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After Shock

Keynotes/Workshops (as of November 4, 2010)




Keynote: The Bad News and the Good News Presenter: Kate Braestrup, Law enforcement chaplain, author of Here if You Need Me.

Kate Braestrup will talk about death, death notification, and what she has witnessed about love, human connections, grief and human creativity through working so intimately with sudden, unexpected death as chaplain for the Maine Warden Service.

Keynote: Two Heads and The Things They Carried Presenter: Tim O’Brien, Award winning author of Going after Cacciato and The Things They Carried.

Tim O’Brien will speak about the difficult and sometimes paradoxical moral choices often encountered by combat veterans, as well as the physical and emotional burdens that combat veterans carry through their lives.

Keynote: Learning About Combat Trauma From Homer’s Iliad Presenter: Jonathan Shay, Author of Achilles in Vietnam: Combat Trauma and the Undoing of Character and Odysseus in America: Combat Trauma and the Trials of Homecoming.

Keynote: Special performance and discussion of Sophocles’ Ajax and PhiloctetesPresenter: Theater of War, a theater company whose readings of ancient Greek plays act as catalysts for discussions about the challenges faced by service members, veterans, their caregivers and families. Bryan Doerries, Founder and Director; Phyllis Kaufman, Producer.

Since 2008, Theater of War has presented readings of Sophocles’ Ajax and Philoctetes to military communities across the United States. These ancient plays timelessly and universally depict the psychological and physical wounds inflicted upon warriors by war. By presenting these plays to military audiences, Theater of War hopes to de-stigmatize psychological injury and open a safe space for dialogue about the challenges faced by service members, veterans, and their caregivers and families.

Ajax tells the story of a fierce warrior who slips into a depression near the end of The Trojan War, attempts to murder his commanding officers, fails, and takes his own life. It is also the story of how his wife and troops attempt to intervene before it’s too late. Philoctetes is a psychologically complex tragedy about a famous Greek warrior who is marooned on a deserted island by his army after contracting a horrifying and debilitating illness.

A Clinician’s Guide to Invisible Wounds: Seeing Inside Our Patients and Ourselves Presenter: Veneta Masson, RN, MA, Author of Rehab at the Florida Avenue Grill, Ninth Street Notebook—Voice of a Nurse in the City, and Clinician’s Guide to the Soul.

As a family nurse practitioner, I relied on countless “clinician’s guides,” concise, up-to-the-minute print or online references on specific topics like antibiotics, common skin conditions or lab values. There are, no doubt, similar guides on trauma care and rehab protocols. But science and technology can take the clinician only so far into the world of hurt that our patients inhabit. The consequences of trauma, loss, incapacity, shock and grief often elude our ability to diagnose and treat. That’s where healing art comes in. Poetry, story, drama—all these can enlarge our understanding of the human condition and deepen the practical wisdom we bring to patient encounters.

In this workshop, I’ll share some poems, my own and others, that suggest ways to face what we can’t fix, guide our practice and help our patients heal. We’ll also exercise our creative imagination through some simple play with words and images that I think of as “balancing acts.” This kind of play is an excellent way to care for the soul and enrich our personal and professional lives.

AND WE FLEW...Storytelling and the Medicine of Meaning Presenter: Laura Simms, Storyteller.

Listening to stories can provide access to inner resources of healing: the way the “told” events unfold in the mind of the listener can interrupt loops of self defeating preoccupation. Listening to storytelling provides rest, restoration and zeal for moving beyond trauma, and can even transform suffering into the medicine of meaning. The storytelling can settle mind and heart in ways akin to mindfulness-awareness practice. This workshop will offer simple and powerful tools for learning to tell a story that frees the mind from habitual patterns and prepares an individual to tell their own story.

Collateral Damage: The Hidden Cost of Caring for Others Presenters: Hugh Silk, MD, FAAFP, Family physician and Education Director at Hahnemann Family Health Center in Worcester, Massachusetts and David Loxterkamp, MD, Family Physician in Belfast, Maine and author of A Measure of My Days.

Most of us entered the health professions to ease the afflictions of others. Some, too, hoped to assuage their own pain. Our connection to suffering is powerful and, at times, overwhelming. As Seamus Heaney has written, “Human beings suffer; they get hurt and get hard.” The toll of this exposure can be ‘burn-out,’ blaming, loss of professional/personal balance, and over-identification with the patient. Our workshop will address the potential dangers and antidotes to working closely with those who suffer, drawing from the well of the medical humanities. We will share personal stories and examine how writing and sharing poets, art, and film can help us heal ourselves and those we work with.

Films and Feelings: Beyond Spectacle to Process and Reflection Presenter: Maura Spiegel, PhD, Associate Professor of English and Comparative Literature, Columbia University and Barnard College; Core Faculty in the Program for Narrative Medicine and the Master of Science program in Narrative Medicine at Columbia College of Physicians and Surgeons; former co-editor of the journal Literature and Medicine.

In this workshop we will look at clips from recent films in order to explore how cinematic representations can function as a reckoning and as part of healing. Most cinematic representations of combat provide the viewer with little more than a spectacle of violence; in a few remarkable instances, however, cinematic language has been deployed to explore the combat soldier’s internal experience and relation to external events in a way that positions the viewer to explore the subject of trauma. In these instances, watching a film becomes an act of witnessing, and the film becomes a testimony. A short writing exercise will help to demonstrate how feelings and experiences accessed by film viewing can be channeled toward reparative work for caregivers and in some cases for those suffering PTSD as well.

From Ancient Greece to Baghdad and Beyond: Reading Homer with Combat Veterans Presenters: Roberta Stewart, PhD, Associate Professor of Classics, Dartmouth College; Alan Oakman, US Navy, 1966-70, served in Vietnam 1969-1970; Father Joseph O'Keeffe, Chaplain (Colonel) U.S. Army Ret. and White River Junction VAMC

This workshop explores the experience of an experimental book group designed for combat veterans in which we read Homer's Odyssey and Iliad. Literature provides insight into human experience and, more specifically, the Iliad and the Odyssey provide insight into the warrior's experience of combat and return from war, as Dr. Jonathan Shay has so eloquently shown. But, in addition, Homer offers up a rich depiction of a whole society, the home front as well as the battlefield. Through his representations of soldiers, veterans, their families and friends, we can gain a understanding of the complex effects of war within society, and make comparisons with our own experience, whether we are military, veterans or civilian. The book group also offers an understanding of the power of narrative to shape individuals and communities, and it allows us to identify a shared human experience.

The workshop will include a brief summary of the book group’s premises, design and logistics, reflection by two participants, both combat veterans, on the value of the readings and the structure of the book group for thinking about combat experience and homecoming, and an opportunity for workshop participants to read aloud and discuss (in small groups) selected passages of Homer. A packet of materials will offer course-outlines, our original promotional material, as well as suggestions of ancient authors, accessible translations, and supplementary material for those interested in creating their own book groups.

Graphic Witness: Comics, Drawing and Trauma Presenters: Catherine Belling, PhD, Assistant Professor in the Program in Medical Humanities and Bioethics at Northwestern University Feinberg School of Medicine. Her work focuses on anxiety, narrative, and representation in health care and MK Czerwiec, nurse, graphic artist, and graduate of Northwestern’s Masters in Medical Humanities & Bioethics.

Although Traumatic Brain Injury (TBI) is the signature wound of US soldiers fighting in Iraq and Afghanistan, it was not until Toggle, a young soldier in G. B. Trudeau’s critically-acclaimed book, Signature Wound, suffered from TBI that the public realized both the prevalence of TBI among soldiers and its sometimes devastating effects on their lives. Patients, health care providers, and others are increasingly using graphic narratives (also known as comics) to unpack the experience of medicine and disease.

In this workshop, we will examine how the subgenre of graphic medicine can address issues of trauma, and we will explore bearing witness to trauma by producing and discussing drawn imagery. During the workshop, participants will be encouraged to take part in exercises involving making and sharing drawings, but no artistic expertise is expected or needed.

How to Start a Literature & Medicine: Humanities at the Heart of Health CareŽ Program at your Institution Presenters: Suzanne Brown, PhD, Literature & Medicine Program Scholar; Visiting Assistant Professor, Dartmouth College; Victoria Bonebakker, Associate Director for the Maine Humanities Council; creator of the Literature & Medicine program; Lizz Sinclair, Program Officer for the Maine Humanities Council; coordinator of the Literature & Medicine program; Laurie Quinn, PhD, Associate Dean of Academic Affairs at Granite State College; Timothy J. Richardson, Chief of Staff of the VA Medical Center, Togus, Maine.

PLEASE NOTE: This pre-conference workshop will be all day on Thursday and requires separate registration.

Literature & Medicine: Humanities at the Heart of Health CareŽ is an innovative, award-winning program for health care professionals that helps them increase their job satisfaction, cultural awareness, communication skills, empathy and inter-personal skills—all through the reading and discussion of literature with colleagues. It brings professionals within a health care facility together monthly for scholar-facilitated discussions of fiction, non-fiction, plays and poems that illuminate issues central to their work of caring for people, whether they are well, sick or dying. The groups focus on literature because it provides the best means we have of standing in the shoes of others, of seeing the world through others’ eyes, and gives everyone within the group a common framework for discussion.

Literature & Medicine groups are open to all who work within the hosting health care faculty- physicians, nurses, chaplains, receptionists, social workers, housekeeping, administrators, allied, home health and hospice staff, etc.. Both the scholar who facilitates the group and the literature itself provide a safe framework for everyone to share their thoughts, questions, and experiences with one another. The informal, first-name basis discussion format invites participants to step out of their professional roles and share their reflections on what they have read, and, in doing so, explore the human dimensions of their work. Group members come to know one another in new ways, and become more appreciative of each other’s, as well as patients’, perspectives. More than 2000 health care professionals in hospitals in 26 states (including 14 Veterans Administration Medical Centers) have participated in Literature & Medicine groups since the program began in 1997, with more participating every year. The program is offered through partnerships with state humanities councils. Not only are CEUs and CMEs often available, it is also a lot of fun. As one participant described it, “It brings joy back into my work.”

This pre-conference training is for for those interested in starting the program, and for those new to it, to get the basic tools they will need to launch a successful Literature & Medicine program of their own. It will combine small group discussions, sessions on the nuts & bolts of organizing, an introduction to readings, and opportunities to interact with one another. Anyone interested in organizing a program will find this training valuable and is welcome to attend (ideally, participants will have already communicated with their state humanities council). All participants will leave with the tools they need to organize a program. Learn more.

How Wounded Healer Stories Help Us Heal Presenter: Jonna Goulding, MD, Family doctor and palliative care specialist, Gifford Primary Care and Gifford Medical Center, Randolph, Vermont.

The earliest recorded tale of a wounded healer is over 2,500 years old. Legends of wounded healers are stories of monsters and queens, mythical beasts and ordinary women and men who, through illness, madness, battle wounds, or accidental wounds are forced to descend to a literal or metaphorical underworld from which they returned transformed, bearing healing gifts for their people.

In this workshop, we will first experience deep listening, the receptive “other side” of storytelling, to demonstrate listening’s power to focus our presence in this multi-tasking world. The presenter will then tell one of the oldest known legends of a wounded healer. Via lecture and discussion, we will then review the history of storytelling, and wounded healer myths. The conclusion of this session will focus on where our personal wounds, as caregivers and palliative care professionals, “fit” in the circle of wounded healer legends. We will examine story-telling and story-listening as strategies to access presence and mindfulness, and as tools to help us acknowledge our wounds and understand the wisdom that they can bestow. Finally, we will discuss practical ways that our stories can become part of our work, and can help us support each other as caregivers.

Literature and Understanding Sources of Trauma Presenter: Noel J. Genova, MA, PA-C, has been a clinical Physician Assistant for 30 years, working in a variety of settings, including primary care practices, an abortion clinic, occupational medicine, a drug and alcohol detox unit, and a clinic serving refugees and asylum seekers in inner city Birmingham, England.

In the settings where I have worked for over 30 years, trauma histories, whether overt, covert, or implied, have been an integral part of my patients' presentations. In considering a patient's trauma history, I try to remember that the story, its context, and its interpretation belong to the patient, not to society or to me, the listener, and further, that many patients want to focus on healing, rather than the trauma itself. The goals of treatment must be set by the patient. However, as care providers we also need to understand the etiology of the presenting problems even if our patients do not want to talk about them. I have found that reading literature increases my imaginative and empathic capacity so that I can “read between the lines” of the stories my patients choose to tell me to gain a deeper understanding of their history. This in turn enables me to offer more effective care.

In this workshop we will read a short literary account of a patient’s trauma and, in a brief exercise, write our own accounts of trauma, drawing from literature or personal, family, or work experiences. We’ll then discuss and share the “clinical pearls”—the insights—that these texts we read and/or create can yield.

Reflective Engagement: Creating Effective Partnerships with TBI Family Caregivers Presenter: Janet M. Cromer, RN, MA, ATR, LMHC, Psychiatric RN, licensed psychotherapist, and Registered Art Therapist with an MA in Expressive Therapies from Lesley University and author of Professor Cromer Learns to Read: A Couple’s New Life After Brain Injury.

Creating effective partnerships between professional care providers, the patient, and the family caregiver involves developing mutual trust, communicating in a shared language, focusing on agreed-upon problems and goals, and conveying respect and empathy for each person’s contribution. Professional providers who are skilled in reflective engagement benefit from a collaboration that leads to honest reporting of family/patient problems, better treatment participation, ethical decision making, and personal satisfaction. The patient benefits from receiving empathic, patient-centered care that can reduce hospitalizations and complications. The family caregiver feels better understood, confident, supported, and valued, and is less vulnerable to stress, as well as physical and emotional health problems. This is especially true in the context of TBI patients, but is also applicable to all such partnerships.

In this workshop we will explore ways in which narrative, poetry, blogs, and journals can link professional and family caregivers as they explore experiences of trauma, adaptation, healing and empowerment. Participants will participate in a reflective writing exercise on their personal experience as a caregiver for a family member—which they will have the option of sharing (in small groups.) In response to the group’s discussion, I will share readings from my book, as well as poetry and narratives written by other TBI caregivers.

Reliving and Relieving Traumatic Suffering as Death Approaches Presenter: Elizabeth Balsam Hart, MD, Family physician with board certification in Geriatrics and Hospice and Palliative Medicine. Her clinical practice focuses on the care of people living in nursing homes, and for those living with dementia or nearing the end of life.

This workshop will use texts, both poetry and narrative, as well as short video clips, to explore how trauma histories reemerge at the end of life. We will discuss the implications for providing end of life care for those with a history of trauma or post-traumatic stress. Together, we will reflect on how trauma affects the dying person, the family and friends of the dying, and those who provide care for dying people. We will consider the ways in which traumatic memories might affect “the essential work of the dying” and potential to make peace with life and find closure as death approaches. Using short readings to stimulate discussion, we will discuss the implications of trauma on the care offered by hospice and palliative clinicians and family caregivers and how we may better relieve the suffering of trauma survivors. We will also explore the nature of traumatic experiences due to medical interventions, and how these may be experienced by those approaching death, as well as how such experiences might affect the memories and grief of the bereaved.

THE STORIES WE TELL: Medicine for the Heart Presenter: Laura Simms, Storyteller.

Stories can inspire renewal, self compassion and resilience, or become the cause of mental fixation and further pain. How we tell a tale makes the difference between liberation and repeated loops of suffering. Working with refugees, I use the template and images of traditional stories to unlock personal narratives that give expression, directly and indirectly. to traumatic memory without reactivation. I will tell one story, and guide participants in creating a personal transformative narrative. We will begin to understand what constitutes a “healing tale”, regardless of the context.

Towards Knowing: Can We Teach and Develop the Capacity for Empathy? Presenter: Kerryellen Vroman, PhD, Faculty member in the College of Health and Human Services at the University of New Hampshire.

This interactive workshop will focus on experiential teaching strategies that use literature to understand and integrate the narratives of traumatic injury, the meaning of illness representation, and the process of adjustment to disability. These topics, taught conceptually in “banker style teaching,” deposit psychosocial principles of practice without context and thereby risk becoming an intellectual exercise. Consequently, students are less likely to internalize the knowledge, translate it to empathetic patient-centered behaviors, or engage in the self-reflective activities that will sustain them as practitioners.

For students, many of whom are yet to experience the successes, limitations, or emotional challenges experienced in everyday practice, literature opens a door to worlds the students have not seen nor experienced. The specific focus of this workshop is the psychological trauma and severe combat injury (e.g., post-traumatic stress disorder, amputation, and head injury) that influence successful re-integration post military service. This workshop will use examples from health care curricula. In particular, it will demonstrate how Michael Weisskopf’s (2006) book, Blood Brothers can be used to provide powerful insight into a soldier’s experience of combat injury, psychological trauma, and the adaptation to living with a disability. It is not necessary to have read this book to attend the workshop. Click here to read the New York Times’ review of Blood Brothers.

Veterans’ Stories: Trauma and the Experience of War Presenters: Bob Patrick, Colonel, USA (ret), Director, Veterans History Project, American Folklife Center, Library of Congress; Gala True, PhD, Associate Investigator, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; 1LT Samuel J Console (Inactive), Service Connected Disabled American Veteran, Operation Iraqi Freedom II.

Veterans who have served combat deployments-both during the current wars and earlier conflicts-have rich stories to share about their experiences of military service and about coming home. These narratives can teach us a great deal about the experience of combat trauma and its aftermath. Understanding the role of combat trauma in social isolation is essential to promoting successful reintegration of veterans into their families and communities. The simple act of telling ones story in a safe and supportive environment or hearing another veteran's story can lead to healing for many veterans.

This workshop will highlight the work of the Veterans History Project at the American Folklife Center of the Library of Congress and the Life Story study at the Philadelphia VA Medical Center. The Project enables veterans to share their stories for an expanded purpose: to contribute to greater understanding of the realities of war by listening to the stories of those who were involved. Veterans' experiences will be shared through multi-media presentation of video, still photographs, and excerpts from the Veterans History Project and session participants will have the opportunity to discuss case studies taken from the Life Story study. An Iraq War veteran will talk about his experience of sharing his story with others. There will also be a brief demonstration of suggested approaches and questions for engaging a veteran in conversation about his or her military service.

Violence and the Remaking of a Self: A Philosophical Perspective on Trauma and Narrative Presenter: Susan Brison, PhD, Associate Professor of Philosophy, Dartmouth College, and author of Aftermath: Violence and the Remaking of a Self

This workshop will explore the role of narrative in piecing together a self shattered by trauma. As a philosopher, I am intrigued by the performative aspect of speech in trauma testimonies: how saying something about a memory (in a given context) does something to it. The communicative act of bearing witness to traumatic events not only transforms traumatic memories into narratives that can then be integrated into the survivor’s sense of self and view of the world, but it also reintegrates the survivor into a community, re-establishing bonds of trust and faith in others.

In different contexts, however, trauma narratives can have very different functions; they are epistemologically useful in bearing witness to events and bringing perpetrators to justice and they can also have a therapeutic function. But there can be a tension between these two functions of narrative—between “getting (and keeping) the story straight” for an assailant’s trial, for example, and being able to rewrite, play with, change the ending of, the story to enable the survivor to go on with her life’s narrative in any number of ways. In this workshop, we will discuss this tension between living to tell, that is, surviving in order to bear witness, and telling to live, that is, telling a story in a way that enables one to carry on with life.

“Who Am I?” The Essence of Identity After Traumatic Brain Injury Presenters: Suzanne Brown, PhD, Literature & Medicine Program Scholar; Visiting Assistant Professor, Dartmouth College; Celeste Campbell, Psy.D., Neuropsychologist serving in the Polytrauma Program at the Veterans Administration Medical Center in Washington, DC.; Debjani Mukherjee, PhD, Director, Donnelley Ethics Program, Rehabilitation Institute of Chicago; Assistant Professor, Physical Medicine & Rehabilitation and Medical Humanities & Bioethics, Northwestern University Feinberg School of Medicine.

This session brings together the perspectives of humanities, ethics and science to explore the essence of who we are and who we become after a Traumatic Brain Injury. How does the brain define who we are, and does that definition thus change as the result of a brain injury? How do the contracts (spoken and unspoken) of relationship change if the persons involved change? How do our interventions as medical professionals and providers reflect and/or support the long term adjustment to these changes? Have we truly “healed” if we do not address these issues? Centered on readings from the first-person spousal narrative of Cathy Crimmins’ book, Where is the Mango Princess?, this session aims to stimulate thought and discussion about what is essential to defining, and living with, ourselves.

Working through Words: Narrative and Self-Care Presenters: Nellie Hermann, MFA, Chief Writing Faculty, Program in Narrative Medicine, at Columbia College of Physicians and Surgeons; Adjunct Professor, Barnard College; author of The Cure for Grief; Maura Spiegel, PhD, Associate Professor of English and Comparative Literature, Columbia University and Barnard College; Core Faculty in the Program for Narrative Medicine and the Master of Science program in Narrative Medicine at Columbia College of Physicians and Surgeons; former co-editor of the journal Literature and Medicine; Patricia Stanley, MA, MBA, Core faculty in the Program for Narrative Medicine and clinical coordinator of the Masters in Narrative Medicine at Columbia College of Physicians and Surgeons.

Through reading and discussion of a literary text followed by a short writing exercise, this workshop aims to demonstrate the benefits of reflective practice to nurture clinical communities and replace isolation with affiliation, cultivate enduring collegial alliances, and reveal meaning in clinical practice. Through writing and skilled listening, caregivers reflect upon and honor the difficult stories they absorb and attend to day in and day out.

“You’ve Gotta Be Twice as Bad as the Boys:” The Uses of Narrative to Explore the Experiences and Needs of Women Veterans Presenter: Helen Benedict, PhD, Professor of Journalism at Columbia University and author of The Lonely Soldier: The Private War of Women Serving in Iraq.

In this workshop, I will discuss my three years of interviews with more than 40 female veterans of war, and the ways in which my writings based on those interviews (a play, book of narrative nonfiction and novel, all about the war in Iraq and the experiences of female troops) might help to illuminate these women’s experiences and needs, both in and after the military. I will be discussing how the combination of careful and sensitive questioning, imagination and background research can recreate both inner and outer life, thus illuminating the experience of war.

I will explain my findings and explore how they can help to inform therapists and doctors working with veterans. Among the topics I plan to cover are childhood trauma, military sexual assault, the attitude in the military toward women and toward sexual assault, and the aftermath of war.

Topics of discussion will include: why women enlist, sexual persecution and assault within the military, the female experience of combat, military culture and women, health hazards in the Iraq and Afghanistan wars, the needs of women once they come home, and how to help and not harm women veterans who suffer from multiple traumas.