Bringing Poetic Medicine to Singapore | John Fox, PPM

In Februrary 2024 John Fox brought the practice of poetic medicine to doctors/trainees, nurses/hospice, those in the medical humanities, and others serving those with cancer, as well as patients in the SingHealth (Singapore Health Services) system. In his letter below he reflects on what emerges from the practice of poetic medicine and his experiences with some of the extraordinary people he met while there. This letter was included in the

March 2024 edition of the IPM Newsletter.

Dear Poetic Medicine Friends,

I am excited to experience results and possibilities that emerge from the practice of poetic medicine. This is hard to communicate in a linear way. When I pay attention to the process of poetic medicine, result and possibility happen simultaneously.

Results Turning into Possibilities, Vulnerability Unfolds a Deeper Power

The word “result” is not exactly right because what I mean is what happens when someone makes a poem. This isn’t a mechanical event; it is a process event. The words “what happens” are key because they mean that connections are occurring in the process of poem-making.

Those connections are brain synapses sparking. Those connections transcend time and space. They are our imaginative way back machine, and it could be the way forward machine. Those connections are the unique and sovereign domain of each person. They are the opposite of, or better put, they are other than this mechanical world that presses in upon us.

The poem written on page or screen, in that particular moment, and in a practical sense, is a “result” of the time taken to write it. I want to make the point that the word result, in a healing way, is only useful if the result leads to possibility. 

That grace of this is that this happens. What I am saying is that the body is a result of being born but it is with the process of breathing that it is necessary for possibilities to happen.

That poem is a breathing, living thing and is the prophet of possibility.

For instance, someone writes a poem that is clearly vulnerable, meaning that there is an unprotected quality in what the poem says, and a willingness to let another in close to what is unprotected, when our lives are more often, armored, at least, defended.

Yet, this poem because it is vulnerable may, very likely, contain hard-won insight or in some way get down to a bone-truth. I think it is surprising to people, perhaps especially men, that the expression of vulnerability can lead to insight. That vulnerability and bone-truth may come in the form of a question or a crying out. 

That kind of poem also has a deep current of strength, one might even say power. 

That is something that we do not often allow and hear staying close together, vulnerability and power. The vulnerability can be felt in the choice of words and the way a voice speaks those words. That kind of speaking, in and of itself, is a gift of poetry-as-healer, and the profound courage to share such a poem has power.

When time is slowed down in this process of self-expression, with the bearing of witness by another or a group of people having time, a healing moment emerges.

A paradox is that as a poetry therapist, I want to protect that person — and I will if necessary if a critical or insensitive response could hurt — but the truth is that the expression of that vulnerability is a great strength that should be deeply honored and with safety assured, go undisturbed, albeit, protected in a therapeutic space. 

Keeping a Sacred Space Around the Poet

Leading a group, I want to make sure that there is space around a person and what they speak out loud so that their vulnerability, which usually does not even need to be referred to — why? — because the quality of silence around our hearing becomes sacred, and within that kind of sacred silence and listening our hearts know. 

This is that holy space that matters, not words that might try to describe and paraphrase that space.

The poet, sometimes the new poet, knows too. I must silently acknowledge the spirituality and holiness of this even if it is allowed to simply be without words. 

This simple recognition of something vulnerable is also a kind of “result” — not a result that is quantifiable. Rather, this vulnerability is where possibility comes into the picture. 

Possibility is an organic, felt-sense that this moment of the poem finding its voice for the first time — is alive, is breathing and could be further encouraged and grow. What to encourage? The specifics are unknown.

Certainly not a particular outcome for another planned result. That possibility is the creative space between the poet and his or her poem and all the connections that are made and felt within.

Play — A Revelatory Happening

This is the point where revelation becomes…the possibility of play. Possibility that breathes and is alive is where play is given a chance to step further forward. Play is a revelatory happening integral to the process of poem-making — from the beginning of putting a single word down on page or screen and the going forward.

I wrote my first book Finding What You Didn’t Lose to encourage and provide access to discover the playfulness of poem-making. I believed it was children that could teach adults this truth. That’s why that book is replete with poems by children and teens. 

That is what I want to encourage — the possibility of play. Possibility as play in a way that is not unlike what revered child psychologist D.W. Winnicot describes:

"It is in playing and only in playing that the individual child or adult is able to be creative and to use the whole personality, and it is only in being creative that the individual discovers the self."

We don’t have to think of “play” as putting on feathered hats that go along with wooden swords, although the great Spanish poet Federico García Lorca, known for his childlike sweetness and powerful imagery, named these poetic medicines of play for recovering his spirit of childhood:

My heart of silk

is filled with lights,

with lost bells,

with lilies and bees.

I will go very far,

farther than those mountains,

farther than the oceans,

way up near the stars,

to ask Christ the Lord

to give back to me

the soul I had as a child,

matured by fairy tales,

with its hat of feathers

and its wooden sword.

Lorca brings us his childhood through lilies and bees, stars and oceans, his hat of feathers and his wooden sword. These kinds of things can be your poetic medicines, too.

Playing with a poem might be surprisingly straight-forward. Making the connection between the result of a vulnerable poem and possibility inherent in a poem might be encouraged by simply asking the poet if they would be willing to stand up and speak their poem again.

One can usually count on some hesitancy to do this. There is more vulnerability because there is more exposure. Usually, after a deeper breath and a slight rocking of the body back and forth, the person/poet who is asked, says a rolling yes and then rises to their feet.

This is welcoming a possibility that this different orientation — where the person with their whole body will have greater access to their diaphragm and breath is often a way to allow voice, words, breath, and heart — that make up the whole bodied person and poem — to more fully inhabit the life of the poem, the life being expressed by a person. 

We hear it in those four aspects — words, voice, breath, and heart.

Something within that standing poet person lifts and grows…which they can feel.

A Visit to Singapore and Reaching Healthcare Professionals

These thoughts and feelings about vulnerability and possibility are what I have thought about for a long time — but they also have a very fresh origin. I recently spent two weeks in the country of Singapore delivering the practice of poetry therapy/poetic medicine. 

What I experienced was extraordinarily beautiful.

The vulnerability and possibility that kept rising to the surface from the personal and professional depths at each meeting could stun me to a nearly simultaneous heart-breaking/opening silence. 

How did this happen? In 2017 Dr. Joanne Ngeow, senior consultant at the National Cancer Center, Singapore, attended a five-day Leadership and Mentoring for Doctors program I was giving at Brandeis University in collaboration with Sally Hare. The leadership and mentoring program was directed towards doctors who wanted to get a mid-career vocational boost. Sally does the brilliant “courage” work initiated by Parker Palmer, and we have found a wonderful overlap with courage, renewal, and poetic medicine. 

Each morning began with a poetry session! Our intention was to shake things up in a creative way — and we did!

Dr. Joanne got wind in her sails — especially from the poetry. We were in contact starting in 2018, and she was committed then to one day bring me to Singapore. Finding the funding was a challenge and then Covid-19 slammed into reality and this possibility got put on the shelf. 

Only the true greatness of Dr. Joanne’s visionary desire to bring this to her friends and colleagues was not on any shelf. She kept it at heart. She was still working to make it happen and after tremendous planning it finally did happen with the funding for IPM and the support for my trip, February 12 – 25.

Below is a photo I took with the wonderful Dr. Joanne Ngeow front left, Dr. Soong Yoke Lim, back right, who supported this whole visit with administrative assistant, Jasmine Lim Pei Leng, front right — who was essential to the smooth flow of a complicated preparation, working with IPM’s Operations Director, Mary Price.

Dr. Joanne Ngeow, John Fox, PPM, Dr. Soong Yoke Lim, Jasmine Lim Pei Leng

The Rediscovery of Poetry

We were able to reach in substantial ways physicians, both pediatric and adult doctors, nurses, medical social workers, medical humanities folk, medical social workers, allied health professionals, hospice and palliative care physicians, office people and patients. 

I designed unique programs for these groups. Joanne, with her great team, helped me to offer this. Acting as Joanne’s intern I received steady and trustworthy help from a young woman, Diya Jalan. Diya kept careful notes and wrote a very exciting narrative of what happened. 

She wrote about one session:

“This session hosted by NCCS (National Cancer Centre, Singapore) had participants of various backgrounds including genetic counsellors and research coordinators as well as doctors and students. The session was focused on providing participants with opportunities to write their own poetry and rediscover poetry outside of the academic session.

Multiple participants described their previous relationship with poetry as negative due to poor experiences in school or an over-emphasis on examinations. Through this experience of poetic medicine, participants were able to view poetry through a different lens — particularly engaging with the playful or emotional aspects of writing.

Listening to participants express themselves with the prompt ‘these days…’ was particularly insightful with the range of approaches to the prompt in the room. Some shared reflections on regret and choices they had made and others on their view of the world.

The wide range in tone was also indicative of the range in approaches taken when interpreting the prompts. An interesting technique John used was in identifying ‘stand-up poems’ and asking certain participants to stand whilst sharing which gave power to their voices and brought a greater degree of confidence. Overall, the session elucidated the power of poem-making as a form of expression and reflection for anyone — proving anyone can be literary inclined.”

I am moved that Diya, who sat through and was present for all of these sessions, arrives in her last paragraph, to see that this spark of creativity and poem-making is accessible to anyone! She captures the faith that I have when doing this work.

Poems by a Pediatrician

For now, let me acknowledge three poems written by Chan Mei Yoke, MD. Mei Yoke is the leader of the children’s intensive care unit at KKH Hospital. One of her poems, “Words,” opens this newsletter. Here is another poem:

You may get a deeply felt-sense of Mei Yoke’s love for her child patient as a pediatrician in her poem “Caring.” You may also hear the guilt she feels — a frequent guilt that is so rare to be admitted to by physicians and yet terribly important for a doctor to acknowledge. 

Once that guilt is given a voice, Mei Yoke finds release from it and the next line brings self-care for herself. 

This is a demonstration of what poetry and poem-making can offer to people with such intense responsibilities in medicine and the need to welcome love, joy and self-care. We can smile that Mei Yoke finds the word “soothe” to express love and “groove” to express joy. 

Mei Yoke, like every sensitive human being, has profound concerns that extend beyond her immediate situation. Our time together gave her a chance to give that large compassion, a voice in her poem “These and Those Days.”

Below is a photo of health professionals at KKH Hospital. Chan Mei Yoke, MD, is in light green, and Dr. Joanne Ngeow is next to her on the right. Next to me is Dr. Lois Teo Ling’en, a psychologist who added so much to various sessions and next to her is Dr. Siti in the lavender hijab. Together they made a poem-making visit to a 16-year-old patient. I don’t know the names of the others pictured, but I do know that they each brought their expressed hearts forward.

Chan Mei Yoke, MD, is in light green, and Dr. Joanne Ngeow is next to her on the right. Next to me is Dr. Lois Teo Ling’en, a psychologist who added so much to various sessions and next to her is Dr. Siti in the lavender hijab.

It’s Been So Long!

I hope this letter finds you doing well. I am glad for your interest in poetic medicine. Please consider participating in one of our available programs featured on our website. I recently heard from someone who 25 years ago attended a small group I led at my home on Tuesday evenings. She hadn’t forgotten. She wrote, “I am interested in writing more poems. It’s been so long! Are you offering a venue to do so?”

That message brightened my day! I could remember clearly this poetry circle participant and one of her poems. You have to imagine that you may have such a beautiful memory 25 years after your poetic medicine experience. Give this a try! After I responded, her reply was, “Hooray! I found you! Yes, please send me newsletters and any upcoming circles that would fit the bill.”

I hope you recall a poetic medicine experience that has stayed with you … recently or from long ago. May whatever that experience means to you, may it flourish now in fresh, vulnerable, powerful and possible ways.

Right now, today, there is a wealth of IPM program opportunities to “write more poems.” I feel sure that one of these is right for you. You can add to the poetic spirit of our world and find friends who are doing the same. We need more poetry in 2024!

We hope to hear from you. IPM is all about communication. 

Kindness,

John