Assessment, Sitting Beside Someone, and Altering the DSM into a 3-Dimensional Sculpture

Assess: the literal meaning of Latin assidere, ultimate source of assess was ‘to sit beside someone’

I am thrilled to be starting an ongoing altered book group this January.  This kind of an art process is ideal for someone ready to separate from outdated beliefs and old stories about themselves.  One of the most meaningful art projects I have done was, over the course of a year, altering the Diagnostic and Statistical Manual of Mental Disorders (DSM), into a 3-dimensional sculpture.  The DSM is the Bible of the clinical therapy world, and as much as I value the clinical perspective on psychopathology, I find it incredibly lacking...particularly in terms of depth, texture, and its ability to identify strength and beauty within our clients.  Altering this book was a practice in using image, intuition, felt sense, beauty, and a variety of art supplies to “assess” the clients I was working with at the time.  At this time in my career, I was an art therapist working in a retirement home and thus my clinical focus was in grief and loss, major life transitions, and institutional trauma.  Many of the images in the book reflect my own process of sitting with dementia and death and dying.  

When you read an intake form, or a client comes into your office pre-diagnosed, it’s easy to assume what that means.  Dementia: Alzheimer’s Type...part of me goes ‘click, got it.  I know what to do with that.  I know what that means.’  Another part of me, the artist in me, wants more.  I want to lean in.  I want to know what it feels like in the room with you.  What’s the shape of your face?  How do you smell?  Your voice-- is it deep and low, or kind of sing-songy?  And if you were a landscape, what would you be? In working with clients with dementia, sometimes there were few words.  The words that did come sometimes made “sense” in the usual way, and other times did not.  Sometimes one line says it all.  A 90-something-year-old woman living on a locked dementia unit said to me:

    One morning in October I awoke with a black hole, a storm cloud, in one eye.  And now the nurses say I have to sit where they can see me.

So on the left you see the diagnosis: Dementia: Alzheimer’s Type, and on the right you see the correlating image.  For me, her words penetrated, clung to me, needed to be recorded and documented in image form.  Working imaginally in this way with this woman allowed her and her diagnosis to touch me.  And that’s deep assessment.  That’s sitting beside someone, in a sacred way.  Feeling into them.  Letting the image that is them touch you.  

I’ll share several other altered DSM pages with you.  As you can see, I have sewn jingle bells through the mood disorders section.  Anxiety disorders have been completely torn out, torn apart, and rearranged to the point of illegibililty.  I developed another way of experiencing and understanding various diagnoses based on how my creative side worked with them, which continues to inform how I empathize with the people I work with.  Including poetry, prayers,and other visual responses to the clients provided an ongoing way for me to be with them in a deeper way, and also supported me in sublimating some of the vicarious grief and trauma I picked up on while working with this population.  I hope that these images touch you.

Alison's 8-session altered book group starts January 23.  For more information, see