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

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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

The Arts Alive and Thriving in Medical Education

C. L. McLean, Publisher IJCAIP


It has been reported that the use of arts and humanities in medical education may help develop observational skills and enhance understanding of the human condition. Programs integrating the arts and humanities in medical education continue to flourish and gain momentum with leading medical schools and universities offering programming such as Stanford School of Medicine, Arts, Humanities and Medicine, established to “promote creative and scholarly work at the intersections between the arts, humanities and medicine in order to enhance understanding of the contextual meanings of illness, healthcare, and the human condition”,  and The Centre for Medical Humanities at Durham with a research programme organized around five research clusters,  Imagination and Creativity; Practice and Practitioner; Policy Politics Collective; Transfiguring and Mind Body Affect.
 

 

In Canada, Dalhousie University, Halifax, Humanities in Medicine, offers five core initiatives: History of Medicine; Narrative Medicine (oral storytelling film, mass media, and literature); Music; Spirituality; and Visual Arts. The Arts and Humanities in Health and Medicine Program at the University of Alberta was launched in May 2006. The program is directed to engendering a balance of scientific knowledge and compassionate care with a mission statement that formally acknowledges “the explicit recognition within the Faculty that clinical practice is both an art and a science.”

The arts are alive and thriving in arts and health and medical education today, offering opportunities for learning and a place for self expression and healing. A leader in the field of Narrative Medicine, Dr. Rita Charon, Professor of Clinical Medicine and Director of the Program in Narrative Medicine at Columbia University has long advocated for the use of narrative in medical education to honour stories of illness. Dr. Arthur Frank, Professor of Sociology, University of Calgary, and author of “The Wounded Storyteller, Body, Illness and Ethics”, writes about the meaningful uses of storytelling for those experiencing illness, “The personal issue of telling stories about illness is to give voice to the body, so the changed body can become once again familiar in these stories.”

In issue 8 of IJCAIP Journal, IJCAIP, http://www.ijcaip.com, "Physicians Speak Out About Arts in Medicine" we offered physicians a place to voice their stories and share how they use the arts in education.

Our featured article “Stories and Society, Using Literature to Teach Medical Students About Public Health and Social Justice,” was contributed by Martin Donohoe, MD, FACP, Adjunct Associate Professor, School of Community Health, Portland State University and Senior Physician of Internal Medicine at The Kaiser Sunnyside Medical Centre. Donohoe offered an argument for “enhancing public health education of medical students through the use of literature with the goal of creating activist physicians knowledgeable about, and eager to confront, the social, economic and cultural contributions to illness”. In addition, he generously provided an extensive list of books, articles and resources. A follow up commentary by Dr. Jay Rosenfield, MD, MEd, FRCPC, Vice-Dean of Undergraduate Medical Education, Faculty of Medicine, University of Toronto, stressed the need for continuing research to examine the use of literature and story in medical education further, particularly when linked to advocacy and health of populations and patient outcomes.

Maureen Rappaport MD, FCCFP, is a family doctor who splits her time between working in a busy community practice in Montreal , Quebec, and teaching family medicine residents and medical students. In the article, “The Poetry of Practice” she wrote about the creative writing course she teaches as an elective to fourth year medical students at McGill University, a course that provides an important place for students to express their feelings through narratives and poetry.

Physician and Educator Pippa Hall MD, CCFP, MEd, FCFP, at The University of Ottawa, has been a palliative care physician for over ten years. She has integrated arts into learning activities for pre-licensure students and in post graduate programs as well as in continuing professional development activities in nursing and spiritual care. She explained how she found the arts in many forms provided opportunities for learning while offering new insights into the human condition.

Seema Shah, MD, MSPH, reported on a unique perspective as both a physician and patient who has experienced chronic illness. Working with The University of British Columbia Community Partnerships for Health Professional Education Initiative, she explained how she has facilitated group sessions using literature and story to help teach students about the lived experience of illness.

Our closing commentary explored the exciting potential for other innovative and creative technologies incorporated into teaching and medical education. Kim Bullock, MD, family medicine and emergency room physician, and Director of the Community Health Division and Assistant Director of Service Learning in the Department of Family Medicine at Georgetown University, Medical Centre, Washington, believes digital storytelling in medical education has the potential to “link the social, environmental, and historical issues that influence health and illness through graphics”. “What emerges,” she writes, “are voices from the community that bear witness to issues that influence health including problems related to the environment, housing, public safety violence, inequities ..”

The voices represented in this issue of IJCAIP spoke about progressive approaches to learning that have the potential to offer hope and change in education and in healthcare practice. There may yet be questions to be answered but, given the space, there will always be stories to tell and those who will witness, learn and be transformed.

In addition to editing two books in the CAIP Research Series, "Creative Arts in Interdisciplinary Practice" and "Creative Arts in Research for Community and Cultural Change" published by Detselig Temeron Press, now Brush Educational Publishing, Calgary, Cheryl McLean is also editor of the upcoming book, "Creative Arts in Humane Medicine" to be published in 2013.

Cheryl McLean, Executive Editor, Publisher
The International Journal of The Creative Arts in Interdisciplinary Practice
Editor, CAIP Research Series, "Creative Arts in Interdisciplinary Practice" and "Creative Arts in Research for Community and Cultural Change" Detselig Temeron Press, Calgary
New text, "Creative Arts in Humane Medicine" scheduled for release 2013.

info: CherylMcLean@ijcaip.com