My name is Leila Keneo, I'm a first, almost second year psychiatry resident at Yale in New Haven, and I took a gap year between my third and fourth years of medical school to complete the Master of Science in Narrative Medicine program at Columbia. And clinically, I'm interested in all of the intersection between medicine and psychiatry. So thinking about a career in palliative care versus addiction psychiatry versus CL psychiatry versus eating disorders. Hi everyone, my name is Harini Sridhar, I'm a third year medical student at the University of North Carolina at Chapel Hill, and I'm oriented towards a career in psychiatry. Prior to medical school, I worked as an ABA therapist for kids with autism, and I was pretty involved with community organizing, particularly within the South Asian mental health space. And so I co-founded a non-profit called We Are Soft to increase access to mental health care for South Asian Americans. And I also got my Master's in Narrative Medicine at Columbia where I met Leila. Can you guys hear us okay? Okay. I realize I haven't seen a session where the speakers bop around every slide, but that's going to be us. So just let us know if you can't hear us at some point. There's some height differences. All right, so this is where we'll go together over the next hour and a half, maybe more like an hour. And it's really just in three parts. So first, we'll share our qualitative research work, designing and implementing two narrative medicine workshop series at a residential treatment program for patients living with eating disorders. And Harini and I received fellowship funding from the department at Columbia to complete this work. And then during the second part of this talk, we will invite you to participate in your own narrative medicine workshop experience, because we think that showing and sharing is far better than telling. And then we'll have some time for questions. So Harini and I were really lucky to have had an inpatient eating disorders unit at UNC, where we were first exposed to this population. And one of the most striking qualities to us is just how strongly eating disorders are adopted as a form of identity. How much pride can be associated with having an eating disorder, at least in the population that we worked with. And the other side of that coin is this enormous fear of recovery, this idea of, well, who would I be if I didn't have an eating disorder? So considering these challenges, narrative medicine felt like a really unique tool that we could use to challenge, grapple with, and expand the sense of self. So a conversation is always a good place to start. And as a caveat, there are a lot of things floating around that are being called narrative medicine, like published first-person accounts of illness, which are so important and move our field forwards in important ways. But in this talk, we'll be referring to sort of the classical vision of narrative medicine. And for those of you who may not be familiar with the field, it was founded by Rita Sharon, who is an internal medicine physician, now retired, who after a decade in practice went on to get a PhD in English, concentrating on narratology and the work of Henry James, who's her favorite author. She describes the discipline as clinical practice fortified by narrative competence, the capacity to recognize, absorb, metabolize, interpret, and be moved by stories of illness. The way that this is practiced is through the pedagogy of the field, which is the narrative medicine workshop. And it's quite formulaic by design, so it always contains two parts. The first is close reading of a work of art, and that can really be art in any form. It can be a poem, a short story, a piece of music, a clip from a film. And then the second part of the workshop is writing, we say, in the shadow of a text. So it's a prompt that's sort of exquisitely designed to follow that particular work of art and invites a different kind of reflection. And at the end, you'll experience this workshop for yourselves. And the premise is that this kind of attention exercises a muscle that makes us better listeners and ultimately better knowers. The second quote on this slide is an example of the kind of academia that the discipline borrows from and is interested in. This is the scholar Rita Felski, who's a professor of English at, I think, the University of Virginia. And she writes about readerly recognition. She says, I can feel myself addressed, summoned, called to account. I cannot help seeing traces of myself in the pages I am reading. Indisputably, something has changed. My perspective has shifted. I see something that I did not see before. And that captures some of the internal work that close reading tries to accomplish. And just to mention that phenomenology is another cornerstone of the discipline. It's a branch of philosophy that's interested in the first-person experience. And our curriculum is deeply rooted in phenomenology. More on this later. I really adore this quote. So Henry James, Rita's favorite author, once wrote, try to be one of the people on whom nothing is lost. And I really see this as the goal of narrative medicine sort of practice, that it's pinnacle. So these were our three research questions when we first set out. One, how can narrative medicine help patients expand their notion of self beyond their identity as someone with an eating disorder? Two, how can providers reorient themselves towards the changing other as patients inhabit different identities? And three, how can narrative medicine aid a patient as partner approach to treatment and recovery? So in order to investigate our research question further, we implemented two workshop series, one for patients and one for providers at Carolina House, which is a residential eating disorder treatment center in Chapel Hill. For patients, this was an offering that happened on the weekends. The picture that you see here is the tree house, a dedicated space for dialogue and creativity at the Carolina House. And the provider series workshops were also offerings that happened over Zoom during the lunch break. So considering the power dynamics inherent to the patient-provider relationship, we aimed to create a sanctuary where patients could engage freely without performance and providers could share more of themselves and their stories. So after the workshops, we worked and hired a narrative medicine colleague of ours to conduct individual interviews using a semi-structured guide that we wrote that explored themes of self, other, and the world. Leila and I analyzed these interview transcripts separately using an approach called grounded theory. And so in essence, we pinned codes to capture notable themes that spanned across the interviews and we were able to get seven participants to take place in the research interviews. And so after that, while we started individually analyzing the transcripts, we came together and consolidated, updated, and revised these code applications. So I wanted to share more on the content of the patient workshops. Our goal was to make the themes additive, so starting at the here and now and blooming outwards. So they began by paying attention to the immediate. Where am I sitting? Who is in this room with me? And then we dug deeper into the self, the ways that we are molded by the people, places, and time that make us who we are. We read a short story called Girl by Jamaica Kincaid that details a mother's prescription for how she believes her daughter should live. And then we wrote about the prescription that we might write for ourselves on how we should live. Looking even broader, we looked at portrait photographs and considered our worlds. From there, the next workshop was centered on the theme of embodiment and feeling at home and unhomed in our bodies. We also watched a music video from Dear Evan Hansen, the musical, which featured the lived experience of a high school boy living with social anxiety and demonstrating the universality of this experience of loneliness and struggle. Our writing prompt for that workshop was to write from the inside. And then we took a pause and we asked participants to write from the outside and up to interpretation what that meant for them. The fifth workshop series was focused on reading Kindness by Naomi Shihab Nye to build off the universality and to mobilize kindness towards both self and other as a necessary antidote to our shadows. And in our last session, we oriented towards resilience, possibility, and what it means to win. So we read Ada Limon's poem, which takes place at a horse race. And we did a partnered exercise where we define triumph to one another. We also listened to Vienna by Billy Joel. And for the final writing prompt, we wrote, What Waits for You? And the workshop ended with an offering just as it began. And we read, I Am Offering You This Poem by Jimmy Santiago Baca. There were a lot of parallel themes between the patient workshop series and the provider workshop series. So I won't spend too much time here. But the curriculum reflected a similar kind of blooming. But with the providers, we opened instead with a discussion about the limitations of language. And we'll show you what the poem was and the writing prompt. The second and third workshops centered around themes like defining the self and thrownness. And we'll talk about this important concept later. And then the final session explored irresolution, messiness, ambiguity that exists in each of our lives and in our relationships with each other. And we read an excerpt from The Argonauts by Maggie Nelson, which is a genre-bending book about the ever-changing nature of identity through time. So in our first session with patients, we read Blessing the Boats by Lucille Clifton. And we used this concept of a blessing to establish a space of mutual respect, reciprocal support, and projected hope to frame our series and our workshops and our time together. So we'd actually bought each of our participants notebooks that they could write in and decorate and make their own. But for this session in particular, we had participants write to the prompt, which was write a blessing to the people in this room on construction paper. And so Leila and I actually took these pieces home, and we folded them into paper boats. And we displayed them at the center of each workshop series as a reminder of strength and the hope that we had for each other throughout the work that we were doing. And at the end of the series, we actually gave out the paper boats to participants who took a blessing home with them. This is what we used to open the provider series, on the other hand. And the idea behind using this poem is we recognize language as the most powerful tool that we have to connect with ourselves and each other. But even then, sometimes what we experience and feel and hope for doesn't really have a form and can't really be pressed into a word, especially when we're doing really hard work like caring for these patients. So we asked our participants to think about that place where language ends in each of their own work as providers for patients with eating disorders. So to explore this theme of the world, for both patients and providers, we had an identical session where we decided to introduce the philosophical concept of thrownness, which was described first by Heidegger. So in essence, we are thrown into a world that is given to us rather than chosen by us. Our world is situated within a historical, political, economic, and social landscape. While my past is something I was thrown into, my future contains many possibilities, albeit limited by my past. And I do have this power to actively project myself into the future through the choices that I make. So using this theme in this session, patients thought about their agency in treatment, shifted their focus to future goals and interests, and there was a dissolution of fault when considering the past. So this slide sort of distills the fruit of all of this labor, but our analysis identified three major themes, and we identify them as timestamps along a trajectory. The first is the phenomenology of illness, which captures the before, reflections on time that participants had prior to the beginning of the workshop and including and extending to the present day. The second major theme is phenomenology of change, and this described the now, what participants were grappling with as a result of the workshop. And the final theme is orientation to treatment, which conceptualizes the future, ways that the workshop may have altered a participant's relationship towards illness recovery and challenged their notion of identity. So the first theme, phenomenology of illness, was subdivided into three categories. These were etiology, experience of eating disorders, and recovery. So each of these categories were comprised of codes, and in the parentheses here, you can see how many times each of these topics were referenced. And so I want to talk a little bit more about etiology, which we used very qualitatively to capture the phenomenon that participants described as a beginning, a place from which their eating disorders either developed or intensified. Participants spoke of how perfectionism, gender and sexual orientation, seeking approval, religion, and a complexity of variety of factors coalesced at the start of their illness. The experience category captures participants' descriptions of what an eating disorder feels like, particularly describing it as a separate entity. These are some quotes here, but it was described as a monster that screams at you. An eating disorder was described as a love triangle. Patients and providers alike shared the futility of fighting against eating disorders. And to put it into the words of a text that we did use in our workshop series, it felt like punching a cloud. Others shared how any semblance of control in their lives was what they were searching for and how developing this eating disorder is how they achieved it. And it doesn't help that society values smaller bodies. Finally, successful treatment was characterized by trust and patience. A huge barrier to recovery was the idea that perhaps I should stay sick because I am not deserving of treatment. The second theme, phenomenology of change, identified internal shifts that resulted from this workshop series experience. It described shifts in behavior and thought patterns, relationships, orientation to treatment. It captures ideas like theory of mind and perspective taking, narrative humility, thrownness, dissonance, the recognition that comes from realizing we all have shared experiences. That includes the universality of struggle and vulnerability. People also talked about joy and the workshop series as an outlet. They talked about ideas that lingered from workshop discussions and carried through their day, things that they talked about over dinner that night at the Carolina House. This is an example of what this theme looked like in our data. Listening to everyone's story just shows you how deep of a beast it really is. It's not just the little piece of the eating disorder, it's the suicidal ideations, it's the cutting, it's throwing up. People opened up because of the close readings, just to see that you're not alone in the struggle. We talked about thrownness and what life we're thrown into and it kind of changed my perspective on feeling like it's just so unfair that I have an eating disorder and I was kind of just stuck on self-pity, thinking about it as okay, I was thrown into this and yeah, that sucks but there are things I can do to improve myself and have a better future. This is Dear Evan Hansen, going through the lyrics and listening to the lyrics and understanding that we all feel like we're unnoticed, that we're just kind of a number, and we're just kind of standing still, and everything else is just moving past us. And then the final theme is orientation to treatment. And this theme captured how the workshop created shifts in the way people engage with their vision of the future, and we also received some good feedback about how to move this work forward. I really feel much more strongly about using pronouns than I ever have before. This came from a provider. We do a whole bunch of learn this skill, learn that skill, or write in your journal about this, or do this or do that, but this was so open and personally expressive that it really allowed you to see who people were. It's also just hard to be the frontline person who basically receives the brunt of all emotional dysregulation events, where sometimes you're just the closest person in the vicinity, and that's usually what we were. There's a real need to have support spaces for frontline workers, and it's nice to know that somebody has written about it, or you know that somebody else was feeling very similarly to me in that situation. So I think we could each say so much about what we learned and how this project changed us. Here are some thoughts. In this first paragraph, Harini wrote, and I think it's absolutely a brilliant summation of this. The Narrative Medicine Workshop provides resistance to these thought patterns in a simple but important way. It offers an invitation to think of who else we are. It connects us to portion of our being that may have been dormant or forgotten. It invites us to gaze at works of art, and by virtue of this gazing, turn inwards to encounter a memory, a skill, a value, or belief that often surprises us. And I would add that this element of surprise is something that I've carried through in my work. I just finished six weeks on our inpatient psychosis unit, and I give my patients a lot of homework. I give them a lot of writing prompts, and I ask them about it the next day, and I often tell them to write and write and write until you surprise yourself, until you write something that shocks you, and then you know you can put it away and that you've done a good night's work. And one example is I get a lot of patients with substance use disorders that are pre-contemplative, so I might tell them, write about what it would mean to continue using, and write about what it would mean to stop. And patients have told me that they're shocked by what the second writing prompt leads them to think about and who it leads them to think about reconnecting to. Thank you. I think another really important part of this work was the community created that spreads kindness and brings light to the dissonance that perhaps people didn't see you the way that you thought they did. Maybe you treat yourself much differently than you would a friend. And that dialogue really helped many participants, both providers and patients, realize that we are not alone. The workshops also served as a space to build skills and advocacy, for patients to find the language to describe their experiences, and for providers to find the language to affirm patients. And this language really created a bridge for allyship. And I want to end on a quote from how the Narrative Medicine Workshop specifically allowed for these reflections to come up. You know, it was something different, and it wasn't so much about hearing this person telling you, oh, use these coping skills, it will help you so much with your eating disorder. It was more open, and people not being afraid to express themselves. And with the musical realizing, hey, I know exactly how that feels, and if this person can talk about how they feel, you know, why can't I? That kind of thing. So are you guys down for an interactive next hour? Some nods. All right, I'll take it. That's good. So we talked a lot about, actually, maybe we'll take a couple of questions before we get into this. There's a poem that's being passed around that we're gonna think about together. And we were told that this session is recorded, so if anyone does have a question, you'll have to migrate to the microphones. Hi there, thank you for your presentation. I have a question about this whole idea. Is it just something you guys came up with, or is this also out of... Is there any research that is working, or how did you come up with these workshops that you had? Yeah, so do you mean sort of narrative medicine as a discipline, or working with the eating disorder population? No, I mean that, because you had these workshops with the eating disorder patients and the caregivers. The ideas for what you will do every session, is it something that... Is there scientific evidence for it, or is it just something that you guys came up with an idea? Okay, let's go through this song, or let's read this poem. Yeah, yeah. So this sort of was born about 20 years ago, the idea of narrative medicine and the workshops. And in the last five or so years, there's been more of a surge towards qualitative research specifically, and studying these projects in a very similar way to what we've done. I will say that most of the research out there tends to have a small sample size, so this work is being done with groups of probably 20 people and smaller. So there's room to increase the power, definitely. And what you guys use, that's out of the books. It's not an idea that you came up with yourself. What did you want to say? So the specific sessions itself, the curriculum we developed, was things that we... So we both, as going through the narrative medicine program at Columbia, we took a lot of classes in philosophy, in writing. And so there were some themes that we really identified and resonated with, like thrownness. And so we used those concepts to create the curriculum. And we were the ones who went in and sort of picked the texts. And so a huge component of the narrative medicine program at Columbia is training folks who go through the program to learn how to facilitate and learn how to lead a workshop and kind of in the same framework. So reading a text and then writing to a text and sharing, which we will do soon. But it's really up to the facilitator to pick and choose what text they think might work with the population they work with or the groups that they're in. And so a lot of the work has been done on the provider side. And so there's been a lot of evidence shown that this work really helps fight against burnout in providers of all types because they have a shared space to talk about grief, to talk about other things that are really difficult in the training process of becoming physicians and health care providers. And then on the patient side, there's much less research being done. But it's sort of coming up because people are really interested. Oh, this is something that can be applicable to everyone. And it's slowly been growing. And we've seen it in groups of people living with cancer in the hospital setting and in other spaces. I think there's few in psychiatry, though. Thank you so much. Just one last question. Do you have a recommendation for a book or something that can really prescribe like, OK, this is a method you can use for that kind of interaction in patient? There is like the narrative medicine textbook that's called Principles and Practices of Narrative Medicine. And it's written by Rita Sharon and a group of seven or eight other faculty members at Columbia. Together, they created this field. But there are several specific, like chapter seven in that book is brilliant. And it talks about the reason why this works and really the ideology behind close reading and exactly how it's supposed to translate to the clinical encounter, which that link isn't always evident. But they really slow down and spend time making the link. OK. Thank you. Yeah. OK. So does everyone have a writing utensil? Because we went to Target and brought extras. So usually the way that we start off a question or a pen. OK. So the way that we do these workshops is the piece of art is read out loud, usually twice, usually by volunteers. Just tricky. Does anyone feel? Yes, Sarah. Thank you. And just so everyone knows what to expect. Sarah will read it aloud once and we'll let it sink in. And then hopefully someone else feels brave enough to, thank you so much, to read it out loud a second time. And when we're reading it out loud a second time, start thinking about what this poem is telling you besides the story that's being told. So think about diction, tone, form, audience. And then we always open with the same question, which is what arrests your attention. So we'll ask that after the second reading. Thank you, Sarah. Many Ask Me Not to Forget Them by Naomi Shihab Nye. Where do you keep all these people? The shoemaker with his rumbled cough, the man who twisted straws into brooms. My teacher, oh, my teacher, I will always cry when I think of my teacher. The olive farmer who lost every inch of ground, every tree, who sat with his head in his hands in his son's living room for years after. I tucked them into my drawer with cufflinks and bow ties, touched them with each evening before I slept, wished them happiness and peace. Peace in the heart. No wonder we all got heart trouble. But justice never smiled on us. Why didn't it? I tried to get Americans to think of them, but they were too involved with their own affairs to imagine ours. And you can't blame them, really. How much do I think of Africa? I always did feel sad, in the back of my mind for places I didn't have enough energy to worry about. That was beautiful. Thank you. Many ask me not to forget them by Naomi Shabab Nye. Where do you keep all these people? The shoemaker with his rumbled cough, the man who twisted straws into brooms. My teacher, oh, my teacher, I will always cry when I think of my teacher. The olive farmer who lost every inch of ground, every tree. Who sat with his head in hands in his son's living room for years after. I tucked them into my drawer with cufflinks and bow ties, touched them each evening before I slept, wished them happiness and peace. Peace in the heart. No wonder we all got heart trouble. But justice never smiled on us. Why didn't it? I tried to get Americans to think of them, but they were too involved with their own affairs to imagine ours. And you can't blame them, really. How much do I think of Africa? I always did feel sad in the back of my mind for places I didn't have enough energy to worry about. Thank you. So as we sit and ponder the verbal readings of this poem, think about this question. What arrests your attention? The APA did not think about this format. But we'll try to get your participation on the recording here. So I'll walk around and pass this around if anyone would like to share their preliminary ideas. I found myself drawn to the line about cufflinks and bow ties, the images of taking all these people with very full lives and then stuffing them in a drawer next to these objects that make me think of, you know, like you're going to a high society event and so they represent wealth and something sort of superficial and kind of puzzling over keeping them in this drawer. Is that actually a sign that the people are precious or are they discarded or does it matter if they're in a drawer regardless? I love that question. And it's interesting. I think my mind took me to like the top drawer of a dresser at the bedside and how we keep our most precious things sometimes there. But it is out of sight. So I hadn't thought about that before you brought it up. Naming cufflinks and bow ties makes me think of who's omitted by these symbolic things. Hi, I'm a psychiatrist from New Jersey. My reaction is probably a little bit unique because I'm in the unique position of having had an eating disorder when I was younger and treating patients with eating disorders now. Everyone has to deal with adversity even if they are extremely different. No matter where you come from there's always adversity. We tend to think of ourselves as Americans as being privileged and that is not necessarily so. We Americans struggle for a lot of reasons and in general we have a tendency to see people who we think perhaps are absolutely normal, functioning fine in the world and in reality are struggling a great deal. That's beautiful. Thank you so much for sharing yourself and your thoughts with us. I think there's something so important as a theme in there is that we walk through this world and we think we may look all the same but there's so much that's still unknown when you encounter a face. I really appreciate your writing. What arrests my attention is the many ask me not to forget them. As a part-time genealogist these people are rumpled in papers, crushed in my many cabinets of data about historical people, people that are my ancestors, people that are our ancestors because so many of us are intertwined and interconnected. No matter how distantly we are apart in the world our families have intertwined over and over again in some kind of winding paths so this keeping and crying and lost and slept wish them happiness and peace, peace in the heart but too involved to imagine. Can't blame them really. How much do I think? I always feel sad in the back of my mind for places I didn't have energy enough to worry about and the parts of the history that I don't have enough energy to worry about. What a connection. Wow your genealogy background also sounds fascinating and I love that you brought up the word rumpled at the very beginning and all the the media that that the types of substances that that sort of evokes Cough and papers stuffed in an office that must be overstuffed I imagine. I wonder if anyone else had thoughts about the rumpled cough? I'm a psychiatrist also, but I think my first feeling after reading it through was, there's a poem expressed for me a lot of anxious rumination about life. I think the one character in it who struck me strongly was Olive Farmer, who lost every inch of ground, every tree, and sat with his head in his hands in his son's living room for years after, because farmers depend on longevity, on the plants that they plant will be there for generations even, and olive trees in particular are considered very holy in many parts of the world, and they tend to survive almost anything. So it's a very striking image for me to consider what that would be if you're an older person and you've invested everything in a field and it's all destroyed in a moment or in a short period of time, particularly with all the floods that are happening right now in Italy, California, Pakistan, a lot of places. I really appreciate the connections to the current, and you know, even this poem was actually written, I want to say in 1950s, but yet there's so much that we can still see today within it, and just the amount of connection that you described, right? It's not just you as a person, but it's, there's so much that we depend on and that depend on us. And I'm struck by the fact that every tree is its own line in this poem, and it's the very shortest line in the whole poem. So what is that asking us to think about when it comes to a tree? Like there is so much history, work that goes into growing trees, and it seems like such a substantive loss to lose a whole tree, and then it's making me think about genealogy all over again, and those kinds of trees. Is there any other character or person addressed here that stands out to you? My teachers, my mentors, I always think with gratitude and warmth of their guidance that helped me out in the world with ways of thinking that have been working for me. They're such an evocative part of that line, right? It's the teacher because it's the only person addressed that also has a deep emotion and all of us have had many teachers throughout the training process and so I can't help but feel also drawn to that line as well. Are there any last thoughts before you move on to the writing portion of the workshop? Does everyone have paper? I guess this is why we printed out the poem actually it was an excuse to have a writing canvas. So we're going to give you about five minutes just silently to respond to this prompt. Write about who or what you tuck in your drawer. Thank you so much for engaging in this sort of different activity, more interactive than some of the other sessions. Yeah so for the last sort of 10 minutes before open Q&A we wanted to hear your thoughts about what that experience was like. So there's sort of three thought questions that you can choose to share. One is what was the experience of writing to that prompt like for you? Or two, what came up in groups? And if you feel brave or moved if you wouldn't mind sharing what you wrote. One part of my life, I was a teacher. First, the last part. In my drawer, I tucked the oyster shell from Thanksgiving, quotation marks, Thanksgiving Camp Lewis, Neil Walter Myers, 1918, inscribed in its curvilinear surface. Tucked also is the ring with five tiny diamonds my mother received from my father on their fiftieth anniversary, and she wore it twenty-five years after his passing. Tucked in are all my bands, gold band with JCJ capturing the loss of one from that marriage of JCJ and CJM, one lost, and the silver and orange bands of the batterer, and the purple of the partner I could not wed. That was all such a poignant experience to write, to see what I wrote, and to experience that, and the recollection of what things are in my drawer. I have many drawers in the storage area, I'm a nomad currently, but that experience of sharing it with our group and of hearing what they shared was, again, so poignant and touching and very moving to be with three people I've never seen before or know, and yet to feel the bonds of connection when we shared these things. Thank you. Thank you so much. And I'm struck by sort of the many layers of geometry in your response, like one was the physical space of a drawer, like a rectangular cube, and then you talked about curvilinear was such a fascinating word to think of and write down, and then ring, band, like my mind was thinking in spheres as you were reading, that was beautiful, thank you. And so if there's a lot of things you can share and so if you wanted to talk more about your thoughts on what we just read or what we just heard share what came up in group or share your piece would be wonderful. Hello. So the experience of writing, for me, it's not a familiar experience. I am not really creative in this type of way, at least. So I had to really think more concretely about what drawers I'd have, and I don't really have that many drawers. So then I thought more about drawers in my childhood home, and what's in them, and keeping things probably for too long at this point that are a bit out of date, like CDs and some Twilight books or something. I don't know. And then my partner and I connected on keeping things for a long time, things that have value to our memory, and when we keep things or when we let things go, and how difficult it can be to even think about it or try to do those things. Thanks. A drawer can be such a story, right? I was imagining who you must have been at that point in time, the CDs and the books. And even though I don't know you and have never met you, thinking about who you are now and what's similar and what's different, yeah, thank you. Did anyone, oh, sorry, did you want to go? I think I found the topic, or somehow the concept was a little difficult, and maybe I understood it differently, but anyway, I wrote, I tuck everyone, and no one, into my drawer. No one is always present, but no one is forever gone. The people I meet, who I touch, who touch me, live eternally in that moment that can also be relived or remembered. Forgetting does not mean losing them. We must focus to be here in the present. All moment in time, all moments in time combined to provide the launching pad for the now. So I see us as all particles in a great dance of creation that really is eternal and very profound. So that's how I conceptualize everything that you experience, because life doesn't disappear, as far as we know. I mean, even if people leave the planet or are no longer here physically, they still are there in your memory in all that they have manifested. So that's what I have to say. And I think part of the biggest joy that we have is seeing how people interpret the writing prompt. And it's meant to be, it's meant to combine with who you are and everything that's happened in your past to be interpreted however you come to it. So there's no wrong answers, which as physicians, that feels maybe uncomfortable, but hopefully freeing also. Yeah. I love the part in your piece that said moments in time combine. It felt like a math equation. Yeah. When I start reading the poem, I had to think about how I used to travel a lot as a student of medical. And each and every place I would go, I would get to know people and I would like to, I had this fear of losing them again. Like I wanted to have them with me somehow and have the relationships that I had built, but which wasn't really possible because you go back home and then the people go on with their life and you go on with your life. And something that helped me kind of in those time to have peace with that was the movie, Night Train to Lisbon. I don't know if you guys have seen it, but a phrase in that movie is about everywhere you go, you take something from there with you. So it can change something inside of yourself. It can teach you something. So you take that with you. There's always something with you, but also you leave a part of you behind. Anywhere you go, you leave something behind as well. And somehow that helped me like, okay, but it's okay that it's gone. The moment is gone. The connection that I had with a person is gone, but at least I took something. Like that person taught me something about myself or about them. It inspired me to something and that's what I'm taking with me. But also I'm giving something. I'm leaving something behind for that person or that space or whatever, which could help me to just be at peace. It's okay. It's going further. I'm going further, there is something still alive. And by doing this exercise, actually it helped me to realize that, yeah, once you're busy having a family and work and everything, you forget about the creativity that is also helpful. So being busy with this again, I realized how much I actually do like to be busy with poetry or in other ways with art and learning something about myself. I like that movie that I really love to watch and teaching me something. So it's nice. Now I feel inspired again to, okay, once I'm back home, I want to do something with this. I want to read poetry or whatever. I don't know. I don't know what I'm going to do about it, but I want to keep that part of me alive again. So thank you for this exercise. Wow. Thank you so much for sharing that. That's just, I don't know, I think very moving for both of us to hear that, especially I think both of us have had also, within the busyness and messiness of life moments that we forget who we are and what makes us us. And I think it's a lot of it for many people and many humans. It's engaging in this creative, innovative, maybe artistic side of us. And so I really, yeah, I really appreciate that. And I think one thing that you said really struck out to me, which was sort of how the experience of maybe love or strong emotion like that, like love is both really beautiful and really wonderful to love someone or something in the world, but also really, really sad because there's this grief that goes with it because you may lose it. And it's really two feelings at once. And I think the way that you described it as well, we all know it's a reciprocal relationship within there that I impact someone and they impact me and there's something still alive. I really love that language. And so I just find a lot of recognition in what you said and really appreciate it. Recognition, yes, that's the word. I think I needed to hear on a personal level what you shared. So thank you. Yeah, and this is like a total aside, but Harini and I are not only research partners, but we're very good friends. And narrative medicine is somehow a way that we also care for each other. And this is TMI, but I've been going through something and one midnight a couple of weeks ago, Harini sent me a piece of art and a writing prompt and was like, write to this. And it was exactly what I needed. So we have, maybe if anyone else would like to share, that would be wonderful. And if anyone has a question, we're also happy to receive them. All right. Is this on? Yes. So hi, everyone. I'm a first year psychiatric resident from Finland. And regarding the writing exercise, it was really anxiety inducing to do it in the foreign language. But also I really, really liked it. This also has to do with our, kind of like the Finnish people are very introverted and like talking in front of people is hard. So, but in a good way, of course. But I really liked the writing prompt because I tried to write something, but five minutes is not a lot of time to write in a foreign language. So maybe I'll tell it anyway. But I liked the prompt because it really brought in mind one specific person for me. I had this friend when I was younger and we were quite close. Not the best friends, but close whatsoever. And later he got schizophrenia, which is also part of probably why I'm here in doing psychiatric residency. And I tried to hold on to that friendship for a long time, but it was really difficult because he was in a bad shape and was not taking his meds and really disorganized and also having substance use disorder. And so we ended up drifting apart. And later when I was visiting my hometown, I saw this person and he was in a much better shape, but this was like 15 years later. And we went for a coffee and talked things out and it was really, it was narratively great to have an ending on this, but bittersweet at the same time because there was this seed that maybe there could be a friendship or something because he was in a much better shape and taking his medicine, but still I felt that we had grown apart so much because of all of this hard stuff. So I felt like the train had already kind of passed and kind of feels like he is now stuck in the drawer for me. So these kind of things, sorry, very personal, but it was a good prompt. Thank you. Thank you so much. Yeah, and I also, yeah, someone came to mind for me too, who maybe I'm realizing now feels very hard to contain, which is why I wanted to put them in a drawer, or there's something about someone that you can't identify in the world, in your mind, in your body. So wanting something you can pull out and see them inside felt comforting, but I think I understand. Yeah, thank you. And I can't help but smile and just feel drawn to the word that you used, like it's narratively great, kind of finding some sort of, like meeting this person again after years and sort of finding, I don't know if closure is the right word, but sometimes we do get that and sometimes we don't and it's really difficult. And so sort of draw, yeah, that word I think I will definitely start using. Inspired by the unexpected extraversion of my Finnish colleague, Lauri, I take this opportunity for personal growth and try to share something as well. Yeah, just first a thought about the text that this reference to Americans, which I saw as a reference to maybe Western people in general because, well, the American culture is also coming to Finland or has been coming to Finland for decades and just made me sad in a way, the busyness with how we're focused on our own lives and just try to think about ourselves and not really having time to think about the others. And another insight I was given was really because I interpreted the question more like who are the people I tend to think about all the time instead of some people I maybe met earlier in my life. But when I listed what I tend to think about in the evening before I go to bed, it wasn't a long list, but it's the same list I go through every evening when I think about the same people and my relations to them and my issues. So it was kind of insightful to realize how small maybe my thing, the group of most important people in my life are, but writing it down helped me to see it. But yeah, thank you for the exercise. Thank you for sharing that. There's also this, like there seemed to be loss in what you shared of something. I don't know that I identified it, but it reminded me of what you shared with us, this idea that the people that we know change even if they stay in our lives, and there's loss in that. And there are people who leave all the time, and that's a different kind of loss. Maybe worrying about people is a different kind of loss, too. Thank you, the extroverted Finnish people for the win. Thank you. With your prompt, there was a swirl of thoughts in my head about people and times and past and memories and all of this and suddenly my sock drawer popped into my head. And so I wrote my socks. I have one small drawer with all my socks. At first they were just a jumble and it bothered me. Some socks were getting worn a lot and others ignored. It was a small worry compared to the many other big worries that I deal with every day. I thought about creating a sock dispenser, but this seemed silly and too much work. At some point the socks moved into two rows. Then later I developed the habit of taking the front left sock pair and moving the others over in line, making my life a little bit simpler. Thank you. Wow, I really, really love that piece because it's just up to so much interpretation. We can think about it just as the actual socks and take it for what you've written and think about our own sock drawer. Everyone has it. But then you can also really think about who else those socks can be, like how you describe them as not just limited to objects in a drawer, right? It's the way that you would describe your friends or people you meet through time. And so I just really, I really appreciate the metaphor and I'm really drawn to that. And the places you go in your socks, like they're on our feet. Yeah, I realize I didn't have our emails up before. But yeah, these are our emails. If you have any questions, interested in connecting and continuing these conversations, we would absolutely adore that. Thank you. And thank you guys for everyone here for sharing themselves and participating in this sort of activity. Sometimes it's really hard to step back and slow down and think about these things and very, very brave to both think and reflect and share. And so I think we're both really, really grateful. Especially in this setting, I think. Yeah. Thank you.

narrative medicine

psychiatry

eating disorders

identity issues

self-exploration

Yale

University of North Carolina

qualitative research

Carolina House

storytelling