Abstract
The development of critical approaches to medical humanities education is crucial: an integral educational underpinning that recognizes the need for social justice and health advocacy within medicine; and a way to humanize medical practice in an era of rapid, ground-breaking technological advancements coupled with a rise in doctor burnout, patient dissatisfaction, and medical errors.
I write to make the case for dance, of all the art forms dance in particular, as an effective tool for inciting reflective thinking on empathy, compassion, responsibility, leadership, collaboration and partnerships as one develops the moral, ethical and socially just principles for one’s identity as a medical practitioner. Putting theory into praxis, in 2013 I worked with students from my undergraduate liberal arts college and a class of 1st and 2nd year students in a college of osteopathic medicine. I designed a workshop to be embedded within their Medical Humanities elective course, “Medicine and the Arts.” The workshop brought students and faculty from both colleges together using dance-based improvisational practices, designed for broad-based inclusion, as an embodied ground to reflect on how socio-cultural presuppositions effect interactions between medical professionals, their institutions and their clients. This practice placed the dance/embodied experience not as a ‘zone of creative relaxation’ but rather an active site to reflect, question, and to problematize the taken for granted, including issues around race, class and gender (Bleakley 2015, 37) This article is in the form of field notes from the workshop which subsequently laid the foundation for my continuing work in the field of dance and medical humanities partnerships.
Introduction
Throughout my career in dance – as a solo performer, choreographer, educator and dance-based community arts practitioner – I have been involved in partnerships where dance-based practices are used for relationship building, individual and community reflection, expression and empowerment. Dance and the embodied experience function in aesthetic and critical pedagogy modes. This work is core to who I am as an artist and as a human. Within this framework, my core philosophies and practices dovetail with the work within the field of medical humanities, particularly in the space that examines the intersection of arts and humanities in medical education, with the aim of finding a process of creating ‘more compassionate, more capably communicative doctors...[in a way that may] lead to better health outcomes for patients.’ (Bleakly 2015, 45). As I delve into research into how the various arts disciplines are represented in the medical humanities field, I find dance to be underrepresented and oft misunderstood for its full potential. In making the case for why dance in particular is relevant in medical humanities, I quote from a dance artist/co-facilitator from my workshop team. When asked “Why dance?”, she replied, “Because of the un-deniability of the body.” And truly, for dance and medicine – the body is undeniable.
The 2009/State of the Field Report: Arts in Healthcare identified one of their focus areas as "Community Well-Being" and within that area, noted that “for students in medical and healthcare fields, the arts can enhance skills– improving their observational, diagnostic, and empathic abilities. It helps them to understand patients in a different way and connect with them on a more humanizing level” (2009: 2). And yet, when focusing on the application of dance the report notes the benefits as leisure activity and physical fitness (19). This places dance in what Bleakly might refer to as a “zone of creative relaxation” (37). I argue that dance is oft overlooked as a site for engaging critical thinking, reflection and processing. Education professor Jonathan Miller-Lane invites us to “imagine the body as a site and ally of intellectual and academic work” (2012: 42). And certainly, dance provides tools and means to use embodied practices to reflect, question, and to problematize the taken for granted, including issues of power.
The workshop described here was a result of a partnership between my liberal arts undergraduate college and a nearby medical college. The partnership was prompted by my college’s Director of Service and Social Innovation. She knew about my previous work in the nursing field and was a colleague of the Chair of the medical college’s Behavioral Medicine, Medical Humanities & Bioethics department. After inspirational brainstorming conversations, I proposed a one-session workshop for their medical humanities elective course, “Medicine and the Arts.” I engaged three of my undergrad students as co-facilitators for the workshop. Two of the students were Theatre and Dance majors and one was a Biology major – all three had trained with me in dance, choreography, and participatory dance-making. One student was at work on a dance and spoken word solo about living with a chronic condition.
The syllabus for the “Medicine and the Arts” course, for 1st and 2nd year students, states its purpose as an exploration into “the intersections between the medical world and the arts, offering students the opportunity to examine the relationships among medicine, literature, ethics, philosophy, and the visual arts with special attention to image, social position, and the expectations of the public toward the medical profession” (Hoff).1 It offered students a space to pause and critically reflect on their career choice and path.
The field notes herein combine my facilitation notes with student responses from within the workshop time span, as well as with students' written reflections turned into their professor post-workshop.
At the end of the overall experience I hope the participants will have access to ways in which to incorporate what they have learned into their practice of medicine (and potentially into their ongoing repertoire of ongoing resilience building).2— (Hirsch)
The Workshop
The 150-minute workshop took place in an informal seminar space that allowed us to move tables and chairs to create a circle of chairs, and later a cleared space for moving. In attendance were eight from the medical college: six students enrolled in the course, the course professor, department chair; and three co-facilitator students from my undergrad college.
The workshop was divided into three parts that were sequentially arranged for a scaffolded experience.
- Part One: Pop Bead Dance: A participatory dance-making activity.
- Part Two: Witnessing Performance as catalyst for dialogue.
- Part Three: Partner Walk: A structured improvisation for reflection and expression.
Part One: Pop Bead Dance: A participatory dance-making activity
After a welcome and introduction by the course professor, all participants “circled up”. The circle is a key pedagogical protocol in this work, as are introductions that are not limited to the introduction of the visiting professor/guests but include all participants– everyone in the workshop introduces themselves. Participants were asked to introduce themselves and respond to the prompt: “What are some ideas you have about the connection between medicine and the arts; or what are some salient take-aways from this course, ‘Medicine and the Arts’?”
As everyone in the room took a turn, the responses included:
- “Medicine is an art informed by science.”
- “Music was a big part of my life before medical school and I am struggling to keep it up.”
- “Because I think it takes two different areas of the brain for each, medicine and the arts, and there is a special sauce that is created when you engage both parts of those at the same time.”
After everyone introduced themselves with their answer to the prompt question, my co-facilitators and I coached each person to come up with a movement/gesture that caught the emotional essence of the response.3 We talked about how dance is a language of movement imagery that conjures or suggests an idea, rather than a pantomimed representation of an idea. However the movement is closely related to the idea, perhaps conjuring its essence. For instance, “Music was a big part of my life before medical school and I am struggling to keep it up” became a gesture of lifting something heavy overhead; while “special sauce” was placing the right hand out face up, then the left face up, then bringing the two together and closing with a stirring/mixing movement.
After each person created their gesture, we strung them all together, each gesture following the next, like stringing beads together on a string. Instrumental music, without a strong beat, was added, and the gestures were extended, elongated, slowed down or sped up as dictated by the music. The addition of music, the attention to the detail of the gestural vocabulary combined with musicality, the introduction of basic choreographic tools for manipulation allows the facilitator to get the participants up and moving/dancing, within a relatively short period of time. And at the core of the dance, is the contribution of the participants rather than the translation of the ideas into a movement by a “professional” and then fed back to the participants. We can all dance. When all the gestures were performed together, we had our own unique communal dance expressing the contributions of everyone in the circle. This embodied expression of the ideas placed our intellectual reasonings into bodily experience, illustrating the rich amalgam– why medicine and the arts are fortuitous partners.
Student reflections:
“The first activity we did was creating our own dance, with our own movements. We came up with an idea and used a single motion to explain it. (Example: “Music is a big part of my life I struggle to keep it up”)
“They key behind the movement was that it was so simple, but done in a profound way… The combination of these simple yet profound movements created something beautiful and meaningful. Similarly, in the clinic, I feel we can practice meaningful, beautiful medicine if we do the little, simple things in a profound manner. Talking, touching, listening, and engaging the patient: there are aspects of our doctor-patient relationship we have control over. When done in a mindful way, we have the ability to provide incredible medical care and truly express the art form that medicine is.”
Part Two: Witnessing Performance as catalyst for dialogue
One of my student/co-facilitators had created an original solo that combined dance and spoken word. The dance was a reflection on her experience as a college student, a dancer and a person living with a chronic illness. It was about how she processes and internalizes her disease as one aspect of her full human self. This short work was performed for the workshop participants. After the dance was performed we used the viewing of the short dance, as a catalyst for discussion on the topic of doctor/patient/narrative.
Student written responses:
Through her dance, we were able to gauge much about the meaning behind her movements.
The movement of bringing her hands across the face that signified “hiding” behind her disease, her “coy veins,” and the motion of the medicine “walking” through her veins, carrying her upwards.
We must remember that [a patient’s] body movements and expressions can sometimes tell us more than their words.
The perspective that she offered through her dance would provide very valuable insights to physicians working on being more empathetic with their patients.
I felt that I received something by watching it [the dance] and the discussion that followed. Dance, as well as medicine, is heavily dependent upon narrative, perspective, and recognizing what divides the “speaker” from the “audience.”; which can be translated to the patient and the medical professionals.
I think the application of dance to medicine is a completely different experience than the intersection of medicine with literature, poetry, or art. It’s a much more physical and visceral experience that so blatantly reminds you of the human body and human condition. The physical manifestation of a disease is a very important part of the experience of being ill. The experience and manifestation of the disease in a physical way-through dance– is very powerful.
When my student/co-faciltator was asked why she used the art form of dance to tell her story, she responded, “Because of the un-deniability of the body.”
Part Three: Partner Walk
The final activity was “Partner Walk,” a participatory exercise found in both theatre and dance training.4 I have adapted this exercise for my own practice. It is simple, but multilayered. People partner up, one closes their eyes, the other is instructed to lead their partner through the space. Layers include, changing roles, changing partners, sculpting your partner and more. After each layer is added, the group pauses for guided reflection. These workshop participants associated the experience as a metaphor or analogy for the patient/doctor relationship, for maneuvering through the medical system, and for their own core beliefs or values around issues of power and privilege in becoming a physician.
Essential to the set-up for this activity is the care that is taken to establish the norms of procedure. We discuss the importance of that first moment of physical contact, and the contract that represents between each partner. In that initial touch, the open-eyed partner can immediately begin to sense the degree of comfort/discomfort in the close-eyed partner. The close-eyed partner can sense the degree of control/or “listening” that the open-eyed partner is bringing to the relationship. We talked about being able to “read” this information even before the first step is taken, communication on a two-way road. Both partners are communicative – receptive and giving.
Student responses:
We touched on many great metaphors of how dance is representative of the patient physician relationship. A dance between two partners is just like a patient and their physician. One must be willing to trust the other.
There are many ways that you can lead a person around the room with their eyes closed, but what matters is your attitude. Are you careful? Do you hold them by both hands or just one? Do you keep your arm around them to make them feel safer? I thought this was an excellent analogy for how physicians care for their patients. Don’t pull your patients behind you in tow. It’s important to form a trusting partnership where they feel secure, and at ease with your leadership. It was also a much needed reminder on what it feels like to be vulnerable. I truly appreciated that feeling of vulnerability. It showed me how patients may feel. This feeling of vulnerability is one that I hope to keep with me and apply to my interactions with patients in the future.
The biggest lesson I learned was during the leading and following exercise. I realized that you need to lead [each] patient in different manners. You sometimes need to guide them and really make sure they don’t run into obstacles. But other times, you can just walk behind them and let them know if they are about to run into something. Other times you should walk beside your patients and be more of a friend or companion than a leader or follower. Patients need to be treated with respect and with decision-making power.
I found myself frequently looking at what others were doing (particularly the experienced undergraduate dance students). I felt they understood the principle and value behind the activity, so I occasionally glanced around to learn from them. As a student, I think [it is valuable] to observe what experienced individuals are doing and how they handle certain situations.
In the reflection/pause at the end of the exercise one of the medical students shared how the activity, especially as each layer added more complexity, made her think about the patient’s room as a site for choreography. She pointed out how there are so many people in the room, all doing their own “dance.” The patient, the family, the interns, the nurses, the technicians, and the doctors. She spoke about how if this was perceived of as an improvised choreography it might be easier to navigate as you began to decipher patterns, predict behavior and gently guide/lead all the “dancers.”
Accompanying the email with the student responses attached, the Department chair wrote: “I think you will agree that much was communicated last night and I am convinced that some healing was initiated. This was a very powerful class experience from [our] perspective. So, I have a question, what’s next?” (Hirsch)
1. Hoff, Gary. Private correspondence. back to text
2. Hirsch, Norman. Private correspondence. back to text
3. This build-a-dance format is used by many in the field of community-dance making. It is discussed in the Liz Lerman Tool Box, http://www.danceexchange.org/toolbox/home.html, as “Build-A-Phrase.” I learned this practice from Kimberli Boyd, http://dancingbetweenthelines.com/whoiskimboyd.htm. I have also been part of workshops where this method was used by Urban Bush Women, and Stephanie McKee with Junebug Productions. back to text
4. Liz Lerman calls this activity, “Blind Lead” in her Toolbox. In Augusto Boal’s work it is called “Trust Walk”. The activity can be found in many theatre and dance classes and workshops. I learned this activity originally in a theatre class, and later witnessed it in practice with Liz Lerman. back to text
Works Cited
Bleakley, Alan. Medical Humanities – Medical Education: How the Medical Humanities Can Shape Better Doctors. Abingdon, Oxon and New York, New York: Routledge, 2015.
Miller-Lane, Jonathan. “Toward an Embodied Liberal Arts.” Liberal Education Spring 2012: 42-47.
State of the Field Committee. (2009). State of the field report: Arts in healthcare 2009.
Washington, DC: Society for the Arts in Healthcare.