My friend recently lost his battle with cancer . . . No, he died of cancer. The diagnosis was too late for war, although he won skirmishes to butter a scone or tie a shoelace.
For us onlookers his first chemo infusion represented Alexander’s raised arm on the summit ridge before the great Battle of the Granicus. But my friend knew better . . . and he surrendered with grace.
When illness strikes, a popular way to understand the experience is through the metaphor of conflict.
But curiously, although campaigns are often waged against cancer – former US president Richard Nixon declared a War on Cancer in 1971 – it’s more difficult for the forces of language to launch an attack on, say, persistent diarrhoea.
Nevertheless, where metaphors of illness abound, people are going to write about them. An early contributor to the literary genre of pathography was proto-feminist, sociologist and writer Harriet Martineau (1802-1876), who penned Life in the Sick-Room (1844) when she was wrongly convinced that a uterine tumour of which she first became aware in 1839 would soon prove fatal.
And Virginia Woolf observed in her 1926 essay On Being Ill: "[L]et a sufferer try to describe a pain in his head to a doctor and language at once runs dry . . . He is forced to coin words himself, and, taking his pain in one hand, and a lump of pure sound in the other . . . so to crush them together that a brand new word in the end drops out."
Less sensitive to the virtues of a finely wrought phrase was geneticist and physiologist JBS Haldane (1892-1964). In his poem Cancer's a Funny Thing, he writes: "I wish I had the voice of Homer/To sing of rectal carcinoma . . ." the disease that eventually killed him. Haldane took his title from a line in WH Auden's poem Miss Gee, the owner of poetry's most famous sarcoma.
Blogging
Today therapeutic writing is easily accessible, with members of online communities blogging about their daily struggles with everything from acne to zygomycosis. But does therapeutic writing work?
In the journal Medical Humanities (2009, 35: 80-88), a piece entitled "Finding a voice: revisiting the history of therapeutic writing" adduces evidence to show that although writing about trauma prompts an immediate rise in negative feelings, these are followed by long-term benefits in psychological and physical wellbeing.
Its authors cite work suggesting that therapeutic writing may not only confer cardio-protective benefits by reducing blood pressure but could also “ . . . enhance health-related quality of life in cancer survivors and is a low-cost intervention that . . . can be applied in group therapy settings and through new technologies including the internet”.
And the title of another study in Medical Humanities (2008, 34: 40-46) further illustrates how patients can exert some degree of control over their lives: "Writing is a way of saying things I can't say: Therapeutic creative writing: a qualitative study of its value to people with cancer cared for in cancer and palliative healthcare."
The results of a therapeutic writing course involving 13 teenage cancer patients and 11 cancer patients aged 40 and older receiving community palliative care showed that writing allowed patients to discover what they thought, felt and remembered; promoted greater awareness of issues which required attention; and helped fulfil creative expression.
But perhaps now more than ever, therapeutic writing is an important means for patients to assert themselves in a world where medics are identified less with Sir Luke Fildes's sympathetic portrayal of a physician in The Doctor, hanging in the Tate Gallery, and more with the doctrine of evidence-based medicine (EBM).
One definition of EBM is “the conscientio us explicit and judicious use of current best evidence in making decisions about the care of individual patients”.
Waspish humour
In a fine example of therapeutic writing, a band of medics – Clinicians for the Restoration of Autonomous Practice (CRAP) Writing Group – used waspish humour in the
British Medical Journal
(2002; 325: 1496-8) to alert colleagues to the pitfalls of EBM. For example, the first commandment of EBM states: “Thou shalt treat all patients according to the EBM cookbook, without concern for local circumstances, patients’ preferences, or clinical judgment.”
And there's even a journal called Evidence-Based Mental Health. Why, it's almost as if the patient's mind has become suspect: the couch consigned to the attic to accommodate the CT scanner, because it's axiomatic that mental health problems are not caused by the way we live our lives but by scientifically verifiable brain pathologies.
Brian Appleyard's observation in Understanding the Present (1992) could usefully be applied to those "evidence-basers" who worship at the altar of the randomised controlled trial: "Scientists who insist that they are telling us how the world incontrovertibly is are asking for our faith in their subjective certainty of their own objectivity."
But if therapeutic writing is one way for patients to articulate their thoughts, language is not necessarily the sole medium for communicating feelings about sickness and health.
For example, Dr Deborah Padfield of Birkbeck University of London has used photography successfully in the face2face project to explore the impact of images of pain on doctor-patient communication. The project was carried out in collaboration with Prof Joanna Zakrzewska of University College London Hospitals Trust (UCLHT) and facial and pain management patients and clinicians at UCLHT.
Still, as my late friend proved, one of the best therapies for patient, visitor and doctor alike is conversation.
