Poetry and the Good Death

A reflection by Dr Phil Isherwood.

Phil has been volunteering since 2010 as the ‘hospice poet’ – writing poems inspired by conversations with patients and by their creative work in the Creative Therapy Department at Bolton Hospice. Find him on twitter @Hospice_Poet

I have been a volunteer poet in the hospice for the last nine years and I have completed over 400 poems based upon conversations with, and the creative activities of, patients and staff. The strength of my work is, I believe, to celebrate the mysterious views and connections of someone’s life and character. This is especially valuable to those approaching death. Creativity is able to celebrate mysteries when meaning and understanding prove inadequate; it is also the essence of the sense of self.

From a psychologist’s point of view the work of Douglas P Adams argues that the self is a personal mythology, a creative narrative of an individual. 1 Personal story telling, reminiscence and the sharing of varied experiences are self-affirming. Such stories are mythological in their creative treatment such as to have personal meaning and significance. The self is aesthetic rather than factual. Philosophers, such as Robert Neimeyer, believe that individuals use story to position themselves within family, cultural and spiritual narratives.

So why is creativity so important? I have studied many artists, writers and philosophers and find, within different perspectives, a common claim that creative views of life are at the centre of our greater being. From the point of view of literary criticism, Virginia Woolf wrote ‘Life is not a series of gig lamps symmetrically arranged; life is a luminous halo, a semi-transparent envelope surrounding us from the beginning of consciousness to the end.’2 Her literary argument is that the ‘good story’ requires the details, the wonder and the ‘flickerings’. James Joyce saw life elevated by epiphanies, seeing the profound in the everyday. Keats wrote of ‘negative capability’, meaning ‘when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason’.3 This aspect, of being at peace with uncertainties, underpins why numinous poetry has such a value in end of life care. Mark Cobb writes:

“Death concludes life and the possibility of human creation. This journey towards an ending therefore invites, if not demands, a creative response of lament, celebration and hope addressed to the silence and absence of death. This impulse may be without logic but it affirms the fragile nature of existence and strives to reflect the intimations of a larger reality to which we are sensitive. The writer Ben Okri considers that ‘art is but a sign and a prayer to the greater glory and sublimity of our secret estate. It is a celebration of our terrestrial intelligence, our spiritual yearning, and the irrepressibility of our mischief and joy. George Steiner goes further and argues that, ‘Without the arts, the human psyche would stand naked in the face of personal extinction. Wherein would lie the logic of madness and despair’.” 4

The value of mystery is all the more interesting when considering the work of Dominic McLoughlin from the discipline of psychodynamic counselling. He argues that both the hospice and the poetic form may be defined in terms of a transitional space and the poem may become a ‘transformational object’.5  He writes: ‘Presenting poetry in a hospice as a transformative experience of this kind allows the patient to choose which poem will or will not mean something to him/her’.6 McLoughlin, furthermore, finds particular value in poetry’s ability to represent mystery. His research, running a writing group with hospice patients, ‘shows how the act of reading and writing poetry places a value for patients on not knowing at a time when the plain hard facts of terminal illness loom large’.7

My approaches to poetry, from narrative psychology and literary criticism, can be made integral with a view of creativity. The literary critic and philosopher George Steiner puts his view fully in his book Real Presences:

“I can only put it this way (and every true poem, piece of music or painting says it better): there is aesthetic creation because there is creation. There is formal construction because we have been made form.

[…]

The core of our human identity is nothing more or less than the fitful apprehension of the radically inexplicable presence, facility and perceptible substantiality of the created. It is; we are. This is the rudimentary grammar of the unfathomable.

I take the aesthetic act, the conceiving and bringing into being of that which, very precisely, could not have been conceived or brought into being, to be an imitatio, a replication on its own scale, of the inaccessible first fiat (the ‘Big Bang’…).”

[…]

This essay argues a wager on transcendence. It argues that there is in the art-act and its reception, that there is in the experience of meaningful form, a presumption of presence.8

I believe that poetry in end of life care has special value in these terms. The creative presence of patient and poem can affirm human identity and the wonder of existence. Presence that offers the numinous and transcendent, both in itself and in encouraging other creative activity. As the sense of numinous engenders the emotion of awe it has the potential to increase the perceived well-being and time-availability; the process of developing a poem with a hospice patient can access the sense of vastness in the ‘walk down memory lane’.9 If a poem can have literary value as ‘life’ revealed, can spring from an individual personal narrative, and can offer a ‘radically inexplicable presence’ of numinous quality, then I believe it to be a great achievement. 

The term ‘good death’ is in common usage within end of life care services and campaigners.10 Age UK have identified the following as the principles of a ‘good death’:

1) To know when death is coming, and to understand what can be expected.

2) To be able to retain control of what happens.

3) To be afforded dignity and privacy.

4) To have control over pain relief and other symptom control.

5) To have choice and control over where death occurs (at home or elsewhere).

6) To have access to information and expertise of whatever kind is necessary.

7) To have access to any spiritual or emotional support required.

8) To have access to hospice care in any location, not only in hospital.

9) To have control over who is present at the end.

10) To be able to issue Advance Decisions which ensure wishes are respected. 

11) To have time to say goodbye, and control over other aspects of timing.

12) To be able to leave when it is time to go, and not to have life prolonged pointlessly.11

The strong emphasis of the good death concept currently seems to be upon the medical and the practical and I am not saying in any way that these are not of great importance to patients and their families. Yet my research, and experience within the hospice, convinces me that creative celebration of life is much more than point 7 above -‘access to any spiritual or emotional support required’. We can do more. I would like to help in any way to promote these ideas and to put ‘creative celebration of life’ as a more significant part of the above list, through the use of storytelling, reminiscence, poetry and creative arts.

Another way, of questioning the role of poetry in the hospice, is to consider creativity as a basic psychological need. Mihaly Csikszentmihalyi, from his lifelong psychological research on creativity and ‘flow’, argues:

“Creativity is a central source of meaning in our lives for several reasons. Here I want to mention only the two main ones. First, most of the things that are interesting, important, and human are the results of creativity. We share 98 percent of our genetic makeup with chimpanzees. What makes us different – our language, values, artistic expression, scientific understanding, and technology – is the result of individual ingenuity that was recognized, rewarded, and transmitted through learning. Without creativity, it would be difficult indeed to distinguish humans from apes.

The second reason creativity is so fascinating is that when we are involved in it; we feel we are living more fully than during the rest of life. The excitement of the artist at the easel or the scientist in the lab comes close to the ideal fulfillment we all wish to get from life, and so rarely do. Perhaps only sex, sports, music, and religious ecstasy – even when these experiences remain fleeting and leave no trace – provide as profound a sense of being part of an entity greater than ourselves. But creativity also leaves an outcome that adds to the richness and complexity of the future .” 12

My poetry helps patients to see their own creative existence, from their stories or from their own artwork and craft.  To Csikszentmihalyi’s views I can add those of philosopher Nicolas Wolterstorff who identifies the basic human desire to live and act artistically.13 He uses the examples of how work-song ennobles and elevates everyday activities and how memorial art is far more befitting, than historical fact, for remembrance. Wolterstorff’s view is that art has an intrinsic worth, a greater adequacy, and as such is close to Steiner’s view on ‘real presences’.

These views from psychology and philosophy support my thesis: creative connections recognise and signify a patient’s life, character, passion and person in ways that are not ‘documentary’ but art, as life is art. My claim is that patients are best served by these creative views to elevate the mysteries of life details and able to celebrate the self and personal significance in a way that transcends illness and prognosis. This approach is not clinical therapy but should be a key component of the hospice declared mission to ‘live well’ as death approaches.

We’d love to hear your thoughts about Phil’s reflections and his poetry.

Let us know what you think! @what_death

 

 

 

 

 

 

  1. Dan P McAdams, The Stories We Live By; Personal Myths and the Making of the Self (New York: Guildford Press 1993).
  2. Virginia Woolf, The Common Reader (London: Vintage-Random House, 2003), p.150.
  3. Robert Gittings, ed., Selected Poems and letters of John Keats, (London: Heinemann 1966), p.33.
  4. Mark Cobb, Spiritual and Artistic Care. In: Gillie Bolton (ed.), Bereavement and the Healing Arts. London: Jessica Kingsley, 2008, p.182.
  5. From the field of psychoanalysis where object-relations theorists view an ‘object’ as anything in the external world that can be related to by a person, and that can be internalized into one’s inner psychic world.  Experiences, people and things are all ‘objects’. Object-relations theorist, Christopher Bollas says: ‘the objects of our world are potential forms of transformation’. C. Bollas, Being a Character: Psychoanalysis and Self Experience, New York: Routledge, 1992, p.4.
  6. Dominic. McLoughlin. ‘Transition, transformation and the art of losing: some uses of poetry in hospice care for the terminally ill’ Psychodynamic Counselling, 6 (2), pp. 215-234. 2000. p.227.
  7. Dominic. McLoughlin p.215.
  8. Steiner, p. 214.
  9. Rudd, Vohs and Aaker, ‘Awe Expands People’s Perception of Time, Alters Decision Making, and Enhances Well-Being’ Psychological Science, Vol. 23 (10), 2012, pp. 1130-1136.
  10. For example, see Eve Richardson’s article People deserve to have their end of life care wishes met (make good death a priority). The Guardian, Wednesday 18 January 2012.
  11. Debate of the Age Health and Care Study Group. The future of health and care of older people: the best is yet to come. London: Age Concern (now Age UK), 1999.
  12. Mihaly Csikszentmihalyi, Creativity: Flow and the Psychology of Discovery and Invention (New York:Harper Collins, 1996), pp. 1-2.
  13. Nicolas Wolterstorff, Art in Action (Grand Rapids: W.B. Eerdmans Publishing, 1980).

Posted: 20th October 2019

Categories: Reflections