Creativity in People With Cancer

Statement of the phenomenon of interest

The phenomenon of interest has been clearly identified in the research paper. Reynolds and Prior have studied women who had cancer therapy and who have adopted some method of creative arts in their lives after the therapy and which have given them rich experiences. How these experiences have helped them to cope with their health problem is amazing by their enthusiastic recounting of experiences of flow in their creative adventures. Their description tells us vividly how the “fear-arousing diagnosis” and the “discomforts of potential disfiguring” are allayed through the creative arts.

The authors have discussed the findings of previous studies which have indicated distress in cancer patients due to recurrence and metastasis (Saegrove and Halding, 2003). Frank (1991) spoke of a stigmatized cancer identity where the patient feels disconnected from the familiar self.

Some people are believed to have positive changes after learning about having cancer (Urcoyo et al, 2005). Others have spoken of an experience accompanied by feelings of aliveness and vitality (Nakamura and Csikszentmihalyi, 2002).

The concept of flow has been taken from Csikszentmihalyi (1997). Its relevance to occupational therapy has been indicated by Emerson (1998). Flow activities provide stimulus to develop skills but task difficulty does not optimize flow but causes stress and anxiety (Rebeiro and Polgar, 1999). Flow experiences have been studied in many leisure activities like keeping scrapbooks, cake decoration, listening to music, seeing works of art and creative writing (Csikszentmihalyi, 1990; Dickerson, 2000; Scheerer et al, 2004). Flow is associated with clear goals and clear feedback and is related to optimal psychological wellbeing.

It is described as allowing the development of skills, leads to accomplishment, control and autonomy. The experience allows the person to feel comfortable in the environment without distracted thoughts away from thoughts about the illness, pain, and mortality. Tocher (2002) had interviewed 22 women who had cancer and had since joined dragon boat racing teams. The feelings were similar in them.

The authors have suggested that the qualitative approach was selected for acquiring the varied and vibrant flow of rich experiences of the creative processes. There was an initial list of possible themes gathered from previous studies: challenge, intense concentration, sense of altered time or extended present, reduce awareness of environment and self, developing skills, feelings of confidence and achievement, clear goals and feedback. The aim of the study was to elicit how the ladies learned to cope with their cancer through their creative adventures and so semi-structured interviews were selected. The template approach of Csikszentmihalyi (1997) was used to find out how the ladies forgot their thoughts of cancer and “reprioritized their goals”.

The philosophy of creative occupation really working for people with life-threatening illnesses to positively change them and to alleviate their stress must be remembered by all occupation al therapists in their practice. Flow experiences involve great concentration and total involvement in the chosen art form. Confidence and control increases, boredom is lost and life becomes more challenging. Patients forgot that they were labeled doomed with the diagnosis of cancer. Their foray into the new fields of adventure is a “voyage of discovery”.

The themes

Tasks need to be posing some challenge in order to elicit flow. Artistic challenges brought interest into the lives of cancer patients. Stitching, embroidering, dragon boat racing and cross stitch are some of the leisure time activities resorted to in times of stress. However one comment indicated that the activity itself should not be too stressful or too easy as either would not serve the purpose of providing joy and achievement. The flow of experiences should be the objective.

Current skills can change and the art adventure needs to be adjusted accordingly. Intense concentration was another accompaniment of flow experiences; being engrossed helps to discard intrusive thoughts and fears. This could be developed even in between the activities. Managing frustration allowed the refocusing of thoughts away from cancer.

When one lady found solace in her textile art, another became thrilled with cross stitching. During the period of indulging in their activities, they had a sense of altered time and forgot to think about themselves or the environment (reduced awareness). The patients who had pain forgot their problem when fully engrossed in their art activity. Becoming more committed to their new preoccupations, they turned out to be skilled in their activity. Where their self confidence had diminished to the ground level, their new skills boosted their confidence levels. Setting clear goals and feedback, they managed to come out of the depressive situations they were hurled into with the diagnosis of cancer.

The purpose of the study

The researchers have clearly explained why the study has been done: it is seeking information as to whether ladies with cancer when engaged in some creative occupation have flow experiences and if these experiences have helped them to positively cope with their illness.

The significance of the study for occupational therapists has been noted in the abstract.

The Research Method

Current and previous researches have been discussed in the literature review ranging from 1990 to 2005. Most of the studies have been interviews. The method here is considered appropriate for this research as the purpose was to find out how much the participants referred to flow experiences in their answers by the theory of Csikszentmihalyi (1997). The participants were not introduced to the word ‘flow”. The researchers helped them come out with answers by using some features of flow as themes to decide the extent to which the participants refer to them.

The method is sufficient to keep up interest as each participant’s answers were as interesting as expected and different from each other’s. The semi-structured interviews allowed ample freedom for participants to come out with answers in their own words. It was obvious that the ladies enjoyed their creative arts, being immersed deeply and exhibiting the confidence gained through their experiences. The flow helped to block out worries during the activity and enhanced their positive self-image.

One sentence in the discussion raises a doubt about whether the experiences shared really fall within the traditional idea of flow. This may be a limitation open to debate but the study definitely provided ideas about how people living in stressful conditions can come out of them and live positively. These can be adopted for future usage by occupational therapists and the nursing profession.

Sampling

Participants were selected through advertisements in national arts magazines in the United Kingdom. Purposive sampling was done; women with a diagnosis of cancer of any variety and had lived with it for 1 year at least were selected. The period of one year would have allowed them to become emotionally stable after their being diagnosed. The resorting to creative arts was another condition for the selection.

Full information and the main interview questions had also been advertised: only the right people volunteered for the study. They were in the ages of 23 to 66 years and lived in different parts of England. All were white and eight married. Many had adult children and they had been employed previously. Some were still on treatment. The informants were the right people and could give plenty of useful information.

The sample was small but for the qualitative study, it was considered sufficient. Generalization was not possible as the participants were all white and all women and a control group was not used. The advertisement called for women with cancers and who had indulged in creative arts following the diagnosis. There was no group of cancer patients who had not indulged in creative arts or who found other ways to cope with their cancers.

Data collection

Semi-structured interviews were used to collect the detailed human experiences of how creative arts have helped the participants cope with their cancers. The semi structured interviews helped the researchers to gather information which appeared common to all and more flexible questions were asked when unexpected responses came forth. The interviews took between 60-90 minutes. 7 interviews were in the client’s homes and 3 were over the phone according to their preferences. All were audio-taped and transcribed. Ethical approval was taken from Brunel University and informed consent was given for the interviews by the participants. Saturation of the data has not been described. The procedure for data collection has been made explicit otherwise.

Data analysis

Interview data was screened for features of flow like challenge, intense concentration, reduced awareness of environment or self during activity, sense of altered time, development of skills, feelings of confidence or achievement during and after the activity, clear goals and feedback. The reliability of the findings was cross-checked (Marshall and Rossman, 1995).

Data which disconfirmed evidence was also noted. Further themes were also looked out for to find more features conforming to the flow state which could have been neglected in previous studies; those found were sensuous vitality, flexible responsiveness and the creative adventure. Complex verbal reflections are subjective and depend totally on the researchers’ personal experience and professional sensitivity.

The template or the inferential approach cannot be certain to obtain the impressions of the participants. Rigour can be enhanced by participant validation of themes. Details of the findings have been provided but the analysis is not provided in such a manner that the reader can understand quickly. Moreover this being a qualitative research, the interpretations can vary depending on personal experiences.

Credibility is addressed as the participants consider the experiences their own. Auditability is present: the research process has been documented well by the researchers and it is easy to follow their line of thought. Fittingness is addressed too: the findings are applicable outside the study situation. The results are meaningful to people who have not participated in the research. The message that occupying oneself with creative arts helps a person distressed with severe illness forget his situation and become a completely absorbed happy person for the time he spends with his arts. The illness need not necessarily be cancers. Heart patients and other chronically ill people can indulge in some creative adventure that their health allows. The strategy used for analysis appears compatible to the purpose of study.

Findings

The findings are presented within a context. The reader would find it fairly easy to grasp the essence of the flow-like experiences of the participants from the findings report. The researchers have found three more themes which have not been identified in earlier studies. These flow like experiences including the sensuous vitality, flexible responsiveness and the creative adventure produced a great deal of satisfaction to the participants as evidenced by Csikszentmihalyi (1997).

Sensuous vitality refers to the feeling of coming alive when involved in their selected activity. Flexible responsiveness indicates the freedom with which they select materials or colours based on their whim and fancy of the moment: they just did what they pleased. Their new ventures are described as creative adventures by the patients. These three additional flow experiences were found in this study apart from the original themes mentioned earlier.

Conclusion, Implications and Recommendations

The conclusion is short but sums up the essence of the study well. Implications of the creative arts in the life of cancer patients are also mentioned. The recommendations for more studies in the future have not been suggested as such. However there is a subtle suggestion that the surrounding environment should facilitate the art adventure and that this needs to be investigated.

The Usefulness of this Study

Creative arts help a lot of people who are distressed due to severe illnesses like cancers. However that is not the last word on helping cancer patients to cope with their illness. There may be other means of transferring their attention occasionally like going for walks, for picnics, trips to nearby towns for shopping, having get-togethers with similar people, watching films together gardening and the like.

The authors do not specify any application but it can be surmised from the study that encouraging cancer patients to take up a creative art helps them to cope with the illness and makes them feel active and alive, pushing themselves towards achievement. The patients garner social support, physical well being, confidence and control over themselves in the meantime. The feeling of oneness when in the boats brought them upto new challenges.

Physical disabilities, emotional upsets, social distances affecting them and cognitive stressors would be forgotten for a short duration. The effective coping strategies save the patient from a decline in many ways. The flow or revitalizing experiences include a depth of involvement significant to themselves and eliciting the best in them. Subjective well being would overcome the biographical disruption that is cancer. Negative thoughts give way to positive ones; a sense of confidence overcomes the thought of failure and impending doom. The camaraderie during the activities contributes to therapeutic effects.

The training and the challenges of competition enhances their self esteem and morale and they assume a persona of ruthlessness and aggressiveness to win. The intrusive thoughts about the illness disappear for some time and they become thoroughly focussed. The loss of or waning of certain social relationships that have upset the patients following the diagnosis is forgotten in the building up of new relationships. The restoration of self worth and being able to converse on topics other than cancer does the patients a world of good. Providing their art masterpieces for sale and then donating to charity is another means of satisfaction.

A control group of cancer patients who found other sources of entertainment for spending their leisure time could have been included. Even a control group who had no such pastimes could have been selected. Gender and race bias appears to cloud this study. The writing of the paper is clear and easy to follow. The authors do not detract from the article topic.

Visuals have not been included and this may be a limitation of the study.

Conclusion of Critique

Reynolds and Prior have studied white women who had cancer therapy and who have adopted some method of creative arts which have given them rich experiences. The concept of flow has been used here and the flow of the participants’ personal experiences elicits enthusiasm and the urge to live with zest. This qualitative study which followed the principles of ethics was done after due approval and informed consent was obtained. Semi-structured interviews helped the extraction of flow experiences of the 10 white women in the study; the ladies were all enthusiastic about their activity and freely shared their experiences.

Three additional themes were evolved after checking the original themes of challenge, intense concentration, sense of altered time or extended present, reduce awareness of environment and self, developing skills, feelings of confidence and achievement, clear goals and feedback; they were sensuous vitality, flexible responsiveness and the creative adventure. This well written paper does have a few shortfalls but the theme behind the study has a practical application to it. People who have been diagnosed with cancer may be taught to find some creative art which helps them cope with the miseries of their illness.

References

Csikszentmihalyi, M. (1990). Flow: the psychology of optimal experience., New York: Harper and Row.

Csikszentmihalyi, M. (1997). Finding flow: The psychology of engagement with everyday life New York: Basic books.

Dickerson, A. (2000). The power and flow of occupation illustrated through scrapbooking. Occupational therapy in Health Care, Vol. 12, No. 213, p. 127-140.

Emerson, H. (1998). Flow and occupation: A review of the literature, Canadian journal of Occupational Therapy, Vol. 65, No. 1, p. 37-44.

Frank, A. (1991). At the will of the body: Reflections on illness. New York:Houghton Mifflin.

Marshall, C. & Rossman, G. (1995). Designing qualitative research, 2^nd Ed., London: Sage.

Nakamura, J. & Csikszentmihalyi, M. (2002). The construction of meaning through vital engagement. In CLM Keyes, J.Haidt, eds. Flourishing: Positive psychology and the well- lived. Washington: American Psychologists Association.

Saegrov, S. and Halding, A. (2003). What is it like living with the diagnosis of cancer? European Journal of Cancer Care, Vol. 13, no. 2, p. 145-153.

Tocher, M. (2002). How to ride a dragon: Women with breast cancer tell the stories. Toronto: ON: Key Porter Books.

Urcoyo, K., Boyers, A., Carver, C, & Antoni, M. (2005). Finding benefit in breast cancer: Relations with personality, coping and concurrent well-being, Psychology and Health, Vol. 20, No. 2, p. 175-192.