A picture is worth a thousand words

In 1911 Arthur Brisbane, editor of the New York Evening Journal, advised members of the Syracuse Advertising Men's Club to ‘Use a picture. It's worth a thousand words’. That is certainly true of this issue's disquieting cover picture ‘Child's drawing coded as showing bizarreness’, accompanying the article which is my Editor's pick below.

A strong visual style has been a feature of Advances from its inception. Coloured headings, boxes and tables have been used to break up the text and highlight key points. The aim in this is not only to improve readability but also to support learning. Diagrams in particular are a powerful way of conveying complex information in succinct and memorable ways.

In this issue, a good illustration of the effective use of diagrams appears in the discussion of bulimia nervosa and other binge eating disorders by Zafra Cooper & Christopher Fairburn (pp. 129–136). Their Fig. 1 shows the binge eating record of a patient with bulimia nervosa; Fig. 2 shows diagnostic overlaps and boundaries in a schematic way that is both concise and easily remembered; Fig. 3 shows the surprising (to me) relative prevalences of eating disorders in out-patient samples, with such a large proportion receiving the DSM–IV diagnosis ‘eating disorder, not otherwise specified’ and only relatively few being diagnosed with anorexia nervosa; Fig. 4 shows a diagnostic formulation. Another formulation appears in Catriona Kent & Graham McMillan's article on a cognitive–behavioural approach to treating medically unexplained symptoms (pp. 146–151). Many clinicians will be familiar with Chris Williams' Five Areas assessment model for CBT: their Fig. 1 shows a completed Five Areas template resulting from a collaborative therapeutic approach between patient and clinician.

Form and mental state

This month's front cover image is one of four pictures drawn by children that illustrate Jonathan Green's article on the embodiment of states of mind in paintings and other visual art (pp. 137–145). All four are arresting images but it is ‘The gates of Buckingham Palace’ (Fig. 10) that has stayed with me. Drawn by a 10-year-old boy with autism, it expresses something of the qualitative impairments of that condition in a way that is beyond the gift of even a thousand words.

Might studying a painting be the same sort of intimate and personal process as discerning a mental state? Could the forming of a relationship be at the heart of both? Is it possible that engaging with art is good for both our continuing personal and continuing professional development? In his review of the first draft of this article, Jeremy Holmes (no mean author himself) stated ‘This is a magnificent paper that engaged and delighted this reviewer – indeed producing the very responses that the article discusses. Essentially it brings a relational perspective to bear on making, and responding to, artworks’. In discussing mental states, empathy, intuition, interpersonal relationships and cultural awareness, Jonathan Green underlines the value of including the arts and humanities in medical education.