Writing to Keep on Living: A Systematic Review and Meta-Analysis on Creative Writing Therapy for the Management of Depression and Suicidal Ideation.

PURPOSE OF REVIEW: The purpose of this review and meta-analysis was to explore the effectiveness of creative writing therapies for the management of depression and suicidal ideation. RECENT FINDINGS: Twenty one of the 31 reviewed studies showed that creative writing significantly improved depressive symptoms, while five studies suggested improvement in other symptoms. The results of meta-analyses showed that narrative writing significantly reduced depression compared to those in neutral writing or treatment as usual condition in both post intervention and follow-up. However, the number of studies exploring the effects of creative writing in suicidal ideation was too low to perform a meta-analysis. A structured and well-targeted intervention using creative writing could have beneficial results for the management of depressive symptoms. More studies are needed to explore the potential benefits of creative writing for reducing suicidal ideation.

Medical education and creative writing: Poetry and how it can assist trainees in developing psychiatric formulation skills.

OBJECTIVE: To reflect on the importance of teaching formulation skills in psychiatry training and explore how creative writing, particularly writing poetry, can help achieve this goal. CONCLUSIONS: It is vital that formulation skills are embedded throughout psychiatry training. Formulations have an artistic element, and writing poetry can help foster a capacity for curiosity that can assist trainees in developing these skills.

Intrusion of the other: identity, ethics and transplantation in Sui Ishida's Tokyo Ghoul.

This essay examines the profound themes and complex narratives presented in Sui Ishida's Tokyo Ghoul, focusing on the illegal xenotransplantation and the transformation of the protagonist, Ken Kaneki, as he undergoes ghoulification. It delves into concerns surrounding patient autonomy and the integrity of medical procedures within organ transplantation, raising thought-provoking questions about identity and the process of reconciling one's sense of incompleteness in the context of xenograft research aimed at surpassing the transplantation. Through his transformation into a ghoul, Kaneki embodies the challenges faced by individuals undergoing organ transplantation and the profound impact it has on their sense of self, relationships and societal acceptance. The essay offers an insightful analysis of the stages of Kaneki's ghoulification, shedding light on the interplay between medical technology, power dynamics, oppression and personal agency. It draws connections to philosophical and literary works, such as Jean-Luc Nancy's reflections on organ transplantation and Kafka's The Metamorphosis, to enhance the exploration of themes within Tokyo GhoulIn this essay, a comprehensive examination of the intricate dynamics of power, control and oppression within medical technology takes place. It underscores the challenges Kaneki faces as he navigates his transformed body and grapples with societal prejudices and discrimination. The essay critically reflects on the complex interplay of power, identity and ethics within the context of Tokyo Ghoul, prompting contemplation of the multifaceted dimensions of human existence and the societal structures that shape our understanding of identity, autonomy and acceptance. Kaneki's transformation serves as a lens through which readers can examine the nuanced complexities and challenges associated with organ transplantation, medical ethics and the social implications of difference. By exploring the multifaceted themes and intricate narratives of Tokyo Ghoul, this essay considers the profound implications of xenotransplantation and the ethical considerations that arise in medical practice.

Can 'life writing' be therapeutic in response to trauma? An exploratory research project in Medical Humanities in South Africa.

The therapeutic benefit of expressive writing has been well researched in the Global North but there is no literature from the Global South. Potentially healing interventions need to be investigated in different contexts, particularly where there is a need to build social cohesion. South Africa has a violent past and is a highly stressed society. An exploration of self-reports by a diverse group of South Africans on the effects of life writing on their health and well-being was conducted using qualitative methods. Twenty members of a writing collective, the Life Righting Collective (LRC: www.liferighting.co.za), were purposively sampled and interviewed by medical students as part of a Medical Humanities special study module. Five major interconnected themes emerged. The LRC as a specific intervention was central to the benefits described. The findings of this study indicated that life writing is a useful non-medical, cost-efficient method to improve resilience to trauma, as well as improving the psychological well-being of the participants. In addition, participants reported positive experiences regarding personal development, overall wellness and mental health, and that life writing can engender a sense of community. Resource-constrained countries in the Global South, like South Africa, where there have been historical and ongoing multiple traumas, need interventions for healing and wellness that are low cost and can be replicated.

Written on milk: exploring messages written on donated human-milk bags.

Every so often, among the bags of breast milk sent for donation to milk banks, clear bags of milk are found that are hand decorated and accompanied by short texts written by donating mothers. In the bank labs, the milk is poured into pasteurisation containers, and the bags are thrown away. The milk comes to the neonatal ward packed in bar-coded bottles. Both donor and the recipient are anonymous to one another. To whom are the donating mothers writing their messages? What can be learnt from their writings and drawings about their lived experiences of transitioning into motherhood? In the current study I integrate theoretical content about the transition to motherhood and theories about epistolary literature, likening the milk bags to postcards and letters. In contrast to a private letter written with ink on folded paper in a closed envelope, writing on 'milk postcards' is exposed and privacy is absent. 'Milk postcards' have a double transparency: the self is reflected in the messages and the contents of the bag-breast milk, a bodily fluid from the body of the donor. From a visual analysis of 81 photos of human-milk bags with text and drawings photographed by milk banks laboratory technicians, it appears that the milk postcards serve as a 'third voice' that echoes the difficulties and the joys in the transition to motherhood, and that donors experience an imagined solidarity with unknown mothers. The milk itself serves sometimes as an image and sometimes as the background for the writing, while its colour, texture and the form in which it is frozen constitute part of the text and serve as self-testimony for the mother of her capability and of her being a nurturing mother, for both her own baby and other unknown babies.

Meeting up in broken word/times: communication, temporality and pace in neuromixed writing.

The article investigates letter writing as a way to explore neurodiverse collectives, neuromixed communication and neurodiverse research collaboration. From the perspective of neurodiversity studies and translation practice/studies, the article negotiates new perspectives of inherited images of neurological selves and others, such as the non-autistic as the 'typical' in contrast to the 'atypical' autistic person. Experimenting with autistic time, allowing different sensory modalities and different approaches to time, detail and narrative, the article challenges deficit approaches to autism. Through a letter writing practice the possibilities and challenges of subjectivity, cultural translation and writing as method are examined. The article suggests that 'counter narratives' are important sources of knowledge as they reclaim personhood from dehumanising perspectives. By performing neuromixed conversation and dialogue with theoretical concepts, and pen paling as play as a fruitful form for responsible cross-neurotype translation, the article illuminates challenges and opportunities in neurodiverse collective writing.

In Dialogue: How Writing to the Dead and the Living Can Increase Self-Awareness in Those Bereaved by Addiction.

This article examines how writing can increase the self-awareness of a socially isolated and often stigmatized population: those bereaved by addiction. Writing about a traumatic event has been shown to increase self-awareness which can improve health and regulate negative behaviors. Using narrative analysis on the writing of individuals bereaved by addiction, this study found that participants were able to increase their self-awareness through writing to the dead, the living and themselves. Participants' writing also demonstrated their attempts to make sense and make meaning out of their loss which are both strong predictors of positive health outcomes. All participants in this study demonstrated increased self-awareness as well as sense-making and/or meaning-making which can lead to improvements in behavior regulation, psychological health and physical heath. This suggests that writing may be a uniquely beneficial therapeutic intervention for those experiencing disenfranchised grief as a result of bereavement by addiction.

A caring science study of creative writing and human becoming.

The previous research describes creative writing to have a potential for self-care and healing in relation to illness and mental health conditions. The aim of this article was to deepen the understanding of creative writing and human becoming, from a caring science perspective. A data material consisting of answers from an e-form and diaries was analysed with a thematic analysis. The result depicts two main themes and seven subthemes. The first main theme, Creative writing - an act of emotional reactions and release, shows that creative writing is an act where fears and emotional reactions are unveiled; it is a relieving valve for the writer and includes moments of liberating wordplay. The second main theme, Creative writing - a key to self-understanding and personal growth, shows that creative writing is a genuine conveying of oneself to others, to experience mercifulness within oneself, to keep up faith in oneself and hope for the future and to find a new order of values. Creative writing enhances human becoming and gives possibilities for human beings to find inner peace and balance in life.

The poetics of vulnerability: creative writing among young adults in treatment for psychosis in light of Ricoeur's and Kristeva's philosophy of language and subjectivity.

There is a growing interest in the application of creative writing in the treatment of mental illness. Nonpharmacological approaches have shown that access to poetic, creative language can allow for the verbalisation of illness experiences, as well as for self-expressions that can include other facets of the subject outside of the disease. In particular, creative writing in a safe group context has proven to be of particular importance. In this article, we present a pilot on a creative writing group for young adults in treatment for psychosis. We set the texts and experiences from the writing group in dialogue with Paul Ricoeur's and Julia Kristeva's philosophies on poetic language as meaning making and part of subject formation. The focus is on language as materiality and potentiality and on the patient's inherent linguistic resources as founded in a group dynamic. As a whole, the project seeks to give an increased theoretical and empirical understanding of the potentiality of language and creativity for healing experiences, participation and meaning-making processes among vulnerable people. Furthermore, a practice founded in poetic language might critically address both the general and biomedical understanding of the subject and disease.

Beyond subjective judgments: Predicting evaluations of creative writing from computational linguistic features.

The question of how to evaluate creativity in the context of creative writing has been a subject of ongoing discussion. A key question is whether something as elusive as creativity can be evaluated in a systematic way that goes beyond subjective judgments. To answer this question, we tested whether human evaluations of the creativity of short stories can be predicted by: (1) established measures of creativity and (2) computerized linguistic analyses of the stories. We conducted two studies, in which college students (with and without interest and experience in creative writing) wrote short stories based on a writing prompt. Independent raters (six in Study 1, five in Study 2) assessed the stories using an evaluation rubric specifically designed to assess aspects of creativity, on which they showed high interrater reliability. We provide evidence of convergent validity, in that the rubric evaluations correlated with established creativity measures, including measures of divergent thinking, associative fluency, and self-reported creative behavior and achievements. Linguistic properties of the short stories were analyzed with two computerized text analysis tools: Coh-Metrix, which analyzes aspects of text cohesion and readability, and Linguistic Inquiry and Word Count, which identifies meaningful psychological categories of the text content. Linguistic features predicted the human ratings of creativity to a significant degree. These results provide novel evidence that creative writing can be evaluated reliably and in a systematic way that captures objective features of the text. The results further establish our evaluation rubric as a useful tool to assess creative writing.

Use of Creative Writing to Illustrate Lived Experiences in Hemodialysis-Dependent Children with Chronic Kidney Failure.

Pediatric kidney failure is a relatively rare but devastating medical condition associated with a high degree of disease-related burden, but little is known about children's lived experiences. Finding ways to better understand their experiences can lead to improvement in direct patient care, health-related quality of life (HRQoL), and long-term functioning. Arts in Health (AIH) may be one means of understanding children's lived experiences. A retrospective review of a creative, writing-based AIH project by pediatric patients on hemodialysis was conducted. A qualitative directed-content analysis identified five main themes, including physical shackle, feeling mental and emotional distress, relying on a hemodialysis machine, dealing with problems, and feeling different. This study elucidates the lived experiences of children with chronic kidney failure by validating patients' experiences and highlighting their resilience.

Bringing Creative Writing Instruction into Reminiscence Group Treatment.

OBJECTIVES: This article describes the program evaluation of a group intervention combining reminiscence with literary creative writing instruction. METHOD: This 10-week, 1-hour group was completed seven times in an outpatient geriatric mental health clinic. Each session introduced a different reminiscence theme and creative writing practice. Feasibility and acceptability were assessed through group monitoring and qualitative feedback. Effectiveness was assessed with pre- and post-test depression screening (PHQ-9) and qualitative feedback. RESULTS: A total of 34 veterans participated in the groups, with a mean group size of 4.86 (SD = .69). Participants were 85% male (n = 29) and 15% female (n = 5) with a mean age of 70.89 (SD = 8.30). To increase accessibility, several adaptations were made. There were statistically significant reductions in PHQ-9 depression scores (p = .005). Veterans reported qualitative improvements including increased motivation and self-expression. CONCLUSIONS: This intervention was feasible and acceptable to the veterans being served. Randomized controlled research is needed to better understand efficacy. CLINICAL IMPLICATIONS: Clinicians may consider ways to augment or adapt reminiscence interventions to meet the needs of their patient population. Clinicians may find it useful to integrate creative writing instruction into reminiscence interventions.

Choir singing and creative writing enhance emotion regulation in adults with chronic mental health conditions.

OBJECTIVES: Adults with mental health conditions commonly experience difficulties with emotion regulation which affect their social functioning. Arts-based groups provide opportunities for shared emotional experiences and emotion regulation. This study explores emotion regulation strategies and the emotional effects of arts-based group participation in adults with mental health problems and in controls. DESIGN AND METHOD: The 62 participants included 39 adults with chronic mental health problems who were members of arts-based groups (ABG) and 23 comparison choir (CC) members who were not specifically experiencing mental health problems. The repeated measures design included self-reports of emotion upon waking (T1), the hour before group (T2), end of the group (T3), and evening (T4), as well as participant notes to explain their emotion ratings at each time. They also completed measures of individual and interpersonal emotion regulation. RESULTS: The ABG participants engaged marginally more in affect worsening strategies than CC (p = .057 and .08), but there were no other group differences. All participants reported a significant increase in positive emotions, F (3, 180) = 28.044, p < .001, np2 = .319; and a decrease in negative emotions during the arts-based activity: F (2.637, 155.597) = 21.09, p < .001, np2 = .263. The influence on positive emotions was short-lived, while the effect on negative emotions lasted until evening. CONCLUSION: Findings show that participation in arts-based groups benefits the emotions of both healthy adults and those experiencing mental health conditions through individual and interpersonal processes. PRACTITIONER POINTS: Individuals with chronic mental health conditions often experience difficulties in emotion processing Participation in arts-based groups was associated with significant increases in positive emotions although these were short-lived Negative emotion was significantly decreased during arts-based group activities, and sustained to the evening assessment Adults with chronic mental health conditions were equally able to derive emotional benefits as healthy adults.

Illuminating and inspiring: using television historical drama to cultivate contemporary nursing values and critical thinking.

As the world prepares to commemorate the centenary of the First World War, it is timely to discuss meaningful learning activities that students of nursing could be engaged in to encourage them to reflect on the nurse's role then and now. Several films and television series about the war and featuring nursing have already been aired. No doubt there will be many more stories to come. Such stories have the potential to do more than eulogise nursing for students and practitioners. Stories, such as The crimson field, have potential to stimulate serious contemplation about values and cultural practices that have remained constant or have changed and to assist students to develop and articulate values that will be fitting for contemporary practice. Recently, excerpts from the series were examined with a group of nursing students and key learnings were found. These are shared in this paper for the benefit of educators planning to utilise public discourse as triggers to engage nursing students in discussions about nursing values, nursing history and representations of the profession.

Role of Creative Therapies in Gynecological Oncology: Results of a Multigenerational Survey in Patients and Caregivers.

INTRODUCTION: Although creative therapies like painting, dancing, and writing are often used and encouraged to treat various diseases, including cancer, there are few systematic scientific studies on innovative therapies in medical care. METHODS: An anonymous survey was developed for female patients, their relatives, and female medical staff on the impact of creative therapies on optimizing clinical therapy management in exclusively female trials. RESULTS: Of 718 respondents, 358 were female patients, 69 were medical personnel, and 291 were in the control group. Overall, 91.2% of respondents had sought access to creative therapies, indicating strong self-motivated engagement in activities to improve health and well-being. This study also uncovered a significant preference for creative writing among patients. Furthermore, the data suggest that integrating innovative therapies into biopsychosocial anamnesis could offer valuable insights into patients' mobility, mood, and social behaviors. Despite a general hesitation to discuss leisure activities with medical professionals, many patients wanted to incorporate creative activities into their treatment plans. Moreover, group settings for innovative therapy were preferred, highlighting the need for more structured support in medical environments to facilitate these therapeutic interactions. CONCLUSIONS: This study suggests creative therapies can be valuable in medical care.

Expanding Narrative Medicine through the Collaborative Construction and Compelling Performance of Stories.

This essay proposes an expansion of the concept of narrative competence, beyond close reading, to include two more skills: the collaborative construction and compelling performance of stories. To show how this enhanced form of narrative competence can be attained, the essay describes Off Script, a cocurricular medical storytelling program with three phases: 1) creative writing workshop, 2) dress rehearsal, and 3) public performance of stories. In these phases, Off Script combines literary studies, creative writing, reflective practice, collegial feedback, and drama. With increased narrative competence, Off Script participants are likely better equipped to engage in more impactful health advocacy and partner with patients more effectively.

Creative writing as a means to recover from early psychosis- Experiences from a group intervention.

BACKGROUND: In this paper, we explore the subjective experiences of a group intervention in creative writing (CW) for young adults being treated for psychosis. METHOD: A qualitative and exploratory design was applied. Five out of eight patients who were offered a course in CW with two-hour weekly sessions for 12 weeks took part in this study. The five participants who followed through were interviewed after project termination. Systematic text condensation was applied to the transcribed interviews. RESULTS: The analysis revealed three overarching themes: a) the group was valued as a creative community, b) there was safety in the structured yet flexible framing of the course, c) the participants experienced creative freedom that enabled a feeling of mastery. CONCLUSION: CW was well conceived. The feelings of connectedness and mastery were prominent. The participants experienced growth on several levels. Our findings support previous work on arts therapy as a means to recovery.

"Live Gerontology": Understanding and Representing Aging, Loneliness, and Long-Term Care Through Science and Art.

This article proposes an expansive conceptualization of gerontological research by engaging with a "live gerontology" that combines sciences and arts to better understand and represent aging and its diverse meanings and contexts. Borrowing the sociological concept of "live methods," we argue that gerontology can benefit from a "live" approach-not only methodologically, but also conceptually. To guide pathways between artistic and gerontological fields and frame its practices and outcomes, we suggest four propositions for a live gerontology: (1) using multiple genres to artfully connect the whole-interweaving micro-, meso-, and macrolevels to contextualize aging within various sociocultural milieus; (2) fostering the use of the senses to capture more than just what people say-what they do, display, and feel; (3) enabling a critical inventiveness by relying on arts' playfulness to design/refine instruments; and (4) ensuring a constant reflection on ethics of representation and public responsibility. To apply and experiment with a live gerontological approach, we describe collaborations with an award-winning writer and an illustrator. The collaborations drew on qualitative data from a study on lived experiences of loneliness in long-term care through ethnography and interviews with residents of 2 Australian facilities. The writer explored participants' accounts as creative stories, which were then illustrated. Motivated by an ethics of representation, we aimed to represent findings without othering or further marginalizing participants. The creative materials offered more than appealing representations, shining new light on the intricate nature of aging, loneliness, institutionalization, and gerontology research and practice.

Exploring the behavioral and neural correlates of semantic distance in creative writing.

Creativity is critical to economic growth and societal progress. However, assessing creativity using objective approaches remains a challenge. To address this, we employ three objective indicators based on semantic distance to quantify the originality and appropriateness of creativity by analyzing long texts in a story-writing experiment. Global and local distances were generated separately by computing the mean distance of the whole text and the distance between adjacent sentences, and they were positively correlated with story originality in writing. Global cohesion was positively correlated with story rationality in writing, as generated by computing the semantic coherence between the text and story context. At the behavioral level, three semantic indicators were used to measure originality and appropriateness of creativity and reflected individual differences, including creative achievement and creative personality. At the neural level, global distance was best predicted by the features of the salience and default networks, whereas global cohesion corresponded to the control and salience networks. These findings point to a stable neural basis for semantic indicators and verify the idea of separating different dimensions of creativity. Taken together, our results demonstrate the significance of semantic indicators in assessing creativity and provide insights into analyzing long texts in natural paradigm.

Impact of Daily Choral Singing and Creative Writing Activities on the Cognitive Development of Second-, Third-, and Fourth-Grade French Children from Low Socioeconomic Backgrounds.

In France, around one-fifth of children have reading difficulties, and school results are highly dependent on their socio-economic status. In this context, the need for alternative and innovative teaching techniques holds importance, and more artistic approaches are promising. The aim of this study was to assess the impact of a daily choral singing or creative writing practice on the cognitive and linguistic development of French children from disadvantaged backgrounds. Eighty children participated in this longitudinal study, for whom we measured several cognitive and linguistic skills at the beginning (pre-test) and end (post-test) of the school year. The results showed that children in "singing" classes improved both their reading skills and processing speed, while those in "writing" classes improved their reading skills and vocabulary. These results open up new avenues of learning support, specifically for children with difficulties.