SINGAPORE – For a few days in February, about 200 doctors, nurses, medical students, hospice staff and patients in Singapore read and wrote poems.
In a series of workshops, they and other healthcare workers reflected on poems that grappled with illness and mortality. Inspired by their own work and lives, they penned down their thoughts in free verse, even though some said they did not enjoy the literature classes they took decades ago in school.
One participant recalled a patient who had died unexpectedly. Another wrote stanzas sparked by the application of a medical grant. Some attendees pondered the burden of living with tumours. One person sang part of her poem.
The workshops, held from Feb 13 to 24, were conducted by Mr John Fox, the American founder of The Institute for Poetic Medicine, a non-profit organisation based in California. Organised by the National Cancer Centre Singapore (NCCS), the sessions were held at the cancer centre, Singapore General Hospital, KK Women’s and Children’s Hospital, and Assisi Hospice.
The programme, titled Poetry As The Healer (Path), was an introduction to poetry therapy or – as Mr Fox prefers to term it – poetic medicine.
While similar to art and music therapy, poetry therapy is little known in Singapore. Still, there has been greater emphasis on the medical humanities in recent years in institutions like the Lee Kong Chian School of Medicine at Nanyang Technological University.
Medical humanities programmes, which are usually targeted at undergraduates, explore disciplines such as the arts, psychology, sociology, history and culture as they relate to the human experience of illness and caregiving.
Neurosurgeon Paul Kalanithi’s best-selling memoir, When Breath Becomes Air (2016), is an example of the intersection of literature and medicine. In his posthumously published account of the cancer that killed him at the age of 37, the physician-turned-patient wrote about the loss of control and about his infant daughter coming into the world as he was about to slip away.
Mr Fox, 68, says there are “many overlapping connections” between poetic medicine and other expressive therapies.
“Poetic medicine is the use of poetry and poem-making as a therapeutic modality – just as art, music and dance are modalities that offer a creative pathway for expression. The big difference is the need to focus on finding words that are truly yours,” he says.
“A significant benefit is that people discover that their voice matters and that they can surprise themselves with those words. Their unique experience can be shared with a trusted counsellor, family member, confidant and friend. That therapeutic benefit comes down to the importance of being listened to.
“We’re not here to judge or critique. Neither are we writing poems to be published. We’re looking to be heard. It’s so rare to be heard.”
Mr Fox stumbled into poetry therapy when he wrote about his own pain and disability 50 years ago.
Born the third of four children in Ohio, he understood early on that “life isn’t perfect”, he recalls. He has neurofibromatosis (NF), a genetic disorder his late father also had, which causes tumours to form on nerve tissue. His late sister had Down syndrome.
Mr Fox had seven surgical operations in childhood. At 18, his right leg was amputated below the knee.
At the time, he felt so “fragmented” that he could not finish his sentences. He eventually wrote a poem, Even To This, where the words were scattered near the top of the page, mimicking his own brokenness. He hid in his Boston University dormitory for days when an infection meant that he could not use his prosthetic leg.
“Writing was a necessity to me then. It was a great tool for me. It helped me come to terms with losing my leg. It was an act of loving myself in spite of this great loss,” he says.
Six years later, he found a poetry therapist who inducted him into the craft he had unknowingly practised. He became certified as a poetry therapist in 1992, hoping that others would find solace like he did.
Besides teaching poetry therapy at tertiary institutions like the California Institute of Integral Studies and the John F. Kennedy University, he has written two books about poetic medicine and worked with thousands of individuals, including healthcare practitioners, adult and child patients, people with disabilities and prisoners.
He founded The Institute for Poetic Medicine in 2005, which offers a three-year training programme to become a practitioner of poetic medicine.
One of the main challenges of spreading the word about poetry therapy is the disavowal of creativity, he says.
“So many adults have experienced negativity in their relationship to their self-expression because someone shut down that creativity when they were children. Because of that hurt, that wounding, it was given up at that time. This challenge prevents so many people from beginning,” says Mr Fox.
He once encountered an 86-year-old who initially resisted poetry therapy because of a 78-year-old memory. When she was eight, her teacher had stopped her in class when she wanted to recite a poem she had memorised.
Poetic medicine helps people express the hidden parts of their experience, says Mr Fox.
Years ago, he knew of one 16-year-old serving time in a juvenile prison, who wrote: “When I write I escape the world/Because it eases my mind./To me it’s a second world;/It has no time.”
Almost 30 years after his amputation, Mr Fox himself wrote a poem about the phantom pain he still feels, which he describes as “the jellyfish you touch in the dark water”.
He adds: “I was married for 4½ years, but it didn’t last. I married myself to this work. It felt like a calling.”
Mr Fox, who is based in Mountain View, California, was invited to Singapore for his first visit here by Dr Joanne Ngeow, who heads the Cancer Genetics Service at NCCS.
She had attended a workshop conducted by Mr Fox in 2017 during a leadership course in Boston about changing the culture of medicine.
“I personally found it empowering. It gave me permission to feel whatever I was feeling,” says Dr Ngeow, who is also an associate professor at the Lee Kong Chian School of Medicine.
“Poetry allows us to hear from patients in a direct but different way. The same is true for healthcare workers. It allows for empathy and a better understanding between clinicians and patients.”
Ms Yessika Sutawijaya, a 42-year-old manager in a consulting firm, attended a workshop for patients with NF that Mr Fox conducted.
Ms Yessika, who was diagnosed at 11 and uses a wheelchair, says: “It was an eye-opener. I always thought I was not an artistic person, so I went to the workshop with no expectations. But as John read the poems and encouraged us to write, the words just flowed.
She wrote a poem on hope.
“There is no cure for NF and we don’t know if it will manifest as cancer later. There’s a lot of uncertainty. The word ‘hope’ is totally abstract, but it helps to pause from life’s busyness and take time to connect with our inner thoughts. Hope probably feels more tangible; I described it as the sun on my face and a rainbow,” she says.
There has been rising interest in the medical humanities in Singapore.
From 2024, the Lee Kong Chian School of Medicine will be expanding its medical humanities curriculum across the five years of its Bachelor of Medicine and Bachelor of Surgery programme. It was previously taught in the first two years of the degree course.
In Year 2, for example, medical students are invited to write prose or poetry reflecting on issues like the doctor-patient relationship and life and death, in a module known as Narrative Medicine.
One poem is selected from those written by Year 2 students from the previous academic year to be recited at the White Coat Ceremony for Year 1 students, which is held at the start of the academic year in August. The ceremony signifies the beginning of their journey to receiving the physician’s long white coat.
The expanded scope of the school’s medical humanities, which trains the eventual doctors in delivering compassionate, patient-centred care, comes alongside more course content relating to artificial intelligence (AI) and digital health, which will help them use technology confidently.
Professor Joseph Sung, dean of the Lee Kong Chian School of Medicine, says it is important that “patients do not feel that they are in the care of a robot”.
He sees an opportunity in the impending “AI tsunami”.
If AI can be used for routine tasks, for instance, doctors should be able to spend more time with their patients, Prof Sung says.
“Medicine is both a science and an art. There is an art to knowing and listening to your patients. If you have only the knowledge and skills and no heart, or your heart is not in the right place, you are not a good doctor.”
