Consultant Clinical Psychologist and poet Khadija Rouf explores how poetry can help to heal trauma
The COVID 19 pandemic which has been sweeping the world since December 2020 has profoundly affected many of us. In the tumult, we have seen the best and worst of humanity. We have seen dreadful decision making and creative and adaptive innovation. We have witnessed reckless neglect and compassionate activism. We have felt a yearning for those things in life which it is impossible to measure, but whose absence has taken a deep toll on many of us; shared and embodied togetherness – physical proximity, touch, connection and attunement.
In this storm, and perhaps because of the absence of these ‘taken-for-granted’ treasures, we have also seen a renewed focus on the arts, wellbeing and nature – with an urgent and refreshed conversation about the mental health consequences of dramatic cultural change, lockdowns, trauma and grief.
This renewed interest in the arts is welcome. The arts have abilities to provide social connection, hope, meaning and to help language experiences. My particular interest is poetry; whilst poetry is not therapy, it can be therapeutic. It is part of the natural collective repertoire of remedies which society has available to it. At its best, it is perhaps part of what helps cultures to stay within a healthy emotional zone, without being disconnected or inflamed.
WHO Director-General Tedros Adhanom Ghebreyesus said that the Covid-19 pandemic has caused more “mass trauma” than World War II
There is a burgeoning interest in its capacities to help us express emotions about the often unmapped zones of life experiences, to face emotions in potentially safer ways and to build empathy with each other. It is so striking that poetry is often drawn upon at the most heightened and precious moments of our lives – births, weddings and bereavements – and at times of national significance. It can help us through our darkest times and most joyous times, providing solace, joy and giving voice.
Distress in the new millennium
There has been a growing and urgent conversation about the level of mental health difficulties in society. It is estimated that 1 in 6 children have mental health difficulties, and that 1 in 4 people will experience mental health problems at some point in their lives. This concerning level of distress cannot be seen as something that is about individuals. We need to reflect on what is happening in society, to lead so many of us to feel distressed.
The Mental Health Foundation cites loneliness as one of the major issues facing people (2020), and social isolation has been amplified for many during the pandemic. There have been many acts of social good – online massed choirs, exercise classes, virtual discos, online theatre and poetry. Many people have renewed their love of creativity and nature, and started to see these connections with an emotional and ecological landscape as vital to a sense of wellbeing, and research evidence also bears out the value of this connection.
On 5th March 2021, WHO Director-General Tedros Adhanom Ghebreyesus said that the Covid-19 pandemic has caused more “mass trauma” than World War II. With much of the globe still in an ‘acute phase’ of pandemic, we are likely to experience mental health impacts for many years to come (see Feuer, 2021).
The case for the arts in mental health
Advocates and policy makers are now starting to talk about the importance of art in promoting good mental health. In the days before COVID, an All Party Parliamentary Group (2017) reported on strong evidence that creative and cultural activities can have a positive impact on health and wellbeing. They highlighted that such activities can help with mental health, promoting positive ageing and also mitigating some of the impacts of social inequalities. They felt that some of the ingredients involved, were the creative arts ability to enable self-expression; to empower; to reduce isolation and also to prevent worsening of illness.
More recently, the Mental Health Foundation (2020) recommended that the arts should be supported via social prescribing schemes across the UK, as part of wellbeing programmes. Greater Manchester has committed to ensuring that art and culture are integral to its health strategy (2017-2021). The Welsh NHS Confederation stated that, ’The creative impulse is fundamental to the experience of being human. This impulse may be expressed through art, craft, creative writing, dance, design, drama, film, music-making or singing, by ourselves or with others, and we are making more creative use of digital media.’ (2018, p2).
This creative impulse, this shared need within people, is not incidental to human experience. It is central and it is vital. We often talk about the ‘arts and humanities’ together – and they really are interlinked – there is something within artistic expression which makes us human, and indeed, humanises us.
The therapeutic value of poetry
There are many fascinating possibilities within poetry. Poetry connects deeply with perception, plays with attention, memory and emotion. It can have healing possibilities and offer soothing, both in the reading of poetry and in the writing of it. It provides many potential opportunities – meaning making, self- expression when there is a need to try and forge understanding out of raw emotion, soothing, and hope – amongst its many avenues. We often turn to poetry when we are at pivotal moments in life.
Alice Oswald writes in Falling Awake, ‘Poetry is not about language but what happens when language gets impossible’. Oswald’s quote, that language can be impossible, resonates so much with therapeutic experiences, where there are efforts to try to language experiences which have not been expressed, named or processed. Here, language is often new. In the words of Ezra Pound, poetry should endeavour to ‘make it new’. There are commonalities here.
Recovery and healing from mental health difficulties have key features –the creation of meaning, having control over one’s life and building a sense of belonging and social connection. Out of these things there is a creation of hope, so central a need to existence. Often people need to be heard, be visible, when so many will have had experiences that will have left them feeling unheard and invisible. Poetry can bring voice and help to establish a sense of identity, a mapping of story.
Poetry as meaning making
Meaning making is central, in helping us to find words when we may have none of our own. Our lives are constructed from a series of narratives; our experiences must be ‘storied’. However, narrative therapists, White and Epstein, comment that ‘much of our stock of lived experience goes un-storied and is never ‘told’ or expressed’ (1990, p.11). Similarly, Bruner (1986b) comments that experiences can remain ‘inchoate, in that we simply do not understand what we are experiencing, either because the experiences are not storyable, or because we lack the performative and narrative resources or because vocabulary is lacking’ (p.6). Additionally, in The Good Story (2015), Dr Arabella Kurtz (Consultant Clinical Psychologist and Psychoanalytic Psychotherapist) and the novelist JM Coetzee reflect on the importance of storytelling in our lives, saying that storytelling and meaning making are vital, though we may often encounter barriers to being able to story our own lives.
Perhaps poetry has the capacity to help readers identify and label un-storied parts of experience, sometimes openly, sometimes in coded ways and sometimes moving beyond autobiographical truth into emotional truth. If so, then poetry, whilst not therapy, can be therapeutic in its capacity to help people to ‘re-author’ their lives (White & Epstein, 1990).
Poetry as expression
Through the naming of unmapped terrain and landscapes that have been suppressed, the process of poetics can offer a means of self-expression which allows us to create ourselves, to become visible, when we have previously been unseen. We may have experiences which have never been named because of shame, stigma or social taboo. The inability to speak about what we have been through – to talk through, be witnessed, held and recognised – can leave deeply significant parts of us hidden, suppressed and ‘unsafe’.
Finding languages for emotions helps us to gain control over them. Raw experience can be distilled into emotional truth
All of us are acts of co-creation in our relationships, and it can come at great personal, psychological cost to have parts of ourselves which ‘do not exist’ or are ‘erased’ and silenced. It can be extremely damaging to also have embodied parts of us (which we cannot hide), such as ethnicity, disability and gender, which are attacked and othered. The stories around this may remain hidden and dislocated.
Voicing the unspoken can help us to become ourselves. Finding languages for emotions helps us to gain control over them. Raw experience can be distilled into emotional truth. The eminent cognitive therapist, Aaron Beck (1976), argues that emotion is not located in events themselves but the meanings we ascribe to those events. Poetry has the capacity to make connections between events and their meaning and in so doing, to make leaps with insight. It also helps us reconnect with the sensory, to observe and scrutinise the intimate and to distil the essence of experience. The poet, Jo Shapcott alludes to this, when talking about her poems in Of Mutability, which mapped some of her experience during treatment of cancer. She says, ’They are emotionally autobiographical. What has happened is not the most interesting thing. The most interesting thing is what does it mean?’ (McKay, 2011).
Poetry and sitting with emotion safely
Poems can make us feel powerful emotions. Importantly, they are also boundaried, sometimes by form (for example, the sonnet) but often as vignettes that have a beginning, middle and end. This allows visual containment on the page, and a contained externalisation of high emotion. Sometimes it also allows us to examine the limitations of language in capturing the enormity of some experiences. For instance, Christopher Reid’s collection, A Scattering (2009), explores his wife’s illness and death. He employs astonishing simplicity to sketch her last moments.
Sparse breaths, then none
and it was done.
This is a shattering moment. The creation of this emotional truth also offers startling insights into intimate moments. There is so much weight and depth in these two lines. Poetry has the ability to convey this with startling powers, and often in ways that a clinical textbook on death and dying could never do. There are many different forms of knowledge and knowing – poetry has the power to instantly connect us to emotion and mood. However, the reader can also maintain some safe distance, even with such resonance. We can turn the page, we can step away.
Poetry as re-imagining the world
Another capability of poetry is to lift us into the imagination – to allow the possibilities of escapism, the possibility of different narratives. Poetry can provide a means to transform stories; as acts of imagination, they allow us to reimagine, to create new possibilities and to ‘play’. As Shapcott says, ‘Poems can reveal profound truth about emotion and spirit without being literally true. It’s the whole beauty of the imagination, surely, that it grants us the freedom to tell our stories by making things up’ (Vianu, 2006).
This ‘making things up’ also potentially allows us to create new scripts, freeing the mind of literal experience in order to create a new horizon. This is potentially liberating, not only to the imagined life, but also perhaps impacting on our ability to change our embodied lives. If we want things to be different, we first have to be able to comprehend a world in which they can be different.
Poetry as connection and empathy
Poetry also contains the possibility of connecting us to perspectives and experiences other than our own. We can safely encounter other experiences in the most intimate of ways, gaining insights into things we have never been through. We can develop some distal, yet powerful, insight to what a phenomenon feels like, and how that might chime with our own vulnerabilities and shared human experiences.
This intimacy can lead to connection and empathy. Hirsch (2008) argues that the poet’s ‘contract’ with the reader begins with a relationship, ‘Reading poetry is an act of reciprocity, and one of the great tasks of the lyric is to bring us into right relationship to each other. He believes that poetry facilitates deep connection with ourselves and others, through opportunity to explore our interior world.
Poetry can create an emotional intimacy, honesty, compassion and understanding. As the ‘relationship’ between poet and reader is mediated through text, there is no fear of judgment. There is space within which to make sense of the material over a period of time. Poetry, like friendship, can help us to construct our identity. Friendship, like poetry, is underpinned by trust – when a reader truly engages with a poet’s work, they are taking an emotional risk by stepping into someone else’s reality.
Poetry as wisdom and mindfulness
At times of distress, poems can also be soothing. They can bring us into the present, into mindful attention. The landscape of poetry is vast – there are poems on history, autobiography, funny poems, sad poems. Poems which call us to activism, poems which help us to be still. Those which bring us into a mindful place often focus on the natural world and our relationship with and in it. Soothing poems can help us focus and be in the ‘flow’. A state of focussed attention. The addition of rhythm and rhyme can be healing, predictable and absorbing.
The traditional iambic parameter is set at the rhythm of a heartbeat. The heartbeat is a reassuring metre.
Poetry brings us a capacity to help us be distracted from our troubles, often with brevity, which can be appreciated if it’s hard to settle and concentrate. This soothing also offers us chances of Hope in the moment, that we can be peaceful at this precise point in time, away from worries about the future or difficult ruminations about the past.
Poetry can give sense of journey, of balm, and words of solace. ‘This too shall pass’, can be an important message in healing and resilience.
Poetry and medicine
As well as a public conversation about the arts – and poetry as part of this wider conversation – there are also discussions taking place within medicine and other health disciplines about how poetry might be therapeutic. In his article, medical student, Danny Linggonegoro (2018) writes about how the Hippocratic Oath, the vow taken by many physicians, requires doctors to “remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”
He cites growing evidence of how poetry can help patients experiencing invasive procedures, and experiencing physical pain as part of their illness. He writes powerfully about how poetry can be a space for healing, when pills and procedures are unable to help further. He also recognises how poetry can help patients retain a sense of their overall identity, at a time when illness may dominate and a person can feel reduced to a diagnosis.
Rafael Campo, physician, says; “Poetry at its heart is this shared empathetic experience not unlike the clinical encounter, where we are often engaged in the very private experience of another person’s suffering.”
Once again, poetry can humanise us, and it is increasingly recognised that it can humanise the clinical encounter, through sparking empathy. Weiner (2016) interviews Rafael Campo, physician, who says; “Poetry at its heart is this shared empathetic experience not unlike the clinical encounter, where we are often engaged in the very private experience of another person’s suffering.” Medical language can be reductive and patients can feel lost within their encounters with systems. Poetry, again, can forge new ways of knowing and seeing each other.
This renewing conversation is vital for patients, for clinicians in their therapeutic work, but also for the self-care of clinicians. There is a welcome recognition that engagement in helping others is demanding, that the carers need caring for too. Initiatives such as The Poetry Pharmacy, the Hippocrates Initiative for Poetry in Medicine, and The Bigger Picture all tap into understanding the potential for poetry as a part of the remedy. Initiatives such as Medicine Unboxed, also go further in their conversations about the interface between medicine and the arts, recognising issues such as the impact of social inequalities on public health.
Poetry in the therapy room
Moving from the macro, into the micro – there have been many occasions where I have matched creative tools to the needs of clients in the therapy room. Sometimes clips from films will help to voice a scene more powerfully than dialogue between therapist and client. Sometimes a picture or imagery will make a powerful point, and allow the reimagining of something from a fresh perspective. Sometimes this can create a moment of deep new insight.
And sometimes, a poem will provide the emotional texture and resonance that can help to come to a new understanding. Poems which have helped to spark discussions, insights or reflective silences have been The Guest House by Rumi (on sitting with all weathers of emotion); Risk by William Arthur Ward (helpful to think about coming out of one’s emotional ‘comfort zone’); Invictus by William Ernest Henley (on gaining confidence and being autonomous) and Still I rise by Maya Angelou (on resilience and surviving adversity).
The poem is only ever an invitation, and such an invitation evolves out of discussion and dialogue. Poems will be heard differently by different readers – part of the alchemy between reader and poet, so there is always careful checking on what meaning has been take from any reading. A single poem, loved across decades, can shift in meaning and resonance as life changes – poems do not stand still, and so it is always important to check how they land.
Whilst only anecdotal, some of these poems have helped with connection, to reimagine suffering, to move towards the possibility of something new.
Conclusion: the arts, poetry and recovery
We live in Big Times, and we are faced with urgent questions about the nature of how we have been living, and what kind of world we need going forward. The pandemic has highlighted that what matters in human experience and feeling, cannot always be reduced to numbers and metrics. It has taken the absence of what is not easily measured, to see just how important these things are – social connection, touch, laughter, being heard, creativity.
As we imagine easing lockdown in the UK, a national conversation is needed about mental wellbeing, it is vital to consider the role of the arts in helping people to collectively recover from this time, and the Mental Health Foundation report (2020), there is ‘..the potential of the arts for bringing people together and reducing social isolation and loneliness,’ p.12.
The Arts have suffered badly under the pandemic, with some venues being forced to shut their doors permanently. This has particularly impacted on vulnerable communities, and those using the arts and humanities to help people’s wellbeing (see Nicholas’ podcast, 2021). The arts and humanities have a role to play in mental health. There now needs to be a serious conversation about urgently investing in the arts and humanities as an important part of coming out of the pandemic safely. Investments in the natural cultural activities such as music, theatre, fiction and poetry are all social and relational ways to help us improve our wellbeing. Storying our collective and our individual experiences is vital, and important to ensure that people feel held and included in the breadth and diversity of their experiences during the pandemic. Poetry can play its part, whether spoken, lyricised into rap, choral or other forms of song, or written and read on the page.
Carefully chosen words can lift our emotion and imagination in ways that can be fresh, healing and even startling.
Words … can be medicine.
Resources where poetry and healing intersect
The Bigger Picture project is a non-profit collaboration that aims to improve health professional wellbeing and patient care by providing a wider perspective including the arts and humanities.
The Hippocrates Initiative for Poetry in Medicine
References
Association of Directors of Public Health and All-Party Parliamentary Group on Arts, Health and Wellbeing. Creative Health: The Arts for Health and Wellbeing Report. Director of Public Health Briefing – July 2017
Beck, A.T. Cognitive Therapy and the Emotional Disorders. (New York: Penguin Books 1976).
Bruner, E. Experiences and its expression. In V Turner & E Bruner (eds), The Anthroplogy of Experience (Chicago: University of Illinois Press, 1986b).
Feuer, W. (Friday March 5th, 2021) WHO says pandemic has caused more ‘mass trauma’ than WWII. CNBC news.
Hirsch, E. In the Beginning is the Relation. The Poetry Foundation website, (2008)
Kurtz, A. and Coetzee,J.M. (2015) The Good Story:exchanges on truth, fiction and psychotherapy. Penguin Random House: London.
Mental Health Foundation (2020) Creativity and innovation: Findings from the Mental Health Fellowships. Winston Churchill Memorial Trust.
McKay, S. (27 January, 2011) Jo Shapcott: a page in the life, The Telegraph.
Nicholas, R. (May 24th, 2021) Podcast – Pandemic and Beyond Episode 2: Arts, Culture and Mental Health with Josie Billington, Lucy Geddes and Helen Wilson
Vianu, L. Desperado Essays – Interview with Jo Shapcott, Editura Universitatii din Bucuresti (2006).
Weiner, S. (2016) The healing power of poetry. Association of American Medical Colleges article.
Welsh NHS confederation (2018) Arts, Health and Well-being.
White, M. & Epstein, D. Narrative Means to Therapeutic Ends. (Norton Professional Books: Dulwich, Australia, 1990)
Wroe, N. A Life in Writing: Christopher Reid, The Guardian Review (Saturday 29 October, 2011).
