Turning Swords to Paintbrushes, and Warriors to Painters…

          paintbrushes1

On October 12, 2009, the New York Times published an article titled ”Turning Swords to Pens, and Warriors to Writers.”  The story summarizes an effort organized by the Writers Guild of America in mentoring wounded U.S. military veterans to write their stories.  The writing workshop received support from the Wounded Warrior Project, and the National Endowment for the Arts Operation Homecoming.  Below is a summary of the article, some information on traumatic brain injury (TBI),traumatic brain injury and my recommendation to offer painting  and the visual arts as a healing modality for self-expression of the horrors and psychic wounds of war.

Here’s are few veterans’ responses on the writing workshop…

  • One veteran struggled to find what exactly it was that he wanted to say.
  • Another said “…there’s something in my heart…I feel like it’s a calling to write.”
  • Yet, another veteran’s real reason for attending the writing workshop was to sharpen her writing skills for a historical compilation of her family history, and the role America plays in their lives.

Writing offers veterans an avenue for expressing personal stories and experiences of combat, and is a fine medium for those capable and desiring to write.  However,  for veterans with traumatic brain severe-nerve-damageinjuries, writing may not be the best arts modality to offer due to nerve damage or loss of neural connections within the brain. This loss of neural connections may lead to many of the symptoms associated with brain injuries. Depending on the location,  severity, and rapidness of treatment for traumatic brain injuries, there may be difficulties with the following (in relationship to writing).

  • Inability to focus on task
  • Difficulty with problem solving
  • Inability to express language (Broca’s Aphasia)
  • Slower thinking
  • Inability to attend to more than one object at a time
  • Inability to name an object (Anomia)
  • Inability to locate the words for writing (Agraphia)
  • Problems with reading (Alexia)
  • Inability to focus visual attention
  • Difficulties with eye and hand coordination

 (Source: Brain Injury Association of America www.biasusa.org)

To learn more about the other myriad symptoms associated with traumatic brain injuries in the military, visit the link below – DHCC.

According to DHCC  (Deployment Health Clinical Center) , the website states that early mild TBI symptoms may appear subtle, but they can lead to significant, life-long impairment in an individual’s ability to function physically, cognitively and emotionally.  Btw, DHCC is located at Walter Reed Army Medical Center in Washington, DC.

In a New England Journal of Medicine article on TBI in the military, it  Iraq-Soldiers-PTSD15dec04reported 56%  of those diagnosed with TBI are considered moderate or severe, and 44% mildAlso, some symptoms of TBI overlap with those of post-traumatic stress disorder (PSTD).  Those in the military are usually young and healthy, and have a good chance to recover from TBI.  However, they have been hurt in terrible ways which may complicate and affect their recovery outcome. (1)

Use paintbrushes rather than pens…

Given the cognitive, visual and motor coordination problems veterans paintbrushesexperience as a result of TBI, writing may not be the best avenue for self-expression.  Painting (and the visual arts) as a creative intervention is a much better choice of medium.  Why?

  • With writing, there is a tendency for  internal editing and censoring of the written word, and this is by those of us without brain injuries!  Imagine the frusration of veterans suffering from mild to moderate  symptoms of  TBI.
  • Writing requires fine eye – hand coordination. Painting, on the other hand,  involves more gross motor coordination.
  • Painting requires less cognitive and visual perfection or acuity.  For example, Claude Monet painted despite his progressing blindness.

Claude Monet water lilies

(Claude Monet, water lilies, 1840-1926)

  • Painting utilizes imagery rather than words to express psychological and emotional states.
  • In painting, there is no right or wrong methods, techniques or colors to convey meaning and thoughts.  Writing requires concentrated effort, exactness and command of the written language.
  • Paintbrush handles can be adapted for those unable to hold thin paintbrushes.
  • There is less internal editing with painting.

 Note: email me for the references.

Try this simple Creative Intervention…

music-notes1I’d like to introduce and describe a short and simple Creative Intervention to try on your own.  I developed this CI (Creative Intervention) for use in my Creativity Workshops. 

The goal is to visualize the music you hear and transfer these images onto paper.  It will take about 10 minutes to complete the music-notes1exercise, but may be longer depending on how much time is devoted to your drawing; the musical piece is 5:25 minutes long.

But first, read the short list of instructions and then go for it! 

A few Instructions:

1. The music selected for this particular Creative Intervention is Beethoven’s Pathetique Movement 2 by Freddy Kempf.  I chose Freddy beethovenKempf’s version over other artists for his expressiveness and sensitivity in interpeting this piece.

The link below is to a youtube video.  The goal is to listen with your eyes closed. No peeking to watch Freddy during this exercise; you can watch him later!

Note: It’s important to be in an quiet environment for you to benefit from this exercise.  So, close your office door or wait for better time.

2. Gather your supplies: white paper and drawing/coloring tools in different colors (crayons, colored pencils or markers).  Anything you crayonscan draw with is fine, but make sure you have different colors.

3. Listen to the selected piece by clicking on the link. Remember- keep your eyes closed during the entire musical piece.  The goal is to shut out outside visual images and noises, and focus on you.

While you’re listening, picture how the music would look if you could see it.  What are the colors and shapes you see?  Are there lines?  Is it abstract?  What are the rhythms, the melodies and mood(s) you see?  How does the music make you feel?  Are there words or just colors or images? Don’t worry about drawing anything you may not recognize – that’s not important to this exercise.  Remember, there is no right or wrong way of doing this exercise - just your way.

music-notes1

      Are you ready to begin?

Increase the volume on your computer to mid-way – Beethoven’s Pathetique Movement 2 is very soft in certain sections.

CLOSE YOUR EYES and listen for the entire duration.  Click the youtube link below and listen to Freddy Kempf’s version Beethoven’s of Pathetique Movement 2.   According to music interpretation,  Pathetique in its entirety is not a sad song piece.   Beethoven wrote this when he found out he was losing his hearing. The first movement is depicting the rage and sorrow he felt. The  second movement (the youtube video below) is depicting the comfort he receives.  The third movement is almost a testament of joy.


Now, draw what you ’saw’ when your eyes were closed.  When you’re finished, look at your drawing for a few minutes.  Don’t be critical about it – it is what it is.  Try this exercise with your favorite musical pieces – rock, alternative, classical, pop, etc.  Compare the 2nd, 3rd drawing with the first.

Creative Interventions are not just for patients…

Creative Interventions should be experienced by all healthcare professionals, not just patients.  Who will benefit?  Nurses, doctors, ancillary nursing personnel, social workers, OT, PT, healthcare managers and executive staff, and academicians.  By experiencing and expanding your own definition of creativity, it will ultimately benefit your patients and your daily interactions with others.

 mhand_stem-cell-garden_sm(stem cell garden, Marti Hand 2008)

Drawings by patients with lupus…

A comment  received on the post “Drawing as a diagnostic tool in lupus patients” expressed interest in seeing some drawings created by lupus patients who participated in the research study (by Katarzyna Nowicka-Sauer).  Below is the reader’s comment:

“It would be interesting to see some of the drawings by the lupus patients! It would take me a bit to figure out how to draw my illness!!! Interesting concept really.”

In response to the comment, below are 3 drawings and their stories taken from the research article (1)…

lupus pt drawing 1

 

 

“My illness had…still has…many faces: In the beginning I used to cry a lot, I was young and my appearance was the most important thing.  I was angry, sad…These teeth represent the horrible pain I used to suffer.  Now I accept my disease… Nevertheless, sometimes these stages come back.” (JJ, 44)

 

 

 

 lupus pt drawing 2

 

 

 

“Lupus has attached many parts of my body.  Sometimes it’s hard to bear it, especially during flares… It’s also a fear: What will happen next?” (BG, 50)

 

 

 

 

 

lupus pt drawing 3

 

 

 

“My illness is like a monster which sometimes bites, but it still has “human shape’ because I hope it will be ‘humane’ for me.”  (CR, 52)

 

 

 

 

 

 

According to the researcher, ‘drawing is an unconventional task that makes the patients think about their disease in a different way, far from medical view.  It makes them concentrate on ‘feeling’ and ‘experiencing’ the disease … Although we are used to verbalizing our thoughts and feelings, sometimes, it can be easier to express them in the visual way…”

Note: email me if you want the bibliography

Your Body as Healer…

An article titled “Miracle Survivors,” in Forbes (March 2, 2009), portrays stories of people who have spontaneous remissions from several different types of cancers. Explanations by the medical community range from “…a complete mystery,” “divine intervention,” or “the immune system.”  With regard to the latter explanation, our bodies have all the necessary elements to heal itself. 

Everyone knows who Deepak Chopra  is…here is his explanation and understanding of spontaneous remission taken from intentblog

“Essentially remission is based on our understanding of the science of self-repair. Our bodies have learned to heal themselves over millions of years of mhand_bodymindsoulemotionevolutionary time. Our bodies are the best pharmacies in nature. They make antibodies, sleeping pills, tranquilizers, immunomodulators, and anti-cancer drugs in the precise dose at the precise time and for the right taget organ; and all the instructions come in the packaging! The “packaging” is your own inner self - the ultimate and supreme genius which mirrors the wisdom of the universe.  Cognition or thinking, moods, feelings and emotions, behavior, social interactions, personal relationships, environment, diet, and the inner world of consciousness including attention and intentionality all influence the biology of healing.”

Now, back to the Forbes article…

It states that “spontaneous remissions are among the rarest and most mysterious events in medicine, with only several hundred cases that can be considered well documented.”  In 1993, two authors for the Institute of Noetic Sciences, created a database of  medically reported cases of spontaneous remission in the world from more than 3,500 references.  This data shows the ability of our bodies to heal itself is not such a rare event. 

Btw, the authors defined spontaneous remission as “the disappearance, complete or incomplete, of a disease or cancer without medical treatment or treatment that is considered inadequate to produce the resulting  disappearance of disease symptoms or tumor.” 

Activate the body’s self-healing properties with Creative Interventions in Patient Care:

  • Art-making
  • Writing
  • Music
  • Dance
  • Humor
  • Laughing Clubs
  • Art Exhibits with artwork created by patients, families, professional staff
  • Indoor and outdoor gardens
  • Art at the bedside
  • Limitless possibilities

 MHand_cycleswritingpaintpalette1flower-butterfly

Some Messages for Contemporary Medicine…

A little humor for the day by Groucho Marx:

 ”I never forget a face, but in your case, I’ll be glad to make an exception.”

I recently read an article written by two physicians in Greece titled, “The Modern Hippocratic Tradition: Some Messages for Contemporary Medicine.”  The article provides background information on Hippocrates and his major achievements in medicine, namely, modern medical practice of attributing disease to natural causes, and treating based on observations, reasoning, and experience.  However, Hippocrates believed and treated his clientele as psychosomatic entities, a holistic medical approach, unlike modern medicine practice which is very depersonalizing and singularly focused on treating the body – not the whole person.

There are many fine points on the state of current medicine (undesireable) and the need for the medical establishment (and healthcare in general) to return to and embrace the basic philosophy and principles of Hippocrates.  Here, I will mention a few by putting the points in quotation marks.  But, read the entire article which you will find interesting.  Source: Marketos S, MD and Skiadas P, MD.  The Modern Hippocratic Tradition: Some Messages for Contemporary Medicine. Spine 1999;24(11):1159-1163.

“…In our times, there is a tendency to forget that the patient must occupy the center of our attention, and in forgetting this principle, physicians have almost lost control of their profession.  The innovation that Hippocrates introduced to medicine was the holistic approach to the patient…he considered and treated the patient as a psychosomatic entity and not as a mere sum of organs…”

“He believed that the human body acts as a whole, so that when an organ is ill, the whole body is being afflicted.”

Hippocrates had a strong faith in nature’s healing power.  He observed the course of  the disease, trying not to interfere with nature.  This attitude should not be explained as a passive stand toward the healing process, but as a respect for nature’s power to cure.  One of his principles is, “Merely give nature a chance, and most of the diseases will cure themselves.”

“Interest has shifted from clinical evaluation of the patients to the assessment and interpetation of sophisticated procedures. In many cases, the efficacy of advanced medical means is being overestimated.  Apart from the fact that exaggerated trust in technology can lead sometimes to inevitable mistakes, this attitude tends to alienate physicians from their target, namely the patient.”

“…the fragmentation of medical science has created a type of physician who regards the patient as a disordered mechanism rather than a psychosomatic entity…”

Hippocrates believed ,”the physician must assist nature, which is the physician of the diseases.”  The natural environment is constantly and rapidly being degradated through contamination of water and food, accumulation of chemicals, nuclear pollution, and the spread of radiation.  The consequences of these environmental changes are apparent already.  Cancer and cardiovascular disease affect a great percentage of Western countries.  This undeniable reality prompts us to rediscover the principles regarding healthful behavior, the quality of life, and the healing power of nature.”

“…biomedical technology has ignored the psychosociologic aspect, treating the patient more or less as a disease and not a unique human entity.  Depersonalization of the patient and a lost sense of his or her individuality can be confronted by keeping the Hippocratic humanistic values in perfect balance with progress in technology.”

“…medicine more than ever senses the need to combine the concepts of humanistic values and the Hippocratic messages with the techonoloic ‘imperative’ (power).  This bond is necessary to the improvement of medicine in the future because, currently, the enormous biomedical technology so far has contributed little to the traditionally human fields of psychosomatic and functional disturbances, posing new dilemmas and threatening scientific problems.”

So, what do YOU think about all this…?

Note: Please comment by selecting the tiny ‘No Comments’ or ‘Comments’ option (whichever may be the case) located in the tiny menu bar below this post.

Connecting paintings to patient care

At Dartmouth Medical School, a pilot program developed by Dr. Joseph O’Donnell has medical students studying paintings to help sharpen their observational and diagnostic skills.  The medical school collaborates with Hood Museum of Art to assist students to examine paintings, discuss what they (students) have seen, and challenge they to “support their points with visual evidence.”

wassily-kandinsky-solid-green                                      (Wassily Kandinsky 1866-1944, ‘solid green’)

One might ask how examining art is helpful in diagnosing illness and disease in patients.  According to the article, “if a couple of distinctive details in a painting are overlooked, you might arrive at an inaccurate interpretation – very similar to patient diagnosing.”  To read the article, click here.

I’d like to comment on a few points.  First of all, I love that the healthcare industry sees the value in utilizing and incorporating the arts in medical and listeningnursing education.  By applying the same critical observation skills one uses in examining paintings (or any object) to assessing patients, the healthcare practitioner will pick up more of the subtleties regarding a patient’s condition.  However, making an accurate diagnosis is  arrived at carefully listening to a patient’s story of the events leading up her/him seeking medical help, and asking the right questions.

Lingering effects after the I.C.U

Have you had a family member or friend stay in the I.C.U (intensive care unit) for treatment of an illness?  Those of us who work in theICU critical care units (past tense in my case) are happy to see patients tranferred to step-down units because we feel we applied our best efforts in getting these patients on the road to recovery…and we did.  We stablized their bodies and healed them physically, but researchers are finding out that spending days, weeks or months on life support in the units can bring unexpected, long-lasting undesireable effects.

According to a New York Times article (Jan. 11, 2009), some patients  experience lingering effects from staying in the ICU for months to years after they are discharged from the hospital, such as:

  • Lingering generalized weakness
  • 25% of patients on mechanical ventiliation for a minimum of 5 days got so weak, they were unable to lift their arms
  • Poor concentration
  • Significant weight loss
  • Some patients experienced symptoms of PTSD (post traumatic nightmarestress disorder) such as hallucinations, nightmares during sedation, mood disorders, anxiety, shortness of temper and frightening memories - click here for symptoms of PTSD in a previous post.

Dr. Dale Needham at John Hopkins has begun a 5 year study of patients discharged from the hospital and is finding many patients have difficulty in regaining their strength.  Families are finding their loved one(s) are not the same person anymore.  The difficultly lies in determining which disabilities come from the illnes as opposed to the I.C.U stay, when many patients are on a mechanical ventilator, and receives high doses of sedatives, narcotics and anesthetics.  Particularly surprising is how quickly patients loose their strength.

Patients in intensive care not only experience physical stress due to SleepDeprivedbodily trauma, but also psychosocial stressors with pain, inability to communicate, sleep deprivation, feelings of isolation or lonliness, and fear or anxiety being the most common.  A review of the literature has shown each of these stressors are associated with decreased immune functioning. (2)

In  Laitinen’s study, patients emphasized the importance and need of closeness with a healthcare professional whom they could trust to reduce feelings of anxiety, isolation and increased sense of security. (3)

 

And how are medical professionals addressing these issues? 

By…

  • reducing sedation levels of pain medications, narcotics and anesthetics.
  • getting patients mobilized and walking along with all the ICU paraphernalia like intravenous lines, ventilators, and monitoring equipment.
  • mobilizing patients as soon as possible – patients seem to recover faster and spend less time in the intensive care and the hospital.  

music-notes1music-notes1music-notes1

Implement Creative Interventions for patients in the intensive care units

I encourage the use of Creative Interventions as non-invasive modalities to counter the psychosocial stressors and loss of strength patients experience during their intensive care stay.  Families and CB030187friends can help by bringing the supplies listed below, and more importantly, become active participants in their family member’s care.

Naturally, not all patients in the intensive care units will be capable of actively participating in creative interventions due to their conditions.   However, applying a headset to unconscious patients and playing soft soothing music is much better than hearing noxious noises and sounds of ICUs. 

Here are a few Creative Interventions to start with:

  1. Headset,  ipod or CD player.  Encourage families and friends to compose the patient’s favorite playlist (soft and classical music music-notes1are best), and play during visiting hours.  Nursing staff can apply this intervention during non-visiting hours.  I wrote several posts on the benefits of listening to music in reducing anxiety, pain, and as a form of relaxation.  The posts are titled, Rx: Listen to Music, Listening to Music: Another Creative Intervention.
  2. Listening to music with headsets also reduces noise inherent in intensive care units.
  3. Art-making activities: encourage families and friends to bring in simple art-making materials, such as watercolor markers and sketch pad or other creative materials. 
  4. Engaging patients in creative activities provides a sense of enjoyment, pleasure and diversion in a bewildering and frightening environment.                                                                                                                                                                                                                                     
  5. Give a lump of clay to patients with strokes (or any patient) to create small sculptures.  By manipulating the clay with their hands, the physical motions will help with maintaining muscle strength, dexerity, and divert their attention from their current situation.                                                                                                                                                                                                                                                                                     dog mask

 

Note: email me if you want the bibliography.