Mental illness and the Health Professional, A story of my mother the psychiatric nurse

Always a Nurse

Cheryl L. McLean

Delivered as part of the keynote address to the Alberta Psychiatric Conference
Banff Alberta 2014

My mother who is now 85 had been the  head nurse at a geriatric ward at our city psychiatric hospital (previous know as an asylum for the insane)  in Southwestern Ontario for over thirty years.  She started her career in geriatric care  as a nurse in 1952  and worked her way through the 50's, the  60's and 70's, through the days of  electroconvulsive therapies ,  lobotomy surgeries, insulin shock therapy,  strait jackets, restraints.  One of my mother's many assignments was to  dispense medications like tranquilizers and phenobarbital to 450 older patients twice daily on five wards.  Many of her geriatric patients lived out their later lives and  died in hospital.  My mother was proud of her nursing job.  When I was a girl of  fourteen and thinking about nursing as a career myself she drove me to her hospital, turned off the main street  past the grassy fields  and up the shaded tree lined road and down the curved driveway leading to that big old building.

 I met her patients.   They told me their stories.  Some were very interesting.   One elderly lady said she was friends with a "gangster" named "Duninger"  who, she said,  went everywhere with her. 

Mom made sure she kept the staff and the ward together.  But there were serious troubles at home.  Mom worked late most nights and always took her work home with her, sitting at the kitchen table, draining the coffee pot, coughing and chain smoking Export A's while trying to get her time slips done, couldn't sleep at night, was  worried about how to cover for staff  when attendants said they were sick or took time off.  Then one day  she just stopped talking, wouldn't eat, went to her bedroom, turned off the lights and shut the door.  But somehow even through these  darkest of times  she managed to get up in the morning at 5:00 a.m., still got the car started in the dead of winter and  made it in...on time,  to work. My mother, an attractive woman,  always concerned about her appearance, her hair, her makeup, was  meticulously, even compulsively neat.  We knew there was something terribly wrong when she started falling asleep in her uniform...  One sleepless night while fighting yet another migraine headache she cried out, "What's the use?"   Yes, she had her nursing friends,  but most of the time she tried to make it through these dark times alone.  Mom would never have admitted she had a mental health issue nor that was depressed.  You just didn't talk about those things.  She was a psychiatric nurse, and proud of it., she cared for patients with mental illness, consoled the families when their loved ones passed away. Her staff came to her when they were depressed,  to solve their problems.  She was praised by the psychiatrists  for her meticulous attention to detail and  tireless  dedication to her job and her patients.   My mother wasn't just a nurse.  Nursing was my mother.  As I reflect now in this writing  years later I see now that  my own mother, herself a professional working in mental health,  suffered with depression, the  classic DSM  indicators of major depressive disorder but, according to my mother she wasn't sick...she was fine.  It was her job as a psychiatric head nurse to keep in all together at all times,  to keep everything under control.   

  For more information about Cheryl L. McLean keynote presentations CherylMcLean@ijcaip.com
http://www.cherylmclean.com

An Ethnodrama about Aging, Mental Health and Autonomy

Excerpt from the article "Remember Me for Birds, An Ethnodrama about Aging, Mental health and Autonomy by Cheryl L. McLean

from the book Creative Arts in Humane Medicine, Editor Cheryl L. McLean

Brush Education, Edmonton

(dist. by University of Toronto Press)


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The use of narrative in health has made significant inroads, particularly in narrative medicine, an approach pioneered by Rita Charon (2008) , who has long advocated the use of narrative in medical education to honour stories of illness. Others have written about performative forms of narrative such as Sociologist Norman K. Denzin (2003) who established the connections between research inquiry, writing, narrative and performance ethnography. Denzin explains performance is an act of intervention, a method of resistance,a form of criticism, a way of revealing agency: “performance becomes public pedagogy when it uses the aesthetic, the performative, to foreground the intersection of politics, institutional sites and embodied experience” ( Denzin, 2003 , p. 9).

 

Ethnodrama, a qualitative approach considered a form of ethnographic theatre, is an emerging genre, an embodied and multisensory form of research that has much to offer both education and health care. Saldaña (2011) offers further insight with a definition of ethnodrama:

 

An ethnodrama … is a written play script consisting of dramatized, significant

selections of narrative collected from interview transcripts, participant observation,

field notes, journal entries, personal memories/experiences and/or print and

media artifacts such as diaries, blogs, e-mail correspondence, television broadcasts,

newspaper articles, court proceedings and historical documents. … Simply

put, this is dramatizing the data. 1 (p. 13)

 

 

If there is one overarching feature that distinguishes ethnodrama as a research-based art form from fictional dramatic plays, it is that the performance is about true stories.  

 

 Drawing on my writing, acting (Stanislavski (realism) influenced approaches) and arts based research experience and considering the challenges and goals of the inquiry,  I believed the best way for me to foster empathy and raise awareness about aging, mental health and autonomy was to write and act in a solo performance based on research and client stories. The performance, eventually called, "Remember Me for Birds" would be staged for health care workers and those who worked in gerontology. Dr. Muriel Gold, formerly the Artistic Director of the Saidye Bronfman Theatre in Montreal, agreed to direct the performance and offered invaluable feedback during the creative process.

 

I engaged in a rich creative exploration well  before writing the script.   I immersed myself in tactile fact-gathering that started with my creating a floor collage. The collage began as a few newspaper articles and photographs and developed over time to  include client photos; line drawings of clients; client art and stories; case studies, transcripts and videotapes; ditties and songs about growing old; and found objects from the dining room (such as resident dinner menus, spoons, bowls and salt and pepper shakers). This collage became my creative centre, a place for tactile multidimensional construction where I distilled and assimilated materials identifying issues of importance, among them transportation, food, support in crisis, diagnostic labeling, effects of past traumas, environmental triggering and relocations. Early in the process I used the collage to identify common themes, which I indicated in bold lettering across articles and photographs. I would at times contrast one issue with another, historical accounts with newspaper articles, seeking patterns in events past and present. Some of the found objects from the collage eventually became part of the set or were used as props during the performance. The spoon, for example, was one object particularly imbued with metaphor in this piece.

 

I sought to learn as much about my clients as possible, compiling detailed field notes, conducting one-on-one interviews, recording oral histories, taping selected therapy sessions, reading topical community-news stories, attending team meetings, talking with social workers and consulting journals of gerontology.  I got to know the social workers, the staff and the building superintendent, attended social gatherings, shared in music performances and enjoyed lively conversations on park benches. The older people in the resident community shared their stories through participating in interviews and oral histories and when they engaged in story-making during our drama and therapy sessions, as well as when creating visual art and poetry. They were aware they would be the inspiration for a performance and offered their stories willingly to help others.  To protect individuals’ identities, I did not use actual names, nor did I specify locations in the final script.   In some cases I would use compilation characters to convey the stories.

 

 The monologues for  the ethnodrama  Remember me for Birds were constructed to lend voice to older people’s issues and included local stories in the context of the resident environment contrasted with events shaped by personal histories.  I used the research information I gathered, much of it from working directly in the field, in my monologues, which made up the ethnodrama script about real-life issues affecting autonomy and mental health.

 

 I had set out in my research to create a performance based on true stories and lived experience that would raise awareness about autonomy and mental health by re-illuminating stories people working in health care experience every day in their work in aging and health. If I could not, in an immediate sense, bring people to action, I hoped through this performance to transform the way people think about older people. This was, I believed, where change would begin: in care that would contribute to quality of life from day to day for people at home, in residential care or in long-term-care facilities. It might also help in reforming health care policy that can have a direct bearing on well-being, autonomy and consequently the mental health of all those whom the system should be adequately designed to serve. After all, some 40 million people in the United States are currently age 65 or older, and this number is expected to climb to 89 million by 2050.

Active and performative research methods and the use of storytelling in health  have much to offer education and offer new ways for medical educators, students and others in the allied health professions to learn about aging and humane medicine. Through performance and what the arts can offer, caregivers have the opportunity to develop greater awareness, empathy and understanding, which could improve quality of life for us all.

It is, I believe, an offering of hope that we should treasure and hold on to very carefully.


Reading:


Denzin, N.K. (2003), Performance ethnography, critical pedagogy and the politics of culture, Thousand Oaks, CA:  Sage Publications,.
Saldana, J. (2005), Ethnodrama:  an anthology of reality theatre.  Walnut Creek, CA:  Altamira Press.

 

The full article can be found in the book Creative Arts in Humane Medicine.  For more information

or to order this book contact http://www.brusheducation.ca/books/creative-arts-in-humane-medicine


  http://www.cherylmclean.com

 

 

 

Arts and Psychiatry, Meeting the Challenge of Change

Living Stories of Hope and Change

Meeting the challenge of change through the arts in medicine

Keynote:  The Alberta Psychiatric Association Conference, Banff, Alberta
March 28, 2014, Cheryl L. McLean
CherylMcLean@ijcaip.com

______________________________________________________________

This article features a few very brief excerpts from the recent keynote presentation, Living Stories of Hope and Change.

 

 "The business of art is rather to understand Nature and to reveal her meanings to those unable to understand. It is to convey the soul of a tree rather than to produce a fruitful likeness of a tree. It is to reveal the conscience of the sea, not to portray so many foaming waves or so much blue water.    The mission of art is to bring out the unfamiliar from the most familiar."Kahlil Gibran

 This is a presentation about meeting the challenges of change through the arts in medicine.  In this talk,  I want to show how living stories, or personal stories, stories of lived experience,  particularly those written and performed for public witness, might lead to hope and change for the practitioner and the patient.    There are two key questions I will address: The first question,   How can the creative arts be used for my own personal wellness?   I will share with you research as well as  personal stories and performed  illustrations of the work (that I will weave in and through this presentation) to show how living stories have been healing in my own life and in the lives of others and to suggest how they might be healing for you.   The second question,  How do the creative arts in medicine help practitioners, (especially psychiatrists) enhance clinical and relational skills? I will share with you topical research and evidence and  relate performance examples to skills in psychiatry and offer other specific ways the work links to skills in practice.

 I understand many psychiatrists (the healers of the soul)  enter psychiatry as a profession  because they are interested in helping those who suffer and are in need of healing, opening the door to human understanding.  You want to know why people behave the way they do, you want to use your considerable education and skills to help people be well, you want to restore balance and quality of life to those you care for.  Among you today will be those who  commonly deal with issues around depression, anxiety, paranoia, and /sex abuse...

 Many psychiatrists  have themselves seen what it is to live on the other side of the door, they may know, through lived experience, through their fathers, their mothers, their aunts and uncles what abuse and alcoholism is, some have suffered devastating personal losses of those closest to them, many have grown up with family members who have lived with depression and other mental illnesses.   

Research shows that doctors, in general, are at greater risk for depression, mood disorders and suicide and psychiatrists, according to The American Psychiatric Association, commit suicide at rates at about twice that of other physicians.  Dr. Michael Myers, Professor of Clinical Psychiatry and a leader in physician health and wellbeing  also stresses deeply depressed physicians still feel the effects of the stigma of mental illness. 

Meeting this challenge of change for your patients and your profession,for your health and your wellbeing, I believe can be achieved through sharing your stories and the stories of others to help counter stigma and break the silence with your voices in creative communities of love, support and common connection.  There is where hope can be found and where the change can begin.

 EVIDENCE

"In the US, a recent study found that over half of all US medical schools involved the arts in learning activities (Rodenhauser, Strickland, & Gambala,2004). This survey found that the arts are used to foster student well-being,enhance teaching and learning, and improve clinical and relational skills, for example, observation and  reflection and insight."

There are many illustrative examples of the arts in research and in medicine in the book "Creative Arts in Humane Medicine" .   Among the topics, teaching empathy through role play and fabric art, visual arts in dental education, drama for patient communication, reader's theatre and sharing experiences of caregiving, music for practitioner self care and narrative as a reflective process in the illness experience among others. 

Dr. Rita Charon at Columbia University, New York, a pioneer in the field of narrative medicine and founder of the Narrative Medicine program at Columbia has long advocated for the value of sharing stories of medical practice, of reading and writing stories, of attentive listening, reflective writing, and bearing witness to suffering.   

Dr. Arthur Frank  has written extensively about illness narratives.  He encourages people to tell  stories to reflect and help make sense of their suffering.   He believes when illness can be transformed into story this can be deeply  healing.   Other medical educators  like  Dr. Johanna Shapiro, Medical Education, University of California School of Medicine,  who does qualitative research on patient narrative and the doctor-patient relationship with a focus on  communication skills, literature and medicine, believes theatre performance, as well, can provide opportunities for medical students to identify with imagined roles and situations as viewers or participants.    

I have special research interests in  narrative and  ethnodrama which is a form of  performance based qualitative research. While doing graduate work at Concordia University in Montreal I also worked as a drama therapist associated with an Over 60 mental health programme.   I wrote and acted in the ethnodrama  "Remember Me for Birds" based on this research and client stories.   Ethnodramas have been written about communication between physicians and cancer patients, nursing  and home care, stigma and HIV/AIDS, alcohol and drug abuse, schizophrenia, death and loss and eating disorders, for example.

How can such work be healing for the practitioner?

I have personally found that writing and embodying the stories was a transformative and visceral form of learning and healing, a deeply transformative process of self discovery whereby one can explore and re-experience  the personal links between self and family history and the common connections between themes that arise in client/character  stories and themes in one's own life.  For example, it was through my own work in the creative arts and living story that I discovered survival was an important theme in my personal life, as it had been for family members and the many characters  in my performances.

How might the creative arts in medicine help practitioners enhance clinical and relational skills?

Empathy is a key relational skill in clinical practice.  The arts can help foster empathy.

  A study through Thomas Jefferson University has been able to quantify a relationship between physicians' empathy and their patients' positive clinical outcomes, suggesting that a physician's empathy is an important factor associated with clinical competence.

Jodi Halpern, a psychiatrist and professor of Bioethics and Medical Humanities at The University of California, Berkeley, claims that empathy requires experiential not just theoretical knowing. The arts and drama are particularly effective, she reports,  as a means of active and embodied learning and knowing.  

Embodying the living story through an experience with the arts can foster a sense of having being there, to see as another sees,  bringing about  the miracle of empathic connection that Henry David Thoreau refers to in the quote;  "Could a greater miracle take place than for us to look through each other's eyes for an instant?"  

 Empathy is good for practitioner wellness  and important  in the physician patient relationship.   The processes we are referring to, the capacity to read, write and share complex, fully embodied stories, foster great empathy for the patient or client as well as ourselves as we connect closely on an embodied and emotional level while becoming increasingly attuned to our own corresponding issues and themes.  

 There is a  transformative learning  process taking place for practitioners in writing such  narratives and performing living stories.  As well, the audience may learn more about human experience as they witness historical or past events and the present within a performed context. As an audience member witnessing a living story we can see the NOW more  contextually and observe the WHYS in action

 I have presented numerous examples of narrative, story, poetry and monologue in this presentation  that have shown how these creative forms of self expression have been healing for the practitioner.    Sharing your personal story for witness  can be a validating  act of self compassion and love.  Self-compassion that can help protect against anxiety and promote psychological resiliency. We can meet the challenge.  Countering   stigma through sharing our living stories we can break the silence and open the way for others to share their stories.


 
Cheryl McLean  is an educator, publisher, author and speaker.  Editor, Creative Arts in Humane Medicine, published by Brush Education (dist. University of Toronto Press) and
the books Creative Arts in Interdisciplinary Practice, Inquiries for Hope and Change, Creative Arts in Research for Community and Cultural Change.

 For more information:  website:  http://www.cherylmclean.com
email:  CherylMcLean@ijcaip.com

Reviews Creative Arts in Humane Medicine

 

October 5, 2013

We are pleased to share with you the following advance reviews for the book, "Creative Arts in Humane Medicine".





see all recent reviews and Table of Contents  at Brush Education, publishers' website:


http://www.brusheducation.ca/books/creative-arts-in-humane-medicine


others:

"Creative Arts in Humane Medicine takes us on a fascinating journey to meet the educators, clinicians, support workers and artists who apply arts-based methods in innovative ways to enhance patient care, reflexivity in learners and a sense of community, and well-being in practitioners. The book stands out with an emphasis on multiple media (theater, music, visual and digital imagery, literature and reflective writing), as well as the inclusion of international and interprofessional perspectives."

Allan D. Peterkin, MD, FRCPC, FCFP -- Head, Health, Arts and Humanities Program and Humanities Lead, Undergraduate Medical Education, University of Toronto

"Some have said that medicine, rather than being a science, is really an interactive process. It is informed by science but also dependent on psychology, sociology, philosophy, law and human creativity. McLean’s book should be a must read for those responsible for medical education...so that in the end the human connection between healers and those they heal is enhanced."

Michael Gordon MD, MSc, FRCPC -- Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto

"Cheryl McLean's Creative Arts in Humane Medicine is a fascinating collection of essays that evocatively illustrates the importance of literature, music, photography, and art in facilitating self-care and awareness among health care providers, training empathetic physicians, and improving patient care."

Martin Donohoe, MD, FACP -- Author of Public Health and Social Justice (2013)

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"Creative Arts in Humane Medicine is a graceful and important book that offers a groundbreaking, inspiriting engagement with issues such as empathy, empowerment, ethics and evidence, explored by a rich cast of inter-professional authors such as artists, educators, clinicians, and researchers. Through a collage of creative arts methods and messages, these authors illuminate the essence of the “human story of health care” as loving, healing and humanly embodied—an essential message in an era of highly institutionalized technical health care. A must read for academics, researchers, clinicians, and students interested in creative healing arts, narrative health and humane medicine, or for anyone interested in the application of reflection and curiosity, creative expression and arts-based methods to the field of healthcare."

Sue MacRae -- Registered Nurse, Clinical Ethicist, Psychotherapist, Former Deputy Director University of Toronto Joint Centre for Bioethics         

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Available NOW! for order in hard copy and ebook formats.

Heartfelt thanks to a creative team!

Distributed by University of Toronto Press

This publishing project  has been a year in the making and it has been a busy month working with the team at  Brush Education on last minute editing details for our upcoming book Creative Arts in Humane Medicine which is expected to be released in October.  As Editor of the book, Creative Arts in Humane Medicine,  I have been fortunate to work with some of the best editors in the Canadian publishing industry among them, Brush managing editor, Lauri Seidlitz and copy editor par excellence, Leslie Vermeer.  I want to extend heartfelt  thanks as well to our talented cover designer Carol Dragich of Dragich Design  (an important feature of our unique cover is the photography /artwork "Peace of Heart"  by medical student and photographer  Cyrus McEachern, which was featured in  the Heartfelt Images exhibit at the University of British Columbia, Cardiology.) Our creative cover is, in itself,  another fine example of the arts and medicine in action.  CM

Touching the Heart of What it is to be Human

Distributed by University of Toronto Press

Press Release, 
July 21, 2013
International Journal of the Creative Arts in Interdisciplinary Practice


Creative Arts in Humane Medicine 

Book touches the heart of what it is to be human

Cheryl L. McLean

Creative Arts in Humane Medicine, Editor, Cheryl L. McLean, Published by Brush Education,  is a resource book for medical educators, practitioners and students as well as those in the allied health professions who wish to learn how the arts can contribute toward a more caring and empathic approach to medicine.  

In this collection, which features the latest research and real life examples, physicians, medical educators, researchers and allied health professionals, as well as medical students, residents, artists and others across Canada, the United States, United Kingdom and Australia show how the arts in action can contribute toward humane medicine.

To be humane is to show empathy or understanding and to care about the condition and suffering of others, to treat others as we ourselves might wish to be treated.  The word medicine itself is from the Latin “ars medicina” refers to the art of healing, the practice invested in the treatment and prevention of illness. Humanistic Medicine is a growing trend today as more medical professionals integrate the arts into their practice to improve communication with their patients and build better relationships.  A recent study found that close to half of all medical schools in The United States  involved the arts in some form in learning activities(Rodenhauser, Strickland, & Gambala).This survey showed that the arts are used to foster student well-being, enhance teaching and learning, and improve clinical and relational skills,for example, observation and diagnostic skills, reflection and insight.

There are other encouraging signs that the arts are alive and thriving in medical education today with programs integrating the arts and humanities into medical education and leading medical schools and universities offering more programming to promote creative and scholarly work at the intersections of the arts, humanities and medicine.  One Canadian effort, the Medical Humanities HEALS Program at The Faculty of Medicine, Dalhousie University, offers programming in visual parts, performing arts, the history of medicine and creative writing.  Another, The Arts and Humanities in Health and Medicine Program at The Faculty of Medicine and Dentistry at The University of Alberta,  launched in May 2006,  has a mandate to balance scientific knowledge and compassionate care.  Its mission statement formally acknowledges “the explicit recognition within the Faculty that clinical practice is both an art and a science”.  At The University of Toronto, the Undergraduate Medical Education (UME) program,  has begun to integrate different types of narrative systematically into the curriculum with a new companion curriculum.

At Yale School of Medicine, The Yale Medical Humanities and the Arts Council reports it is committed to fostering the use of the humanities, social sciences, and the arts as a lens for examining issues in health, medicine, and healing. Arts and Humanities at Harvard Medical School aim to promote the role of the humanities in medical education, clinical care and research. Stanford School of Medicine, Arts, Humanities and Medicine, has been established to promote creative and scholarly work at the intersections between the arts, humanities and medicine.

And there is growing support for the creative arts in humane medicine today coming from the medical students themselves.  The AMSA (American Medical Students' Association)  has over 150 chapters in medical schools across the United States and an estimated  350 pre-med chapters. Aliye Runyan M.D.,  Education and Research Fellow, American Medical Student Association, reports , The AMSA  Medical Humanities Scholars' Program exposes students to lead faculty in narrative medicine, humanities and the arts as they explore reflective capacity, communication, self care and the art of listening to their patients' stories.  "AMSA,"  Runyan writes, “believes it is paramount that the physician not only be a scientist but a humanist, a communicator and an advocate.”

I was recently a guest presenter for a webinar for The American Medical Student Association’s Medical Humanities Scholars’ Program.  During the session a student asked, “If this work (about the creative arts in medicine) is frequently about empathy and feeling the human story, how much empathy is too much empathy?  What if I can no longer bear it?” The student asked me a very difficult question, one not easy to answer.  Our creative work is powerful and profound in the way it frequently uses all the senses to foster empathy and  draw us closer to human understanding, but what are our human limits?  If I were in bed, ill and fighting for life, I asked myself, how much empathy would I hope my caregivers would extend to me?  When would enough be enough?   This collection raises provocative questions and proposes alternative approaches  in the hopes of inspiring new areas of investigation while opening up a larger conversation about the creative arts in medicine among students and medical practitioners.

The book, Creative Arts in Humane Medicine has been divided into four distinct and related sections.  Section 1, “Educating for Empathy through the Arts”; Section 2, "The Arts in Medicine and Practitioner Self Care" ; Section 3, "Navigating with Narrative Through Life Experience" ; and Section 4," The Creative Arts in Action for Change in Health".

Section l,  Educating for Empathy through the Arts, opens with special attention paid to the overriding theme in this collection, that of care and  fostering empathy through varied arts methodologies.  We begin our book with visual art as the focus as Andre Smith and his research team at The Department of Sociology, University of Victoria, demonstrate an innovative pedagogical approach using fabric art for teaching empathy with end-of-life health care providers.  Similarly, in my own article that follows, I share the process of creating an ethnodrama to raise awareness about aging, mental health and autonomy and discuss how writing and creating a performance based on research led to greater empathy and human understanding.  In his opening essay, Craig Chen MD, an anesthesiology resident at Stanford University Medical Centre, supports the view that the arts and humanities can bring about understanding about  illness and disease.    He explains,  

 “It is not easy to go to work every day and care for people who hurt themselves, are going to die, cry on your shoulder, feel terrified or distrust the health care system…The arts and humanities, with respect to medicine, are about understanding how humans experience illness and disease and placing that within a context of diagnosis, treatment and care”.   

The section’s closing paper by researchers Mina Borromeo, Heather Gaunt and Neville Chiavaroli,  from the Melbourne Dental School, explores the visual arts used in education for increasing observational skills and understanding as students are guided through the rediscovery and re-appreciation of  human responses as it applies to  Special Needs Dentistry.

In Section 2, The Arts in Medicine and Practitioner Self Care, we examine some of the daily challenges of working in medicine and the human realities of illness, disease, aging and death and how the arts can offer healthy opportunities for practitioners to deal with stressful situations while  addressing  their own self care needs.  Alim Nagji MD,  who is also an actor, producer and writer, stresses that teaching people to understand their patients stories must begin early in their training before the erosion of empathy.  Nagji believes using theatre in medical education for “performative reflection” can help students delve into the character’s back stories drawing parallels between those experiences and their own.  In the article that follows, Maura McIntyre’s arts informed research, part of the growing genre of performance ethnography, offers caregivers and others an opportunity to participate in reader’s theatre so that they might experience real stories of nursing home life.  Craig Chen MD informs us about the importance of providing health professionals and others a place for self expression through varied forms of  performance.  At Stanford,  medical students had a vital opportunity for expression and community connection through performance while audiences learned more about what it is like to work in the field of anesthesiology.  In the next article, Rachael Allen, an Artist in Residence (AIR) at university anatomy and clinical skills laboratories in the North East of England, writes about her work witnessing students engaged in lab work with prepared prosections of embalmed and plastinated specimens and believes it is fundamentally important for health and humane medicine that students working in anatomy labs are offered opportunities to express these intimate human encounters through art. Allen offers new and sensory approaches to anatomy and clinical studies while artistically rendering the undergraduate experiences of medical students.  Forms of art therapy for caregivers and varied modalities for healing  are also discussed in this chapter.   Music therapy has long been recognized as being effective for self expression and healing and, as Amy Clements-Cortes demonstrates in her article, music therapy in many forms can also help address stress and other issues for those working in palliative care settings. In other programs expressive approaches have also proven useful for healthcare practitioners as is presented in the article by  Diane Kaufman, MD and her team at The  University of Medicine and Dentistry of New Jersey.

Contributors present  personal stories and engage with narrative in Section 3, Navigating with Narrative Through Life Experience, as well as demonstrating  the applications of literature in medical practice.  Dr. Rita Charon, a leader in the field of narrative medicine,  has long advocated for the use of the narrative in medical education.  Each of our contributors navigate with narrative or use story in uniquely different ways, however, all writers in this section share in common an underlying belief about the humanity and dignity that can be found through fostering the practitioner patient relationship. Jasna Schwind, a nurse educator, writes about her work, informed by narrative inquiry while sharing aspects of her own illness story to demonstrate how intentional and thoughtful reflection allowed her, as both patient and caregiver, to make sense of the experience. Narrative and poetic inquirier, John J. Guiney Yallop,  writes in the article that follows, about his lived experiences over time with medical practitioners and, in so doing, poignantly illustrates the importance of the relationship between practitioner and patient.   Catherine L. Mah, MD, FRCPC, PhD a scientist, practitioner, researcher, and teacher discusses in her article the uses of literature and the childhood novel in pediatrics practice suggesting the approach  may help establish  a foundation for narrative examination in the one on one interview.

In Section 4, The Creative Arts in Action for Change in Health  we embrace change and the future opening with an exploration by Louise Younie,  a Clinical Senior Lecturer, Barts and The London School of Medicine and Dentistry, who writes about her journey of discovery through arts based inquiry and considers the transformative influences of  the arts  in medical education as well as within her own work. In the next chapter Canadian activist artists Carole Conde and Karl Beveridge are featured demonstrating the arts in action for change and the power of story and photography to touch people and advocate for humanity for those  who work in healthcare settings. Bandy X. Lee MD at Yale University believes that today there is a great need for collective and emotional healing. She reports The World Health Organization has noted that health is not just the absence of disease and, in terms of change, effective violence prevention may be the key to health and human flourishing and creativity.  Louise Terry PhD PGCHE LLB illustrates how digital stories and technology can help teach ethics and law to health and social service professionals while contributing to humane medicine.   Visual and audio technologies, she suggests, help realize and bring to life our human stories complete with actions, omissions, aspirations and values.

Our chapter closes with an exhibit from the heart as medical and fine arts students from The University of British Columbia, Canada, reach out and build bridges to understanding health and the heart while connecting to communities through the visual arts.

This is an educational  book in which, through creative processes, we  feel the human story, touching the heart of what it is to be  human in others while attentively loving and caring for ourselves…not only surviving but thriving as humane practitioners in our lives and work.  I invite you, through this book  to read, to engage and to actively learn through these chapters about the creative arts in humane medicine. I believe you will find, in keeping with the embodied nature of our field, each article unfolds in its way as a story, a revealing performance about life, a creative act within itself.

The book, Creative Arts in Humane Medicine will be released October 2013 and can be ordered through Brush Education.  

Brush Education is distributed by University of Toronto Press

  For information about presentations see keynotes:  

http://www.cherylmclean.com/keynote-information.html

 To contact the editor directly at  CherylMcLean@ijcaip.com