Poetry As Therapy For Older Adults

I recently completed my undergraduate degree in English and Psychology. My final year research project for psychology saw me look at the effect of reading poetry in groups on the wellbeing of older adults. The reason for this is that in a hundred years' time, the proportion of 80 year olds in the world population is going to be the same as that of those between 0-14 years (UN, 2013). That's hundreds of millions of older people having to negotiate retirement, bereavement and changing circumstances. Loneliness is expected to be a big problem, especially for men. Depression and anxiety is a worry for policy makers too and governments are looking for cheap, easy and non-pharmaceutical interventions to avoid the ticking time bomb of an ageing population.

The humanities have done a lot of work in this regard. Art as a therapy is very successful among older adults. Reading groups are growing in popularity, too. It is generally regarded that this sort of thing works. It makes intuitive sense. We all know that painting and reading are good for us. We don't necessarily know why, though. That's where psychology and its research methods comes in. You might well wonder why we need to know. Well, if you can understand what's really going on and tease out its nuances you can design an intervention that is more effective, works more quickly and can be tailored to fit individual needs. There is also the fact of life that a peer-reviewed evidence-based study will help project leaders attract funding.

I looked at poetry as a therapy. Billington (2013) conducted research among patients suffering from depression. The bulk of each session was the reading of classic literature. Each session, though, was rounded off with a poem. It was found that while the literature relaxed the participants, the poetry made them more reflective. I decided to try to develop this study by concentrating on poetry. I chose six different themes of poetry (love, family, nature, local, nonsense verse and ageing) and by recording, transcribing and applying a thematic analysis to the group discussion of the poems, I examined how each theme affected them differently.

I found, just as Billington did, that the more difficult, classic poetry was most effective. To understand why I looked at another area of psychological research known as 'flow'. This is where we are so involved in a task we become absorbed, lose our sense of self and of time passing. According to Csikszentmihalyi (1997) a flow state requires two things: instant feedback and a level of challenge that pushes but does not exceed our ability. Learning a musical instrument is perfect for inducing a flow state. I suggest that difficult poetry does the same thing: instant feedback is provided by words, phrases and meaning that we don't understand. And a carefully chosen poem will push our ability to interpret it to our limits. Certainly, participants would report how time flew during those sessions and they expressed how satisfied they felt after deciphering, together, a poem's meaning.

That satisfaction is important. Flow helps you to complete a task more effectively. That, in turn, leads to a higher sense of self-efficacy (Salanova, Bakker and Llorens, 2006). This increased feeling of self-competence extends beyond the task itself and influences how we feel about our ability to complete any task and leads to a reduction in anxiety and an increase in wellbeing (Bandura, 1994).

I also found that poetry on the theme of local settings lead participants to feel nostalgic but in a positive way. Iyer and Jetten (2011) offer an explanation of why this may be the case. In their study, they found that identity continuity moderated nostalgia and leads to positive outcomes. Identity continuity is characterised by an individual’s ability to link the past with the present. This can remain static over time, or, a more dynamic view is that identity’s basic structure remains the same but is adaptable to change (Atchley, 1989). Participants in the continuity condition showed higher levels of well­being, self­-efficacy and an increased tendency to seek out new experiences. Moreover, they found that when links with the past were broken in participants, nostalgia lead to painful emotions, lower self­-efficacy and a reluctance to engage with the current environment. This is significant for my study as the theme of local poetry not only evoked feelings of nostalgia it did so while strengthening links between the past and present.

You'd probably think that poetry on the theme of nature could only lead to wellbeing. However, those who study older adults have noticed that they speaking of ageing as a process that you have to follow. The emancipatory theory of ageing wants them to realise that the ageing process as we understand it is a cultural convention that you can choose to ignore. Far better would be to choose your own process. The trouble with nature poetry is that it encouraged the participants in my study to speak of the stages of life as if they were seasons. Worse still, they described themselves as being in the winter of their lives, a season they associated with decay and death. It wasn't all bad, though. At least this brought the topic to the ageing process and allowed for a discussion to take place where their assumptions about ageing could be challenged. For instance, the seasons are cyclical. Spring follows winter and participants can be encouraged to look at each new stage of their lives such as retirement as the passing of winter and the coming of spring. The language we use to describe such things really matters. 

So as you can see, although we all know poetry can be very therapeutic, we might be able to understand why. Once we know that we can more carefully choose the poems we use to increase self-confidence, improve wellbeing and emancipate older adults to age in the way that makes them most happy instead of passively accepting the inevitable. 

Research into this is multi-disciplinary. Psychology and its research methods has a role to play. For me, the humanities and psychology overlap far more than is admitted. In my dual honours degree, my English course helped my psychology grades and the reverse was true. My final year project in psychology brought both together. As I continue on my academic career in research, I hope to bring the two closer together. 

References

Atchley, R. C. (1989). A continuity theory of normal aging. The gerontologist,29(2), 183­190.

Bakker, A. B. (2005). Flow among music teachers and their students: The crossover of peak experiences. Journal of Vocational Behavior,66(1), 26–44.Bandura, A. (1994). Self‐efficacy. John Wiley & Sons, Inc.

Billington, J., Davis, P., & Farrington, G. (2013). Reading as participatory art: an alternative

mental health therapy. Journal of Arts & Communities, 5(1), 25­40.

Csikszentmihalyi, M. (1997). Finding Flow: The Psychology of Engagement with Everyday

Life. Basic Books.

Iyer, A., & Jetten, J. (2011). What's left behind: Identity continuity moderates the effect of nostalgia on well­being and life choices. Journal of personality and social psychology, 101(1), 94.

Salanova, M., Bakker, A. B., & Llorens, S. (2006). Flow at Work: Evidence for an Upward 7(1), 1–22.

Spiral of Personal and Organizational Resources*. Journal of Happiness Studies,

United Nations. World Population Ageing 2013. New York, USA: Department of Economic

and Social Affairs, Population Division; 2013.

Ethical Change and How To Make It Last

In 2015, the Hoffman Report criticised the American Psychological Association's (APA) complicity in the torture of inmates at Guantanamo Bay. The APA apologised in an email to its members and spoke of the need to make sure something like that never happened again. The thing is, this was not the first time psychologists had chosen to serve the needs of the state. There is a long and dark history of psychology informing various governments on propaganda, torture and mind control. And so much of the power of advertising comes from what psychologists tell the industry will work on us. Is this ethical? Should psychologists serve society instead? If you think so, how should they go about it? Or perhaps psychologists should just produce data and not involve themselves in policy.

I am involved in the research of older adults. Specifically, I am looking at ways to improve their wellbeing. I should add no older adult has ever asked me to do this. Yes, they sign consent forms, but they don't know at the outset what it is I am looking for. If I find something useable and this influences policy, they won't all be consulted. Maybe I should just mind my own business?

It's not even as simple as I just implied. Communities of people are, by their very natures, resistant to change (Wiesenfeld, 1996). This is especially so when change is imposed by an outsider. A lot of very well-meaning community projects only have short-lived effects for this very reason. When the researcher leaves, everything goes back to normal. My own research, which uses poetry reading in groups, was very successful. What bothers me, though, is that I have had to keep going back as a volunteer to keep the group going long after the last data was collected. I enjoy it; that's not the point, though. What is the point is that I can't help wondering the project cannot be a success so long as it needs me, an outsider, to maintain it.

So what to do?

There is a type of research called Participatory Action Research (PAR). PAR confronts a community’s resistance to change directly by making the researched into the researchers. Formerly used in poor countries, PAR is increasingly being employed in wealthier countries today. This is particularly so in mental health and has become a principal tool of the Psychiatric Survivors Movement: a group of psychiatric service users (current and former), which itself emerged from the US civil rights movement (Corrigan, Roe, Tsang, 2011). The purpose of the movement was for mental health patients to assume more power for themselves from the professionals. PAR was ideally suited to this end as it involves the subjects of the research in evaluating, planning and implementing the services they use (Baum, MacDougall & Smith, 2006).

Although PAR is increasing in popularity, resistance to it is impeding its progress. As a form of research, PAR is time-consuming and can be complicated. It also relies on partnerships with local communities and policy makers who need to embrace and learn PAR research methods. Moreover, competing interests need to be continually negotiated. Not least of of which is the task of encouraging professionals to relinquish some of their power and authority.

Indeed, power relationships, defined by Foucault as interactions between people, practices of institutions and use of knowledge, are at the heart of PAR. Wallerstein (2000) who researched health initiatives in New Mexico, USA, reported that the re-negotiation of power relationships between communities and institutions required fundamental organisational change to accommodate this new paradigm. This, in turn, necessitated a process of critical self-reflection and a closer examination of political and community interests, different priorities regarding research and differences in interpretation of findings.

Empowerment evaluation emerged from PAR as a system of encouraging self-determination among individuals and communities. It has the benefit of being highly flexible, allowing it to be applied in a wide variety of settings, it requires the collaboration of those being researched and it lends itself to, indeed requires, qualitative and quantitative research methods (Fetterman, 1994). One such use of empowerment evaluation is the Accelerated Schools Project (Levin, 1988) for disadvantaged children. This project involved parents, teachers and managers to design a more effective educational setting.

Key to empowerment is self determination. Fetterman (1994) states that self determination requires the ability to recognise needs, identify goals, work out a strategy for achieving them and make use of resources available to them. It is important for vulnerable and disadvantaged groups, however, to be supported institutionally for self determination implies risk. An individual taking responsibility for his or her own life course must face the possibility of failure and its consequences. For this reason, such an approach requires the involvement of the institutions who exist to protect those individuals. Particularly, what is needed is a philosophical change to the institution’s view of itself, moving from a controlling power to that of a facilitator and emancipator.

Although Participatory Action Research is necessarily complex and gives rise to unique challenges, it does offer psychology an opportunity to address the ethical issues for which it has been criticised. It allows researchers to avoid the dilemma of whether they are working to serve society or the state as it engages policymakers, communities and individuals equally in the process of identifying aims, interpreting findings and implementing recommendations. And since they interpret the data and agree what to do with it, change is more likely to be accepted by the people it will affect the most. 

References

Baum, F., MacDougall, C., & Smith, D. (2006). Participatory action research.Journal of epidemiology and community health, 60(10), 854-857.

Corrigan, P. W., Roe, D., & Tsang, H. W. (2011). Challenging the stigma of mental illness: Lessons for therapists and advocates. John Wiley & Sons.

Fetterman, D. M. (1994). Empowerment evaluation. Evaluation practice,15(1), 1-15.

Hoffman, D. H. (2015). Report to the Special Committee of the Board of Directors of the American Psychological Association: Independent Review Relating to APA Ethics Guidelines, National Security Interrogations, and Torture.
Levin, H. M. (1988). Accelerated schools for at-risk students. CPRE.

Wallerstein, N. (2000). A participatory evaluation model for Healthier Communities: developing indicators for New Mexico. Public health reports,115(2-3), 199.

Wiesenfeld, E. (1996). The concept of “we”: A community social psychology myth?. Journal of Community Psychology, 24(4), 337-346.