Art and the art of healing

By Janet M. Cromer, RN | April 24, 2007

"Haiku is a pathway that leads to group bonding, self-discovery, and self-revelation," says Lissa Robbins Kapust, LICSW, senior social-work supervisor in the behavioral neurology unit at Beth Israel Deaconess Medical Center (BIDMC). That's why she's made the ancient Japanese poetic art form a part of her therapeutic arsenal. Kapust, who works individually and in groups with family caregivers of people with dementia, has introduced the three-line, 17-syllable lyric verse, which aims for concise expression and deep insight, to her clients. In group sessions, members often open by reading haikus as a prelude to their discussions about loss and grief, the nature of dementia, and strategies for coping.

Kapust's use of poetry in a clinical setting is part of the burgeoning field of the medical humanities, a varied discipline that has emerged from the blending of humanities, social sciences, and the arts as they apply to professional medical education and clinical practice. Medical students discuss literature and philosophy as part of their process for understanding the illness experience. Patients are invited to give readings of their poetry and personal essays about living with serious disease at medical grand rounds. Nursing and social-work students keep journals of their responses to the clients they care for, seeking to understand the universal issues behind individual experience. Paintings and photographs by staff members are exhibited prominently in the entrance lobbies of hospitals. And on inpatient units, musicians perform, offering vitality and peace in a setting that is often overwhelming.

Throughout the Greater Boston area, the medical humanities are reshaping the face of healthcare, and at BIDMC, they are helping many professionals bring a new sense of creativity and deeper understanding to their clinical work.

From the personal to the universal

Elizabeth Lane, RN, MSN, MSW, is one of Kapust's many clients who have benefited from writing haiku. She describes the process as both comforting and centering, and says she started out writing poems about her husband's cognitive dysfunction, as in these lines of verse:

DEM-onstrative no longer--
EN-joy what can be gleaned before
absenTIA is complete

Later she moved on to explore more positive feelings and subjects:

amongst the tangle of
weeds a glorious purple iris
stands proudly--awaiting applause

For support-group member Ed Zawaki, the compressed form of haiku has been a way to release the intense emotions he's felt about his wife's illness:

On Leaving Her at the Assisted Living
She asks, voice trembling
You will come back for me, right?
Yes, of course, I lied.

Fragile Joy
She looked at me
I mean she really saw me
Like before I mean

Kapust says the process of composing haiku leads to a sense of connection as it involves transforming the expression of internal experience into the creation of images that reverberate with universal themes. "Haiku," she says, "is one more way to find inner strengths and the means to go on."

Steven Schachter, MD, is professor of neurology at Harvard Medical School. He says he learned early in his career that patients with epilepsy had much to teach him about treating the whole person. "Simply attending to the quantifiable parameters of seizure frequency and drug levels," he says, "is completely inadequate if our goal is to enable the person with epilepsy to live up to his or her potential." One way he approached this task was to invite patients to write stories about living with epilepsy. The result is a series of six "Brainstorms" books, each told from a different group's perspective. For example, in The Brainstorms Family, children's stories about their seizures and treatment are accompanied by writing from their parents about how coping with epilepsy has affected their family's life.

Story manuscripts, Schachter says, give people words to describe what they are going through, reassuring them they are not alone, and also encourage the sharing of perspective. A common theme in all the Brainstorms books is the idea of epilepsy stigma. In The Brainstorms Healer, some of the physicians and nurses who contributed wrote about what it is like for them to care for people with epilepsy, while others chose to disclose their own personal diagnosis of epilepsy for the first time. The Brainstorms Village offers a collection of stories from patients in 25 countries highlighting the universal as well as the culturally distinct aspects of epilepsy. Over 200,000 books in the Brainstorms series have been sold, confirming Schachter's sense that there is a wide-ranging need for the good that the sharing of experience offers.

Schachter has also collected over 1,000 pieces of art created by artists with epilepsy. After categorizing the contributions as art that's unrelated to the diagnosis, art that addresses the experience of epilepsy, and art that illustrates the experience of simply being a person in society, he produced a fine-arts book and a CD-ROM entitled Visions: Artists Living With Epilepsy.

Schachter is editor-in-chief of www.epilepsy.com, a Web site that contains stories, poems, and art along with medical and psychosocial information about epilepsy. The site receives over 1 million page hits a month.

Art as a teaching tool

When patients on the 32-bed cardiothoracic unit at the Beth Israel Deaconess campus practice post-op ambulation, they take in a display of colorful artwork depicting in detail how to care for themselves at home. The artist is Marnie Chaves-Crowley, RN, BSN, unit educator for the cardiothoracic unit. Chaves-Crowley cites her involvement with the cardiac-surgery quality initiative and cardiac-surgery pathways as the incentive for her project to improve post-op discharge teaching. During a continuing-education program on laughter and healthcare, she learned that people are drawn to look at and learn from cartoon figures since they are less intimidating than medical illustrations. As a result, Chaves-Crowley, who is new to art, drew a series of over a dozen large cartoons featuring a customized heart figure illustrating post-op care following cardiac and pulmonary surgery. Another series she created uses simplified yet anatomically correct sketches to address issues that patients in discharge classes find most confusing.

The peacefulness of therapeutic harp music

Bringing live musical performances to patients and staff further adds a humanizing element to the high-tech and fast-paced hospital environment. Nancy Kleiman, a therapeutic harpist, graces the BIDMC lobbies, inpatient units, and oncology clinic with her enchanting Celtic harp. Kleiman volunteered as part of the Massachusetts General Hospital GentleMUSEs program for six months before being invited to create her position as the only paid harpist in a Boston hospital. People walking by Kleiman often stop to say, "I didn't realize how stressed I was until I slowed down to hear your harp."

Over the past year, Kleiman has refined her role in the hospital in response to requests from patients, nurses, and administrators. Kleiman always keeps a journal with her to collect the myriad stories listeners share about their experience with her harp. A singular element appears in every story. "A connection is made," she explains. "It's about being aligned with your gifts and using your gifts to serve." To that end, Kleiman is open to any request to use her music to accompany a patient on a particular journey. When she played at the bedside of a dying woman, she had never met, the woman's son told her, "Every single piece that you played was significant for my family."

Unit nurses have validated the centering and anxiety-reducing effects of harp music. One nurse reported that while Kleiman was playing, not one call light went on. They often page her to play for patients and families. Kleiman and her harp make paths into nontraditional settings with profound effects, including the psychiatric unit and a memorial service for parents who lost children in the neonatal ICU. Kleiman's ultimate goal is to have therapeutic harpists on staff at every hospital.

Everyone involved in the application of the medical humanities at BIDMC confirms it is making a difference in the life of patients and clinicians alike. Every story told, every musical composition played, and every piece of artwork depicting an illness and its effects serves to deepen the human connection so essential to healthcare and the profession of caregiving.

This is the first of a three-part series on Medical Humanities in the Greater Boston area. Janet Cromer, RN, is a freelance writer and a regular contributor to On Call.