialogue and partnership. The work of Kip JONES (2006, see also JONES et al., 2008) has been helpful to me as he highlights the fact that when we extend our work to other disciplines and find co-creators of our presentations and performances—it can help to insure that, rather than amateur productions, our presentations have artistic quality and are able to reach our targeted audiences in an engaging way. [47]

Very well said. But I think we need to be careful not to negate amateur productions and the fact that they have their place and are often appropriate and powerful. [48]

I think it is a matter of somehow transforming what we think and what we observe into a representational form and way of communication that is different from text. Do we accept the numbering and banal wording more easily than the expressive language of poetry, dance, or performance? I think that this is so for most academics. [49]

How much direction do you think is necessary to give the audience? Can arts-based researchers tolerate artistic freedom when presenting their work without running the risk of their work losing its communicative value? [50]

Well, ultimately, there is a central challenge in ABHR to consider the extent to which we are compelled to explain specifically what things mean, using other traditional text-based methods; and, if clarification is required, what must be done in advance to explain the project, depending upon the purposes of our research and the audience for which the work is intended. We have handled the uncertainly regarding what to tell the audience by ensuring that the context for the work is communicated and to allow the audience to engage in post presentation or post performance "talk-back" sessions. In that way, it opens up a space to dialogue about the topic at hand. These issues need to be troubled/disrupted and the processes we as arts-based researchers experience as we move through this work need to be documented, written about, reflected on, and theorized. [51]

I believe it is the purpose of the work and the audience that dictate how much an artwork is explained. For example, we have to ask: what is the work really trying to achieve? Is its main purpose to inform a group of health professionals or an academic audience about new developments in a particular field? Or create a discussion with multiple stakeholders around the experiences of a marginalized community or a potentially sensitive issue? These two projects will yield vastly different approaches to explaining their work to their audiences. A participant likened the idea of direction in ABHR with a river, a metaphor that resonated strongly with me. The artistic and emotive aspects of the artwork or performance are like water, carrying the observer and directing their sentiment. But it is necessary for the audience to have solid ground to avoid getting "carried away" by the artwork. The factual aspects or data that the performance or artwork is based on are rocks for people to rest on and take stock of to fully appreciate what they are experiencing. [52]

That metaphor really resonates with me and speaks to the need to balance the research and artistic components of any arts-based research project. I believe the challenge lies in that balancing act. At present, there is not a consensus on how to balance the scientific research requirements such as rigor with the aesthetic dimensions of arts-based inquiry. [53]

Based on my conversations with those engaging in ABHR, I think that the majority of tensions and challenges involved in ABHR (particularly in projects that use art as a form of dissemination) stem from the issue of didacticism in the products of the work. Generally speaking, artists seeking legitimacy/authenticity in their work do not want to convey a single message and be seen as one dimensional; rather they want interpretations from the audience to be free-flowing, participatory, and relational. Researchers seeking legitimacy and authenticity feel the need to show that their products can achieve the purpose of conveying consistent messages to their audience—avoiding the possibility of misinterpretation. The work thus needs to be more didactic in nature. There seems to be an inherent conflict here—to share the empirical research results in a way that is consistent, yet leave enough openness and flexibility as well. It is a difficult and complex problem and I believe the solution may lie in changing both disciplines' perceptions of legitimacy and authenticity. [54]

I think that the notion of "legitimacy" of the work—does it meet scientific and artistic rigor?—is very much linked with the ways in which arts-based health research projects are considered "good." The underlying question becomes, how do we understand this? [55]

I think that you've tried to address the issue of impact in some of your previous work. I know that there is little literature that focuses on measuring impact and that there are some very real difficulties associated with doing so. It is very much related to some of the issues of "goodness" that have arisen in the interviews I have conducted so far. One challenge for researchers is establishing a respected body of work without compromising the aesthetic values and passion for art. Several interviewees mentioned the importance of staying "true" to the research being depicted in their performances. The need for research professionals to have competence in the art forms they are using when undertaking ABHR and/or to collaborate with a professional/experienced artist has been raised. I strongly agree with one of our participants on this point and feel that to create "good" ABHR ("good" being, in my opinion, seen within each community as legitimate, created with competence and relevant) both artists and researchers who undertake this kind of work need to have an open mind. They need to be able to understand each of the differing processes involved (creating art and creating research) and adapt their practices to suit the demands of the different epistemologies involved with each profession. [56]

When engaging in ABHR, it is a difficult and intricate task to establish the goodness of the art vis-a-vis its role in the research process and product. This issue arose in our previous research that engaged young people experiencing first episode psychosis to produce a mural painting. The immediate response to the mural on the part of some of our health research colleagues was less than enthusiastic and it was coined the Ugly Baby by our research team member Brenda GLADSTONE (2012), to indicate the way our team felt about this—namely, we were concerned that this (academic) audience response reflected judgments about the aesthetic value of the work. Brenda went on to write a paper detailing our discussions and reflections about this issue (GLADSTONE, VOLPE, STASIULIS & BOYDELL, 2012). She noted that when the same data was used in our dance project the audience response was far more positive—a response that might have been due to the aesthetic beauty of the dancers and their movements. Interestingly, despite the fact that some audiences seemed to identify more positively with the dance performance, in a school setting where we showed both the dance performance and the mural installation, a focus group with students indicated that they preferred the mural to the dance. Students highlighted their need for assistance in interpreting the dance and found it easier to engage with the mural and its visual language. In another example, one of my doctoral students involved in a photo-elicitation study with young people at high risk for psychosis expressed concerns that she found herself drawn to images that she considered good, with pleasing features of color, clarity and form and tended to pass over those which were too dark or blurred or judged to be uninteresting. However, she found in the process of analysis, that it was often precisely those overlooked photographs that participants identified as being significant in reflecting and generating powerful memories and narratives—they did not distinguish between "good" and "bad" photographs. [57]

This issue of "goodness" reminds me of a book I read many years ago and I am amazed at how much my mind is being drawn back to it. In "Zen and the Art of Motorcycle Maintenance" PIRSIG (1974) addresses many of the themes that have come up in this study such as the divide between the classic and romantic schools of thought (form + function = art + science?) and how we as a society have created that divide. But also the metaphysics of "goodness" or, as Robert PIRSIG labels it, quality are also addressed. PIRSIG asks what constitutes quality? Is it something that is universally quantifiable? Or even definable? He believes that it is not. [58]

I can see why you bought me the book. Reading it at the same time as launching this study has been so apropos—PIRSIG is preoccupied with the issue of goodness or quality—these are the very questions we are grappling with in understanding the aesthetics of arts-based research. How do we know when it is/that it is "good"? He argues that we need a more varied and inclusive approach to viewing life and makes a case that originally the Greeks did not distinguish between "quality" and "truth"—they were one and the same—and that it was an artificial separation. This division of human understanding into classical and romantic assumes that individuals tend to think and feel exclusively in one mode or the other. [59]

This division reminds me that, in our research to date, we have witnessed the frequent lack of understanding that often plagues cross-disciplinary work. I think we need to develop a common language that allows researchers and artists to communicate effectively in such collaborative ventures. [60]

Each school of thought has it's own "language". As I saw in my interviews, the spaces that scientists and artists work in also reflect this division. In my field notes I reflected on a particular meeting with an artist during our interview in her office. It was late in the afternoon and following a full day of interviews. Compared to the other researchers' offices I had been in that morning, this particular interviewee had a space that was messy and slightly chaotic, yet I felt comfortable and welcomed. I began to consider how spaces reflected the different occupants. Many of the researchers I interviewed had a very clean, ordered space where everything seemed to "fit" perfectly. Generally the artists had a much more intuitive and spontaneous design to their spaces. Maybe this is a gross generalization or an oversimplification, but I found it novel to consider nonetheless. [61]

Building on this, we know from the existing literature that arts-based researchers have largely failed to consider in any critical manner the ways in which their practices and those of artists are related, or attend to the many different geographic, cultural and social contexts in which they conduct their work. I am thinking in particular of the work of Donal O'DONOGHUE (2009), an installation artist at the University of British Columbia, who cautions that, as arts-based researchers address the methodological, theoretical and ethical challenges central to arts-based research (as we are doing), they also need to attend to art practices and theories from a variety of academic traditions. O'DONOGHUE argues that to date, arts-based researchers have failed to participate in a systematic process of uncovering commonalities and differences with artist practices. This is where I believe that this project can make a significant contribution to the field, in terms of identifying those commonalities and differences. [62]

I think that that divide still remains and is evident in the differences between artists and scientists. However, surely ABHR can mitigate the potential for misunderstanding and underestimating between the two perspectives or schools of thought. Although it's a complicated issue, I think that artist and scientist bifurcation is evident in many components of the work they do. I think there is such a breadth of difference between each school of thoughts' processes and how they approach a project. One participant, who considered herself a scholar of both camps, described her artistic process as "organic" and outlined the ways that process differed from the linear, structured research methods that she employs. Another participant insisted on approaching all her scholarly work using her artistic process such as creating poetry for academic publication. Even with pressure from funding bodies and peers she had been able to form a career and a respected body of work without compromising her aesthetic values and passion for art. [63]

There are so many rich examples of researchers and artists working together and in so doing, confronting these very challenges, working together to mitigate them, and offering something to the broad community that truly has transformative potential in terms of creating and disseminating health research in innovative ways. [64]

ABHR is a rapidly expanding field of study and most of what we know to date focuses on descriptions of the form and content of specific projects—we are in dire need of moving beyond this to focus on a more critical examination of theoretical and methodological depth. This will open up new spaces for inquiry and address the lack of integration with respect to the findings and practices of arts-based methods, especially between health, social sciences and the humanities. [65]

I think that we are acknowledging the significant contrast between the current burgeoning interest in the exploration of arts-based aspects of society by scholars and artists and the somewhat weak conceptual and methodological basis for realizing this interest in a more widely accepted manner. I look forward to contributing to this knowledge base as we move forward with analysis of the study findings. [66]

3. Concluding Comments

This article represents our attempt to move beyond typical formats for sharing academic work to communicate health and social science in a different manner and with a different purpose. Our individual and personified narratives are presented in a form that diverges significantly from health and medical science traditions of reporting. In keeping with DENZIN's (2001) "narrative turn," with an emphasis on different ways of creating and presenting data, we challenge the typical convention of academic writing. As BOCHNER (2012) states,

"If our research is to mean something to our readers—to be acts of meaning—our writing needs to attract, awaken, and arouse them, inviting readers into conversation with the incidents, feelings, contingencies, contradictions, memories, and desires that our research stories depict" (p.158). [67]


We extend our sincere thanks to Janet PARSONS, University of Toronto, Alexandra BOYDELL, Royal Roads University and Molly ANDREWS, University of Cambridge for their insightful comments on earlier drafts of this article.


1) Exploring the Theoretical, Methodological and Practical Challenges of Arts-Based Health Research is a 2-year study funded by the Canadian Institutes of Health Research (CIHR), KTE-120252. <back>

2) This conversation is separated by the use of different fonts and alignments—Michael uses italics and Katherine uses regular font. <back>

3) We realize this term is completely subjective and that everyone does not necessarily agree upon this music as "good." However as this is coming from a personal perspective, and due to the nature and content of what follows in the article about "goodness," we have chosen to keep the term "good." <back>

4) See BOYDELL (2011a, 2011b) for description of research-based dance projects. <back>

5) Our definition of arts-based research is in accord with that used more specifically in educational research (KNOWLES & COLE, 2008). Arts-based research is an emerging qualitative research approach; it refers to the use of any art form (or combinations thereof) at any point in the research process in generating, interpreting and/or communicating knowledge. <back>


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Michael HODGINS is a research coordinator at The Hospital for Sick Children, Toronto Canada.


Michael Hodgins

L36/274, Botany Road
Alexandria, Postcode: 2515
NSW, Australia

Tel: +61 043-402-0809

E-mail: michaelhodginsfac@gmail.com


Katherine M. BOYDELL is senior scientist, Child Health Evaluative Sciences at The Hospital for Sick Children and professor in the Departments of Psychiatry and Dalla Lana School of Public Health at the University of Toronto, Canada.


Katherine M. Boydell

Department of Psychiatry, University of Toronto, Child Health Evaluative Sciences
The Hospital for Sick Children
555 University Avenue, Toronto, Ontario
Canada, M5G 1X8

Tel.: +1 416-813-8469
Fax: +1 416-813-8469

E-mail: katherine.boydell@sickkids.ca
URL: http://www.sickkids.ca/


Hodgins, Michael & Boydell, Katherine M. (2013). Interrogating Ourselves: Reflections on Arts-Based Health Research [67 paragraphs]. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 15(1), Art. 10,

Forum Qualitative Sozialforschung / Forum: Qualitative Social Research (FQS)

ISSN 1438-5627

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