CHMP

The Examined Life, a journal from the University of Iowa's Carver College of Medicine

Joy Jacobson is the CHMP’s poet-in-residence. 

Last week CHMP senior fellow Jim Stubenrauch and I traveled to Iowa City for a conference called The Examined Life: Writing, Humanities, and the Art of Medicine. We attended panel discussions, writing workshops, literary readings, and other presentations by physicians, writers, nurses, medical students, patients, and others exploring the ways that literature and health care can intersect. It was exciting, sometimes downright thrilling, to be in Iowa City, a UNESCO City of Literature, and to hear what others from around the country and around the world have been doing to nurture these intersections.

The keynote address was delivered by Philip Levine, the current U.S. Poet Laureate. Levine has published 20 books of poems and won nearly every award we have to bestow on a poet. But he’s produced a body of work not overly concerned with illness or health care. So what was he doing at this conference? It’s a good question, one that raises another: can poetry have a vital role in health care?

Levine opened his reading with a poem originally published in 1980, “The Doctor of Starlight.” In it, a man visits his doctor with an odd ailment: “a tiny star above my heart.” The poem proceeds, through rhythmic short lines, to describe a medical exam in which the doctor asks his patient what he does for work. “I make the glare / for lightbulbs,” the patient says. It’s an extraordinary statement made ordinary by the workaday diction of the poem. Finally, the doctor and a strong-handed nurse pluck the star from the patient’s chest. “What does it mean?” the patient asks the doctor, and the doctor replies:

“Mean?” he said, dabbing the place
with something cool and liquid,
and all the lights were blinking on
and off, or perhaps my eyes were
opening and closing. “Mean?” he said,
“It could mean this is who you are.”

Levine is an entertainer, a storyteller, both in his poems and in his reading of his poems. (His between-poem banter itself rose to the level of art.) And in its realistic and surrealistic depiction of a medical encounter, “The Doctor of Starlight” reveals something about illness—and the distress surrounding illness—that health care does not always acknowledge: that our bodies are glorious, even when there’s something “wrong.”

That awareness ran as a subtle undercurrent through many of the presentations I heard last week. Nellie Hermann, author of the novel A Cure for Grief and a faculty member at Columbia University’s narrative medicine program, summed up, for me, why we need conferences like this. “Writing creatively,” she said in her lecture, “gives us access to parts of ourselves we might not access otherwise.”

From The Blue Room: www.theblueroomblog.org

This week’s Healthstyles program focuses on the use of the arts to promote health and healing. I interview three people who have been engaged in this work in the NYC metropolitan region: Joy Jacobson, Poet-in-Resident and Senior Fellow at the Center for Health, Media & Policy (CHMP) at Hunter College, City University of New York; Jim Stubenrauch, CHMP Senior Fellow; and Diane Kaufman, MD, poet and child psychiatrist at the University of Medicine and Dentistry of New Jersey (UMDNJ)– University Behavioral HealthCare at Newark, NJ, where she is also the Director of Creative Arts Healthcare.  The three discuss various forms of art that are used with patients and clinicians to foster self-healing, as well as a collaborative project on narrative writing with nurses at UMDNJ. The program airs this week on WXMR-FM (Radio Bistro at www.wxmrfm.com; 100.7 FM) and on WBAI-FM (www.wbai.org; 99.5 FM in NYC on Thursday night from 11:00 to 11:30 PM). To listen to the program, click here: Arts UMDNJ.

Diana J. Mason, PhD, RN, FAAN, Co-Director, CHMP

Angilee Shah’s Career GPS blog for ReportingonHealth.org  interviewed Senior Fellow James Stubenrauch, who co-taught the first narrative writing course to students in the Hunter-Bellevue School of Nursing along with CHMP Senior Fellow and Poet-in-Residence Joy Jacobson. Her post, Why Health Care Professionals Should Write, addresses the reasons and benefits of writing for health professionals. Jim’s quote “”It’s part of a self-care strategy as well as making a better provider out of whoever does this kind of work,” he told Career GPS. “What I’m trying to do in this course is give people permission to get their own voices in the room and down on paper.”  Archived posts on Narrative Writing can be found here.

Reporting on Health is a project of USC Annenberg’s California Endowment Health Journalism Fellowships.

Credit: created by Mark A. Hicks, illustrator.

Manuscript of "The New Colossus" by Emma Lazarus; photo credit / The Center for Jewish History, NYC

In July, I wrote a post on the first-ever narrative writing course for nursing students at the Hunter-Bellevue School of Nursing. CHMP poet-in-residence Joy Jacobson and I taught the five-week course, which met twice each week for three hours per class. I’m happy to report that it was a great experience for us as instructors and, by the end of the course, the consensus among students was that they didn’t want the class to end.

Eleven nursing students were enrolled and one Hunter staff member audited the course; seven of the 12 participants were not native English speakers (their first languages were Mandarin, Korean, Russian, and Yoruba). Most had done little writing for themselves and all needed to improve compositional and grammatical skills. Nevertheless, all of the students produced creative and moving original writing in a variety of formats, including in-class exercises, blog posts, and personal essays.

Several readers of my previous post asked for more particulars about our teaching methods. Here I’ll focus on the in-class writing exercises.

We spent about the first half hour of each class on one or more “quick writes”—guided writing exercises designed to get everyone writing quickly and spontaneously, without concern for the rules of grammar, spelling, and punctuation. The ideas for the quick writes came from several sources, and we adapted freely from books such as Natalie Goldberg’s Writing Down the Bones: Freeing the Writer Within, and The Essential Don Murray, edited by Thomas Newkirk and Lisa C. Miller. We encouraged students to keep their hands moving and to trust their impulses, in the hope that they would get in touch imaginatively with emotions, memories, and sensory impressions, and write about experiences they wouldn’t usually commit to paper. Joy and I did the writing exercises along with the students.

We then spent the next hour of the class reading and discussing what we had just written. While sharing was optional—no one was forced to read aloud—most students were eager to read most of the time. It was remarkable how quickly this sharing helped establish a sense of trust and an atmosphere of mutual support and respect. The feeling that we were coming together as a community of writers proved to be essential as the course progressed and some of the writing prompts led class members into deep and sometimes turbulent emotional waters.

The idea for what may have been the most powerful of the quick writes came from Between the Heartbeats: Poetry and Prose by Nurses, an anthology edited by Cortney Davis and Judy Schaefer. A short piece by Ruth E. Brooks, “Dear Alma Mater,” is in the form of a letter addressed to the Harlem Hospital School of Nursing, which was closed in 1977. The author writes to her alma mater as if it was a person, saying how news of the school’s closing gave her a profound sense of loss. “Let me tell you what part of me was sealed behind those doors,” she writes, and then enumerates not only some of the nursing skills but also the philosophical perspectives she learned there. In concluding, she expresses her sense of indebtedness to the school for helping her transform her life in the process of becoming a nurse.

I found the piece very moving, so I began one class by reading this letter aloud and then asked the students to write a heart-felt letter to a place or a person—living or deceased—that is important in their lives; and I asked them not to hold back, and to write all the things they wish they could say or could have said. When given the chance to express their feelings about what matters most to them, even those students who had the most difficulty with written English wrote clear, straightforward sentences that carried tremendous emotional weight. The stories that came out, the courage the students showed in sharing them, and the way they supported each other’s telling were cathartic and inspiring.

Students also were required to keep a daily journal, and there were assigned readings and writing projects. The final project was a personal essay. One student, Jamie Torres, wrote about her experience of the course itself, and how the close reading and discussion of some of the poems in the Heartbeats anthology had given her a new appreciation of poetry and her own abilities as a writer. She kindly gave me permission to quote from her essay, in which she wrote:

I would encourage all nurses to step out of their comfort zone and start reading poetry, write in a journal, and begin to share their stories. We can call it Narrative Nursing. Louise DeSalvo, author of Writing As a Way of Healing, says, “Through writing we see ourselves as able to solve problems rather than as beset by problems. We enjoy a heightened sense of self. We become more optimistic.” This is what nursing desperately needs. Narrative nursing will give us an opportunity to practice hearing our voice, in a new and fresh way. Maybe through writing we will recognize our own worth.

We’re looking forward to a guest blog post from Jamie sometime soon.

Jim Stubenrauch

Notebook collection, a photo by Dvortygirl on Flickr.

A new writing course for Hunter–Bellevue School of Nursing graduate students got off to a great start this past Thursday evening. CHMP poet-in-residence Joy Jacobson and I will teach the class for the next four and half weeks of Summer Session II. Our immediate goal is to help the students sharpen their skills in writing—scholarly writing, blogging, and narrative writing—and in on-the-job communication. But we also hope to motivate students to invest more energy in their writing by developing a daily writing practice focused on their clinical and personal experience. We’ll supplement this work by close reading of literary and scholarly texts that deal with the experiences of illness and caregiving.

The combination of reflective writing and close reading is an adaptation of the pedagogical approach used in the emerging field of narrative medicine. The mission statement of Columbia University’s Program in Narrative Medicine provides a good introduction to the aims of this discipline:

Narrative Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, the Program in Narrative Medicine helps doctors, nurses, social workers, and therapists to improve the effectiveness of care by developing the capacity for attention, reflection, representation, and affiliation with patients and colleagues. . . .

(I wrote a previous blog post about a presentation given by the founder of the Columbia program and one of the pioneers in this field, Rita Charon, MD, PhD. An extensive bibliography with links to several publications by Charon and others can be found here.)

We adapted our guidelines for developing a daily writing practice from Writing as a Way of Healing: How Telling Our Stories Transforms Our Lives, a fascinating book by Louise DeSalvo, professor of English at Hunter and leader of a memoir workshop in the MFA Writing Program. (She also blogs at Writingalife’s Blog.) Anyone interested in writing as a means of exploring the self will find sound advice and much food for thought in this book. DeSalvo writes

This book is an invitation to engage with your writing process over time in a way that allows you to discover strength, power, wisdom, depth, energy, creativity, soulfulness, and wholeness. . . . to use the simple act of writing as a way of reimagining who you are or remembering who you were. To use writing to discover and fulfill your deepest desire. To accept pain, fear, uncertainty, strife. But to find, too, a place of safety, security, serenity, and joyfulness. To claim your voice, to tell your story. And to share the gift of your work with others and, so, enrich and deepen our understanding of the human condition.

These are not mere self-help bromides. DeSalvo draws on a growing body of evidence from research conducted by James W. Pennebaker and others that demonstrates the beneficial psychological and physiological effects of a specific kind of writing about disturbing or powerfully emotional events. According to DeSalvo, Pennebaker discovered that “to improve health, we must write detailed accounts, linking feelings with events [the emphasis is DeSalvo’s]. The more writing succeeds as narrative—by being detailed, organized, compelling, vivid, lucid—the more health and emotional benefits are derived from writing.” (Pennebaker’s Web page at the University of Texas, Austin, has an extensive bibliography of his research, with links to free downloadable files. Click on Publications. He is also the author of Opening Up: The Healing Power of Expressing Emotions.)

DeSalvo and others, such as Sara Baker, who facilitates what she calls Woven Dialog creative writing workshops with patients at the Loran Smith Center for Cancer Support in Atlanta, Georgia, and elsewhere, also note an important caveat: this kind of writing practice, especially at the beginning of the process, can stir up strong negative feelings, particularly among those who have experienced real trauma (for example, those who have survived cancer or violent abuse). It’s important not to push oneself too far; or, as Baker writes: “We must not use our work to retraumatize ourselves or put ourselves in danger.”

Baker encourages imaginative writing—using the tools of fiction and poetry to offer what she has called “an oblique route” that may give a survivor of trauma “more freedom to connect with emotional and often buried truths” than the more direct route of memoir would provide. (Sara Baker blogs at Word Medicine.)

At the first class meeting last week, students dove right into a guided writing exercise called “My Least-Favorite Patient or Colleague.” First, each of us made up a list of nouns or adjectives beginning with the letter ‘B’ that described the person we had in mind; then another list of words beginning with the letter ‘S’ that described how that person made us feel; and a third list, of verbs or verb phrases beginning with the letter ‘T,’ that described what we would like to do to or with that person. Then, based on this material, each of us wrote a simple “list poem”—that is, a poem in which each line begins with the same word or phrase (such as “I remember…”). The last line has to have a strong twist or surprise, something like the punch line of a joke. And to cap it off, the title of the poem is written last (and is often humorous or ironic in retrospect). You can imagine how this little exercise got the juices flowing.

Stay tuned. We may be publishing some of our students’ writing on the CHMP blog in August.