Poetry and Healthcare

Jules Mann

 

While poetry has been used for therapeutic purposes in health and healing for centuries, there is a noticeable surge of 'grassroots' action in Britain today. This has combined with national initiatives to instigate a formalised field of study and practice of poetry in healthcare. In the past few years this momentum has gathered beyond the individual surgeries and waiting rooms, beyond the poets and nurses and doctors and educators who have steadfastly sought to include poetry as an essential component to treatment and patient care.

The Poetry Society's Poetry Places scheme helped to facilitate a number of innovative poetry-in-health projects, including five described below. While conducting interviews for this article, I asked each of the participants their views on the split between poetry as art and poetry as therapy, and their views on how best to train poets for this sort of work.

 

Projects: | Sheffield Childrens Hospital | Poems for the Waiting Room

| Dean Lane Family Practice | East Midlands Centre for Forensic Health

| The Healing Word | Additional Project Descriptions

 

Future Developments: | Research and National Initiatives | Training for Poets to work in Healthcare | Action Points | Resources

 

 

Debjani Chatterjee
Sheffield Children's Hospital

During her six month residency at Sheffield Children's Hospital (full project report), Debjani Chatterjee spent time with children that she met in the hospital's main reception area, outpatient clinics' waiting rooms, the 'potting shed' (the room where children get plasters put on them), accidents and emergencies, the parents' dining room, the Chaplaincy and the Eye Department, either just reading poems with them or performing her own poetry with them. She also worked with hospital volunteers and staff, and contributed poetry-related news items and poems to the hospital's regular newsletter. "Poetry is life-affirming; that is why I find it - in and out of hospital - such an invigorating tonic. That is also why I hope that my poetry residency, although the hospital's first, will not also be its last."

In response to my query about writing as art or therapy, she responded that the distinction is academic: "Any writing can be therapeutic. However, you are very aware of it in a hospital environment - after all, that's the reason a writer in residence is there". The children can see that it is beneficial (though it's difficult to measure) - it makes them happier, it helps to distract them from an upcoming procedure, it gives them a sense of well-being and achievement when they sit down and work on a poem. If she had had more time she could envision gaining trust and confidence of the patience and would have liked to have done more serious poetry and in-depth work - i.e. not just funny little poems but ones in which she could explore the feelings of frustration and pain.

 

She mentions that another approach she could have taken is to identify those members of staff who would like to develop their own skills further and work with them so they could continue her work after she'd gone. She could also have led training sessions with the Play Workers so instead of just crayons and paper they could also work with words. She encountered quite a bit of frustration from them - saying poetry is difficult - difficult to get children to even do drawings when they'd rather watch TV or play video games. She suggested holding a poetry competition, and to publish poems - or include suggestions for writing poems - in the Hospital newsletter which goes out to all the wards. One of the permanent post-residency fixtures at the Hospital is the Poetry Exhibit (which was produced by the children, the staff and Chatterjee); they hope to continue rotating new work in. They'd also like to print the manuscript to distribute around the wards; they hope perhaps a local printer might donate this.

 

Rogan Wolff
Poems for the Waiting Room

Rogan Wolff produced A3-size poems for general 'poster' display in his project Poems For the Waiting Room. With the help of poet David Hart he commissioned poems by over 50 contemporary poets, including Fleur Adcock, Andrew Motion, Sujata Bhatt, U.A. Fanthorpe, Carol Anne Duffy, Jackie Kay and Amryl Johnson. "I hesitate to lay claims for poetry it cannot meet. Poetry can make waiting rooms more human. But it won't turn them into treatment rooms or rescue us from the predicaments of our time."

He emphasised that hospital staff must be committed to keep the project running: "The scheme relies absolutely on individual networking and consistent individual enthusiasm. The idea cannot be implemented by management directive." Because of the publicity garnered by his project, he has not had to 'bang on doors' but has been approached by professionals who often have a high level of enthusiasm. The poets themselves who have been commissioned (and for this he gives great credit to David Hart for his editing/commissioning help) are extremely excited by the project. So far no publisher has charged copyright fees. "The idea seems to gather friends".

 

Because local people are encouraged to produce their own work, he could see this project as a form of poetry therapy. But his ultimate purpose is to promote poetry.

 

Rose Flint
Dean Lane Family Practice
Rose Flint conducted a six month residency as the 'Poet for Health' at Dean Lane Family Practice (full project report) in Bristol. Patients were encouraged to sign up for individual appointments; Dr. Gillian Rice (who instigated the residency) and her colleagues also referred patients. Flint reflected "it would seem to me that these sessions could benefit so many people. To write your feelings down on paper and then read it later can give you so much information about yourself.... If these sessions could run in Doctor's surgeries and hospitals they could be an extension of treatment". Key to Flint's residency was her desire to explore the language barriers between health professionals and patients. "Sense and pragmatism are necessary, but maybe alongside the advice, a sheaf of poems relevant to this very particular time might help the patient to feel less isolated". Her Dean Lane Family Practice was "an incredible residency, and [she'd] like to do lots more like that".

Flint works regularly as an addiction counsellor, using poetry and creative writing to deal with alcohol addiction. She does feel that a more holistic view of people and illness in general is slowly creeping into the NHS (and hopes that's not just wishful thinking). She is about to begin teaching a modular course on writing and personal development at Bristol University. This will involve an emphasis on the process of writing, and will also point up that when working in health care environments it is not always appropriate to edit patients' writing - all approaches must be made with extreme sensitivity.

 

Dr. Richard Byrt
East Midlands Centre for Forensic Health at Arnold Lodge

The East Midlands Centre for Forensic Health at Arnold Lodge (full project report) was keen for a poet to work with them in furthering creative and expressive activities for patients, not as a form of therapy. Dr. Richard Byrt reports that their selected poet Mahendra Solanki "facilitated four days of sessions of creative writing, mainly of poetry. He enabled patients to appreciate the strengths and positive features of their writing. Where appropriate, he also offered advice and suggested exercises, to facilitate and develop patients' work."

Solanki's residency has been very popular with patients, staff and managers. Much of it has to do with his openness to work as a close member of the team in a not very easy environment. The residency was planned very carefully by a multidisciplinary group (including Senior Arts Therapist, Occupational Therapist and Ward Manager). All heads of departments received letters introducing Solanki and his work, explaining it was a leisure activity but not a therapeutic one. They were not prescriptive about what work the poet should do, other than ensuring he could do so within their security measures. Following an induction training, several people accompanied him to the first poetry sessions.

 

Regarding the split between art and therapy, Byrt's response was "be clear about what the aim is. In the case of hospital settings, staff managers need to be clear about the project. Patients often say they've gained therapeutic value though that wasn't the project's remit". Solanki had to counteract the patients' common complaint of unpleasant experiences of poetry in school... so he took care that people could just sit down and chat with him. Dr. Byrt feels that if the relationship of trust can be achieved, that is the most critical step.

 

Since the Poetry Places funding, Byrt has found more funding (from a local charitable trust, East Midlands Arts, and out of the Hospital's budget from the next financial year) and arranged for Solanki to come back.

 

Fiona Sampson
The Healing Word

Fiona Sampson pioneered the development of writing in health care in the UK. Her publication The Healing Word - a practical guide to poetry and personal development activities, commissioned by the Poetry Society, researches the nature and effects of poetry and healing activities based on actual accounts by workers and users in the health care system. Especially noteworthy are her "Ten Commandments" for good practice in running a poetry project in a healthcare setting. These include:

  • making sure there is supervision in order to provide a briefing and debriefing support system for the poet;
  • avoid a competitive environment;
  • ensure confidentiality with all participants' writing.

As in any project, being clear about the remit equals good management. However, she suggested that future residencies could benefit from a project manager such as the Poetry Society. Especially in healthcare, poets are working alongside health professionals with very specific outcome models, so the more professionally managed a project is the better. "At the moment we know arts and poetry in healthcare is good because it's about access... we could also advocate that people are taking part in a prestigious artistic endeavour", says Sampson.

 


 

additional projects In addition to these examples from Poetry Places are the more recent Regional Arts Boards' Year of the Artist residencies: poet Stephen Watts has been commissioned by Vital Arts to work with the Health Advocacy team and their patients, and Sussex Rehabilitation Workshops commissioned performance poet Bernedette Cremin to undertake a series of workshops with stroke and head injury patients using spoken word. Independent projects have also been developed, such as the Kingfisher Project - after co-producing The Healing Word by Fiona Sampson, this arts-in-health project (funded by Southern Arts and Arts Care Salisbury Hospital) has continued with Sampson working on an ongoing basis with three groups: a psychiatric hospital ward, an orthopedic ward and a mental health group at the Arts Centre.

I rang Professor Harnden at Wythenshawe Hospital (Manchester) just as he received the first response to their recently established poet-in-residence project in the Cystic Fibrosis Unit. "It helped the patients meet each other and open up lines of communication. Without a doubt it contributed to their education and well-being." Poet Pat Winslow's work was so successful that they've earmarked further funding for her to continue. She's about to work in Oncology, then spend five weeks in the Maternity Unit. The Chief Executive at the hospital is enthusiastic about the project and has suggested that the poet work in rehabilitation, for example with long-stay stroke victims.

 

Professor Harnden has been trying to improve the environment in the hospital, and to that end he established an Arts committee with staff members. He wanted to create a better atmosphere for staff and patients - not just physically but using arts and literature as well. His project received a great amount of guidance from LIME (Hospital Arts, Manchester), and because they cannot directly use NHS funding they have approached their regional arts board for support. (It's important to note that most hospital endowments are restricted-use; the arts can only be funded through unrestricted endowment which is very little).

 

Research and National Initiatives
What can we predict for the future of poetry in health care? Fiona Sampson points out the critical need for more research - she explains that unless we can articulate what we are doing and why, poetry in health could simply be an occasion of similar projects taking place in a vacuum, with no models and no real argument for why there should be more of it happening. She is not alone in drawing this conclusion, and it now appears that individual projects are matched by increasing research about them on a national level.

In December 1997, Sir Kenneth Calman (then Britain's Chief Medical Officer) invited several people in the arts and health profession to discuss the possibilities of bringing arts into the National Health Service. This evolved into two conferences at Windsor in 1998 and 1999, funded by the Nuffield Trust. These conferences defined three entities influencing the initiative of arts in health.

 

One entity was entitled Arts and Health, encompassing two distinctive elements:

 

  • using art as a medium for art therapy, and
  • bringing art practice to patients via artists in residence.

Participants on this council created the National Network for Arts & Health (NNAH). A second entity was Arts in the Community, utilising the spread of Healthy Living Centres. The third was Medical Education - introducing and maintaining arts and literature in undergraduate and postgraduate training of doctors. This sector became the provision of Nuffield Trust's Institute of Medical Humanities (IMH). The IMH council meets regularly and is developing syllabus modules for Medical Education curriculum.

 

Gillie Bolton, Research Fellow at the University of Sheffield and an active member of the IMH Council, has written chapters in two textbooks coming out in 2001 about poetry in health, one published by the British Medical Journal Press and the other by the Royal College of Physicians. The focus is medicine and literature, particularly the reading of poetry. One of the main themes is how ethics can be taught through literature - i.e. reading literature (including poetry) to examine and gain access to emotions and human experience.

 

The Nuffield Trust and the University of Durham announced an initiative to launch Britain's first National Co-ordinating Council and Centre of integrating the arts and humanities into the NHS; the Centre for Arts and Humanities in Health and Medicine (CAHHM) was established in January 2000 at the University of Durham, where Sir Kenneth Calman is Vice Chancellor and Warden. Dr. Jane Macnaughton is Director of CAHHM, which is supported by the Nuffield Trust and Northern Arts.

 

Meanwhile the University of Sussex's unique programme in Creative Writing and Personal Development, convened by Dr Celia Hunt, offers the only post-graduate course which deals with "the range of theoretical approaches to thinking about the field, including theory of the author and autobiography, educational theory, theory of social narratives, and the role of narratives and metaphors in counselling and psychotherapy".

 

Besides her work at the University of Sussex, Dr Hunt is also director of Lapidus, a grassroots organisation dedicated to the therapeutic uses of the literary arts. It provides a forum for people to give papers on what they're doing in the general field, and also circulates a members newsletter with notices, articles and points of view for debate. They have future plans to develop a training programme for writers going into healthcare.

 

Training for Poets to work in Health What do poets and healthcare professionals feel about future training for poets who would like to become more involved in residencies within the healthcare field?

This question points up that idealogical split in defining the poets' (and poetry's) role in the healthcare environment. One aspect is considering poetry as art therapy and therefore poets work in essence as therapists. The other considers poetry an art practise set within the healthcare environment, in which poets come in to work solely on the basis of writing skills and do not view their clients as patients.

 

Rose Flint points out that no matter what the context, questions are raised about the dangers of transference. "Ethics is very important; because of patient vulnerability, there is lots of power in the healing field". She sees the two camps as having potential to create some opposition. "These two camps need to have lots of dialogue in order to clarify further directions for poets in health".

 

Dr Celia Hunt warned that "writers go in to health care environments as writers but may get into situations where they could get put on the spot. Writers therefore do need to develop skills to create a safe space".

 

When queried about the need for training for poets, Fiona Sampson commented that it sounds very close to poets in schools. While it would be "a good thing, of course", she emphasises "the importance of starting with high calibre poets to begin with, to keep the focus on the art of poetry". As for establishing some sort of formal training for poets in health, she suggested this should be considered by the Arts Council as a form of Continued Professional Development.

 

As for on-site training, Dr Byrt feels it takes a great deal of careful planning and induction. "Make the poet feel welcome. Respect their expertise, but guide them as to where to go". He suggests that all managers should agree with the concept of a poet residency, as well as staff on wards and patients. Not to take the spontaneity out of it, but "you can't impose on people".

 

While there is still much to be discussed, researched and evaluated, the field itself can benefit from a good deal more grassroots activity. Call it guerrilla marketing, but there is plenty of space for action at your local health authority. Listed below are suggestions from various poets and healthcare professionals.

  • Donate books of poetry to your local surgery's waiting room.

 

  • If you feel moved to run a writing group or one-to-one sessions with patients, approach your GP surgery or hospital; ask if they have an arts administrator, otherwise talk to the receptionist, practice nurse or counsellor.

 

  • If you'd just like to act as advocate, do your bit by talking to people - next time you're in, ask your GP (or practice nurse, counsellor, therapist, dentist) if they prescribe poetry.

 

  • Promote the idea of poems in the waiting room (see resources for list of two separate projects in this area).

 

And if you're feeling flush, donate money to support a poet-in-residence. Most residencies require outside funding, as hospital endowments are usually earmarked for particular use - you could even start your own endowment fund to support poets-in-residence.