Psychotherapy, creative process, and liminality are concepts shared between different fields of art, science, and creativity [1]. Conceived by different fields, applied to different areas, but when interweaved and applied together, they create Art Psychotherapy. This article reflects on the use of art throughout history, of the way in which it is made accessible as a therapeutic agent, the dominant history of its emergence, as well as its alternative history in Latin America.

Art and its meaning in history

One of the main characteristics of all societies is the use of art. The universality of making, and enjoying making art, immediately suggests the importance and need it has had to the human being (Dissanayake, E., 1995), providing a sense of meaning and signifier (Riveros Aedo, E., 2013), or of intensity to human life that cannot be obtained in any other way. Making art has been a response to man's first experiences of existentialism for more than 500,000 years (Haslam, 2011).

The paleolithic human experience allowed a greater temporal, emotional, and cognitive awareness that probably cemented a path for early humans to develop the idea of spirit or soul. It functioned as a biopsychosocial feedback system that allowed to conceptualize themselves as independent of their bodies and begin to question different conditions of life and death, nature processes, creativity, and art as a tool for survival, since then to the present day (Elkins, 2002).

From Ellen Dissanayake's (1995) conceptualization, we understand the arts as a cultural phenomenon: we expect that their manifestations vary from one culture to another and that certain individual art forms, as well as attitudes towards art, are found in some societies and not in others. 

The understanding of the arts has varied over time, with the fine arts playing a significant role for a long period, excluding artistic representations that the Anglo-Saxon Western world did not comprise. In recent years, a revealing and growing movement has criticized the traditional Western interpretation of art and culture as having a Eurocentric bias, which implies neglect and outright oppression of non-Western cultures (Dissanayake, E., 1995).

Seeking discrepant views of history allows us to appreciate excluded and unseen, yet significant, narratives that speak of the lives, thoughts, ideas, ways and how’s of countless societies. History in general, and the history of revolutions in particular, is always richer in content, more varied, more multilateral, livelier, and more ingenious than what even the best historian and the best methodologist could imagine (Lenin, 1967 in Ferbayand, 1975).

In psychotherapy, theories and practices are cultural products subject to the prevailing discourses at each moment of its history. Botella and Figueras (1995) point out that the traditional way of presenting and evaluating the different psychotherapeutic approaches has basically focused on their formal and theoretical aspects (basic concepts, personality structure, vision of psychopathology or conception of therapeutic change), which leads to the idea that this type of constructs promotes the vision of psychotherapeutic models, as if they were objective discoveries about the human being, although isolated from their cultural, socio-political, geographical contexts, etc. It is from the influence of postmodern consciousness that the so-called hard sciences, such as the philosophy of science, recognize the influence of the social context on theories. 

The literature on psychotherapy that has permeated many countries has not been spared from this Eurocentric view with Saxon theoretical and cultural foundations. This article intends to initiate a dialogue on how the perspective of Latin American and Mexican culture, as well as their histories, politics, geographies, and artistic creations influence the definition and application of art psychotherapy in these contexts.

Art Therapy

The origins of art therapy extend back to prehistoric times. Humans have continually created artistic configurations as an attempt to express and manage both the world around them and inside them. Throughout the centuries, art and its expressions in all cultures have shown us the way people lived, thought, related to each other, their ideals, their gods, their governments, as well as their values and rituals.

Fig. 1 Frescoes of Altamira.

The convergences with the discoveries of the prehistoric caves of Altamira in 1897, the Black Art exhibition in 1914, and the African and Oceanic Arts exhibition in 1919, in sum with the interest in psychotic art, awakened the curiosity for "primitive art" (Marxen, E., 2011). Art Brut, another manifestation that escaped the established canons, generated new ideas for both artists and psychoanalysts about artistic expression as an agent of emotional communication (J.P. Klein, 2009).

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Towards the end of the 19th century, the health sciences began to manifest an interest in the artistic activities of the mentally ill. Prinzhorn, marked a turning point in the field between art and psychosis; he stated that people used artistic expression to address their experience with illness, given that the artworks often represent a regression and manifest the "imperious need" of the psychotic "to impose order on chaos", trying to restore symbolic order (Marxen, E., 2011).

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Around the same time, the French neurologist Jean Martin Charcot (1825-1893) analyzed the physical and behavioral forms of the mentally ill with the objective to compare them with the works of the great masters of painting (Goya, Rembrandt, Rubens, El Bosco, among others), whose themes included madness, demonic possessions, etc. Charcot suggested extending medical science to the spiritual field as therapy of the soul, based on the psychophysiological treatment of mental illnesses, justifying his method with examples of artists consecrated by the history of art; he studied the similarities between artworks by these artists and the clinical pictures of the patients in order to determine, classify and categorize the type of pathology they presented (Charcot and Richer, 2002). 

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Sigmund Freud, who was Charcot's student, used throughout his work the processes of mythology, comedy, art products, and dreams as the axis of the manifestation of the unconscious. Undoubtedly, his theoretical positions cemented the artistic creation of countless artists.

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Formally, according to Western history (Jung, M & Asawa, P.,1994), art therapy arose until the 20th century, when in psychiatric hospitals, psychoanalysts, psychiatrists, and doctors observed the way in which patients communicated through art with the artists who imparted "occupational therapy"[2] sessions. This led to the recognition of art as an agent of access to the inner world of patients. Each creative product was understood as an illustration of mental health or disturbance. 

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However, the term art therapy was first coined in England in 1942 by the London artist Adrian Hill (1895-1977) who, while working with soldiers with tuberculosis during World War II, recognized the potential in their recovery by employing art appreciation and using it as a mean of expression, which generated fundamental skills to increase confidence and security in various areas of their lives (Hill, 1945).

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The development of the theory and practice of art psychotherapy has been greatly influenced by psychoanalysis, systemic-oriented psychotherapy, group theory, the use of projective tests and the Rorschach test, as well as critical theories, artistic elements, and cultural, artistic, and social contexts of the time.

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One of the most important representatives of art therapy in the United States is Margaret Naumberg, who began to include the practice of art and its interventions as a central modality of psychotherapeutic treatment; people's art productions were seen as symbolic communications of unconscious material in a direct, concrete, and uncensored way. 

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Additionally, in the late 1950s in the United States, Edith Kramer used art as a therapeutic agent. She witnessed the work of Friedl Dicker-Brandeis with children from the Terezin concentration camp, and following in his footsteps, she began working as an art therapist in New York. Her contributions in this field have been fundamental.

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In 1963 the first professional art therapy associations were founded: in France, the French Society for the Psychopathology of Expression; in the United Kingdom, the British Art Therapy Association (BAAT) and, in 1969, the American Art Therapy Association (AATA). In countries such as France, Spain and Germany art therapy began to spread naturally, opening therapeutic spaces with art; gradually more organizations began to emerge in places such as Australia, New Zealand, and Singapore.

Most articles and books on the history of art therapy are focused on what is described above (Jung, M & Asawa, P., 1994; Haslam, M., 2011). Consideration of the histories of this therapy in other parts of the world have been sparsely named, leaving a significant historical and cultural gap for its development and application.

Art therapy in Latin America.

Searching for the origins of art therapy in Latin America, we consider that in Mexico and Latin America art is manifested everywhere and in very diverse forms: pyramids, frescoes, ceramics, metals, textiles, etc. These objects when created by individuals, groups, cultures, and regions show us their expressions regarding ancestral and present daily life. Likewise, pre-Hispanic mural painting in Mexico encompasses different geographical areas, from the central highlands, the Gulf Coast to the Mayan zone. Spaces in which our ancestors left traces of their gods, symbols, sacrifices and their concepts of life and death (Arias, S., 2018).

According to Dissanayake (1988), indigenous cultures have used art as a way of expressing their understanding of the world and events happening both internally and externally. Art, through the ages, has been used as a way of "making special" and finding physical, psychological, and cultural meanings. Thus, ceramics, textiles, woodwork, music, instruments, and jewelry, among other artistic media, have functioned as symbols of the emotional histories and experiences of each civilization.

Regarding Mexico’s conquest, the art of the original cultures was transformed; theological ideas and the way in which the Spaniards understood the world permeated the artistic expression of Mesoamerica, to the point of reaching a syncretism in art (painting, sculpture, music, ceramics and others), as well as in traditions and religion. It was not until the beginning of the 20th century that the muralists, and the whole artistic and cultural movement around them, offered new ways of generating dialogues related to culture, identity, nationalism, and society among Mexicans. José Vasconcelos was one of the main promoters of this movement in which Diego Rivera, José Clemente Orozco and David Alfaro Siqueiros were its principal representatives.

However, among the most significant representatives of art therapy in Latin America we find the Brazilian Nise de Silveira, "the psychiatrist of creativity" (López, A. self, 2020), who was one of the pioneers in the 1950s. She began to include art as a medium of emotional expression in the psychiatric hospitals of her country.