Arts, Health & Being well

 

image-10

The state of ‘dance’

Dancing exists in my body and imagination even when I’m going about my day-to-day activities not dancing. Its a comfort to know that a small shift in perception towards interoception awakens the felt sense, the feeling of being here in body/mind, noticing my relationship to gravity and space; alongside this allowing imagination into the mix, something changes and I begin to feel my place in the world. What that is, I understand to be the state of dance. It is an immediate wellspring of creative potential where the expansion of the self, a broadening of consciousness, can be made accessible by noticing the feeling of dancing within us, outside us and between us.

I understand dancing to be movement in all its forms. Movement without the spark of the imagination can lack aliveness in some ways. Dancing for me is bound in the imagination and in feeling. By feelings I mean the traces of feelings that have meaning for us in some way, be that a sense of passing joy or sadness or an unknown trace that moves through us briefly, these traces can bring a certain kind of attention to the self.

Mary Oliver speaks so wonderfully about this,

‘Attention without feeling, I began to learn, is only a report. An openness – an empathy – was necessary if the attention was to matter’

A question to us is: How can our attention matter when thinking about working in healthcare?
What kind of attention are we taking about? What ingredients make up this attention? What are the necessary conditions for this attention to be available or to blossom even, given that attention is like water, shape shifting to different forms, constantly changing, evaporating, stilling; it can be wild or flowing, and as water is essential for life, so this attention too can matter and can bring about change. The arts allow us a particular attention and way of being with each other and ourselves.

Cynthia Bourgeault speaks of attention by saying that,

Attention, as we normally understand it in the West, is implicitly an energy connecting subject to object: “I pay attention to my driving.” “I pay attention to the lecture.” “I pay attention to my breathing.” But there is also a different configuration for the attention, in which it does not flow in a straight line linking subject to object, but can rather hold a certain tensile strength as a three- dimensional field of awareness. The best way I can describe it is through a beautiful metaphor from Rumi: “quivering like a drop of mercury.”

When removed from its container and allowed to organize itself on a flat surface, mercury can either act like a liquid and spread out in a puddle, or it can hold its own shape as a drop, rolling about like a Weeble (the children’s weighted toy that will wobble but won’t fall down). Your attention is much like that. In its “liquid” form, it connects subject to object. In its solid, “Weeble” form, it is a tensile field of vibratory awareness, within which you can be conscious of the whole without having to split the field into the usual subject/object polarity.’

The dance, or the movement of health and vitality, exists continually within us like a long sung endless note that’s there sounding under the surface of things. All of us have periods of life where we can barely hear it, or it’s a distant murmur. At other times we know it’s presence is there and nourishes us in each step. All that is asked of us is to slowly turn our ear towards our own experience and attend to the act of listening to ourselves as we would a great storyteller. This is no mean feat. Learning to trust our body is something many of us were not taught to do. Perhaps through illness or loss we learned that we had at some point to listen to our bodies. To others it’s a new adventure to uncover new terrains of sensations that can become resources for us as we go through life. For some the task of befriending new sensations and allowing the inner world to become known can be threatening, but slowly slowly it can be a way of re-kindling our belonging.

 

David Whyte speaks in his poem The Winter of Listening

‘All those years
Forgetting
How easily you can belong To everything
Simply by listening’

Movement and improvisation can be invitations to unfold our physical body, to unfold our feelings, and most importantly to unfold our imagination and psyche from the places where thought and the thinking life, particularly in illness, may have dominated our capacity to welcome any ‘new’ sensations images or feelings.

When we engage with any art form or creative process we get to be in kairos time.
The word kairos was an ancient Greek word meaning ‘opportunity,’ ‘season,’ or ‘fitting time,’ ‘A passing instant when an opening appears’.

These openings can appear when we engage with a creative practice. These openings and fleeting glimpses of our resources, or the feeling of health are a vital small step in a longer journey toward regaining health and recovery.

Entering the state of dance can therefore be a wonderful resource from which one can navigate the thresholds of change we experience in life.

The arts can give us another way of feeling, seeing and imagining our life in the present. This present is the way we live, we spend our time living from here, the past deeply informs the present, and the present can deeply inform the future. When working with dancing we are working with what arises from countless complex streams of conscious and unconscious information – more than we will ever understand, more than we can ever attend to.

We know that movement and touch was our first language, but many people have forgotten that.

Observations on the few still surviving hunter gatherers in Africa, Oceana and the Amazonian basin reveal a great deal of close physical contact between people of all ages. Individuals are embedded in a ‘socio-sensual human organisation’, which began in infancy during a period of almost continuous unusually rich tactile interaction. This sensual network begins in infancy and continues throughout life. When not in the sling, infants are passed from hand to hand around the fire or similar interactions with one adult or child after another beer kissed on their faces bellies, and sung to, Bounced, entertained, encouraged, and addressed at length and conversational tones long before they can understand the words.’ (Konner, 1982, p. 302)

Whatever age we are we still need places of socio-sensual human interaction, even more in those fragile times in older age when the body might not often be touched, in a way that has nothing to do with functionality but more to do with care or meeting each other. Illness intrudes into life, disrupting our biographical experience of time. The ground that we were standing on shifts. The sense of (I) ,our identity, is often in a process of re-negotiation and within that, we can feel a deep sense of loss of control that brings with it questions of mortality, fragility and uncertainty. People can feel as though the story of themselves has fragmented, and been replaced by an unknown story that is imposed due to illness, loss or injury. Perhaps the arts and movement can be a way to slowly re-trace steps to something that can be known again. A sense of physical security can support the deepening of a psychological security.

Deep listening and creative strategies allow us to meet the parables, metaphors, and narratives that shape people’s relationship to illness, but also health to health. These stories, how we carry them, and express them through creative acts allow us a way to make meaning.

The artist brings forth that skill of knowing without knowing. We follow a scent of a creative path that unfolds moment by moment. We befriend uncertainty when meeting others with a sense of curiosity. We have many ways into dancing together and being together but these ways perhaps reveal themselves uniquely to each relationship and in the moment. A ‘one size fits all’ model of activity will engender perhaps a ‘being done to’ feeling as opposed to ‘being with’ – dance for or dance with older people feel like quite different things.

As an artist I am lucky to be able to occupy a different sense of time when working in the hospital or care home. The ‘doing’ culture of the hospital means that we artists can offer something else. Perhaps the role of the artist is in being able hold the space of ambivalence at times, in opposition to or underneath the linearity and functionality which a context such as a hospital needs to adhere to. The possibility of undoing the doing for even a short time and carving out a space of ‘being’ can be vital.

We can attend to the ‘being’ aspect that takes up another space different to medicine. The goal is seen, but in the distance, and perhaps the way towards it is reached with a different ‘feeling of time’ and it is this different ‘feeling of time’ that people feel – ‘Feeling felt’ (Siegel)

‘Where are you from? What’ it like there…
What music do you like? How do you notice that, what’s that feeling there.
Is that comfortable, warm, or other.. Can we move together?’
Every time we ask a question, be it through movement or words, there are small places where one’s agency can be expressed. We can be drawing out the subjectivity again of the body, where perhaps the body in illness and through treatment has become an object. Slowly the body might find its voice and as it finds it voice a slow trust can begin to build. We can support a development of connection, to draw back a sense of conversation between parts of the body so that a map of the wholeness can begin to be woven.

Dynamic 4-D ultrasound research films reveal that by the 7th month of gestation the foetal mouth will open in anticipation if a hand comes near – a striking demonstration that one part recognizes its relation to another part, (Myowa-yamakoshi & Takeshita, 2006)

 

CASE STUDY

Patient L – palliative care patient:

I stand on the side of the ward and I see Patient L looking over. I look back and smile. She signals by gesturing a hand towards her. I notice this in my body as a space opening up as by these small relational moves, like the animals that we are, we give and receive gestures, sounds, words, postures, and in within fractions of seconds we deduce from these communications the availability of relationship, of safety or threat.

I walk over to Patient L- “I can’t breathe I can’t breathe.” She is obviously distressed. She thinks I am a nurse. Possibly … she’s very distressed. It’s not necessary to explain anything right now. I ask if I can sit with her. She keeps saying “I can’t breath I can’t breathe.” I notice that I shift my tone of voice and make more space between my words as if it were possible to slow down time.

“I can see that it’s difficult, but I can also see that you’re breathing.” I reiterate something factual, something solid. She is still very distressed and I ask if I can hold her hand. I apologise about my cold hands and say that it’s biting cold out there today, “looks like snow I think.” I ask her if she can feel my cold hand – an invitation to shift her awareness to the periphery away from the centre. I look out of the window and describe the day, “The sky is blue and the air is crisp.” She begins to respond a little as we move into the social. She drops down a little into a more regulated state for a moment, then goes back to “I can’t breathe”,”I’m frightened, please don’t leave.”

In somatic experience theory she is moving and pendulating back and forth from sympathetic hyperarousal to something more akin to a parasympathetic state. In polyvagal theory it would be worded as the shift between dorsal and ventral vagal states.

After some time I explain who I am and speak of my work and ask her about music – she loves opera, specifically La Bohème. I find it on my playlist and place the speaker on the bed. Slowly slowly she smiles and the sound of the tenor’s liquid voice fills the space and something shifts in her face; something shifts in my body too as she seems more settled. She briefly lets some notes, some voice, come through as I sing a few notes alongside what I hear.

Again she settles deeper and takes the oxygen mask off. She begins to talk about going to the opera, and the dress she wore, and I ask about it. In my response I emphasise the good, the resourcing aspects of what I hear. “I imagine that felt wonderful.” There was a process of mirroring and echoing back the resources. Slowly her hand began to move ever so gently to the music and I was aware of only the intricate dance.

“I like this Prayer, too – the sung version.” She says the words…
“And though we are few, we’re surrounded by many, who have crossed that river before
and this is the song we’ll be singing forever….

 

 

Patient T

A patient in the butterfly room, was at the end of his life. He was in the last stages of (COPD) Respiratory failure. I introduced myself, and he began to speak about his physicality – the physicality of his life, his love of sports, his love of fear, and jumping from cliffs, skiing, his lover at one time who was a singer.I sat and felt these stories fill my legs and hands as I began to gesture in response. As he spoke he sat up and I sat up. We worked with some gentle touch, but he wanted a firm touch, to feel his edges, as these stories of descent and flight seemed to fill the room vividly moving back and forth between loss and anger… the remembering and savouring of the life force through the felt images that he was calling up.

For me, words have a place within the dance. Words can be like fire to the imagination, and they can be a handrail in a way to support the dance and vice versa. When the cold and dark times of life settle in about our bodies, we can begin to sense that perhaps imagination is ‘a divine place’, as John O’ Donohue writes in one of his poems. It can perhaps become a resource in the darkest of times, a place to call yourself back to. Perhaps imagination can be like an echo chamber for our life, a place where images and memory call us back to the dance.

The Waiting Room:

I was seated in a small room, on my placement as an art therapist in psychiatric intensive care unit. There were 3 patients and myself in the room. I was there to offer an open art therapy session. I sat in the room attending to my own  regulation and noticing in and around me.

I saw a soft ball out of the corner of my eye. I held it in my hand and then looked around the room as one of the patients looked up. He met my eyes, and nodded. I threw the ball softly to him and he threw it back. We repeated this for a few moments until the third patient looked up and joined in. We kept going with this action, in silence mostly, for around 10 minutes.

This particular moment has stayed with me deeply as a point when I understood the necessity for the body’s involvement in co-regulation – the importance of rhythm, gesture and facial expression as cues for possible safety.

There was a palpable shift in the way we were together for that time… Just for a moment there was a sense that the nervous system of each other could sufficiently soften into more regulated states that could allow a different way of being together, coming into social engagement in this way, through the body. There was bottom-up approach to being together.

One of my acronyms for my  work: GRACE

GREET: access the social nervous system as a way to build a bridge into connection
RESOURCES: look for resources within the narrative, or bodily communication, drawing out the feeling of health where possible.
AWARENESS: expand and bring about awareness of what is resourcing or what could resource with small movement, touch or breath support, or a story that feels important to be heard.
CREATIVITY: support the emergence of the patient’s creativity through language and imagination (Developing the capacity to think into, feel into well being potentials- other possibilities that exist alongside their current situation/illness.

ENERGY: notice any shift of states of energy/bodily/emotions following the session and integrate and changes through reflection, dialogue and closing.

SELF CARE STRATEGIES

As I enter the ward I stand outside the door, and I bring in this image:
I stand on the edge of a lake in Wales, it’s a place called Cregenan. I know the landscape very well as I grew up there as a child. So I stand on the edge of the lake and look over the lake. From my centre a light begins growing, small at first, then it begins to expand. It grows and meanders towards the heart then out of the top of the head, and it grows down from the heart into the earth. As it exits my feet I see the lake slowly begin to illuminate and I am reflected in the light of the lake. As I begin to open and become more porous, I bring in the mountains that surround me in 360 degrees. I notice the container of them especially around my backspace, the strength and stability. I try to hold that light open quality alongside the solidity.

I imagine 3 candles. I place one in front of the heart, one behind and a light above my head. I notice the light spreading across the surface of my body like a skin of light. Reflecting.

NOTES ON WHAT TO WORK WITH

Deep listening
Imagination
Supporting body schema coherence
The ways in and the ways back out
Up and down regulating- opening energy field for a tired body, or supporting a containing of energy (anxiety)
Working with imagination and images that come from moving.
We can work with Breath to support relaxation and reduce anxiety
Working with Touch – to support connection to parts of the body, for pain relief or to increase movement after injury.
Working with Awareness to bring connection back to the body as a whole.
Working with improvisation to awaken openness/strength and fluidity of movement in the body. Explorations of quality of movement.
Explorations in body posture.
Coming back to body sensations.
Going along with what is happening or/and what were feeling, following the story of the body. Developing a quality of Presence.

 

Projects at CW+ Chelsea and Westminster Hospital ‘Meeting places’

The title of project was ‘Meeting Places’ and central to the ethos of the work was the emphasis on the ‘meeting’ of people through the arts. The interventions offered were bespoke, and were developed through the relationship that prioritized person centred arts interventions as the means to support patients. Many of the staff and patient have spoken about ‘learned helplessness’ that can occur during the time in hospital. This project aimed to address and develop patient agency through the exploration of creative expression.

Creative reflections

Movement and improvisation can be invitations to unfold, our physical body, to unfold our feelings, and to unfold our imagination and psyche from the places where thought and the thinking life have narrowed our capacity for remembering and experiencing the mystery of the body and all that it brings.
Orienting ourselves to mystery it seems, is the place where we can meet our aliveness if its been compromised by ill-health. There is in movement and embodiment it seems a simultaneous forgetting and remembering of ourselves. The arts offer a bridge in which we cross to meet each other. They offer a way of communicating both verbally and non-verbally, where the ungraceful and the graceful aspects of becoming visible to the each other can be revealed. There is a risk to that, it can be tender and powerful and there’s an awkwardness that come with trying. The arts hold us and propel us into the unknown. Chogyam Trungpa Rinpoche Speaks of ‘Shaky Tenderness’ this is the best description I have found of what it feels like to enter the ward of the hospital and relational field with the patients.
Welcoming and attending to the state of ‘shaky tenderness’ means that any agenda I might have, personally, unconsciously and that of the institution (known and unknown) can perhaps be emptied a little from me. Attending to shaky tenderness can soften and widen attention so I can become more available to meet the relational ground of the work with as much honesty as possible. Some times in the work in the hospital I can feel like a detective of sorts, gathering clues as to what the ‘mind of ward’ is in that day. Sometimes it is about hanging out, inconspicuously. Sometimes its about being bold, sometimes embracing the clown, often embracing the clown, and often the awkward artist with too many bags and no sense of direction. Many patients have asked me on the ward ‘are you lost’, in some degree I am, and to some degree I need to be. It seems that it calls for the artist to bring forth that skill of knowing without knowing. What it to be listening, how creative can this act be? What’s possible in this listening? How wide are the things we can listen to, pick up, follow? What is it to begin, where and when does that happen, with and without language?