Finding the Words to Say It: The Healing Power of Poetry.

My purpose in this paper is to help you experience for yourself the potential of poetry to heal by feeling its power through your own voice. Many people have an intuitive sense that voice in general and poetry in particular can be healing. We have all experienced the comfort of soothing words. Finding the words to articulate a traumatic experience can bring relief. A letter between friends who are fighting can heal a relational wound. People are frequently moved to write a poem in times of extremity. In mainstream culture there are subjects that are not talked about. They are taboo. For example, each of us is going to die, but we do not talk about dying. We are all in the dialogue of illness, death and dying, whether or not we are talking about it. Poetry gives us ways to talk about it. Multiple ways of utilizing poetry for healing, growth and transformation will be presented including the Poetry and Brain Cancer project at UCLA. Particular attention will be given to issues of Palliative care. The reader will be directed to the scientific evidence of the efficacy of utilizing expressive writing. The developing professional field of Poetry Therapy, and The National Association for Poetry Therapy will be discussed.

Introduction

My purpose in this paper is to help you experience for yourself the potential of poetry to heal by experiencing the power of poetry through your own voice.

In the United States many people are scared of poetry. They have had bad experiences with it in school. People often believe that poetry is difficult or inaccessible or not relevant to them.

Modern poetry is based on voice, and must be passed through our ears. This is where the sense is made. So, when you read this article and you see poetry

When we speak, we use pauses and phrasing. When we speak, we breathe. When we write poetry, we have punctuation and line breaks. The line breaks are there to help the reader find the natural flow of poetry based on voice.

The passage below is derived from a conversation I had with poet Li-Young Lee on the relationship between poetry and breath and life and death. When you read the passage, pause after each line and take a breath in. Feel for yourself the emergent meaning.

Poetry as a Natural Healing Practice

Many people have an intuitive sense that voice in general and poetry in particular can be healing. We have all had the experience of the comfort of soothing words. Finding the words to articulate a traumatic experience can bring relief. A letter between friends who are fighting can heal a relational wound. Poetry can spring from us naturally in times of need. People are frequently moved to write a poem in times of extremity.

In the aftermath of the World Trade Center attacks on September 11, 2001, poetry sprang up everywhere. A New York Times article on October 1, 2001, documented the phenomenon: “In the weeks since the terrorist attacks, people have been consoling themselves—and one another—with poetry in an almost unprecedented way … Improvised memorials often conceived around poems sprang up all over the city, in store windows, at bus stops, in Washington Square Park, Brooklyn Heights, and elsewhere. …”

Some catastrophes are so large, they seem to overwhelm ordinary language. Immediately after the recent tsunami disaster in Southeast Asia, the Los Angeles Times reported the witnesses were literally dumbstruck. Words failed them. They had lost their voices.

In mainstream culture, there are subjects we do not talk about. They are taboo. For example, even though each of us is going to die, we don't talk about dying. Instead, we avoid it. Even physicians are reluctant to talk with terminally ill patients about the patient's experience, however,

Poetry gives us ways to talk about it. My job as a poetry therapist is to use poetry and voice to help people get access to the wisdom they already have but cannot experience because they cannot find the words in ordinary language.

William Carlos Williams was a poet and a physician. He is credited with making voice the basis of modern poetry. He wrote in his poem Asphodel, That Greeny Flower (1)

Two years ago, I was asked to pair poets with brain cancer patients at UCLA in the Department of Neuro-Oncology, so that the poets could help the patients find the words to articulate their experiences. One patient reported his dilemma following brain surgery to remove his cancer,

Although illness is usually discussed in terms of a patient's symptoms, deficit, or impairment, it is also about how people respond when faced with extreme circumstances and what they have to tell and teach us. One of the poems that came out of the poetry and brain cancer project was “Amazing Change” (2).

Amazing Change

If you didn't read this poem aloud, do so now. What is your experience of reading this poem? How is it relevant to you? Do you identify with the woman or, perhaps, the husband or the guides or even the gorillas? Can you visualize the images, see the people trekking along, then lying down in the grass? What sounds can you hear? What is the smell of the jungle? What physical sensations do you feel in your body as the poem unfolds? What happens to your breathing when you read the last lines? How did the transformation that happened at the end of the poem affect you? Did you have any associations to the poem about a situation in your own life?

Whatever your experiences of reading this poem, they are examples of the ways that poetry works. It gets into us and plays through our psycho/neuro/immuno-sensory selves.

All of my professional life, I have used language embodied in voice as part of my medicine. Whether it was an attempt to talk someone through a traumatic experience or to help them understand the implications of their diagnosis or to aid them in finding the words to write their own stories and poetry, I have encouraged patients to speak and write their truths. At the same time, I have learned from them. One of the privileges of being clinicians is that we have a place in our patients' lives as they live through experiences that we may have yet to face ourselves.

It is becoming more and more common for people dealing with serious illnesses to write and publish their stories and poems as their own healing practice (3–11). Many physicians and other health care providers have joined in writing their own personal experiences with illness, death and dying (12–19).

Poetry and Therapy

In my private practice of family psychiatry, I often ask whether my patients do any writing and for what purpose. In my work with them, I support their writing and encourage its use whether it is through poetry, journals or personal letters. I encourage bringing the writing in as material for discussion, and I may make suggestions. For example, Writing in the third person gives distance to your voice, so try writing in the first person. I also sometimes gives assignments. For example, write what you are having difficulty saying, or bring in a poem which is particularly meaningful to you. This can then become a springboard for discussion and exploration. The poem “I Can't” by Carlene Shaff represents a turning point in her treatment, facilitated by using poetry therapy, and documented in her poem “I Can't.”

I Can't

Did you experience the change that Carlene went through? Poetry therapy is not only used with individuals. It is frequently used in groups. Shahin Sakhi, a psychiatrist who attended a poetry therapy seminar, told me he had never previously written a poem or any other type of expressive writing. The first words he wrote were (19):

It was the first time he had shared this experience. Finding the words to express it was a deeply healing experience for Shahin, and his relief was palpable.

If the group's focus is on a particular theme, for example, cancer, I might use poems that relate directly to the illness. My poem “Eileen” is an account of an incident related to me by a friend that occurred between a mother and her daughter.

Eileen

In “Eileen” I wanted to capture the experience of a healing transformation and ritual passage between a mother and her daughter. Could you see the images and feel the experience of witnessing the transformation?

“Being the Stone,” is written from the point of view of the ritual object and is about how it is imbued with its power. Be sure to read “Being the Stone” aloud and feel the experience of actually being the stone and carrying this power to heal.

Being the Stone

When poems such as “Eileen” and “Being the Stone” are read to a group, people experience a resonance with their own stories in ways they may have never been put into words before. The poems need not be about illness specifically, but might otherwise embody themes that confronts the patients.

Twelve years ago, I myself was going through personally difficult times. One of my patients, a 32 year-old woman who was a wife and mother of a 2-year old daughter, died. At the same time my father was beginning his terminal decline from diabetic multisystem failure, and a friend of mine was dying from a cancer that had metastasized to her brain. In addition, I had recently had reconstructive knee surgery to repair torn ligaments, following which I was disabled for months.

I had never written much before except a few poems in earlier times of crisis. I developed ways of writing as my own healing practice, and I listened to the voices of other poets and writers doing the same (20).

Our voices are saturated with who we are, embodied in the rhythms, tonal variations, associations, images and other somato-sensory metaphors in addition to the content meaning of the words. Our voices are embodiments of ourselves, whether written or spoken. It is in times of extremity that we long to find words or hear another human voice letting us know we are not alone.

The poems “MeFather,” “What Waiting Is,” and “The Family Plot” were all written during this period (8,21). They represent a progression of my experience: from a dreamed awareness of my father's death as he began his terminal decline, through the realization of what the three year process had meant to me, to overwhelming grief in the aftermath of losing both my father and my friend, and, finally, an attempt to come to some resolution.

The Family Plot

When I was asked by the minister of a local congregation if I would read my poetry on illness, death and dying as part of their Sunday service, I viewed it as an opportunity to facilitate a community's healing. The congregation had recently sustained a number of deaths, and the minister wanted to facilitate a dialogue among the congregants who were having difficulty talking about the losses. After reading “MeFather, What Waiting Is,” “The Family Plot,” and others (21), the congregation responded with testament of their own. Below in the poem “We All Sat Around in a Circle” I tried to capture the voices of the congregants.

We All Sat Around in a Circle

For more on the ways in which poetry is employed as a therapeutic tool, you can refer to the following references (23–29).

A Note On Healing

In Chinese, the written character for poem is composed of two characters, one means word and the other means temple. Together they mean poem. The wisdom of poetry is in the combination of the sacred and the word as illustrated by the character in Chinese.

Healing is frequently thought of as taking place at the level of the individual. But if healing is viewed as a process that brings us back to wholeness, then in addition to happening within the individual patient, healing can also take place between patient and family members, between patient and the larger community of which they are a part, and even at the level of the community as a whole. In fact healing is often necessary on many of these levels simultaneously.

In many indigenous cultures, illness is viewed as the individual falling into disharmony with the community, so that in order to heal the individual, their place in the larger order must also be restored. In many West African indigenous cultures, proverbs are told in the oral tradition of poetry. Kykosa Kajangu from the Congo has collected these proverbs and integrated them into what he terms Wisdom Poetry (personal communication).

In one African tribe, when a woman is pregnant, the women of the community assemble in the forest and listen for the new child's song. When they hear it, they bring it back to the community and sing it in public. When the child is born, the song is sung again. When the child goes through ceremonial rites of puberty and marriage, it is sung again. And, when the child grows old and is dying, it is sung again. But, it is also sung when the child has broken with the community, committed a crime, or otherwise fallen out of harmony. The people tell themselves and each other who they are in the order of things, and can thereby bring themselves back into harmony with the world.

Poetry and Palliative Care

The healing concerns of palliative care do not reside only with the patients. The need to give voice to experiences at the end of life is shared by patients, families, caregivers and health care professionals, as well as the larger community, as illustrated in “We All Sat Around in a Circle.”

In 1996, during my father's terminal illness, a friend of mine contracted a nasal sinus cancer, which was thought to be benign. After several surgeries, all of which were too-little-too-late, the tumor spread into her skull and invaded her brain. The following set of poems includes “The Proof in the Pudding,” “The End Game,” and “The i in Poetry.” I was attempting to capture the experience of my friend's terminal illness and engage her in a dialogue of poetry (22).

The i in Poetry

The poem “The End Game” was particularly meaningful to my father while he was dying. The poem “Cherish” tells this story.

Cherish

“The Legacy” came out of the poetry and brain cancer project discussed earlier. In it, a wife of 25 years speaks of her role as caregiver (2).

The Legacy

The poetry and brain cancer project also produced poetry that presented a different sort of perspective. “Median Mortality” by Toby Estler is an example of the humor and courage displayed by people faced with terminal illness (2).

Median Mortality

In a soon-to-be published paper, Jack Coulehan and Patrick Clary, Journal of Palliative Medicine in press write about the need for professionals who work in palliative care to be able to process their own experience, specifically using poetry. John Fox writes of this need amongst hospice care givers to find their own voices in the work they do (23,24). Gregory Gross discusses the need to deconstruct death from his Scientific Medicalization to a more poetic remystification of the process of dying (30). The Man With a Hole in His Face (31) by Jack Coulehan is a dramatic example of a physician trying to come to grips with his own reactions to the reality of this patient.

The Experimental Evidence

Most of the experimental evidence as to the efficacy of Poetry Therapy comes through the literature on expressive writing. The seminal researcher in the field of the therapeutic uses of expressive writing is James Pennebaker (32,33). Pennebaker has shown that the use of expressive writing for as little as 15 min over 4 days has positive health effects as measured by visits to physicians and a diminution of symptom complaints. His original work deals with the use of expressive writing to heal wounds from traumatic stressful events.

Pennebaker's argument and the evidence for the efficacy of expressive writing is well stated in his most recent book Writing to Heal: A Guided Journal for Recovering from Trauma and Emotional Upheaval (33). In it he summarizes his argument for the therapeutic effects of expressive writing on the immune system (34); medical health markers with asthma, cancer, and arthritis patients (35); and decreased physiological stress indicators in the form of lower muscle tension, drops in perspiration levels, and lower blood pressure and heart rate levels. (36) He also summarizes the evidence for the psychological benefits of expressive writing in terms of positive short and long-term mood changes (37) and behavioral effects in the form of school and work performance. (38,39,40)

Findings from numerous experiments have suggested that writing exercises can give a whole array of health benefits including reductions in emotional and physical health complaints (37,41,42), and enhanced social relationships and role functioning (43).

On the other hand not all investigators have found positive effects using writing, and not all people who wrote showed positive benefits (35). Some writers have shown skepticism (44).

In 2002, Lepore and Smyth published The Writing Cure: How Expressive Writing Promotes Health and Well-Being (34), which is the most comprehensive review to date on the research into the efficacy of expressive writing. It presents cutting edge theory and research, and points students and scientist to new avenues of investigation. It also presents how clinicians are beginning to translate basic research into practical applications. The book is divided into four sections: 1. an overview; 2. the therapeutic effects of expressive writing and adjustment to life stressors (including work with cancer patients, expressive writing and blood pressure, working with children and alexithymia); 3. emotional, cognitive and biological processes; and 4. new directions and clinical applications.

Overall, the research on poetry therapy in general and expressive writing in particular is promising. Recognizing the need for additional research, the National Association for Poetry Therapy (NAPT) and Lapidus (the Association for the Literary Art in Personal Development) located in London are planning a multi-center research study on the efficacy of Poetry Therapy with cancer patients. Also, NAPT is embarking on a multi-center clinical research study attempting to assess the efficacy of Poetry Therapy on post-traumatic stress disorder in war veterans (see NAPT below).

In Conclusion

I hope you've enjoyed the ride. If you've gotten this far, you've certainly had some kind of experience. You may or may not understand it, but ask yourself whether you have a better sense of being in the dialogue on illness, death and dying. How do you already use your capacities for poetic expression in working through these questions? If on the other hand, you just skipped directly to this conclusion, here's something for you too.

Resources: The National Association for Poetry Therapy

According to the NAPT, the definition of Poetry Therapy is the intentional use of the written and spoken word to facilitate healing, growth and transformation. The NAPT has been in existence since 1982. It's predecessor was The National Association for Bibliotherapy. A survey of the membership reveals an interesting 25% split. Twenty-five percent of the members are mental health providers (psychologists, social workers, family counselors, etc.), 25% are medically trained physicians, nurses, etc., 25% are educators, and the last 25% are an assortment of artists, writers, building contractors and race car drivers, etc., who also share an interest in the healing power of poetry. NAPT has a training program in poetry therapy and an academic journal, Journal of Poetry Therapy. Please refer to the web site for details. .