Lippin Papers > Words - Embodied



Presented at
The American Physician’s Poetry Association (APPA)
Spring 1997 conference
Farmington, Connecticut USA
Sunday, June 22, 1997

Words - Embodied

Man’s Physiological Need for “Good” Words -The Physician’s Obligation to Provide Them

These remarks are dedicated to a remarkable woman -my mother Margaret Lippin

Good morning. Let me thank Dr. Rita lovino, Dr. Bruce Rhodes, Dr. Henry Schneiderman and Dr. Bill Wortman for their willingness against great odds to maintain the American Physician’s Poetry Association, or APPA; and especially thank Rita for organizing this annual conference -the second. When I founded APPA in 1976, over 20 years ago, my fundamental belief was that “sensitivity” in the practice of medicine could be enhanced through writing, reading, and sharing of each other’s poetry. This day is a concrete manifestation of that dream. And, again, I thank you all.

While I am not a linguistic or poetry scholar, today I would like to talk about words - their awesome power both to heal and to harm, but especially their relationship to the human body. And, I begin by posing the fundamental question, where do words reside in and around us? Also, I will address the unique importance of words to physicians and our special obligation to choose our words carefully as we engage in our noble and hallowed art - the practice of medicine.

In order to go on this journey with me today, I need you to at least consider accepting a few fundamental assumptions, or what some are calling paradigm shifts.

The first is that the human body is not bounded by where our human flesh begins and the surrounding environment ends. David Michael Levine says it well when he says, “In other words, what we interpret as the human body - its development and processes - is formed by communication networks extending within, through, and beyond the visible organism.” Deepok Chopra refers to it as “the overthrow of the superstition of materialism.” I suspect it has to do with Einstein’s E = mc2

The other trend I would like you to consider, in the context of my presentation today, is the emergence of what some would call a holistic or mind-body medical paradigm. Michael Murphy, cofounder of the Esalon Institute, has stated, “I agree that today we have strong evidence that any aspect of bodily function once brought to awareness can be deliberately altered to some extent for healing or the development of new abilities.” Personally, I believe that a mind-body model of health does indeed reflect a fundamental paradigm shift, which has potential for profound and seismic consequences - far greater, for instance, than those consequences produced by the billion dollar human genome project, projected to “revolutionize medicine.”

Once we simply recognize that the mind influences all aspects of human physiology, or what I call the “recognition of the existence of anatomic reality of the neck,” the entire universe and everything in it, including one’s perception of the universe through the human brain, affects all medical outcomes ranging from accidents to dysfunction and disease to wellness and peak performance. It follows therefore that words in a very concrete and measurable manner can and do directly impact human physiology, and that we as physicians need to understand and utilize that reality.

In an essay that I wrote in 1986, I stated that I was firmly convinced that through major advances in neuroscience it would be demonstrated that man indeed has a physiological need for words to connect separate parts of his brain and the body. Furthermore, that man spends his entire life seeking the “right words” to connect to himself and to others, hoping to dispel his existential loneliness and terror, and hoping to augment his and the universal life force. Poetry does this best and lays legitimate claim to being the ultimate bridge or rainbow balancing brain and body, balancing lives and cultures.

Let me now talk about my interest in words and where they might reside in and around the human body. I quote Dylan Thomas, who said, “The first poems I knew were nursery rhymes, and before I could read them for myself, I had come to love just the words of them; the words alone. What the words stood for, or symbolized, or meant was of very secondary importance.” So, too, I myself at Temple Medical School in 1967 remember sitting in class and falling in love with the beauty of medical lexicon, much of which I perceived as noble and onomatopoetic. Majestic words like o’6phoron literally made the hair stand up on my neck, and playful but instructive words like borborygmus made me laugh. Harsh, morbid words like cachexia made me frightened and sad.

I asked myself over the years, from where did these words arise, who was their creator, and where are they now? Mickey Hart, the famous drummer, said, “In the beginning there was noise, the noise begat rhythm, and rhythm begat everything else.” Hence, our mutual love of poetry, which is words and rhythm. And, of course, the Bible or Bibles are full of poetry, and their words through prayer have healed many as Drs. Herbert Benson or Larry Dossey would tell you.

Many of those, however, in the arts say that some things are simply too deep for words, that somehow words destroy an aesthetic or spiritual experience. While I am not in favor of talking about orgasm while one is having one, and sometimes a gentle touch is better than words, I do believe, as I wrote, that poetry is indeed the paragon of the arts, the perfect bridge or rainbow, as I call it, between the unconscious and the conscious minds, bridging the mysterious and powerful forces of our animal heritage with our noblest function of man: the ability to think, speak and write to communicate symbolically. Using language as a tool with words as basic building blocks, poetry aspires therefore to fulfill man’s greatest purpose: to realize himself.

Let me talk to you about what others have said about where words live in and around us; and to that end, I queried some literary friends, who gave me their thoughts. One, I found in a book by writer extraordinaire Diane Ackerman, who said that “Words are small shapes in the gorgeous chaos of the world. But, they are shapes. They bring the world into focus, they corral ideas, they hone thoughts, they paint watercolors of perceptions.

A writer friend of mine, Kathy Scullion said, “I know that when words travel from my heart, they pause as if stuck in a passage in my throat when they are most clearly touching love and grief and tenderness. That’s why the phrase ‘clear the throat’ means ‘make way in the throat for the words to pass through the feelings’ so that they can articulate what the eyes are already saying to one’s most intimate people.” She goes on to say that “I also know that words sometimes stumble playfully from my mouth, and I hear them at the same time the listener does, as if I am thinking and speaking at the same time. Thank God these incidents usually involve humor.” Over the years all of us have heard others reference the concepts of “words from the heart” representing honesty or love, or “words from the gut” representing intuition, passion, courage. I have often wondered why these two organs were consistently referenced. Perhaps it gives us a clue as to where words reside?

Another writer friend referred to “words flowing through her body like blood” and also referred to “words sitting patiently in large memory banks or filing cabinets inside of us, waiting for us to pull them out for use.” Another writer stated that she collected words in all shapes and sizes, and hung them like bangles in her mind. And yet another writer paid homage to modern technology, i.e., the word processor, by stating, “The beauty of word processing, God bless my word processor, is that prose becomes like liquid that you can manipulate at will.”

This fluidity of language was a theme that I heard from many others. Perhaps, words are indeed more liquid than solid. Another writer, talking about words as they are transformed into literature, stated, “Think of all the writers out there in the world, taking the same detour from the word processor to the coffeepot, thesaurus in hand, hopes in tow. We’re all in it together, crossing over and over the elusive bridge between words and literature.

I asked our physician-writer colleague, Richard SeIzer, for his opinion of where words might reside. He told me he had not written on this topic, but said that the earliest forms of language included the howl, the vowels of pain, which had no consonants in them, and the soothing hums of lullabies. I want to ask each of you where the word ohm or its derivative mama or, for that matter, the word appa or iama reside.

The elusiveness of words has also interested me. All of us have had the experience of inability to recall language. In my case, and probably others,’ it happens especially with nouns because they are so numerous
- names of people, flowers, movies, restaurants - things that all us talk about. Where are these words hiding? Do nouns reside or hide in different places than pronouns, verbs, adverbs or adjectives? I would posit that they are not just hidden in the brain. Osip Mandelstam has said, “I have forgotten the word I wanted to say, and my thoughts unembodied returned to the realm of shadows.” One of my friends whom I quoted before, Cathy Flynn, wrote a wonderful poem entitled, “Writer’s Block,” which I will now read.

Like a school of minnows
Shadowy, evasive, ephemeral
Before they can be captured
Only in the deep, primordial subconscious
As they flop on the page

Our dear friend and colleague, Dr. John Graham-Pole, who also spoke at the inaugural annual meeting of APPA last year, building on the metaphor of the fish, says this about writing poetry in regard to clarifying his thinking: “When making poems, I’m learning to listen to myself, turning fragments of racing, disconnected thought into accessible, visual, memorable, wordy substance. I can catch a moment of neuronal synapse, like a fish on a hook that can’t elude me. I can clean it up, fillet it, fry it, taste my fill of it. I know now what was gliding beneath the ripple of my subconscious. I’ve snagged it before it slipped down into a limbic recess.” Perhaps as Flynn and Graham-Pole imply, words are in a vast ocean of thought, water borne creatures waiting to surface or be caught.

Finally, on this theme, I close with a wonderful poem from Dr. Marc Straus entitled, “Semaphore.”

Sometimes a word seems to fall
into an inaccessible gyrus
of my brain and is lost forever.

Then there are times it snaps back,
coursing up from a hidden sulcus,
bounding across thousands
of synapses. Adamantine recently
did that. Ironically, it was a word I once read
and never looked up.

Then this week - brindled, gibbous,
Rift Valley fever, Gaucher disease.
In medical school I depended on

my excellent memory. I was quick.
I gathered them in, each word
a shibboleth to be placed

in its proper quarry. Again today,
a patient I often see was in and
I couldn’t remember her name,

but then a girlfriend’s phone number
from tenth grade came to mine.
That’s the proof. It’s all there

carefully tucked away. Everything
is recoverable: agnosia, semaphore,
von Hippel-Lindau disease.

I, for one, believe words in all the languages of all the peoples of the world are free bits of energy constantly transforming, breathing, beating rhythms, living and dying, in and around us and most importantly between us - billions of little bridges, if you will. Words are found not only in our brain but in all our body systems, organs and even cells. Physiologists are telling us about whole body, tissue and even cellular memory, so why not words as a manifestation of that memory?

I would now like to address probably a more important topic for us as physicians, certainly, with very real application to our everyday work:
namely, the power of words to alter human physiology, and the need for physicians to recognize and utilize that knowledge. For anyone who doubts the power of words on human endeavors or behavior, I point to the word uttered by Alan Greenspan, Head of the Federal Reserve, last winter when he used the word “exuberance” referring to the economy, which sent U.S. and World stock markets tumbling.

But, more importantly, from our own professional perspective, we need to understand not only the behavioral consequences of words but their naked power to heal or harm. We need to understand that our patients need and deserve what I call “good words” from us. They need to be honest words, but words that heal, words that
connect us to them, and words that connect inside of them and, I hope, to a universal healing force. I have always been amazed that patients know this intuitively, for when they come home from a visit to their physician, they do not ask “what did the doctor do?” but always, “what did the doctor say?”

Dr. Morgan Martin said it so well in JAMA way back in June of 1978, when he wrote an essay entitled “Healthy Respect for the Words.” Beginning with a short poem, Martin says, “Here we are, physicians prescribing from our shelves, devising our scenarios, writing out ourselves. Here we are, plain patients, part of your daily rounds, sifting every utterance, hanging on your sounds.” He goes on to say, in regard to the power of words, “Words as causes of sensations bring vivid sights, sounds, even smells. Words touch and leave a sensation of syntax, a shiver on skin like a shimmering on water.”

And, finally, he says something I completely agree with, and that is, “a physician treats with words within the physician-patient social system. Physicians dispense not only medicines, but words that influence medicines, or that all by themselves affect the patient more than medicine.”

I would agree, and I would add that words are so important to physicians that they should study the dictionary and thesaurus and, of course, poetry as much as they study the Physician’s Desk Reference (PDR). And, that there are contraindications for some words in some settings. There are side effects, adverse reactions, word interactions like drug interactions, which can be additive, subtractive, synergistic, or dangerously toxic.

This has been known intuitively for many years by perceptive doctors and patients alike. Rudyard Kipling has said, for instance, that “Words are, of course, the most powerful drug used by mankind.”

Well, what neuro-linguistic or neuro-immunologic or neuro-cardiologic evidence do we have that Kipling was correct? Let me just reference two examples.

One appeared in the British Medical Journal in October of 1990, where recorded phrases like “you feel warm, comfortable, and relaxed” were played through earphones to 30 anesthetized women undergoing hysterectomy. During the first 24 hours after surgery the need for pain medication decreased by 23 percent in these women compared to a control group for whom a blank tape was played.

The other is the work of Dr. Jim Pennebaker of Southern Methodist University in Dallas, with whom I’ve had ongoing correspondence. Pennybaker wrote a wonderful article in the American Journal of Health Promotion in April of 1992 which relates to putting stress into words -the impact of writing on physiological parameters, absenteeism and self-reported emotional measures of well-being.

Of course, the poetry therapy community for decades has promoted the value of poetry as therapeutic interventions in medical settings, but now we have the technical tools to validate this groundbreaking, creative, courageous and important work. We owe a debt of gratitude to this professional community. In short, as Wittgenstein has stated succinctly, “Words are deeds.” I believe the day will indeed come when, with the advances in neuroscience and increasing acceptance of the mind-body model of medicine, science will validate that man, perhaps uniquely as a species, has a physiological need for the “right words,” as I previously stated.

I’d like to close with a few poems that illustrate some of the points that
I’ve made in this latter portion of my talk. One is again a poem by Dr.
Marc Straus entitled, “One Word.”

A man at the bus stop stooped
to retrieve a dime rolling toward
the drain. Looking at me, he said,
“No ordinary dime, mister.” “Really?” I said,

thinking how life is sometimes reduced
to a single word, a reflex, a courtesy.
Like the time I interviewed this young man
for a job in my lab, my mind wandering,

not attached to the conversation
at best noticing his outdated tie.
Perhaps in response to some statement,
I said, “Why?” Then sensing the opportunity

he answered more eloquently and that changed
everything. Like the time a woman walked
into my medical office for one thing
and I put my fingers in the crevice of her neck,
the right side, and touched a fullness
deep within, and I knew that moment
I would say one word to her and nothing
would ever be the same again.

Salvatore Ambrosino, a long-term APPA member, wrote a wonderful poem entitled, “Pent up Rivers.”

thank God for words
because they help me
to hoist my passions
out of my chest
beyond grubby human comforts
in this way
they keep my toes
in touch with my head
and throb my heart in between
that connection keeps me human and alive the hope
to lift me upward
to earn my angel wings

I would like to add, “thank God for Salvatore Ambrosino for writing that poem!”

Finally, my own modest offering - my prayer and hope for each of you in the form of a prescription.

Rx - Take thou

Take thou
The correct words
The words that connect you to yourself
And you to others.

Take thou
The beautiful words
The truthful words
The words that heal and make you whole.

Take thou
These words
Now at the hour of sleep
And forever.

Again, thank you for your attention, thank you for being physician-poets and members of APPA, and God bless you all in your important work.

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