"Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain"

INTRODUCTION

Persistent low back pain (PLBP) is the biggest global cause of disability. Persons with PLBP experience biographic disruption and existential crisis. Guidelines recommend a biopsychosocial approach to management, with the emphasis on coping strategies.

PURPOSE

However, there is a paucity of research exploring the lived experience of persons who self-identify as coping with PLBP.

METHOD

The study used an interpretive phenomenological approach, analyzing transcripts from 1:1 interviews with six persons who self-identify as coping with PLBP. Poetic language was used to elicit empathic, embodied relational understanding and convey a richer understanding of the phenomenon that authentic quotations might not able to reveal.

FINDINGS AND CONCLUSION

Participants' descriptions conveyed the sense of a journey, starting with the loss of a sense of self as they engaged in the pain battle, followed by a transition toward a new 'normal,' in which time, acceptance and trust in their own intuition were meaningful components. Although anxiety and fear were a continued presence, but they became more manageable. Society's role in the coping process was significantly meaningful and is something which requires reflections from therapists' and more widely.

Medical education and creative writing: Poetry and how it can assist trainees in developing psychiatric formulation skills

OBJECTIVE

To reflect on the importance of teaching formulation skills in psychiatry training and explore how creative writing, particularly writing poetry, can help achieve this goal.

CONCLUSIONS

It is vital that formulation skills are embedded throughout psychiatry training. Formulations have an artistic element, and writing poetry can help foster a capacity for curiosity that can assist trainees in developing these skills.

Risking at the Rocks

This article uses storytelling and poetry to emphasize the core concepts of taking a risk while highlighting the mystique of the Grand Canyon in Arizona.

Soft diamonds: poetic sentiment, poetic speech, and poetic specimen in the clinical hour

Three links between poetry and psychoanalysis are highlighted in this paper. These refer to the presence, in the clinical hour, of (i) poetic sentiment, (ii) poetic speech, and (iii) poetic specimen. Each is elucidated in detail and with the help of socio-clinical vignettes. The aim of the paper is to demonstrate that, through the affirmative holding and partial unmasking of the instinctual-epistemic conflation in verse and free-association, both poetry and psychoanalysis seek to transform the private into shared, the hideous into elegant, and the unfathomable into accessible.

Bearing witness poetically in a pandemic: documenting suffering and care in conditions of physical isolation and uncertainty

The COVID-19 crisis is still affecting millions of people worldwide. However, government and mass media attention to the continuing loss of life, severe illness and prolonged effects of COVID-19 has subsided, rendering the suffering of those who have become ill or disabled, or who have lost loved ones to the disease, largely hidden from view. In this article, we employ autoethnographic poetic inquiry from the perspective of a mother/carer whose young adult daughter became critically ill and hospitalised after becoming infected while the mother herself was isolating at home due to her own COVID-19 diagnosis. The first author created a poem from notes she had made in a journal from telephone conversations and messages with the healthcare providers caring for her daughter. The second author responded to the poem, identifying the feelings and meanings it surfaced. Together, the authors draw on scholarship discussing concepts of uncertainty, liminality, moral distress, bearing witness and illness narratives to reflect on how autoethnographic poetic inquiry can document and make visible COVID-19-related suffering.

Creating comics, songs and poems to make sense of decolonising the curriculum: a collaborative autoethnography patchwork

Decolonising the curriculum is a complex endeavour, with the potential to cause harm as well as benefit. People doing the work might find themselves questioning their personal and political identities and motives, it is common for people to get disillusioned. While surveys and toolkits are important to help us start the work, we are interested in finding out how decolonising practices can be sustained. We believe to practise meaningfully in this area we need to understand ourselves as practitioners, make sense of the work and have deep connections with colleagues and possibly our institutions.This research uses collaborative autoethnography; our personal experiences, reflected through the lenses of each other's point of view; to help us know ourselves and make sense of our practice. We also show how art, in the form of comics, poems and a song, can be used to deepen our research by adding meaning, connection and joy. We present this research as a patchwork text of writing, art and conversations. Our work is underpinned by theory, particularly drawing on Sara Ahmed and bell hooks. It is produced by the three of us to illuminate the process of decolonising a curriculum. We see this paper as part of our collective resistance: resistance to colonialism, to scientism and to inhumanity. We hope you will find resonances with your practice, and perhaps discover new ways to find meaning and connections.

Images of depression in Charles Baudelaire: clinical understanding in the context of poetry and social history

There is increasing recognition of the importance of the humanities and arts in medical and psychiatric training. We explore the poetry of Charles Baudelaire (1821-1867) and its evocations of depression through themes of mood, time and self-consciousness and discuss their relation to images of 'spleen', the 'snuffling clock' and the 'sinister mirror'. Following the literary critical commentaries of Walter Benjamin (1892-1940) and Jean Starobinski (1920-2019) we identify some of their roots in the poet's experience of the rapid and alienating urbanisation of 19th-century Paris. Appreciation of the rich vocabulary of poetry and the images it generates adds depth to clinical practice by painting vivid pictures of subjective experience, including subjective experience of the 'social' as part of the biopsychosocial constellation.

Dementia Arts Mapping: observational methods for documenting impacts of poetry and recreation in care settings

BACKGROUND

Long-term care homes for older and disabled adults, including those who are living with dementia, facilitate a diversity of recreational activities and program as social interventions. The relationships between interventional elements and participant impacts are not well understood.

METHODS

This paper explores a poetry methodology and reports the findings from a pilot test of Dementia Arts Mapping, a novel ethnographic observational technique, to better understand impacts of poetry and recreation on people living with dementia in long-term care settings. Between 2017 and 2020, at 17 skilled nursing facilities throughout Wisconsin, researchers situated within care homes observed participants during diverse activities.

RESULTS

We found poetry workshops surpassed other activities in eliciting self-expression.

CONCLUSIONS

Dementia Arts Mapping is an effective instrument for generating insights about dementia care and may be further enhanced for future use in research to inform care provision to foster meaningful engagement with people with dementia.

Bag Lady: A Soulful and Scientific Reflection on Black Women's Health

At the intersection of sexism and racism, Black women experience undue burden of poor health. Established literature in both scientific and artistic arenas archive health disparities facing Black women such as mental health and suicidality. Using poetry, this piece serves as a channel to express the joys and pains of the human experience as well as inspire healing and synergy through honest examination of societal structures. This mixed media artistry (intended to be sung and spoken) weaves together lyrical and literary works, featuring by quotes from Erykah Badu's Bag Lady; Dr. Maya Angelou's many works; Ntozake Shange's for colored girls who have considered suicide / when the rainbow is enuf; and Dr. Melissa Harris-Perry's Sister Citizen: Shame, Stereotypes, and Black Women in America. It ultimately articulates how to journey across the arc of triumph for well-being synergizing mind, body, and spirit.

Charlotte Mew: melancholy poet

SUMMARY

The main purpose of this article is to draw the attention of its readers to Charlotte Mew, a poet who is not well-known but whose work should be of great interest to mental health clinicians. She lived most of her life in the shadow of mental illness. Her poetry provides penetrating insights into her experiences of this in herself and in members of her family.

Poetry: An Avenue of Artsciencing

As an introduction to the inaugural Artistic Expression Column, the construct of artsciencing is briefly discussed and poetry is presented as an avenue of artsciencing.

Logics of Discovery II: Lessons from Poetry-Parataxis as a Method That Can Complement the Narrative Compulsion in Vogue in Contemporary Mental Health Care

This paper highlights the limitations of narrative logic in mental health care, and in particular of "narrative vigilance"-the tendency to watch over experience via narrativisation, and to tether the concrete particulars of experience to the hypothetical structure of a narrative signification. Narrative logic is grounded in hypotaxis-the syntactic structuring whereby a discourse is characterised by different levels of subordination using linking words that connect, especially in terms of temporal and explanatory consequentiality. I offer an alternative approach based on parataxis-the practice of placing phrases or parts of speech next to each other without subordinating conjunctions. Sentences are juxtaposed without a clear connection; the contrast may generate novel and unexpected combinations between these dissimilar fragments. After distinguishing between parataxis and psychopathological phenomena like disturbances of association, I take inspiration from the work and life of a poet, Johann Christian Friedrich Hölderlin (1770-1843), considered among the greatest. He suffered for half his life from a severe form of mental illness that would perhaps, today, be diagnosed as schizophrenia. In the poems written during his illness, hypotaxis and narrative vigilance seem to blur, and parataxis takes centre stage. The fading of narrative structure in no way coincides with the absence of meaningfulness. Rather, meaningfulness is left to parataxis itself, that is, to the recombining power of words, sentences, and images. Parataxis itself can provide meaningfulness or, at least, provide the soil in which it can germinate. The void of narration opens the door for the fullness of "emergent" connections. In the final part of the paper, with the help of Freud's ideas on the relationship between "analysis" and "synthesis" in psychoanalytic treatment, some implications are derived about the relevance of parataxis to the logics of discovery in psychotherapeutic care, especially that of persons with severe mental conditions.

Narrative and its discontents

This review considers recent challenges to, and changes within, narrative medicine as a paradigm for humanities-based medical education. It suggests that, while narrative medicine has often been criticised for emphasising narrative at the expense of other dimensions of human experience, newer criticism has focused more on its relationship with other areas of medical knowledge. In different ways, recent work has shown greater interest in taking in humanities perspectives on their own terms, rather than (this is the charge against narrative medicine) instrumentalising them as diagnostic tools. The review concludes by considering how these criticisms might make their way into the institutional realities of medical education, as well as what they might learn from narrative medicine's success.

[Child psychiatry chronicles, psychology in brief]

To work in a hospital is to believe in poetry, to grasp with wonder all the details that tie each person to an existence. However far-fetched they may be, they also contribute to enriching our belief in a world that can always be rewritten beyond the determinisms that would claim to assign tragedy.

[Radical imagination and the poetic approach to delusion]

A poetic look at delusional disorders. Drawing on Castoriadis' considerations of the radical imaginary, we can show that contemporary objectivist nosography is not sufficient to grasp the full complexity of this disorder. Two of Baudelaire's poems, L'Albatros and Elevation, seem to illustrate what poetry can say about human imaginary productions.

And Yet

Description As healthcare workers, invested in the wellbeing of our patients while also hoping to grow as individuals, we sometimes tend to view our jobs as a rigid duality-we are either "in love" with our practice and persevere flawlessly through all hardship, or we are "burnt out," coldhearted, and defeated by the heavy workload and expectations of medicine. In reality, we all sit somewhere in the middle of a blurry spectrum, balancing out physical, mental, and emotional pain with the immense honor of saving and cherishing human life, while simultaneously struggling to reconcile our altruistic goals with realistic but necessary human incentives. I want this open-ended work to acknowledge these challenging but critical "and yet" moments, and I hope anyone who is reading it can connect to the words personally and find new insight, regardless of where they are in life.

Ambivalence at 10 000 Feet

Description The transition from medical neophyte to seasoned physician is a gradual process spanning the course of many years. However, there are various milestones throughout the experience that capture increases in decision-making capacity and responsibility, such as the switch from pre-clinical to clinical medical education. Medical students in their clinical years are endowed with an abundance of knowledge from their pre-clinical years and are just beginning to synthesize and apply that information to patient care. "Ambivalence at 10 000 Feet" captures a reflection of a third-year medical student on the theoretical decision to provide emergency medical care in the absence of other trained medical personnel.

Pyracanthas

The poem came to me after a particularly bruising appointment with a doctor at the practice I was then a patient at. It was after this encounter that I transferred to another practice. The practice was rated then as requiring improvement, and as a School Improvement Officer retired through ill health I understood what the implications were. I think this painful recall of my previous role had an influence on the arrival of the poem. I certainly was not expecting to write it. Since developing ataxia, I set myself the task of moving more from 'mawkish to hawkish', a metaphor I used when I asked to contribute to the 'Storying Sheffield' project under Professor Brenden Stone. The metaphor of 'trams' used is this project was chosen to represent tram stops in the city and I have used it subsequently in presentations to illustrate something about what rehabiliation can entail. The "Burden-gift" of living with rare diseases is something I have found clinicians have found hard to encounter and acknowledge that these are "new" to them, and patients being ambassadors a challenge; I have seen doctors Googling their queries as they turn away to go down the corridor, to return moments later to continue the appointment….Nature is generally perceived as being healing, and yet here was someone indifferent, impatient and unwilling to hear what my expert team at a Centre for Excellence were saying - so different in nature to what I had hoped for in that appointment.This variety of Pyracanthas might be named 'Schadenfreude'.

Notes on growing love: Cherríe Moraga's "If," a world-making incantation conjuring collective consciousness through Chicana lesbian po(i)esis

This essay introduces the embodied ceremonial practices of deep presence and sustained attentiveness as Chicana lesbian poetic devices that shape-shift Chicana lesbian subjectivities, socialities, and simultaneously the violence of colonial capitalist racial heteropatriarchies. My reading of the poem "If" in Carla Trujillo's rendering of Chicana lesbian desire in Chicana Lesbians: The Girls Our Mothers Warned Us About, delves into the shape-shifting and time-bending potentiation at the heart of Chicana lesbian poetics. Cherríe Moraga's "If" generously offers a map that stalls time with the magnificence of sustained attentiveness. The poet's observations entice the reader with a depth of presence that illuminate the subject, casting life-sustaining reimagined meanings onto otherwise commodified individuated bodies. Moraga's "If" refracts the meaning of loss, ghostly pasts, and unimaginable futures through embodiment, imbuing a vivid and deep presence capable of casting spells on futures yet to come. The poem posits total immersion in being-ecstasis, that blooms with the transformational potential of the ecstatic. This essay reads the poem "If" in the context of Moraga's oeuvre as ceremonial world-making incantation conjuring collective consciousness through Chicana lesbian po(i)esis.

Characterizing the visualization design space of distant and close reading of poetic rhythm

Metrical and rhythmical poetry analysis is founded on the systematic statistical analysis and comparison of sonic devices (e.g., rhythmic patterns) that emerge from a combination of pre-established aesthetic and structural rules and the poet's abilities and creative genius to convey a given message adhering to the said constraints. These rhythmical patterns, which have been traditionally obtained by means of a careful close reading of the poems, in a process known as "scansion," can now be obtained and made visible by automatic means. However, the visualization literature is still scarce on approaches that allow an insightful close and distant reading of the rhythmical patterns in a poetry corpus. In this work, we report our initial efforts in characterizing of the visualization design space of distant and close reading of poetic rhythm. By employing a digital version of a corpus of 11,268 verses originally written by the Spanish poet and playwright Federico García-Lorca (1898-1936), we could craft several prototypical visualizations representative of the inherent complexity of the problem which we expect to employ in future user studies and that we share here with the rest of the community to foster further discussion around this interesting topic.

Aesthetic Knowing: Cut-Ups and Haiku Poems

Enhancing course design and pedagogy to encourage engagement and creativity is fundamental in doctoral education. Using poetry is an innovative way to enrich nursing education through aesthetic knowing. The authors in this paper aim to describe an educational exercise utilizing the Cut-Up Method to create haiku poems. PhD nursing students used the Cut-Up Method to produce haiku poems describing the meaning of nursing science. Themes from the haiku poems include relationship building, caring and caring relationships, and the evolution of nursing. Learning activities promote aesthetic knowing to facilitate engagement, creativity, and collaboration. The Cut-Up Method and haikus are creative ways of developing aesthetic knowing.

'In the picture': perspectives on living and working with cancer

We explored working and living with cancer at a large research-intensive National Health Service hospital breast cancer service and adjoining non-governmental organisation (NGO). The project had three elements that were largely autonomous in practice but conceptually integrated through a focus on personalised cancer medicine. Di Sherlock held conversations with staff and patients from which she produced a collection of poems, Written Portraits At the same time, we conducted interviews and observation in the hospital, and hosted a public series of science cafés in the NGO. The trajectory of this project was not predetermined, but we found that the poetry residency provided a context for viewing participation in experimental cancer care and vice versa. Taking themes from the poetry practice, we show how they revealed categories of relevance to participants and illuminated others that circulated in the hospital and NGO. Reciprocally, turning to findings from long-term ethnographic research with patients, we show that their observations were not only representations but also tools for navigating life in waiting with cancer. The categories that we discovered and assembled about living and working with cancer do not readily combine into an encompassing picture, we argue, but instead provide alternating perspectives. Through analysis of different forms of research participation, we hope to contribute to an understanding of how categories are made, recognised and inhabited through situated comparisons. In personalised medicine, category-making is enabled if not dependent on increasingly intensive computation and so the practices seem far removed from mundane processes of interaction. Yet, we emphasise connections with everyday practices, in which people categorise themselves and others routinely according to what they like and resemble.

My Heart

Description A poem expressing a daughter's love for her father through their shared passions for cardiology and medicine.

What a difference a syllable makes-Rhythmic reading of poetry

In reading conventional poems aloud, the rhythmic experience is coupled with the projection of meter, enabling the prediction of subsequent input. However, it is unclear how top-down and bottom-up processes interact. If the rhythmicity in reading loud is governed by the top-down prediction of metric patterns of weak and strong stress, these should be projected also onto a randomly included, lexically meaningless syllable. If bottom-up information such as the phonetic quality of consecutive syllables plays a functional role in establishing a structured rhythm, the occurrence of the lexically meaningless syllable should affect reading and the number of these syllables in a metrical line should modulate this effect. To investigate this, we manipulated poems by replacing regular syllables at random positions with the syllable "tack". Participants were instructed to read the poems aloud and their voice was recorded during the reading. At the syllable level, we calculated the syllable onset interval (SOI) as a measure of articulation duration, as well as the mean syllable intensity. Both measures were supposed to operationalize how strongly a syllable was stressed. Results show that the average articulation duration of metrically strong regular syllables was longer than for weak syllables. This effect disappeared for "tacks". Syllable intensities, on the other hand, captured metrical stress of "tacks" as well, but only for musically active participants. Additionally, we calculated the normalized pairwise variability index (nPVI) for each line as an indicator for rhythmic contrast, i.e., the alternation between long and short, as well as louder and quieter syllables, to estimate the influence of "tacks" on reading rhythm. For SOI the nPVI revealed a clear negative effect: When "tacks" occurred, lines appeared to be read less altering, and this effect was proportional to the number of tacks per line. For intensity, however, the nPVI did not capture significant effects. Results suggests that top-down prediction does not always suffice to maintain a rhythmic gestalt across a series of syllables that carry little bottom-up prosodic information. Instead, the constant integration of sufficiently varying bottom-up information appears necessary to maintain a stable metrical pattern prediction.

'Looking before and after': Can simple eye tracking patterns distinguish poetic from prosaic texts?

Introduction

The study of 'serious' literature has recently developed into an emerging field called neurocognitive poetics that applies cognitive neuroscientific techniques to examine how we understand and appreciate poetry. The current research used eye-tracking techniques on a small sample of young adults to see if and how the reading of short pieces of poetry differed from the reading of matched prosaic texts.

Methods

With 'proof of concept' intentions reflecting arguments first proposed by 19th Century literary figures, there was a particular focus on the differences between the reading of poetry and prose in terms number and frequency of fixations and regressive eye movements back and forth within the texts in this two-by-two experimental design (poetry vs. prose x need vs. no need for final line reappraisal).

Results

It was found that poetic pieces compared to prosaic pieces were associated with more and longer fixations and more regressive eye movements throughout the text. The need to reappraise meaning at the prompt of a final line was only significantly associated with more regressive eye movements. Comparisons examining the 4 text conditions (poetic reappraisal, poetic non-reappraisal, prosaic reappraisal, and prosaic non-reappraisal) showed that the poetic reappraisal condition was characterised by significantly more regressive eye movements as well as longer fixations compared to the prosaic non-reappraisal condition. No significant correlations were found between self-reported literary familiarity and eye tracking patterns.

Discussion

Despite limitations, this proof-of-concept study provides insights into reading patterns that can help to define objectively the nature of poetic material as requiring slower reading particularly characterised by more and longer fixations and eye movements backwards through the texts compared to the faster, more linear reading of prose. Future research using these, and other psychophysiological metrics can begin to unpack the putative cognitive benefits of reading literary material.

PRESENCE//Gifted: On Poetry, Antiracism, and Epistemic Violence in Health Promotion

Through poetry, I offer a critical reflection on the racialized contexts, consequences, and (mis)representations of overlapping pandemics-COVID-19 and structural racism-crafted as counternarrative to public health's and medicine's ahistorical, apolitical, and racist proclivities in times of crises (e.g., plague, 1918 flu, HIV/AIDS, addiction, racialized police violence). I weave public health and medical concepts together with Black music, poetry, scholarship, and history to (re)frame/analyze interconnections between COVID-19 and structural racism-centering love, resistance, and solidarity to counter Black erasure within the public health knowledge canon. I contextualize the poem/use of poetry as praxis in public health antiracism discourse through a brief essay, drawing from critical, critical race, and Black feminist theory to position poetry as a space of health equity testimony, and a mode of antiracist praxis to reclaim/center the margin as site of knowing and resistance. Specifically, I discuss testimonial quieting, testimonial smothering, and testimonial incompetence as critical concepts for health promotion scholars, practitioners, and students to engage as germane to interrogating our present knowledge production norms in regards to epistemic violence and its implications for prospects of antiracist public health futures. In doing so, I suggest that poetry can play a critical role in challenging, opening up, and reimagining discourse of antiracism for advancing health equity knowledge and action.

Theodor Meynert (1833-1892): Famous brain-anatomist and poet

This paper focuses on the lesser-known side of the famous neuropathologist, anatomist, and psychiatrist Theodor Meynert (1833-1892): Meynert as a poet. Meynert decided to become a doctor late in life, a decision that required him to give up on having a career as a writer. This analysis outlines that Meynert, as a scientist, was significantly shaped by his multifaceted interests and surrounding environment. It refers to previously unknown archival materials and especially letters that gives new insights into his multifactored personality. Thus, as this paper argues, his poetic affinity is of great importance to understanding his work.

Chrysalis

Description This poem explores the experience of being an Asian American care provider and civilian, growing up and trying to mesh together culture with "fitting in" and suffering racism from other individuals and patients. It was inspired by the March 16, 2021, shootings in Atlanta and discusses the origin of hatred and racism/xenophobia. What I hope this conveys is a glimpse into the shared perspectives of many Asian American and Pacific Islanders and describes the optimism moving forward as we begin to tackle these issues.

Whispering at the edges: engaging ephemeral phenomena

This paper conceptualizes the analyst's capacity to recognize and engage ephemeral phenomena in the analytic setting as an essential pillar of deep analytic engagement. It proposes that the analyst's capacity to engage the ephemeral is an ongoing developmental progression which complements and deepens the other areas of analytic knowledge acquired during analytic training such as theory, technique, archetypal patterns, psychopathology and development. The paper provides a working definition of the ephemeral and focuses on the phenomenological experience of the ephemeral. It also discusses the use of reverie in ephemeral engagement and the use of poetry to develop the analyst's sensitivity and responsivity to ephemeral moments.

Orfeu da Conceição: the political dimension of the carnival chant

This paper explores the images related to Carnival in the texts of early Brazilian modernist writers, who wanted to minimize the feeling of inauthenticity due to the systematic emulation of European aesthetic matrices. This critique of Brazilian 'nationalist' complexes was manifested in cultural forms which were unlinked from academic approaches, but were instead expressed in the registers of the popular songbook - sung-poems in which Carnival-related images abounded. In the analysis of this set of poems, the paper outlines the emerging of a poetry of 'masking', raising the hypothesis that these poets had invented a tradition that aimed for a native originality, having the celebration of Carnival and its mythical variants as its literary motivation. During the 1930's, Carnival-related images became rare in written poetry, establishing the sung poems as their permanent ground. With Orfeu da Conceição, in 1956, Vinicius de Moraes converged these two elements, dissolving the remaining boundaries that set them apart. This paper explores the images of Carnival and the mask, and attempts to unmask the characteristics of a form of Brazilian culture, including, in particular, its racism.

Painting and Poetry From a Bereaved Family and the Caring Physician

This is a case description and personal account shared by a palliative care physician whose team provided specialist palliative care support to a patient who attempted immolation. This case depicts a family at risk of complicated grief due to the violent nature of self-inflicted burns and the lingering social stigmatization of suicide. Here, we explore important psycho-emotional considerations and share our experience using art and poetry to build therapeutic connections with the grieving family.

'Unprepared for the depth of my feelings' - Capturing grief in older people through research poetry

Background

Older people are more likely to experience bereavements than any other age group. However, in healthcare and society, their grief experiences and support needs receive limited attention. Through innovative, arts-based research poetry, this study aimed to capture older people’s bereavement stories and the effects of grief on their physical and mental health.

Method

Semi-structured in-depth interviews with 18 bereaved older adults were analysed using thematic and poetic narrative analysis, following a five-step approach of immersion, creation, critical reflection, ethics and engagement.

Results

Research poems were used to illustrate three themes of bereavement experiences among older adults: feeling unprepared, accumulation of losses and ripple effects of grief. While half of participants reported that the death of their family member was expected, many felt unprepared despite having experienced multiple bereavements throughout their life. Instead, the accumulation of losses had a compounding effect on their health and well-being. While these ripple effects of grief focussed on emotional and mental health consequences, many also reported physical health effects like the onset of a new condition or the worsening of an existing one. In its most extreme form, grief was connected with a perceived increased mortality risk.

Conclusions

By using poetry to draw attention to the intense and often long-lasting effects of grief on older people’s health and well-being, this article offers emotional, engaging and immersive insights into their unique bereavement experiences and thereby challenges the notion that grief has an expiry date.

A Body Now, Perhaps Once Someone

Description Personally driven by compassion in hospital medicine, I can't help but pen down certain emotions we experience as caregivers. It feels too selfish to not share some of those emotions, as profound as they are, though we seldom are aware that such feelings exist, even as they become palpable during adverse outcomes. Most of the time, thankfully the sick patients we encounter, recover and are discharged home. There are smiles of relief and gratitude to our profession as healers. But at times, with certain incurable conditions, we only can treat and try our best as doctors. There are tears, broken hearts, feelings of dread towards an approaching, certain end that we bitterly fight against, but lose. Commiserating with a patient in pain and with their loved ones is natural as a physician. And in this work, I share one of those unfortunate moments.

Engaging the Poetic Perspective on Care of the Surgical Patient: Lessons from W.H. Auden's "Surgical Ward"

Attention has been brought to the importance of cultivating empathy, communication skills, reflective writing, and self-care in surgeons-in-training. Classical literature and poetry pertaining to themes of surgery, specifically sonnets, can be exemplary methods for cultivating such skills. "Surgical Ward" by W.H. Auden is such a sonnet. Here we suggest that working poems such as "Surgical Ward" can cultivate transferable skills for analysis of text, context and subtext, as well as providing a substrate for discussion of multiple perspectives. These skills can aid in the development of surgical decision-making to produce positive outcomes, yet also benefit self-reflection when mistakes are inevitably made.

Links Between Arts and Health, Examples From Quantitative Intervention Evaluations

The author presents eight of his own group’s studies. They have been published from early 1980s until 2016. Each study will be placed in its scientific context and discussed in relation to possible progress in arts and health research. In these examples, statistical methods with longitudinal designs and mostly control groups have been used. Some of them are randomized controlled trials. Physiological and endocrinological variables have been assessed in some of these studies in efforts to increase our understanding of how music experiences and other kinds of arts experiences interact with bodily reactions of relevance for health development. Although some of the studies have suffered from low statistical power and other methodological weaknesses, they show that it is possible to do statistical evaluations of arts interventions aiming at improved health.

Impact of poetry-based ethics education on the moral sensitivity of nurses: A semi-experimental study

BACKGROUND

The nurses' moral sensitivity is the first step to make right decisions in difficult moral situations. Therefore, its education and promotion is highly important.

RESEARCH OBJECTIVES

The aim of this study was to examine the impact of poetry-based ethics education on the nurses' moral sensitivity.

RESEARCH DESIGN AND METHODS

This was a semi-experimental study. The sample consisted of 108 nurses who were selected by convenience sampling method and randomly assigned to three groups: intervention with poetry (G1), who read a booklet about values and principles of professional ethics as well as poems related to these subjects for 1 month; intervention without poetry (G2), who only read the booklet without any poetry; and control group (G3), who did not receive any intervention. Data were collected by Moral Sensitivity Questionnaire that was completed by the participants prior to the intervention (T1), 1-month post-intervention (T2), and 2-month post-intervention (T3). Data were analyzed by SPSS 16 software.

ETHICAL CONSIDERATIONS

This study was conducted in accord with the principles of research ethics and regulations relating to informed consent.

FINDINGS

Changes in the mean score of total moral sensitivity were significantly higher in G1 than in G2, which was in turn significantly higher than in G3. This increase was significant from T1 to T2 and T2 to T3 (P < 0.001). In all subscales, there was a significant difference between the mean changes in the three groups, so that in these subscales, the mean changes in G1 were significantly higher than those in other groups.

DISCUSSION

In line with previous studies, our results showed the effectiveness of poetry-based education on the transfer of educational concepts and increase moral sensitivity scores with greater lasting effect.

CONCLUSION

The use of interdisciplinary subjects such as poetry, due to its entertaining, fun, and lasting effect on minds; level of awareness; and actions of nurses, can help raise nursing moral sensitivity.

Rhythmic subvocalization: An eye-tracking study on silent poetry reading

The present study investigates effects of conventionally metered and rhymed poetry on eyemovements in silent reading. Readers saw MRRL poems (i.e., metrically regular, rhymed language) in two layouts. In poem layout, verse endings coincided with line breaks. In prose layout verse endings could be mid-line. We also added metrical and rhyme anomalies. We hypothesized that silently reading MRRL results in building up auditive expectations that are based on a rhythmic “audible gestalt” and propose that rhythmicity is generated through subvocalization. Our results revealed that readers were sensitive to rhythmic-gestalt-anomalies but showed differential effects in poem and prose layouts. Metrical anomalies in particular resulted in robust reading disruptions across a variety of eye-movement measures in the poem layout and caused re-reading of the local context. Rhyme anomalies elicited stronger effects in prose layout and resulted in systematic re-reading of pre-rhymes. The presence or absence of rhythmic-gestalt-anomalies, as well as the layout manipulation, also affected reading in general. Effects of syllable number indicated a high degree of subvocalization. The overall pattern of results suggests that eye-movements reflect, and are closely aligned with, the rhythmic subvocalization of MRRL.

This study introduces a two-stage approach to the analysis of long MRRL stimuli and contributes to the discussion of how the processing of rhythm in music and speech may overlap.

The fable of "The Doctor and the Goose," by Charles Chauvin Boisclair Deléry, D.M.P

Charles Chauvin Boisclair Deléry, D.M.P. - doctor of medicine of Paris, was perhaps the prototypical representative of Creole physicians, practising medicine in Louisiana in the 1800s, who were regarded as being equally proficient with pen, pills or pistols. This paper presents accounts of Deléry's yellow fever debate with Jean-Charles Faget, D.M.P., and their near duel, and his famous duel with Joseph Rouanet. Because of the personal and professional need to maintain honor, Rouanet may have challenged Deléry to a duel, not only because of vociferous disagreements between them over blood transfusion safety and efficacy, but due to Deléry's humiliation of Rouanet in his fable, "the Doctor and the Goose." We recovered the poem, transcribed and translated it, and discuss it as a device of witty rhetorical persuasion-a technique of the time used to belittle one's learned opponents. Fortunately, Deléry was not as equally proficient with pens and pistols, as both he and Rouanet survived the duel.

Deviants Are Detected Faster at the End of Verse-Like Sound Sequences

Songs and poems from different traditions show a striking formal similarity: lines are flexible at the beginning and get more regular toward the end. This suggests that the free-beginning/strict-end pattern stems from a cognitive bias shared among humans. We propose that this is due to an increased sensitivity to deviants later in the line, resulting from a prediction-driven attention increase disrupted by line breaks. The study tests this hypothesis using an auditory oddball task where drum strokes are presented in sequences of eight, mimicking syllables in song or poem lines. We find that deviant strokes occurring later in the line are detected faster, mirroring the lower occurrence of deviant syllables toward the end of verse lines.

Purification, Punishment, and Control: Eating Disorders, Self-Harm, and Child Sexual Abuse

Eating disorders continue to be viewed as curable diseases, forcing people into predetermined narratives of pathology that shape how they are viewed and treated. Situated in a feminist application of Bakhtin's sociological linguistics, we were concerned with how participants understood eating disorders, the nature of their experiences, and the causes of their distress. Following a dialogical method, multiple in-depth interviews were conducted with seven women who experienced an eating disorder and who had been sexually abused previously, and participants' own drawings and poetry were obtained to gain deeper insights into meanings and emotions. We found an eating disorder offered a perception of cleanliness and renewal that was attractive to participants who experienced overwhelming shame. It is critical that researchers use a range of visual and sensory methods to move eating disorder understandings and treatment beyond illness and pathology.

Grief in Times of Corona (Envoi)

This autoethnographic poem tells of personal grief happening in a time of lockdown. It draws on the concept of chronotope, a discrete time and space unit, a parenthesis of sorts, which I have chosen to illustrate as a bubble. In our daily speech, we see bubbles as related to both time and space, now with the added meaning of close relationship of people, those who belong to the same COVID bubble. In this autoethnographic piece, relationships are mediated by technology which anchors our bubbles together, with multimodal links carrying affect and emotion.

Cachexia, Following Flowers

Description This poem explores a similar experience I once encountered working with an oncologist, as a patient learns about the recurrence of cancer after being in remission. The situation struck me as I felt the stir of human sadness and courage, and I would like to dedicate the poem to those living with cancer, who face the trepidation of their daily lives with bravery. What I hope this writing demonstrates is the depth and complexity of emotions felt by both patients and their physicians in times of bad news and expresses the beauty that underlies a strong and genuine patient-physician relationship.

Auden's Prose and Poetry

Clinical empathy is a professional skill, representing a conscious commitment to showing patients that they are heard, understood, and accepted. Here, we explore ways in which masters of language, such as the mid-20th century poet W. H. Auden, use prose and poetry to teach us the patient's expectations of a truly empathic physician and surgeon.

Reflections on Fortifying Wisdom

The author in this article explores seven day-to-day living experiences that expand understanding of the humanbecoming concept of fortifying wisdom. Poetry is used to enhance understanding of the seven living experiences of (a) the use of words, (b) the experience of the body, (c) love, (d) compassion, (e) faith, (f) hope, and (g) forgiveness.