Innovative concepts in textiles and fashion for palliative care and therapy

Arts-based therapies have been purported to ameliorate physical and/or psychological symptoms in patients with serious chronic illnesses.

Palliative care improves the quality-of-life (QOL) and well-being of patients (through, for instance a reduction in the burden of symptoms) and of their families, but also benefits health care systems by reducing unnecessary admissions to hospital and use of health care services. Recently, the World Health Organisation (WHO) Executive Board adopted the resolution entitled “Strengthening of palliative care as a component of integrated treatment through the life course”. The document emphasised the need to integrate evidence-based palliative services into the care continuum at all levels of chronic life-threatening conditions, with an emphasis on primary care, and community- and home-based care. A critical component of well-being is having the agency and ability to construct a sense of self through dress, an important aspect of narrative identity. Arts-based therapies have been purported to ameliorate physical and/or psychological symptoms in patients with serious chronic illnesses and research on the potential for arts-based approaches to enhancing palliative care is increasing. Recent studies have examined the potential for art-based therapies such as movement or visual and written expression to promote well-being (Ehresman 2004; Byers 2011; Collier 2011; Cowl and Gaugler 2014).The project discussed in this article focused on creative expression via cloth (textile) and dress (fashion) as the primary integrative modality.

The wearing well-being study, conducted by design researchers at two institutions, facilitated exercises in the agency of identity expression through the co-creation of a unique textile design. The resultant “wearable narrative” functions as a tactile prop and talking point, encouraging conversational and social space. Visually, the repeat-pattern textile exists as a cognitive tool, the implication being that iconography might evoke connections to personal histories and memories.

Figure 1: Dream suits

Rationale and context

Whereas a literature review chronicles written work about a given subject, this project required a different framework. A contextual review extends more broadly to include a critique of other media, interviews, exhibits, and artifacts. The design researchers conducted a contextual review to include creative artifacts, projects, and concepts (linking creative textile practice to broader activities) that might offer insight to guide an exploratory creative study.

Background The original incarnation of this research, known as the Dream Suit Project, was a collaborative textile installation that existed as part of a larger contemporary gallery exhibition of textile practitioners responding to history and place. The installation consisted of exhibited tactile dream suits, photographic documentation, and process documentation of surveys, objects and collages (see Figures 1 and 2). The premise of the collaboration proposed the expressive body as a unique site and inspiration for one of a kind wearable textiles. A qualitative survey consisting of open-ended questions gathered information regarding participant preferences and specific memories related to clothing/cloth. Additionally, the questions served as probes to encourage participants to develop an imaginary narrative:

• If you were an animal/plant what would you be?
• What was your favorite childhood garment?
• Who is your favorite superhero?
• Name five things you love to do but never have the time.

If you could have five other fantasy lives what would they be?

Figure 2: Dream suits

Wearing well-being, the second iteration of this concept, was conducted formally as design research with institutional protocols at two institutions. The design researchers concentrated on developing a design approach (through practice) to assist in structuring and stimulating narratives that bolster the initial 2006 textile installation. Articulated, this approach is based on a problem or question that is derived from practice. A contextual review is conducted.

Practice is the main method of discovery though other appropriate methods may be adopted, adapted or developed. Wearing well-being combines research through practice and co design as theoretical framework. Context mapping was adopted as the method for engaging participants in creative, idea generating activities to help inform the design process. Reflection during practice was recorded and became the data for analysis and interpretation. Artifacts resulting from the practice and analysis of this practice are disseminated via this article.

On well-Being

  To prepare for the proposed design research pilot, it was necessary to understand what is meant by “well-being” from a research perspective, and to identify key indicators of well-being specific to the study population. In existing literature on health-related QOL, well-being measures assess an individual or group’s perceived physical and mental health over time. As a psychological outcome, well-being includes the presence of positive emotions (e.g. contentment or happiness), the absence of negative emotions (e.g. depression or anxiety), satisfaction with life, fulfillment and positive functioning. For the purpose of this study, the design researchers adopted the definition of well-being as fundamentally “judging life positively and feeling good”. Statistical measures such as gross domestic product (GDP) are not sufficiently nuanced; they fail to provide details about the lives, conditions and satisfaction of ordinary people. Measuring subjective well-being (e.g. what people think and feel about the quality of their relationships, positive emotions, resilience, realization of potential and satisfaction with life) is an established area of research. While not covered in great detail in this article, the design researchers note the importance of research that advances our knowledge of well-being.

Well-being in aging adults

The connection between physical health and psychological wellbeing becomes more important as people age. Research suggests that psychological well-being may even be a protective factor in health, reducing the risk of chronic physical illness and promoting longevity.

To better determine key indicators of well-being for the study population, design researchers conducted a keyword search. Keyword research is used to find and research alternative search terms that people enter into search engines while looking for a similar subject. Primary keywords included the terms “happiness” and “wellbeing.” We expanded the keyword search using the terms “aging,” “creativity” and “textile.” Information was accessed from publicly available data sources such as the U.S. Census Bureau, health data.- gov, The Office of National Statistics, the Bureau of Labor Statistics and Centers for Disease Control and Prevention (CDC). Globally focused sources, including the World Health Organization and European Social Survey, were also explored. Indicators of well-being for aging adults (over 65) include material conditions, social and family relationships, social roles and activities, all of which are factors that change with age [12-14]. Indicate that psychological well-being and health are closely related. Research further indicates that psychological well-being should be addressed as a valuation of health and considered in health care resource allocation.

Fashion design and well-being

Fashion is a highly visual form of personal expression. Through garments, individuals can express their values, interests and identities. William James linked fashion and well-being together in 1890; he understood that clothing, as an expressive extension of the wearer, could promote psychological fulfillment. James believed clothing to be an essential part of the material self. As shelter and clothing, textile products play a vital role in meeting basic human needs. Beyond function, the wearer of clothing makes aesthetic decisions regarding the clothing he or she wears in terms of what the wearer views as beautiful. By imbuing powers of expression and beauty into the functional soft architecture that protects us, clothing becomes a signifier capable of generating or promoting happiness, health and comfort. Who we are (or hope to be) can be expressed and (we posit) well-being can be evoked through what we wear.

Arts-based approach to therapy

Engagement with artistic activities, either as an observer of the creative efforts of others or as an initiator of one’s own creative efforts, can enhance one’s moods, emotions, and other psychological states, as well as have a salient impact on important physiological parameters. The term “arts” refers not only to artistic activities, but also to creative activities, such as literature, rituals, oral histories, storytelling, etc. Creative artistic expression generally discussed in literature, organises “arts-based therapy” into the genres of music engagement, visual arts, movement-based creative expression and expressive writing. Video-documents strategies have been undertaken through art and other creative therapies to encourage positive outcomes affecting the behavioral and psychological symptoms of elders with dementia. The importance of utilising narratives and expressive arts to create meaningful connections in palliative care has been stressed; they state that “Given the proper conditions, the telling of the story through words, visual images, bodily gestures, musical rhythms, or dramatic enactment can support the experience of a world of meaning that revitalizes our connections with self and others.”

Textile-based therapy

Creative arts-based methodologies focusing on textiles as the primary mode of expression (within public health, psychotherapy and art therapy literature) organize “textile” under the umbrella of visual arts methods, and discuss it alongside expressions such as “card making”. In the field of contemporary textile/fiber art, themes of “health”, “textiles” and “well-being” are central to many socially engaged projects that use the social space created by the act of making as a space for healing. Within these projects, social and tactile fabrics are constructed, both literally and metaphorically. The meanings of textile art-making for people living with long-term illnesses has been reviewed, a key finding reveals that textile-based therapy facilitates social contact, catalyzing mutual social contact as well as fostering connectedness with the outside environment (in all its social, physical, and spiritual aspects). Moreover, social connections were valued for being on equal status terms rather than implying dependency, or care-giving.

Distinctive phenomenological features of textile art have been cited; the rich traditions and inherent conviviality of collective making within the practice of textiles can be seen as beneficial intervention.

Threads and yarns

Intergenerational engagement and cross-disciplinary research through textiles, involved making fabric flowers while participants shared their personal experiences of health and well-being.

In doing so, they explored changes to many areas of public health. These testimonies were interpreted by medical design researchers and public health historians, who subsequently communicated their insights at the Thread and Yarns public engagement event discusses the vital role “textile crafting” plays in terms of creative engagement, mental and physical stimulation, social interaction, self-esteem and therefore, positive well-being in aging populations.

Identity expression through dress/the agency of dressing

Dressing is our most immediate daily interaction as wearers of clothing. The “dress” that individuals wear can be defined as an assemblage of modifications of the body and/or supplements to the body. Psychologically, clothing is the wearers’ pliable context, a tangible imprint of individual and relational identities. The social and psychological aspects of dress are a robust area of research. We touch on this area of research briefly in order to better provide context for our design concept. The agency to dress oneself and thereby express and construct identity through clothing and other adornments is taken for granted by wearers of clothing who are ablest. The fashion system perennially targets a youthful market. Older people have been largely absent from fashion studies which, reflecting the values of the fashionable world, has focused its gaze on the young, subversive and transgressive. While dress studies historically have focused on youth, a growing body of research explores the intersection between aging, the body and dress, and the role of dress in the constitution of age. The prolific Dementia and Dress study sought to further explore the implications of dress for embodied identity, as well as the concept that clothing might trigger memories for people with dementia “as they are touched, held and worn.” The study explored creative visual, sensory methods such as “wardrobe interviews” and “Reminiscence Theater” to access “distinctive phenomenological features” and clothing in the enactment of memories, in order to better understand the experiences of people with dementia.

Wearable narrative

The desire to express one’s identity and the subjective experiences of appearance do not lessen with age. The passage from a study captures the phenomenological power of dress harnessed as a tool and beneficial intervention: Aging adults retain a personal “set of rules” regarding dress – a sense of the colors, styles, and textures which constitute their “personal aesthetic.” A critical component of well-being is having the agency and ability to construct a sense of self through dress, an important aspect of narrative identity. Items of dress such as rings, necklaces, or cufflinks could embody memories of people or significant transitions, evoked through touching or holding. In this context, handbags could act as “identity kits,” containing items relating to the owner’s identity and personal history. For instance, Marie’s handbag contained a pair of ballet slippers; a gold locket containing a picture of her parents; and an army cap badge belonging to her Uncle. It is suggested that clothing is imbued with memories, intertwined with our histories and identities, and interwoven into the fabric of our lives. In the study reported through this article, each wearable narrative consisted of a unique co-created textile design. The iconography of the print was derived through the co-design process.

The wearing well-being study facilitated exercises in the agency of identity expression, of which the “wearable narrative” is an artifact. Both process and artifact offer an opportunity for broader life-narratives in care settings, evoking memories of relationships, past identities and life-events. Akin to the above “identity kit” handbag scenario, the wearable narrative functions as a tactile prop with a series of visual talking points, so that iconography might promote (and over time evoke, recall and unveil) connections to personal histories and memories.

References

• World Health Organization (WHO). 2014 “Strengthening of Palliative Care as a Component of Integrated Treatment throughout the Life Course,” Journal of Pain & Palliative Care Pharmacotherapy, 28(2), 130–134, World Health Organization (WHO). 2017 “WHO j Dementia.” Available online at: http://www.who.int/mediacentre/factsheets/fs362/en/
• National Institutes of Health (NIH). 2014. “PAR-14-294: Arts-Based Approaches in Palliative Care for Symptom Management (R01).” Available online at: https://grants.nih.gov/grants/guide/pa-files/..
• Ehresman, C. 2004. “From Rendering to Remembering: Art Therapy for People with Alzheimer’s Disease,” International Journal of Art Therapy, 19(1): 43–51.
• Byers, A. 2011. “Visual Aesthetics in Dementia,” International Journal of Art Therapy, 16(2): 81–89.
• Cowl, A. L. and Gaugler, J. 2014. “Efficacy of Creative Arts Therapy in Treatment of Alzheimer’s Disease and Dementia: A Systematic Literature Review,” Activities, Adaptation & Aging, 38(4): 281–330.
• Bye, E. 2010. “A Direction for Clothing and Textile Design Research,” Clothing and Textiles Research Journal, 28(3): 205–217.
• Cobb, K. and Smull, M. 2006. Dream Suit Project. Philadelphia: Coral Street Arts House.
• Schifferstein, H.N.J. and Visser, F. 2013. “Designing for User Experiences in Specific Contexts: Contributions from Context Mapping”. Advanced Design Methods for Successful Innovation, 78–93.
• Centers for Disease Control and Prevention (CDC). 2016. “Well Being Concepts.” Available online at: https://www.cdc.gov/hrqol/wellbeing.
• Steptoe, A., Deaton, A. and Stone, A. 2015. “Subjective Wellbeing, Health, and Ageing,” Lancet, 385(9968): 640–648.

About the authors:

• Dr.N.Gokarneshanis from the Department of Textile Chemistry, SSM College of Engineering, Komarapalayam, Tamil Nadu.
• M Sakthivel is from the Department of Textile Technology, KSR Institute of Technology, Tiruchengode, Tamil Nadu.
• K Velumani, M Manoj Prabagar, N Saravanan, and V Tamilanbanare from the Department of Textile Technology, SSM College of Engineering, Komarapalayam, Tamil Nadu.
• Sona M Anton and Z Shahnawazare from Department of Fashion Design and Arts, Hindustan Institute of Technology and Science, Chennai, Tamil Nadu.
• B Padma and R Hari Priya are from the Department of Costume Design and Fashion, Dr SNS Rajalakshmi College of Arts and Science, Coimbatore, Tamil Nadu.