Momentum Gains with Small-Scale Studies about the Arts and Mental Health

By Sunil Iyengar
graphic that says Measure for Measure. On the left side of the graphic, there are hatchmarks that suggest bar graphs

One spring day in 1840, on the bank of Goose Pond in Massachusetts—not far from Walden Pond, where Henry David Thoreau would make his stand—Ralph Waldo Emerson and the poet Jones Very were admiring the interplay of wind and water. “I declare this world is so beautiful that I can hardly believe it exists,” Emerson was moved to say. His more empirically-minded companion noted: “See how each wave rises from the midst with an original force, at the same time that it partakes [in] the general movement.”

The exchange appears in Emerson’s journals. It is quoted in God’s Scrivener: The Madness and Meaning of Jones Very, Clark Davis’ biography of the troubled, messianic figure. It may seem improbable, but Very’s remark is an apt metaphor for the constant flow of small-scale studies that attempt to locate specific mental health benefits from arts participation. These studies are as wavelets on a pond. Though small, each study often reflects an original theory or methodological insight, even while partaking of a common narrative about the arts’ potential effects on psychological well-being.

The latest such study (or wavelet) to cross my desk is titled “Impact of Opera on Resilience and Thriving in Serious Mental Illness.” Published in Community Health Journal, the article describes the results from a pilot evaluation study of how audiences responded to a 75-minute opera about recovering from schizophrenia. The performance was preceded by a 45-minute workshop on approaches to recovery and resilience.  

The opera itself was composed by Kenneth Wells, a psychiatrist and the director of the Center for Health Services and Society within UCLA’s Semel Institute for Neuroscience. It was based on The Center Cannot Hold: My Journey through Madness, a 2007 memoir by Elyn Saks, a professor of law, psychology, and psychiatry at University of Southern California. With funding from the Los Angeles County Department of Mental Health, the opera premiered before 117 online attendees and 107 in-person attendees in an auditorium at UCLA’s Semel Institute. 

The pre-opera workshop featured stories by local community members, facilitated dialogues, talks by academic and community partners, and a choral work that was co-created by Wells and a community leader, Loretta Jones. 

Pre- and post-event surveys were conducted with the help of the Arts Impact Measurement System (AIMS), an online assessment tool that has been developed by the NEA Research Lab at UCLA. AIMS includes validated question-items about positive and negative mood affect. The technology permits survey respondents to indicate their mood on a color-gradient by using a mouse or touchscreen. Social connectedness was also measured as a primary outcome.  

Secondary outcome measures included assessing whether the events increased understanding of mental illness and sympathy, and whether it reduced stigma of mental illness, as well as whether audience members improved their willingness to engage with people with mental illness or schizophrenia. In the post-event survey, the researchers also explored how well the opera and workshop communicated the importance of social or family support, of hope for recovery, and of one’s personal journey toward resilience/recovery, among other themes.

Based on these and other data collected from attendees at the opera and workshop, “primary findings on post-pre outcomes are consistent with potential for opera events on true lived experience of serious mental illness to increase positive affect and social connection,” the researchers write, noting also the workshop seemed to have been “more engaging” for healthcare providers or people with “lived experience” of mental illness.

Demographic data suggest that the average age of the pre- and post- survey respondents as in the mid-50s. Half the respondents were White, half were female, and 41 percent were mental health providers.  The authors caution: “While characteristics were similar for persons with only pre- and pre- and post-surveys, findings could reflect selection effects with those with more experience and a tendency for positive reaction to such events to complete both surveys.”

“However, findings could reflect actual impact, and may inform future studies of more general audiences, larger survey samples, and as feasible, comparison conditions such as participation in other types of events,” they conclude. 

Greater statistical power and representativeness, standardization of outcome measures, and appropriate selection of comparison or control groups—all of these challenges are frequently cited as hindering the dramatic scale-up of studies involving arts-based programs or interventions. (Other common pitfalls include the lack of a mechanistic understanding of the intervention being studied, or poor fidelity measures—i.e., tracking whether the program is being implemented exactly as theorized.) 

Still, studies like the one in Community Mental Health Journal hold promise for other researchers seeking to investigate the premise that musical performances—in this case, opera—when coupled with educational efforts, can improve emotional and social well-being and attitudes toward mental health trauma. 

Regarding the mental health of older adults, the National Institutes of Health has produced a Music-Based Intervention Toolkit to assist music/health researchers and practitioners with designing and evaluating therapies and programs that address brain-related disorders of aging. Further, in the March 30, 2024 issue of The Lancet, representatives from NIH, the NEA, and the Kennedy Center—including the soprano Renée Fleming, published “Music and medicine: quickening the tempo of progress.” 

This article reviewed the proceedings of a December 2023 workshop, “Music as Medicine,” and concluded that more transdisciplinary partnerships are needed. Specifically, “a shared lexicon must be cultivated that enables scientists, musicians, music therapists, technologists, and health-care providers to design research projects collaboratively,” we wrote. Embodying this ethos is the Sound Health Network, which the NEA supports at the University of California San Francisco. 

There is plenty of work ahead, to be sure. But the UCLA opera study—like so many small but rigorous studies that have received NEA and/or NIH support—is contributing to a stream of evidence that has picked up velocity in recent years. Even if we lack a single large, prospective study that can establish a causal link between music on mental health outcomes, the pace of learning has been torrential.

Sunil Iyengar directs the Office of Research & Analysis at the National Endowment for the Arts.