GOUT | Crystallisation of Thought | 2016-18
This project is an artist’s interpretation of the disease Gout. A commonly misconceived disease, both amongst physicians and the general public. Tainted with the misconception that it only manifests in those who gorge on red meats and consume vast quantities of alcohol, the name ‘Gout’ trails behind it the stigma of a ‘rich man's disease’ a self inflicted, old fashioned almost laughable illness. Many people are under the impression that it is their own fault they were diagnosed with Gout. It is in fact a form of Arthritis and the result of a persistently high level of uric acid in the body, which causes urate crystals to form. The crystals can trigger extremely painful “attacks” of joint inflammation, deforming subcutaneous lumps (“tophi”) and irreversible joint damage. Unknown to most, gout also associates with many comorbidities, increased mortality and reduced quality of life. It is highly prevalent and found in both men and women of all ages, ethnicities and weights. It can also be hereditary, passed down from generation to generation. It is the only form of Arthritis that is essentially 'curable', another strong reason for this project to manifest. In raising the awareness of Gout through these Artworks we hope to help people to receive an early diagnosis and ultimately prevent them from experiencing the excruciating acute attacks or from any permanent damage to their joints.
I became interested in Gout through my father, Michael Doherty, who is a Professor of Rheumatology and leading specialist in the disease. I grew up surrounded by my fathers spectacular collection of taxidermy and cabinets of curiosities, ranging from animal skeletons, human skulls, insects and biological slides. These objects that surrounded me became my muses and played a large role in influencing my work today. Within my work I explore the human condition, which has included the psychological effects of disease and how we interact and communicate within society. My work maintains a certain biological constituent within it and I am interested in the relationship between the Arts, sciences and mathematics in the natural world.
There are many reasons why Gout in particular was of great interest to me, namely as I had one of the world's leading specialists of the disease as a father, but also because it is a disease that people are suffering from unnecessarily. This project was realised in collaboration with my father. It is challenging to capture people’s attention and change perceptions, but artwork has strong potential to deliver a message and ultimately tell a story. Each image in this project displays and unearths a dark truth about the disease.
I have researched the disease in depth, both in terms of clinical and research knowledge gained from my father and in speaking to patients about their experiences and perceptions of gout. I would like for this project to reach out to those who are suffering or have suffered from Gout in their lives and also to those who are prescribing treatments and being educated about the disease. We aim to bring to light that this is a disease, which demands attention, to help break down the barriers to care and bring strength in knowledge to patients or potential sufferers of gout. This project aims to create a new perspective and meaning to the term ‘gout’, to raise awareness of its symptoms and causes, bringing understanding to a disease, which is all too commonly misunderstood.
This project could be realised with the dedication, help and support of the following people:
Michael Doherty | Professor of Rheumatology and Head of Rheumatology, Orthopaedics and Dermatology Academic
Rheumatology at The University of Nottingham.
James Mackay | President and Chief Executive Officer at Ardea Biosciences, a member of the AstraZeneca Group.
Maren Winkler | Research physician at the Charité Centre for Stroke research. Editor and scientific researcher for the Crystallisation of Thought project.
This bronze sculpture of Embodied portrays a man perched on top of a mountain of gout tophi (subcutaneous lumps of crystal), which have grown out from beneath him. Stranded, he balances with his head in his hands, at the peak of his fear. Suboptimal care in the field of gout leads to long term suffering and a reduced quality of life. Embodied aims to exhibit the depression, psychological trauma and desperation that can be additional symptoms of Gout.
This painting, entitled Hidden, illuminates kidney dysfunction as a major, but often unrecognized, cause of Gout. The kidneys act as snail shells, the snail being a creature suggestive of slow or impaired movement. Inefficient kidneys or kidney failure is a possible cause of gout, as the kidneys are unable to excrete the uric acid efficiently, therefore raising uric acid levels within the body.
The Nest Focuses on the element of pain, which the disease typifies. I was interested to speak with patients to find out about the degree of pain they endured both during an acute "attack" and on a daily basis. I was interested in how they had dealt with it over the years, being that some patients had lived with gout for over 30 years or for the majority of their life. The Nest aims to visually represent the level of pain during an acute attack, strengthening the idea that it is not a comical disease and demands to be taken seriously. Numerous patients mentioned that the initial acute "attack" felt like a wasp sting, with sudden onset and then increasingly worsening within just a few hours. With this painting I wanted to represent the scale and intensity of the pain. It was described as an unbearable, unstopable sensation, perhaps that of repeated wasp stings.
Within the Grasp looks in to the trauma that gout can cause on the heart. This is a very unrecognized outcome of the disease, the increase in uric acid can cause damage to the artery's lining, which triggers clots and can ultimately lead to heart failure. It is a terrifying result and this is mirrored in the bleak imagery. Within the Grasp shows the arteries being choked by vines growing out from within them. They slowly crush and suffocate the heart as they grow. It shows the strength and unstoppable forces of nature. It rains acid rain within the confines of the canvas, burning any surface that it comes into contact with it, this draws attention to the uric acid as the cause.
An Inescapable pressure highlights the depression and the psychological strain that can arise in gout sufferers. Imagine the thought of thousands of tiny needle-like crystals growing inside of your joints, forcing their way to the surface. It must be a pretty terrifying experience. This is coupled with the long term debilitating effects of the disease on people's daily life. This is due to the suboptimal levels of care and understanding of gout, which means that people are suffering from the disease, unnecessarily for many years of their lives. The title suggests the psychological pressures involved as well as the acute physical pressure gout has on the joints.
The Significance of Time draws attention to the continuous build up of crystals within the joints. Persistently raised levels of uric acid in the body cause sodium urate crystals to slowly but relentlessly form and eventually clump together. The marching ants illustrate a constant movement of crystal growth. Commonly people are unaware of this and often will cease taking medication once the pain of an acute attack dissipates. In addition to gout attacks, continuing crystal deposition can result in hard, slowly expanding subcutaneous crystal concretions (“tophus” – Latin “a small hill or mound”). The crystals can appear as lumps under the skin and cause episodes of acute pain, swelling and irreversible chronic joint damage. The Significance of Time emphasises the importance of receiving a correct diagnosis and course of treatment early on.
Ants are part of a colony and operate as a unified entity; they are known to collectively work together to instinctively bring food back to the nest and will stop at nothing in order to support the colony. The idea of the ants represents this cycle, creating a visual image, which shows that over time the quantity of crystals is increasing and causing clumps to form. Crystals continue to form unless the level of uric acid is controlled. It is only once the crystals have been growing for some time and are present in large numbers that it becomes clinically apparent to the patient.
These particular ants are red imported fire ants, they are an invasive species and are able to establish themselves in environments where they have been accidentally introduced. The red ants are also known for their painful bites.
Embodied portrays a man perched on top of a mountain of gout tophi (subcutaneous lumps of crystal), which have grown out from beneath him. Stranded, he balances with his head in his hands, at the peak of his fear. Suboptimal care in the field of gout leads to long term suffering and a reduced quality of life. Embodied exhibits the depression, psychological trauma and desperation that can be additional symptoms of gout.
The Monster Swims Within Our Blood is a modern take on an image that is frequently reproduced to portray the pain of an acute attack of gout. It was originally drawn by James Gillray in 1799, depicting the pain of the artist's podagra (“seizing the foot”) as a demon or dragon. For my interpretation of this gout demon I have chosen the most life threatening symptom of gout to represent, heart failure. The title suggests that it is the uric acid which runs in our blood that is the true monster.
Roots visually depicts kidneys in the place of large gout tophi. By revealing kidneys in their place it leads the viewer to consider the possible causes of their disease. It is important to realise and treat the root of the problem and not simply the symptoms.
An unfortunate Gift reveals gout as a hereditary disease. In this image gout is literally being passed down to the next generation, in the form of a balloon. The balloon is a representation of the physical swelling and feelings of pressure caused by the tophi, while simultaneously implying the pressure the parents must carry who are unable to prevent it. It highlights that the majority of people suffering from gout do so through no fault of their own.
Crystallisation of Thought Exhibition
Asklepios Medical School Hamburg
22nd March - 31st July 2018
More information on gout can be found in the following articles written by Professor Michael Doherty: