Introduction: Touching the Heart of What It Is To Be Human

Cheryl L. McLean

“I want to be loved with a love that is true and is truthfully expressed. I want to be loved with a love that connects me to another and connects another to me. I want to be loved with a love that embraces and that, while holding me in care, also frees me to live with care.”

— John J. Guiney Yallop

Creative Arts in Humane Medicine has been created as a resource book for medical educators, practitioners and students, as well as for those in the allied health professions who wish to learn how the arts can contribute to a more caring and empathic approach to medicine. In this collection, which features the latest research and real-life examples, physicians, medical educators, researchers and allied health professionals, as well as medical students, residents, artists and others across Canada, the United States, the United Kingdom and Australia, show how the arts in action can contribute toward humane medicine.

To be humane is to show empathy or understanding, to care about the condition and suffering of others, to treat others as we ourselves might wish to be treated. The word medicine, from the Latin ars medicina, refers to the art of healing, the practice invested in the treatment and prevention of illness. Humanistic medicine is a growing trend today as more medical professionals integrate the arts into their practice to improve communication with their patients and build better relationships. A recent study found that more than half the medical schools in the United States involved the arts in some form in learning activities (Rodenhauser, Strickland & Gambala, 2004). This survey showed that the arts are being used to foster student well-being, enhance teaching and learning, and improve clinical and relational skills: observation and diagnostic skills, reflection and insight, for example.

There are other encouraging signs that the arts are alive and thriving in medical education today, with programs integrating the arts and humanities into medical education and leading medical schools and universities offering more programming to promote creative and scholarly work at the intersections of the arts, humanities and medicine. One Canadian effort, the Medical Humanities HEALS (Healing and Education Through the Arts and Life Skills) Program at the Faculty of Medicine, Dalhousie University, offers programming in visual arts, performing arts, the history of medicine and creative writing. Another—the Arts and Humanities in Health and Medicine Program at the Faculty of Medicine and Dentistry, University of Alberta, launched in May 2006—has a mandate to balance scientific knowledge and compassionate care. Its mission statement formally acknowledges “the explicit recognition within the Faculty that clinical practice is both an art and a science.” At the University of Toronto, the Undergraduate Medical Education (UME) program has begun to integrate different types of narrative systematically into the curriculum with a new companion curriculum.

At Yale School of Medicine, the Yale Medical Humanities and the Arts Council reports it is committed to fostering the use of the humanities, the social sciences and the arts as lenses for examining issues in health, medicine and healing. Arts and Humanities at Harvard Medical School aims to promote the role of the humanities in medical education, clinical care and research. At Stanford School of Medicine, the Arts, Humanities and Medicine program has been established to promote creative and scholarly work at the intersections among these
disciplines.

Growing support for the creative arts in humane medicine today is also coming from medical students themselves. The American Medical Student Association (AMSA) has more than 150 chapters in medical schools across the United States and an estimated 350 pre-med chapters. Aliye Runyan, MD, Education and Research Fellow, American Medical Student Association, reports that the AMSA Medical Humanities Scholars program exposes students to leading faculty in narrative medicine, the humanities and the arts as they explore reflective capacity, communication, self-care and the art of listening to their patients’ stories. AMSA, Runyan writes, “believes it is paramount that the physician not only be a scientist but a humanist, a communicator and an advocate.”

I was recently a guest presenter for AMSA’s Medical Humanities Scholars program. During the session a student asked, “If this work [about the creative arts in medicine] is frequently about empathy and feeling the human story, how much empathy is too much empathy? What if I can no longer bear it?”

The student asked a very difficult question, one not easy to answer. Our creative work is powerful and profound in the way it frequently uses all the senses to foster empathy and draw us closer to human understanding. But what are our human limits? I asked myself, if I were in bed, ill and fighting for life, how much empathy would I hope my caregivers would extend to me? When would enough be enough? This collection raises provocative questions and proposes alternative approaches in the hopes of inspiring new areas of investigation while opening up a larger conversation about the creative arts in medicine among students and medical practitioners.

This book has been divided into four distinct and related sections: Section 1, Educating for Empathy Through the Arts; Section 2, The Arts and Practitioner Self-Care; Section 3, Navigating with Narrative Through Life Experience; and Section 4, The Creative Arts in Action for Change in Health.

Section l opens with special attention to the overriding theme in this collection, that of fostering empathy through a variety of arts methodologies. We begin with visual art as the focus. Andre Smith and his research team at the Department of Sociology, University of Victoria, demonstrate an innovative pedagogical approach using fabric art to teach empathy with end-of-life health care providers. Similarly, in my article, I share the process of creating an ethnodrama to raise awareness about aging, mental health and autonomy, and discuss how writing and creating a performance based on research led to greater empathy and human understanding. Craig Chen, MD, an anesthesiology resident at Stanford University Medical Centre, supports the view that the arts and humanities can bring about understanding about illness and disease. In his essay he explains,

“It is not easy to go to work every day and care for people who hurt themselves, are going to die, cry on your shoulder, feel terrified or distrust the health care system. With respect to medicine, the arts and humanities help us understand how humans experience illness and disease, and place that experience in a context of diagnosis, treatment and care.”

The section’s closing paper, by researchers Mina Borromeo, Heather Gaunt and Neville Chiavaroli from the Melbourne Dental School, explores the visual arts used in education for increasing observational skills and understanding as students are guided through the rediscovery and re-appreciation of human responses as it applies to special-needs dentistry.

In Section 2, we examine the daily realities of working in medicine—illness, disease, aging, death and after death—and how the arts can offer healthy opportunities for practitioners to address their self-care needs. Alim Nagji, MD, who is also an actor, producer and writer, stresses that teaching practitioners to understand their patients’ stories must begin early in training, before the erosion of empathy. Nagji believes using theatre in medical education can help students delve into patients’ back stories, drawing parallels between those experiences and students’ own. In Maura McIntyre’s article, arts-informed research, part of the growing genre of performance ethnography, offers caregivers and others an opportunity to participate in reader’s theatre so that they might experience real stories of nursing home life. Craig Chen informs us about the importance of providing health professionals and others a place for self-expression through varied forms of performance. At Stanford, medical students and community members connected through performance while audiences learned more about what it is like to work in the field of anesthesiology. Rachael Allen, an artist in residence at university anatomy and clinical skills laboratories in northeast England, writes about witnessing students engaged in lab work with prepared prosections of embalmed and plastinated specimens. She believes it is fundamentally important for health and humane medicine that students working in anatomy labs are offered opportunities to express these intimate human encounters through art. Allen offers new and sensory approaches to anatomy and clinical studies while artistically rendering the undergraduate experiences of medical students. Music therapy, too, has long been recognized as an effective tool for self-expression and healing and, as Amy Clements-Cortés demonstrates in her article, can also help address stress and other issues for those working in palliative care settings. In other programs, expressive approaches have also proven useful for health care practitioners, as Diane Kaufman, MD, and her team at the University of Medicine and Dentistry of New Jersey explain.

Readers will explore personal stories through narrative in Section 3 as well as learning about the applications of literature in medical practice. Each of our contributors navigates with narrative or uses story in unique ways, but all writers in this section share an underlying belief about the humanity and dignity that can be found through fostering the practitioner-patient relationship. Jasna Schwind, a nurse educator, writes about her work, informed by narrative inquiry, while sharing aspects of her own illness story to demonstrate how intentional and thoughtful reflection allowed her, as both patient and caregiver, to make sense of the experience. Narrative and poetic inquirer John J. Guiney Yallop writes about his lived experiences with medical practitioners over time and, in so doing, poignantly illustrates the importance of the relationship between practitioner and patient. Catherine L. Mah, a scientist, practitioner, researcher and teacher, discusses the uses of literature and the childhood novel in pediatrics practice, suggesting the approach may help establish a foundation for narrative examination in the one on one interview.

In Section 4 we embrace change and the future, opening with an exploration by Louise Younie, a clinical senior lecturer, who writes about her journey of discovery through arts-based inquiry and considers the transformative influences of the arts in medical education as well as within her own work. Canadian activist artists Carole Conde and Karl Beveridge are featured demonstrating the arts in action for change: the power of story and photography to touch people and advocate for humanity for those who work in health care settings. Bandy X. Lee, MD, believes there is a great need for collective and emotional healing today. She reports that, in terms of change, effective violence prevention may be the key to health and human flourishing and creativity. Louise Terry illustrates how digital stories and technology can help teach ethics and law to health and social service professionals while contributing to humane medicine. Visual and audio technologies, she suggests, help bring to life our human stories complete with actions, omissions, aspirations and values. Carol Ann Courneya closes this section with an exhibit from the heart as medical and fi ne arts students from the University of British Columbia build bridges to understanding health and the heart while connecting to communities through the visual arts.

This is an educational book in which, through creative processes, we feel the human story and touch the heart of what it is to be human in others while attentively loving and caring for ourselves ... not only surviving but thriving as humane practitioners in our lives and work. I invite you, through this book, to read, engage and actively learn about the creative arts in humane medicine. I believe you will find, in keeping with the embodied nature of our field, each article unfolds in its way as a story, a revealing performance about life, a creative act in itself.