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One part of the Hippocratic Oath, the vow taken by many physicians, requires us to “remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” When I, along with my medical school class, recited that oath at my white coat ceremony a year ago, I admit that I was more focused on the biomedical aspects than the “art.” I bought into the mechanism of insulin lowering blood sugar. I bought into the concept of diabetes-induced kidney damage. I bought into the idea of small intestinal bacterial overgrowth in patients with diabetes. But art’s—poetry’s—role in the modern practice of medicine?
I’ve changed my mind. Physicians are beginning to understand that the role of language and human expression in medicine extends beyond that horizon of uncertainty where doctor and patient must speak to each other about a course of treatment. The restricted language of blood oxygen levels, drug protocols, and surgical interventions may conspire against understanding between doctor and patient—and against healing. As doctors learn to communicate beyond these restrictions, they are reaching for new tools—like poetry.
Researchers have demonstrated with functional magnetic resonance imaging that reciting poetry engages the primary reward circuitry in the brain, called the mesolimbic pathway. So does music—but, the researchers found, poetry elicited a unique response.1 While the mechanism is unclear, it’s been suggested that poetic, musical, and other nonpharmacologic adjuvant therapies can reduce pain and the use and dosage of opioids.2
One randomized clinical trial by researchers at the University of Maranhão studied the effect of passive listening to music or poetry on the pain, depression, and hope scores of 65 adult patients hospitalized in a cancer facility. They found that both types of art therapy produced similar improvements in pain intensity and depression scores. Only poetry, however, increased hope scores. The researchers conjectured that poetry can break the so-called law of silence, according to which talking about one’s perception of illness is taboo. After listening to poems from Linhas Pares by Claudia Quintana, one participant said “I feel calmer when I hear those words. That agony, that sadness passes. They are important words, they show me that I’m not alone.”3
Poetry is a way to both embrace the hospital encounter, and escape from it.
In another study, 28 Iranian women undergoing chemotherapy for breast cancer participated in eight weekly sessions of group poetry therapy. Their quality of life, as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire, showed improvements.4
Insights like these are already making their way into the clinic. Sarah Friebert, a physician at Akron’s Children’s Hospital, has integrated poetry into her clinical practice. She runs a pediatric palliative care center where children are visited by a writer-in-residence who helps them create poems and stories. On discharge, patients and families can request home visits on a monthly basis, and patients can submit completed work for publication.
I learned about Friebart’s program at a poster session at the 9th Annual Hippocrates Poetry and Medicine Symposium, which I attended this year in Chicago along with three of my medical school classmates. We were all supported by the Poetry Foundation and the Poetry in America Initiative. Armed with a bit of training in how to use a video camera and how to do an interview, we camped out in the lobby of Northwestern Medical School, interviewing a slate of researchers and poets alike. In one interview, we met with Catherine Belling, an associate professor of medical education, and asked her how she thinks poetry can be used in the medical sense.
“Poetry is a beautifully condensed form of what all of language does, which is what captures the real world and turns it something manageable and meaningful,” she told us. Physicians and patients can sometimes assume that the other party is on the same page, she said, when they are not. Language is not always transparent and sometimes our vocabulary is insufficient to describe our mood. Poetry is, in some ways, uniquely capable of addressing this problem. “Poetry has a structure, which is something we can experience with our bodies,” Belling says. The medical evidence suggests that this is true in more ways than one.
We also interviewed the poet Eric Elshtain, who uses poetry on the wards to teach children the power of self-expression at Children’s Hospital University of Illinois. He’s found that many of his patients (whom he likes to call “students”) write haikus about the things that make them human, like sports or their favorite stuffed animal, rather than their experience in a hospital bed. Poetry, he said, is a way to both embrace the hospital encounter, and escape from it.
Midway through the conference, we filmed one of the plenary events of the day: a discussion between our mentor, the physician and poet Rafael Campo, and the poet Mark Doty, a National Book Award winner who came to prominence with his poems about the AIDs epidemic. Campo and Doty lamented that medical professionals can get too easily caught up in treating disease. When pharmacology and procedures end, there is still a space for healing. While a sonnet a day won’t help a diabetic’s blood glucose, it might help with preventing diabetes burnout—the state in which he grows tired of managing his condition. When physicians care for their patients, they have a responsibility both to treat, and to heal. And poetry can help with healing.
As Campo and Doty talked, I thought about Doty’s poetry reading the night before, when his sublime words prompted all of us to gaze at the horizon of our mortality. One of the poems he shared was “This Your Home Now,” set in a barbershop called Willie’s:
… the men I have outlived …
—though in truth I have not forgotten one of you,
may I never forget one of you—these layers of men,
arrayed in their no-longer-breathing ranks.
Willie, I have not lived well in my grief for them;
I have lugged this weight from place to place
as though it were mine to account for,
and today I sit in your good chair …
The poem reminded me that each person has a story of griefs and happiness; that my mundane day at the hospital may be someone’s worse day of their life. In my first year of medical school, I’ve been taught how to conduct a thorough history. That means asking patients about their illness, medical history, medications, and about how their illness is affecting their life. The problem is, all of this needs to fit inside the boundaries of an electronic medical record template.
I’ve decided that I’ll learn how to meet my patients beyond the chart documents; that I’ll encourage them to write their own empowering stories; that I will heal as well as treat. In other words, that I’ll honor each and every word in the oath I took last year.
Danny W. Linggonegoro is a medical student at Harvard Medical School.
This article was supported by the Poetry Foundation, an independent literary organization and publisher of Poetry magazine.
References
1. Wassiliwizky, E., Koelsch, S., Wagner, V., Jacobsen, T., & Menninghaus, W. The emotional power of poetry: Neural circuitry, psychophysiology and compositional principles. Social Cognitive and Affective Neuroscience 12, 1229-1240 (2017).
2. Huang, S.T., Good, M., & Zauszniewski, J.A. The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial. International Journal of Nursing Studies 47, 1354-1262 (2010).
3. Arruda, M.A., Garcia, M.A., & Garcia, J.B. Evaluation of the effects of music and poetry in oncologic pain relief: A randomized clinical trial. Journal of Palliative Medicine 19, 943-948 (2016).
4. Gozashti, M.A., Moradi, S., Elyasi, F., & Daboui, P. Improvement in patient-reported outcomes after group poetry therapy of women with breast cancer. Social Determinants of Health 3 (2017).
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