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Notebook collection by Dvortygirl
Notebook collection, a photo by Dvortygirl on Flickr.

A new writing course for Hunter–Bellevue School of Nursing graduate students got off to a great start this past Thursday evening. CHMP poet-in-residence Joy Jacobson and I will teach the class for the next four and half weeks of Summer Session II. Our immediate goal is to help the students sharpen their skills in writing—scholarly writing, blogging, and narrative writing—and in on-the-job communication. But we also hope to motivate students to invest more energy in their writing by developing a daily writing practice focused on their clinical and personal experience. We’ll supplement this work by close reading of literary and scholarly texts that deal with the experiences of illness and caregiving.

The combination of reflective writing and close reading is an adaptation of the pedagogical approach used in the emerging field of narrative medicine. The mission statement of Columbia University’s Program in Narrative Medicine provides a good introduction to the aims of this discipline:

Narrative Medicine fortifies clinical practice with the narrative competence to recognize, absorb, metabolize, interpret, and be moved by the stories of illness. Through narrative training, the Program in Narrative Medicine helps doctors, nurses, social workers, and therapists to improve the effectiveness of care by developing the capacity for attention, reflection, representation, and affiliation with patients and colleagues. . . .

(I wrote a previous blog post about a presentation given by the founder of the Columbia program and one of the pioneers in this field, Rita Charon, MD, PhD. An extensive bibliography with links to several publications by Charon and others can be found here.)

We adapted our guidelines for developing a daily writing practice from Writing as a Way of Healing: How Telling Our Stories Transforms Our Lives, a fascinating book by Louise DeSalvo, professor of English at Hunter and leader of a memoir workshop in the MFA Writing Program. (She also blogs at Writingalife’s Blog.) Anyone interested in writing as a means of exploring the self will find sound advice and much food for thought in this book. DeSalvo writes

This book is an invitation to engage with your writing process over time in a way that allows you to discover strength, power, wisdom, depth, energy, creativity, soulfulness, and wholeness. . . . to use the simple act of writing as a way of reimagining who you are or remembering who you were. To use writing to discover and fulfill your deepest desire. To accept pain, fear, uncertainty, strife. But to find, too, a place of safety, security, serenity, and joyfulness. To claim your voice, to tell your story. And to share the gift of your work with others and, so, enrich and deepen our understanding of the human condition.

These are not mere self-help bromides. DeSalvo draws on a growing body of evidence from research conducted by James W. Pennebaker and others that demonstrates the beneficial psychological and physiological effects of a specific kind of writing about disturbing or powerfully emotional events. According to DeSalvo, Pennebaker discovered that “to improve health, we must write detailed accounts, linking feelings with events [the emphasis is DeSalvo’s]. The more writing succeeds as narrative—by being detailed, organized, compelling, vivid, lucid—the more health and emotional benefits are derived from writing.” (Pennebaker’s Web page at the University of Texas, Austin, has an extensive bibliography of his research, with links to free downloadable files. Click on Publications. He is also the author of Opening Up: The Healing Power of Expressing Emotions.)

DeSalvo and others, such as Sara Baker, who facilitates what she calls Woven Dialog creative writing workshops with patients at the Loran Smith Center for Cancer Support in Atlanta, Georgia, and elsewhere, also note an important caveat: this kind of writing practice, especially at the beginning of the process, can stir up strong negative feelings, particularly among those who have experienced real trauma (for example, those who have survived cancer or violent abuse). It’s important not to push oneself too far; or, as Baker writes: “We must not use our work to retraumatize ourselves or put ourselves in danger.”

Baker encourages imaginative writing—using the tools of fiction and poetry to offer what she has called “an oblique route” that may give a survivor of trauma “more freedom to connect with emotional and often buried truths” than the more direct route of memoir would provide. (Sara Baker blogs at Word Medicine.)

At the first class meeting last week, students dove right into a guided writing exercise called “My Least-Favorite Patient or Colleague.” First, each of us made up a list of nouns or adjectives beginning with the letter ‘B’ that described the person we had in mind; then another list of words beginning with the letter ‘S’ that described how that person made us feel; and a third list, of verbs or verb phrases beginning with the letter ‘T,’ that described what we would like to do to or with that person. Then, based on this material, each of us wrote a simple “list poem”—that is, a poem in which each line begins with the same word or phrase (such as “I remember…”). The last line has to have a strong twist or surprise, something like the punch line of a joke. And to cap it off, the title of the poem is written last (and is often humorous or ironic in retrospect). You can imagine how this little exercise got the juices flowing.

Stay tuned. We may be publishing some of our students’ writing on the CHMP blog in August.

Notebook collection, a photo by Dvortygirl on

lyndon-havilandWith more than 25 years’ experience in domestic and international public health, Dr. Haviland brings broad expertise in management consulting, health policy, advocacy, social marketing, corporate social responsibility, and branding, as well as applied research design and evaluation. A passionate advocate for social justice and women’s and children’s health around the world, Dr. Haviland acted most recently as a Senior Project Leader for the UN Secretary-General’s Global Strategy for Women’s and Children’s Health. This initiative helped to align hundreds of world actors around a common strategy for saving more than 16 million lives and raised more than $40 billion in new resources for women and
children. Dr. Haviland has directed programs in philanthropy, HIV/AIDS care, maternal and child health care, vaccines and tobacco prevention and cessation services. She has also worked in a broad range of professional environments spanning domestic, academic, multinational and multilateral organizations and including the Aspen Institute, UNAIDS, the UN, the UN Foundation, HRSA and SPNS projects, UNDP, WHO, the International Medical Corps, the American Legacy Foundation, and the award winning truth® campaign against smoking which won both a gold and silver Effie award during her tenure. Dr. Haviland serves on the Board of Directors of Pact, where she is leading an effort to fund microfinance programs for impoverished women worldwide and recently completed a rotation on the Executive Board of the American Public Health Association where she was awarded one of their highest honors. She holds a masters and a doctorate degree in public health, and has completed Advanced Management & Leadership training at the Harvard Business School. An accomplished writer and public speaker, Dr. Haviland has published more than 25 peer reviewed publications and is a regular contributor to the Harvard Business School Alumni magazine.

With more than 25 years’ experience in

obese-childLiz Seegert is a freelance health writer and adjunct instructor in Media and Communications for Empire State College.

A statement released last week by the American Academy of Family Practitioners confirmed what many in public health already know: childhood obesity is still on the rise, and TV advertising bears a large share of the responsibility. In addition to the sendentary nature of watching TV, the AAFP pointed specifically to marketers who advertise high sugar, high fat, high salt, high calorie meals and snacks that do nothing to foster good nutrition. It’s bad enough our kids are spending so much time in front of the TV screen, computer screen, and smartphone screen. The push by food manufacturers to encourage unhealthy snacking during these activities only serves two purposes. The first is to contribute to the corporate bottom line. The second is to fuel the time bomb of childhood obesity.

Study after study has confirmed this link. According to the National Center for Health Statistics, between 2007 and 2008, 17% of children and adolescents aged 2–19 years were obese. The Centers for Disease Control and Prevention reported that, since 1980, obesity prevalence among children and adolescents has nearly tripled. Health providers continue to document the growing prevalence of what were once only adult diseases like hypertension, and Type II diabetes. In addition to the physical toll, there is often a psychological and emotional toll upon obese children that leads to low self-esteem, poor school performance, and depression.

The advertising industry argues that it’s not the ads that are to blame. However, the number of TV ads a child in the US watched in the 1970s doubled to 40,000 by the 1990s. This doesn’t even factor in other media that play on children’s psyches.  Kids ages 8-12 are most at risk for this overt influence – they watch more TV than their older counterparts, but do not yet have the cognitive ability to discern the underlying messages presented. More kids home alone after school, more disposable income by even young children, and pressure upon working parents to “give in” or grab some fast food to go after a long day at work, means kids are making more and more food choices on their own while being bombarded with hundreds of messages daily for chips, fries, soda, cookies, candy…

What to do? The Institute of Medicine has called for a ban on food advertising to children if voluntary restrictions by marketers are not effective. It’s clear from the evidence to date that industry self-policing has failed. Some experts believe a complete ban on such advertising would reduce incidence of childhood obesity by as much as 15 percent. Ironically, our Constitution may not permit a total ban in the US, as there is in the UK, where results of strict guidelines have been highly favorable.

While there is plenty of blame to go around for the increasing prevalence of childhood obesity, one thing is clear: the data shows the problem is getting worse, not better. TV ads contribute significantly to this plight. The Federal Trade Commission must step up, and enforce tighter regulations on advertising to children. It may be challenging to do so while balancing the First Amendment rights of food companies to promote their products – however unhealthy they may be – but the corporate bottom line must take a back seat when it comes to the health of our children.

Liz Seegert

Liz Seegert is a freelance health writer