Rewriting one's life story unfolds in interaction with other people, but may also occur in interaction with meaning-making resources including, for instance, literature, poetry, music, and visual art. Whether through a poem, piece of music, or painting, interacting with art entails a specific mode of relating to reality: to view a work of art as “art”, it is essential to perceive it with a degree of distance and abstraction. For example, old aluminum cooking pots can simply be seen as cooking pots. However, with an ‘aesthetic attitude’, they can be experienced as art—as demonstrated by the Saudi Arabian artist Maha Malluh in her work ‘Food for Thought—Al-Mu'allaqat’, which features old aluminum cooking pots traditionally used by Bedouins.
The aesthetic attitude offers a unique perspective on reality: not seeing cooking pots as mere objects but as ‘some-things’ different—containing beauty or holding a particular meaning. Similarly, this attitude may facilitate individuals to self-distance and view their own life story in a novel manner. This was the aim of the project ‘In Search of Stories’ (https://cco.amsterdamumc.org/projecten/). Patients with advanced cancer participated in a life review interview and the drawing of a Rich Picture, after which they received a collection of literary texts specifically curated for the project. These stories were about characters facing major, unexpected disruptions, challenging them to reinterpret or adjust their life values and goals. Stories included, amongst others, Jonah and the Whale from the Bible and Koran, Metamorphosis by Franz Kafka and The Fault in our Stars by John Green. The patient selected a story at home and discussed it with a spiritual caregiver, reflecting on their life story through engagement with literature.
Reading literary texts engaged patients in narrative identification: (re-)constructing their self-identity by integrating fictional story elements into their personal narrative. Patients identified with a myriad of fictional story elements, particularly protagonists facing their fate, and valued metaphors for understanding their own challenges with finitude. As one participant explained the importance of metaphor, as a form of visual language: “to see the images is to better understand oneself.” Discussing the stories with a spiritual caregiver provided patients with a sense of agency, allowing them to examine their responses to emotions, find words for them, and explore different ways to relate to advanced cancer as a contingent life event—which could ultimately positively affect their sense of overall wellbeing.
Following the discussion of the literary texts, patients participated in co-creative sessions with professional artists to reflect on their evolving life stories through art. The form of the artwork was flexible, allowing patients to reshape their narratives using various materials. Throughout these sessions, patients interacted with generative materials while discussing their life stories, further exploring their experiences of contingency. The co-creation of a physical artwork was the culmination of this process and often expressed patients' ultimate life goals. For instance, one painting featured a full-body portrait in bright colors, symbolizing intense self-expression (Fig. 1). The patient explained that her previous grey work attire represented her ‘business identity’ and difficulty expressing other facets of herself. The bright colors and firm posture in the portrait revealed these hidden aspects and symbolized strength. The co-creative process allowed patients to articulate and rediscover parts of their identity, unexplored before their cancer diagnosis, ultimately enhancing their well-being.
Fig. 1. Artwork created during ‘In search of stories’, by artist Ruud Lanfermeijer and ‘Patient 17’, consisting of a co-designed and co-painted self-portrait. The portrait reflects a search for post-work life identity, expressed in the multiple, underexplored ‘colours’ of the self after being dressed in ‘grey’ outfits for most of the working life years. This portrait has been published previously in Weeseman et al
From 11 January to 16 February 2024, 18 of the co-creations were exhibited in the outpatient clinic building of the Amsterdam UMC, location VUMC (https://www.youtube.com/watch?v=d0hz-u62jXo). From an artistic perspective, this exhibition—featuring a diverse range of artworks from the self-portrait to video-art, a novelle or a specially released vinyl record—would undoubtedly belong in a museum, gallery or art center. Yet, above all, a hospital is the place where patient stories must be heard. In the hospital setting, patients' lives are transformed by their diagnosis, the subsequent treatment, or the news that there is no treatment available. Thus, also here, in the hospital we should support our patients in the reconfiguration of their life stories. As one of the visitors of the exhibition wrote: “It is nice to feel here, surrounded by stories, that we are not alone.”
However, the significance of the exhibition extends beyond direct recognition and the sharing of feelings. The narratives exhibited are not literally patients' life-stories: the narratives are their stories retold, and presented aesthetically. This produces a certain degree of abstraction, and it is abstraction that affords visitors of the exhibition the opportunity to re-examine their own personal life narrative. As one visitor to the exhibition wrote: “I am moved, indeed touched, by the stories, the connection with others, their story and how recognizing their experience and strength offers me comfort. Please let this exhibition remain permanent.” Indeed, we acknowledge the urgency of narrative-aesthetic interventions, such as project ‘In Search of Stories’, to contribute to patients' challenges in narrative meaning-making beyond the disruptive experience of falling severely ill.
Contributors
Both Hanneke van Laarhoven and Niels van Poecke contributed to the conceptualization of the Commentary, the literature search, building of the figure. Hanneke van Laarhoven was responsible for the funding acquisition of the project described in the Commentary and wrote the first draft. Both authors further shaped the final manuscript.
Declaration of interests
Hanneke van Laarhoven and Niels van Poecke do not report conflicts of interest for this Commentary.
Acknowledgements
Funding was granted by the Dutch Cancer Society for the listed project ‘In Search of Stories’. The listed exhibition, about which we report in the manuscript, has also been funded by this grant (grant ref. number 11507). The Dutch Cancer Society had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Find the article here: In search of stories: narrative-aesthetic interventions to hear cancer patients’ voices - eClinicalMedicine (thelancet.com)