Updates: Tentatively, our title is "Strategies for Maintaining Physiological and Mental Health during COVID-19," which will be divided into two central parts: (1) strategies from a physiological perspective, and (2) strategies from a mental health and awareness perspective. The groups have been divided accordingly, with discussions on herd immunity (by Harrison Cheng) starting off the topic, leading into potential treatment methods via Vitamin D (by Shriraj Susarla) and prevention strategies with cannabis (by Tristan Wesson) and masks (by Rhea Sahu), from the physiological perspective. The mental health perspective will start off with Seda Shirinan discussing mental health during COVID-19 and provide art therapy as a solution, leading into my (Marie Bae) topic regarding histology as a potential medium for art therapy methods to curb irrational fears incited by disease, Amirah Nathani's topic on body image and anxiety, and Jae Su's topic on hormone therapy for transgender individuals.
Histology, the study of microscopic structures of tissues, has become a novel medium for artistic expression. Though the underlying pathological indications presented on a histology slide suggest a conceptual threat of disease, several artists have recognized an unexpected visual beauty in these images, creating stunning artworks. We may also utilize histology as a therapeutic palette for creative expression and rewire our current nosophobic fears surrounding COVID-19.
Creative depictions of art often manifest themselves from our visual perception of our macroscale environment. Meanwhile, microscopy not only taps into a new source for artistic inspiration but also informs a better understanding of the invisible world. Often used as a diagnostic tool in clinical settings, this technology enlightens us on our current health state from a cellular perspective. Ironically, images produced underneath the microscope, especially with histological stains, feature an unexpected beauty, severely contrasting with the malignant pathologies that they actually represent. We also process disease with the symptoms that we exhibit, which may exacerbate publicized fears of catching a disease. On a pandemic level, such as the case with COVID-19, panic can introduce a stigmatizing behavior toward others and a sense of xenophobia toward the origin country of spread. To combat the growing fears associated with disease, we may look to the unsuspecting beauty of histopathology.
Histology refers to the study of microscopic structures of tissues and is typically done by staining a thin section of tissue and visualizing through a light-utilizing microscope. A common staining technique utilizes hematoxylin, a basic dye that stains negatively charged nuclei purple, and eosin, an acidic dye that stains positively charged cytoplasm pink. Meanwhile, specific stains can be used for various tissue specimens; for example, Luxol fast blue is specifically used for visualizing neurons, showing a distinct blue image of star-like projections. Furthermore, distinct histological patterns based on tissue functionality and structure can be distinguished among different types of tissue. Skeletal muscle tissue is multinucleated at the sarcolemma, and a cross-sectional image reflects these distinctions with purple dots speckled at the peripheries of pink hexagonal shapes.
Before Anton van Leeuwenhoek’s famous use of compound microscopes to look at tiny structures, very little was known about the invisible pathogens that may potentially cause disease. Thus, technological advances in microscopy have facilitated a better understanding of research in identifying pathologies from a microbial context. Today, pathologists utilize microscopy to visualize stained tissues and search for any abnormal signs, and these histological examinations have helped to identify the underlying pathogeneses associated with various diseases (Levenson et al., 2015). For example, researchers have recently scrutinized tissues samples from a COVID-19 patient, concluding a link between SARS-CoV-2 infection and pneumonia. These findings may allow physicians to develop effective therapeutic strategies for COVID-19 patients based on these morbidities and thus reduce mortality rates (Xu et al. 2020).
How We Process Beauty and Threat:
Interestingly, our mental processing of beauty and threat utilizes the same neural circuitry, the orbitofrontal, prefrontal, and motor regions of the cortex. However, according to neurobiologist Semir Zeki, the activation of these different regions depends on our perception of an object. The orbitofrontal cortex appears to be stimulated upon recognition of images interpreted as beautiful, while the motor region of the cortex seems to be activated by emotionally charged stimuli, which Zeki correlates with mobilization of the motor system to escape a perceived threat (Kandel, 2012). Other studies have suggested - surprisingly - that the anterior insula, which is generally associated with negative perception, is also activated by positive aesthetic appraisal across visual, auditory, olfactory, and gustatory sensory modalities (Brown et al., 2011).
Meanwhile, many factors contribute to how an individual may perceive an object with a certain emotion, such as evolutionary influences or subjective experiences. Our hippocampus and prefrontal cortex make up the fear-processing centers of the brain that draw contextual information from a detected threat, while the amygdala carries out behavioral and physiological defense responses (LeDoux, 2017). Dr. Joseph LeDoux and Dr. Daniel Pine suggested a two-systems framework for understanding the concept of fear and anxiety, in which a distinction between subjective emotions and defensive behaviors is drawn (LeDoux, 2017).
According to historian Mary E. Fissell, how we are currently reacting to COVID-19 appears to be reflective of how individuals 350 years ago responded to the bubonic plague (Fissell, 2020). Neither COVID-19 nor the bubonic plague were well understood at the time of spread, understandably eliciting fear and preventative measures such as social distancing and avoiding disease hotspots (Fissell, 2020). However, in both cases, persecution of a specific group as scapegoats for an epidemic has been engendered by rumors and xenophobic sentiments, as well. For example, Jews were accused of poisoning food supplies and wells, while prostitutes were also accused of spreading the disease and driven out of their towns. Unfortunately, history has repeated itself with a sharp increase in anti-Asian bias and misnomers tying the virus to a specific country (Fissell, 2020).
Because we process positive and negative emotions using the same neural circuitry, it may be possible to rewire our brains toward mentalities instilling positive thinking and problem-solving rather than fixed mindsets dominated by fear and anxiety. As suggested by the two-systems framework, it remains critical to address subjective emotions that accompany defensive behaviors.
Dichotomy of Disease in Fear and Art:
Fears Engendered by the Concept of Disease
During these unprecedented times of social distancing, many individuals also equip themselves with gloves and hand sanitizers and don their favorite masks before going to the market. However, along with precautionary measures to combat viral spread follows a slew of extreme panic regarding COVID-19, not limited to avoiding takeout Chinese restaurants and hoarding toilet paper and perishable food items.
Nosophobia refers to the irrational fear of contracting a specific disease and may be applicable to many during this COVID-19 era. Interestingly, other phobias can be associated with disease as well. Recent studies suggest that trypophobia, a repulsion or discomfort toward irregular patterns, may have emerged from conceptually unrelated entities appearing to look like skin lesions in patients with parasitic infections (Martínez-Aguayo et al., 2018; Sarabian et al., 2018). Interestingly, these visual cues may be abstractly unrelated with the disease itself. For example, lotus seeds have a striking physical resemblance to skin lesions which may stir an irrational association with a parasitic infection. A similar concept of irrational associations can be applied to xenophobia, prejudice against people from other countries. For example, epidemics such as the swine flu and, recently, SARS-CoV-2 have led to stigmatization of the country where the disease originally spread (Scherr and Holthouse, 2009; Ganesan, 2020).
Visual Cues from Microscopic Designs
Juxtaposing nosophobic sentiments, Dr. W. C. Gibson offers an alternative perspective when perceiving the essence of disease, transforming the negative connotations of pathology into unexpected beauty through histology slides, likening them to snapshots of the macroscale universe around us, regardless of the actual pathological meanings. For example, a histology slide of malignant tumor cells may appear to look like stars in a galaxy that leaves trails of stars as it plows through space (Gibson 1993; Crockett 2014).
Histology as an Artistic Palette:
Histology has become both a novel source for inspiration and a medium for creative expression for many artists.
Atsuko Tanaka’s painting “Work” (1973) showcases vibrant circular shapes invoking a sense of activity. These shapes, representative of blood cells at work, recapitulate an image of a hematological slide colored by Wright’s stain (Quin, 2019). The different colors may represent various type of blood cells, as red blood cells lack a nucleus and are predominantly stained pink, while circulating immune cells contain a nucleus and are thus stained blue. Tanaka eloquently captures the functional purpose of red blood cells in transport, as referenced by a trailing red line, as cells are shuffled through the bloodstream to carry nutrients and oxygen to different parts of the body.
In 2014, researcher Dr. Esther Baena and designer Arielle Gogh from team TRANSMUTATION of the Descience project collaborated to transform clothing to works of art using histology as an inspiration. To do so, they developed intricate textile patterns inspired by with histology images from prostate cancer research (Amsen, 2020). Their work recapitulated tissues at different stages of the disease, from normal to aggressive, based on the Gleason system. Gogh experimented with different fabrics and dyeing techniques to create aesthetically pleasing designs that simultaneously represented a malignant disease (Baena 2014). The design patterns not only looked at the color of cells from staining but also the pathological signs of metastasis to fully visualize the progression of prostate cancer (Baena, 2014). As the fabric transforms into a stunning dress, the implications of a fatal disease seem to fade away, as well.
Meanwhile, other artists have also been inspired to create artworks using histology as a medium while also transmuting the concept of disease into a beautiful piece, as showcased as a part of “Portraits of Pathology” in the website The Pathologist (The Pathologist, 2018).
For example, “Polypathia” by Aadil Ahmed fashions together an array of histological slides from skin, muscle, bone, marrow, blood, kidney, bladder, lung, liver, and colon tissue surrounding a heart shape of cardiac muscle tissue with a neuronal center background (The Pathologist, 2018).
Mary E. Landau reimagines a hematoxylin and eosin stain of squamous cell carcinoma at 40X magnification into a pink seashore, which she dubs as “Angry Ocean” (The Pathologist, 2018).
For Ashley Cecil, a histological stain of a frog infected by fungal chytridiomycosis acts as the background for her piece “Diseased” that serves to portray the impact of the disease on an endangered frog species, the Panamanian golden frog (The Pathologist, 2018).
Rewiring our Perceptions of Disease:
Much like how Dr. W. C. Gibson spins histopathology slides into a creative story that recapitulates our macroscopic universe, using microscopy to not only bridge our knowledge gap of the microscopic world but to also offer a fun optical illusion activity may help to relieve extreme stress and trepidations against disease.
We can also gain inspiration from aforementioned artists to create our own masterpieces using histological patterns as a medium, accompanied by simple painting techniques.
Our coping mechanisms amidst the SARS-CoV-2 pandemic may impact us and our relationships with others. While it remains imperative that we practice social distancing and cautionary measures to prevent further spread, irrational fears arising from panicked mis-associations with the incidence of disease should be addressed. We may look to histopathology as a novel artistic medium to combat the growing fears associated with disease and rewire our current perceptions of COVID-19 and other diseases.
Amsen, Eva. “Science and Culture: Researchers embrace fashion to show off science concepts.” PNAS, 31 Mar 2020. https://doi.org/10.1073/pnas.2003370117. Accessed 25 Apr. 2020.
Baena, Esther. “When Tumors Meet Fashion.” The Guardian,13 Oct 2014, https://www.theguardian.com/science/occams-corner/2014/oct/13/when-tumours-meet-fashion-baena-gogh. Accessed 25 Apr. 2020.
Brown, Steven, Gao, Xiaoqing, Tisdelle, Loren, Eickhoff, Simon B, and Mario Liotti. "Naturalizing Aesthetics: Brain Areas for Aesthetic Appraisal Across Sensory Modalities." Neuroimage. 15 Jun 2011, https://pubmed.ncbi.nlm.nih.gov/21699987/.
Fissell, Mary E. "Pandemics come and go. The way people respond to them barely changes." Washington Post, 7 May 2020. https://www.washingtonpost.com/outlook/2020/05/07/coronavirus-bubonic-plague-london/
Ganesan, Rajeshwari. "COVID-19 will find a cure. Stigma will not." Daily O, 26 Mar 2020. https://www.dailyo.in/variety/covid-19-coronavirus-coronavirus-in-india-stigma-leprosy-cholera-yellow-fever-hiv-aids-tuberculosis/story/1/32620.html. Accessed 1 May 2020.
Gibson, W. C. “Introduction to Art and artifice in the science of histology.” Histopathology, Jun 1993, https://doi.org/10.1111/j.1365-2559.1993.tb00171.x. Accessed 25 Apr. 2020.
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Quin, John. "Is it a Sound Piece, or a Painting? The Subtle Transfigurations of Female Gutai Artist Atsuko Tanaka." Frieze, 11 Nov 2019. https://frieze.com/article/it-sound-piece-or-painting-subtle-transfigurations-female-gutai-artist-atsuko-tanaka
Sarabian, Cecile, Curtis, Val, and Rachel McMullan. “Evolution of pathogen and parasite avoidance behaviours.” Philosophical Transactions B, 13 Apr 2018, http://dx.doi.org/10.1098/rstb.2017.0256. Accessed 25 Apr. 2020.
Scherr, Sonia, and David Holthouse. SWINE FLU PROMPTS ANTI-MEXICAN SENTIMENT. Southern Proverty Law Center, 2009 Aug 20. https://www.splcenter.org/fighting-hate/intelligence-report/2009/swine-flu-prompts-anti-mexican-sentiment
Xu, Zhe, et al. “Pathological findings of COVID-19 associated with acute respiratory distress syndrome.” Lancet Respir Med, 18 Feb. 2020, https://doi.org/10.1016/S2213-2600(20)30076-X. Accessed 25 Apr. 2020
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Van Gogh’s original Starry Night: Zelazko, Alicja. “The Starry Night | History, Description, & Facts.” Britannica, https://www.britannica.com/topic/The-Starry-Night
Histological representations of Starry Night: “The Starry Night: Histology Remix | Science art, Art.” Pinterest, https://www.pinterest.com/pin/13581236351977799/
“Acryllic Painting Techniques.” Jennifer Funnel Visual Arts, https://www.youtube.com/watch?v=cDzcoyeaRKI&feature=youtu.be
“Portraits of Pathology.” The Pathologist, 19 Jul. 2018, https://thepathologist.com/subspecialties/portraits-of-pathology. Accessed 2 May 2020.
“this guy's acne filled face : trypophobia.” Reddit, https://www.reddit.com/r/trypophobia/comments/7c4y8a/this_guys_acne_filled_face/
“What is Trypophobia?” World Atlas, https://www.worldatlas.com/articles/what-is-trypophobia.html
“Peacock Wallpaper.” Amazon. https://www.amazon.com/SHITAL-PIPALIYA-Peacock-Wallpaper/dp/B07H1HLMP6
“Lotus Flower Meanings.” What’s your sign?, https://www.whats-your-sign.com/lotus-flower-meanings.html
“Diseased” by Ashley Cecil: “Portraits of Pathology.” The Pathologist, 19 Jul. 2018, https://thepathologist.com/subspecialties/portraits-of-pathology. Accessed 2 May 2020.
A skin section of rabbit showing cross-sections of hairs show eye-like forms looking out from the follicles, while melanophores (black cells) enhance the visual appeal with dynamic color contributions (Gibson 1993).
A histology slide of malignant tumor cells appear to look like stars in a galaxy (Gibson 1993).
The ESO 137-001 Galaxy leaves trails of stars as it plows through the normal cluster (Crockett 2014).
Baena and Gogh’s Descience project showcases textile masterpieces that represent the progression of prostate cancer. Sections of tissue at different stages of the disease were stained and visualized under a microscope, later reimagined into a fabric design (Baena 2014).