Positive Health Online

Key Terms

[Cure, as used in this article, refers to total elimination of disease, whereas healing refers to a process of personal restoration. And discourse, as a formal treatment of a subject in speech, or writing. Narrative as used in this article, refers to words that are written; words that are spoken and words that are read].

Healing

Everyone is interested in healing; it holds universal appeal arising from the human condition. We are all born, we all become ill, and at some point we all die. But, when cure is no longer possible, personal healing can still be experienced; as the balm that soothes despair.

This article's focus is the therapeutic use of discourse narrative to achieve healing – a therapy currently available under Complimentary Alternate Medicine (CAM) within the NHS.

Biomedical Discourse to Reverse Discourse

Patient-healing is achieved by the reversal of Biomedical Discourse[1] in a process whereby, narratives of therapy (illness narratives) become therapeutic narratives.

Biomedical discourse in medicine is the predominant feature of the clinical medical milieu. Medical words used in confidential patient-records of tests, proposed treatment, diagnosis and patient-prognosis, whether in general practice, or hospital – are the only existing account of a patient's illness within this biomedical model – which effectively disempowers the patient, who feels excluded from all that relates to his care.[2]

Key therapeutic functions of empowering illness narratives, which overcome biomedical discourse are perversity, empowerment and transformation.

Only a powerful, perverse illness-narrative, can challenge the stigma and subordination surrounding a patient's disease, and also overcome the key factors within biomedical discourse, which places the authority with the doctor, and demands acceptance of this from patients.[3]

Additionally, if healing is to be achieved, patients also need to be able to draw support from a sense of belonging to a community of people, who suffer from the same illness as themselves. But the most important function of reverse discourse is that it enables patients to accept a new story, which, from a process of patient acquiescence, then becomes a part of their lives.[4]

Healing and Becoming Ill

Healing and illness, are inextricably linked. There is a recognized link between opening up about personal life-traumas and the positive healing changes in both brain and immune- function resulting from this.

On the other hand, it is confirmed that excessively inhibiting personal stressors is detrimental to immune function related to the heart and vascular systems, and the nervous systems. This indicates that exposure to the risk of minor and major diseases from inhibition is why people eventually become ill.[5]

On the other hand, confronting our deepest thoughts and feelings, through written disclosure, can promote health, in the short and long term.

The positive role of spoken disclosure in healing is confirmed by the cathartic ritual of Confession, currently practised within both Eastern and Western religion, as a specific example of this.[6]

[It is just as important in healing from spoken disclosure, as with any other healing practices – such as, the hands-on, Reiki and Quantum Touch, that the healing environment must be suitable, if healing is to take place]. Recognition of widespread deficits in NHS care environments, prompted the launch of a remedial King's Fund programme in 2002.[7]

Evolving Towards Holistic Care in the NHS

After doctors in Britain and US, in the 1960s-1970s, realized the rapid avalanche of technology and pharmacology of the mechanistic 'Biomedical' model of medicine was making patients disappear, the more holistic Biopsychosocial model was evolved, to restore priority to the patient. But unfortunately medicine has an inherent perennial problem – in its entrenched failure to get behind the patient to essence of the person.[8]

Healing Environment?

But in contemporary NHS care, the care-environment is often experienced by patients as non-conducive to the basics of respecting their individual dignity and privacy, although positive input from care-givers in themselves, can compensate from this health- environment deficit.[9]

One example to confirm how care staff can compensate for an inadequate environment for healing is demonstrated by a doctor's positive input to patient care during the doctor/patient admission interview. Doctors who give undivided attention during this interaction with a patient can dramatically improve the patient's outcomes from their medical care. Using skills of  Person Centred Counselling, to actively listen to a patient's illness disclosure and accurately reflect-back what the patient is telling him, confirms for the patient that they have been both heard and understood – to the benefit of both patient and doctor.

The doctor will have more readily reached his patient-diagnosis, and the patient's self-esteem will be restored – from knowing someone else has heard his voice, someone else has understood, someone else knows what he has been through from listening to the patient's spoken disclosure of his illness story.[10]

Written Disclosure and the Mind Body Link

A connection between disclosure narrative, psychological insight and mind body link confirmed that different psychological conflicts are linked to specific physiological bodily changes. For example, different people, given the same bad news, – such as the death of a loved one – will individually have a different physiological response from receiving this news.

Wheezing, congestion and other respiratory changes, are long-recognized symptoms of asthma, while extreme hypertension is linked to cardiovascular disease. In different physiological responses – to the same stressor – an asthma sufferer therefore, will experience increasing respiratory difficulty; whereas a hypertension sufferer's blood pressure will dramatically shoot upwards.

If the hypertension and asthma sufferers vented their grief from the same bad news by writing about their feelings on receiving the bereavement news, a sequence of healing would be initiated, from reduced severity of their individual physiological symptoms, and then prevention, respectively, of either respiratory failure or a stroke – in a confirmation that emotionally venting of grief is healing.[11]

The results of a 2006 randomized medical control trial on possible healing effects of written disclosure on Asthma, found that despite no change in lung function, written disclosure had reduced functional disabilities from asthma symptoms among adolescents with elevation of these difficulties at baseline.

Additionally, the researchers also found that disclosure narratives with more emotionally negative words predicted improved health. And that written disclosure was found to have improved positive mood and internalizing of problems and behavioural functioning, among adolescents with asthma.[12]

A randomized clinical control trial in 2006 aimed at examining gender differences in physical and psychological symptom changes, related to written narrative disclosure. It concluded that written disclosure was associated with significant improvements in both psychological and physical health for both men and women; with no gender differences.[13]

Another control trial, described as a 'getting it off your chest exercise' tested for effectiveness of written personal disclosure of asthma and/or rheumatoid arthritis. In the trial, patients were randomized to write about either their most stressful experience or about their plans for the day, for three separate 20 minute periods over a few days, and then to drop their completed essays into a sealed box.

The study showed a significant improvement in standard measures of disease severity – of both asthma and rheumatoid arthritis – over the following 4 month period. Overall, nine of the 43 in the control group, and 33 of 83 in the experimental group, had improved at 4 months.

Significantly however, the trial's outcomes also highlighted that not all researchers of written disclosure narrative as healing had found positive effects from using writing, and not all people who wrote them showed positive benefits. Smyth.[14]

[Perhaps 'the human factor' is the responsible variable here? Not everyone engaged in cathartic writing to achieve healing is emotionally, and/or physically ready to confront their demons, with the vigour necessary to achieve healing. This is a fact that, unfortunately may not become apparent until individual disclosure from narrative is under way].

Psychological Disclosure Narrative and Healing:

In 1983 Richard Hillman[15] in The Failure of the Medical Model  describes how healing in Psychology, was born from the medical model, when Freud and Breuer – Medical Doctors – attempted to conceive treatments for psychological symptoms, which medicine could not provide.

He then considers – in relation to the psyche – what in reality does the word healing mean within psychology and this medical model. It seems a fair question. But, more importantly, given the frequency of return visits of patients to psychologists and psychiatrists, there is no doubt that these patients experience a powerful therapeutic process. Could this be healing?

Authors and Healing from Written Disclosure Narrative

There is much anecdotal evidence from contemporary authors to confirm healing from written disclosure narrative. In his book, The Wounded Storyteller, just a few years after his own illness experience, Arthur Frank[16] author and sociologist describes how facing chronic illness disability, or the prospect of dying, plunges us into a frighteningly insecure and chaotic experience, and from this threat to our lives, we experience acute physical and mental suffering. Significantly, Frank describes the writing of his illness story – discourse narrative – as his salvation.

Frank states that three types of first-person written narrative are available for healing; restitution, chaos and quest,[16] and, importantly for healing, that only the quest narrative enables this therapeutic experience.

He identifies the quest narrative as requiring patients to accept illness as a journey of insight, meaning and purpose for their lives. And that the well have an ethical responsibility to the ill to listen to their stories, to witness their endured human suffering, and learn perhaps how not to get ill, and suffer themselves.

Additionally, Frank views illness disclosure narrative as special, as an effective witness testimony to illness, and states that only this type of illness testimony will help listeners to heal.

One such healing disclosure narrative is Dominique Bauby's The Diving Bell and the Butterfly.[17] Bauby, 43, the successful editor of Elle fashion magazine, suddenly suffered a massive brainstem stroke on Dec 8, 1995, resulting in Locked-in Syndrome.

Bauby retained hearing and sight, but his remarkable mind was imprisoned in an almost completely paralyzed body. His moveable left eyelid became the writing 'hand' that 'blinked' the words of the memoir he had within him.

Blinking preserved Bauby's humanity. It rescued him from becoming just another object in the room. There is inestimable healing to be had for readers of Bauby's story. It is a worthy example of Frank's healing witness testimony; and makes the reader appreciate every moment they are given – a gift beyond price, from author to reader.

Anatole Broyard,[18] author and prostate cancer sufferer, writes in Intoxicated by My Illness that he discovered his need to read about other peoples' experience of cancer. It is in times of life-crisis that the ill long to hear another person's voice to confirm they are not alone in their quest for healing, and Broyard found inspiration from memoirists such as Leo Tolstoy and Thomas Mann, emotionally supportive in his healing quest.

Broyard also intuitively knew that sick people need their own language to enable an authentic description of personal illness. Writing such words in a disclosure narrative serves a dual purpose – they are self-healing for the writer, and healing for their reader.

Nobel laureate Kenzaburo Oe[19] wrote a fictionalized memoir about the effects of his first-born son Hakiri being born brain-damaged. Following the birth, Hakiri 's parents were told that he would never be more than a vegetable. As it turned out, Hakiri, despite remaining mentally a child, became an established musical composer.

Oe found it difficult to confront his powerful negative feelings about having brain-damaged Hakiri as his son. Writing helped Oe to come to terms with the hopelessness of the situation. He wrote to process unbearable pain, and the act of writing his pain dramatically transformed Oe's attitude towards Hakiri .

In Oe's memoir, the boy's father Bird unsuccessfully tries to kill his son several times. Oe confronts his guilt from his desire to be rid of Hakiri, by writing; to safely confront – and slay – these particular dragons.

After the shock from Hakiri's only a cabbage prognosis, Oe describes passing through several disturbing stages – [which significantly and to a large degree mirror the Kubler Ross[20] stages of dying: Shock, Denial, Anger/Confusion, Effort Phase/Seeking Solutions and Acceptance].

And given that acceptance is an inherent process of living, Oe , inevitably re-experienced these emotionally disturbing phases throughout his life with Hakiri. Oe's writing was his saviour. It healed him, giving him the  forbearance to repeatedly assimilate – and accept – what had happened to his life with Hakiri.

The Pulitzer Prize-winning author Alice Walker[21] stated that the deep personal pain she experienced during her childhood prompted her to become a writer and that all her writing stemmed from her need to ward off powerful suicidal urges to cut her wrists.

As a child, Walker wrote to gain some comfort, and the made up stories she kept in her head served the same purpose. And while she doesn't pinpoint a specific reason for her chronic despair, she tells a family-based story, where on one occasion as a child, she was shot in the eye by her brother, and left partially blind.

And, also, that because her family didn't hold her brother accountable for the shooting, the incident somehow caused her alienation from her family, and the writing and telling of her stories as her salvation.

Healing Disclosure Narrative Through Poetry

Dr Robin Philipp of Bristol Royal infirmary conducted research into the health benefits of writing poetry as a way of venting emotion. 56% of the study's participants confirmed that writing poetry reduced their anxiety and provided a way to express emotions. Results of the study confirmed that writing poetry helped some of the research participants to cope with bereavement pain; others were able to stop taking anti-depressants or tranquillisers.[22]

[Healing through the writing, reading and speaking of poetry was dramatically confirmed by the phenomenal outpouring of poetry the in the wake of the World Trade Centre attacks in New York, on September 11, 2001. World-wide media coverage from television news and newspapers in the weeks immediately following the terrorist attack, confirmed that poetry was being intuitively used – in an almost unprecedented way, not just by survivors, but possibly, by everyone touched by the tragedy].

Because some subjects in everyday life, such as death, are taboo, they are not talked about, and although we all know we will die, this is never spoken of;  poetry allows these taboos to be confronted, and this enables healing.

Catastrophic events – such as the NY World Trade Centre attack 2001 and the South-Eastern Tsunami – cause such a degree of shock, that those involved were left without words – they had lost their voices.[23] [The voices of such traumatized souls are thereby restored from writing, reading and speaking of poetry.]

Palliative Care, Poetry and Healing

In Palliative Care reverse discourse and assimilating the new story, as discussed earlier, is crucial if dying persons are to – paradoxically – experience healing.

Within palliative care poetry gives sorrow a voice; inside every poem a dying person writes, they leave something of themselves – a gift for posterity. But, while healing of the patient is paramount in palliative care, it must be remembered that healing can also take place between the dying patient and their family; and the patient's wider social network.[24]

Assimilation of the new story, effected by reverse discourse, is crucial if dying persons are to experience healing.[25] [A healing that is evident when we visit a Hospice. where acceptance, peace, tranquillity and often quiet joy, unexpectedly permeates the environment, nurtured by integrated, wholistic care.

Dale Borglam in Living/Dying Project[27] describes a somewhat simplistic method which can be used to actively seek healing. He states that the specific essential qualities included in all healing paths such as religion, psychotherapy and twelve- step programmes, must be present if lasting healing is to occur.

The person seeking healing invokes the healing Presence of their particular Deity; then they might feel and express compassion and devotion to self and others, and devotion to their external Deity. And lastly, when devotion and compassion have deepened sufficiently, the person asking for healing rests in the invoked, empowered harmony of divine will. Then healing can naturally unfold. 

[In the Hospice environment – where the patients have varying faiths and specific Deities – spiritual needs of individual patients are fully addressed. And perhaps those dying patients within the Hospice environment at some point in their healing quest unconsciously embark on a path similar to that described by Living/Dying Project – in tandem with seeking healing from discourse narrative – to achieve spiritual healing of their soul.] [28]

CAM, Healing and the Future NHS

Healing from the CAM therapy of using disclosure narrative for healing – both within and out-with the NHS – is indisputable from the evidence presented in this article. However, for how much longer will this healing CAM therapy remain available to NHS patients?

Brian Beber in Positive Health magazine Issue 130 December 2006[29] reveals the existing prohibiting factors which will probably prevent full integration of CAM into the NHS, and this, despite the wishes of many CAM practitioners to the contrary.

Additionally, the NHS Confederation's projected budget shortfall of £8-£10 billion between 2011- 2014, with probable further cuts to staff and drug budgets, does not sit easily with finding cash to train additional CAM therapists required from a full integration of CAM into the NHS.

Fortunately, whatever the outcome of attempts to fully unite CAM and the NHS in the future, using disclosure narrative for healing can still be experienced free at the point of delivery. And as confirmed in the spontaneous flood poetry written in response to the September 11 terrorist attacks on the World Trade Center in New York, disclosure narrative heals.

References

1. Brooks R. Therapeutic Narrative: Illness writing and the Quest for healing. Sydney eScholarship Repository, Post Graduate Theses. A Thesis Submitted in fulfilment of the requirements of the degree of Doctor of Philosophy. March 11. pp 1-8, 52 pages. [Online]Available: http://ses.library.usyd.edu.au/handle/2123/663  Accessed August 16/8/2009. 2004.
2. Brooks R. ibid.
3. Brooks R. ibid.
4. Brooks R. ibid.
5. Pennebaker, J. Writing to Heal: A Guided Journalfor recovering from Trauma and Emotional Upheaval. New Harbinger Publications. Oakland California. ISBN 1-57224-365-1 (pbk). 2004.
6. Pennebaker,J. Opening Up The Healing Power of Expressing Emotions. Guilford Press, a division of Guilford publications, Inc. New York 10012. ISBN 1-57230-238-0.
7. Kings Fund Paper, Enhancing the Healing Environment. March 27, 2009, [Online]. Available  http://www.kingsfund.org.uk/research/projects/enhancing _the_healing environment/ Accessed 13/08/2009.
8. Svahn, D. M.D. The Role of Narrative in Medical Education and Practice. Health Column. September 26. BASSETT HEALTHCARE. Office of Medical Education, Bassett Healthcare. [Online ] 2003, Accessed 2007.Available at : (medical.education@bassett.org)  
9. Svahn, D. M.D. ibid.
10. Svahn, D. M.D. ibid.
11. Frank, A. Wounded Storyteller : Body, illness and Ethics. University of Chicago Press. Chicago. ISBN 0-226-25993-5 (pbk) .1997.
12. Warner, L.J. et al. Health Effects of Written Emotional Disclosure in Adolescents with Asthma.  A Randomised, Controlled Trial. Journal of Paediatric Psychology. Vol 31, number 6. pp 557-568. [Online]. 2006. Available http://jpepsy.oxfordjournals.org/cgi/contentAccessed  23/2/2007.
13. Epstein, E.M. et al. Getting to The Heart of the Matter : written disclosure, gender, and heart rate. Psychosomatic Medicine. May- June; 67 (3): 413-9.2005 [Online]. Available www.ncbi.nlm.nih. gov/entrez/query.fcgib=pubmed&cmd=Retrieve&dopt=A Accessed ( 23/02/2007).
14. Smyth, J.M.et al, Effects of writing about stressful experiences on 15. symptom reduction in patients with asthma or rheumatoid arthritis : a randomised trial. JAMA. 281 :1304-1309. 1999. [PubMed].
16. Frank, A. ibid.
17. Bauby, J.D. The Diving Bell and the Butterfly. HarperCollins. ISBN 9780007241668 / ISBN 10 0007241666. 2007.
18. Broyard, A. Intoxicated by my Illness. Ballantine Books New York. ISBN 0-449-90834-8. 1992.
19. Kenzaburo O. A Healing Family. Kodansha International Ltd. Japan.17-14 Otowa, 1 Chome Bunkyo, Tokyo 112-8652. ISBN 4-7700-27330-8. 2001.
20. Kubler-Ross, E. On death and Dying (3rd ed).Routledge, Abingdon, Oxon. ISBN 0203-88965-7. 2009.
21. Walker, A. To Hell with Dying. Voyager Books. Harcourt Brace Publishers. Florida. ISBN 0-15289074-2. 1967.
22. Philipp, R. In Balfe, S. Writing for Health. Positive Health Magazine. Issue 33-October, 1998. [Online]Available from http://www.positivehealth.com/article-view.php?articleid=208  
23. Carroll. R. Finding the Words to Say it : The Healing Power of Poetry. Evidence-based complementary Medicine .Vol. 2: 2 [Online] Available from  http://ecam.oxfordJournals.org/cgi/content/full22161 . Accessed 22/2/07.
24. Brooks, R. ibid.
25. Brooks, R. ibid.
26. Brooks, R. ibid.
27. Borglum, D (2002) How We Heal. Living Dying Project.
28. [Online].Available from, http://www.livingdying.org/ed-how-heal.html  
29. Beber, B. Evidence-Based Medicine :The Over- Reliance Upon Science? Positive Health Magazine Issue 130. Available at www.positivehealth.com/article-view.php?articleid=2018 Dec. 2006.

Further Reading

Kubler-Ross E. (3rd ed.) The Stages of Dying. Routledge, Abingdon, Oxon. ISBN 0203- 88965-7. 2009.
Mann T. The Magic Mountain. (Reprint pbk) Vintage Books, London. ISBN 07049386428. 1999.
Mearns D and Thorne B. Person Centered Counselling in Action. (pbk). Sage Publishers, London. ISBN 978-1-4129-2855-7. 2007.
Tolstoy L. The Death of Ivan Ilyich. (Bantum Classic Edition), Bantam Dell: Random House Inc. ISBN 0-553-21035-1. 1981.