In tribute to Luigi Castagnetta-drawings. A narrative approach for children with cancer

In troublesome situations, each of us uses verbal communication carefully, at times diminishing our meaning with words of little significance. However, since the need to communicate remains a part of us, body language or other forms of expression are put into use. Inside a hospital a child is always a stranger with regards to the uneasiness that accompanies his/her experience. Because diagnostic and therapeutic ends are the primary concern of the health care professionals, there is often little sign of affection in their impersonal gestures, glances and body language. Graphic and pictorial communication, therefore, hold great importance for sick children since this is an area they have easier access to, and that they cultivate at school and through play. This activity fulfills their innate need to communicate with themselves and with others. Children express themselves through drawings, using them as a stage to dramatize their needs, wishes anxieties, and joys. When in hospital, children are afraid, and they feel embarrassed around strangers and even parents, especially when the parents are speaking with their caregivers. The children are afraid of making a poor impression and of being rejected by adults, of being considered inadequate and untruthful. Their need for truth and for communication unfolds through artistic expression, and this is the basis of art therapy. The opportunity to express themselves through drawings is what makes the ill child his/her won therapeutic agent through a self-healing mechanism. This may be further guided so as to lead to an increase in self-esteem, which in turn will lead to both enhancement of their full expressive possibilities and to positive feedback of their self-image. In addition to verbal language itself, art therapy is the preferred and ideal means to communicate following the rules of "narrative-based medicine", and to understand children. In this study spontaneous drawings of 50 Italian children affected by leukemia or cancer in different stages were evaluated during 2003 at the outpatient clinic of G. Gaslini Children's Hospital. Ages ranged from 4 to 14 years (median 8 years); 27 were males and 23 females. They drew in three situations: spontaneously when they were alone; with play workers; and with the psychologist. Pictures emerging from these settings have proven to be significant and denote the children's perception of the disease, and of their fears and hopes. The children's drawings allowed them to depict their present and future relationship with the disease, with the hospital, and with the environment in general. Their pictures reflected not only their current state of mind, but also past experiences and future prospects. Art therapy proved to be a vitally important means of "narrative" communication for severely sick children in hospital. Thus, collecting and evaluating drawings in an attempt to establish the intellectual, cultural, and emotional status of each child is of paramount importance. To this end, workers have been trained to carefully observe ech child while drawing. Such extremely important collaboration prevents the loss of relevant and vital details. This research confirms our theory that art therapy has to be included in the total care of a severely ill child while in hospital. Drawings accompanied by comments certainly provide a broader approach to better understanding the child's anxiety and feelings.