Poetry in the Clinic

Towards a Lyrical Medicine

Alan Bleakley, Shane Neilson

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000532081
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Education

This book explores previously unexamined overlaps between the poetic imagination and the medical mind. It shows how appreciation of poetry can help us to engage with medicine in more intense ways based on 'de-familiarising' old habits and bringing poetic forms of 'close reading' to the clinic.

Bleakley and Neilson carry out an extensive critical examination of the well-established practices of narrative medicine to show that non-narrative, lyrical poetry does different kind of work, previously unexamined, such as place eclipsing time. They articulate a groundbreaking 'lyrical medicine' that promotes aesthetic, ethical and political practices as well as noting the often-concealed metaphor cache of biomedicine. Demonstrating that ambiguity is a key resource in both poetry and medicine, the authors anatomise poetic and medical practices as forms of extended and situated cognition, grounded in close readings of singular contexts. They illustrate structural correspondences between poetic diction and clinical thinking, such as use of sound and metaphor.

This provocative examination of the meaningful overlap between poetic and clinical work is an essential read for researchers and practitioners interested in extending the reach of medical and health humanities, narrative medicine, medical education and English literature.

Part I Setting out to alter the narrative

1 In difference (and not deference) to narrative medicine

DOI: 10.4324/9781003194408-2

Prolegomena

Later, we engage critically with narrative medicine as represented in the influential work of Rita Charon and associates at Columbia University in New York (Charon 2006; Charon and Wyer 2008; Charon et al. 2016). We show how non-narrative poetry has not simply been overshadowed, but rather eaten whole, by narrativist approaches. There is time enough for this. But for now, we want to start our book with the evergreen reason for why we’re writing it. So let us tell you a story.

During the rise of the narrative medicine movement in the noughties, the California-based medical educator and psychologist Johanna Shapiro (2009) published a book on medical students’ poetry and how this can illuminate the nature of their studies and identity formations. But the strange feature of Shapiro’s book – given that the students’ poetry is its springboard – is that poetry (as we understand the genre and phenomenon) is entirely engulfed by narrativism. For Shapiro (ibid.: 42), all students’ poetry is a form of story and is treated as such in her analysis, where further, poetry is explicitly understood to be an art consisting of information: “This book is predicated on the argument that poetry can be understood as a form of qualitative data”.

More, Shapiro, a psychologist, proceeds to (predictably?) psychologise her material. By this, we mean placing an emphasis on what happens to the individual person internally, and not focussing on that person’s engagement with the world. The developmental psychologist Jean Piaget (Inhelder and Piaget 2006) called the first approach “assimilation” (the world is adapted to the individual’s needs) and the second approach “accommodation” (the person adapts to the world). Shapiro’s book is appropriately entitled The Inner World of Medical Students. In contrast, the celebrated poet Geoffrey Hill (in Phillips 2000) was adamant that poetry is not about personal growth, the poet’s ego, or the betterment of individual “wellbeing”. Rather, poetry is a gift to culture and an invitation to diversity and inclusivity, where, as Hill says, “genuinely difficult art is truly democratic”. Carefully crafted, thoughtful verse adds to the richness of poetry’s field independent of its author. If, by inhabiting that field, we feel differently about the world or ourselves so much the better, but poetry may infect us differently.

The first half of our book will explain how Shapiro’s (in our view) rather bizarre approach – when surveying the field as a whole – is actually normative. But for now, we ask, with the fervour of poets: how could such a misreading and misapplication have ever come to be?

Taking 576 poems written by 386 medical students (sampled from published examples in medical and medical humanities journals), ranging across all years of study, Shapiro subjected the poems to “content analysis” from which the following themes emerged inductively: the experience of cadaver dissection; becoming a doctor; becoming a patient; doctor-patient relationships; student-patient relationships; language and culture differences; death and dying; issues of inequity and social justice; and students’ general reflections on life and love.

These themes are then made sense of by drawing on the narrative framework categories of the medical sociologist Arthur Frank (1995), who identified a typology of four kinds of “illness narratives”: chaos, restitution, journey, and witnessing. These were seen as guiding metaphors organising patients’ experiences around a theme. Shapiro, in utilising Frank’s narrative-based typology, then imposed narrativism on poetry, whether or not the original poetry was written in a narrative or non-narrative style. Poetry was given no room to exert its unique character where it was deformed into narrative, and further reduced to data or information.

More, the overall message of the book is that students write poetry instrumentally – the poetry is put to use. That it is put to “use” is one contentious argument; how it is put to use is another – in Shapiro’s analysis, the point of poetry is to fulfil the requirements of Frank’s four illness narrative types where the students’ poems supposedly describe: (i) making meaning of chaos; (ii) restitution for something lost; (iii) illness as a journey; or (iv) acts of witnessing. Shapiro (ibid.: 41) sees overlap between these categories, but claims that “[M]ost of the poems that I reviewed made sense within these Frankian-influenced narrative typologies”. Thus, the typologies were not inductively drawn out from the data, but the pre-existing typological framework was used as a classification and meaning-making device. In the process, all poetry was made to go through the narrative mill. A product of this reduction from raw poems to categorical types is the boiling down of wide metaphor content, where Shapiro (ibid.) says, “[T]wo overarching metaphors dominated my conclusions”. To wit, illness described as a “foreign land” and coping with illness as an “heroic journey”.

As poets, we find this worrisome. As scholars, we appreciate the work done in classification and yet return, inevitably, to the misframing. Shapiro’s work is conducted according to a misapprehension of what non-narrative (primarily lyrical) poetry is and what it does. Was no poet or poem available to tug the robe of this confident narrativist to whisper, Memento Mori?

We will see many more examples of poetry being used for instrumental purposes (as Shapiro advertises above) throughout these opening chapters as we gradually lose the poetry itself to data, used to supposedly “improve” our understanding of medical education. But wait, there are bigger blows: Shapiro’s data may be untrustworthy for we do not know how representative this sample is of gender and ethnic mix among medical students, and it is obviously North American-centric. Such medical students’ poems represent a privileged source. While Shapiro’s brief is not to look beyond the poetry, foregrounding this does remind us of the need to highlight minority, suppressed and excluded poetic voices. To merely stuff the students’ poems into the Western canon box advertises a missed opportunity.

More, the medical students’ poetry is technically suspect (we illustrate this with examples later). The cynical side of us rejoices at this milling of suspect poetry into data: better to have good information than questionable verse. Not all of Shapiro’s examples are poorly conceived or crafted, but, as Shapiro (ibid.: 44) herself admits, “[I]t is true that much of this writing is imperfect, unpolished, lacking in formal craftsmanship, and does not appear to pay attention to the formal structural or rhythmic conventions of poetry”. In defence of such paucity, Shapiro (ibid.: 45) quotes Gillie Bolton, once a key figure in UK medical humanities circles, who says, “poetry does not have to be great so long as it is useful to the writer and to an appropriate audience”. Hmmm – we baulk at the mention of “useful” in this context, and cannot agree that it is a good excuse for potentially poor verse. Indeed, we strenuously disagree. Would we use the same framework and terms to describe a doctor or surgeon’s work?

We wince in a familiar fashion when we read Bolton’s predictable invocation of “useful”: poetry is useful for what? Bolton leaves that question wide open. At least Shapiro brazenly says that poetry has an instrumental use to “improve” the perceptions of medical students. But again, of what use is poetry? Presumably, for those relatively few publishers who make a profit out of selling poetry books, poetry is useful for making that profit, and constitute the rare instances when poetry becomes commodity. Perhaps, for many of the medical student poets that Shapiro or Bolton refer to, poetry is not central to their lives and they could take it or leave it, so poetry serves a decorative function. For Bolton and Shapiro, poetry has therapeutic value. Not one of these justifications appeals to us.

We do recognise that relationships to poetry are multiple and complex. Some will say that poetry saved their lives, where others will say that it ruined theirs. Seamus Perry (2019) writes of the Scottish poet W. S. Graham, who re-located in the far West of Cornwall: “Many poets end up having a hard life but W. S. Graham went out of his way to have one. His dedication to poetry, about which he seems never to have had a second thought, was remorseless”. And yet, by his own admission, Graham was slowly drinking himself to death. In a posthumous address to his near neighbour, the painter Peter Lanyon, Graham said of his alcoholism: “The poet or painter steers his life to maim // Himself somehow for the job”. Graham couldn’t live without writing poetry, but couldn’t write poetry without drinking, so poetry did not act as therapy at all, but was complicit in self-harm.

The Indian poet and scholar Meena Alexander says that poetry is the primary art form for “the essentially unsayable”, but we do not buy into poetry as unreachable, or even necessarily revelatory. We like the fact that poets are baldly and boldly political, like Linton Kwesi Johnson (from the album “Bass Culture” 1980), the Jamaican dub poet and activist based in London, commenting on police harassment of black people:

Hours beat, the scene moving right

When all on a sudden

Bam, bam, bam, a knocking pon the door

“Who is dat?”, asked Weston, feeling right

“Open up, it’s the police, come on, open up”

“What address do you want?”

“Number 66, come on, open up”

Weston, feeling high, replied, “Yes, this is Street 66, step right in and

take some licks”.

The poetry, of course, is performed (as a dub song: https://www.youtube.com/watch?v=UnAV1Ec4Z9M) that adds a critical dimension. In the subsequent age of Black Lives Matter, antagonism between black communities and the police, the front line of institutional racism, has been exposed as part of a complex health issue. Since the beginning of the Covid-19 outbreak in the UK, for example, black and ethnic minority groups have lower life expectancy than the white population (The King’s Fund 2021). Social deprivation, inequalities, and injustice are major factors in susceptibility to Covid, and lowering of life expectancy. Stop and search by UK police is heavily biased against black communities (Gov.UK 2021).

So poetry, indeed, can have an instrumental function in representing oppression in order to contest or resist oppression. Poetry, of course, can be of use, and can be operationalised. But it must also have the useless valence in play, an optional-applied rule at play at all times. Otherwise it dies. At the level of politics poetry is about the political relation and not ideology, or necessarily resistance. Poetry helps one to see and feel, perhaps to understand more, if not perfectly, than to afford a deeper imperfection; and in this affective identification, one creates in oneself the inapplicability of the oppression, the resistance condition. In short, poetry is transformative, but through and by indirection.

Clearing out the interruptions to poetry

It is bad enough that poetry’s appearance in terms of scope might be frustrated by certain kinds of privilege. But do committed literary scholars really need to keep frustrating the appearance of poetry in full expression through tactics such as “tired” instrumentalism (poetry serves a purpose other than its full expression as an art form, where its cumulative work is reductive of surprise, complexification, meaning, or defamiliarisation of the familiar), and narrative oppression (poetry is subsumed in narrative). For example, returning to the Program in Narrative Medicine at Columbia University, Rose Bromberg (2008: 63), then resident poet, wrote, “There’s a special relationship between poetry and medicine, and great value that physicians, other healthcare professionals, and patients could derive from making better use of this art form”. Thus, poetry gains value by putting it to good use in medicine. But what about stand-alone poetry and not poetry as springboard?

Bromberg then suggests what poetry can do, advertising naked instrumentalism: “Poetry can sharpen listening, attentiveness, observation, and analytical skills. It can refine the artistic side of medicine: Poetry allows us to express ourselves, fosters creativity, and accepts ambiguity. It enhances empathy, self-awareness, and introspection”. Poetry too is therapeutic, cathartic and is about personal growth, for which Bromberg makes big claims:

Poetry about illness includes addressing not only the symptoms of illness, but the experience, which includes emotions and responses. We use various ways to share and validate our physical, emotional, intellectual, and spiritual perspectives, commonly through written and spoken language. The way we perceive and use poetry devices, for example: diction, tone, voice, organization/arrangement, meter/rhythm; the interactions and physical and emotional spaces/silences between the healthcare professional and patient or between the poem and reader, helps us to define and interpret ourselves and others, and to direct thoughts, feelings, and actions. Communication thus improves. Changing the cadence may influence healing and even outcomes.

And, predictably, poetry is drawn into the maw of story, controlled by the narrative gaze in personal-confessional and identity-constructing mode: “The poetic voice orders thoughts and allows for control, clarity, and reflection. It shapes our past narrative, and how we may construe our future narrative”.

If we chip away at this claim by exposing brazen instrumentality and the narrative tic, two of our bugbears, poetry itself is left with nothing. Bromberg offers “an example of a brief poem I wrote to express relief and provide comfort after an unpleasant medical experience”:

SERENITY

White

water lilies

float

atop the pond;

a petaled quilt

to keep

me

warm.

We have empathy for Bromberg’s unpleasant medical experience, but less for the poem itself, again used as a directed and specific self-therapeutic instrument (means-end writing) rather than for the sake of poetry. The haiku- like feel of the poem takes on none of the challenges of the haiku form, although that is no great offence; we are surely in the presence of the spirit of haiku, an identification that we are pleased to make. There is formal awaren...