Face to face: towards a philosophy of socially engaged arts in health.

There is now an extensive and robust evidence base for arts and health, but few accounts of how or why socially engaged practices matter in ethical, experiential and aesthetic terms. This paper develops a philosophically grounded account of arts and health engagement with people whose distress is uniquely configured by the visual: those who live with facial nerve paralysis. These patients paradoxically experience hypervisibility due to their facial difference, but the resulting (often subconscious) social judgement and the profound disruption to their own sense of identity also renders them unseen. For over 4 years an experienced socially engaged artist was embedded in the multidisciplinary Sydney Facial Nerve Clinic, working with patients and clinicians through an emergent, relational practice-based artistic methodology, and eventually producing an exhibition of 15 artworks. We discuss four of these works in detail-large-scale projected portraits that superimpose patients' faces onto their clinician's hands, a surgically unravelled French horn, an oblique dialogue between surgeon and patient, and a technology infused lachrymal vase-analysing both the processes of creation and responses of participants and gallery viewers to the outcomes. We argue that both the form and effects of the practice can be understood through Emmanuel Levinas' ethical 'optics'. The processes and aesthetics of this relational, experimental and unforeclosed practice resist dominating forms of knowing. The 'site' of the work is in the open encounters in which the artist responds to the ethical responsibility of coming 'face to face' with the Other-in this case, patients and clinicians-by making themselves vulnerable to being affected through this practice. In the artistic outcomes, patients and clinicians can be seen without being reduced, and gallery visitors are kept safe while experiencing vulnerable witnessing. We suggest that rather than providing predefined and predictable benefits, the arts here become a hospitable practice of attention, uncertainty and responsibility that enables new conversations in the clinic and beyond.