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Poetry as Healer

Healing words - Some doctors find poetry can treat wounds that medicine can't always reach. 
By Deborah L. Shelton, AMNews staff. American Medical News, May 17, 1999.
 

"I can't tell you how many times patients have come in and said a poem has changed their understanding of the experience [of their illness]," said Rafael Campo, MD, assistant professor of internal medicine at Beth Israel-Deaconess Medical Center. "Poetry has the power to say that others have been through this, that you can live with it too." As a physician-poet, he understands the importance of that message. For example, "a breast cancer diagnosis is a terrifying experience for many people," said Dr. Campo, who discusses poetry with about a third of his patients. "But here's something -- a poem -- that will give a different perspective on the experience. You're engaging the patient and letting them know you see them as a whole person and not just a lump in a breast." Sometimes patients seeking more information about their disease find a book of poetry among the resource materials compiled by the Boston internist.   

"The written word is very powerful," said John Graham-Pole, MD, a professor of pediatrics and affiliate professor of clinical psychology at the University of Florida, Gainesville. "It helps [people] to make sense of things that are otherwise hard to make sense of." Poetry is finding its place in the practice of medicine as more medical schools include literature courses in their curricula and as an increasing number of doctors turn to the healing power of words. Among the specialists who utilize poetry in their work are psychiatrists, oncologists, pediatricians and internists.  

There's a growing interest in poetry among physicians, says Jack Coulehan, MD, MPH, director of the Institute for Medicine in Contemporary Society at State University of New York at Stony Brook. "Ten to 15 years ago, no one would have expected poetry in a medical journal." Yet today, the Journal of the American Medical Association, Lancet and Annals of Internal Medicine are among the prestigious clinical journals that regularly publish poetry.  

Published last year was a book of poems, some written by physicians, Uncharted Lines, Poems from the Journal of the American Medical Association. "Poetry related to medicine, along with poetry in America generally, has burgeoned over the last decade, becoming a recognizable genre in its own right," wrote JAMA Associate Editor Charlene Breedlove, who edited the collection.  

A long history 

The marriage of poetry and medicine goes way back. In ancient Egypt, sacred words were chanted in rituals to promote healing. Ancient Greeks left poems in shrines in remembrance of their healing. And the spoken word is integral to Native American traditional medicine. "Poetry and medicine are so closely intertwined," Dr. Coulehan said. "When you go back in history and think about how healing occurred in traditional societies, most healing was [related to] the power of the word."  

Even in the modern era, poetry has played a role. The famed Benjamin Rush, MD, included a library in the hospital he founded in 1810 so patients could read poetry and other literature prescribed by their doctors. Many notable poets throughout history were physicians, including William Carlos Williams, Anton Chekhov, John Keats and Oliver Wendell Holmes. "For Williams, medicine was the springboard from which his poetry came, and he repeatedly said that he could not practice one without the other," wrote Anne Hudson Jones, in the Jan. 25, 1997, Lancet.  

A study published in JAMA April 14 reported on the health benefits of written expression for patients. Researchers studying 112 patients with asthma or rheumatoid arthritis who wrote about traumatic life experiences found a greater reduction in symptoms at four months than for those in a control group (47% compared with 24%). "These gains were beyond those attributable to the standard medical care that all participants were receiving," the authors wrote. It was the first study to demonstrate that writing about stressful experiences improved physician ratings of disease and objective indices of disease severity in chronically ill patients.  

Poetry and mental health 

Poetry therapy, as employed by some psychiatrists, can "help a person to distill and condense a whole set of experiences and feelings into something that can be put on the page, be tangible, so the person can get hold of it and share it with others," says John Fox, a certified poetry therapist in California who teaches use of poetry therapy to health care professionals.  However, it's the process, not the final product that matters, he said. "It's what the patient says and the colorful way in which that patient says it," said John Stone, MD, a professor of medicine at Emory University. "It's the way a patient tells us the most painful things about his or her life."  

Poetry therapy shares the philosophy of most forms of psychotherapy. "The difference is that poetry therapists give special weight to the transforming power of beauty and creativity as expressed in words," said Kenneth Gorelick, MD, vice chair of the department of psychiatry for the District of Columbia Commission on Mental Health Services and past president of the National Association of Poetry Therapy.   

Poetry therapy can include all forms of literature such as short stories, fables, myths, fairy tales, memoirs and journal writing, he said. "Often patients say: 'Reading what I wrote, I realized for the first time what I was thinking and feeling,'" Dr. Gorelick said.  Another dimension of poetry therapy involves reading poems written by others, he added. Patients "find the truth of their own experience reflected back in a way they can recognize."  

Poetry therapy has been used with a range of psychiatric patients, from those who are psychotic and admitted to acute psychiatric wards to people going through a life crisis or developmental transition such as divorce, job loss or the death of a loved one.  It has been used with old and young, and applied in settings from elementary schools to nursing homes, Dr. Gorelick said. Writing is widely used in pediatric hospitals, often in conjunction with art, to help children articulate their fears and experiences with illness. Some physicians invite patients to get creative while waiting for their appointments, supplying crayons and other writing materials, because they have found it to be calming.  

Poetry as a therapeutic tool 

Since poetry is generally the shortest form of self-expression, "its brevity is adapted to the length of the therapy session, especially in this era of managed care," Dr. Gorelick said. "It gets to the heart of the matter most quickly." But it's most effective when used in groups because of the sharing of experiences and perspectives.  

Poetry is not something Stephen Rojcewicz, MD, uses with every patient, or even most patients, "but sometimes it seems to be the perfect therapeutic tool," he says. "What I like about poetry is the balance between raw emotion and some kind of governing structure," said Dr. Rojcewicz, a psychiatrist and president of NAPT. "There are some patients in which this clicks. Some patients can express raw emotion if they have a structure to work with." He asks patients if they have ever written poetry or other work and, if they have, to bring it in. It's not unusual for a patient to bring a poem that hasn't been shared with anyone, not even a spouse. Poems are discussed at about one-fourth of patient visits, and poetry therapy is always accompanied by other therapeutic techniques. In one case, Dr. Rojcewicz suggested a minor change to the ending of a patient's poem to allow a more optimistic view of a very difficult part of her life. The poem described her life in a critical way and ended with a negative statement. Although the patient didn't make the change he suggested, she decided to end the poem with a question mark, allowing for the possibility of hope.  

Teaching the healers 

Some doctors have written poems about patients. Dr. Coulehan wrote one poem, "I'm gonna slap those doctors," in the voice of a patient who was furious with his surgeon because the physician had mistakenly assumed he was an alcoholic. But the man couldn't find a way to express his anger and frustration. Dr. Coulehan gave the man a copy of the poem, which has since been published widely.  "It was therapeutic for him," Dr. Coulehan said. "I'm not a believer in being distant or detached. I've always been willing to share my own expressions with [patients] as well as expecting them to share theirs with me."  

If a patient seems inclined to write, he will encourage it. He suggested that one man, a paraplegic polio survivor, write about the experience of being disabled. The poem was later published in the Annals of Internal Medicine. "While he was a gruff, abrasive man, who didn't get along well [with the health care team], underneath he was a very thoughtful guy," he said.  On another occasion, Dr. Coulehan sent a poem about a patient who had died of lung cancer to the man's daughters, one of whom called to thank him.  

In the academic setting, Dr. Coulehan teaches medical students to appreciate the power of poetry in class, something several medical schools now do. In a recent exercise, he assigned first-year students taking gross anatomy class to write a personal essay, poem or short story about their response to dissecting a human cadaver. An accompanying reading assignment was a series of poems dealing with cadavers, some written by physicians. In small groups of 10, the students discussed issues that poetry raises, such as aging and dying. "It's very accessible and it's immediate," Dr. Coulehan said.  

Poetry can facilitate effective communication and empathy, said Dr. Campo. And that's an important part of being a good doctor. "Empathic care providers provide the best care to patients, and poetry is a useful means for exploring empathy and forming those connections with patients," he said.