My patient seemed skeptical at first. "What am I going to do with that?" she asked as she stared at the cover of Marilyn Hacker's book of poems "Winter Numbers," with its image of ripe pears, full as a woman's breasts, tangled in blood-red yarn. I have shared this book -- and others, like Audre Lorde's "The Cancer Journals" and Alicia Ostriker's "The Crack in Everything" -- with other patients of mine who are newly diagnosed with breast cancer.
"To survive/my body stops dreaming it's twenty-five," ends one of Hacker's most devastating poems. For a long moment, I too questioned whether words could heal.
But in responding to that poem's killer couplet, in grappling with its blend of resignation and persistence, I felt the unique power of poetry. Aside from finding an alternative to the sea of medicalese in which she was about to be immersed, aside from finding answers to questions she might not dare ask her overworked and/or imperious physicians, aside from the breaking of her own heart in each carefully rendered line break, I knew that in poetry my patient would discover courage, comfort and, ultimately, precious wisdom.
Elizabeth, as I'll call her, proved more resistant to the healing power of language than most of the patients with whom I have tried to share poetry.
"Look," she said, "I appreciate you trying to show you care. But I want you and all my doctors to know what to do about my medical condition, and not my feelings." I noticed how the rim of tears forming in her blue eyes seemed to magnify their beauty. "So you can keep this." Abruptly, she ended our encounter by leaving my office, slamming the door definitively behind her.
What I told Elizabeth -- who is now two years out from her initial diagnosis (infiltrating ductal carcinoma of the breast, stage II, eight of 16 lymph nodes positive), still going strong and beginning to write her own poetry about her illness -- is that creative self-expression has been an important part of healing since the beginning of recorded human history. This ancient truth is being validated today, with the publication this year of a study in the Journal of the American Medical Association that showed patients who wrote about their chronic illnesses suffered fewer symptoms and less disability. Patients stricken with asthma or debilitating rheumatoid arthritis actually improved over the course of months just by writing imaginatively about stressful experiences.
In a glitzy, high-powered medical establishment that often fails to meet many of the basic human needs of our patients, such results have created quite a stir. Soul-numbing managed care and mind-boggling technological advancement seem to have conspired to distance doctors from patients. The addition of an increasingly aged and multicultural society creates chasms so wide they threaten to swallow us all. It makes one wonder how anyone can make sense of the experience of illness.
It's not all that surprising that poetry -- whose soothing rhythms have their origins in our physical bodies, in the ebb and flow of our breathing or sobbing, in the very beating of our hearts -- can be so effective in restoring empathy and thus kindling the healing process. In many Native American cultures, incantation and voice were the principal therapeutic instruments. Spanish explorer Cabeza de Vaca lived for many years among the Capoque people, and recounted the dramatic cures effected by their use of performative language. (A few examples of Native American healing rituals, such as the Iroquois "condolence ritual" and the Navajo "night chant," have survived, and are being studied today.) Ancient Greek theology recognized the potent and inextricable interrelationship between poetry and healing in its most revered deity Apollo, who governed both; Apollo's symbols are the poet's lyre and the healer's staff.
Even the Judeo-Christian tradition explicitly links poetry and healing. Biblical poetry such as Psalms and the Song of Solomon make frequent reference to physical afflictions that God assuages. Christ himself restores sight, and even life, with divinely fluent pronouncements. Today's faith healers and Christian Scientists continue to rely solely on prayer for the treatment of illness.
Modern medicine itself has made use of literature to heal patients. Benjamin Rush, founder of the famous Pennsylvania Hospital in 1810, is considered the father of the centralized modern American hospital. He included in his design a grand library where patients could go to read on themes prescribed by their physicians. A school of thought among psychiatrists today holds that bibliotherapy -- defined in a recent review by two scholars as "the guided use of reading, usually as an adjunct to psychotherapy in mental-
As compelling as it may be to survey historical examples of the marriage between poetry and healing, still there is little scientific data to support its validity. The situation is similar to that surrounding the placebo effect: If we can't understand how it works, then it must not be real. And in the case of St. John's wort or echinacea: If the medical or pharmaceutical industry can't profit from it, then it must be quackery -- never mind new discoveries of chemicals in herbal remedies that may be the basis for their claimed benefits. While it would certainly be wrong to say that poetry can cure cancer or AIDS or depression, it is fair to consider how reading and writing poetry could help those who are "intoxicated" by illness, to borrow from the title of literary critic Anatole Broyard's indelible memoir of his battle with prostate cancer.
Having been well trained by Harvard Medical School, I come prepared with a list of possible "mechanisms of action." It would be difficult to prove any of these, but some are accepted in psychiatric and behavioral medicine circles.
First, there is the therapeutic effect of assigning a name to a patient's symptoms; imagine amplifying that effect by allowing the patient to discover and to name the affliction. Creating metaphors in poetry is similar to the healing process in that it involves an imaginative translocation from one state to another. The poem, in its rhythms and rhymes, metaphorically restores the sufferer's control over deranged bodily functions.
At the same time, poetry places the patient in direct communication with others who have suffered with a disease, across centuries and cultures. Writing poetry dramatically establishes the patient's authority, which so often is taken by the medical establishment. Poetry also empowers by allowing the patient to identify with the illness. Perhaps most important, the poem provides a non-judgmental way to explore and accept death as one possible ending to the patient's life story, an outcome doctors are notoriously inept at helping patients to understand.
Poetry teaches not only about the illness itself but about the human experience of it. When I talk to Elizabeth, who is actively engaged in the process of re-imagining her own illness through creative self-expression, I wonder whether some of these principles might resonate with her. I wonder how she felt when she finally did read "Cancer Winter," an unforgettable sequence of sonnets in Hacker's collection. A sonnet is a love poem in which the speaker immortalizes the beloved against the ravages of time. I wonder whether it is possible to love one's disease, what it would feel like to forgive the terminal diagnosis the way Hacker does when, at the end of one sonnet, she declares:
The setting sun looks terribly like blood.
The hovering swarm has nothing to forgive.
Your voice petitions the indifferent night:
"I don't know how to die yet. Let me live."
I have always drawn a sharp breath of recognition at this confrontation with one's own mortality, and the power of the human spirit to overcome. I don't know whether this is the definition, really, of love -- but whatever it means, I feel certain that Elizabeth, her blue eyes stubbornly ablaze with life, has understood it.