"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
"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
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 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.
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
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.
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.
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,"