Narrative Medicine in Action Series: The Artistry of Medicine with Hisla Bates

Opening on art, flow, and Dr. Talks 0:00

It allows our mind to rest and it allows us to be creative. And as you know, some of the psychologists that Mihaly Csikszentmihalyi has written about flow and the more states of flow we have, the greater joy we may feel and happiness. And that's why art is so important because it can bring joy and it allows our mind to wander a little bit and just relax. Welcome to Dr. Talks. The podcast where every episode leads to a healthier you. Join us as we navigate the world of optimal health, uncovering groundbreaking strategies to conquer chronic disease.

In each episode, we'll bring you the latest insights from leading health experts, medical innovators, and wellness warriors. If you're seeking to transform your health journey, or if you're looking for answers to burning questions, you've come to the right place. Get ready to unlock the secrets of lifelong health and vitality. This is Doctor Talks. Real talk from real doctors on the issues that matter to you most. Welcome to the To Curious MD podcast, where we ask those unasked questions in ketamine treatment, psychedelic treatment, and narrative medicine, and bringing in all elements of what heals in this space in our health system.

Introducing Curious MD and Hisla Bates 1:14

And this is the kind of the platform where we meet with other expertise, patients, their stories, and really engage in that space of learning and being curious to the things that we experience in healthcare. So we are happy to have Hisla Bates with us today. Hisla, would you give us a little bit of an intro about yourself and the work and what brings you to the work that you do and how you got to that place. Yeah, I always, I never know where to start with this. I'll start where I am right now and that is in private practice.

I have a psychiatry practice where I see adults and teens and I also do art assisted therapy. I started the doctor's art school where physicians can come and where we are creating community to use expressive arts, narrative medicine, graphic medicine, and so on. And that's my way of helping physicians heal from burnout. very interested in the whole burnout situation that's affecting a lot of us. And I feel like if I can help one physician, I can help many patients because if our physicians aren't well, then healing becomes very difficult for our patients.

And so that's kind of my mission. I started out as a fashion designer. I got pushed into fashion design by my art teachers in high school when I was pretty determined to go to medical school. But I got talked out of it when I took a summer course at Parsons School of Design and realized that there was a whole other world that I didn't even know existed. I never knew existed. And I decided, OK, I think I'll try this thing. So I went to Parsons and graduated. But then I still had this yearning to be a doctor.

I really wanted to help people and it was this altruistic yearning that got me to go back to school and do all of the pre medical requirements and so on and go on to medical school.

From fashion design to psychiatry 3:26

That's been my journey trained. I trained at Yale for my internship and. ophthalmology. I did a year of ophthalmology and then went to Mount Sinai for general psych and Harvard for my child and adolescent psychiatry fellowship. And I've been at this for probably 20 something years. Yeah, 25 years. So wonderful to meet you, Lisa. Nice to meet you both. This, the part of the story where, you know, my kind of interest was like, you got talked out of medical school to go to art school, to go to fashion school.

I love that. Yeah, my teachers were trying to get me to go to the High School of Art and Design. So this started early on. And I said, no, absolutely not. I want to go to an academic high school because I want to go to medical school. And then I get to high school and I get the same thing. My high school teacher is saying, you absolutely have to go to art school. And I said, no, I want to be a doctor. I love chemistry. I love math. And she said, OK, just go to Parsons for the summer. just do it.

And so she convinced me and I went and it kind of changed the trajectory for sure. Yeah. And I'm curious about how I'm even just imagining a reality in which we have so many intelligences, right? We have so many different kinds of intelligence. Right. And because of being caught in this duality of between art and science, one part of you had to wait to be fulfilled, right, until the other part was. But we can imagine a reality in which both those things can coexist and work together and grow together, right?

Like, isn't that how we're supposed to? So it just brings me to the fact of where we have divisions that can create such just just choices, right? And sometimes we label ourselves this, oh, I'm this kind of person. So I can't do that. And how concreted that becomes into identity. But here you were kind of like being able to lightly step between those two sides. And what was that like? Like, did you have mentors at the time? Or did you have your own personal way of you know, making sure that the creative mind was fed while you were in medicine and the kind of sciency mind was fed while it was in the arts.

How did you navigate that? Well, I was pretty focused when I was in, you know, when I was in art school. You had to be, you know, there were 75 of us that were admitted that year and only 25 of us graduated. Pretty intense, high attrition rate. In some ways, I didn't really think about science, but I met a young woman who was changing careers. And she was about 28 years old. And she said, oh, I was in corporate. She was doing something in, you know, business of some kind. And she said, I'm going to medical school.

And all of a sudden I thought, oh, wow, you could actually do that. You could. You could go to medical school after doing something completely different. Once I discovered that, I was thinking, okay, maybe I ought to try this. And so that's how I got back on board. I also saw a documentary of these people who lived in the southern parts of the United States who were very poor and they had no medical care at all. And most of them were people of color. And I thought, you know, If I have any ability at all to make a difference, I think I need to, I need to at least try.

And at the time I had a boyfriend who was a philosopher, mathematician and a playwright. And he said, just go for it, you know, and I'll tutor you in physics or math or whatever, you know.

Why art and medicine belong together 7:18

And so he really helped me. along the way and encouraged me to just go for it. It wasn't an easy decision, especially because I was probably about 28 at the time when I started, 29 when I started medical school. So yeah. I want to ask what was more difficult, art school or medical school? Because what you described about Parsons seems like it was really high pressure. because you know you have to meet deadlines and you have to produce a lot of work and at the time I was in the fashion design department so and I was also commuting like an hour each way which was not easy and there were very strict rules at the time we couldn't wear pants we couldn't wear pants or jeans we had to dress you know, a certain way every day.

It was very strict and it was Anne Kagee was the chair of the department and it was as if it were the 19th all over again. And we had to not only illustrate, I mean, you have to learn how to draw and illustrate fashion and clothing. You had to do textile design. You then had to drape the garments, make the patterns, create the outfits. There were fashion shows and competitions and You know, so it was, it was a lot of work and, um, an amazing experience. I have no regrets of doing that first. Yeah.

I was going to say the same thing. I'm like, that sounds like you learn about teamwork and how to work long, hard hours at a project and kind of have a vision, but also know how to make compromises, right? How to kind of like, yeah, get reviewed and get crushed and come back again and do it better. Like the resilience of that. That's amazing. It's so also there is something called design thinking where you you get one outfit Let's say I take one outfit and then we had to create 50 different outfits from that one outfit So, you know you change the neckline you change the sleeve length you change the cuff that helps you to really think creatively and to think quickly so you're you're always thinking about what this could be.

So when you look at anything and I do the same thing, whatever I'm faced with, whatever problem I'm faced with, I think about multiple ways in which that problem could be remedied or changed in some way. That's the creative mind. I'm going to ask you a question. I think it goes back to kind of learning and how we learn and the framework that we you know we lay down as we start that learning experience from childhood all the way through adulthood and even later in life right and I can resonate with your story very well because I said I was an engineer before I was a doctor and I had no plans of being a med doctor at all just to do research stick to the plan and figure out this stuff was not for me I know I was like no way and and coming around And seeing the human body as a machine is an incredible, fascinating, like what, you know, from that vantage point to this day lives with me.

Like I look at the, you know, now studying the human brain and saying, my God, you can map out the way of thinking. Like you can, your thoughts are mappable. There's a communication network. I mean, and seeing it from that vantage point. But I think what my question is, is. the integration of how we learn and what your thoughts are on why do we have to separate it all out? Why is that necessary? Why is math a math topic? Why is physics a physics? Why isn't it about learning about how a flower grows and seeing it in that way, the colors, the textures, the fluid mechanics, the chlorophyll, the photosynthesis?

How can we not See it in that way. What are your thoughts on how we learn and. Now, and how we're learning that question. Well, I think that it all comes down to what we value. We've, you know, we're a society in general that values math and science above the arts and. And we need both, and we need the integration of all of the topics. And it's the same thing that's true with medicine. We separate different parts of the body. I did ophthalmology, but I could have been a cornea specialist, a retina, anterior chamber, neuroophthalmology.

There are seven different types of ophthalmologists for one body part, which the eye is a pretty incredible organ. We also separate the bones. I mean, there's a hand doctor and a foot doctor and a knee doctor. And so why is medicine so separate? That is my question.

Childhood creativity and the loss of imagination 12:22

And why are we not thinking in terms of integrating the mind and the body? And why is psychiatry off here and addictions here? And addiction and psychiatry are separate as well. You know, it may make some people's lives easier to focus only on one thing, but it makes our lives richer to focus and integrate all of these things. And I'm not sure why that is. I think other cultures are probably better on integrating both, but I think the value is placed on math and science and what we can explain, although I don't think we know the answers most of the time.

And I think it really brings up the question of education as it is even now. I would even say it's kind of global. The ways of learning have become very global and there may be some places that have held. to the experience of learning in this very imaginative way and kept that imaginative mind available and not discredited. You know, the child that I was reading about, the perfect age of learning, the perfect age of the human being is age six. You know, that's the perfect age. They have a sense of dignity.

They have that still, that curiosity. They have a sense of spirituality. They have emotional and they're so They're so aware and, you know, that four to six, I would say that magical thinking that's such a beautiful age. And what happens to it? Where does it go? And, you know, as soon as they enter school, everything changes. Yeah, I think around the age of eight or so that's, you know, and Picasso said, you know, every child is born an artist, but somehow that just disappears. And I think it's when we start to compare ourselves and judgment creeps in that person does it better than I do.

So I'm, I'm not good at it. And then we decide not to take that risk anymore. And it's part of that industrialized education system is what's created that because that's there's no purpose to that. It doesn't help us learn better. Actually, judging, pairing, grading constantly is a way of shutting down creativity and even that learning impulse. So, absolutely. You were told to be an artist and You know, you were really guided in that path. People saw things in me that I didn't, you know. I mean, I always like to draw and color.

As a young child, that is something I did a lot on my own. I was kind of an only child, so that's what I did. You know, I would get these coloring books from America with my 64. Crayola crayons and the 140 where you had 3 shades, 10 shades of pink and midnight blue. You know, my roommate, she had it. Her parents sent her box of I was fascinated colors to. The whole thing. Yeah. We are talking about the ability to lose yourself in hours and hours with absolutely no expectation other than to just have, you know, do what you want to absolutely want.

And if you love colors and if you love solitude and just that way in which communion, right? You're really in communion with yourself. Yeah, absolutely. Right? You're playing. You're not planning. There's no like, oh, I'm going to draw a red heart. No. Yeah. I mean, you get into a state of flow, you know, and that state of flow is really, it's important. It allows our mind to rest and it allows us to be creative. And as you know, some of the psychologists that Mihaly Csikszentmihalyi has written about flow and the more states of flow we have, the greater joy we may feel and happiness and that's why art is so important because it can bring joy and it allows our mind to wander a little bit and just relax.

In your school, what do you learn about the people that come, the doctors in your program, what changes as they kind of learn this way of expression? Well, I am really working with the first cohort right now and we're in week two. Okay, week two. We're pretty early on and For our last session, because, you know, we talk about our first session, we talked about the disconnect between the mind and

Doctors Art School and expressive healing 16:48

the body and how a lot of us have shut down ourselves and are disconnected. And in medical school, how we're taught to not go to the bathroom when we need to and to just keep working. You're in a 12 hour surgery, you're not going to move. You're not going to go anywhere. You're not going to eat. We grab a donut and we don't drink enough water and we don't take care of ourselves because the patient comes first. And that leads to our being very disconnected from our bodies and we don't listen to our bodies anymore.

And so I ask people to draw what that disconnect looks like. Is your head separate from your body and what is your head saying to your body? Um, you know, my body was saying, you don't exercise me enough, you know, you need to, to move. I need, you need to move more or whatever. And what's my head saying? I don't have time. I don't feel like going to the gym. I don't feel like walking. I don't feel like putting on a heavy coat. You know, we make all these excuses. And so how can we merge those two?

So the Doctors Art School, I mean, a lot of the stuff comes out of my head. You know, how do I create these concepts visually? And how can others create these stories visually? And graphic medicine is also a movement where people are expressing themselves through cartoons to talk about illness, to talk about mental health, or experience being a resident or a medical student using cartoons. And so I'm bringing in poetry, literature, narrative medicine, and visual storytelling and merging them in this concept of the Doctors Art School.

I am hoping that more doctors will be open to it because the basic reason for this is really about forming community and forming a safe place where we can actually not only talk, but draw together. And the very last session I did with them, you know, the people who were drawing stick figures, I showed them how you can actually do facial expressions and draw a face and and draw a body instead of a stick figure and that was for one person who had never drawn before that was a revelation. It's like I didn't I didn't think I could draw something and now I can.

So you're moving from a very fixed mindset to a growth mindset where you're just expanding your mind You're expanding your ability, expanding your imagination and really learning to create and think differently. So that's, that's, you know, that's what I'm hoping they'll get out of it. That's amazing. I want to go there. I love that because the visual metaphor, right? I really think what we're doing here is, is yeah, like just capability, just connection, and then expressing those things that are just hard to express being at that edge.

And you're really playing with neuroplasticity. I love how you brought up growth mindset. mindset as well. Yeah, we get into fixed mindset. The only way to get out of that is to like, yeah, challenge yourself. Yeah. Get uncomfortable going. Yeah. My drawing's not very good. Nobody says, I mean, there's always going to be somebody better than you. Um, you know, uh, I strive to be better. I'm, you know, I'm not the greatest either, but that's not the purpose of it. The purpose is really the experience of it all.

Yeah. Somehow in middle school, because I'm a medical educator as well, and the middle school had started to talk about growth mindset and fixed mindset and this ability to fail, right, that needed to happen and normalizing it. So there were these teachers who were talking about it. Meanwhile, you know, and this is how both hands don't talk to each other, you know, then they're bringing in into K through 12, like all of this evaluation is constant testing and everything. And so, yeah. We need to learn that, but unfortunately it's going to put you in fixed mindset.

You know, if you're constantly just, just testing, testing, testing. And, and I, and I was very kind of, um, and looking at that in medicine where fear of failure is really baked into our training, right? Like the judgment is huge. Yeah, I always say, you know, when you're staring at a blank canvas or a blank page, that you're facing uncertainty every time. And no matter what we imagine our drawing to look like when we're finished, it never looks that way. So there has to be an acceptance of imperfection, an acceptance that things are not always going to turn out the way you want them to.

So drawing and art becomes a metaphor for life. It's interesting, both Andrea and my daughter are also artists and went to art school, got into Parsons and I, my daughter, but she didn't go because I was like, well, you need to go to four-year college, which I, which I regret because she really is an artist and she's that artist that still feels her work is incomplete and never signs her work. And I'm always like, why didn't you sign your work? It's never complete, right? That's what she says. It's just not complete.

It's just not there. It's. what maybe, like you said, she imagined. And I think we do this talk, you know, this is our self-talk of ourselves and how we see ourselves in what we express, which I find is kind of a place of, I mean, maybe a place to kind of open up and say, hey, what's with that? And like with your students as they come in, you know, what is it about what they express even that shows up that they weren't, they didn't see or somebody else sees and there's a perception. of what's shared on that page.

And I find that that's a beautiful place. I love that we used to do this, used to take, this is how I got into arts and art and medicine was as a medical educator taking on a medical humanities course to design it, you know, this kind of observation exercise that we would go to the modern art museum and, you know,

Observation, self-care, and art as medicine 22:48

and have these exercises where you're standing around a piece of modern art and all of us are just standing there and looking at it and interpreting, right? Just that act of interpretation. And how much that is exactly what we're doing in the hospital, right? Around a bedside, around a case, there is an uncertain, there's a pattern that's emerging and everybody has a piece of it. So it became a great way to kind of teach about ambiguity, about respecting each other's perspectives and opinions and really recognizing like what we bring to the interaction is what we're going to see also, right?

So there's just this idea that when we're looking at a patient and, you know, in the Western materialist mindset where we say, this is that and nothing else, we've just shut that story down. And, you know, when let's say we have conflict around a certain story in the Western medical model, There's always this kind of competition amongst who's right. The dialogue is really about, well, who's accurate, who's right. And instead of saying, well, this is a complex situation, there's multiple perspectives, including the patient's perspective.

In the Western medical model, what we've done is just objectified the patient and everybody's standing around opining versus what's the patient's perspective and how can we hold that. Just art even as a teaching tool for these observation exercises, for these ways of looking and these qualities that you want to cultivate in just the practice of medicine to me seems like a very untapped resource. Yeah, I don't know if you could speak to that. There are programs at Harvard and Yale have had for a long time based on observation going to art museums and so on, and it is very helpful.

Research shows that the ones who did the observation but also took an art course were better diagnosticians and And so the observation is important because I think it makes you a better physician. We have to observe and notice subtle changes. And I think because I draw, I notice subtlety. I notice every little change, every asymmetry in a face or body, the way people stand or walk. Because if you have to draw something, you notice it in a way that you didn't before. An apple. You'll never look at an apple the same way.

If you try to draw it, you'll notice it has 20 colors and it's got bumps and grooves. And yeah, so you have a greater appreciation. It's a meditative process. I love that. And, you know, we're going back to even medical training, right? Where when we first learn to take care of our patients, observation is the first piece that we're taught, right? It's just even as you enter the room, just take it all in, right? And the more you can be silent and silence your own self, You can be more open to what's there instead of trying to figure out or label it or come in with preconceived notions even, right?

Like how many times have we done that? You know, it's easy to get into that. It's like, oh, I read the chart. I know what to expect. There's going to be a five minute visit and you walk in and you're like, wait a second, something's off. Let me see what it is. And then you just kind of get silent. And there is a moment of where observation and developing that observation capacity. So I'm really excited for Doctors' Art School to even just kind of bring people to recognize that we have this innate observation capacity that we can cultivate, right?

Like, that's what we're talking about here. That's beautiful. I also think it's self-care too. It's really taking care of yourself and noticing yourself and getting outside of your comfort zone a little bit and connecting with people. The way I was able to get back into the arts, because I completely dismissed it in order to get through medical school and residency and being an attending and a parent, I thought I have no time, I can't do this and I started buying art instead of making art and I discovered this community in my neighborhood where there were 10 artists that would get together once a week and I joined this group and once a week, for most weeks, I couldn't do it every week, I took the two or three hours and started creating art and it was all new for me but it changed my life, you know, and I realized this is what was missing.

This was what was missing. I was pretty miserable and unhappy. I love that because when you kind of do that, when you kind of abandon part, a part of yourself, you're kind of testing it too. Cause does it call me back? Yelling. It was like, do this. It was such a strong yearning. I mean, I was, you know, I always give this example. Notice that yell. I mean, what was it that it was yelling? We're like, I was, I was in Arizona at the time and I was buying art of this artist that whose name slips my mind right now, but she painted these red dogs and I thought, wow, those are so cool.

And, and then she did this motif for houses and I have this. I don't know. I love real estate. I love houses and the house motif is something that I really like. So it's this really large painting that she'd done. And it was this house motif, multiple houses on it. And I loved it, wanted to buy it. It was $10,000. And my daughter who's nine years old said, mom, I think you can do that. But she's like, don't buy it. I think painted and so I literally went home and I made a smaller version of it and and I could I could paint it and so that I started thinking about maybe I should do this, but I didn't know how I would get started or anything.

And then someone told me about this group and it was in Brookline, Massachusetts. And one thing led to another. I started printmaking. I knew nothing about printmaking. And that's what they did in the group and painting with oils. I didn't even know how to mix the paints. You know, it was all new to me. And then I started showing my work and selling my work and entering juried shows and showing in galleries. I mean, it was just like I just started Hey, well, I'm going to try. I'm going to try this.

So there's a jury show. Yeah, I'm going to sign up. I'm going to go. And I don't know. It just, it was when I started talking to people about my work, I realized, wow, this is powerful stuff because you can communicate. I did this triptych about Valley fever.

Single stories, perspective, and closing reflections 29:28

And people would ask me about these tryptic, which are just three self-portraits that I did in a row when I had Valley Fever. And people would talk to me and I would be able to educate them around Valley Fever. And I thought, wow, this art thing could be a real educational tool. It helps me to communicate and meet people. And people are buying my work because they're emotionally moved by it. And then when you sell it, it's like, that feels really good. So I started to feel really good. And there's a German couple who came in and wanted to buy a piece of mine and they couldn't afford it.

It was this bridge behind me. It was a smaller version of it. And so I gave it to them and I said, just pay it forward. Six years later, they DMed me and they said, we still have your painting. It's in our living room. We're living, you know, we're in Germany. We want to pay it forward. What charity do you want me to, us to donate to? That was like six years later. I mean, when you can connect with someone in that way, it's powerful. So that's what I want to share with others. Oh, wow. That's medicine.

That's medicine, right? That's your. to something that has carried so much weight and connection in so many different ways. We can't even see it at the time until we do. And it's a connection to the heart. I really think these images, when we resonate with an image. It's like you're being pulled to it and there's something in it for you. And I love that about art to be something that you can relate to over time. And as you change, it changes for you, right? So it's not just a thing. It's actually a relationship and it's beautiful.

And it's no accident that the word art is in the word heart. There's no such thing as nexus. I love that. Things are not by chance. I think I would also highlight what you said, Saraya, about, I know you've said this before, the danger of a single story, right? When we see art and even writings and the danger of really seeing it in one way. and how that takes away from the experience. But what I brings up my curious mind is, well, if everything is a different version of the same thing, then what is it the thing that we're, you know, I mean, like, if you watch movies and Rashomon, I think is the movie that talks about the scene and it's seen, it's a Japanese movie and there's a death or the murder in the forest.

And there's all these different witnesses, but they present their story of what was observed and it's all different. The story is different seven ways. So what's the real story? What really does happen? You know, so give us to that element of how we co-create our reality, right? Yeah, I mean, it's like what is reality? It's very personal. Yeah, and even in medicine, we kind of we kind of We tell the story of the patient, we think we know that story and we don't. And what is the real story from all the different versions of that experience?

Yeah, and the same thing, you know, when it comes to art, I mean, I might draw a flower and you'll draw the same flower and it'll look completely different. And it's what we see. Yeah. And how like that training can be so helpful when we're training in medicine to not get stuck on your own ideas and your own biases. I remember, and we'll wrap up soon, but I remember a chief resident of ours getting everybody to, you know, he was describing a picture, but, you know, he was just describing it to everybody in the room and everybody drew their version of it.

And just that awareness that we all have of our perceptive lenses being so different that we've got to investigate them. We've got to become familiar with them and we've got to also be able to have the ability to share them. And the visual arts are so powerful for that. Well, this has been an absolute treat, Isla. Thank you so, so much for the deep dive into medicine and art and the heart and just the journeys of being physicians. I feel like we, in today's session, today's conversation, we expanded what it means to be a physician in society when you really try to imagine the full scope of what that looks like.

and how beautiful and well thought out it can be. I really am brought to this idea that we create the beauty that we want to see in the world and we do it with this kind of love and intelligence that I think we've had on display here today. So thank you so, so much for this lovely conversation. Well, thank you so much for having me. I appreciate all of the unasked questions about things that are happening in healthcare that you feel could be different. There's a lot in healthcare. I feel could be different.

I feel very strongly about the doctor patient relationship and how we can improve that. I'm very passionate about that as well, because, you know, I'm not loving the direction that things are going in. Yeah, and, you know, I think we're losing the humanity in medicine. And that's also why I do what I do is because I do think it brings back the humanity that's missing and what you do as well, you know, with writing and. It's so important that we connect as human beings, because one day we'll all be patients.

And, you know, it's, yeah, it's just something we need to pay attention to how we treat other people. That's so true. Absolutely. I think for the for the doctor, it's always hardest to be the patient. And I've been the patient as we probably all have been a patient in some form or fashion. Yeah, the things in that What we can learn from patients to in their creative expressions. Yeah, they're just like us and being still black humor just to get the day dark medical humor to get it going. Yeah. Lovely to be in the trenches.

Looking forward to meeting you both as well. Thank you so much. Thank you for tuning into Dr. Talks. We hope today's episode has enlightened and inspired you on your path to optimal health. Each day is a new opportunity to make choices that empower your well-being. For more insights and strategies, subscribe to our podcast and visit our website, www.DrTalks.com. Stay connected, stay healthy, and join us next time on real doctors on the issues that matter to you most.