Innovative Collaborative

Practice and Reflection in

Patient Education

Jennifer Lynne Bird

Florida Atlantic University, USA

A volume in the Advances in Human Services and

Public Health (AHSPH) Book Series
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Innovative collaborative practice and reflection in patient education /
Jennifer Lynne Bird, editor.
p. ; cm.
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ISBN 978-1-4666-7524-7 (hardcover) -- ISBN 978-1-4666-7525-4 (ebook)
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[DNLM: 1. Patient Education as Topic--methods--Personal Narratives. 2. Attitude to Health--Personal Narratives. 3.
Writing--Personal Narratives. W 85]
RA427.8
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Editorial Advisory Board
Andrea Asciutto-Houck, Martin County Schools, USA
Jennifer Kabis, Martin County Schools, USA
Cassandra Kenski, Grassy Waters Elementary, USA
Melissa Lucrezia, Florida Atlantic University, USA & Port Salerno Elementary, USA
Marianne Robin Russo, Florida Atlantic University, USA
Ryan Urenda, D1 Sports Medicine, USA
Eric Wanner, Palm Beach Sports Medicine & Orthopaedic Center, USA
Louise Waterfield, Florida Atlantic University, USA & St. Clare School, USA


Table of Contents

Preface..................................................................................................................................................xiii

Acknowledgment................................................................................................................................. xxi

Introduction.......................................................................................................................................xxiii

Chapter 1
Multigenre Medicine................................................................................................................................ 1
Jennifer Lynne Bird, Florida Atlantic University, USA
Eric T. Wanner, Palm Beach Sports Medicine & Orthopaedic Center, USA
Ryan Urenda, D1 Sports Medcine, USA
Robin Perry, Rolling Green Elementary School, USA

Chapter 2
Write to Transform Your Health............................................................................................................ 27
John Frank Evans, Wellness and Writing Connections, USA
Karen Roussel Jooste, Duke University Medical Center, USA & Storia International PLLC,
USA

Chapter 3
Teacher Stress and Anxiety: The Infinite Quest for Inner Peace........................................................... 35
Casey M. Brown, Centerville High School, USA

Chapter 4
Preventing Burnout: Stress Management Strategies for Administrators in Higher Education.............. 50
Irene H. Johnson, Florida Atlantic University, USA

Chapter 5
Self-Directed Learning and Adult Education: Overcoming the Medical Fog....................................... 63
Valerie Bryan, Florida Atlantic University, USA
Kristin Brittain, Florida Atlantic University, USA
Elizabeth Swann, Florida Atlantic University, USA





Chapter 6
Well Teachers Teach Well...................................................................................................................... 82
Tammy Metcalf, Greeneview High School, USA
Liz Wrocklage-Gonda, Sycamore High School, USA

Chapter 7
Healing through Self-Discovery and Artistic Design Journals............................................................ 103
Susannah Brown, Florida Atlantic University, USA

Chapter 8
The Gift of Grief.................................................................................................................................. 114
Marnie S. Reed, Indiantown Middle School, USA

Chapter 9
Piti, Piti, Wazo fe Nich Li (Little by Little, the Bird Builds its Nest): Promoting Change and
Health Education in Post-Earthquake Haiti......................................................................................... 129
Shewanee Howard-Baptiste, University of Tennessee – Chattanooga, USA
Mo Baptiste, Haitian American Caucus, USA

Chapter 10
Cutting-Edge Technology Adoption for Building Holistic Patient Experience................................... 152
Roma Chauhan, IILM Graduate School of Management, India

Chapter 11
Curing Autoimmune Naturally: My PMR Story.................................................................................. 167
Donna J. Karaba, Karaba Consulting, USA

Chapter 12
The Advantages of PsychoSpiritual Psychotherapy............................................................................. 194
Elizabeth Caparros, The Odyssey Foundation, USA

Chapter 13
Truly Nourished................................................................................................................................... 208
Christine Bandy-Helderman, Jupiter First Church, USA

Chapter 14
Strength from Spirituality.................................................................................................................... 237
Eric T. Wanner, Palm Beach Sports Medicine & Orthopaedic Center, USA
Jennifer Lynne Bird, Florida Atlantic University, USA

Related References............................................................................................................................. 254

Compilation of References................................................................................................................ 289

About the Contributors..................................................................................................................... 302

Index.................................................................................................................................................... 307
Detailed Table of Contents

Preface..................................................................................................................................................xiii

Acknowledgment................................................................................................................................. xxi

Introduction.......................................................................................................................................xxiii

Chapter 1
Multigenre Medicine................................................................................................................................ 1
Jennifer Lynne Bird, Florida Atlantic University, USA
Eric T. Wanner, Palm Beach Sports Medicine & Orthopaedic Center, USA
Ryan Urenda, D1 Sports Medcine, USA
Robin Perry, Rolling Green Elementary School, USA

This chapter provides an introduction to the concept of multigenre writing and explains methods of
multigenre writing used in the field of medicine to create the concept of multigenre medicine. The authors
share their stories using a multigenre format, which includes multiple perspectives and multiple writing
styles such as linking personal narratives with academic research. Therefore, the reader not only learns
about multigenre writing but also experiences it.

Chapter 2
Write to Transform Your Health............................................................................................................ 27
John Frank Evans, Wellness and Writing Connections, USA
Karen Roussel Jooste, Duke University Medical Center, USA & Storia International PLLC,
USA

This chapter is a description of the workshop, ‘Transform your Health: Write to Heal,’ created by John
Evans. Writing and facilitating optimal well-being and vibrant living are the authors’ passions and they
feel privileged to fuse these passions in this chapter.

Chapter 3
Teacher Stress and Anxiety: The Infinite Quest for Inner Peace........................................................... 35
Casey M. Brown, Centerville High School, USA

This chapter illustrates the author’s struggle with stress and anxiety associated with the teaching profession.
After conversations with colleagues, it is apparent that many teachers drive to and from school with
knots in their stomachs, exhausting themselves with worry about students, parents, administrators, state




standards, and more. As educators, we search to find balance between our school lives and our “normal”
lives. We struggle to take a mental break from our jobs. In this chapter, the author uses a multigenre
style to illustrate her anxiety and healing throughout her teaching career. Many authors write about the
needs of the student, yet it is also worthwhile to explore the mental health of teachers. Teachers cannot
best serve students if teachers cannot first take care of themselves. It is an idea that is often overlooked,
and the author hopes this chapter may help educators who have experienced similar issues of anxiety
in their careers.

Chapter 4
Preventing Burnout: Stress Management Strategies for Administrators in Higher Education.............. 50
Irene H. Johnson, Florida Atlantic University, USA

The essential administrator in higher education must maintain a healthy work-life balance. The process of
attempting to balance the demands and expectations of career, personal life, interpersonal relationships,
partnerships, and family has been explored extensively over the last decade. Achieving a sense of work-
life balance is both physically and psychologically necessary to promote life satisfaction, wellness,
and occupational success. Many challenges and responsibilities confront administrators daily, some
of which they have little or no control over and are commonly labeled as stressors. A large number of
publications and media address the topics of stress and burnout-related health issues which may lead to
chronic illnesses. This chapter explores stress and strategies to help individuals in administrative careers
cope with the day-to-day stressful events and/or situations in their personal or work-life. The information
included will dispel the idea, take two aspirins and call the doctor in the morning!

Chapter 5
Self-Directed Learning and Adult Education: Overcoming the Medical Fog....................................... 63
Valerie Bryan, Florida Atlantic University, USA
Kristin Brittain, Florida Atlantic University, USA
Elizabeth Swann, Florida Atlantic University, USA

Patients are increasingly being asked to take more responsibility for self-care in a complex healthcare
system; this can be a challenge for even the most educated individual. Learning is central to health, health
decisions, and self-care. Adult educators’ insights regarding lifelong, self-directed learning are critical in
helping adults learn about their disease and make informed decisions. This chapter presents documentation
of self-directed learning in health education through a series of case studies with reflections. The authors
draw attention to self-directed learning in the context of one’s own personal health management and
propose self-directed learning as a solution to the numerous barriers to personal health education. Ideas
for increasing a self-directed approach when seeking health information are offered based on the case
studies reviewed. Ideas regarding future research needs are included.
 

Chapter 6
Well Teachers Teach Well...................................................................................................................... 82
Tammy Metcalf, Greeneview High School, USA
Liz Wrocklage-Gonda, Sycamore High School, USA

No matter what field one enters, landing that first job and depositing that first paycheck is like no other
feeling in the world. The excitement, anticipation, and demands of any career can be exceptionally
challenging, and many people underestimate the toll that work—even meaningful work—can have on
one’s physical and mental well-being. This underestimation is especially true in the field of education,
where many teachers in ever-expanding roles (teacher, mentor, counselor, etc.) work non-stop nine
months out of the year only to find themselves physically and perhaps mentally exhausted. This chapter
explores the teaching careers of college friends and how they have been able to break the cycle of Work/
Exhaust/Repeat by recognizing, modifying, and preventing patterns that are ultimately harmful to their
physical and mental well-being and make them less effective as educators.

Chapter 7
Healing through Self-Discovery and Artistic Design Journals............................................................ 103
Susannah Brown, Florida Atlantic University, USA

The author explores the process of healing through the use of artistic writing activities in a journal, which
promote self-discovery. Techniques that involve art making and writing are shared, such as collaborative
drawing and writing, ekphrasis, hand-made journals, mandala drawing, marble paper abstract drawing,
and sensory printing. Through artistic design, the journey to better understand the self is addressed,
emphasizing management of everyday stresses such as those stemming from relationships, roles, and
change. Managing these stresses leads towards a healthy life by providing a balance between creative drive
and daily obligations. Guided exercises using various media are explained. The process is emphasized, not
the end product or artistic merit of the creation. It is through this creative process that tension and stress
are released and the joy of discovery becomes a part of life. Individuality is valued through thoughtful
reflection of the activities that are embedded in artistic design journals.

Chapter 8
The Gift of Grief.................................................................................................................................. 114
Marnie S. Reed, Indiantown Middle School, USA

My journey began with a call that brought me to “the edge”: the farthest reaches of what any mind can
handle. I found every notion I had of myself was a fallacy, an illusion created so completely I’d fooled
even myself. The days ahead found me by my father’s side for the less than six weeks it took him to die
from pancreatic cancer. The journey toward healing my mind, however, took far longer than I could’ve
imagined. From the first days of wandering into the local Hospice building begging for help to a seemingly
innocuous lunch with one of my third grade students that turned into a soul-soothing balm, I have sought
more help than I once would’ve cared to admit. My story is an excursion to the deepest depths of grief
and the extended passage back to a version of mental health I could’ve in no way imagined.


Chapter 9
Piti, Piti, Wazo fe Nich Li (Little by Little, the Bird Builds its Nest): Promoting Change and
Health Education in Post-Earthquake Haiti......................................................................................... 129
Shewanee Howard-Baptiste, University of Tennessee – Chattanooga, USA
Mo Baptiste, Haitian American Caucus, USA

After the 2010 earthquake in Haiti, many people desired to help in relief efforts. Despite “good intentions,”
there are a number of mistakes educators, scholars, and do-gooders make in an effort to “serve” those they
determine to be “in need.” A married couple provides their individual and collective perspective about
their experiences in Haiti. They discuss the histories and cultures that influence the structural barriers
that exist between different communities. In order for relief efforts to be sustainable, it is imperative to
create a culture that puts the Haitian community and their perspectives at the center of any change that
would take place. The authors discuss personal and professional efforts to address the need of health
education standards in a school in Haiti.

Chapter 10
Cutting-Edge Technology Adoption for Building Holistic Patient Experience................................... 152
Roma Chauhan, IILM Graduate School of Management, India

Internet acceptance has exponentially risen globally in the last decade with the advent of collaborative and
interactive Web technologies. E-learning techniques are extensively used by medical educators to impart
learning to their patients and caregivers. E-Learning 2.0 has appeared as amalgamation of traditional
e-learning model and capabilities of Web 2.0. It is a supplement to treatment provided by doctors, used
for educating patient and equipping them to handle preventive and disease-specific conditions resulting
in affirmative patient experience. The contemporary medical practices emphasizes building patient
experience and not restricting patient treatment. This chapter explains the need of shifting e-learning
focus from the software product design to service design and drawing the comparative model between
the two. It reviews existing E-Learning 2.0 practices being used in medical education and recent state-
of-the-art technologies including webcasting, virtual learning environment, mobile technology, etc. The
focal point of the chapter is how to use technology to promote patient-centered culture.

Chapter 11
Curing Autoimmune Naturally: My PMR Story.................................................................................. 167
Donna J. Karaba, Karaba Consulting, USA

In September 2010, Donna, an active 49-year-old woman, experienced an autoimmune attack. After
eight months of intense pain, she underwent a 10-day supervised fast at True North Health Center
in Santa Rosa, CA. Her inflammation was eliminated and she has regained an optimal level of health
and an active lifestyle including tennis, hiking, yoga, biking, and swimming. Donna also continues to
practice and teach meditation. This chapter is intended to relay a case example of how one woman cured
her symptoms of Polymyalgia Rheumatica (PMR) in the hopes of reducing unnecessary suffering and
financial drain in the lives of others.
 

Chapter 12
The Advantages of PsychoSpiritual Psychotherapy............................................................................. 194
Elizabeth Caparros, The Odyssey Foundation, USA

The purpose of this chapter is to educate those interested in the value of understanding psychological
theories and how they may contribute to the mental and emotional healing of individuals, personally,
socially, spiritually, and universally. It also examines some principles that relate to one’s search for meaning.

Chapter 13
Truly Nourished................................................................................................................................... 208
Christine Bandy-Helderman, Jupiter First Church, USA

A nutritionist presents case studies of patients who learned not only lessons about nutrition but also
lessons about life. Details about the patients’ stories are fictionalized, but the life lessons learned by
the patients and the nutritionist lead to reflection on healthy choices. The nutritionist uses her faith and
conversations with God to guide her as she helps patients.

Chapter 14
Strength from Spirituality.................................................................................................................... 237
Eric T. Wanner, Palm Beach Sports Medicine & Orthopaedic Center, USA
Jennifer Lynne Bird, Florida Atlantic University, USA

How does spirituality inform research, writing, and life? What chain of events led the authors to write
this chapter? Some readers may view the experiences survived by the authors as a series of random
coincidences, but because religion plays a large role in the lives of both authors, they believe that their
experiences happened for a reason. They are not trying to convert you to a certain religion but simply
want to show the power religion can have. It is recommended to take out all prejudgments on this issue
and read the chapter as is. After that, take out of it what you wish. The more you read into this the more
you will realize that everything truly does happen for a reason and there is a greater power amongst us.

Related References............................................................................................................................. 254

Compilation of References................................................................................................................ 289

About the Contributors..................................................................................................................... 302

Index.................................................................................................................................................... 307
 xiii

Preface

Dear Reader,
I asked for stories, and I received them. The authors who contributed chapters to this book opened
their hearts, minds, and souls with the goal of sharing their stories to help other people. They include
academic references and resources, but most importantly they illustrate their experiences and make a
lasting contribution to the field of patient education. Sharing takes courage. The authors submitted their
stories knowing others will read their words, learn from them, and hopefully feel inspired by them. I
hope readers of this book will feel encouraged to write their own stories and share them with a trusted
medical professional the next time physical or emotional pain occurs.

DISCLAIMER

The strategies and treatments discussed by the authors in this book do not take the place of a visit with
a medical professional such as a physician, physical therapist, psychiatrist, nutritionist, or other trained
specialist. As the editor of this publication, I do not advocate attempting any treatment plan on your own.
I encourage you to feel inspired by the stories the authors share, but please consult a medical professional
if you are experiencing physical or emotional pain.

THIS BOOK’S PURPOSE

This book has the overall objective of connecting the fields of education and medicine to present eclectic
and innovative approaches to health education. It will use the practice of multigenre writing to encourage
authors in the education and medical fields to share their personal and professional stories of wellness
and healing.
Multigenre writing, as defined by Dr. Tom Romano (2013), is as follows:

A multigenre paper arises from research, experience, and imagination. It is not an uninterrupted, exposi-
tory monolog nor a seamless narrative. A multigenre paper is composed of many genres and subgenres,
each piece self-contained, making a point of its own, yet connected to other pieces by theme and content
and sometimes by repeated language, images, and genres. A multigenre paper may also contain many
voices, not just the author’s. The craft then—the challenge for the writer—is to make such a paper hang
together as one unified whole. (p. 8)


 Preface

Dr. Jennifer Bird, a former student of Dr. Romano’s and teacher of multigenre papers in her English
classes, collaborated with physical therapist Dr. Eric Wanner to design a multigenre project to help her
heal from neck pain. Jen designed a pain journal incorporating multiple writing styles to describe how
she felt and Eric used her writing to adjust her treatment plan. This idea resulted in published chapters
and research projects studying the use of writing as healing (Bird & Wanner, 2013).
So what’s your story? Whether a classroom teacher leads a professional development seminar about
well teachers teaching well or a medical practitioner uses a patient’s journal to rework a treatment plan,
such writing can illuminate new methods of helping others to heal. Maybe you are a teacher who has
advice for teachers to stress less and take better care of themselves. Maybe you have a powerful narrative
from the perspective of when you were a patient who took control of your health to help your medical
practitioners help you. Maybe you are a doctor, physical therapist, or other medical practitioner who uses
out of the box approaches to heal and educate your patients. All of your stories are worth sharing and
will fit with this publication. You will have the opportunity to write about your own unique approaches
to educating the community about health issues. This book will impact the field of health education
by encouraging readers to think about their health in new ways as well as encouraging educators and
practitioners to get out of their comfort zones to design new approaches to healing.
Multigenre papers intertwine the technical dimension of writing, where authors search for facts and
provide specific details about their research, with the artistic dimension of writing, where authors use
creativity and their own unique voices to share their research.

MULTIGENRE WRITING

I felt honored to receive an email from Tom Romano, stating I was breaking new ground by bringing
multigenre writing to the medical community. Is multigenre research a documentation of academic theory
or the practice of creative writing? Both. Picture a figure skating routine from the recent Olympics. The
technical score focuses on the required elements, such as the number of jumps and spins. Without the
technical dimension of figure skating, skaters circle the ice with no direction or purpose. The artistic
score focuses on the creativity of the routine. Without the artistic dimension of figure skating, a routine
is a series of jumps and spins with no coherence or unity to pull the routine together. Just like skating
routines, multigenre research dovetails technical research, where writers share facts learned from research,
with artistic interpretation, where writers can choose a creative method such as poetry or artwork to
share their knowledge. I love to compare writing and teaching to the artistic and technical terms used
in figure skating and dance (and my students enjoy the dance routines we do in class to illustrate this
concept) (Bird, 2010).
This book’s title, Innovative Collaborative Practice and Reflection in Patient Education, reflects my
philosophy of RICE (Reflection, Innovation, Collaboration, Evaluation). All of us will be patients at
some point in our lives, and I want these innovative methods to inspire you to be an educated patient and
collaborate with the medical experts who want to help heal you. Educators, whether they are a teacher in
a classroom or a medical practitioner in a clinic, need to reflect on their practice. They also need to use
innovation to develop a lesson plan or a treatment plan. Collaboration, whether teachers collaborate with
their students or medical practitioners collaborate with their patients, becomes essential for learning to
take place. And finally, educators need to evaluate the needs of their students or patients. For teachers,
the process is RICE, because like all teachers I need to reflect on each class I taught before planning the

xiv
Preface

next one. However, physical therapists and other clinicians need to complete the evaluation step first
with patients so their process is ERIC. When we first started working together, Eric found it interesting
that his work was the same as his name. We discovered English professors and physical therapists can
learn from each other’s fields of expertise.
Planning a successful multigenre paper is a lot like a teacher planning a lesson or a city planner
planning a city. Harper (1996) writes, “Monitoring implementation is the only way to know if a plan
is becoming effective” (p. 196). She’s writing about city planning, but multigenre writers also need to
monitor if the implementation of ideas is effective. Throughout my life, I have heard my dad use the
terms survey, analysis, plan, implementation, and feedback to describe the city planning process. Whether
working with a city or a multigenre paper, careful planning is required. So I became a planner, just like
my dad; I just plan lessons and writing pieces instead of cities.

WELCOME TO A DIFFERENT KIND OF BOOK

For readers who live in the scholarly world IGI targets with its publications, this book encourages you to
step outside the box with your thinking. I appreciate the team at IGI taking a risk by publishing a book
that merges the world of academic theory with creative writing practice, so I encourage you to keep an
open mind as you explore multigenre medicine.
Since it values narratives, narrative medicine provides the foundation for presenting a patient’s story
using a multigenre format. Rasminsky (2012) tells the story of Dr. Rita Charon, “the founding director
of the Program in Narrative Medicine at Columbia University, where future MDs participate in writing
workshops and examine texts by authors” (p. 88). Charon uses information about writing and literature
typically found in an English teacher’s classroom to inform her practice because she “realized that the
clues she needed weren’t confined to lab results and diagnostic scans. They were hidden in her patients’
habits, fears, beliefs, family circumstances, even their insurance battles” (p. 88). Writing can provide
subjective qualitative information often missing in quantitative objective measures.
Narrative medicine presents an integrative approach to medicine that focuses on the patient’s story.
Patients can benefit from focusing on what Duke Integrative Medicine (2010) at Duke University calls
the Wheel of Health. By asking patients to reflect on movement, exercise and rest; nutrition; personal
and professional development, physical environment; relationships and communication; spirituality;
mind-body connection; and mindful awareness, “The Wheel of Health represents a comprehensive
perspective of well-being and it addresses all the resources available to you to optimize your health”
(pp. 5-6). Integrative medicine provides patients with the opportunity to take ownership of their health,
frequently by partnering with a health coach, and set wellness goals to achieve.

NARRATIVE INQUIRY AND EMOTIONAL TRUTH

Most of the authors of chapters in this book use first person to tell their stories. Heard (2002) believes,
“The more you include yourself in the piece and are able to tell your unique story, including your particular
details, the more we, as readers, can experience it too” (p. 54). The authors use the pronoun “I” to own
their stories. As you will see from reading the chapters, they include research and the citation of sources
as part of their stories; therefore, you are reading narratives with a scaffold of research as the objective

xv
 Preface

research frames the subjective narratives. This type of research is called narrative inquiry. Clandinin
and Connelly (2000) explain, “Voice, and dilemmas created by the consideration of it, are always sorted
out by the exercise of judgment” (p. 147). Each writer makes the judgment call of how to present his or
her story. We skate a thin line on the ice between artistic and technical and have research to support us
as we let our voices sing. The theory of narrative inquiry supports the practice of multigenre writing.
Most of the authors of chapters in this book use the concept of emotional truth. We quote factual
truth, but the emotional truth will always be told from our perspectives. Examples of emotional truth
include a clinician fictionalizing part of a patient’s story to change identifying details or a teacher not
remembering the exact clothes worn during a class but remembering perfectly the emotional resonance
of the lesson taught that day.
Here is a good description of emotional truth from an author with the same last name but no relation to
my research teammate Eric. Wanner (1994) says, “Stories may claim to be factual truth at one end of the
spectrum or metaphoric truth at the other, with all shadings in between. A story’s ‘truth’ depends more
upon its coherence than upon its faithfulness to actual events” (p. 18). So I maintain my responsibility to
my readers by informing them that not every detail may be true, but the message of the piece becomes
its emotional resonance. As Handler (2013) states, “What’s emotionally true for you may not have the
ring of truth for others who were present in the same situation” (p. 63). This is because “Emotional
truth isn’t always provable truth” (p. 155). If the emotional truth of the story resonates with you, do the
details really matter? For example, a medical practitioner can share the essence of a patient’s story to
provide life lessons for readers while simultaneously changing personal details to protect the patient’s
confidentiality. That enables the reader to comprehend the emotional truth of the experience regardless
of the modification of specific details of the story.

DESCRIPTION OF BOOK CHAPTERS

I now present a brief overview of each of the chapters before you turn the pages and experience them. I
smiled as I arranged a file folder with each chapter on my dining room table and moved them around like
a deck of cards to determine the best order. In the end, I grouped chapters with similar themes together,
so if you read the book in order it will have a flow to it. If, however, you prefer to jump in anywhere and
begin reading, you will still learn an amazing amount of information from each author. I feel grateful to
all of the authors for sharing their stories, and writing from every person in this book enhanced the quality
of the publication. I believe that I was supposed to work with everyone who contributed to Innovative
Collaborative Practice and Reflection in Patient Education so we could educate and help people together.
I began the overview of each chapter with a summary listing the topics you as the reader will encounter
by diving into the pages. Multigenre writing, however, means objective writing and subjective writing
coexist. So I take the opportunity to share a short story about each author and the lessons I learned from
reading the chapters.
After this preface, you will read an introduction written by my friend and colleague, Dr. Eric Wanner.
During the past two years, Eric and I experienced an incredible interdisciplinary research journey that
resulted in two research projects and ten publications. There is no better person to introduce the book
and share from a medical perspective why it makes sense for an English professor to edit a book about
patient education! I love working with Eric because he respects my ideas and his insights make me a
better writer and researcher.

xvi
Preface

Chapter 1, “Multigenre Medicine,” began as an introduction to the book about the concept of mul-
tigenre writing and evolved into a chapter. Jennifer Bird, Eric Wanner, Ryan Urenda, and Robin Perry
combine their stories to introduce you to multigenre medicine. It became interesting to see the lessons
I learned while simultaneously being a patient and beginning my health coach training. It was fun to
write with my cousin and the two physical therapists who were always willing to listen to my pain story
and knew exactly what methods to use to help me heal.
In Chapter 2, “Write to Transform Your Health,” John Frank Evans and Karen Roussel Jooste de-
scribe the writing concepts they teach to healthcare providers. They connect their passions for writing
and wellness to illustrate how writing can lead to healing. Each genre of writing they present serves a
purpose and serves as a tool for mind-body healing. I met John and Karen while being a participant in
the seminar they describe in their chapter. Through their words they demonstrate why educators respect
them as two of the leading experts in the field of writing as healing.
In Chapter 3, “Teacher Stress and Anxiety: The Infinite Quest for Inner Peace,” Casey M. Brown uses
a multigenre format, including poetry and journal entries, to share her story of anxiety. She demonstrates
strength, wisdom, and courage while reminding teachers they cannot be fully present for their students
if they do not take care of themselves. I admire her willingness to share so much of herself on the page
and she inspires me to share more of myself in my writing for my own chapter. As former students of
Tom Romano’s, we each submitted an excerpt of our writing for one of his books. I played it safe; Casey
took a risk. She took another risk with the chapter for this book, and I don’t remember breathing while
reading it because I became entranced by the power of her words.
In Chapter 4, “Preventing Burnout: Stress Management Strategies for Administrators in Higher
Education,” Irene H. Johnson discusses the value of higher education administrators maintaining a work
life balance. Her valuable strategies for stress management can be used for anyone who feels stressed
and overwhelmed by the demands of daily life. Stress is becoming an epidemic on college campuses,
and I love that numerous fortunate students learned relaxation techniques from Irene, a compassionate
teacher and counselor. I hope she continues to give stress management seminars to college students
and faculty. I know when she shares her wisdom about dealing with stress that I will be in the audience
taking detailed notes.
In Chapter 5, “Self-Directed Learning and Adult Education: Overcoming the Medical Fog,” Valerie
Bryan, Kristin Brittain, and Elizabeth Swann report the results of their research of self-directed learn-
ing in health education. The information presented serves as a valuable navigation resource for patients
searching for health management references in the current complex health care system. The passion that
all three of them possess for transforming the health care system combined with their compassion for
patients means that patient education will become more integrative and focused on the person, not the
disease, because of their presentations and publications.
In Chapter 6, “Well Teachers Teach Well,” Tammy Metcalf and Elizabeth Wrocklage-Gonda pres-
ent information from their successful wellness presentation for teachers. They include survey questions
and writing space for reflection while stressing the need for teachers to find time for their own physical
and mental well-being during the hectic pace of a school year. During the presentation they write about
in their chapter, I kept time for them and served as panel moderator. Watching Tammy and Elizabeth
present meant witnessing magic in action. They possess a gift for transforming stressed out teachers into
calmer, more peaceful people. They remind us life is not an endless to do list to conquer; it is a journey
to be savored and enjoyed.

xvii
 Preface

In Chapter 7, “Healing through Self-Discovery and Artistic Design Journals,” Susannah Brown shares
her passion for visual art and techniques for self-understanding through artistic design. She illustrates how
tension and stress can be released through the creative process and lead to healing. Susannah’s beautiful
artwork appears in her chapter and I love her willingness to share her designs as part of her writing. She
provides the powerful reminder we can pick up a paintbrush just as easily as a pen to express our emotions.
In Chapter 8, “The Gift of Grief,” Marnie S. Reed educates about pancreatic cancer by sharing the
story of her father’s final days and his refusal to be defined by the disease. She describes how her father’s
experiences and her own grief inspired her to be an activist while finding a way to use her loss to help
others. When I sent out the chapter acceptance letters for this book, a voice in my head told me I needed
to send them on a certain day even though that day had no significance for me. As Marnie writes, that
day she received her acceptance letter held great significance for her, and I know the timing of everything
was much more than a coincidence.
In Chapter 9, “Piti, Piti, Wazo fe Nich Li (Little by Little, the Bird Builds its nest): Promoting Change
and Health Education in Post-Earthquake Haiti,” Shewanee Howard-Baptiste and Mo Baptiste provide
their perspectives about their experiences in Haiti. They give hope to a community impacted by an
earthquake by addressing health education. Their inspirational story will create a positive ripple effect
and motivate others to follow their lead to transform lives. People can change lives by building bridges
between communities; Mo and Shewanee demonstrate that it becomes possible for two compassionate
and dedicated people to change the world.
In Chapter 10, “Cutting Edge Technology Adoption for Building Holistic Patient Experience,” Roma
Chauhan presents information of the methods technology can be used to enhance health care. Medical
practitioners have the opportunity to use the newest technology and resources for patient education. I
have never met Roma in person since we live halfway around the world from each other, but I feel I
know her well even though all of our correspondence has taken place through technology such as the
resources she discusses in her chapter. Her technology expertise will make life easier for patients and
clinicians while enhancing the quality of communication in the medical field.
In Chapter 11, “Curing Autoimmune Naturally: My PMR Story,” Donna J. Karaba shares the story of
her quest to unravel a medical mystery and her journey to regain optimal health. She describes how her
constant pain led her to take full ownership of her health issue, including placing health as her number
one priority, and collaborating with a knowledgeable compassionate health care team. Autoimmune
conditions often present as medical mysteries. Donna, however, played the role of dedicated detective
and never gave up until she found an answer. Her story will inspire other patients to take ownership of
their own health.
In Chapter 12, “The Advantages of PsychoSpiritual Psychotherapy,” Elizabeth Caparros presents
the contribution of psychological theories to demonstrate how significantly spirituality contributes
to mental and emotional healing. An individual’s search for meaning leads to self-understanding and
wellness. Elizabeth’s detailed connections illustrate that science and spirituality don’t have to exist in
isolation from each other.
In Chapter 13, “Truly Nourished,” Christine Bandy Helderman shows the power of faith and her
conversations with God as she treats her patients. As a nutritionist, she explains that while it is important
to be nourished by food, it becomes even more important to be nourished by spirituality. As a minister,
Christine shares how her spirituality plays a role in her life and how sharing her spirituality became a
gift to help the patients she counseled as a nutritionist find greater meaning in their lives.

xviii
Preface

In Chapter 14, “Strength from Spirituality,” Eric Wanner and Jennifer Bird discuss their own stories
of spirituality and the path their individual experiences took to lead them on their research and writ-
ing journey research. They discuss their research and writing of outlook and healing using a spiritual
perspective. This chapter meant the most to me personally because usually in academic publications
authors are encouraged to separate their personal beliefs and their writing. My spirituality is an essential
part of who I am and I enjoyed writing about it. I also enjoyed reading Eric’s story of his own spiritual
experience. It was an honor to have that story in the book, and it motivated me to make my own writing
even stronger to match the emotional impact of his story.
For the cover of this book, my cousin, Melissa Bird, used her talents as a medical artist to create a
picture that represents both the artistic and technical dimensions of medicine. I am excited for her to
share her talents with readers.

THE NEXT CHAPTER

Growing up with the last name of Bird, I heard endless bird jokes and flying metaphors from my family.
One of my favorites from my parents was that baby birds needed to leave the nest and fly. My parents
taught me to have roots and wings; roots for a strong set of values and wings to fly far and follow my
dreams. These words help no one if they remain on a computer disk; it is time for the words to fly free
and for you to read the chapters written by the authors. It has truly been a joy to edit this book, and all
of us who contributed to it hope our words inspire reflection and healing.

Jennifer Lynne Bird

Florida Atlantic University, USA
August 2014

REFERENCES

Bird, J. L. (2010). Choreographing creativity. Lanham, MD: University Press of America.

Bird, J. L., & Wanner, E. T. (2013). Multigenre narratives as a healing process. In V. C. X. Wang (Ed.),
Handbook of research on teaching and learning in K-20 education (pp. 416–428). Hershey, PA: Infor-
mation Science Reference.
Clandinin, D. J., & Connelly, F. M. (2000). Narrative inquiry. San Francisco, CA: Jossey-Bass.
Duke Integrative Medicine Staff. (2010). Personalized health plan manual. Durham, NC: Duke Integra-
tive Medicine.
Handler, J. (2013). Braving the fire. New York, NY: St. Martin’s Griffin.
Harper, A. N. (1996). Tooling up for effective planning. In B. W. McClendon & A. J. Catanese (Eds.),
Planners on planning (pp. 190–198). San Francisco, CA: Jossey-Bass.

xix
 Preface

Heard, G. (2002). The revision toolbox. Portsmouth, NH: Heinemann.

Rasminsky, A. (2012). The story doc. Oprah, 13(7), 88.
Romano, T. (2013). Fearless writing. Portsmouth, NH: Heinemann.
Wanner, S. Y. (1994). On with the story. Portsmouth, NH: Heinemann.

xx
 xxi

Acknowledgment

Whenever I write a thank you page, I always hope I don’t forget anyone! This book wouldn’t have been
possible without an entire team of people. Yes, it’s an old song and an old cliché, but all of you really
are the wind beneath my wings.

This idea began when a friend and colleague, Barbara Danielski, and I sat at an outdoor café near the
water and over lunch discussed the power of patients sharing journals of their symptoms and pain with
clinicians. Barbara became an educated patient during her experiences with cancer. Because of the
tragedy of cancer, Barbara did not live to read these words. Neither did my uncle, Steve Bird. While I
can visit my grandma, Mary Ann Kepler, as soon as I move my cats Lucy and Andy off the computer
keyboard and finish typing this sentence, she will most likely not be here to hold the published book in
her hands. Their stories, as well as the stories I read while editing this book, motivate me to continue my
quest of providing health education while simultaneously encouraging patients and clinicians to build
collaborative partnerships.

Thanks to my editor at IGI, Hayley Kang, and the rest of the publishing team who took a chance on a
unique academic publication. As soon as I have an idea for my next book, I know exactly who to call.
Thanks also to all the authors of chapters in this book for sharing your research and stories.

I don’t have enough words to share my gratitude for my Editorial Board. I truly feel I put together a dream
team of intelligent and creative friends who never hesitated to help me with whatever needed to be done.
Whether reading papers, offering advice, or cheering me to succeed with words of encouragement, this
book happened because of Andrea Asciutto-Houck, Jennifer Kabis, Cassandra Kenski, Melissa Lucrezia,
Marianne Robin Russo, Ryan Urenda, Eric Wanner, and Louise Waterfield. Thanks also to your families
for their kind words during this project!

I feel blessed to belong to an amazing family who encourages my dreams and makes me feel I can do
anything. Thanks to my dad, Dann Bird, for teaching me that for birds, the sky is the limit! Much love
to Diane McLoughlin, Susie Perry, Bill DeBeck, Robin Perry, David Bird, Patricia Bird, Melissa Bird,
Derek Bird, Gabrielle Bird, Marsha Bird, Sandy Bridges, Joanna Claridge, Mike Bridges, Carl Claridge,
Erica Younkvich, Daniel Younkvich, Margaret Earl, Tim Earl, Michael Schafer, Cher Schafer, Benjamin
Schafer, Crystal Schafer, Arthur Bruggisser, Brian Bruggisser, Amanda Bruggisser, the O’Connor fam-
ily, and all the new kids in the family!


 Acknowledgment

This book also became possible because of the support of all my friends, colleagues, and students
throughout the years. The names are too numerous to mention in this space, which shows me how much
I mean to a lot of people, and please know that I thank you for being part of my life and appreciate the
role each one of you played in my life’s journey.

And to my mom, Marilyn Kepler Bird, for being my inspiration and my guardian angel.

Jennifer Lynne Bird

Florida Atlantic University, USA

xxii
 xxiii

Introduction

Learning how to manage stress is a huge component of one’s health. This whole idea came about when
Dr. Jennifer Bird, an English professor at FAU, was a patient of mine and created a journal of how she
was feeling each day. This helped me see other contributing factors for her symptoms and led to her
getting 100% better in physical therapy. We both went more into depth about that style of writing (mul-
tigenre writing) which led to research projects and multiple publications about this topic. We researched
how a subject’s positive outlook related to objective measures for physical therapy surveys and found
groundbreaking results. Turns out the higher the subject’s positive outlook, the more gains they made in
physical therapy. There was also a link between higher scores with artistic writing, and objective gains
they made as well. That seemed to suggest an idea that writing may be a catalyst in healing. This led to
another research project that had subjects at FAU write freely about how they were feeling in a journal
on four different sessions. Besides finding out that a vast majority of college students were stressed, there
seemed to be a correlation for subjects demonstrating a more positive writing voice and having less anxiety
on the HRQOL (Health Related Quality of Life) survey. This led Dr. Bird’s search to collaborate with
more professionals to create this book. This book discusses similar issues on health and the benefits that
certain variables can have on it such as: religion, finding inner peace, self-awareness, dealing with grief,
self-directed learning, promoting change, stress management, holistic patient experiences, meditation,
nutrition, psycho-spiritual psychotherapy. All of these components are crucial to one’s health and you
will gain a deeper understanding of each of these after reading this book. As a practitioner in the health
field I cannot express how crucial it is to manage stress for maintaining one’s health.
This book’s intent is not to make you do everything it talks about but simply allows you to make more
educated decisions for your health. Patients that stay healthy heal quicker, are less prone to injuries, less
prone to certain diseases, and have a higher quality of life. It may also help you make wiser decisions
in life by managing stress.
Religion and finding inner peace have several benefits that will be further discussed in the book. Keep
your mind open while reading about these experiences and what was taken out of them by the authors
no matter your religious views. It may change your life more than you would think.
Self-awareness is something crucial in the medical field. It is something that could help people in the
medical field make the proper diagnosis when you see them. Physicians and Physical Therapists need to
know your symptoms when you see them since it allows them to rule certain things in and others out. A
lot of diagnoses can be similar but one difference in symptoms could be a totally different thing. Self-
awareness also will help you realize what is helping, versus what is making you worse. This can also
make one more accountable for their health as an individual and motivate them to educate themselves
more prior to going to a Doctor. You don’t have to try to diagnose yourself since a majority of the time


 Introduction

it will be incorrect and could scare you more than anything, but it might help you to ask more educated
questions that could help you out more in the long run. Any question though is a good question and it is
recommended that you prepare questions in advance of a Doctor visit. A simple question such as “is it
normal that I lost 10 pounds in a week and have night pain?” The answer is no and could lead to proper
testing to be performed along with the Doctor making proper referrals and performing appropriate tests.
Learning different ways to deal with grief can decrease stress levels and allow one to have a more
positive outlook on life whether that is through artwork, writing, working with a psychologist, etc. Hav-
ing a higher positive outlook has been proven to lead to a higher potential for recovery gains in physical
therapy. It can also help motivate a patient to perform suggested exercises for healing in physical therapy.
Just keeping the mindset you will get better helps one set goals for themselves, which in-turn leads to a
higher potential of meeting those goals and getting better. Perhaps that goal could be related to keeping
on track with a proper diet. It could make you re-evaluate your eating habits and start along a healthy
path potentially leading to more longevity.
Each of these chapters dive much further into each individual topic. This is an eclectic approach from
people in different fields to enhance a person’s quality of life with greater health benefits. The book
defines collaboration with all of the professionals in different fields coming together. So put on your
seatbelt while reading this book because you will be on the ride of your life for health.

Eric T. Wanner
Palm Beach Sports Medicine & Orthopaedic Center, USA

xxiv
 1

Chapter 1
Multigenre Medicine
Jennifer Lynne Bird Ryan Urenda
Florida Atlantic University, USA D1 Sports Medcine, USA

Eric T. Wanner Robin Perry

Palm Beach Sports Medicine & Orthopaedic Rolling Green Elementary School, USA
Center, USA

ABSTRACT
This chapter provides an introduction to the concept of multigenre writing and explains methods of mul-
tigenre writing used in the field of medicine to create the concept of multigenre medicine. The authors
share their stories using a multigenre format, which includes multiple perspectives and multiple writing
styles such as linking personal narratives with academic research. Therefore, the reader not only learns
about multigenre writing but also experiences it.

CONNECTING MULTIGENRE be helped as a result of unexpected col-

WRITING TO MEDICINE laborations, such as an English professor
working with a physical therapist.
Because patients in a physical therapy
clinic or other medical setting need to share Found Poem Multigenre Definition
their stories just like students in a writing Using Tom Romano’s Quotes
classroom
Because everyone’s voice deserves to be Writing is learned only through participation.
heard
 Teachers who write and share their words as-
Because the first flash of insight that writ- sume a humane, participatory stance toward
ers have can lead clinicians to a diagnosis learning and teaching the craft of writing
and help them adjust a patient’s treatment (1987, p. 43). The multigenre research paper
plan
 I’ve described in this chapter requires that
Because writing can heal people physically creativity and imagination be part of research
and emotionally
 (1995, p. 130). Multigenre papers defy most
Because lives can be saved and people can readers’ expectations. Multigenre writers,

DOI: 10.4018/978-1-4666-7524-7.ch001

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.
 
Multigenre Medicine

therefore, must be doubly careful to orient shines through when writers, whether they
readers quickly and supply information that are patients in a clinic or students in a class-
will help them build meaning the further they room, follow the advice Goldberg (2007)
read (2000, p. 33). I’m a narrative creature. gives, which is, “say what you want to say,
Through telling stories I experience the power not what you think you should say” (p. 2).
of my voice and come to understand what the Voice also influences how the writers in this
stories mean (2004, p. 29). Could they learn book share their stories. As Goldberg (2013)
facts about their topic and combine those advises writers, “you have to find the entry
facts with imagination to render intellectual into what you know inside, the way to bring it
and emotional truths? (2008, p. 183). I want out so people will listen” (p. 26). Sometimes
to know the ins-and-outs of students’ learn- this means sharing information through ex-
ing and creative journeys. I want students to pository writing that you are used to reading
be academically responsible and practice the in academic textbooks. Other times, however,
habit of scholarly integrity. So I ask them to it involves sharing information through nar-
include endnotes (2013, p. 153). ratives. The concept of voice in writing led
to breakthroughs in the research Eric and Jen
designed because it captured not just what
MULTIGENRE INSTRUCTIONS physical therapy patients and college students
said (technical writing) but also how they said
Write, and then share
 it (artistic writing).
Participate in your own story
 End notes for this piece are included but
Dovetail creativity, imagination, and facts
 not musical notes, so feel free to imagine the
As well as research and experience
 music as you choose, either as a slow tempo
To tell the intellectual and emotional truth
 ballad or a fast tempo rock song.
Defy expectations
 Here are the quotes that inspired the lyrics:
But be responsible

Tell your story and find your voice
 New insights are mine (It’s my experience) 

Voice Lessons
 Barbieri (1995): “All writing leads to in-
New insights are mine
 sight and discovery, and revising offers op-
(It’s my experience) 
 portunities to dig deeper, to refine thinking,
Take my turn to shine
 to follow new trains of thought” (p. 25). 

(My truth is serious) 
 Take my turn to shine (My truth is serious)

Future will be fine
 Fletcher (2013): “Voice in writing has to do
(Speak from the page) 
 with a unique personality-on-paper” (p. 78)

Leave the past behind
 Future will be fine (Speak from the page) 

(My voice remains) Murray (1985): “Voice allows the
reader to hear an individual human
being speak from the page” (p. 21). 

END NOTES Leave the past behind (My voice remains) 

Graves (1994): “Voice is the imprint of our-
Usually when people think of voice lessons, selves on our writing” (p. 81).
music comes to mind first. Writing voice

2

Multigenre Medicine
MEMORIES OF MARILYN
Winter in Kettering, Ohio was more brutal
than usual this year. Marilyn Kepler Bird
looked out the window of the hospital at the
blizzard. She had been a patient in the hospital
for some minor medical tests and felt ready to
go home. However, no one was going home
in this storm.
Things seemed serious. The hospital em-
ployees who had been snowed in at the hos-
pital were on the front lines of dealing with
any medical crisis. The doctors and nurses on
call were snowed in at their homes and could
not travel to the hospital to provide relief. In
this era before cell phones, patients couldn’t
send a quick text home to let loved ones know
they were okay. The landline looming on the
desk at the nurses’ station provided the only
lifeline to the outside world. The phone started
ringing. No nurses stayed at the station; they
needed to be dispatched to various parts of the
hospital to help patients. A trained hospital
volunteer, Marilyn picked up the phone and
reassured the frantic caller his loved one was
okay. Marilyn put her hands on her hips, and
her green eyes surveyed the chaos around
her as she flipped her brown hair over her
shoulders. Time to get to work.
During that blizzard week, Marilyn worked
more volunteer hours than some of the paid
hospital staff. To her, reassuring patients was
not a job, but a calling. They needed her,
and she was there. Trained as a high school
social studies teacher, Marilyn liked teaching
but loved health care. She counseled hospi-
tal patients scared by their internal medical
conditions as well as the external blizzard.
Before the medical field had a name for the
role she played, she used the skills of listening
and inquiry implemented by health coaches.
Let’s Take a Theory Break
The previous scene you just read was a work
of fiction based on fact. That scene happened
before I (Jen) was born, so of course I did not
witness my mom Marilyn helping patients. I
heard the story from her when I was a kid,
and as I was getting ready to begin my health
coach training I discovered an article my dad
wrote about my mom’s heroism. Eric and I
write about the strength of spirituality in a
later chapter for this book, so for me finding
that article served as an affirmation that I was
on the right path in my life.
You are in the midst of reading the practice
of multigenre writing applied to the field of
medicine. Great writing shows instead of tells,
so instead of reading a definition of multigenre
writing, you are being immersed in it.
Most fiction has some foundation in factual
experiences. Even if they are not writing a
fictional novel, authors of multigenre writing
borrow elements from fiction to present their
research as creative nonfiction, poetry, journal
entries, or other genres. For example, a con-
versation as presented by the author is based
on subjective memory and not objective facts,
and therefore may not be presented in this book
as exactly as it originally occurred. However,
the emotional resonance of the conversation is
true. As fiction writer Cleaver (2002) writes,
“when you deepen the connection to your
character, you deepen your connection to
yourself” (p. 85). In research methods such as
narrative inquiry, the lines between fact and
fiction often become blurred. Clandinin and
Connelly (2000) elaborate, “when pressed,
what seemed like fact appears more and more
as memory reconstruction, either ours or
participants’. Are these reconstructions best
thought of as fiction?” (p. 179). As Romano
3

(2000) says when teaching multigenre writing,
“ I encourage students not just to report fact
in a multitude of genres but also to fictional-
ize what they cannot know in order to create
what could or should have happened” (p.
68). Fiction, as well as other creative writing,
gives writers the opportunity to present the
emotional truth of a story while experienc-
ing freedom from details either too trivial or
painful to remember.
One notable example of an author recon-
structing fact as fiction is The Things They
Carried, where O’Brien (1990) writes, “I’m
forty-three years old, true, and I’m a writer
now, and a long time ago I walked through
Quang Ngai Province as a foot soldier. Al-
most everything else is invented. But it’s not
a game. It’s a form” (p. 179). As Goldberg
(2000) writes when discussing The Things
They Carried, “as I read I knew the book was
all true, but he’s also saying what is truth?” (p.
129). DeSalvo (1999) provides another insight
about the book by stating, “but he says too,
that to tell truthfully what happened to him
as a foot soldier in Quang Ngai Province in
Vietnam, he has had to resort to invention”
(p. 165). The important thing about all stories
like this one that use fiction or other forms
of creative writing to present facts is that the
reader comprehends the emotional truth of
the story.
Writing about emotional truth can heal
people. I first explored multigenre writing as
healing when I wrote my doctoral dissertation
and used a fictional character to share factual
information. I created a character named
Jenna Kepler, who was a thinly disguised
variation of me, and sent her into horrific
circumstances worse than my reality in order
to process some of the events in my life. I
used emotional truth to capture the essence
of an issue while freeing myself from being
4

Multigenre Medicine
obligated to remember every single factual
detail. Writing Jenna Kepler’s story helped
me heal. That’s the real truth.
When writing fiction, Jenna the character
said things Jenny the author couldn’t because
I was hurting too much. As DeSalvo (1999)
explains, “if the emotional aftermath of our
trauma is similar to O’Brien’s, we, too, can
use semifictional alter ego to tell our stories, to
help us feel” (p. 167). After a crisis, fiction can
help us find our way back to a new reality as
we skate the fine line between fact and fiction.
O’Brien (1990) describes this experience as,
“I’m skimming across the surface of my own
history, moving fast, riding the melt beneath
the blades, doing loops and spins, and when I
take a high leap into the dark and come down
thirty years later, I realize it is as Tim trying
to save Timmy’s life with a story” (p. 246).
Goldberg (2000) describes her reaction to
reading O’Brien’s words as, “tears sprang to
my eyes. I, too, have attempted many times
to keep my childhood safe, warding off death
with a story” (p. 131). I agree with this sen-
timent. By writing a story about my mom’s
experiences volunteering in a hospital, for a
few moments she is alive again and I get to
spend a little more time with her.
Writing as Healing
Similarly, the writers in this book want to
change lives with their stories. Research ex-
ists that supports using creative writing as a
healing device. Pennebaker (1997) explains,
“the mind torments itself by thinking about
unresolved and confusing issues. One reason
that writing about traumas can be so beneficial
is that it is a powerful tool to discover mean-
ing. Writing promotes self-understanding”
(p. 93). But if reporting the facts of a trauma
causes too much emotional pain for the writer,

Multigenre Medicine
it may help for the writer to write about the
event using creative writing. As Pennebaker
and Evans (2014) discuss, “you can’t help but
wonder where personal narrative ends and fic-
tion begins. Does writing fictionalized stories
improve health as much as exploring your
own experiences? Possibly” (p. 94). Lepore,
Greenberg, Bruno, and Smyth (2002) discuss
a study by Greenberg and her colleagues
where study participants were asked to write
about personal traumas, imaginary traumas,
or nonemotional events and learned, “both
real and imaginary trauma groups visited the
student health center for illness less often at
1-month follow up relative to controls” (p.
106). In the original study, Greenberg, Wort-
man, and Stone (1996) reflect that “writing
about a hypothetical trauma could also facili-
tate development of a more resilient version
of self” (p. 600). In other words, we save our
lives with stories.
And we can save other lives too. While
there is research that shows writing helps the
author heal, can it help readers of the author’s
words heal? While reading the words in this
book won’t cause any pain to vanish, perhaps
the stories in this book will inspire you to
share your story.
USING NARRATIVE INQUIRY TO
CAPTURE ONGOING STORIES
Life takes unexpected directions. The previous
paragraph was supposed to serve as a beautiful
introduction to the other authors in this book
using multigenre stories as well as a powerful
conclusion to the research journey. There will
be more research and writing in the future,
but since such ideas seemed like abstract pos-
sibilities instead of concrete projects, it felt
like the right time to breathe a sigh of relief,
put a bow on this book, and send it to the
editors at the publishing company.
But the story wasn’t over.
Welcome to the world of narrative inquiry.
Our stories evolve as we evolve. Clandinin
and Connelly (2000) elaborate, “narrative
inquiry carries more of a sense of continual
reformulation of an inquiry than it does a sense
of problem definition and solution” (p. 124).
We live our stories, tell our stories, and in the
reliving and retelling of our stories we often
find new answers and think of new questions.
Whether it is in a classroom, a clinic, or in life,
we take the theories we learn and transform
them in to practical strategies. Connelly and
Clandinin (1988) believe, “we may think of our
own education through curriculum situations
in terms of theory and practice” (p. 89). In the
field of narrative inquiry, a research project
may end, but the stories of the participants
continue. Students continue their lives long
after they leave a teacher’s classroom, just as
patients continue their lives long after they
leave a doctor’s clinic. The stories of people’s
lives remain ongoing, and the addition of new
narratives can change a story.
A TRANSITION TO THE NEXT
CHAPTER OF THE STORY
SCREETCH!! Since you are reading instead
of listening to an audio version of this book,
instead of hearing the annoying noise, just
picture the needle scraping across the music
of an old time record player. A new song
plays, and it’s time to take this chapter in a
different direction.
5
 
Multigenre Medicine

END NOTES the valuable life lesson, “only in hindsight can

This letter was inspired by What I Know Now:
Letters to My Younger Self, where Ellyn
Spragins asked famous people to write letters
to their past selves sharing advice. While the
authors of the letters could not rewrite their
stories, they could offer advice to readers who
would learn from the experiences of others. As
Spragins (2006) asks, “if you could somehow
postmark a letter back through time to your
younger self, what age would you choose and
what would the letter say?” (p. xiv). She offers
we see that our fears and worries were unwar-
ranted, that insecurities and doubts were just
illusions, or that we should have taken a risk
or dared something new sooner” (p. xviii).
We can’t repeat the past, so for the future
everyone can learn from the advice shared
with college seniors in Lean in for Graduates
by Sheryl Sandberg (2014), who writes, “so
start by aiming high. Be ambitious. Seize
opportunities. Make opportunities. Embrace
leadership. Lean in” (p. xviii). In the end, the
rest of all our stories remain unwritten.

Letter to Self (7:30am on 7-30-14)

July 30, 2014

Dear Jen,

Okay, decision time. To share or not share the story? Please. You know what
you are going to do, so stop debating and start writing. While your present
self wants to finish this project and stare at the ocean while lounging on the
beach, you owe it to your future self who in about six months will hold this
book in her hands and your past self who spent hours looking through library
books to find the perfect quote to tell the next chapter. It may help some-
one, and that will certainly motivate you. Weren’t you just telling your stu-
dents yesterday in class to take risks? I know you wanted to have everything
neatly wrapped up and all the loose ends of each story tied up when finishing
this book, but you know life doesn’t work that way. Try not to be so much of a
perfectionist and realize there is still an unwritten story here. There will
still be time for the beach. Right now, you have writing to do.

Love,

Yourself

6

Multigenre Medicine
AWAKENED BY AUTHORS
It is Friday morning, 1:38am. Our heroine,
attempting to sleep through the night while
dealing with migraines, has been drifting in
and out of sleep.
Authors (In Unison): Jenny….Get up!
Jen (Groggily): What? Not again! I finally
fell asleep! Can’t all of you just leave me
alone for a few hours?
Authors: But you weren’t thinking about us
for a few hours. We were worried.
Jen: I may never sleep again. Okay, now that
I’m awake, explain yourselves. I know
I took some pain medicine to deal with
my migraines. You all are not really here
watching me sleep, so what is really
happening here?
Emma: As Jane Austen’s heroine who likes
to meddle in the novel named after me,
Emma, I will be the leader of this group
of authors. You seem to have taken a
recent detour into the field of medicine.
We’re worried that you are going to break
up with us and never share our stories
with students again in a literature class.
Anne: We need to make our voices heard. As
you know from my story, Persuasion, not
all Jane Austen heroines are as vocal
as Emma. I just sit back and hope good
things happen to me.
Newland: And as much as I don’t like you
criticizing me every semester when you
discuss The Age of Innocence, I’m start-
ing to think you have a point. Maybe I
should have been bolder and chased
after Ellen, the love of my life, instead
of walking away at the end of the book.
Nora: Let’s not forget your dramatic inter-
pretations! I love it when you portray me
and recreate the scene in A Doll’s House
where I throw my keys across the room!
Your students love that too.
Mrs. Danvers: Oh, please. You know I hate
people and love to terrorize them, but I
actually kind of like it when you tell the
story of Rebecca in my words. Some of
your students seem scared of you when
you speak my words. I like it.
Cyrano: And what about the brilliant con-
nections you make? Most of your college
students may not have heard of Cyrano
deBergerac, but they have all seen a
television show or movie where the main
character can’t share true feelings with
a crush.
Edna: And I get to live again when you discuss
The Awakening. Maybe it was a mistake
to drown myself.
Bert: And what about the analysis of the edu-
cation system you express so elegantly
when sharing my story in Inherit the
Wind?
Jen: I still care about all of you. You know
that. But your stories are never going
to have different endings no matter how
many times I teach them. I can ask my
students to rewrite the endings of your
stories and discuss what they think should
have happened, but it doesn’t change the
fact the pages of your books have already
been filled. I love literature, but writing
is my true passion. When students or
patients share their stories in journals,
the world opens up to new possibilities to
explore. I want to be part of that journey.
I like the possibility of blank pages still
unwritten. Now if only I could sleep……
Back to Sleep
Lucy the cat knows

Whenever Jen can’t sleep, Lucy is there

She curls up next to her person and starts
purring

Lucy’s brother Andy runs around in a circle
chasing his tail

7

He stops his game and joins Lucy to start a
chorus of purrs
 wrote down what he said and how it looked
Jen’s breathing slows and for a moment
forgets her pain
 This is the tension Jen experienced when
Thanks to pet therapy
News Flash: Animals
Provide Comfort
Dr. David Dosa, a geriatrician, witnessed
the story of Oscar the cat when checking on
patients at a nursing home. Oscar, a cat who
lived in the nursing home, sensed which elderly
patients were the sickest and about to die, so
he would visit their rooms, curl up next to
them on their beds, and provide comfort. Dosa
(2010) reports that “I’d like to think Oscar
embodies empathy and companionship. He
is a critical cog in a well-oiled and dedicated
health care team” (p. 218). Animals may not
have medical training, but they know when
they are needed.
MULTIGENRE PERSPECTIVES
Multigenre perspectives present two sides
of a story as researchers live their narratives
through creative genres and then step back to
report on the research, much like a journalist
reporting the news. Journalist Anna Quindlen
(2004) describes this perspective as, “it’s a
strange job, covering and commenting on
the news. Life washes over us as it does all
our fellows, and yet we see it in a completely
different way than they do” (p. xxi). She de-
scribes the perspective of her personal feelings
about an issue needing to coexist with her
role as a reporter to objectively tell the facts
of a story. When she and another bystander
witnessed the scene after September 11, she
8

Multigenre Medicine
relates, “I took a notebook from my bag and
and how I felt” (p. xxv).
she began experiencing migraine headaches
while editing this book. She was supposed to
be the editor, collecting and reporting stories
by other authors. She wasn’t supposed to be
adding another one of her stories to the col-
lection. To make things more interesting, Jen
had just started her health coach certification
program at Duke Integrative Medicine. The
irony was that she was training to counsel pa-
tients on dealing with their own health issues
while experiencing one of her own. She read
the Personalized Health Plan Manual (2010)
and realized she needed her own personal
health plan! By learning the process as well
as living it, Jen could demonstrate additional
compassion for the patients with whom she
would soon work. How she viewed her story
would influence her healing.
Eric’s Perspective
The beauty of this situation by having Jen go
through these symptoms, she will have more
of an understanding what my patients may be
going through when coaching them. Having
an understanding of what patients feel versus
memorizing from a textbook what they should
be feeling makes a significant difference. If
patients understand that you went through a
similar situation that they are going through,
they will be much more willing to listen what
you have to say and actually be compliant
for what you recommend. Jen will also be
able to explain things more accurately from
a firsthand perspective. Will writing about
headaches always cure it? No. It depends
on the situation for what’s causing it, but it

Multigenre Medicine
could lead to physicians and physical thera-
pists making more accurate diagnoses for the
patient. On top of that, when patients write
about their symptoms including their outlook
it has been shown to decrease their stress
levels, increase self-awareness, and increase
goal setting which in turn can speed up their
recovery process. This eclectic approach is
where healthcare should be going.
Jen’s Perspective
Healthcare does need an eclectic approach.
The Wheel of Health from Duke Integrative
Medicine (2010) encourages patients to reflect
on multiple dimensions of health including
movement, exercise and rest; nutrition; per-
sonal and professional development, physical
environment; relationships and communica-
tion; spirituality; mind-body connection; and
mindful awareness (p. 5). This makes health
become a comprehensive plan that focuses on
the person, not just the disease. I didn’t want
to be a patient and experience pain again, but
it is amazing seeing both sides of the story
from perspective of patient and health coach.
It is going to make me a better clinician. Eric
and I have learned about the power of writing
to influence healing from our research. I love
that I am going to be able to use my writing
training to help patients in a clinic as well as
students in a classroom. However, I’ve learned
that writing is not the only answer. My cousin
Robin loves writing, but music motivates her
more. So a “PT CD mix” of music to motivate
her to do her at home exercises inspired her
more than a journal. Other patients may want
to use painting, watching sitcoms, or reading
an inspirational book as resources to help them
heal. I also had to adjust my own expectations.
With my original neck pain journal, I wrote
information that helped Eric find patterns to
my pain. With my migraines, creating that style
of journal didn’t work because the headaches
were constant, so my notes to Ryan about
how I felt after each physical therapy session
helped him the most. Clinicians achieve suc-
cess with treatment plans by individualizing
them for each patient.
Acrostic Poem about Migraines
Maddening

Intolerable

Gigantic

Relentless

Agitating

Inflexible

Nonstop

Endless
Text Message Conversation
Recalled from Memory
Eric: I just sent you a few different sites about
headaches. Let me know which one
sounds more like your symptoms. Seems
like it could be cervicogenic.
Jen: So my neck could be causing my head-
aches? Headache sounds like cervico-
genic.
Eric: If cervicogenic, you may still have some
facet restrictions or over-facilitated mus-
culature without pain due to the posture
teachers naturally tend to be in while
grading papers.
Jen: I’m still taking your advice and propping
papers on a pile of books when grading
them. It helps me not look down as much
and makes writing comments on essays
easier too.
Eric: There are many more things that can
cause this type of headache, but those
would be most likely for you since the im-
aging and tests came back unremarkable.
Jen: It was a relief that the MRI and all the
other diagnostics came back normal, and
9

given my history of neck pain it makes
sense that there is a connection.
Eric: Facet restrictions can also lead to over-
facilitated muscles which in turn can put
pressure on upper cervical nerve roots or
peripheral nerves causing a headache.
Jen: Thanks so much! Stupid facet joints!
The weird thing is I have no neck pain.
Eric: Headaches don’t always make sense.
They can be very tricky to diagnose. With
your past history of neck pain though, I
wouldn’t be surprised if this was the case.
Might want to ask your physician what
they think about doing physical therapy
to help your symptoms.
More about Headaches
According to the Center for the Study and
Treatment of Pain at New York University
Langone Medical Center (2014), “a cervi-
cogenic headache is, by its definition, any
headache which is caused by the neck. The
term ‘cervicogenic’ simply refers the cervi-
cal area, which is a part of your spine located
right near the base of the skull. The pain of
cervicogenic headache is usually unilateral;
it originates in the neck and then spreads to
the oculofrontal-temporal areas of the head.
The headache initially presents as intermittent
episodes and then progresses to an almost
continuous pain” (http://pain-medicine.med.
nyu.edu/patient-care/conditions-we-treat/
cervicogenic-headache). The article by Dr.
Biondi (2005) about cervicogenic headaches
states that “Head pain that is referred from the
bony structures or soft tissues of the neck is
commonly called cervicogenic headache. It
is often a sequela of head or neck injury but
may also occur in the absence of trauma. The
clinical features of cervicogenic headache
may mimic those commonly associated with
10

Multigenre Medicine
primary headache disorders such as tension-
type headache, migraine, or hemicrania con-
tinua, and as a result, distinguishing among
these headache types can be difficult” (p.
S17). He goes on to state that “Patients with
cervicogenic headache will often have altered
neck posture or restricted cervical range of
motion. Diagnostic imaging such as radiog-
raphy, magnetic resonance imaging (MRI),
and computed tomography (CT) myelography
cannot confirm the diagnosis of cervicogenic
headache but can lend support to its diagno-
sis” (p. S18).
Jen’s Journal
I cannot believe I am going to be a physi-
cal therapy patient again. The irony is that I
have no neck pain, but I can’t live with these
migraines. My cousin Robin asked if stress
was causing them, but I’m relaxed and con-
tent with my life. Seriously, in the past few
days I’ve made egg salad, a pizza, a vegetable
dish, and an apple crisp. When I create edible
meals it means I am not stressed. Since Eric
is now working at the hospital he can’t be my
physical therapist, so he is recommending that
I see his colleague Ryan. I’m really hoping
this pain doesn’t get so bad that I end up in
the hospital, although there were a couple
nights when my head hurt bad enough to con-
sider it. Ryan was Eric’s student a while ago
and Eric has complete confidence in Ryan’s
ability to relieve my symptoms. Robin’s go-
ing to physical therapy with Ryan too so we
will have fun (and provide Ryan with hours
of entertainment) scheduling our physical
therapy sessions together and cheering each
other on when doing exercises. It’s exciting
knowing that I will be going to a very good
physical therapist in a clinic right across the
street from where I live. There are too many

Multigenre Medicine
other patients Eric and I need to save with our
research and writing for me to be in the hos-
pital! Although Eric and Ryan are constantly
reminding me I need to take care of myself
before I take care of other people. The weird
thing is that my original neck pain journal led
to this research and writing journey, but now
I can’t even keep a pain journal. The pain is
ALL THE TIME! AHHHHHH!!!!
And Now a Word from the
Medical Dictionary
According to the North American Spine
Society (2014), “headache caused by neck
problems is called cervicogenic or neck-
related headache. It may be caused by injury
to an upper cervical disc, facet joint or higher
joints called the atlanto-occipital or atlanto-
axial joints. Cervicogenic headache can
also make migraines worse” (http://www.
knowyourback.org/Pages/SpinalConditions/
Injuries/Whiplash.aspx). Going into how a
nerve from the neck can refer pain to the head
Dr. Biondi (2005) states in his article that
“The trigeminocervical nucleus is a region of
the upper cervical spinal cord where sensory
nerve fibers in the descending tract of the tri-
geminal nerve (trigeminal nucleus caudalis)
are believed to interact with sensory fibers
from the upper cervical roots. This functional
convergence of upper cervical and trigeminal
sensory pathways allows the bidirectional re-
ferral of painful sensations between the neck
and trigeminal sensory receptive fields of the
face and head. A functional convergence of
sensorimotor fibers in the spinal accessory
nerve (CN XI) and upper cervical nerve roots
ultimately converge with the descending tract
of the trigeminal nerve and might also be
responsible for the referral of cervical pain to
the head” (p. S16).
Jen’s Journal
Ryan thinks my atlantoaxial joint is out of
alignment, which could be causing the mi-
graines. He suggested I look it up if I wanted
more information, and he’s probably not sur-
prised I’m writing about it. Thanks to Ryan’s
physical therapy treatment plan, I had my first
headache free day in three months. I’ve been
on five different medications that didn’t help
much, and it makes sense. According to Dr.
Biondi (2005), “medications alone are often
ineffective or provide only modest benefit for
this condition” (p. S19). Medicine wouldn’t
put this joint back where it belongs. Finally,
I have hope.
CONVERSATIONS IN PHYSICAL
THERAPY CLINICS (THEORY)
In order for physical therapists to effectively
treat patients, it helps them to know their pa-
tients’ stories. This helps the physical therapist
properly diagnose patients, determine their
prognosis, and development an appropriate
intervention. By learning patients’ stories,
physical therapists can also help patients set
goals. Randall and McEwen (2000) discuss the
value of physical therapists collaborating with
patients to write patient-centered functional
goals and elaborate, “physical therapists who
incorporate a patient-centered approach to
writing functional goals may see a change in
how they interact with their patients and the
decisions they make regarding patient care.
Therapists may spend more time getting to
know their patients and the self-care, work,
or leisure activities that are important to
them” (p. 1202). Clinicians need to believe
in the value of goal setting and take time to
discover a patient’s story. When the patient
11

sets out goals it brings them more onboard to
achieving them and increases accountability
for the patient.
Most patients want to know that their
clinician understands them and cares about
them as individuals, not just names on charts.
As Croft (1980) explains, “the therapist does
not need to accept each patient’s beliefs and
values as his own in order to be empathetic
toward that patient. What is important is
that the patient has something to say that is
important to him at that time. The therapist,
then, needs to convey to the patient that noth-
ing at the moment is more important to him
than listening to and helping the patient as
much as possible” (p. 1034). Because when a
patient is in pain, having an empathetic clini-
cian who listens becomes essential. This can
also increase the patient’s outlook for their
recovery process, allow the patient to become
more optimistic, work harder at reaching their
goals, and increase their compliance. All of
those combined leads to a quicker recovery!
CONVERSATIONS IN PHYSICAL
THERAPY CLINICS (PRACTICE)
While it is not possible every day due to their
busy schedules, at least once a week Jen and
Robin schedule their physical therapy ses-
sions at the same time. Of course neither one
of them wanted to be in pain, but since the
situation is what it is, it helps to have a fam-
ily member who cares about you and cheers
you on during your recovery from pain. We
seem to be entertaining our physical therapist
Ryan too with our different personalities.
Ryan and Robin are enjoying talking about
concerts they’ve attended while he gives her
instructions for exercises, while Jen needs the
occasional reminder from both of them to relax
12

Multigenre Medicine
while she does her exercises (she remembers
Eric’s advice to “think like a turtle” and make
slow and steady progress). Ryan shares this
sentiment. While Jen and Robin relax with
moist heat packs on physical therapy tables
next to each other, Ryan reminds both of them
that it took time for the pain to occur, so it is
going to take time to heal too.
DEFINITION OF THINKING
LIKE A TURTLE
Turtle Thinking (n): Slowing down and
realizing the healing process is a jour-
ney. Can also be used as a slang phrase.
Example: If someone says, “think like
a turtle,” to you, it probably means you
are moving too fast or multitasking too
much. Slow down.
Eric’s advice to Jen during physical therapy:
“Think like a turtle.”
Ryan’s advice to Jen during physical
therapy: “Relax.”
Robin’s advice to Jen as her cousin:
“Laugh.”
Excerpt from Jen’s College
Scholarship Essay
I forgot I wrote this and found it only when
transferring files to a new computer. I wrote
all about wanting to work with hospital pa-
tients, even though I was studying to be a
high school English teacher while serving
as a resident assistant in a college residence
hall. It serves as another affirmation, or what
Rushnell (2012) calls a Godwink, that my life’s
journey led me to where I am supposed to be
on this path to becoming a health coach. And
I won that scholarship too.

Multigenre Medicine
I enjoy counseling residents and look
forward to a job as a counselor for a school
or hospital. I read magazine articles about
stress and observe how it affects my friends.
Some are desperate for love and attention,
while others have no idea what they want to
do after they leave the security of Miami’s
campus. I don’t have all the answers, but I
will eventually figure everything out. I will
not spend unnecessary time worrying about
it, however, because it only ruins the present
moment.
USING THE WANNER BIRD HEALING
SURVEY FOR PAIN RECOVERY
FOR HEALTH COACHING
Physical pain hurts, but the way patients
share their pain narratives can lead to either
more or less emotional pain. As Beck (2003)
explains, “therapists from a branch of psy-
chology called ACT (short for Acceptance
and Commitment Theory) coined the terms
‘clean pain’ and ‘dirty pain’ to refer to suffer-
ing that comes from real events, as opposed
to suffering that comes from the stories we
tell ourselves about those events” (p. 37).
Beck describes clean pain as a person’s actual
pain and dirty pain as a reflection of what
the person thinks about the actual pain. She
concludes, “in other words, most of your
pain comes not from reality, but from your
stories about reality” (p. 38). Health coach-
ing and conversations about the responses to
both written and numerical subjective ques-
tions can help patients illuminate the health
stories they tell themselves. Health coach-
ing can also build a bridge between helping
patients decode complex medical terms and
comprehending their treatment plan. Brown
(2010) argues, “our stories are not meant for
everyone. Hearing them is a privilege, and we
should always ask ourselves this before we
share: ‘Who has earned the right to hear my
story?’ (p. 47). When patients feel that their
medical practitioners and health coaches earn
the right to hear their stories, the sharing of
narratives can become healing conversations.
Eric and Jen combined their expertise in
the fields of medicine and writing to design
The Wanner Bird Healing Survey for Pain Re-
covery. They completed a successful research
project with Dr. Claudia Jayne Brahler at the
University of Dayton that they hope to publish
in a physical therapy journal discussing the
numerical subjective and written subjective
questions they asked physical therapy patients
to complete. The study illustrated that patients
with a strong positive outlook and a clear ar-
ticulation of goals scored higher on existing
objective physical therapy measures.
However, due to the busy pace of the
physical therapy clinic environment, patients
wrote their answers to the written subjective
and numeric subjective questions but did not
have the opportunity to discuss their answers
with anyone. After she began her training
at Duke Integrative Medicine to become a
health coach, Jen wondered if talking to pa-
tients about their answers to survey questions
would add another dimension to The Wanner
Bird Survey for Pain Recovery. Robin began
physical therapy for reversal of increased
cervical lordosis. The cervical spine naturally
has a lordotic curvature to it. This cannot
be reversed; however, if it has an increased
lordotic curvature, the muscles can stabilize
it better and put the spine in a more efficient
postural position. Jen’s original plan was to
practice asking Robin the survey questions
before she needed to coach strangers about
their health goals as part of her clinical intern-
ship. This was not a research project, although
13

Robin’s answers would provide answers into
future research possibilities. Because of her
migraines, Jen ended up also completing the
survey questions she and Eric wrote during
her own physical therapy treatment.
Jen’s Perspective of the Survey
Being a patient and answering the survey
questions I co-designed became an amaz-
ing experience. Sometimes I found myself
laughing as I answered survey questions. I
co-authored the questions and spent hours
scoring the responses from other physical
therapy patients. I knew exactly what numbers
I needed to circle for the numerical subjective
questions and how optimistic my writing voice
needed to sound for the written subjective
questions in order to get the highest possible
score. The really funny thing is that for a
couple of the numerical subjective questions
I knew my honest responses weren’t going to
give me the highest score. It was extremely
enlightening. Despite the fact I teach stress
management strategies to other people, my
stress level isn’t at the lowest possible end of
the numerical scale due to my crazy busy life.
And my score showing I could use more time
for my home exercise plan meant I needed
a reminder to take care of myself and not
overwhelm my schedule. The best physical
therapy treatment plan in the world isn’t going
to help if I as the patient don’t do my part to
implement it.
Furthermore, as a researcher scoring the
surveys completed by other patients, I looked
at the data as a whole to see patterns. As a pa-
tient completing the survey, the only score that
matters is mine because I am in pain and need
to reflect how my responses provide insights
on my healing goals and any obstacles I need
to remove to achieve my goals. Interestingly,
I didn’t add up the total score on my surveys
14

Multigenre Medicine
or Robin’s. From a research perspective, the
quantitative numbers matter the most to pro-
vide statistical analysis of the results. From
a patient perspective completing my own
surveys and from a health coach perspective
talking to Robin about her responses, the
qualitative narratives matter the most to help
each patient with an individual health plan.
Robin’s Perspective of the Survey
I remember the moment my doctor told me
that I needed to see a physical therapist. I
admit that I was not at all thrilled with the
idea. With my already jam-packed schedule
of teaching, tutoring, taking classes, complet-
ing my internship for behaviorial analyis, and
volunteering at Big Dog Ranch Rescue, I did
not want to have to add one more thing to my
to do list. I already didn’t have enough time
for myself, let alone time for physical therapy
sessions two-three times a week!
When I arrived home after my appoint-
ment with my doctor, I immediately went to
my computer and looked up my diagnosis of
reversal of increased cervical lordosis to find
out if there were any different alternatives
for treatment in order to avoid the doctor’s
orders. I was looking for a quick and easy fix
that would cut corners and save time from my
hectic schedule. No such luck.
My cousin Jenny was going to an extraor-
dinary physical therapist and was always
talking about how amazing the treatment
plans designed by Eric and Ryan were and
how much she healed from the exercises. I
decided to give physical therapy a chance. I
went to meet with Ryan and he evaluated me
with a series of questions and some exercises
to see what would help me the best. I felt
like I was in good hands and was motivated
to build my weak muscles in order to relieve
the pain symptoms.

Multigenre Medicine
I was also excited to work with my cousin,
who wanted to practice with me during her
health coach certification, and be her first
patient (or as she jokingly called it, her guinea
pig). With an outstanding physical therapist
and health coach, I felt like I had the support
system I needed to feel better. That is, until
school started back up and schedules got dif-
ficult. My at home exercises were frequently
forgotten; I was only motivated when I was at
a physical therapy session and for a few days
after, or when I would meet with my health
coach. Physical therapy and health coaching
would make me aware again about what I
needed to do. I like the survey and health
coaching because it holds you accountable.
I didn’t know a lot about physical therapy
before I began treatment, but Ryan’s plan
helped pull me back to awareness of my posture
and lifestyle changes that will help me, which
is nice to have. As my family member, Jen
will still ask me how I am doing, but I think
it helps that health coaches set up a system
for patients to monitor themselves and give
them tools to succeed on their own.
Ryan’s Perspective of the Survey
This survey can be a valuable instrument to the
success and betterment of both physical thera-
pists, and more importantly, the patients that
place their healthcare in the hands of others.
It allows patients to take a look at themselves,
from an accountability standpoint, to truly
understand the way that they are feeling and
progressing through physical therapy instead
of just viewing it as a way to get rid of pain.
From the perspective of a physical therapist,
if patients are able to hold themselves ac-
countable for their healthcare, based upon the
exercises and health improvement strategies
given to them by their physical therapist from
the initial evaluation and follow up visits, the
more successful the therapy will be. Patients
are able to utilize this survey to set goals and
monitor themselves throughout the progres-
sion of the four weeks in therapy. The physical
therapist is already monitoring their progress,
but the more the patient becomes involved in
his or her own healthcare, the better. It can
potentially open up important dialogue that
may not go on otherwise. Patients are able to
look at the progress they have made from the
first visit in therapy, to the halfway mark, and
at the end of their treatment. Treatment can be
altered by the physical therapist in a positive
manner based upon how detailed patients are
with their survey, and how accountable they
hold themselves to their recovery outside of
the clinic. From my perspective, the goal of
physical therapy is not to just get rid of pain,
although this happens to be the main reason
patients come in. But, more importantly, it can
be used a method to teach patients of multiple
ages to be accountable for their healthcare and
to live a healthier lifestyle. This survey can help
to improve the way patients set their goals and
give themselves timetables to achieve them,
as well as improve the delivery of therapy by
the physical therapist.
Eric’s Perspective of the Survey
I feel like this survey is a very valuable instru-
ment for patients to utilize with the eclectic
approach it uses for healthcare. It not only in-
creases accountability for the patient, but also
increases self-awareness, motivation, allows
patients to set goals, helps develop a course
of action, and can help the PT see where his
or her patient is and how the patient is feeling
at the time. This survey is a three part survey
given to patients on the first day of physical
therapy, end of week two and end of week four
15

during physical therapy. This survey has vari-
ous factors in it including having the patient
set goals, write down if they feel those goals
will be achieved, their current stress levels,
and if they feel they have time or will make
time for home exercises. It then has patients
write how they feel about their physical therapy
intervention, if they have made time to do their
exercises at home, if they feel like they are
making good progress, and asks why or why
not for each question. This allows patients
to really analyze their progress and whether
or not they are making time for things they
should be making time for. This also helps
the patients see how motivated and optimis-
tic they are being throughout their treatment
intervention and determine if there are any
barriers preventing them from achieving their
set goals. The final survey asks patients if they
feel like they have reached their goals, if they
did their home exercises routinely, if they had
a good experience overall in PT including if
they liked their physical therapist. It allows
for the patient to explain why or why not after
each question. This set of questions overall
helps paint a perfect picture on what was go-
ing on in the patient’s mind throughout the
process. Having a physical therapist modify
their treatment approach due to how the pa-
tient answers the survey questions could lead
to greater recovery gains. I really hope that
physical therapists start utilizing this survey
for their patients after seeing what it can do
for their patients from the research that was
conducted by Jen, Jayne, and myself.
Robin and Jen’s PT CD
While completing pain journals and other
types of journal writing help some patients
organize their thoughts, other patients may
16

Multigenre Medicine
prefer a different method of motivation other
than writing. Singer Amy Grant (2007) shares,
“my passion has always been the connecting
power of music, connecting us to each other,
to ourselves, and to the love of God” (p. 210).
Robin’s passion for music inspired Jen and
Robin to create a “PT Mix,” otherwise known
as a mix CD to listen to while completing
physical therapy exercises. Every patient’s
physical therapy playlist is different; Jen
enjoys dance music to motivate her to move,
while Robin loves more mellow songs to fo-
cus on her exercises instead of moving to the
music! For Jen, who loves writing, Robin’s
insights inspired her to think of new genres
of healing.
Note: This list represents a small sample of
the numerous songs that have inspired
us over the years! While we have some
contemporary songs, the music our
parents listened to inspired us too! We
designed it as a representation for you
to create your own music mix to listen
to if you need to do exercises at home.
Warm Up Songs (High Tempo Music)
1. Firework by Katy Perry,
2. Wow by Kylie Minogue,
3. Oh What a Night by Four Seasons,
4. Losing My Ground by Fergie,
5. Whenever by The Black Eyed Peas,
6. Gold by Britt Nicole.
Cool Down Songs (Low Tempo Music)
7. This Train Don’t Stop There Anymore
by Elton John,
8. Back to December by Taylor Swift,

Multigenre Medicine
9. Have You Never Been Mellow by Olivia
Newton-John,
10. There You’ll Be by Faith Hill,
11. Sail On by Lionel Richie and Tim
McGraw,
12. Takes a Little Time by Amy Grant.
Text Messages between Two Teachers
Jen: Let me know if you want me to do my
annual library organization in your
classroom on Friday.
Robin: Yes!
Jen: Wait a minute. Reading……
BIBLIOTHERAPY: FIND AN
INSPIRATIONAL STORY
According to the Bibliotherapy Education
Project at Central Michigan University (2002),
“at its most basic level, Bibliotherapy means
helping through books. Bibliotherapy can be
used by different types of helpers with many
different ages and concerns” (http://biblio-
therapy.ehs.cmich.edu/) There are two types of
bibliotherapy and the descriptions are as fol-
lows: “Clinical Bibliotherapy is implemented
by trained helping professionals dealing with
significant emotional or behavioral problems.
Developmental Bibliotherapy may be used by
teachers, librarians or lay helpers to facilitate
normal development and self-actualization
with an essentially healthy population” (http://
bibliotherapy.ehs.cmich.edu/) In other words,
patients who are experiencing emotional
pain may need the help of a psychologist to
discuss issues that may be creating barriers
to healing. However, most people can receive
benefits from finding books they relate to and
that inspire them.
From a teaching perspective, Routman
(2003) frames the issue of being excited about
literacy and elaborates, “if we want our stu-
dents to be excited about literacy, they need
to have teachers who love coming to work,
who are literacy learners themselves, who
find ways to make curriculum relevant to
students’ lives, and who can put high stakes
testing into perspective” (p. 4). The key is
making literacy relevant. No one wants to
feel like they are alone in their experiences,
and books can provide hope for students and
patients if they do not know anyone personally
who has experienced similar pain. Granted,
reading a book is not a substitute for having
a conversation with a medical professional
or receiving a hug from a supportive friend;
nevertheless, books make us feel that someone
else has lived our experience.
Numerous nonfiction books feature true
stories of people coping with health issues.
Actor Michael J. Fox (2009) describes his
optimism after being diagnosed with Par-
kinson’s as, “for everything this disease has
taken, something with greater value has been
given – sometimes just a marker that points
me in a new direction that I might not oth-
erwise have traveled. So, sure, it may be one
step forward and two steps back, but after a
time with Parkinson’s, I’ve learned that what
is important is making that one step count;
always looking up” (p. 6). Fox’s words in his
book Always Looking Up provide hope to
anyone experiencing chronic pain while si-
multaneously illustrating the value of keeping
a positive attitude during medical treatments.
Readers looking for additional inspiration
can find advice in the words of Randy Pausch
(2008), who stood on a stage in a college
lecture hall with months to live in The Last
Lecture, and told his students to follow their
17

childhood dreams. After Randy’s death, his
wife Jai (2012) wrote a book called Dream
New Dreams that encouraged people who
endured loss to pick up a broken piece of an
old dream and dream a new dream. David
Menasche (2013) discovered that illness ne-
cessitated early retirement from teaching, so
he contacted his former students to see if he
made a difference in their lives. He learned
his class assignment and life lesson asking
students to create a priority list of what really
mattered to them resonated long after the final
classroom bell rang. His book, The Priority
List reminds us that while pain may be part
of life, it shouldn’t define our lives. Anyone
questioning faith during a difficult illness can
turn to the books Proof of Heaven (2012) by
Dr. Eben Alexander and To Heaven and Back
(2012) by Dr. Mary C. Neal. Dr. Alexander, a
neurosurgeon, and Dr. Neal, an orthopaedic
surgeon, both questioned if the science of
medicine could coexist with spirituality until
they each had a near death experience.
For fiction books, the following passage
from Just like Heaven by Marc Levy (2000)
sounds like it could come from a medical
journal when you read the words, “after his
reading, he spent evenings emailing emi-
nent professors of medicine and researchers
describing his dilemma, pretending he was
working on a novel. Some of them answered.
They all agreed – the situation he described
was medically impossible” (pp. 89-90). But
the words aren’t from a medical journal; they
are from a fiction story about a man named
Arthur who is trying frantically to help his
love Lauren while she is in the hospital. Or
for a reminder of the power of love and faith,
in A Walk to Remember by Nicholas Sparks
(1999), teenager Landon sits by the bedside of
his girlfriend Jamie and reads the Bible with
18

Multigenre Medicine
her while she shares her hope for a miracle as
she battles cancer. Don’t want to read a book?
The movie version of the novel, especially
the scene when Jamie confesses her disease
and Landon tells her he isn’t going anywhere
while the ballad Someday We’ll Know plays in
the background is just as powerful for finding
courage during difficult times.
Robin teaches second grade and Jen has
taught high school and college English, so
this list of books could easily become its own
book! If you want to find someone who shares
your story, after a trip to the doctor’s office
it might just help to take a trip to the library.
Beach Picture Break
In the book, this photo will appear in black
and white, but try to imagine the beautiful
colors of sunrise at the beach. Jen took this
photo at Carlin Park in Jupiter, Florida on a
Saturday morning as the sun was rising over
the Atlantic Ocean. The stairs leading through
the trees to the sand symbolize the journey
patients often feel when the pain fades away
and healing leads to new possibilities. Eric
once said the beach can be healing, but even
if you live nowhere near a beach you can
search for places of tranquility and serenity
to bring you peace.
Remember to Laugh
For the survey question of what helped her
most in physical therapy, here is part of Jen’s
answer: “I love being encouraged to laugh
and have fun with my exercises. I can be a
very serious person so the reminder to lighten
up will help me and my patients as a health
coach.” Ryan believes in the value of humor,
because laughter makes a difference if patients

Multigenre Medicine
Figure 1. Photograph by Jennifer Bird of the beach of Carlin Park in Jupiter, Florida
aren’t excited about being in physical therapy.
It’s true that most adults don’t find time in
their lives to laugh. As Beck (2003) writes,
“consider that a typical small child laughs
over four hundred times a day. For the aver-
age adult, the number is a paltry fifteen” (p.
152). Whenever patients are getting too serious
at the clinic, Ryan will lighten the mood by
telling jokes. He once set several timers to go
off at once (and admitted that a similar joke
was Eric’s introduction to his sense of humor
on the first day they ever worked together).
19

On an old episode of the medical drama ER,
the character of Dr. Mark Greene advises his
student, Dr. John Carter, “you set the tone,
Carter.” Whether it is on a fictional television
drama or a real life physical therapy clinic,
one clinician truly can set the tone by creating
an environment that will help patients heal.
Robin has renamed the chin tuck exercises
that are part of her home exercise plan, “the
double chin exercises” so she smiles when
she does them. Jen was also forced to laugh
at herself when she said “I love you” to her
cousin Robin on the way out of the clinic one
day. The other patients and physical therapists
joked if she knew Robin or was just going
around telling random strangers at the clinic
that she loved them! Beck discusses the heal-
ing value of laughter and explains, “laughter
– even the anticipation of laughter – shifts
our internal chemistry measurably, reducing
stress hormones and increasing the number
of natural virus-killer cells available to fight
disease from colds to cancer. It also triggers
the release of endorphins, hormones that
lessen the perception of distress and make us
feel fabulous. The cliché is true; laughter re-
ally is good medicine – so much so that some
hospitals have ‘laugh mobiles’ that hand out
videotaped comedy routines and squirt guns
to their patients” (p. 154). So consider that
watching your favorite comedy on television
may not be a waste of time; the laughter may
just help you heal.
Headache Journal
For any patient in pain, it can help clinicians
make a diagnosis if the patient keeps a journal
of symptoms. Dr. Hagen and the Mayo Clinic
Staff (2001) recommend that for recurrent
headaches, keep a headache diary and include
20

Multigenre Medicine
the following factors: severity, frequency and
duration, related symptoms, location, family
history, and triggers (p. 83).
But don’t feel you need to follow a specific
format if a different writing style works for
you. One of Jen’s headache journals looked
like this (Box 1).
FUTURE RESEARCH POSSIBILITIES
This chapter is not going to have a magical
movie ending that states Jen and Robin are
now completely healed thanks to Ryan, while
Jen and Eric conducted a successful research
project illustrating how health coaches can
help physical therapy patients. Jen and Robin
will soon heal with Ryan’s help, but not be-
fore this book goes to the publisher. Jen and
Eric will design more research projects in
the future, and will hopefully implement a
research project demonstrating the benefits
of health coaching for physical therapy pa-
tients. But as of the typing of this sentence,
such stories remain unwritten. Concluding a
narrative inquiry feels similar to leaving the
theater before the end of a play, but then the
researcher must have faith there will be other
stories to tell and other chapters to write.
By writing those chapters in a multigenre
format, like this chapter, writers see and share
such stories from multiple perspectives. As
Gruwell (1999) writes of her students, the
Freedom Writers, “I realized that in order
for them to grow, they had to branch out and
explore new ground” (p. 273). This state-
ment applies not only to students in a writing
classroom, but also patients in a clinic. While
it certainly helps to have a health coach guid-
ing you through the process, all patients can
benefit from a reminder they have the power

Multigenre Medicine

Box 1.

Hi Ryan,

Pain free for four days after Wednesday’s PT session!!! Yay!!! Thanks for the
atlantoaxial joint manipulation!!

Eric’s impressed – said you are really smart and that’s why he sent me to you!

Dull headache started Sunday after church when I looked down while praying
(oh, the irony…..) I know the fast neck movement triggered it, but it is still
only a dull ache instead of a sharp pain.

Have not needed pain medicine indomethacin in a week and this morning neurolo-
gist said that if the cortisone shot and PT is working I can stop taking pain
medicine unless needed. He has not ruled out additional cortisone shots in
the future and is writing a note to my department chair stating I must take it
easy and not push myself when teaching (I think I need that note more than she
does – ha!)

Have three PT sessions this week and then am leaving for NC for a seminar so
the real test will be how I do with doing my “at hotel” exercises (since I
won’t be at home!) and without that lovely stretcher machine on my neck!

Thanks for everything – I forgot what it is like to be pain free!!!

Jen

to write the next chapter in their lives and
achieve their optimal health visions. In Dead
Poets Society, teacher John Keating quotes the
words from the poem O Me! O Life! by Walt
Whitman (1855): “That you are here – that
life exists and identity, that the powerful play
goes on and you may contribute a verse” (p.
341). For us as the authors, this chapter be-
comes part of the larger health care narrative
and we plan to continue contributing verses
to that story.

21

REFERENCES
Adams, W., & Ferguson, S. (2010). When-
ever [Recorded by The Black Eyed Peas].
On The beginning [CD]. Santa Monica, CA:
Interscope Records.
Alexander, E. (2012). Proof of heaven. New
York, NY: Simon and Schuster.
Alexander, G., Brisebois, D. A., & Holland,
D. (2002). Someday we’ll know [Recorded
by Mandy Moore and Jonathan Foreman].
On A walk to remember [CD]. New York,
NY: Epic/Sony.
Austen, J. (1981). Emma. New York, NY:
Bantam. (Original work published 1816)
Austen, J. (1984). Persuasion. New York,
NY: Bantam. (Original work published 1818)
Barbieri, M. (1995). Sounds from the heart.
Portsmouth, NH: Heinemann.
Beck, M. (2003). The joy diet. New York,
NY: Crown.
Biondi, D. M. (2005). Cerviogenic headache:
A review of diagnostic and treatment strate-
gies. The Journal of the American Osteopathic
Association, 105(4), 16S–22S. Retrieved
from http://www.jaoa.org/content/105/4_
suppl/16S.full PMID:15928349
Brown, B. (2010). The gifts of imperfection.
Center City, MN: Hazelden.
Chopin, K. (1981). The awakening. New York,
NY: Bantam. (Original work published 1899)
Chulack, C., Crichton, M., Wells, J., & Za-
bel, D. (1994-2009). ER [Television series].
Burbank, CA: Warner Brothers.
22

Multigenre Medicine
Clandinin, D. J., & Connelly, F. M. (2000).
Narrative inquiry. San Francisco, CA: Jossey-
Bass.
Cleaver, J. (2002). Immediate fiction. New
York, NY: St. Martin’s Press.
Connelly, F. M., & Clandinin, D. J. (1988).
Teachers as curriculum planners. New York,
NY: Teachers College.
Croft, J. (1980). Interviewing in physical
therapy. Physical Therapy, 60(8), 1033–1036.
PMID:7403279
DeSalvo, L. (1999). Writing as a way of heal-
ing. Boston, MA: Beacon Press.
DiNovi, D. (Producer), & Shankman, A.
(Director). (2002). A walk to remember [mo-
tion picture]. United States: Warner Brothers
Pictures.
Dosa, D. (2010). Making rounds with Oscar.
New York, NY: Hyperion.
Duke Integrative Medicine Staff. (2010).
Personalized health plan manual. Durham,
NC: Duke Integrative Medicine.
DuMaurier, D. (1938). Rebecca. New York,
NY: Avon.
Farrar, J. (1975). Have you never been mel-
low [Recorded by Olivia Newton-John]. On
Have you never been mellow [CD]. Universal
City, CA: MCA.
Ferguson, S., Sandstrom, R., Ridel, S., &
Boldt, R. (2006). Losing my ground [Recorded
by Fergie]. On The dutchess [CD]. Santa
Monica, CA: A&M Records.
Fletcher, R. (2013). What a writer needs (2nd
ed.). Portsmouth, NH: Heinemann.

Multigenre Medicine
Fox, M. J. (2009). Always looking up. New
York, NY: Hyperion.
Gaudio, B., & Parker, J. (1995) December
1963 (oh what a night) remix [Recorded by
the Four Seasons]. On Oh what a night [CD].
Nashville, TN: Curb Records.
Goldberg, N. (2000). Thunder and lightning.
New York, NY: Bantam.
Goldberg, N. (2007). Old friend from far away.
New York, NY: Free Press.
Goldberg, N. (2013). The true secret of writ-
ing. New York, NY: Atria.
Grant, A. (2007). Mosaic. New York, NY:
Doubleday.
Grant, A., & Kirkpatrick, W. (1997). Takes
a little time [Recorded by Amy Grant]. On
Behind the eyes [CD]. Hollywood, CA: A&M
Records.
Graves, D. H. (1994). A fresh look at writing.
Portsmouth, NH: Heinemann.
Greenberg, M. A., Wortman, C. B., & Stone,
A. A. (1996). Emotional expression and
physical health: Revising traumatic memo-
ries or fostering self-regulation. Journal of
Personality and Social Psychology, 71(3),
588–602. doi:10.1037/0022-3514.71.3.588
PMID:8831163
Gruwell, E., & The Freedom Writers. (1999).
The Freedom Writers diary. New York, NY:
Broadway.
Hagen, P. T. (Ed.). (2001). Mayo clinic guide
to self-care. Rochester, MN: Mayo Clinic.
Ibsen, H. (1958). A doll’s house. In Four great
plays. New York, NY: Bantam. (Original work
published 1879)
John, E., & Taupin, B. (2001). This train don’t
stop there anymore [Recorded by Elton John].
On Songs from the west coast. New York,
NY: Universal.
Lawrence, J., & Lee, R. E. (1955). Inherit the
wind. New York, NY: Bantam.
Lepore, S. J., Greenberg, M. A., Bruno, M.,
& Smyth, J. M. (2002). Expressive writing
and health: self-regulation of emotion-re-
lated experience, physiology, and behavior.
In S. J. Lepore & J. M. Smyth (Eds.), The
writing cure (pp. 99–117). Washington,
DC: American Psychological Association.
doi:10.1037/10451-005
Levy, M. (2000). Just like heaven. New York,
NY: Pocket Books. (Originally published as
If only it were true).
Menasche, D. (2013). The priority list. New
York, NY: Touchstone.
Minogue, K., Poole, K., & Kurstin, G. (2008).
Wow [Recorded by Kylie Minogue]. On X
[CD]. Hollywood, CA: EMI.
Murray, D. M. (1985). A writer teaches writing
(2nd ed.). Boston, MA: Houghton Mifflin.
Neal, M. C. (2012). To heaven and back.
Colorado Springs, CO: WaterBrook Press.
Nicole, B., Muckala, D., & Cates, J. (2012).
Gold [Recorded by Britt Nicole]. On Gold
[CD]. Brentwood, TN: Capitol.
North American Spine Society. (2014).
Whiplash and whiplash associated disorder.
Knowyourback.org. Retrieved from http://
www.knowyourback.org/Pages/SpinalCondi-
tions/Injuries/Whiplash.aspx
23
 
Multigenre Medicine

NYU Langone Medical Center. (2014). Cer- Romano, T. (1995). Writing with passion.
vicogenic headache. Center for the Study Portsmouth, NH: Heinemann.
and Treatment of Pain. Retrieved from http://
Romano, T. (2000). Blending genre, altering
pain-medicine.med.nyu.edu/patient-care/
style. Portsmouth, NH: Heinemann.
conditions-we-treat/cervicogenic-headache
Romano, T. (2004). Crafting authentic voice.
O’Brien, T. (1990). The things they carried.
Portsmouth, NH: Heinemann.
New York, NY: Broadway Books.
Romano, T. (2008). Zigzag. Portsmouth, NH:
Pausch, E. J. (2012). Dream new dreams. New
Heinemann.
York, NY: Crown Archtype.
Romano, T. (2013). Fearless writing. Ports-
Pausch, R., & Zaslow, J. (2008). The last
mouth, NH: Heinemann.
lecture. New York, NY: Hyperion.
Rostand, E. (1950). Cyrano de Bergerac. New
Pehrsson, D. E., & McMillen, P. (2002). The
York, NY: Bantam. (Original work published
bibliotherapy education project. College of
1898)
Education and Human Services at Central
Michigan University. Retrieved from http:// Routman, R. (2003). Reading essentials.
bibliotherapy.ehs.cmich.edu/ Portsmouth, NH: Heinemann.
Pennebaker, J. W. (1997). Opening up: The Rushnell, S. (2012). Divine alignment. New
healing power of expressing emotions. New York, NY: Howard Books.
York, NY: The Guilford press.
Sandberg, S. (2014). Lean in for graduates.
Pennebaker, J. W., & Evans, J. F. (2014). Ex- New York, NY: Alfred A. Knopf.
pressive writing: words that heal. Enumclaw,
Sparks, N. (1999). A walk to remember. New
WA: Idyll Arbor.
York, NY: Warner.
Perry, K., Eriksen, M., Hermansen, T., Wil-
Spragins, E. (Ed.). (2006). What I know now:
helm, S., & Dean, E. (2010). Firework [Re-
Letters to my younger self. New York, NY:
corded by Katy Perry]. On Teenage dream
Broadway.
[CD]. New York, NY: Capitol.
Swift, T. (2010). Back to December [Recorded
Quindlen, A. (2004). Loud and clear. New
by Taylor Swift]. On Speak now [CD]. Nash-
York, NY: Ballantine.
ville, TN: Big Machine Records.
Randall, K. E., & McEwen, I. R. (2000).
Wanner, E.T., & Bird, J.L. (2013). The Wan-
Writing patient-centered functional goals.
ner Bird healing survey for pain recovery.
Physical Therapy, 80(12), 1197–1203.
Original work copyrighted by the authors.
PMID:11087306
Warren, D. (2001). There you’ll be [Recorded
Richie, L. (2012). Sail on [Recorded by Lionel
by Faith Hill]. On Pearl Harbor [CD]. Burbank,
Richie and Tim McGraw]. On Tuskegee [CD].
CA: Hollywood Records/Warner Brothers.
Nashville, TN: Mercury.
Weir, P. (Director). (1989). Dead poets society
Romano, T. (1987). Clearing the way. Ports-
[motion picture]. United States: Touchstone
mouth, NH: Heinemann.
Pictures.

24

Multigenre Medicine
Wharton, E. (1920). The age of innocence.
New York, NY: Collier.
Whitman, W. (1993). O me! O life! In Leaves
of grass (p. 341). New York, NY: Random
House. (Original work published 1855)
KEY TERMS AND DEFINITIONS
Bibliotherapy: Using books to help
people. Bibliotherapy shows people they are
not alone in their experiences. An example
of bibliotherapy would be if a person is ex-
pericing health issues, he or she might find a
either a nonfiction book where the author has
experienced similar health issues, or a fiction
book where the literary character experiences
similar health issues.
Godwink: A moment where synchronicity
occurs in the form of a coincidence; instead of
being interpreted as a coincidence the event
is perceived as a message from God.
Integrative Health Coach: Health coach-
es have a variety of educational backgrounds
but participate in specialized training, such
as the training at Duke Integrative Medicine,
to help patients design personalized health
plans. Health coaches help patients clarify
their vision and values. They also work with
medical professionals to assist patients in
comprehending the treatment plan while set-
ting goals to achieve optimal health.
Integrative Medicine: A holistic approach
to medicine that treats the person, not the dis-
ease. Patients and doctors form a partnership
to treat the patient’s mind, body, and spirit.
Migraines: A type of painful headache.
Migraines have a variety of symptoms and
causes. Patients suffering from migraines
should consult a medical professional to help
with a treatment plan.
Multigenre Writing: Originally made
popular in the field of education by Tom
Romano, a multigenre paper consists of two
parts: creative writing in multiple genres and
the writer’s analysis of the genres.
Narrative Inquiry: Originally made
popular in the field of research by F. Michael
Connelly and D. Jean Clandinin, narrative
inquiry is a qualitative interpretative form
of research that focuses on the telling, retell-
ing, and sharing of stories. Researchers who
complete narrative inquiries interpret stories
and search for common threads to find pat-
terns. Some narrative inquires begin with a
research question, while others evolve over
time. Narrative inquires adapt to emerging
circumstances and frequently change based
on new information.
Physical Therapy Interview: The initial
intake session where a physical therapist
asks patients questions and learns about the
patient’s story.
Story-Truth and Happening-Truth:
Happening-truth is an objective factual ac-
count of events which occurred. Story-truth,
sometimes referred to as emotional truth, is
a subjective reflection of a person’s thoughts
and feelings about the same event when retell-
ing that story. Writers such as Tim O’Brien,
Natalie Goldberg, and Louise DeSalvo believe
in the power of emotional truth that enables
writers to switch back and forth from objec-
tive observations to subjective emotions when
sharing a story.
Thinking Like a Turtle: This philosophy
means taking on one task at a time, which can
lead to less stress.
Wanner-Bird Healing Survey for Pain
Recovery: An original survey designed by
Dr. Eric Wanner and Dr. Jennifer Bird. This
survey features a combination of numerical
subjective questions, where patients are asked
25

to respond to statements by circling a number
from 1-5, and written subjective questions that
evaluates patients on a rubric with a score of 1,
3, or 5 to incorporate the technical and artistic
dimensions of writing. The survey questions
can also be used for health coaching.
26

Multigenre Medicine
Writing Voice: Voice in writing describes
how a writer uses word choice and tone when
writing a journal entry or other composition
that reflects the personality of the writer. Just
like each person has a unique speaking voice,
each writer has a unique writing voice.
 27

Chapter 2
Write to Transform Your Health
John Frank Evans
Wellness and Writing Connections, USA

Karen Roussel Jooste

Duke University Medical Center, USA & Storia International PLLC, USA

ABSTRACT
This chapter is a description of the workshop, ‘Transform your Health: Write to Heal,’ created by John
Evans. Writing and facilitating optimal well-being and vibrant living are the authors’ passions and they
feel privileged to fuse these passions in this chapter.

WRITE TO TRANSFORM pants. In addition to describing specific work-

YOUR HEALTH
The following chapter is a description of the
workshop, ‘Transform your Health: Write to
Heal™,’ created by John Evans. The concepts
of ‘Transform your Health: Write to Heal™’
are taught to healthcare providers at our sig-
nature retreat, ‘Leading Patients in Writing for
Health.’ When we are leading this workshop,
we are truly in FLOW as our friend and col-
league, Michelle Bailey (2014) reminds us
in her description of “fully living our why.”
Writing and facilitating optimal well-being
and vibrant living are our passions, and we
feel privileged to fuse these passions in this
work. It is our joy to witness the transforma-
tion – sometimes gentle, sometimes dramatic
and dynamic - that writing, as the alchemist,
facilitates in our workshop and retreat partici-
DOI: 10.4018/978-1-4666-7524-7.ch002
shops, our chapter draws on our experiences
as participant/observers in both ‘Transform
your Health: Write to Heal™’ (Evans, 2010)
and as co-leaders of our the signature ‘Lead-
ing Patients in Writing for Health’ which
we created to meet the needs expressed by
healthcare providers who wished to use this
work with their own patients and clients.
‘Transform Your Health’ was first offered at
Duke Integrative Medicine three years ago and
currently is offered there two or three times a
year. ‘Leading Patients in Writing for Health’
is offered at Duke Integrative Medicine each
spring. We are honored to describe our work
for this collection of essays.
We use several genres of writing to lead
our clients towards self-awareness and self-
knowledge, to the compassionate examination
of their lives and to intentional and joyful

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.
 
Write to Transform Your Health

living. At the center of vibrant well-being is Words without consonants—you know

the practice of mindfulness. Jon Kabat-Zinn where they led; 

(2009) describes mindfulness as “paying at- Salad dressing words on white bread; 

tention, on purpose, to the present moment, Pregnant words that never bled. 

non judgmentally”. The power of writing lies Words that run through southern blood. 

in its capacity to be a mindfulness practice. Words I dare to drag through the mud

By writing, we can pay attention, on purpose, Powerful words freed after a flood. 

to the present moment, without judgment 4-14 Sandy Roberts.
and with compassion. Seeing our lives and
ourselves with clarity and compassion is at Roberts reminds us that as words shape our
the core of well-being. life, actually creating our world, they have a
As a mindfulness practice, writing becomes powerful impact on our interpretation of our
the alchemist, which moves our clients from life and world. We recognize at the end of the
darkness to light, which transforms them poem words become powerful when freed.
from fragility to resilience, from suffering
to joy, from emotional discomfort to inner
well-being. THE PROCESS
All participants who are quoted in this
chapter granted permission for their work to ‘Transform your Health: Write to Heal’ is a
be published. process. It is typically facilitated over 6 – 8
A significant part of mindfulness writing is weeks, meeting once a week, or can be facili-
paying attention to the power of our language tated over 3 days. ‘Leading Patients in Writ-
as a co-creator of our lives as suggested in this ing for Health’ is a retreat, facilitated over 3
poem created by writing workshop participant, days, which moves through the same process,
Sandy Roberts this year. experientially, but with greater depth in terms
of how the process works, so that healthcare
I Carry Words providers can understand the process through
which they will be leading their patients or
I carry words in my hip pocket.
 clients. They are also provided with the tools
Blue words sung by John Lee Hooker; 
 with which to create their own writing prompts
Secret words hidden in a locket; 
 and exercises, by learning the defining charac-
Sinning words heavy as lead; 
 teristics and guiding principles of the writing
False words that lovers said; 
 exercises. Several types and genres of writing
Scarlet letters full of dread; 
 are employed. These are expressive writing,
Shaming words common as sand. 
 transactional writing, poetic writing, (which
Scaring words from a bully’s brand. 
 includes poetry, and creative non-fiction),
Guilty words that came pre-canned. 
 affirmative writing and legacy writing.
Haunting words from those now dead; 

Bootleg words from behind the shed. 
 Expressive Writing
Gossip words I wish I’d never spread; 

“I told you so” words not worth your spit; 
 Our workshops begin with expressive writing.
Goddamn words worse than shit; 
 Expressive writing is the foundation of our
Cutting words that widen the split. 
 work. The expressive writing experience in

28

Write to Transform Your Health
our workshops is based on the work of James
Pennebaker (1990), and the prompts, are well-
known as the Pennebaker Paradigm. In his
groundbreaking research about the power of
writing to be a tool for well-being and a tool
to work with difficult and traumatic events
and move from psychological difficulties
such as post traumatic stress and depression,
to psychological flourishing and resilience,
he worked with students in a study which was
facilitated over four days. Each day, a prompt
was given to students to respond to. Following
the four days of writing, their psychological
and physical well-being were monitored for
several months. Analysis of this research
showed that both psychologically and physi-
cally, the students moved closer to optimal
well-being. Apart from the research results,
many students returned to James Pennebaker
declaring that the writing had changed their
lives dramatically for the better. The four
prompts are the following:
Expressive Writing Prompts Writing
Experiences One and Two
In the Pennebaker Paradigm, the prompt for
writing experience day one and day two is the
same prompt. Here is the prompt:
In your writing, I would like you to really let
go and explore your very deepest emotions and
thoughts about the most traumatic experience
in your entire life. You might tie this trauma to
other parts of your life: your childhood, your
relationships with others, including parents,
lovers, friends, relatives or other people im-
portant to you. You might link your writing to
your future and who you would like to become,
or to who you have been, who you would like
to be, or who you are now.
Not everyone has had a single trauma but all
of us have had major conflicts or stressors and
you can write about these as well.
All your writing is confidential. There will
be no sharing.
Do not worry about form or style, spelling,
punctuation, sentence structure, and grammar.
Expressive Writing Prompt Three
Now shift your writing so that you are con-
sidering the topic from a different perspective
or different point of view. Write about how
this event shaped your life and who you are.
Explore, especially those deep issues about
which you may be particularly vulnerable
Expressive Writing Prompt Four
Now stand back and think about the events,
issues, thoughts, and feelings that you have
disclosed. Really be honest with yourself about
this upheaval and do your best to wrap up your
writing about this topic in a meaningful story
that you can take with you into the future.
In our workshops, our clients experience all
four prompts in one two-hour session com-
pressing the Pennebaker Paradigm four-day
writing experience into a series of four 20
minute writing experiences. Research with
the paradigm suggests health benefits accrue
with as little as a few minutes of writing with
only short periods of time between writings.
We believe this may suggest the key to health
benefit has more to do with the progression
of the writings, the depth of expression and
the shift in perspective rather than the amount
of time spent of writing.
29

Following each writing experience, our
participants write a reflection about their
experience, and then share this reflection,
in discussion, with two fellow workshop
participants. The reflection writing is a key
part of our process. In reflecting upon their
writing experience in response to the Pen-
nebaker prompts, and then reading these to,
or discussing this with, the fellow workshop
writers, many unconscious and internal issues
are raised to their consciousness and are lead
to the self- awareness and self- knowledge that
we spoke of earlier. The alchemy takes place
in that often their perspective of the subject
about which they have written is changed, and
it takes on a new meaning. Louise de Salvo
(1999) says that a healing is often a change
in perspective. What is of great importance
in the writing in response to the Pennebaker
prompts, is the movement from expression of
the trauma, to finding the meaning and purpose
of that trauma within the writer’s life, which
allows the change in perspective and begins
to facilitate healing.
The following is a reflection from one of
our clients, following the expressive writing
exercise.
My first two days seemed to spew negativity.
After that, it was remarkable how I could shift
my perspective by writing about my feelings.
This exercise gave me insight into the pos-
sibility of examining my life, learning from
my past and using it to inform my future, not
control it! What a concept. While I am joyful
at this discovery, I am also sad that I have
suffered years without this knowledge. I am
also aware of how little I really know about
myself on a conscious level. Depression and
food have been my companions. Can I learn
more about them by writing?
30

Write to Transform Your Health
The Process: Transactional Writing
The second type of writing used in our work-
shops is transactional writing. Transactional
writing is so named, as it involves a “ trans-
action” in that it is writing to an audience.
Whereas in expressive writing, we encourage
participants to simply write, paying no atten-
tion to grammar and spelling and writing form,
but rather to that which needs to be expressed,
transactional writing is formal writing, usu-
ally taking the form of a letter. Participants
write in the form of a letter, addressed to a
particular person (themselves, a friend, a par-
ent, a teacher, a loved one etc.). This letter is
usually not sent to the person to whom it is
addressed. Rather, it is kept privately by the
writer, or sometimes symbolically destroyed.
There are several different types of letters:
1. The Compassionate Letter,
2. The Empathetic Letter,
3. The Gratitude Letter, and
4. The Forgiveness Letter.
During the workshop, participants spend
about 20 minutes writing the letter privately.
After writing the letter, participants write a
reflection about this letter. This is followed by
discussion in groups of three (triads), about
the experience. Participants may choose to
share their letters if they wish to, or share their
reflections only. Many insights are gained by
writing the reflection, and then by sharing the
experience in discussion.
Below are several reflections written by
participants of our workshops.
• I wrote an empathic letter to my ex-wife. We
were married for 32 years and we divorced
20 years ago. We meet a couple of times
each year at my daughter’s house, and we

Write to Transform Your Health
get along well. The divorce was very trau-
matic for me, and difficult for her (though
she requested it). My letter expresses my
attempt to understand and sympathize with
what I imagine were her feelings about our
marriage. I have thought about her feelings
many times but this was the first time I had
written about them. The letter was difficult
to write, and it left me with sad and regret-
ful feelings. I certainly do not feel happy
thinking about the marriage and divorce,
but I feel a greater sense of calmness and
closure after writing the letter. The experi-
ence has thus been very productive.
• This was a very meaningful experience. It
was surprising to learn the depth of con-
cern I held for the difficult time my adult
daughter is experiencing. I have offered
to send it to her so that she may know the
depth of my concern and love.
• I did not find it difficult to write to some-
one about my traumatic experience because
it was meant to help them deal with theirs.
The person I wrote to is a friend about my
age who has a similar medical condition
and treatments that I can relate to easily. We
share similar supportive life partners and
spiritual resources to help us cope with our
traumas. It felt good to be able to communi-
cate with her in this manner. Being helpful
is an uplifting experience for me!
The Process: Poetic Writing
Poetic Writing is divided into two sections:
poetry and creative non-fiction. Poetic writing
is defined as writing which expresses the hu-
man condition using figurative language and
narrative structures. It is imaginative, descrip-
tive, rich and detailed, tells stories and uses
metaphors and analogies. It includes poetry,
prose, essays and creative non-fiction. In our
workshops, we usually choose two poems to
begin our poetic writing work. We read the
poems aloud and then provide the scaffolding
of these poems i.e. keywords from the poems
with blank spaces in between, to our clients.
They then write their own poems using this
scaffolding to guide them. This is a wonderful
exercise! Beautiful poems are produced and
participants are often deeply surprised by
what they are capable of writing, using the
scaffolding. One of the key purposes of poetic
writing, is to change the writer’s perspective
about a topic. One of our favorite poems is
Otherwise by Jane Kenyon.
Here is an example of one participant’s
poem, using Jane Kenyon’s poem for scaf-
folding.
Otherwise

I got out of bed, 

Sheets silky, white cat purring, 

It might have been otherwise. 

I delighted

In a hot cup of tea

It might have been otherwise. 

I played with my children on my bed.
Laughter, tickling, joy. 

All morning, I read, wrote and ran, Some of
my favorite things. 

At noon I reveled in a hot shower, then

Went to a friend’s house. 

It might have been otherwise. 

We ate dinner, Moroccan and delicious. 

Drank wine, shared stories, laughed, ate
more, drank more. 

I slept in a bed, 

Hydrangeas outside my window, 

My children’s artwork on the walls and
planned another day, 

Just like this one. 

But one day, I know it will be otherwise.
For our second section on poetic writing,
we use an essay by Langston Hughes, named
31

“Salvation.” We read the essay aloud to the
workshop participants, and then have them
write for 15 minutes about a “rite of passage,”
which was significant in their own lives.
Following this, they write a reflection and
then discuss this in groups of three.
Here is a reflection from a participant:
This was not an easy piece to write -- in part
because I chose a deep wound. But I realized
in writing this, how important it is to be true
to what I believe whether it is what my family
or others want to hear. We can be haunted
by the ghosts of things that we did not say or
situations that we did not confront.
In terms of my own development, I have
learned to listen carefully to others and try
to understand what they really mean. I have
also learned that sometimes it is enough to
sit quietly with someone in a tough situation
and not judge them when times are difficult.
The Process: Affirmative Writing
Next in the writing process is Affirmative
Writing. This moves the workshop participants
along the journey from darkness and difficulty,
to light, insight and hope. This exercise begins
by having participants examine their values
and their strengths and skills. They write a
list of those things that they most value in
life such as friendship, integrity, loyalty or
adventure. Following this, they write a list
of their personal strengths or talents such as
being creative, or organized, being gifted as
a teacher or a writer. Fusing what they most
value, with their skills and strengths, they then
write a “vision” of themselves in 6 months’
time, painting a picture of themselves with
words. This is written in the present tense.
This is the prompt:
32

Write to Transform Your Health
Visualize the change you wish to see in your
life, and write it all down in first person present
tense. I am now…” Describe the change by
naming it, and by describing a typical good
day as a result of this change. Observe the
change in your reflective writing as it takes
place over the next days, weeks, and months
until you are the change you wish to see.
Write about yourself six months from today.
What do you look like? How do you feel?
How do you express yourself? Describe your
self talk, your interactions with others, your
relationships, your work, your recreations.
These are reflections of previous partici-
pants, following this exercise:
• Very meaningful – I know how positive
and effective affirmative writing can be.
Especially valued the connections made
between values and gifts. As well as the
process of individuation ; at age 48, I feel
I am just now individuating from my fam-
ily’s values, a number of which are not my
own. The discord between my values and
that of my family has been an important
part of both my depression and low self-
esteem. Thank you for helping me better
understand this.
• This was one of the most, if not the most,
rewarding assignments for me. I love the
idea of putting into the written word what
we want for ourselves in the future.
• This exercise stunned me. Visualizations
are always a challenge for me and far too
abstract. Writing into the future however
was truly a transformative experience. I
felt like I was on a journey.

Write to Transform Your Health
The Process of Legacy Writing
Finally, in the writing process, we teach
Legacy Writing. Here we think about ourselves
in the future, looking back on our lives, and
imagining what the legacy is, which we hope
we will leave. This helps us decide how we
would like to live now, in this present moment.
We ask participants to write down five words,
that they hope would be used to describe
them. These five words, such as “ honest”
or “ enthusiastic”, can be used to guide their
living in the present moment and the choices
that they make today. This is a powerful and
simple exercise.
Legacy writing can also take the form of a
letter written to share those values and hopes
and dreams that are important to us and that
we wish to share with others, for example, with
a child, upon their graduation form college
or as a keepsake for a new grandchild. It can
also take the form of a blessing that we wish
to give someone. During this session, we have
participants write a short letter to someone,
as a blessing or as deeply cherished wishes
and values that they wish to share.
Of the five genres of writing in ‘Transform
Your Health: Write to Heal,’ legacy writ-
ing may be extended beyond the scope of a
weekend retreat. In one workshop, a woman
who had gone back to school to become a
veterinarian after starting a family, discov-
ered she wanted to create something for her
sons, ages eight and ten, to explain what she
wanted them to know about that time in the
their lives when she was not always there when
they expected her, but that she was fulfilling
a lifelong dream. She created a photographic
essay with written description of the various
stages and aspects of her training to become
a veterinarian and presented to her sons as a
legacy memorializing this part of their lives.
She explained that this kind of legacy writing
expressed a value that she wished to pass on
to her sons, the value of following your dream
where it leads despite the timing.
CONCLUSION
Several genres of writing are used in our
workshops to serve as a tool for clients for
mind-body healing and well-being. Each genre
of writing serves a purpose. Expressive writing
is cathartic. It is a tool for the client to reveal
to himself or herself, on paper, experiences
which have been buried within. This provides
the client with the opportunity for catharsis
and with an opportunity for self-examination.
Transactional writing serves the purpose of
finishing “unfinished business,” with our-
selves or others in our lives. Poetic writing
is a powerful tool for changing perspective.
This change in perspective is at the core of
healing. Affirmative writing serves the pur-
pose of creating a clear vision for our lives,
based on our values, strengths and skills. This
vision provides a roadmap of how we may
move forward, using our strengths and skills
to contribute to the world and live joyfully.
This way of living leads to vibrant well-being.
Legacy writing provides us with a way in
which to communicate what is important to
us, to others. Through legacy writing we can
bless others, or share our values and wisdom.
Legacy writing also facilitates purposeful,
intentional living.
Living intentionally, knowing our purpose,
being true to ourselves and our values, and
being mindful of the creative power of our
language leads us to healing and optimal
and vibrant well-being. This is the purpose
of writing to heal.
33

REFERENCES
Bailey, M. (2014) The mindful physician.
Lorice Coaching & Consulting, LLC. Re-
trieved from http://www.drmichellebailey.
com/about.html
Bolton, G. (2005). Reflective practice: Writ-
ing and professional development. Thousand
Oaks, CA: Sage.
DeSalvo, L. (1999). Writing as a way of heal-
ing: How telling our stories transforms our
lives. Boston, MA: Beacon Press.
Evans, J. (2010). Wellness & writing connec-
tions: Writing for better physical, mental, and
spiritual health. Enumclaw, WA: Idyll Arbor.
Frankl, V. (2006). Man’s search for meaning.
Boston, MA: Beacon Press.
Fredrickson, B. (2009). Positivity. New York,
NY: Three Rivers Press.
Kabat-Zinn, J., & Hanh, T. N. (2009). Full
catastrophe living: Using the wisdom of your
body and mind to face stress, pain, and illness.
New York, NY: Random House LLC.
Kominars, S. (2010). Write for life: Healing
body, mind, & spirit through journal writing.
New York, NY: Kaplan.
Lepore, S., & Smyth, J. (2002). The writing
cure: How expressive writing promotes health
and emotional well-being. Washington, DC:
APA. doi:10.1037/10451-000
Pennebaker, J. (1990). Opening up: The heal-
ing power of expressing emotions. New York,
NY: Guilford.
Pennebaker, J. (2002). Emotion, disclosure,
and health. Washington, DC: APA.
34

Write to Transform Your Health
Pennebaker, J., & Evans, J. (2014). Expressive
writing: words that heal. Enumclaw, WA:
Idyll Arbor.
Seligman, M. (2012). Flourish. New York,
NY: Free Press.
Stockdale, B. (2009). You can beat the odds:
The surprising answers behind chronic illness
and cancer. Boulder, CO: Sentient.
Zolli, A., & Healy, A. M. (2012). Resilience:
Why things bounce back. New York, NY:
Free Press.
KEY TERMS AND DEFINITIONS
Affirmative Writing: Personal, usually
intended for the self, it states expresses desired
outcomes with specific descriptions and with
positive language.
Expressive Writing: Personal writing,
always intended for the self. Not meant to
document, memorialize, judge, analyze or
critique, it simply expresses in personal lan-
guage our deepest feelings about intensely
significant events.
Legacy Writing: Writing that communi-
cates a message to self or others as we wish
to be known by those we love.
Mindfulness: Paying attention, on pur-
pose, to the present moment, non-judgmen-
tally.
Poetic Writing: Personal, intended for
self or others expressing our experience of
the human condition in metaphoric language
and often using narrative structures.
Transactional Writing: Personal writing
that communicates a message to self or oth-
ers using conventions inherent in personal
correspondence.
 35

Chapter 3
Teacher Stress and Anxiety:
The Infinite Quest for Inner Peace

Casey M. Brown
Centerville High School, USA

ABSTRACT
This chapter illustrates the author’s struggle with stress and anxiety associated with the teaching pro-
fession. After conversations with colleagues, it is apparent that many teachers drive to and from school
with knots in their stomachs, exhausting themselves with worry about students, parents, administra-
tors, state standards, and more. As educators, we search to find balance between our school lives and
our “normal” lives. We struggle to take a mental break from our jobs. In this chapter, the author uses
a multigenre style to illustrate her anxiety and healing throughout her teaching career. Many authors
write about the needs of the student, yet it is also worthwhile to explore the mental health of teachers.
Teachers cannot best serve students if teachers cannot first take care of themselves. It is an idea that is
often overlooked, and the author hopes this chapter may help educators who have experienced similar
issues of anxiety in their careers.

DISCLAIMER 1: I AM NOT A
DOCTOR. I AM A TEACHER.
I was diagnosed with anxiety in 2005, my
fifth year of teaching. I became paralyzed
with fear while doing the job that I felt I was
called to do. I was prescribed medication and
therapy that helped me manage my anxiety.
I was able to return to the profession I truly
loved without feeling the fear of panic in my
classroom. Despite my successes, even today,
after fourteen years as a secondary teacher,
I still lose sleep over student issues and les-
son plans for the next day. I still struggle to
free myself from the stress and demands of
being “on” every day no matter what. I have
realized that I am not alone in this struggle.
Many of my teaching colleagues face similar
challenges. I have decided to tell my story to
help others. Maybe other educators will not
feel so alone in their struggles with stress
and anxiety. Maybe all of us stressed out and
sometimes anxious teachers can help each
other heal just a little bit.

DOI: 10.4018/978-1-4666-7524-7.ch003

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.
 
Teacher Stress and Anxiety

DISCLAIMER 2: ANXIETY ABOUT just stare at me? What if I finish way early?
WRITING ABOUT ANXIETY What if I take way too long? What if—


These pieces, although based on my experi- (BELL RINGS) 


ences, are not 100% true. I have used creative Here they come…
license when needed by adding characters,
changing names, borrowing stories from The Vicious Cycle: Part 1
close friends, etc. This is a memoir, yet a
semi-fictional memoir. Mostly true, but not Planning

100% true. Grading

I feel anxious about sharing my story, but Email

I think ultimately it is a good thing. I feel Worries

anxious that others might feel I am portray- Sleeplessness

ing them unjustly (especially the fictional Planning

representations based on teachers I know). Grading

I feel naked to the world when I put what I Email

have gone through on paper. I hope you will Worries

accept this paper with an open mind and no Sleeplessness

judgment. Planning

I just wanted to put this out there to feel a Grading

bit less, you know, anxious… Email

Worries

1st Year of Teaching Journal Sleeplessness

Planning

See Box 1. Grading

Email

Just Before Class Worries

Sleeplessness

There’s a bell that runs my life.
 Planning

Most grown-ups escape it. Not me. 
 Grading

Every 54 minutes a bell. Five minutes pass. Email

Another bell. 
 Worries

Sleeplessness

Like rats in a cage, we live and die by a Planning

bell. 
 Grading

With every bell, there is a pit in my stom- Email

ach. 
 Worries

Sleeplessness
Is everything set? What am I doing first?
And then after that? And what if they don’t
get it? What if they are bored? What if they

36

Teacher Stress and Anxiety

Box 1. ­

January 17, 2001

How did I not know? How did I not know how much exhaustion I would face as a
teacher? I’m 22 years old, and I’m in charge of five classes of fourteen to
eighteen-year-olds. Five different classes with five different textbooks and
five different workbooks (and CDs and test books and listening activity work-
books,…so much…) Five hours of presentation a day and non-stop juggling. And
just plain acting.

“Mme Brown, you’re always so happy! Are you ever in a bad mood? You never seem
stressed.”

Oh, but I am. Yet, it’s easier to present a happy face. And it motivates the
students more if I don’t really show them how tired I am. “Never let them see
you sweat?” “Fake it ‘til you make it…” Teacher mottos to live by…

Don’t get me wrong—I love teaching. It’s all I ever wanted to do, and I’m hap-
py to do it. I feel oddly at home and “in the zone” in class. You might even
say I’m doing pretty well at it. However…to do well, I’ve been driving myself
insane. I don’t leave school without at least two to three hours of work to
do. Weekends consist of me on the floor surrounded by my lesson plan book and
mounds of textbooks. I have family functions where I always bring things to
grade. It never ends.

And when I’m not planning or grading, I’m thinking about school. When I wake
up, when I go to bed, when I’m in the shower, when I’m driving to and from
school, I’m constantly prepping for or reflecting on lessons. Is this normal?
Am I crazy?

Daily, I am torn between the highs of teaching and the exhaustion I feel from
doing it all. Does this ever get easier? I can’t imagine it does. I just want
one day where my brain can relax and not think about school. Just one day…

Oh, and today I agreed to coach dance and lead sophomore student council.

I think I am crazy.

The Vicious Cycle: Part 2
Monday Lesson Plan: Read short story and
submit a one page reaction.
Monday night plan—goal is to read 70
reactions. Save 70 others for tomorrow night.
Monday night reality—read 46…fell
asleep.
Tuesday Lesson Plan: discuss short story.
Vocab quiz tomorrow. Rough draft of research
papers due Thursday.
Tuesday night plan—goal is to finish read-
ing reactions. Finish creating vocab quiz. Be
first at school tomorrow to get to copier to
copy vocab quiz. Answer parent emails. One
parent very angry about make-up work taking
a long time to grade. Ugh…

37

Tuesday night reality—all done. Cannot
sleep. Graded other reactions. Parent email
hurt my feelings to the core. Behind on grading
make-up work. Must grade it all tomorrow.
Worried about not getting to copier on time
to get vocab quizzes copied. Trying to find
peace so I can sleep.
Wednesday Lesson Plan: Vocab quiz. Pass
back reaction papers.
Wednesday night plan—goal is to grade
all vocab quizzes.
Wednesday night reality—still grading
make up work. Halfway through a stack of
vocab quizzes. Principal told me he needs to
observe me this week (Thursday or Friday?)
Students were not happy with reaction paper
grades. Hours upon hours of grading for dis-
satisfactory responses from students about
their B’s. They all wanted A’s. So did their
parents. Worried about the emails to come.
Cannot sleep again. Need to get up early to prep
for pre-observation with principal during my
plan period. Losing my 54 minutes of plan…
Thursday Lesson Pl—Screw it…you get
the idea…
Heart Attack at Age 26
This cannot be happening. Oh God. My chest!
Why is my heart beating like this? And my
Box 2. ­
January 7, 2005
Got dizzy today in class. Just after lunch. Looked out at the students, and
they started to spin in my head. Students went to get the principal for me be-
cause I couldn’t walk straight. What the hell?
January 10, 2005
Took a relaxing bubble bath after coaching and grading papers. Felt like my
chest was going to collapse. Definitely thought I was having a heart attack.
Scariest moment of my life. I’m okay, but shaken.
38

Teacher Stress and Anxiety
chest! Oh my God. I cannot breathe. This is
a heart attack. It’s like nothing I’ve ever felt.
I must sit down. Should I call 911? Seriously.
I’m all alone in this house and they will find
me dead here. I need help.
(Call the neighbor) “Can you come over
here? I feel like I’m having a heart attack, but
I don’t want to call an ambulance yet. Not sure
what to do. So scared.” Tears start to come
and sheer panic. I’m dying. This is the end.
Dizziness. I cannot breathe now. I can hardly
swallow. I’m starting to suffocate. I want to run
out of this house, but to where? Should I call
911? What the hell is going on? Somebody.
Anybody. Please help me!
False alarm.
Are you serious?????
15 minutes later, and it looks like I’m just
fine.
What the hell was that?????
5th Year of Teaching Journal
See Box 2.
Psych Eval
Psychiatrist: Do you feel stress and anxiety
often?
continued on following page

Teacher Stress and Anxiety

Box 2. Continued
January 11, 2005

Internet says it was a panic attack. What the hell is wrong with me?

January 12, 2005

Am I having panic attacks?

Here’s what the library book by Davidson (2003) says: Ask yourself if you are
having any “episodes lasting up to a half hour that are characterized by in-
tense fear accompanied by one or several of the following physical sensa-
tions or feelings: trembling, pain, nausea, dizziness, numbness, tingling, hot
flashes, cold flashes, shortness of breath, a choking sensation, a sense of
detachment or unreality, fears of losing control, or fears of dying” (p. 51).

Yep…that’s me...I feel like a crazy person.

January 13, 2005

More info about anxiety from Davidson’s book: symptoms of anxiety include
“chronic fearfulness, difficulty concentrating, irritability, sleeplessness,
obsessive thoughts, ritual behaviors, avoidance of normal work challenges or
social situations” (p. 15).

Yep…that’s me…even more of a crazy person. I swear these books are telling the
story of my life. Why didn’t someone label me with this a long time ago?

January 14, 2005

Couldn’t drive to school today. Tried. Got dizzy driving out of our neighbor-
hood. Turned around and went home. How am I going to get there? Am I ever go-
ing to feel normal again?

January 15, 2005

Can’t get to school. Can’t get out of bed. Afraid of dizzies, driving, panic
attacks, expectations, death, failure, public speaking, having to leave my
classroom, and everything you could possibly fear. Overwhelmed and crying.

What am I supposed to do????

39

Me: All the time. I’m always “on” and need
to be at my best.
Psychiatrist: You’d be amazed how many
teachers I treat for anxiety.
Me: I kind of feel like I’m the only one some-
times. Everyone else seems to have it
together.
Psychiatrist: And what is their perception
of you?
Me: That I have it all together.
Psychiatrist: Exactly.
Me: So we’re all suffering the same anxiety
but hiding it under masks of confidence?
Psychiatrist: Most of the time.
Me: Makes sense. They should have some
sort of support group for us all.
PAXIL
Paralyzed with fear
 • Journaling
Anxiety
 • Weekly sessions with therapist.
eXpectations too high

I cannot live like this
 More from 5th Year Journal
Let’s medicate
RECOMMENDED READING
BY PSYCHIATRIST
Direct quote from the Mayo Clinic’s website
on lifestyle and home remedies to treat gen-
eralized anxiety disorder (2011):
• Get Daily Exercise: Exercise is a powerful
stress reducer, can improve your mood and
can keep you healthy. It’s best if you de-
velop a regular routine and work out most
days of the week. Start out slow and gradu-
ally increase the amount and intensity of
exercise.
40

Teacher Stress and Anxiety
• Eat a Healthy Diet: Avoid fatty, sugary
and processed foods. Include foods in your
diet that are rich in omega-3 fatty acids and
B vitamins.
• Avoid Alcohol and Other Sedatives:
These can worsen anxiety.
• Use Relaxation Techniques: Visualization
techniques, meditation and yoga are exam-
ples of relaxation techniques that can ease
anxiety.
• Make Sleep a Priority: Do what you can
to make sure you’re getting enough quality
sleep. If you aren’t sleeping well, see your
doctor.
RX for Casey M. Brown, 26-Year-Old High
School Teacher
• Paxil CR 20 mg/day
• Meditation/breathing/yoga
See Box 3.
Start of 6th Year Journal
See Box 4.
More Recommended Reading
from the Psychiatrist
Davidson’s The Anxiety Book. Davidson
(2003) claims that with SSRIs (anti-depres-
sants like Paxil) help the brain make more
serotonin connections from neuron to neuron.
These connections are crucial to stable moods.
The success rate for SSRIs used for any anxiety
disorder ranges from 60-80 percent (p. 214).

Teacher Stress and Anxiety

Box 3. ­

February 15, 2005

Back to school for a while now. Feel somewhat normal and that is nice. Calmer
about teaching, but maybe a little too numb. At least the vertigo is gone and
I can get here every day. Do I seriously have to be medicated to succeed in a
job I was meant to do? Ugh…celebrate the small victories like showing up and
doing a good job. I’ll take it for now.

Box 4. ­

August 15, 2005

Starting year six tomorrow and finally feel okay. I am not going back to
school following tears of anxiety. Thank God for Paxil! I can’t believe I’ve
been stressed for all my school years, and everyone else feels like I feel to-
day. If this is normal, then I want to feel this way forever! No more paralyz-
ing stress. This will be my stress-free, Paxil-induced year.

Psychiatrist Session, Fall If you have panic disorder, consider cutting

of 6th Year of Teaching back (caffeine) entirely, since even 1 cup might
contribute to panic. Don’t indulge in more than
Me: I want to start a family this year. I finally 3 or 4 alcoholic beverages a week (p. 251).
feel like I can take it on.
Psych: You need to get off your meds if you can A Love Letter
before trying. It’s just safer for the baby.
Me: (feeling defeated) I don’t think I can do it. See Box 5.
Psych: We can wean you off the meds. We
will continue counseling. We can explore More Recommended
alternatives to help you that will not be Reading by Psychiatrist:
harmful for a fetus.
Me: I don’t know if I can. I’ve only felt this Complete workbook pages to work through
stress-free with these drugs. some of your thoughts:
Psych: You can do it. We will work on it
together. • The Anxiety and Phobia Workbook by
Edmund J. Bourne (2011).
More Recommended Reading
from the Psychiatrist Thanks, Doc. This is actually easy to fol-
low and helpful to me.
Davidson’s The Anxiety Book. He makes the
following recommendations:

41
 
Teacher Stress and Anxiety

Box 5. ­

Dear Diet Coke,

Ours has been a love affair for a decade. It started off innocently enough. An
occasional can here, a 20-ounce bottle there. My love for you grew and grew.
It almost became an obsession.

At first, I would only have you at lunch. But then the temptation grew. I
would have you again at dinner. And at restaurants, always with a lemon. Soon,
I needed you in the mornings too. I was seen teaching my first period class
with a can of Diet Coke in my hand. I couldn’t part from you. In fact, I need-
ed you more and more. The fizz, the burn down my throat, and the taste was
what I craved. It has been a delicious relationship.

Recently, things haven’t been as good for me. I’m shakier at work. My heart
beats fast, and I have been getting dizzy. My doctor is saying I should try
saying goodbye to you. As much as it pains me to say it, I think he is right.
I can’t stand the thought of being without you. I’m lost as to how I am going
to make it without you. But I feel like for my own sanity, I have to at least
give it a try.

Please know that every water I have to drink now, I will be drinking the wa-
ter, but imagining it is you.

It’s not you. It’s me. It’s always been me. Maybe after I finish working on
myself, I can get back to loving you again. Only time will tell.

Much love,

Casey

Teacher Conversation (14th Must Get Sleep

Year of Teaching)
3:00PM: School dismissed.
Teacher Friends: What is the chapter you’re 3:15-5:15PM: Coach dance.
working on about? 5:15-5:45PM: Drive home.
Me: Teachers and anxiety. 5:45-6:15PM: Eat dinner.
Teacher Friends: You could interview all of 6:15-8:15PM: Plan lessons.
us. We all qualify. 8:15-10:15PM: Grade some tests.

42

Teacher Stress and Anxiety

10:15PM: “Must get sleep.” I can’t go to school tomorrow.

10:16-10:32PM: Rethink all lesson plans 
But I have to. 

for tomorrow while trying to fall asleep. And I love to. 

10:33PM: “MUST get sleep.” But I physically and emotionally can’t. I
10:34-11:30PM: Get up and finish grading just can’t. 

the rest of the tests. But I do.
11:31PM: “MUST get sleep.”
11:32-11:48PM: Think about test scores. Sunday Night Text Message
Maybe I should reteach the first concept.
11:49-12:16AM: Rethink tomorrow’s lesson Jen: Sunday blues again…
plan. Running them over in my head for Me: Wine?
each class. Jen: Yep. 2 glasses.
12:17AM: MUST GET SLEEP. Me: Me too:)
12:18AM: MUST GET SLEEP. Jen: Essays not graded. Feel like a failure.
12:19AM: MUST GET SLEEP. Took grading to my cousin’s bday party.
Got harassed the whole time. Finished
Casey’s Drug-Free Plan to Reduce 15 essays. 15 more to go. Ugh…
Anxiety: The No-More-Paxil Plan Me: Ugh is right! I need one more day. I feel
sick about it.
• No caffeine. Jen: Me too. Wine is the answer.
• No alcohol. Me: So true…so true…
• Exercise (heart rate up)—30 minutes—
four times a week. Another Night Text Message
• Breathe/meditate every day.
• Positive self-talk: YOU CAN DO THIS!! Me: Feel like crying. Can’t go back there.
Jen: What happened?
I Can’t Me: Roberta told her students I didn’t cover
what I was supposed to cover and now she
I can’t go to school tomorrow. 
 has to re-teach it. NOT TRUE! Former
I just can’t. 
 students are asking me if Roberta hates
Tearing up. Eyes crying. Just want to stay me because she makes comments. Feel
home. 
 sick about it.
I can’t go to school tomorrow. 
 Jen: She’s just jealous and unprofessional.
Overwhelmed. 
 You are a good teacher. Your students
Overwhelmed. 
 learn what they are supposed to. She’s
So much to do. And after school. So much just being a bully.
more. 
 Me: I’m so tired—exhausted—of having to
I can’t go to school tomorrow. 
 defend myself to insecure people who
Nervous stomach. Brain keeps churning try to make my life hellish.
ideas. 
 Jen: Amen! It’s the same thing in my depart-
Why do I get this way? 
 ment. Why can’t we just teach?

43

Me: Seriously!
Jen: Hang in there.
Me: Thanks. Hope I can sleep tonight. School
is all over my brain. Now I feel like vom-
iting. Walking in the building makes me
feel sick.
Jen: I hear ya. It’s like that for me sometimes.
Back to wine…
Me: Yep…back to wine.
Another Text Message
Jen: SLOs make me break into a sweat.
Me: SLOs make my stomach churn.
Jen: No time to add more to this plate.
Me: Want to buy an apartment in the south
of France and escape?
Jen: Meet you at the airport tomorrow morn-
ing.
Mantras for Driving to School
1. You can do this.
2. You’re a good teacher.
3. Your students are learning a lot.
4. You can do this.
My Calling
Teaching is all I want to do.
All I have ever wanted to do.
Email to All Staff From Our Principal
TO: ALL STAFF
RE: SLO—Student Learning Objectives
Message: New state mandates require all subjects to be tested in September and
April. We need you to collaborate to create assessments to measure SLOs—stu-
dent learning objectives—over the summer. We will be gathering data based on
how students perform. Not sure what we will do with the data, but be prepared.
Lots of changes ahead for us.
44

Teacher Stress and Anxiety
Yet the amount of stress and anxiety kills
me.
It is killing me.
8:00 AM to 3:00 PM I adore working with
my students.
3:00 PM to 8:00 AM I cannot clear my
mind. Stress overwhelms me.
Is it normal?
I love my job. It is my calling.
Is it normal?
It is killing me.
AN ATTEMPT AT COGNITIVE
BEHAVIORAL THERAPY (CBT)
Psych: I want you to do some cognitive be-
havioral therapy.
Me: What’s that?
Psych: The National Institute of Mental Health
states that “cognitive-behavioral therapy
(CBT) is very useful in treating anxiety
disorders. The cognitive part helps
people change the thinking patterns that
support their fears, and the behavioral
part helps people change the way they
react to anxiety-provoking situations.
For example, CBT can help people with panic
disorder learn that their panic attacks are not
really heart attacks and help people with so-

Teacher Stress and Anxiety

cial phobia learn how to overcome the belief • Thursday: Run 30 minutes/weight/abs.
that others are always watching and judging • Friday: Yoga.
them. When people are ready to confront their • Saturday: Run 1 hour/weights/abs.
fears, they are shown how to use exposure • Sunday: Off.
techniques to desensitize themselves to situ-
ations that trigger their anxieties” (“Anxiety This will be great!
disorders,” n.d.).
Letter from a Former Student
My Challenge (5 Years after His High
School Graduation)
In times of great stress, there is great op-
portunity for growth. 
 See Box 6.
Your brain is a muscle. Exercise it, and it
will be stronger. 
 Reflection on Daniel’s Letter
Train your brain to be afraid, and you will
be stronger at creating fear. 
 If he only knew…I taught him during my first
Train it to move past a fear, and you will be five years, and I was terrified…and loving
stronger at knocking down fears. 
 it all at the same time. I guess that is what
Each day I choose to get up, get dressed, all teachers face. A paralyzing anxiety and
and drive to school, I’m exercising my rewards beyond measure. Well maybe not to
brain to be stronger in these activities. 
 that extreme…but pretty close. I would wish
If I falter, if I stay home, my brain becomes him well on a stress-free career in teaching,
stronger in the wrong direction. I become but I think everyone knows that is an impos-
stronger at being weak. 
 sible goal.
I can strengthen anxiety lines in my brain. 

Or I can strengthen anti-anxiety lines in my Conversation with My
brain. 
 7-Year-Old Son
It’s my choice. 

I choose to keep fighting, go against my Owen: What’s wrong, Mommy?
fears, and come out stronger on the other Me: Mommy’s just a little stressed.
side. 
 Owen: What is “stressed?”
In times of great stress, there is great op- Me: Mommy just has to get these papers
portunity for growth. 
 graded tonight and make sure I have
And I continue to grow stronger every day. everything ready for my classes tomor-
row. And I feel like I don’t have enough
Afterschool De-Stress Exercise Plan time to get it all done. That makes me
feel stressed.
• Monday: Yoga. Owen: My teacher doesn’t get stressed.
• Tuesday: Run 30 minutes/weights/abs. Me: She might not show it in class, but I bet
• Wednesday: Elliptical. she does.

45
 
Teacher Stress and Anxiety

Box 6. ­

Ms. Brown,

I just wanted to let you know I am graduating from college tomorrow, and I
wanted to thank you. After twelve years of school and five years of college,
you top the list of educators who have inspired me. I’m thankful I took your
class and that I had the privilege of having you as my teacher.

Every day you were energetic and excited about teaching. You made us want to
be there. You were passionate and compassionate. You made us care for your
subject and for each other. I looked forward to coming to your class every
single day.

Now, I am going to be a high school teacher. When I was student teaching, I

would get so nervous and stressed out. I would channel your calm and confident
demeanor. I don’t know how you made it look so easy. I realize now how hard it
truly is. I hope someday to teach and inspire others like you inspired me.

Thanks for everything. I appreciate it all.

Love,

Daniel

Owen: Nope. Her lessons are always ready to
go. I don’t think she has to do anything
at home.
Me: I’m sure she has to prepare things for
your class. All of your lessons, papers,
homework,…she has to make sure it is
ready for you. Owen, do you ever feel
stressed? Like if you have too much to
do or something just makes you worry?
Owen: No.
Me: You may feel stressed during your spell-
ing tests? Like when you’ve studied all
week and you want to do your best and
show what you know? That might be what
stress feels like in your life.
Owen: Nope. She just reads the words and we
write them down. Not stress. Just easy.
Me: I hope it stays that way for you…
Year 14 of Teaching:
Where Am I Now?
Journal Entry
See Box 7.

46

Teacher Stress and Anxiety

Box 7. ­

January 31, 2014

Well, here I am. Anxiety? Do I still have it? Yes. About teaching? Yes. About
life? Yes. Is it as bad? No.

Year five was definitely my peak with vertigo, panic attacks, and anxiety.
Therapy and meds helped a lot. I did manage to drop meds and replace them with
exercise and a semi-healthier lifestyle. I still make sure I exercise a lot to
manage my stress and anxiety. I had originally dropped all caffeine, but I now
have chocolate daily and an occasional decaffeinated coffee.

Now, I do not have panic attacks, which is awesome. I do feel chronic stress
and lots of worry about the details of school and life. Probably more so than
“normal” people, but not more so than many of my teacher friends.

Fear of public speaking is always one of the top fears for people. For me, I’m
not afraid of speaking. I just always want my presentation to be engaging (for
teenagers) and valid and educational and worthwhile and energizing. That’s a
lot of pressure five classes a day, five days a week.

I see people who work “normal” jobs stress because they have a presentation to
give. They say things like, “I have a big presentation this week for a cli-
ent coming in from (any given place).” This means they have to prepare one
presentation, one PowerPoint, maybe some handouts. They need to think about
what they are going to say and how they are going to keep their audience’s at-
tention. The night before (or even the week before), they might have trouble
sleeping because they might be running through the presentation over and over
in their heads. They want it to be perfect. No one wants to step in front of
a room full of people and be boring, disorganized, or uninformative. Their
hearts beat faster than usual as they approach presentation time. They might
get a little sweaty, or talk a bit faster. And when the big presentation is
over, they breathe a sigh of relief. Pleased with the results, they head home
and celebrate a job well done. And wait for the next big presentation to come.

Teaching is just like preparing those presentations. Five (or more) times a
day. Five days a week. It’s no wonder teachers are balls of stress ready to
explode. In addition to engaging 150 or so students we see each day hour af-
ter hour, we have to please their parents and our administrators. And pray we
don’t slip and say something any student or parent might deem inappropriate or
politically unacceptable. We have to constantly watch guard over what we post
on Facebook or Twitter, and what we say in circles of parents in our neighbor-
hoods. We are never allowed to let loose and be ourselves. We are held to a

continued on following page

47
 
Teacher Stress and Anxiety

Box 7. Continued
higher standard as teachers. It’s a lot of pressure that very few careers have
to face.

Outside of the day-to-day teaching assignments, teachers have to take on a

lot of other roles including counselor. Kids come to teachers and express a
lot of what is going on in their lives. Students tell me they think they might
be pregnant. They tell me about their problems at home, in other classes, and
with their friends. They have friends using drugs, parents abusing alcohol,
and other things in their lives they can’t handle. They have eating disorders,
relationship issues, peer pressure, and more. We carry the students’ stresses
and burdens with us 24-7. There is no off-switch. There is truly no “break.”

I have learned, ultimately, that this is what life is like for a teacher. And
I have learned that I am okay with that lifestyle. My life is fulfilled as a
teacher. I still cannot imagine doing anything else. I am forever seeking bal-
ance and peace, and I’m getting closer. I am much closer than I was ten years
ago, or even five years ago. My confidence as a teacher has grown—I know I’m
making a difference and my students are learning a lot. My love for my stu-
dents is too much for words. I look forward to seeing them every day—truly. I
can’t imagine working a job without that interaction.

As I learn to breathe more, and find more balance, I become a better teacher
for my students. I try to coach them through stressful times. I understand
students who suffer anxiety and can help them.

There is a slight anxiety or fear that by publishing my words and thoughts,

people will see my weaknesses. But I should not be ashamed. As I have fought,
and continue to fight, to experience less anxiety, I have become a much stron-
ger person. I have continued to be a successful teacher maybe because of my
struggles. Maybe by sharing my story, I can help others. Maybe other teachers
might not feel so alone. Maybe my students who struggle with anxiety will see
that I was able to work with my issues and become stronger by facing my chal-
lenges.

I’m growing, and I continue to grow. As I search for peace, I know the quest
for peace is where I am finding strength and wisdom. I have accepted my chal-
lenge as a gift. This gift has given me the opportunity to live a life that
has been stronger and more fulfilling than I would have ever known. And I will
continue to appreciate my quest for peace wherever it shall take me.

48

Teacher Stress and Anxiety
REFERENCES
Bourne, E. (2011). The anxiety and phobia
workbook. Oakland, CA: New Harbinger
Publications, Inc.
Davidson, J. (2003). The anxiety book: Devel-
oping strength in the face of fear. New York,
NY: Riverhead Books.
Mayo Clinic Staff. (2011). Generalized
anxiety disorder. Retrieved from http://
www.mayoclinic.org/diseases-conditions/
generalized-anxiety-disorder/basics/lifestyle-
home-remedies/con-20024562
National Institute of Mental Health. (n.d.).
Anxiety disorders. Retrieved from http://
www.nimh.nih.gov/health/topics/anxiety-
disorders/index.shtml
KEY TERMS AND DEFINITIONS
Anti-Depressant: Classification of drugs
used not only to combat depression, but also
to help control anxiety in some patients.
Anxiety: Fear and/or stress that is chronic.
It can trigger the “fight or flight” response
in our bodies that once was very helpful in
survival. Nowadays, people can have anxiety
that can hurt their survival instead of help
them. The body suffers when it experiences
constant “fight or flight” responses. Also,
people suffer when they can’t handle the day-
to-day stresses of everyday life.
Cognitive Behavioral Therapy: Learning
how to face your fears and anxieties little by
little. For example, I have anxiety about driv-
ing, but instead of avoiding driving, I might
first just take a ride with a friend. Then I
might try driving with a friend in an area of
low traffic. When I am feeling brave, I can
drive on the highway with a friend. Eventu-
ally, I feel strong enough to drive by myself
on the highway.
Panic Attack: A brief period of extreme
anxiety where a person feels out of control and
an intense fear. For me, I would feel suffocated
and I would experience chest tightening. I felt
as if I was having a heart attack and was go-
ing to die. These feelings usually only lasted
about 15-30 minutes for me.
Serotonin: A neurotransmitter that helps
to deliver messages from one part of the
brain to another. An imbalance in serotonin
can sometimes trigger anxiety or depression.
SSRI: A type of anti-depressant that works
to make sure serotonin levels in the brain are
steady and not out of balance.
49
50

Chapter 4
Preventing Burnout:
Stress Management Strategies for
Administrators in Higher Education

Irene H. Johnson
Florida Atlantic University, USA

ABSTRACT
The essential administrator in higher education must maintain a healthy work-life balance. The process
of attempting to balance the demands and expectations of career, personal life, interpersonal relation-
ships, partnerships, and family has been explored extensively over the last decade. Achieving a sense of
work-life balance is both physically and psychologically necessary to promote life satisfaction, wellness,
and occupational success. Many challenges and responsibilities confront administrators daily, some
of which they have little or no control over and are commonly labeled as stressors. A large number of
publications and media address the topics of stress and burnout-related health issues which may lead to
chronic illnesses. This chapter explores stress and strategies to help individuals in administrative careers
cope with the day-to-day stressful events and/or situations in their personal or work-life. The information
included will dispel the idea, take two aspirins and call the doctor in the morning!

INTRODUCTION initiatives; budget decisions; faculty/staff

The essential administrator in Higher Educa-
tion must maintain a healthy work-life balance.
However, balancing work-life with personal
life is a constant struggle. Many challenges and
responsibilities confront administrators daily
and may be commonly labeled as stressors.
These challenges include: pressure to achieve
unrealistic expectations; ironclad and unbend-
ing institutional rules and procedures; rapid
technological advances; confusing change
turnovers; salary negotiations; and sixteen
hour workdays. Stressors are identified as
unpleasant events, issues, people, etc., which
enters an individual’s life producing distress
and distraction (Hackney, 2001). Therefore,
administrators must not only be aware of
their stressors, but must also understand the
effects that work and life stress can have on
mental and physical health, which may result
in increased health problems.

DOI: 10.4018/978-1-4666-7524-7.ch004

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

Stress Management Strategies for Administrators in Higher Education
WORK STRESS
Universities and colleges are highly stressful
environments for administrators e.g. presi-
dents, provosts, chancellors, vice presidents,
dean/directors, and department chairs. While
all employees, faculty, and staff, experience
work stress, those in leadership positions have
particularly stressful positions due to the high
levels of demands associated with the leader-
ship position (Hambrick, Finkelstein, & Money,
2005). Activities that may generate potential
work stress for administrators usually focus on
events or issues such as organizational and/or
policy changes; program/university accredita-
tion; shrinking budgets; student retention and
enrollment; and environmental conditions that
may pose some degree of challenge or threat
(Hughes et al, 2009). A college dean warns
concerned individuals that “college or univer-
sity administration is a place where, despite
our best efforts, connotations are all too often
unpleasant, the disagreements over terminol-
ogy are never ending; and just when you think
an issue is solved, that one voice from the back
of the room makes you reconsider everything”
(Buller, 2012, p.xiii)
An important component of leadership de-
velopment should include preparing administra-
tors to manage work stress. Higher Education
institutions are not very intentional or coherent
in training administrators to handle their job
responsibilities or work stress. A research study
by Cipriano & Riccardi (2010) revealed that 80.7
percent of the department chairs responding to
a survey had no formal training in their admin-
istrative responsibilities. Many of the publica-
tions, workshops, etc. typically focus on topics
related to managing tasks and responsibilities
related to the job, especially those earmarked
for accountability and performance evaluation.
A dean emeritus at a Midwestern university
describes a typical list of tasks and responsi-
bilities he would encounter on any given day
included: “ meeting deadlines, listening to com-
plaints, chairing a meeting or two, responding
to irate parents, negotiating with faculty, and
entreating (or castigating) state legislators”
(Fish, 2004, p.C1).
Focal Point of Stress
Stress! It’s all relative…and relatively easy
to manage. I wrote this quote because of an
event that occurred during enrollment in the
doctoral program. One of my peers completing
his doctoral dissertation on stress and I had
a long conversation on the effects of stress
in our lives. I recall the long debate we had
regarding whether stress is relative. After
discussing information he had written in his
literature review, we came to the conclusion
that stress is relative. I also recall the topic
of relative risk in my biology statistics class.
Wikipedia defines relative risk as the ratio
of the probability of an event occurring (for
example developing a disease, being injured,
etc.). Probability is a measure of the likeliness
that an event will occur. I hope these defini-
tions explain how I reached the conclusion
that stress is relative. The idea that stress is
relatively easy to manage is discussed in the
examples identified in the chapter.
I learned to develop resiliency to stress at
an early age. During my preparation to take a
test I would experience a great deal of anxiety
which would give the sensation of butterflies
in my stomach, so I wouldn’t eat. My parents
suggested that I put the book and/or my notes
under my pillow to help me remember the
subject material. They assured me this would
help me to remember and make the butterflies
51

Stress Management Strategies for Administrators in Higher Education
in my stomach disappear. This intervention
relaxed me and boosted my confidence. It
worked and I continued to practice this until I
learned other interventions to help me handle
stress and anxiety. James & Guilland (2005)
define stress as a relationship between the
person and the environment in which the
person sees the current demand as exceed-
ing his/her coping responses. Stress may be
good or it may be bad. So which one is it?
Actually it’s both. Stressful events raise the
adrenaline, focus one’s thinking, and help
an individual make instantaneous decisions
e.g. swerving out of the way of an oncoming
automobile. However, chronic stress, like a
micromanaging supervisor, a troubled teen-
ager and/or spouse, can put the body into a
long-term hyper- alert status. For example, a
client came to counseling complaining that the
criticism she was receiving from her manager
at work was having a negative impact on her
home life, her relationship with her husband
and her interactions with her children. The
counselor indicated that, “the criticism stays
on her mind constantly. She thinks about it
all the way home, she thinks about it at home
and it wakes her up in the middle of the night”
(Shallcross, 2012). Guroff (2010) asserts
that “chronic stress tends to lower the body’s
immunity which increases the individual’s
susceptibility to illness” (p.37).
Elmore (2006), an associate dean of sci-
ence and professor of biological science at
Marshall University, suggests that “one of
the more undesirable tasks to befall college
and university administrators is dealing with
a complaint by an angry student, irate spouse
of a student, or outraged parent accusing a
faculty member of unfairness, cruelty, or
misconduct.” In addition, allegations of pro-
fessional malevolence can be lodged at all
52

levels of the administrative chain. They are
typically referred down the chain from the
president, provost, dean, and associate dean
to the chair who has the unenviable task of
addressing the problematic accusation and
communicating with the alleged offending
professor. The following steps are interven-
tions recommended by Elmore to keep stress
at a minimal level.
• Establish a channel for receipt of
complaints.
• Implement a standard means of document-
ing complaints.
• Keeping student and faculty handbooks
accessible.
• Seeking training on dealing with difficult
people and conflict resolution.
• Keeping the phone number of campus se-
curity or campus police by the telephone
(pp18-19).
It is impossible to predict the variety of
complaints and nature of event that may oc-
cur on any day in the life of an administrator.
Elmore (2006) suggests that it is good fore-
sight to prepare for the worst while hoping
for the best!
Stressors and Their Impact
Doctor Oz, well known cardiothoracic sur-
geon and television host, advises that among
the major stresses in our lives are Nagging
Unfinished Tasks (NUTS). He recommends
that one should identify the NUTS in your
life and then resolve to fix them, so they
don’t become a constant source of anxiety
(Guroff, 2010). One strategy which might be
useful is, identify and prioritize two or three
of these tasks to complete by an established

Stress Management Strategies for Administrators in Higher Education
deadline. If some unexpected issue or event
interferes with the completion, I establish a
plan to complete parts or stages of the tasks
daily until completed.
Stressors in the workplace which have
been linked to cardiovascular disease include
lack of control over work and the workplace,
because of the presence of employment or
workplace uncertainty, dysfunctional conflict,
and tasks as well as work demands (Landy,
1992; Lovelace, et al., 2007). Cardiovascular
disease has been selected as a primary health
issue because it is the leading cause of death
in the United States. Additionally, stress has
been identified as a key risk factor for the
disease (World Health Organization, 2014;
Lovelace, et al., 2007). Coronary heart disease,
high cholesterol, and high blood pressure
(hypertension) are recognized as forms of
cardiovascular disease (World Health Orga-
nization, 2014).
A 57 year old university president col-
lapsed and died while jogging around the
campus track field. “It’s likely he had some
underlying heart problem he was unaware
of” said the cardiologist (Lake, 2006, p.1).
The coroner listed “heart failure” usually
meaning the victim died suddenly. A close
colleague commented, “the president seemed
to be in good health. He was fit and thin, did
not smoke, and ran often to keep in shape”
(Lake, 2006, p.2). Albeit this administrator
had a stressful high profile job, “he seemed
to handle it well,” said another anonymous
president of a university in a nearby city dur-
ing a telephone conversation with me. The
stress test is one sure technique to indicate
serious coronary disease when cholesterol,
blood pressure, and the electrocardiogram
are normal. Dr. Oz advises “that one test a
person should take after age 50 is the Stress
Test” (Guroff, 2010, p.37). Perhaps this test
would have helped to save the life of the 57
year old president cited above.
Burnout
Billions of dollars are lost each year because
workers in all professions cannot perform their
jobs adequately because of Burnout (Farber
1983). James & Gilliland (2005) assert that
“burnout is experienced as a state of physi-
cal, mental, and emotional exhaustion caused
by long-term involvement in emotionally
demanding situations” (p. 480). Research
has isolated emotional exhaustion as the core
construct of burnout, arguing that deperson-
alization (or cynicism) is a method of coping
with emotional exhaustion (Lovelace, et al.,
2007). Some common symptoms include
physical depletion; feelings of helplessness
and hopelessness; disillusionment; negative
self-concept; and negative attitude towards
work, people, and/or life itself (Golembiewski,
et al. 1986). An individual may experience one
or a combination of these symptoms. “Burnout
represents a breaking point beyond which the
ability to cope with the environment is severely
hampered” (Pines & Aronsen, 1988, p.9).
For example a president of a large university
had just completed eleven years in the posi-
tion. He confided to a colleague in a similar
administrative position that “he finally retired
because the stress that came from being on the
job 24 hours a day and the stress of knowing
something could happen anytime just got to
him” (Lake, 2006, p.2).
In this scenario, the president probably ex-
perienced a substantial imbalance (perceived
or real) between the environmental demands
and his response capability. Obviously the
president didn’t have support systems or
53

Stress Management Strategies for Administrators in Higher Education
other buffers to ease the unrelenting pressure.
Therefore, he decided to retire before his
stress reached a job burnout stage. During a
conversation on the topic of stress a couple
of years ago, a colleague who is an admin-
istrator admitted that “we all need a release,
otherwise, it (stress) just builds up and you
get cranky. I know my limits on this and if I
don’t my wife will know.”
STRESS MANAGING POLICIES
Typically, college and university admin-
istrators play a key role in policy-making
decisions. A primary goal of a policy is to
standardize procedures whose intentions will
result in consistent outcomes. Administering
policies is a common practice for administra-
tors. Imagine that there are self-management
polices (interventions and strategies labeled
as Stress Managing Policies) to become more
resilient to stress. It then becomes part of your
responsibility to adhere to these policies. The
expected outcome is to condition the body
and mind to respond positively to stress. The
intention of the (imaginary) Stress Managing
Policies identified below is to help individuals
accomplish this expected outcome.
• Policy #1: Become more aware of the
nature of the stressors in your daily life.
Examples include responsibilities with
unusually high workloads and deadlines,
or associations with disorganized and de-
manding individuals. Advance knowledge
and understanding can help prevent and re-
duce harmful impacts.
Keep in mind that an urgent matter is not
necessarily an important one! Furthermore,
54

an important one is not always urgent. Natu-
rally, your top priority as an administrator is
to deal with matters that are both urgent and
important. Find a way to delegate issues that
are neither urgent nor important to make sure
they still get completed by the deadline. Use
your discretion to delegate matters that are
urgent but unimportant.
A few years ago when I first began re-
searching the topic on stress, A chancellor of a
large southern university advised me that ‘he
tries’ to keep whatever problems he’s dealing
with in perspective; there’s always someone
else dealing with issues more important and
harder to fix.
Tip: See problems as challenges. Set realistic
goals and don’t procrastinate.
• Policy #2: Prioritize and manage time and
activities carefully. Time management is a
skill one should continuously find ways to
improve because of the continuous involve-
ment of changes in our daily lives and work
environment. Some guidelines include:
◦◦ Learn to live with unfinished tasks
and loose ends.
◦◦ Allow time in your schedule for the
unexpected; this often means sched-
uling fewer tasks each day that you
reasonably expect to finish without
pressure.
◦◦ Leave enough time between activities
to minimize overlap. Allow for lead-
time and after burn.
◦◦ Practice saying NO to new responsi-
bilities or opportunities, which would
overload or rush your day or cut into
your planned leisure time.
◦◦ Take personal responsibility for your
pace of life; the choice of major life

Stress Management Strategies for Administrators in Higher Education
changes (e.g. marriage, home mort-
gage, job relocation); and for the way
you consciously and unconsciously
choose to respond to the stressors in
your life.
◦◦ Structure time for reading and re-
sponding to email messages.
Tips: Make lists; ask others to help; and leave
details for someone else, especially when
you’re feeling too busy.
Structure your day and priorities, so that
you accomplish many small things and at least
one or two large things every day.
Think like a farmer, they know that it takes
long periods of time between planting and
harvesting. At the end of each day of work
thinking about how much is left is depress-
ing. Instead look back and think how much
you have accomplished and make sure you
have accomplished some of the small things
as well as one or two of the large priorities.
• Policy #3: Enhance self-worth and
self-talk.
◦◦ Self-Talk: Seligman (2001) describes
self-talk as a positive pep talk that an
individual gives to his/her self each
day. When a troubling issue arises,
a person repeatedly states a helpful,
supportive phrase, which is an ex-
ample of positive self-talk. Negative
self-talk is another type of self-talk.
Negative self-talk is frequently self-
defeating and prevents an individual
from improving and/or succeeding.
In some instances, negative self-talk
helps the individual recognize a risky
situation; therefore, it is not always
unhealthy. That being said, a balance
between positive and negative self-
talk is important.
• Policy # 4: Using self-statements to cope
with stress. Using self-statements to cope
with stress is a practical model used by
counselors. The model described lists
stages and examples of positive state-
ments in each stage an individual can
practice (Anonymous). The stages do not
have to be followed in a particular order.
The key factor is to identify the stage the
individual is encountering and practice
using the positive statements.
Stages and Positive
Statements Model
Stage of Preparing for a Stressor
What is it I have to do?

I can develop a plan to deal with it.

Just think about what I can do about it.
That’s better than getting anxious.

No negative self-statements just think ratio-
nally.

Don’t worry. Worry won’t help anything.

Maybe what I think is anxiety is actually
eagerness to confront it.
Stage of Confronting and
Handling a Stressor
Just “psych” myself up. I can meet this
challenge.

One step at a time; I can handle the situ-
ation. 

Don’t think about fear, just about what I
have to do. Stay relevant. 

This anxiety reminds me to use my coping
55
 
Stress Management Strategies for Administrators in Higher Education

exercises. 
 Practice repeating these “SELF TALK”

This tenseness can be an ally, a cue to statements until each becomes a part of your
cope. 
 mindset, contingent upon the stage you are
Relax; I’m in control. Take a slow deep encountering.
breath. Ah, good.
Tip: Know your values, priorities, and limits:
Stage of Coping with the Feeling practice being centered.
of Being Overwhelmed
• Policy #5: Strive to identify a purpose in
When fear comes, just pause. 
 every major event or issue that arises in
Keep focus on the present; what is it I have and around the organization and/or your
to do? personal life. Accentuating the positive

Let me label my fear from 0 to 10 and may not always be possible in the short-
watch it change. 
 run, but in the long run, positive thinking
I was supposed to expect my fear to rise. 
 individuals will usually be able to under-
Don’t try to eliminate fear totally; just keep stand the measuring and value in practi-
it manageable. 
 cally all events and issues they may ex-
I can convince myself to do it. I can reason perience. Researchers say that the people
my fear away. 
 with more positive attitudes may deal with
It will be over shortly. 
 stress better. Part of remaining positive is
It’s not the worst thing that can happen. 
 being able to see humor in situations, in-
Just think about something else. 
 cluding those that may normally stress
Do something that will prevent me from you out. One trait that I have is a sense of
thinking about fear. 
 humor and an infectious laugh. I would
Just describe what is around me. That way often remind my colleagues that confront-
I won’t think about worrying. ing events and/or issues are really seri-
ous if I don’t laugh. Laughter really is the
Finally, Reinforcing Self-Statements best medicine when it comes to reducing
stress. Why? Fredrickson (1998) explains
It worked, I was able to do it. 
 that “laughing reduces the production of
It wasn’t as bad as I expected. 
 cortisol and increases the level of health-
I made more out of the fear than it was enhancing hormones like endorphins and
worth. 
 neurotransmitters. Laughter also increases
My darned ideas, that’s the problem. When the number or antibody-producing cells
I control them, I control my fear. 
 and enhances the effectiveness of T-cells”
It’s getting better each time I use the proce- (p. 305). This reaction literally equates to a
dures. 
 stronger immune system and fewer physi-
I’m really pleased with the progress I’m cal effects from stress. Furthermore, posi-
making. 
 tive emotions have been shown to enhance
I did it! abilities to process and retain new infor-

56

Stress Management Strategies for Administrators in Higher Education
mation, and to create patterns of thought
that are flexible and creative. Additionally,
individuals who report more positive emo-
tions show more constructive and flexible
coping skills following stressful events
(Fredrickson, 1998).
Tip: Accept that you can’t control some
events in your life. Try being assertive
and positive instead of aggressive in
stressful situations.
• Policy #6: Learn how to relax. Saying,
“relax” when your stress levels are build-
ing isn’t easy, but actually doing it is much
easier if an individual develops a few re-
laxation techniques. Examples of some
relaxation techniques include: deep slow
breathing, progressive muscle relaxation,
listening to pleasant music, and visual im-
agery. Additionally, a description of the
procedure and/ or definition for each tech-
nique is given. These techniques are com-
monly used by professional counselors and
the skills are taught to counseling trainees.
Deep Slow Breathing (DSB)
Deep Slow Breathing (DSB) is a simple activ-
ity an individual can do anytime and anywhere.
It may be very good to perform during a long
meeting (especially when volatile issues are
included on the agenda) or sitting in traffic.
DSB is one of the easiest and most cleansing
stress relievers with a variety of body benefits.
Deep breathing helps oxygenate the blood,
which “wakes up” the brain, relaxes muscles,
and quiets the mind (Erford, 2010). Perform-
ing this technique simply requires moving
the abdomen in and out, reaching way into
the lower abdomen (gut). Focus on relaxing
the body and release air on each breath. The
website “calm.com” provides a two-minute
relaxation exercise good for mental well-being
and the heart.
Progressive Muscle Relaxation (PMR)
A technique commonly used to manage stress,
tensing and relaxing all the muscle groups in
the body relieves tension in a small amount
of time (Erford, 2010). This technique is
performed without any special training or
equipment. Follow the steps below:
1. Start by tensing all the muscles in your
face, holding a tight grimace for 10
seconds.
2. Completely relax the muscles from step
one for 10 seconds.
3. Repeat steps one and two with the neck,
followed by shoulders, and continue with
the lower back, arms, hands, all the way
down to the buttocks, abdomen, legs, and
toes.
Music
Music can be a powerful tool to help one
relax. Whether or not you’re listening, per-
forming or writing, music can lower blood
pressure and calm the mind. It’s frequently
used as part of stress-management programs
or in conjunction with exercise. Sonan (2013)
recommends one way to combat the risks of
high blood pressure (hypertension) and weight
gain is listening to music if you take long trips
commuting to work.
Visual Imagery
A technique used to reduce anxiety, facilitate
relaxation, promote a sense of control, improve
problem solving and decision-making, as well
as help individuals develop new perspectives
57

Stress Management Strategies for Administrators in Higher Education
on their lives (Seligman, 2001). The individual
conditions the mind to think of a pleasant
scene, real or imagined (Erford, 2010). The
technique involves envisioning a pleasant
scene or picturing oneself achieving goals or
increasing performance in some specific way.
Individuals who practice visual imagery move
into a deeply relaxed state which provides
significant stress reduction benefits.
A university administrator confided to me,
“to keep things in check, he prefers “quiet,
spiritual time” reading and spending time
with his wife.” To accomplish this, he wakes
up at 5:30 a.m. every day, then walks around
campus if he is not out of town.”
Tip: Find time each day to relax, meditate,
exercise, and have fun. Commit yourself
to the value of scheduling leisure time
for both you and your organization/unit
and family.
• Policy # 7: Meditation is an essential ele-
ment in all of the world’s major spiritual
and philosophical traditions (Goleman,
1988). Currently meditation practices are
being taught in secular forms that do not
require adherence to cultural and religious
beliefs (Hart, 2007; Kabat-Zinn, 1996). All
types of meditation share the common goal
of training an individual’s attention and
awareness so that consciousness becomes
more freely attuned to events and experi-
ences in the present (Kabat-Zinn, 1996).
Meditation is not a relaxation technique
(Kabat-Zinn, 1996). Meditation involves
witnessing events and experiences as they
present themselves on a moment–to-moment
basis (Shapiro, Schwartz, & Santerre, 2002). It
actually builds on the technique of deep breath-
58

ing and helps slow down brain waves which
reduce stress. After mastering the technique
of deep slow breathing to calm the body, the
process of meditation can begin. Select medi-
tation techniques which focus on recognizing
and accepting feelings in the moment without
trying to change them and without dwelling on
them. Dr. H. Benson, Benson-Henry Institute
for Mind Body Medicine, recommends that
during meditation, clear the mind of any focus
or distraction. This enables one to detach from
stressors and restores the body, the process
of meditation can begin. Select meditation
techniques which focus on recognizing and
accepting feelings in the moment without
trying to change them and without dwelling
on them. This enables one to detach from
stressors and restores the body. Meditate for
5-10 minutes (Guroff, 2010).
• Policy #8: Follow a Healthy Lifestyle re-
quires an individual to exercise on a regu-
lar basis and focus on balanced nutrition.
Exercise to lower stress is frequently rec-
ommended to individuals by health care
providers. Frequently participating in
physical activity such as exercise is one of
the best natural cures for stress according
to Dr. Oz (Guroff, 2010). Furthermore new
research from the University of Maryland
reports that working out doesn’t just ease
stress, but also helps to prevent it (Mahoney,
2013). Dr. Oz (Television show host) be-
lieves that stress isn’t an emotional reaction
to a deadline or a scary event. He advises
that “it is connected to famine; so when
you have chronic stress, your body thinks
it’s thousands of years in the past on an arid
plain in Africa. You tend to eat anything
you can get your hands on and a greater
amount” (Mahoney, 2013, p. 42). Stress

Stress Management Strategies for Administrators in Higher Education
hormones then cause weight to be stored as
abdominal fat, the type linked to heart dis-
ease and other illnesses (health disorders)
(Mahoney, 2013). Researchers have found
that individuals who exercise have fewer
stress related heart problems (Blair, et al.,
1989, Frew and Bruning 1988). Findings
for a Swedish study confirmed that “exer-
cise sessions” two times per week boosted
workers efficiency enough for the rest of
the week to compensate for any lost desk
time (Sonan, 2013). An administrator at a
large Midwestern university admitted (to
me) that at the age of 61, he still runs five
or six miles a day. He explained it helps to
ease away any stress he feels. In summary,
Lovelace, et al., (2007) report that physical
fitness is an important way for leaders to
build resiliency toward work stress and are
less likely to become physically worn out
from the high job demands (p.381).
Tip: Exercise leads to the release of endor-
phins, which has a healing effect on the
body and mind as well as harmful effects
of stress.
GOOD NUTRITION
“Eating well may be challenging, but it can be
done” says Pamela Smith nationally known
nutritionist and author (The Diet trap & Eat
Well-Live Well). Smith’s “Ten Command-
ments of Great Nutrition” (2010) emphasizes
what you should eat, rather than what to avoid.
Think of these commandments as principles
and guidelines to follow for self-improvement.
1. Thou should never skip breakfast.
2. Thou shall eat every three to four hours.
3. Thou shall decrease the amount of intake.
4. Thou shall eat fruits and vegetables.
5. Thou shall always eat a carbohydrate
with a protein.
6. Thou shall measure the amount of fiber
in your meals.
7. Thou shall consume foods that provide
vitamins and minerals not pills.
8. Thou shall consume eight glasses of
water daily.
9. Thou shall consume limited amounts of
sugar, salt, caffeine, and alcohol (every-
thing in moderation).
10. Thou shall skip the fad diet: diets don’t
work. (Smith, 2010 pp. 9-15).
All ten of these policies can serve the con-
cerned and positive thinking administrator in
efforts that are generated to address stress.
CONCLUSION
The essential higher education administrator
works in a highly stressful environment. There-
fore, it is necessary for these individuals to be
aware of recognizing the need for and how to
maintain a healthy lifestyle. Additionally, it is
critical for them to recognize that self-care is
a key element in making life and work run in
sync. The purpose of the content included in
this chapter is to contribute to the leadership
development for administrators by offering
guidelines to manage the stressful demands
encountered by them on a daily basis. To
accomplish this purpose, a literature review
integrated burnout and stress; explained/in-
structed the use of cognitive and behavioral
counseling techniques to manage stress before
reaching the stage of job burnout; and anecdot-
al testimonies. The cognitive and behavioral
techniques have been practiced by me during
the 18 years of my career while working in
five administrative positions (Dean, Associate
Dean, Assistant Dean, Program Director and
59

Stress Management Strategies for Administrators in Higher Education
Department Chair) and ten years as a practic-
ing Professional Counselor and Professor of
Counseling. One additional intervention is
inclusion of The Stress Survivor Kit. Prepar-
ing a stress survivor kit is an enjoyable and
practical activity. Keep one at the office and
at home. The items identified are examples
included in a typical kit. Customize your kit
with additional items to help manage your
stress. Place the items in a colorful basket or
container which has special meaning to you.
The stress survivor kit is a nice gift to give to
friends, colleagues, and students for various
occasions.
Kit includes:
• Stress balls to squeeze your tension away;
• A package of tissues to wipe tears away;
• Seeds to plant a garden;
• A slinky a reminder to stretch often;
• A koosh ball to soften your approach;
• A mirror to confront your feelings; glue
sticks, a reminder to avoid sticky situations;
• Silly putty to help adapt to change;
• A book to take time to read;
• Massage lotion as a reminder to stop and
smell the roses!
REFERENCES
Blair, S., Kohl, H., Paffenbarger, R., Clark,
D., Cooper, K., & Gibbons, L. (1989).
Physical fitness and all-cause mortality:
A prospective study of healthy men and
women. Journal of the American Medical As-
sociation, 262(17), 2395–2401. doi:10.1001/
jama.1989.03430170057028 PMID:2795824
Buller, J. L. (2012). The essential department
chair. San Francisco, CA: Jossey-Bass.
60

Cipriano, R. E., & Riccardi, R. (2010). What
is unique about chairs? A continuing explora-
tion. Department Chair, 20(4), 26–28.
Elmore, W. H. (2006). Administrator as in-
terposer: Helicopter parents vs. alleged ma-
levolent professors. The Department Chair,
17(2), 18–19.
Erford, B. T. (2010). Thirty-five techniques
every counselor should know. Upper Saddle
River, NJ: Pearson.
Farber, B. A. (Ed.). (1983). Stress and burnout
in the human services professions. New York:
Pergamon Press.
Fish, S. (2004). The party’s over. The Chron-
icle of Higher Education, 51(2), C1–C4.
Fredrickson, B. (1998). What good are
positive emotions? Review of General Psy-
chology, 2(3), 300–319. doi:10.1037/1089-
2680.2.3.300 PMID:21850154
Frew, D., & Bruning, N. (1988). Improved
productivity and job satisfaction through
employee exercise programs. Hospital Ma-
teriel Management Quarterly, 9, 62–69.
PMID:10287092
Goleman, D. (1988). The meditation mind.
Los Angeles, CA: Tarder.
Golembiewski, R. T., Munzenrider, R. F., &
Stevenson, J. G. (1986). Stress in organiza-
tions: Toward a model of burnout. New York,
NY: Praeger.
Guroff, M. (2010). America’s most trusted
doctor. AARP Magazine, 53(3A), 34–37.
Hackney, H. C., & Cornier, L. S. (2001). The
professional counselor. Boston, MA: Allyn
and Bacon.

Stress Management Strategies for Administrators in Higher Education
Hambrick, D., Finkelstein, S., & Mooney, A.
(2005). Executive job demands: New insights
for explaining strategic decisions and leader
behavior. Reading of Measurements Review,
3, 472–491.
Hart, J. (2007). Clinical application for
meditation: A review and recommendation.
Alternative and Complementary Therapies,
13(1), 24–29. doi:10.1089/act.2006.13104
Hughes, R., Garnett, R., & Curphy, G. (2009).
Leadership (6th ed.). Boston, MA: McGraw-
Hill Irwin.
James, R. X., & Gilliland, B. E. (2005). Crisis
intervention strategies. Independence, KY:
Cengage Learning.
Kabat-Zinn, J. (1996). Mindfulness medi-
tation: What it is, what it isn’t, and its role
in health care and medicine. In Y. Haruki,
Y. Ishii, & M. Suziki (Eds.), Comparative
and psychological study on meditation (pp.
161–170). Eburon Publishers.
Lake, R. (2006). Heart failure cited in Bris-
tow’s death. The Clarion-Ledger. Retrieved
from http//clarionledger.com
Landy, F. (1992). Work design and stress. In
Work & well-being [Washington, DC: Ameri-
can Psychological Association.]. Agenda
(Durban, South Africa), 1990s, 119–158.
Lovelace, K. J., Manz, C. C., & Alves, J. C.
(2007). Work stress and leadership develop-
ment: The role self-leadership, shared lead-
ership, physical fitness and flow managing
demands and increasing job control. Human
Resource Management Review, 17(4), 374–
387. doi:10.1016/j.hrmr.2007.08.001
Mahoney, S. (2013). Jump start your weight
loss. Good Housekeeping (New York, N.Y.),
256(4), 38–43.
Pines, A., & Aronson, E. (1988). Career
burnout: Causes and cures. New York, NY:
Erie Press.
Seligman, L. (2001). Systems, strategies, and
skills of counseling and psychotherapy. Up-
per Saddle River, NJ: Merrill Prentice Hall.
Shallcross, L. (2012). Bringing work home.
Counseling Today., 54(10), 32–38.
Shapiro, S. L., Schwartz, G. E., & Santerre, C.
(2002). Meditation and positive psychology.
In C. R. Snyder & S. Lopez (Eds.), Handbook
of positive psychology (pp. 632–645). Oxford,
UK: Oxford University Press.
Smith, P. (2010). Following the ten command-
ments of nutrition. In Well-being for dummies.
Indianapolis, IN: Wiley.
Sonan, M. (2013). Feel better from 9 to 5:
Lower your stress and increase you fitness-
it’s all in a day’s work. Good Housekeeping
(New York, N.Y.), 256(4), 100–101.
World Health Organization. (2014). The atlas
of heart disease and stroke. Retrieved from
http://www.who.int/cardiovascular_diseases/
resources/atlas/en/
KEY TERMS AND DEFINITIONS
Burnout: Depletion of physical and
mental resources resulting in loss of motiva-
tion, interest, and capability to perform job
responsibilities.
Meditation: Training attention and aware-
ness so that consciousness becomes more
freely attuned to events and experiences in
the present.
Progressive Muscle Relaxation (PMR):
Tensing and relaxing all the muscle groups in
the body to relieve tension in a small amount
of time.
61

Stress Management Strategies for Administrators in Higher Education
Self-Talk: A positive or sometimes nega-
tive pep talk that an individual gives to his/
herself each day.
Stress: A relationship between the person
and the environment in which a person sees
the current demand as exceeding his/her cop-
ing responses.
62

Stressor: An unpleasant event, person,
issue, etc. whose presence produces distress
and distraction.
Visual Imagery: Conditioning the mind
to think of a pleasant scene real or imagined;
picturing oneself achieving goals or increas-
ing performance.
 63

Chapter 5
Self-Directed Learning
and Adult Education:
Overcoming the Medical Fog

Valerie Bryan
Florida Atlantic University, USA

Kristin Brittain
Florida Atlantic University, USA

Elizabeth Swann
Florida Atlantic University, USA

ABSTRACT
Patients are increasingly being asked to take more responsibility for self-care in a complex healthcare
system; this can be a challenge for even the most educated individual. Learning is central to health,
health decisions, and self-care. Adult educators’ insights regarding lifelong, self-directed learning are
critical in helping adults learn about their disease and make informed decisions. This chapter presents
documentation of self-directed learning in health education through a series of case studies with reflec-
tions. The authors draw attention to self-directed learning in the context of one’s own personal health
management and propose self-directed learning as a solution to the numerous barriers to personal health
education. Ideas for increasing a self-directed approach when seeking health information are offered
based on the case studies reviewed. Ideas regarding future research needs are included.

INTRODUCTION 2011). Adult learning aids individuals through

A central charge in one’s life is caring for
his/her own health. Health is not static; it is
constantly changing in response to aging,
wellness management, or disease. Researchers
agree that learning is essential to health (Hill,
DOI: 10.4018/978-1-4666-7524-7.ch005
changing physical abilities, medical condi-
tions, lifestyle changes, or social conditions
resulting from health related issues (Hill &
Ziegahn, 2010) and empowers the individual
to become a participant rather than an observer
in her own treatment. A recent proliferation

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

of peer reviewed articles addressing health
promotion and health literacy indicates a need
to further explore the connection between
learning and an individual’s self and preven-
tive health care.
The overarching goals of the Healthy
People 2020 include:
1. Attain high quality, longer lives free of
preventable disease, disability, injury,
and premature death.
2. Achieve health equity, eliminate dispari-
ties, and improve the health of all groups.
3. Create social and physical environments
that promote good health for all.
4. Promote quality of life, healthy develop-
ment, and healthy behaviors across all
lifestages (U.S. Department of Health
and Human Services, 2011, Oct., p.3).
All of these goals can be better served if
both the individual receiving the health care,
and the medical practitioners prescribing the
health care, work in tandem, and in such a
manner to eliminate the barriers between
the patient and the health care provider.
Due to increasing expectations for adults to
take responsibility for their own health care
management, many individuals experience
difficulties. Take for instance, a newly diag-
nosed patient attempting to decipher medi-
cal information’s unfamiliar vocabulary and
concepts. One such struggle is identified as
health literacy. Healthy People 2010 (U.S.
Department of Health and Human Services,
2000, Jan.) defined health literacy as “the
degree to which an individual has the capac-
ity to obtain, process and understand basic
health information and services needed to
make appropriate health decisions” (Centers
for Disease Control and Prevention, 2011,
p.1). Research indicates that being a healthy
64

Self-Directed Learning and Adult Education
literate person means one is more informed
and better able to make intelligent choices
about his/her health care and lifestyle choices.
Many current studies have addressed the
impact of low health literacy on an individual’s
choice of treatment regimens and the response
to those regimens. The Partnership for Clear
Health Communication (n.d., p. 2) identified
literacy skills as the strongest predictor of an
individual’s health status from the following
demographics: age, income, literacy skills,
employment status, education level, and racial
or ethnic group. Based on current information,
90 million people “have difficulty understand-
ing and using health information” (Partnership
for Clear Health Communication, n.d., p. 2).
Individuals need information regarding
their own role in their health care. Extensive
literature is available regarding how being a
better informed patient positively impacts his/
her own health care, but if that information
is given in code or medical jargon the indi-
vidual patient may not value the information
or understand what she is being told. Without
appropriate or valued information, and the
comprehension of that information, an indi-
vidual may make choices that could increase
the time to achieve wellness or the individual
could even make life-threatening choices.
Individuals are often presented informa-
tion that could inform and aid them to make
intelligent decisions about their own care, but
often the information is clouded in obtuse
language, charts or graphs that confuse even
the most educated user. Medical jargon or
language is used that often requires extensive
medical vocabulary training, and this dis-
tances the patient from their freedom to make
individual health choices. These individuals
are at a disadvantage that results in a lack of
understanding of what role they are to play
in this setting.

Self-Directed Learning and Adult Education

Figure 1. Causal pathways between health literacy and health outcomes

Note: Paasche-Orlow, M.K., & Wolfe, M.S. (2007). The causal pathways linking health literacy to health outcomes. American
Journal of Health Behavior, 31(1) 19-26.

Patient’s Individual and Americans have limited literacy (Williams,

Contextual Factors in Chronic
Illness and Health Literacy
Literature on health literacy demonstrates the
complex issues faced by the novice patient that
is associated with the multifaceted language
and complicated treatment processes that
impact his/her treatment and health manage-
ment processes. It is estimated that 40 million
Davis, Parker, & Weiss, 2002). This translates
to approximately one-third of the population
(36%) estimated to have basic or below basic
health literacy (Martin, et al, 2009). Addition-
ally, the Institute of Medicine found that 90
million American adults may lack the neces-
sary skills to effectively use the US health care
system (Institute of Medicine, 2004). Those
who suffer from chronic disease are among

65

these statistics and are also more adversely
affected by the contextual factors considered
in the literature.
Several factors have been identified as
contributing to an individual’s level of health
literacy. They are as listed:
1. Efficacy (Parker & Kreps, 2005; Parikh,
Parker, Nurss, Baker & Williams, 1996);
2. Age (Gazmararian, Curran, Parker,
Bernhart, & DeBuono, 2005: Baker,
Williams, Parker, Gazmararian, & Nurss,
1999; Matzke, 2007; Schecter & Lynch,
2010; Williams, Davis, Parker, & Weiss,
2002);
3. Cognitive ability (Baker, Gazmararian,
Sudano, & Patterson, 2000; Baker et al.,
2002; Matzke, 2007; Paasche-Orlow,
Parker, Gazmararian, Nielsen-Bohlman,
& Rudd, 2005);
4. Income (Matzke, 2007);
5. Ethnicity (Matzke, 2007);
6. Geographic location (Matzke, 2007);
7. Education level (Matzke, 2007),
8. Shame (Parker & Kreps, 2005; Parikh
et al., 1996);
9. Happiness (Angner, Miller, Ray, Saag,
& Allison, 2010);
10. Fear (Parker & Kreps, 2005; Parikh et
al., 1996);
11. Physical abilities such as hearing (Porth,
2007; Saeed & Rasden, 1994) or vision
(Porth, 2007; Solomon & Donnenfeld,
2003);
12. Social trust (Schecter & Lynch, 2010);
and
13. Unwillingness to disclose information
about personal health status to health
professional (Schecter & Lynch, 2010).
All of these associated issues play a large
role in the treatment processes for the novice
66

Self-Directed Learning and Adult Education
patient and they have a resulting impact on the
treatment and health management processes.
Individual factors are not the only barriers
toward the treatment process. Factors within
the health system, such as compliance with
complicated medication regimes (Matzke,
2007) influence the successfulness of the
treatment process. Today, “there are 11,000
types of medications available in the United
States today than compared to several hun-
dred available in the 1960s” (p. 22, as cited
in Matzke, 2007). The amount of time spent
the patient spends with the medical provider
is another factor (Davidoff, 1997). “Patients
are experiencing shorter office visits and not
having adequate time to communicate with
their physicians” (p 4., as cited in Matzke,
2007). Physicians are also requiring that pa-
tients should assume a higher level of self-care
(Williams et al., 2002) and are able to use
multiple health care choices (Matzke, 2007).
The resulting inadequacies can lead to:
1. Higher medical costs (Weiss et al 1994);
2. Increased hospitalization (Baker, Parker,
Williams, & Clark, 1998; Baker et al.,
2002; Baker, Parker, Williams, Clark,
& Nurss, 1997; Kalichman & Rompa,
2000 ;Williams, et al., 2002);
3. Poorer health outcomes (Matzke, 2007);
4. Poorer health knowledge (Matzke, 2007;
Williams, et al., 2002);
5. Lack of awareness of health services
available (Davis, Meldrum, Tippy,
Weiss, & Williams, 1996);
6. Less likely to participate in health pre-
vention activities (Matzke, 2007); and
7. Less likely to participate in health screen-
ings (Bennett et al, 1998; Lindau, Tomori,
McCarville, & Bennett, 2001).

Self-Directed Learning and Adult Education
These factors can lead to late entry into
the health care system allowing for advanced
stages of disease to occur.
The access and use of health care in these
cases can become compromised. Patients may
have difficulty with discharge instructions
(Spandorfer, Karras, Hughes, and Caputo,
1995; Wilson & McLemore, 1997) or fol-
low up appointments (Williams et al, 1995).
Matzke (2007) cites studies that found patients
with low health literacy to have:
1. Poor recall and comprehension of health
care advice and instructions;
2. Poor understanding of diseases; and
3. Poor problem-solving skills.
Issues of noncompliance with the plan
of care (Gazmararian et al., 1999; Williams,
Baker, Honig, Lee & Nowlan, 1998; Williams,
Baker, Parker & Nurss, 1998) and medication
adherence (Matzke, 2007), (Williams et al,
1995) are of special concern when looking
at chronic disease management.
When looking at health and wellness
management, experts indicate certain char-
acteristics, such as self efficacy, motivation
(Schecter & Lynch, 2010), and even empower-
ment among the characteristics that encourage
and identified with better health management.
Furthermore, this study demonstrates that
self-directed learning is central to coping
with chronic disease and should be considered
among the characteristics that offset the barri-
ers toward health and wellness management.
Doctor’s View of Patient
in Chronic Illness
In some cases, medical practitioners dismiss
these individuals (those with chronic illnesses)
and label them as ‘noncompliant.’ Kleisinger
(2003) reports that patients often exhibit be-
haviors that interfere with their own treatment
for a variety of reasons:
1. Patient is unable to understand what is
communicated by the health professional
due to education level, language fluency,
or even dementia and the health practi-
tioner fails to address those possibilities;
2. The patient’s culture or personal beliefs
may cause the patient to be non receptive,
and again, the medical practitioner takes
minimal time to unearth the issues;
3. The patient may be noncompliant be-
cause of fear, psychological conditions,
or other coping mechanisms to deal with
his or her illness;
4. Patients may enjoy “being ill” to avoid
other things such as an unpleasant work
setting or home situation; or
5. Patients may have secondary issues that
make noncompliance of less importance
to them than some of their primary issues
such as alcohol, drug dependency, or the
effects of the addiction.
Furthermore, patients that take the initia-
tive to find, understand, and appraise informa-
tion received from the medical team can be
viewed by the medical team as “bothersome”
and “time consuming.”
In 2009 the Calgary Charter on Health
Literacy defined health literacy as the skills
and competencies that all people develop to
seek out, comprehend, evaluate, communicate,
and use health information and concepts to
make informed choices, reduce health risks,
and increase quality of life (Coleman et al.,
2009). It is essential that the patient and the
caregiver share these concepts.
67
 
Self-Directed Learning and Adult Education

Figure 2. Crisis of care

Note: Koh. K., Berwick, D., Clancy, C., Baur, C., Brach, C., Harris, L., & Zerhusen, E. (2012). New federal policy initiatives
to boost health literacy can help the nation move beyond the cycle of costly “crisis care.” Health Affairs, 31(2), 1-10. DOI
10.1377/hltaff.2011.1169.

68

Self-Directed Learning and Adult Education
Since learning is central to health, health
decisions, and self-care, adult educators’
insights regarding lifelong, self-directed
learning (SDL) are critical in helping adults
learn about their disease and make informed
decisions. Research in the field self-directed
learning (SDL) has found that SDL occurs in
a wide variety of contexts, can be a response
to a personal need, and it can be conducted
independently or collaboratively (Guglielmi-
no, 2008). Changes in health, diagnosis of a
disease, or the desire for improved health may
trigger a need for learning. Adults will turn
to health providers, friends, family, support
groups, the internet, and written material to
seek out health related knowledge. Many of
these resources are easily accessible, however,
in some cases this is the pivotal point in po-
tential barriers to learning.
This paper presents documentation of self-
directed learning and health education pres-
ent within the virtual reflections of a group
of individuals actively involved in their own
health management. Authors share reflections
through a series of mini case studies on recent
medical care that addresses the following:
• The processes and practices used by recent
patients to assume a more self-directed ap-
proach to their own health care;
• The impact, or lack of impact, that the self-
directed approaches had with the medical
team engaged with their care;
• The self-directed methods or materials, if
any, suggested or available for the patient;
• The complexity of the language or treat-
ment processes for the novice patient and
resulting impact on the treatment process.
PURPOSE
The purpose of this research was to examine
patients with a chronic disease for documen-
tation of self-directed learning in the context
of one’s own personal health management. In
particular, their approaches to learning and
personal characteristics were analyzed and
compared to the characteristics associated
with the elements of self-directed learning.
Through these case studies the authors draw
attention to self-directed learning as a coping
mechanism and health management tool for
individuals diagnosed with a chronic disease.
METHODS
Based on the literature reviewed, online
searching for health information has become
common practice. According to the Pew In-
ternet and American Life Report (2011) the
following is occurring:
1. 8 out 10 internet users have looked online
for health information;
2. Many e-patients say the internet has had
a significant impact on the way they care
for themselves or for others;
3. “1 in 5 internet users have gone online
to find others like them” (Pew Internet,
2011, p. 7); and
4. “1 in 4 internet users living with high
blood pressure, diabetes, heart condi-
tions, lung conditions, cancer, or some
other chronic ailment (23%) say they
have gone online to find others with
similar health concerns” (Pew Internet
and American Life Report, 2011, p. 8).
This pilot study was conducted through
analysis of a virtual community comprised of
lupus patients. All information described was
self-reported. No attempts were made to iden-
tify the participants by name or other related
characteristics. The participants’ identities
were kept anonymous from other participants
and the researchers. No attempt was made by
69

the researchers to determine if the informa-
tion reported by the patients was accurate or
inaccurate. As with any self-reporting of data,
this is one limitation of the study. Based on
the data available, the researchers examined
the web forum posts, reached a consensus of
the predominant characteristics, and compared
those characteristics to characteristics associ-
ated with self-directed learning.
PROCEDURES
Sampling
Purposeful sampling was used in this study.
Researchers sought to access a unique popu-
lation. Use of “virtual communities as sites
for research … to gain access to groups and
individuals who would be difficult, if not
impossible, to reach through other channels”
(Wright, 2005, p. 2). The researchers chose to
use the site www.lupus.org for their sample
selection due to the nature of the group. The
site selected was composed of individuals
dealing with a medical condition known as
lupus. This group met the criteria of being
“people who share specific interests, atti-
tudes, beliefs, and values regarding an issue,
problem, or activity” (Wright, 2005, p. 3). All
members of the virtual community are self-
reported as being positively diagnosed with
lupus, a chronic disease. For the purposes of
analysis, this study was viewed as a case study
approach even though there were multiple
viewpoints in all the forums under review.
The case studies in this research endeavor
were limited to the medical condition of lupus.
Lupus is an autoimmune, chronic disease in
which the body’s immune system becomes
hyperactive and attacks normal, healthy tissue.
70

Self-Directed Learning and Adult Education
This stage of the disease results in symptoms
such as inflammation, swelling, and damage
to joints, skin, kidneys, blood, the heart, and
lungs, however, it can cause damage to any
part of the body. Furthermore,
Lupus is an autoimmune disorder and it af-
fects organ systems, skin, joints, and internal
organs. Lupus can affect both men and women,
but it is eight times as likely in women […]
typical age range for someone to get Lupus
is ten to fifty […] more common in African
American people […] (and) Asian people […]
usually hereditary, . . . . Lupus is a disease
that turns the body’s defenses against the body
itself […] Certain drugs can cause Lupus as
well. Most cases have some family background
to them, but in a few cases there is no ap-
parent cause for the disease […] Symptoms
[…] vary in a wide variety of areas in the
body […] it affects the joints […] arthritis in
the hands . . . rashes, skin lesions, and pain-
ful nodules . . . (possible) renal failure […]
mental dysfunction, seizures, psychosis, and
severe headaches […] pulmonary embolism
[…] chest pain, endocarditis, and myocarditis
[…] blood clots […] Shortness of breath and
even pleurisy (Essortment, 2011, p.1)
Data Collection
The researchers scanned one hundred and six
threads posted to an open source web forum
that allowed public access for individuals
with a chronic disease. As to date, there are
11,008 individuals in this public web forum.
The range of participation varies from active
participation to lurkers (infrequent posters).
No procedures existed to determine the actual
person posting. The researchers selected forty-
four quotes from the dialog in the postings.

Self-Directed Learning and Adult Education
The quotes were identified as demonstrating
characteristics of self-directed learning based
on work of Guglielmino (1977/78). The char-
acteristics under investigation were based on
the following summary of her work:
A highly self-directed learner, based on the
survey results, is one who exhibits initiative,
independence, and persistence in learning;
one who accepts responsibility for his or her
own learning and views problems as chal-
lenges, not obstacles; one who is capable of
self-discipline and has a high degree of cu-
riosity; one who has a strong desire to learn
or change and is self-confident; one who is
able to use basic study skills, organize his
or her time and set an appropriate pace for
learning, and to develop a plan for complet-
ing work; one who enjoys learning and has a
tendency to be goal-oriented. (Guglielmino,
1977/78, p.73)
The priori code method, using codes
developed before examining the data, was
used in order for the data to be compared to
characteristics of self-directed learning. Even
with this process in place, some of the codes
were not covered by the characteristics of self-
directed learning. No attempts were made to
force fit the data to the codes.
Data Analysis
Inter-rater reliability was established with two
raters identifying segmented portions of the
forums and coding the materials separately.
The coded quotes were created by “assigning
units of meaning . . . words, phases, sentences,
or whole paragraphs” (Johnson & Christensen,
2012, p.520). The two raters then compared the
results of the codes. Over time, it was noted
that intracoder reliability, or consistency by
each rater, was reached. A third reviewer was
then used to further refine the coded materials
resulting in triangulation of the data.
Categories of themes were established and
raters assigned various responses to the identi-
fied themed areas. The raters then reviewed
the categories and the related coded quotes,
some were added and some were dropped.
Discussion and analysis of themes by the
researchers resulted in all researchers coming
to agreement of the codes and the categories
of themes. Ultimately, intercoder reliability,
or consistency among different coders, was
reached, thus enhancing the objectivity of
the research.
FINDINGS
Based on the analysis of the data found in Table
1, and the nature of this online population, the
participants’ posting demonstrated high levels
of characteristics of self-directed learning.
Specific examples of quotes are in Table 1.
The characteristics most reflected were
1. Initiative, independence, and persistence
in learning;
2. Acceptance of responsibility for his or
her own learning;
3. View of problems as challenges, not
obstacles;
4. High degree of curiosity;
5. Strong desire to learn or change; and
6. Goal orientation.
Minimum codes were found for some char-
acteristics, such as “capable of self-discipline”
and “self-confidence in ability to learn.” In
some cases, the individuals were so overcome
71
 
Self-Directed Learning and Adult Education

with the disease that they were not able to
function or to deal with daily life needs. In
these cases, it was illustrated that the family
members served as an impediment for some
and a support for others.
No evidence was provided on character-
istics related to characteristic eight of the
self-directed learning feature, “ability to use
basic study skills, organize his or her time
and set an appropriate pace for learning, and
to develop a plan for completing work.” The
individuals within the forum acknowledged
that the chronic disease took over their lives
and little planning was evident. In many cases,
the patient’s family became the initiators in
developing a plan to address the chronic con-
dition or encouraging the patients to be part
of a support group.
Rather than an explicit focus on the “enjoy-
ment of learning,” the patients did note more
“relief” of finding answers that assisted them
in their care. Many patients were also relieved
to find that others in the online community
were there as a support to them, as well as a
source to provide answers not found through
their medical practitioners.

Table. 1. Coding chart for virtual threads self-directed learning characteristics

Self-Directed Learning Passages (Quotes Quotes Supporting SDL Characteristics

Characteristics
Initiative, independence and
persistence in learning
Acceptance of responsibility for
own learning
View problems as challenges, not
obstacles
Capable of self-discipline
High degree of curiosity
Strong desire to learn or change
Self-confidence
Goal orientation
Novel Finding of CoPs
Community, give advice, ask
questions, communicate with
others, sharing
Note: Found 44 total quotes in 106 pages and 41 threads.
or Actions) Found
Supporting Patient
SDL
Do any of you have any more information/research that I could use to educate
16
myself in order to have an intelligent discussion with my doctor?
I’m reading the book ‘Despite Lupus’ right now and it’s been very helpful
8 thus far, I can’t wait to read more. I highly recommend it. Very insightful, and
helps you cope with the daily challenges we encounter.
Over the years as the lupus and new hurdles come you just have to take a
7
deep breath and say I can do this.
I was diagnosed this past Sunday with Lupus. I do not know much about it
[…] I’m just glad it is not something worse. I am looking on the bright side of
1
the disease and that is that I found this forum and that I am not alone. That’s
a start. Future tests are starting next week.
I don’t necessarily trust the wait and see mentality of my clinic, although I do
like my doctors. If I am going to insist on this, I need to have studies or good
7
information to arm myself against clinic policy. What suggestions do you
have?
I’ve never had a doctor or shrink or therapist who has any kind of clue to
what it is really like to live with this disease during the various seasons as we
6
figure out what it is, find a way to accept it, replace fear with faith as we are
able to regain a different perspective as our experiences change
But eventually we get the time to actually figure out and observe our own
2 bodies. And we figure out HOW we are now able to move on to other
‘solutions’ so that we can give total deference to a flare up.
Hi everyone. I have been lurking around on this board for the last two months
7
trying to learn about this disease as I was recently diagnosed in September.
Also, what has your experience been with this? I’m hoping more people chime
14 in now that the holiday is over.
I know this whole thing is miserable. I’m there with you- I think we all are.

72

Self-Directed Learning and Adult Education
Raters reviewed the “patient factors”
related to motivation, problem-solving, self-
efficacy, knowledge/skills, and other factors
and coded the threads into the categories. See
Table 2. The factors parallel the “Self Care:
Patient Factors” of Paasche-Orlow and Wolfe
(2007) (see Figure 1).
An Ad Hoc Finding: Virtual
Community of an Open Source
Forum as a Community of Practice
Communities of practices (CoPs) take many
forms and are created by adult learners with
common interests, experiences, and learners
with a shared quest for knowledge. All commu-
nity of practices have some things in common,
the most predominate characteristics is that
Table 2. Factors associated with low health literacy
Factors Associated with Low Health Literacy
Age
Alienation
Attitude towards medical team
Cognitive ability
Efficacy
Ethnicity
Fear
Geographic location
Grief
Guilt
Income
Lack of understanding
Level of happiness
Loss of control
Self pity
Shame
they involve self-directed learning by individu-
als, as well as group learning through each
other’s experiences and interactions (Hans-
man, 2008,p. 294). The virtual community
of patients positively diagnosed with lupus,
www.lupus.org, analyzed by the researchers
embodies the core characteristics of a com-
munity of practice. In fact, the creation of such
a group is in itself a recent phenomenon of
patients taking a more self-directed approach
to the management of their own health care.
Self-directed learning and peer support is
essential to managing and coping with any
chronic illness. The debilitating and ever-
fluctuating nature of lupus demands a support
network geared towards individuals wanting
to positively manage his/her own health.
Number of Times Codes Few Examples
Appeared
13 “I am too young . . . “ or “I am too old . . .”
1
26 All negative
4
6
3
11 Fear in general or specific
7
2
2
7
2
11 Addressed level of happiness
5
2
7 Shame of disease, hiding of disease, etc.
73

Peer support is also effective in health
management because of its non-hierarchal
reciprocal relationship created through the
sharing of experiences and knowledge with
others who have faced, or are facing, similar
challenges. This exchange promotes mastery
of self-care behaviors and improves disease
outcomes. In addition, people often learn bet-
ter when they are taught by peers with whom
they identify and share common experiences
with (Heisler, 2006, p.8). The patients sharing
experiences in public forums learn through the
virtual experiences and exchanges with other
patients. This method of sharing is examined
through the reflections and creation of the
virtual community of practice supported by
the situated view of learning, because signifi-
cant learning happens primarily when people
interact within a community and social context
(Merriam, Caffarella, & Baumgartner, 2007).
Communities of practices (CoPs) are cre-
ated from a social fabric, made up of practi-
tioners with a network of common assump-
tions and learning needs. There are specific
qualities that create a community of practice
which include:
1. Emerging problems (such as a chronic
illness);
2. An exchange of experiences which is
frequent among peer support groups
focusing on such illnesses, and are often
informal, similar to the forum analyzed
in this case study.
The virtual community of practice ana-
lyzed in this case study provides patients with
chronic illnesses a way to communicate, share
experiences, and learn from other patients.
One such patient writes: “Hi everyone. I
have been lurking around on this board for
the last two months trying to learn about this
disease as I was recently diagnosed in Sep-
tember.” By the simple introduction into the
74

Self-Directed Learning and Adult Education
community of practice this patient is showing
self-directed characteristics defined by the re-
searchers of “initiative, independence and per-
sistence in learning, as well as a strong desire
to learn or change.” The innate self-directed
nature of the virtual community of practice
is evident by the organization surrounding a
shared goal; these individuals are taking the
initiative to define their own learning needs,
create their own learning objectives, and are
not only sharing resources and tools with other
patients, but their very own experiences act
as resources as well, and these functions are
integral parts of successful communities of
practices (Hansman, 2008, p. 301).
IMPLICATIONS
The researchers in this study view self-directed
learning as a tool for patients afflicted with
chronic disease to use in order to offset the
stumbling blocks as they deal with their
specific illness. Self-directed learning is a
learning process, personal characteristics, and
goal (Merriam, Caffarella, and Baumgartner,
2007). The findings of this study show that
adults with chronic disease demonstrate
characteristics of self-directed learning. The
medical community can assist their patients
in identifying how the patient and the medi-
cal team can work in tandem in establishing
a learning community or even virtual CoPs
to address chronic illness.
Five million people throughout the world
have a form of lupus (Lupus Foundation of
America, 2013). The Lupus Foundation of
America (2013) estimates that there are at
least 1.5 million Americans currently living
with lupus, with more than 16,000 new cases
reported annually. However, it is believed that
the actual numbers of people living with lupus
may be higher, but due to the fact that there
have not been any large-scale studies that

Self-Directed Learning and Adult Education
reflect the true number of individuals living
with lupus in the U.S., the numbers reported
are not accurate.
Since learning is central to health, health
decisions, and self-care, adult educators’
insights regarding lifelong, self-directed
learning (SDL) are critical in helping adults
learn about their disease and make informed
decisions. Research in the field of self-directed
learning has found that SDL occurs in a wide
variety of contexts, can be a response to a per-
sonal need, and conducted independently or
collaboratively (Guglielmino, 2008). Changes
in health, diagnosis of a disease, or the desire
for improved health may trigger a need for
learning. There are many symptoms of lupus.
It is hard to diagnose; in fact, it is called ‘the
great imitator’ because the symptoms are
often like several other common chronic dis-
eases (Lupus Foundation of America, 2013).
Because lupus can affect so many different
organs, a wide range of symptoms can occur,
appear and disappear at different times, and
affect many different organs. Due to the vary-
ing nature of lupus, it is important for patients
to become active, self-directed learners.
By looking at health related research
recently produced there is an indication
that the role of learning and an individual’s
health care management needs to be explored.
Furthermore, the literature that is available
shows that being a better informed patient
positively impacts health care. However, if the
information provided to the patient is done so
in medical jargon, the individual patient may
not value the information or understand what
he/she is being told. Without appropriate or
valued information, and the comprehension
of that information, an individual may make
choices that could increase the time to achieve
wellness or the individual could even make
life-threatening choices.
Not only is research on the correlation
between the role of learning and healthcare
needed, but further research on lupus and the
patient is imperative. According to the Lupus
Research Institute, lupus is one of America’s
least recognized major diseases. “While lupus
is widespread, awareness and accurate knowl-
edge about it is lacking” (Lupus Research
Institute). In fact, it wasn’t until 2011 when the
first lupus-specific drug therapy was approved,
and it is the first therapy produced solely for
lupus in over 50 years (Lupus Foundation of
America, 2013). With lupus affecting so many
individuals, and the rise of chronic diseases,
the development of lupus-specific research is
crucial, if not mandatory.
Novel Findings on Self
Reflection of Raters
The raters in this process were also impacted
by this study. One of the primary raters is a
healthy individual. One rater was diagnosed
with Lupus at the age of 12. Their personal
reflections during this study also were of note.
Researcher 1: Rater Reflection
Looking back to the moments I spent reading
each post, I can remember feeling of heavy
sadness for those individuals who were pour-
ing their hearts out, searching for answers, or
just wanting to be heard. It is not easy reading
something as personal as those posts. There
was a sense of intimacy. The individuals ex-
pressed so freely, their emotions, the realities
of what life is like with lupus, and the hopes
for themselves and others.
Through the process of coding I picked
up on central themes. These themes would
appear over and over again. Most of the posts
were centered on triumph over an obstacle.
The posts conveyed a view of learning from
mistakes, misdiagnosis, or medication misdos-
age. Over all, the story blended into themes
that didn’t seem so stark, it began to take a
75

new form. One (form) where collectively, the
individuals who had made the online posts
felt empowered to make decisions about their
own health. Knowing the risks and consulting
the doctor’s advice, several individuals posted
that they were choosing what medication
they could tolerate the best or taking a break
to have children. It was this collective voice
that really told the story of empowerment and
self-direction in this community of practice.
The idea that these individuals sought out
and participated in an online forum, moreover
a community of practice, is a testament of our
societal trends. Self-direction and communi-
ties of practice can and do take to the virtual
form. This current model allows for limitless
inclusion and access for communities of prac-
tice. Future studies should look into the online
or virtual communities of practice model.
Researcher 2: Rater Reflection
It’s not every day that I get the chance to thumb
through hundreds of other lupus patients’
complaints, symptoms, personal experiences,
and advice. A lot of their complaints and
anxieties I have already lived and it wasn’t
something that I was too keen on experienc-
ing again through their words. It’s hard to be
faced with “what could be” and “what once
was” for me.
Honestly, at a superficial level, some of the
posts were really depressing. However, as I
went more in depth into the coding process it
not only made me more appreciative for the
technology that is now available, but it also
relayed a strong message of what a community
is capable of. When I first became very ill at
eight years of age, and finally diagnosed four
years later, this type of virtual community
was not available. I did not get the chance
to discuss my symptoms and gain advice
from other patients through the source of an
76

Self-Directed Learning and Adult Education
online community. While being immersed
in the research process and conducting the
pilot study it made me more aware of the
vast amount of resources available on the
internet. Furthermore, this research endeavor
illustrated the true strength and healing pos-
sibilities created with a group individuals
once united with a similar goal. Personally,
I am now more conscious of patient/doctor
communication, available treatments, and
outside support systems.
The most important aspect I gained through
reflecting upon this research endeavor is the
gratitude I garnered. A lot of the posts that
I examined were self-defeating. Yes, the
patients wanted answers, but a lot of them
had negative attitudes and self-pity. Also, I
appreciate my personal support system and
I am very thankful for always having a full-
time advocate in family members. Through
this research it became more apparent to me
how important it is for patients to take charge
of their medical treatments, become more
involved in working with their medical team,
and creating a self-directed approach to creat-
ing a healthier version of oneself.
CLOSING
The value of self-directed learning and com-
munities of practice (CoPs) in this study were
extremely evident. But other research needs to
follow on the self-efficacy of these individuals
and other factors related to demographics that
was not studied due to the nature of the research
design and the anonymity of the individuals
being researched. The study also suggests that
medical teams need to find more effective ways
to communicate with their patients that can
encourage a team approach, the patient and
the doctor and other health professionals, in
addressing the illness at hand.

Self-Directed Learning and Adult Education
REFERENCES
Angner, E., Miller, M. J., Ray, M. N., Saag,
K. G., & Allison, J. J. (2010). Health literacy
and happiness: A community-based study.
Social Indicators Research, 95(2), 325–338.
doi:10.1007/s11205-009-9462-5
Baker, D., Gazmararian, J., Sudano, J.,
& Patterson, M. (2000). The association
between age and health literacy among el-
derly persons. Journal of Gerontology, 55(6),
368–374. doi:10.1093/geronb/55.6.S368
PMID:11078114
Baker, D., Gazmararian, J., Williams, M.,
Scott, T., Parker, R., & Green, D. et al. (2002).
Functional health literacy and the risk of
hospital admission among Medicare managed
care enrollees. American Journal of Public
Health, 92(8), 1278–1283. doi:10.2105/
AJPH.92.8.1278 PMID:12144984
Baker, D., Parker, R., Williams, M., & Clark,
W. (1998). Health literacy and the risk of hos-
pital admission. Journal of General Internal
Medicine, 13(12), 791–798. doi:10.1046/
j.1525-1497.1998.00242.x PMID:9844076
Baker, D., Parker, R., Williams, M., Clark, W.,
& Nurss, J. (1997). The relationship of patient
reading ability to self-reported health and use
of health services. American Journal of Pub-
lic Health, 87(6), 1027–1030. doi:10.2105/
AJPH.87.6.1027 PMID:9224190
Baker, D. W., Williams, M. V., Parker, R.
M., Gazmararian, J. A., & Nurss, J. (1999).
STOHFLA: Short test of functional health
literacy in adults: Development of a brief
test to measure functional health literacy.
Patient Education and Counseling, 38(1),
33–42. doi:10.1016/S0738-3991(98)00116-5
PMID:14528569
Bennett, C., Ferreira, R., Davis, T., Kaplan,
J., Weinberger, M., & Kuzel, T. et al. (1998).
Relation between literacy, race, and stage of
presentation among low-income patients with
prostate cancer. Journal of Clinical Oncology,
16(9), 3101–3104. PMID:9738581
Centers for Disease Control and Prevention.
(2011). Health literacy: Accurate, acces-
sible, and actionable health information
for all. Retrieved from http://www.cdc.gov/
healthliteracy/
Coleman, C., Kurtz-Rossi, S., McKinney,
J., Pleasant, A., Rootman, I., & Shohet, L.
(2009). Calgary charter on health literacy,
2009. Retrieved from www.centreforliteracy.
qc.ca/Healthlitinst/Calgary_Charter.htm
Davidoff, M. (1997). Time. Annals of
Internal Medicine, 127(6), 483–485.
doi:10.7326/0003-4819-127-6-199709150-
00011 PMID:9313007
Davis, T., Meldrum, H., Tippy, P., Weiss, B.,
& Williams, M. (1996). How poor literacy
leads to poor health care. Patient Care, 30(16),
94–98,100, 103.
Essortment, Your Source of Knowledge.
(2011). What is lupus disease? Retrieved
from http://www.essortment.com/lupus-
disease-63919.html
Gazmararian, J. A., Baker, D. W., Williams,
M. V., Parker, R. M., Scott, T. L., & Green,
D. C. et  al. (1999). Health literacy among
Medicare enrollees in a managed care orga-
nization. Journal of the American Medical
Association, 281(6), 545–551. doi:10.1001/
jama.281.6.545 PMID:10022111
77

Gazmararian, J. A., Curran, J. W., Parker, R.
M., Bernhart, J. M., & DeBuono, B. A. (2005).
Public health literacy in America: An ethical
imperative. American Journal of Preventive
Medicine, 28(3), 317–322. doi:10.1016/j.
amepre.2004.11.004 PMID:15766622
Guglielmino, L. M. (1978). Development
of the self-directed learning readiness scale.
(Doctoral dissertation, University of Georgia,
1977). Dissertation Abstracts International,
38, 6467A.
Guglielmino, L. M. (2008). Why self-directed
learning? International Journal of Self-
Directed Learning, 5(1), 1–14.
Hansman, C. A. (2008). Adult learning in
communities of practice: Situating theory
in practice. In C. Kimble, P. Hildreth, & I.
Bourdon (Eds.), Communities of practice:
Creating learning environments for educa-
tors (Vol. 1). Charlotte, NC: Information Age
Publishing, Inc.
Heisler, M. (2006). Building peer support
programs to manage chronic disease: Seven
models for success. Oakland, CA: California
Healthcare Foundation.
Hill, L. H. (Ed.). (2011). Adult education
for health and wellness. San Francisco, CA:
Jossey-Bass.
Hill, L. H., & Ziegahn, L. (2010). Adult
education for health and wellness. In C. E.
Kasworm, A. D. Rose, & J. M. Ross-Gordon
(Eds.), Handbook of adult and continuing
education. Thousand Oaks, CA: Sage.
Institute of Medicine. (2004). Health literacy.
Retrieved from http://www.iom.edu/Activi-
ties/PublicHealth/HealthLiteracy.aspx
78

Self-Directed Learning and Adult Education
Johnson, B., & Christensen, L. (2012). Edu-
cational research: Quantitative, qualitative,
and mixed approaches (4th ed.). Los Angeles,
CA: Sage Publications, Inc.
Kalichman, S., & Rompa, D. (2000). Func-
tional health literacy is associated with health
status and health-related knowledge in people
living with HIV-AIDS. JAIDS Journal of Ac-
quired Immune Deficiency Syndromes, 25(4),
337–344. doi:10.1097/00126334-200012010-
00007 PMID:11114834
Kleisinger, F. (2003). Understanding noncom-
pliant behaviour: Definitions and causes. The
Permanente Journal, 7(4). Retrieved from
http://xnet.kp.org/permanentejournal/fall03/
behavior.html
Koh, K., Berwick, D., Clancy, C., Baur, C.,
Brach, C., Harris, L., & Zerhusen, E. (2012).
New federal policy initiatives to boost health
literacy can help the nation move beyond the
cycle of costly “crisis care”. Health Affairs,
31(2), 1–10. doi:10.1377/hlthaff.2011.1169
PMID:22262723
Lindau, S., Tomori, B., McCarville, B.,
& Bennett, C. (2001). Improving rates of
cervical cancer screening and pap smear
follow-up for low-income women with limited
health literacy. Cancer Investigation, 19(3),
316–323. doi:10.1081/CNV-100102558
PMID:11338888
Lupus Foundation of America. (2013). Re-
search. Retrieved from http://www.lupus.
org/research
Lupus Research Institute. (n.d.). Retrieved
from http://www.lupusresearchinstitute.org/

Self-Directed Learning and Adult Education
Martin, L. T., Ruder, T., Escarce, J. J., Ghosh-
Dastidar, B., Sherman, D., Elliott, M., & Lurie,
N. (2009). Developing predictive models of
health literacy. Journal of General Internal
Medicine, 24(11), 1211–1216. doi:10.1007/
s11606-009-1105-7 PMID:19760299
Matzke, B. R. (2007). Rural care registered
nurses’ interpretation of health literacy and
its effect on patient care. (Doctoral Disserta-
tion). Available from ProQuest Dissertation
and Thesis database. (UMI No. 3256340)
Merriam, S. B., Caffarella, R. S., & Baumgart-
ner, L. M. (2007). Learning in adulthood: A
comprehensive guide (3rd ed.). San Francisco,
CA: Jossey-Bass Higher and Adult Education.
Paasche-Orlow, M. K., Parker, R. M., Gazma-
rarian, J. A., Nielsen-Bohlman, L. T., & Rudd,
R. R. (2005). The prevalence of limited health
literacy. Journal of General Internal Medi-
cine, 20(2), 175–184. doi:10.1111/j.1525-
1497.2005.40245.x PMID:15836552
Paasche-Orlow, M. K., & Wolfe, M. S. (2007).
The causal pathways linking health literacy
to health outcomes. American Journal of
Health Behavior, 31(1), 19–26. doi:10.5993/
AJHB.31.s1.4 PMID:17931132
Parikh, N., Parker, R., Nurss, J., Baker,
D., & Williams, M. (1996). Shame and
health literacy: The unspoken connection.
Patient Education and Counseling, 27(1),
33–39. doi:10.1016/0738-3991(95)00787-3
PMID:8788747
Parker, R., & Kreps, G. (2005). Library out-
reach: Overcoming health literacy challenges.
Journal of the Medical Library Association:
JMLA, 93(4), 81–58. PMID:16239962
Partnership for Clear Health Communication.
(n.d.). Do you know? Which of the following
is the strongest predictor of an individual’s
health status? Retrieved from http://www.
askme3.org
Pew Internet and American Life Report.
(2011). Peer-to-peer healthcare. Retrieved
from http://www.pewinternet.org/~/me-
dia//Files/Reports/2011/Pew_P2PHealth-
care_2011.pdf
Porth, C. M. (2007). Essentials of pathophysi-
ology concepts of altered health states (2nd
ed.). Philadelphia, PA: Lippincott Williams
& Wilkins.
Saeed, S., & Rasden, R. (1994). Hear-
ing loss. The Practitioner, 238, 454–460.
PMID:8208663
Schecter, S., & Lynch, J. (2010). Health
learning and adult education: In search of a
theory of practice. Adult Education Quarterly,
60(4), 1–18.
Solomon, B., & Donnenfeld, E. (2003). Re-
cent advances and future frontiers in treating
age related cataracts. Journal of the Ameri-
can Medical Association, 290(2), 248–251.
doi:10.1001/jama.290.2.248 PMID:12851280
Spandorfer, J., Karras, D., Hughes, L., &
Caputo, C. (1995). Comprehension of dis-
charge instructions by patients in an urban
emergency department. Annals of Emergency
Medicine, 25(1), 71–74. doi:10.1016/S0196-
0644(95)70358-6 PMID:7802373
U.S. Department of Health and Human Ser-
vices. (2000). Healthy people 2010: General
data issues. Retrieved from http://www.cdc.
gov/nchs/healthy_people.htm
79

U.S. Department of Health and Human Ser-
vices. (2011). Healthy people 2020. Retrieved
from http://www.healthypeople.gov/2020/
TopicsObjectives2020/pdfs/HP2020_bro-
chure.pdf
Weiss, B. D., Blanchard, J. S., McGee, D. L.,
Hart, G., Warren, B., Burgoon, M., & Smith,
K. J. (1994). Illiteracy among Medicaid re-
cipients and its relationship to health care
costs. Journal of Health Care for the Poor
and Underserved, 5(2), 99–111. doi:10.1353/
hpu.2010.0272 PMID:8043732
Williams, M., Baker, D., Honig, E., Lee,
T., & Nowlan, A. (1998). Inadequate lit-
eracy is a barrier to asthma knowledge
and self-care. CHEST: The Cardiopulmo-
nary and Critical Care Journal, 114(4),
1008–1015. doi:10.1378/chest.114.4.1008
PMID:9792569
Williams, M., Baker, D., Parker, R., & Nurss,
J. (1998). Relationship of functional health
literacy to patient’s knowledge of their chronic
disease. Archives of Internal Medicine, 158(2),
166–172. doi:10.1001/archinte.158.2.166
PMID:9448555
Williams, M., Parker, R., Baker, D., Parikh,
N., Pitkin, K., Coates, W., & Nurss, J.
(1995). Inadequate functional health lit-
eracy among patients at two public hospitals.
Journal of the American Medical Asso-
ciation, 274(21), 1677–1682. doi:10.1001/
jama.1995.03530210031026 PMID:7474271
Williams, M. V., Davis, T., Parker, R., &
Weiss, B. (2002). The role of health literacy
in patient-physician communication. Family
Medicine, 34(5), 383–389. PMID:12038721
80

Self-Directed Learning and Adult Education
Wilson, F., & McLemore, F. (1997). Patient
literacy levels and discharge education.
Rehabilitation Nursing, 22(6), 311–317.
doi:10.1002/j.2048-7940.1997.tb02124.x
PMID:9416192
Wright, K. B. (2005). Researching internet-
based populations: Advantages and disad-
vantages of online survey research, online
questionnaire authorizing software packages,
and web survey services. Journal of Computer-
Mediated Communication, 10(3), 1–19.
KEY TERMS AND DEFINITIONS
Adult Learning: Learning experiences,
formal or informal, of adults aged 18 and
older, it does not occur in a vacuum, and it
is constantly changing due to the changing
demographics, socioeconomic state, and
technological trends constantly engaged the
amorphous, boundless field of adult education.
Chronic Illness/Disease: Chronic diseases
are complex and varied in terms of their na-
ture, how they are caused and the extent of
their impact on the community. While some
chronic diseases make large contributions to
premature death, others contribute more to
disability. Features common to most chronic
diseases include complex causality, with
multiple factors leading to their onset, a long
development period, for which may there may
be no symptoms, a prolonged course of illness,
perhaps leading to other health complica-
tions, and associated functional impairment
or disability.
Community of Practice: Created from a
social fabric, made up of practitioners with a
network of common assumptions and learning

Self-Directed Learning and Adult Education
needs. There are specific qualities that create a
community of practice which include, emerg-
ing problems (such as a chronic illness) and
an exchange of experiences which is frequent
among peer support groups focusing on such
illnesses, and are often informal, similar to the
forum analyzed in this case study.
Health Education: Any combination of
learning experiences and increases in knowl-
edge that aids individuals and communities
on improving health.
Health Information: Timely and trustwor-
thy information regarding health and wellness.
Health Literacy: The degree to which an
individual has the capacity to obtain, process,
and understand basic health information and
services needed to make appropriate health
decisions.
Health Management: An individual’s
ability to engage in self and preventive health
care. There has not been a concrete conceptu-
alization of the term “self-management” for
healthcare purposes, therefore, the overarch-
ing concept is that self-management aims at
helping patients to maintain a wellness in their
foreground perspective, self-management
healthcare is based on the patient’s perceived
problems, and one of the largest problems
amongst self-management in health care is
integrating it into the health care system.
Lupus: An autoimmune disease in which
the body’s immune system mistakenly at-
tacks healthy tissue. It can affect the skin,
joints, kidneys, brain, and other organs. The
underlying cause of autoimmune diseases is
not fully known.
Self-Directed Learning: A process in
which a learner takes the initiative and re-
sponsibility to plan, implement, and evaluate
his/her own learning experiences.
Virtual Community: Made up of prac-
titioners with a network of common as-
sumptions and learning needs exchanging
information over an online forum. There are
specific qualities that create a community of
practice which include emerging problems
(such as a chronic illness) and an exchange
of experiences which is frequent among peer
support groups focusing on such illnesses,
and are often informal, similar to the forum
analyzed in this case study.
Wellness Management: The deliberate
approach to healthcare that emphasizes pre-
venting illness, prolonging life, and maintain-
ing a quality state of being that is healthy in
body and mind.
81
82

Chapter 6
Well Teachers Teach Well
Tammy Metcalf
Greeneview High School, USA

Liz Wrocklage-Gonda
Sycamore High School, USA

ABSTRACT
No matter what field one enters, landing that first job and depositing that first paycheck is like no other
feeling in the world. The excitement, anticipation, and demands of any career can be exceptionally chal-
lenging, and many people underestimate the toll that work—even meaningful work—can have on one’s
physical and mental well-being. This underestimation is especially true in the field of education, where
many teachers in ever-expanding roles (teacher, mentor, counselor, etc.) work non-stop nine months out
of the year only to find themselves physically and perhaps mentally exhausted. This chapter explores
the teaching careers of college friends and how they have been able to break the cycle of Work/Exhaust/
Repeat by recognizing, modifying, and preventing patterns that are ultimately harmful to their physical
and mental well-being and make them less effective as educators.

SECTION 1: TAMMY’S TIME mentally, was that I was—really and truly—

AS AN UNWELL TEACHER
The Presentation
“Well Teachers Teach Well” was the title of a
session Liz and I co-presented along with sev-
eral others at the National Council of English
Teachers (NCTE) 2010 Annual Conference at
Disney World. For someone who had never
visited this magical site, I believed the stars
had aligned and that my reward for finally
achieving better health, both physically and
going to Disney World. After nearly twenty
years in education, I was ready for the trip of
a lifetime.
Ironically, this presentation on teacher well-
ness was incredibly stressful. I wasn’t sure the
presentation was going to happen. We didn’t
meet our fourth presenter until we arrived in
Florida. We had communicated with her via
email, but until the night before, we didn’t
know her from Eve. Next we discovered that
our presentation was scheduled in the same
time slot as that of Dr. Tom Romano from

DOI: 10.4018/978-1-4666-7524-7.ch006

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

Well Teachers Teach Well
Miami University of Ohio. Dr. Romano is a
rock star in the English teacher community.
Choosing between the two presentations was
the equivalent of choosing between visiting a
candy factory or going for a root canal with no
anesthesia. Again, there was no stress there.
After all, I wanted to see Dr. Romano’s pre-
sentation, too (and I did see him—on a shuttle
bus. I was this close…), but we decided that
we’d be satisfied with whatever number of
participants attended our session. Our room
was large enough to accommodate eighty
people, but realistically we expected maybe
twenty, at best. A disastrous trial hair run the
day before added to my anxiety. Seriously,
what was I thinking trying to straighten my
hair in southern Florida? The next morning
we arrived at our designated room and set
up for the presentation. As we attempted
(unsuccessfully) to get our laptops and con-
nections in working order, attendees started
trickling in, first slowly, then more quickly,
then frantically.
“Those poor people,” we thought (Why
won’t this load?). “They must have missed
the bus to the other site to see Tom Romano,”
we said to each other (Um, there’s no internet
connection). “Oh well. His loss is our gain!”
(We’ll just have to wing it!)
But they hadn’t missed the bus. As we
prepared to start our presentation, we looked
out upon a room full of people—standing
room only—who had come to hear us discuss
teacher wellness. Why were so many people
in our session? I think it was because they
were literally sick and tired and were looking
for answers beyond medication and “Why are
you stressed? You have summers off.”
So we built a presentation and they came.
Our panel consisted of five educators from
different levels and backgrounds and our
motives were true; we wanted to help Eng-
lish educators cope with the increasingly
demanding stressors placed on them. For that
ninety minute period, there was no stress, no
anxiety, and no competition. There was only
happiness—and wellness.
“But You Have Summers Off!”
Since starting my teaching career, I have been
sick. There was self-induced worrying (about
implementing a new writing program) and
externally-induced worrying (such as being
targeted as an ineffective teacher and surviving
a book challenge), but in each case I seemed
to be able to pull through, first with the help
of my family doctor and pharmaceuticals and
then with the help of supportive friends and
administrators (yes, there ARE supportive
administrators out there).
Then something changed. Medications
didn’t work; friends were unable to help; my
husband was at a complete loss. It was clear
that I needed to make some changes, but like
most other teachers (and people for that mat-
ter), I had to learn my lesson the hard way.
Liz, my soul sister, has also had some ups and
downs. In fact, Liz and I have been united in
friendship and stress for over twenty years. It
was her friendship and guidance that helped
me realize that I needed to make changes. For
that reason, this chapter is comprised of two
sections. The first section chronicles how I
landed up in The Land of Stress, while the
second section provides stress management
strategies so you don’t end up in there.
Hi, My Name is Tammy and
I’m an English Teacher
Teacher, counselor, confidant, learner, wife,
daughter, dog mom, worrier—not always
in that order, but that’s me. Six years after
83

completing my degree and licensure program
(and one almost-graduate degree, one shoe
salesperson job, one automotive industry job,
several other small jobs, and a puppy later), I
was finally hired full-time two weeks before
the start of the new school year. My husband
rejoiced. My parents and grandparents cried.
I had finally achieved the goal I set in second
grade. I was a teacher—an exhausted, over-
whelmed teacher, but a teacher, and nothing
could have made me happier. I had done
some substitute teaching the prior semester,
but while subbing helps hone your classroom
management and planning skills, it does little
to prepare you for the onslaught that is full-
time teaching.
With only two weeks to prepare, I was off
and running. Had I known that almost twenty
years later I’d still be running at the same
break-neck pace, I would have run right out
the door and never looked back. What began
as “I’m sure you’ll get the hang of it, honey”
stress evolved into “It’s break and you’re
sick—AGAIN?!?” stress, all the way to “You
don’t have asthma but you do have Vocal Cord
Dysfunction” stress. Um, what? Allow me to
digress. Vocal Cord Dysfunction occurs when
the vocal cords do not open correctly while
inhaling. Because it presents with the same
symptoms as asthma (wheezing, chest pain,
difficulty breathing, tightness in the throat,
and hoarseness), many people are incorrectly
diagnosed with asthma until they are seen by
an allergy and asthma specialist, who, based
on test results measuring the inhalation and
exhalation of air, is able to determine that the
problem isn’t air coming out, but air going in.
VCD is not an allergic or immune system re-
sponse, and you probably will not be surprised
to hear that stress contributes to this disorder.
According to N. R. Williams’ (2003) Review
of Literature regarding occupational groups at
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Well Teachers Teach Well
risk for vocal disorders, teachers were second
only to singers. There has been an illogical
progression of physical and mental ailments
that has followed me throughout the course
of my teaching career, and with each year the
ailments have become worse; frustratingly, I
have become less able to fully recover from
them. Spoiler alert: I did eventually discover
that these illnesses are the result of my al-
lostatic load, but we’ll get to that.
Chipping Away at My Health
and Self-Esteem
During my first year of teaching I averaged 12
hour days—every day, including weekends.
There was so much to do—three sets of les-
son plans for each week (one for the assistant
principal, one for the department chair, and
one that I could actually read and follow in the
classroom); preparing for class; parent-teacher
conferences; grading…grading…more grad-
ing…and more grading. By the time gradua-
tion arrived, I had used all but ten of my sick
days; additionally, I had been sick on every
break and every holiday. I promised myself
that next year I would do things differently
both in and out of the classroom so as not to
be so rundown, but that didn’t happen due to
having surgery the second day of school and
missing the entire first quarter. Instead of
being calmer and more focused, I spent the
rest of the school year trying to make up for
lost time. I was more exhausted than I had
ever been in my life; even my husband didn’t
want to talk to me.
The next three years were difficult. As I
was gaining more confidence as a teacher
and looking at the larger picture, I was also
becoming more anxious about both my profes-
sional and personal lives. I began experiencing
full-blown panic attacks at school. My family

Well Teachers Teach Well
doctor sent me to a heart specialist, who found
nothing wrong, and I was prescribed the stan-
dard anti-depressant regimen to control my
anxiety. I’ll say this about anti-depressants:
you don’t feel as bad as you did without them.
That said, my personal experience was that
I didn’t feel anything—no highs, now lows,
no middles, neither happiness nor sadness.
My personal wake-up call came in my sixth
year of teaching, and it came from the least
expected person: my principal.
Teaching is hard on marriages, mostly
because the lines between work and home are
often blurred. Case in point: I began my sixth
year with startling twin revelations: both my
father and my principal were battling prostate
cancer. As the year progressed, my marriage
got worse, but my father got better; his treat-
ment options were limited due to an earlier
stroke, but he was beating cancer. Mike, my
principal, on the other hand, was not. His
cancer had metastasized, first to his lymph
nodes and then to his brain. During one of our
weekly chats about my father’s progress, Mike
was in the middle of a sentence and couldn’t
find the words he wanted. He threw his hands
in the air and said that since they started doing
treatments on his head, he couldn’t remember
much of anything, and then he thanked me for
stopping by and said to tell my father hello.
That was in late March. Mike passed May
25, 2004. Within a nine month time span, my
father was diagnosed with cancer and my
principal was diagnosed with and died from
cancer. I was on anti-anxiety medication,
anti-depressants, birth control pills, reflux
medication, and, of course, multiple allergy
medications. And then my doctor quit practic-
ing so she could have children. I never knew
what hit me.
Things really got interesting during my
next (and last) year in this school. The school
president had taken a position in California and
as I mentioned earlier, our former principal
had passed at the end of the last school year
leaving our professional community no real
opportunity to mourn him. These vacancies
meant there were to be two new sheriffs in
town. Also, I had moved out of our house into
an apartment, and my husband and I were see-
ing a marriage counselor. For the first half of
the school year (August through January), we
saw our counselor twice a week. The coun-
seling helped me as a teacher and as a wife.
I’d waited far too long to seek professional
help and by the time I did, I was in jeopardy
of losing everything. My husband could not
understand how upset I was over losing Mike
or about the stress at school, and the counselor
helped us through many of those issues. Our
marriage almost didn’t survive for several
reasons, but chiefly due—I believe—to the
demands placed on me as a teacher.
Getting Thrown Under
the (School) Bus
There have been two times in my professional
career when I thought I would not physically
survive. The first one happened in the spring
of 2005, when I was targeted as being an in-
effective teacher. Here’s a quick rundown of
what transpired: a student underperformed in
each of his classes; this student had a well-
known and powerful parent (who happened
to be the former president of the school); five
of the student’s teachers were called into the
principal’s office individually, where they
were told that they were on professional im-
provement plans, would be assigned a mentor
from a local university, and were in serious
jeopardy of not being renewed for the next
year. The teachers were told that if they dis-
cussed this matter with anyone, they would be
85

immediately terminated. The administration
proceeded to conduct twice-weekly obser-
vations of said teachers, as did the assigned
mentors. When added to the stress of losing
both of our leaders and possibly my marriage,
this burden became too much. There was no
amount of medication or counseling that would
help. Even my friends couldn’t help, as they
had been warned to not get involved.
Where’s the Magic Pill?
A trip to my new doctor proved most interest-
ing. “You’re not grounded,” he said. “I want
you to go outside for at least thirty minutes
every day and walk around barefoot in the
grass. Every day. And dig in your toes. And
you’re too hyper. You need to get on a horse.”
What? Walk in the grass…and get on a horse?
Seriously? Unlike my previous doctor, this one
had no intention of using medication to relieve
my stress and anxiety. In fact, he refused to
use any medication, which I initially found
really irritating until I figured out that he
was right. I had to learn to control my stress,
anxiety, and reactions without using crutches.
So I tried walking in the grass. It did help,
but I had neither the time nor the courage to
explore horseback riding, which he assured
me would cure my anxiety very quickly.
Meanwhile at school, my mentor stopped
visiting me. She said she saw nothing that I
needed to improve and questioned why she
was called. The classroom visits from the
principal continued; twice a week he would
show up and spend half a period in my room;
I’d like to say this was helpful, but since he
was mostly asleep and flatulent, it was more
annoying and stressful than helpful in any
way. And no, I’m not exaggerating. When
my students inquired as to why he was there,
I put on my best teacher face and lied, even
86

Well Teachers Teach Well
though I knew they knew the truth and dis-
agreed with what was happening. Besides
being completely unprofessional and rude,
the visits were humiliating. I was so worn out
that I was lucky to stay awake until 8:00 p.m.
This pattern continued for two months and
when April 30th rolled around and I did not
have a renewal letter in my mailbox (despite
following all conditions established by the
administration), I took matters into my own
hands and resigned my position for the fol-
lowing year. Even though the future of my
marriage was at that point unclear and I had
no job prospects for the next school year, I
felt a profound sense of peace. Immediately,
I started losing weight. My mood lifted and
I stopped taking most of the medications. I
began spending more time outside (barefoot in
the grass) and less time indoors enjoying my
personal pity party. I did have support during
this process. In fact, many of my colleagues
openly challenged the administration regard-
ing these practices, but in the end I took control
and decided to leave and never look back. On
the last day of school, I received a job offer
from a small rural district. It was there that
I would experience my second life-changing
professional challenge.
Head West, Young Woman!
In my earlier years of teaching, one person was
responsible for the majority of my stress: me.
This was certainly the case when I moved to
my second teaching position, which was my
first job in the public school system. Previ-
ously, I had been a part of a large English
department where multiple teachers taught the
same courses; in my new district I was one of
three English teachers. I was THE sophomore
English teacher, which is only important if
one understands that the required graduation

Well Teachers Teach Well
test, also known as the Ohio Graduation Test
(OGT), is administered to sophomores, and
that I was responsible for preparing students
for both the Writing and Reading sections of
the test. What had been a collaborative effort
at my last district now became a solitary effort,
and everyone would be watching to see how
my students performed. To say I was nervous
would be the understatement of the century.
Fortunately, I had a not-so-secret weapon;
at the time I was serving on a state-level OGT
committee, which helped me develop specific
strategies to help my students be successful on
the test. I was able to construct assessments
that modeled questioning techniques on the
OGT. I say this was a not-so-secret weapon
because I, like every other teacher in the state
of Ohio, had access to released test materials
through the Ohio Department of Education
(ODE) website. What I did have that other
teachers did not have was a more thorough
understanding of how the scoring worked,
particularly for the reading section. I also had
time to think, as my daily commute was at least
45 minutes each way in the opposite direction
of most of the traffic. This commute gave me
time to plan—and talk to myself aloud—about
what I needed to do to help my students. So
we did practice questions. We reviewed how
to read double-barrel prompts; we discussed
choosing and supporting a position instead
of sitting on the fence. When the final results
arrived, I held my breath and hoped I wouldn’t
be fired. I could hear that little voice in my
head saying, Tammy…you’re not a teacher.
You’re not smart enough or good enough to
be a teacher. You should have learned how
to type. But then I heard another voice, a
booming voice.
“Mrs. Metcalf? May I see you in the hallway
for a minute?” It was my principal. (Well, at
least you gave it a try.)
“We just got the preliminary results for the
OGT. Would you take a look at this with me?”
“Sure. What am I looking at?” (At least
the paper isn’t pink.)
“Now before you look at these, I need to
let you know that last year we scored 91% in
Reading and 82.5% in Writing. Did you know
that?” I nodded no. He pointed to a line on
the paper.
“What does that say?”
“100%.”
“What does this line say?”
“96.5%.” (Wait a minute. I think he’s happy.
Yes! Happiness—he’s happy!)
“Do you know what that means? All our
kids scored Proficient or higher in Reading
and our Writing scores went up 14 points.
Those are the highest scores this district has
ever had. You did that. Damn fine job, girl!”
What a way to end the year. (See? You are a
good teacher after all.)
During my second year in this district I was
much more relaxed. I had proven myself as an
English teacher and had earned the respect of
the school board, the administration, and my
fellow teachers. That was enough to temporar-
ily silence the little voice in my head that for
so long had spread doubt throughout my con-
sciousness. The stress that had plagued me for
so long was starting to diminish. I was taking
riding lessons each Wednesday with a former
colleague who owned horses and was a certi-
fied instructor. As it turns out, my doctor was
right. Animal Assisted Therapy is used with
many groups, including troubled adolescents,
the elderly, and special needs children, and it
is used for many reasons—to increase confi-
dence, to strengthen balance, and to process
emotions (Masini 2010). Even though I was
not in an official therapy program, the results
were the same. Having a pet helps with one’s
blood pressure and overall health; being on a
87

horse forces one to acknowledge and control
emotions, words, and responses. But getting
on a horse is one thing—staying on a horse
is another. Diana Barr, my friend and riding
instructor, started me on her private horse, an
Arabian, as a means of quickly reducing my
stress and anxiety. Arabians are considered
one of the most intelligent breeds of horses
and are known for being, as Diana said, “built
for speed.” Like most other horses, Arabians
are particularly sensitive to human energy,
so in order to stay on the horse, I had to be
completely calm. I found riding calmed my
mind and soul. Riding required me to focus
on what was ahead, control my energy, and
guide a half-ton animal around things that
scared it, like garden hoses, twigs, and rakes.
It was glorious.
My Friends Call Me the Preble
County Porn Queen
But that spring brought something that was not
as pleasant. In March of 2007 I was part of a
book challenge; a set of parents accused me of
teaching a pornographic book to sophomore-
level students. The book in question was July’s
People, by Nadine Gordimer; it had won the
Nobel Prize for Literature in 1981 and is
acknowledged as one of the most important
South African novels of the twentieth century.
July’s People contains some graphic elements;
however, each of these incidents reinforce the
power shift—from the white family to the
black servant—and the unexpected challenges
that could have arisen as a result of a violent
end to Apartheid. I was crushed.
Things escalated quickly. There was a
county-wide petition to have me removed
from my position; there were weekly prayer
vigils held for me, the sinner who was expos-
88

Well Teachers Teach Well
ing children to pornography; angry parents
protested at school board meetings. Attacked
from all sides, my judgment as a professional
was called into question. Even though this
experience began just as stressful as the “inef-
fective teacher” one, something was different,
and those differences were what kept me from
completely falling apart.
Two factors affected this experience. I was
once again living with my husband (who,
after seventeen years of working with the
same company lost his job the same week I
was accused of teaching porn), and I had the
full support of the administration and board
of education. I cannot say enough good things
about the people who supported me in this
process. They shielded me from the brunt of
the controversy, surrounded me with positive
energy, hugs, gift cards for professional mas-
sages, and places where I could feel safe, like
in the fetal position on their office floors. My
students, too, were supportive. July’s People
is a challenging book for many reasons,
but it’s a difficult read primarily due to the
use of African-English writing conventions
instead of our normal writing conventions.
For example, in Gordimer’s novel a change
of speaker is designated by a dash instead of
quotation marks; this simple change makes it
more challenging to follow what is happening
in the text.
As a result of the book challenge, the
superintendent assembled a committee of
community members who were tasked with
reading the book and determining if it was,
in fact, pornographic. I, too, was a member
of the review committee, but I was there as a
professional courtesy only and to answer any
questions posed by the other members. Once
each member had read the book and discussed
the specific passages identified by the parents

Well Teachers Teach Well
involved, the committee determined that the
book was not pornographic but should be
taught at a higher level due to the complexity
of the text. The parents removed both of their
students from the district. I was awarded the
2007 NCTE / SLATE Affiliate Intellectual
Freedom Award (Midwest Region) for sur-
viving the book challenge. Back at home, my
husband found employment with a consulting
firm. Things were looking up.
Let’s Try Heading East Instead
Looking for better opportunities and to be
closer to my parents, I accepted a teaching
position in the town where I grew up. I didn’t
move to my hometown; I like the comforts
of a small city too much to go back to rural
Ohio, but the drive was fifteen minutes shorter
than that of my last commute and I would be
squarely between my parents, which alleviated
some of my concerns about being able to get
to them in case of emergencies.
I was hired specifically to teach a course
that was part of a new dual-enrollment initia-
tive in conjunction with a local community
college. I would be teaching three freshman-
level English courses within one Honors
English course in twelfth grade. As happy as
I was to return to my “home” school, I was
dismayed to discover that the composition
course had twenty-five students in it. This
was in addition to my other five courses for
which I was responsible throughout the day.
Most college composition classes are capped
at twelve to sixteen students, with occasional
classes of twenty students, but the constraints
of teaching on a college campus are different
from those of teaching in a high school, and
my class size remained at twenty-five until
the day before the first portfolios were due,
when four students dropped the class.
My first semester in the new school was
not ideal. While people were friendly, I found
I was usually isolated due to the workload of
teaching such a large composition class along
with five other classes. I ate lunch alone in
my room, I didn’t attend school events, and
I pretty much spent most of my first year in
zombie-like state. I was functioning, but I
wasn’t doing much more. I didn’t like who I had
become, so I decided to make some changes.
The first change occurred in September of
2008, when I stopped taking birth control
pills. I had been taking the same pill for five
years, and for five years I’d not had a cycle.
Although my gynecologist insisted this was
fine, the little voice inside my head said it was
crazy. During my yearly exam she suggested
I have a hysterectomy when I complained of
breast pain and no libido, an idea my little
voice didn’t like, either. After all, there were
no issues with my working parts. The issues
I had stemmed from the birth control pills,
which had completely suppressed most of my
hormones, affected my moods, and basically
shut down my entire body. It was at this point
that I decided two things:
1. I needed to find a new doctor; and
2. I needed to stop taking the pill.
So I did both, and doing so set me on the
path to better physical and mental health.
Within two weeks I felt like a new woman.
I was more energetic in the classroom; I slept
better; I was more patient with both my hus-
band and my students. The fog I had been
living in lifted and I was able to be the teacher
I knew I could be. I managed to complete my
first year in the district with no major health
scares, other than being sick on every break.
I decided that I would take a few days right
after the end of school and just hibernate
89

somewhere so I could unwind. In the spring
of 2009, I spent my first school-free summer
weekend in Columbus at a shopping mall. I
had enough credit card points to get my room
for free, so I spent Friday and Saturday nights
alone, walking around the outdoor mall and
sleeping whenever I wanted. I didn’t worry
about the dogs, my husband, the phone, bills,
or anything else. It was total me-time.
That was the first year I didn’t get sick
when school let out.
The next two years were very busy. I had
accepted a position as an adjunct instructor
in a licensure program at a local university
and started a second master’s degree. Dur-
ing winter quarter of 2010, my supervisor
underwent emergency neck surgery and I took
over her classes, which meant I was teaching
full time during the day, taking six semester
hours online (which is full-time for a graduate
student), and teaching 12 quarter-hours worth
of classes at the local university.
By June my body was spent. I decided to
take a vacation someplace where I could go
riding, so I went to a resort in West Virginia.
It was beautiful, and on the second day I
mounted a horse and prepared for a relax-
ing ride. Needless to say, that didn’t happen.
Instead of my relaxing ride, I ended up with
a dislocated pelvis. My horse spooked and
bolted to the front of the line; as she did so my
saddle, which had been put on and tightened
by resort staff, slid to the right and I was un-
able to get it back to center. We were ¼ mile
from the paddock and I knew I was going
down. All I could hear was Diana’s voice:
tuck and roll! Tuck and roll! So just like in the
movies, I found myself falling off the horse
in slow motion—left foot out of the stirrup,
right foot in the stirrup, saddle sliding, slid-
ing, sliding until it was perpendicular to the
ground. I landed on the asphalt, right hip first,
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right leg still in the stirrup, and fell backward,
knocking the wind out of me. Fortunately the
horse stopped immediately or I would have
been dragged. I know what you’re thinking:
were you wearing a helmet? Of course I was
wearing a helmet, but I landed on my hip, so
my helmet wasn’t much help, even when I
fell backward.
The lead rider immediately stopped and
called security, who hauled me back to the
resort in a golf cart. I was at a 5-Star Resort
with an equally impressive spa. I was able to
soak in mineral spring water right after my
fall and, after an evening of icing my hip, re-
ceived a phenomenal two and a half hours of
massage therapy the next day. When I returned
home I saw my doctor (my original one, who
had returned after having two children and
was now my new doctor’s partner), who sent
me to physical therapy, who then sent me to
a chiropractor, who popped my pelvis back
into place.
Each of these experiences—the stress of
teaching, marital stress, specific work chal-
lenges—contributed to my allostatic load, a
phrase important for us to remember.
Teacher Stress
Let’s apply all that background information to
the presentation. I was responsible for the first
section of the presentation, which focused on
what stressed teachers and how stress affects
the body. Many teachers can identify the fol-
lowing items as some of the most common
stressors within our occupation:
• Poor classroom working conditions (like
my room, where it’s always a balmy 75
degrees);
• Inadequate teaching materials and
resources;
• Fire drills, assemblies, etc.;

Well Teachers Teach Well
• All the roles teachers play;
• High-stakes testing;
• Students not taking responsibility for their
learning;
• Having great opportunities presented at
professional development sessions but not
being permitted to implement them;
• Lack of respect from students;
• Students who think our job is to entertain
them;
• Lack of parental involvement.
Keep in mind that this list was compiled
prior to the implementation of Race to the Top
and the formal adoption of The Common Core
Standards and Ohio’s new Online Teacher
Evaluation System (and its accompanying
Student Learning Outcomes (SLOs), three
items that have only increased the amount
of stress placed on teachers. Additionally,
due to winter weather woes this year, many
districts have implemented “Blizzard Bag”
or “E-Learning” days, where teachers assign
work to be done outside of class that will
count as attendance for each day. One of the
provisions written into the Blizzard Bag day
proposal for my current district is that after
one week, each teacher must call the parents
of every student who has not yet turned in his/
her Blizzard Bag work, even though students
are given two weeks to complete the work.
Contact logs must be submitted to the district
and attendance records are kept in a binder.
Also, legislation in Ohio gave schools back
three calamity days if districts implemented
“Blizzard Bags” or “E-Learning” days. This
proposal, on top of the work for SLOs and
Blizzard Bags and End of Course Assessments
and the Third Grade Reading Guarantee and
the OGT, has teachers rightfully concerned
and seriously overwhelmed. But even before
this year, it was painfully obvious that teach-
ers were experiencing serious physical and
mental health issues.
What the Allostatic Load
Means for Teachers
When I was in college I had a large button
that provided an unofficial definition of
stress: “The confusion created when one’s
mind overrides the body’s basic desire to
choke the living daylights out of some jerk
who desperately deserves it,” and while it
was accurate for the time, teacher stress is in
a field all by itself. If only it were as simple
as what my button said.
Stress affects what’s called the allostatic
load (AL), which is a cumulative measure of
physiological wear and tear on the body (Bell-
ingrath, Weigel, & Kudielka, 2009). These
folks, by the way, specialize in Theoretical
and Clinical Psychobiology, a combination
of psychology and biology. Anyway, the AL
is officially defined as “the physiological
consequences of chronic exposure to fluctuat-
ing or heightened neural or neuroendocrine
response that results from repeated or chronic
stress.” The same researchers cite four condi-
tions that lead to AL:
• Repeated frequency of stress responses to
multiple novel stressors;
• Failure to habituate repeated stressors of
the same kind;
• Failure to turn off each stress response in a
timely manner due to delayed shut down;
and
• Inadequate response that leads to compen-
satory hyperactivity of other mediators.
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Is your classroom environment the same
every day? Do you have time to stop and pro-
cess what has happened or are you forced to
move on to the next thing on the agenda? Do
your students accuse you of having “bat hear-
ing” because you can hear what they say on
the other side of the room while sitting at your
desk? You know the answers. Most teachers
have two speeds: ON and OFF. For me, the
list above means that each of those stressful
items listed earlier in this section not affected
me immediately, but also long-term as well.
According to the same researchers, the
following ten parameters are measured in the
allostatic load (AL):
• Cortisol;
• Epinephrine and norepinephrine;
• DHEA-5 (testosterone);
• WHR (waist/hip ratio)
• HbA1c (blood sugar);
• HDL;
• Total cholesterol/HDL –ratio; and
• Systolic and diastolic blood pressure.
More Chemicals?
Some of the factors listed above can be ob-
served while others require specialized tests. I
first had my hormone levels tested in October
of 2010, and what I found out explained why
this research was so important. My cortisol
level, which should have been high in the
morning to help me get out of bed, was too
low and got lower as the day progressed,
ending at the lowest end of the normal range.
I had been under so much stress for so long
that my adrenal glands were shot. Not enough
cortisol means not enough epinephrine or
norepinephrine—no “fight or flight.” While
others thought I was able to maintain my cool
in difficult situations, the truth was I was
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physically unable to do anything more than
stand my ground, and even that was challeng-
ing. The tests also revealed that I had estrogen
dominance, an unusually high amount of
estrogen (6.7 pg/ml with a normal range of
1.3-3.3 pg/ml for women in my age group),
and an extremely low level of progesterone
(36 pg/ml with a normal range of 75-270 pg/
ml). My DHEA-5 numbers were good at this
point, but when I retested in January of 2014
that number was out of range also, as was my
testosterone. What do these numbers mean?
These numbers mean that because of the
amount of stress I had been under, my body
was not well and neither was I, which takes
us back to Bellingrath, et al., who found that
“Significantly higher AL scores were found
in female school teachers with high levels
of effort-reward imbalance and exhaustion,
reflecting subtle dysregulation across mul-
tiple stress-sensitive systems,” and the “AL
composite might have high predictive power
for onset or progression of a variety of stress-
related health problems in apparently healthy
individuals or in individuals in sub-clinical
states.” (Bellingrath, Weigel, & Kudielka,
2009).
Reading the findings of the study were like
a slap in the face; they were talking about me.
I thought I had taken control of my wellness
in 2004, but six years later I discovered that I
had been taking baby steps when I needed to
be base jumping. As has been the case since
we met in college, Liz was my go-to person.
SECTION II: GETTING BACK TO
WELLNESS—LIZ’S STORY
I am an educator—just like you. We teach in
an environment that on a daily basis can be
exhilarating, exhausting, depressing, fascinat-

Well Teachers Teach Well
ing, downright scary, or a combination of all
of the above. It is often an emotionally charged
and physically draining experience. While
it may be intense at times, we also have our
favorite aspects about the job—the challenge,
the intrinsic rewards, the importance of what
we do, or, my personal favorite: the captive
audience. Fifty minutes a day, five times a
day…they are all mine! Helpless pawns to my
jokes and whims…oh, the power! Ok, not re-
ally…but facing that multitude of shining faces
sounds better some days than others, doesn’t
it? We all have bad days, but when those
days stretch into weeks, months, or—heaven
help you—years, there is a problem. I am not
talking specifically about depression or other
mental health issues, but I am talking about a
gradual wearing away and running down of
one of the most valuable assets to the teach-
ing profession—YOU. That is what led me
to write on a subject very close to my heart,
the fact that I believe “Well Teachers Teach
Well”—a nifty little phrase I coined which I
believe is so spot-on that I did my Master’s
thesis on it, have taught a class on it, been a
guest speaker to pre-service teachers about it,
and am now sharing it with you.
Hang Up the Spandex
Most teachers I know, and have ever known,
love teaching. But do we truly stop and
take inventory of what this job does to us
as individuals? Taking time to read this is a
testimony to how much you care about how
well you do your job because it also indicates
that you are searching for a way to do your
job well without it sucking the life out of
you. We have to remember that we are also
parents, spouses, friends, daughters and sons,
siblings, in-laws, and most importantly, indi-
viduals. As teachers, we make it a habit to be
all things to all people, which is a completely
unrealistic expectation, and one in which we
are doomed to fail. We caution others daily
about undertaking too much, but why do those
same rules not apply to ourselves?
That is where my story comes in—you, too,
must give yourself permission to be only you,
not some crazed superhero. As a friend used
to say when I was going in too many direc-
tions at once and starting to crack, “Honey,
it’s time to take off the spandex and hang up
the cape.” Why do we have to be reminded
that we are not Wonder Woman or Superman,
and that it is ok to be sick, tired, grumpy, or
to say “NO!” and mean it when we are asked
to do the one billionth favor for someone that
day? Why do we think it is a failure when we
have to do less, rest more, or ask for help…
but we completely encourage others to do
just that? Why can’t we be truly happy with
who we really are, just as we are: absolutely
imperfect, but totally awesome? Why don’t we
realize that if we would just save ourselves, we
might have a better shot at saving the world?
Let me tell you about my wake-up call.
I want to share with you what happened
when I hung up my “cape” and really looked
in the mirror at who I was, instead of what I
wanted everyone to see. Not a pretty picture,
I must say, and there was some permanent
damage, but with time, care, and education,
I think I bear a striking resemblance to a hu-
man being again. It was hard, but hey! I’m a
TEACHER—I love a challenge!
I hope by the end of this you feel a little
more like a person than a job description, and
that you will take home and to heart some of
these very simple but hugely valuable sugges-
tions to preserve that feeling. I ask that you
think over what I share with you and what
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you discover, hold on to it, and use it when
it is time. I stress that you do not need to put
into action everything you read here, but that
you at least give one or two suggestions a try.
I promise you will learn something valuable
from your effort.
Would You Like to Take a Survey?
In order to start the journey to the real you (I
don’t like to say “new” because we are really
just uncovering the person you already are,
hidden under all that stress), please take the
survey below. I designed this survey based
on my own life experience and research, and
therefore own the legal rights to it—if you
share it, please keep your karma positive: cite
me as the source, or please get my permission.
Please place a check mark next to those items
you actively and consistently do (no rationalizing,
please!).
Part A
1. _____ Get a good night’s sleep and wake
up feeling rested
2. _____ Exercise at least 30-60 minutes 3
or more times a week
3. _____ Eat a well-balanced diet, with
the emphasis first on fruits and veg-
etables, then protein, then dairy and
grains (chocolate is not a food group,
by the way) as well as actively avoiding
chemicals and highly-processed foods,
and possibly even gluten
4. _____Take vitamin and herbal supple-
ments to complement your diet
5. _____Spend some time each day (15-30
minutes or more) on thinking about what
you, and only you, need—spiritually,
emotionally, or physically
6. _____Spend time (15 min. or more) each
day writing down and being thankful for
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Well Teachers Teach Well
what went RIGHT that day, even the
smallest of successes--like not getting cut
off on the freeway, or that someone held
the door for you when your arms were
full (most likely with papers to grade!)
7. _____Make it a point each day to spend
time specifically thanking others (or a
higher power) for how they have been
helpful to you, even for the smallest action
8. _____Read several times—or at least
once—a week 15-30 minutes for pleasure
only
9. _____Spend “quality” time (talking,
playing, reminiscing, etc.) with family/
spouses/pets/friends on a regular basis
10. _____Drink a combined amount of 64
oz. (or more) of water, sports drink, or
tea
Part B
11. _____Drink caffeine daily—1 or more
6-8 oz. servings—because you just can-
not make it through the day without it
12. _____Crave sugar—you eat candy or
mints frequently, drink soda or juices
daily, eat sweets other than natural sweets
like fruit, or even crave something sweet
after meals
13. _____ You rarely eat anything that
doesn’t come in a box, bag or can and/
or eat “diet” food with aspartame and
other chemicals
14. _____Have pain in the neck, mid-back,
lower back, or arms that may come and
go, or used to come and go, but now flares
up and nags you regularly but you often
excuse it as weather or stress-related; can
also be located in hips and/or knees or
feet
15. _____Have migraines—often or oc-
casionally, or at least intense headaches
that disrupt your work or free time

Well Teachers Teach Well
16. _____Have had body aches that feel
flu-like, but go away in a few days with
no other flu symptoms developing, or
you are frequently prescribed antibiotics
(or other drugs) that may help for a few
days, but then the symptoms return with
no explanation
17. _____Have trouble committing to an ex-
ercise program because either too much
is going on in your life, or once you start
you often get hurt or feel too exhausted
to keep it up
18. _____Have felt more intense anxiety in
situations that perhaps in the past would
not have elicited such a reaction, but
in retrospect excused the incident (and
perhaps several others) to being tired or
stressed out
19. _____Spend time daily telling others
how crappy you feel, or how bad life,
the universe, and everything in it are
20. _____Have erratic sleep patterns or
habits: inconsistent bed and/or wake-up
times; frequent “startles” or wake-ups in
the middle of the night; never feel rested
Survey Creation and Interpretation
Before we interpret your score, let me explain
a little about the survey. I created this survey
a couple of years ago as a part of a presenta-
tion on teacher burnout prevention. I figured
the survey would be a quick way to get the
participants to focus on what they were already
doing that was either positive or negative, and
if nothing else they would leave knowing that
they were making small but important choices
every day that affected their health. I thought
it was not only an easy way to introduce the
simple positive suggestions I was presenting,
but also gave them something tangible to focus
on while I talked. I designed this checklist by
a fairly simple process: I listed all the habits
I had before I was diagnosed with fibromyal-
gia, and then all the habits I learned, through
research and experience, to embrace after I
was diagnosed. I found several books that
were particularly readable and helpful: From
Fatigued to Fantastic! by Jacob Teitelbaum,
M.D; Fibromyalgia and Chronic Myofascial
Pain: A Survival Manual by Devin Starlanyl
and Mary Ellen Copeland; Spontaneous
Healing: How to Discover and Enhance
Your Body’s Natural Ability to Maintain and
Heal Itself by Andrew Weil; and Reversing
Fibromyalgia: How to Treat and Overcome
Fibromyalgia and Other Arthritis-Related
Diseases by Dr. Joe M. Elrod. These books
were a blessing in that they generally agreed
that simple changes create major relief—there
were no guilt trips, no shame, just support.
They also provide plans and structure to re-
build your health, and while I chose to make
a change in one are at a time and see how that
went, all of them have merit. They also are
great references to go back to when you need
to get back on track. I put the positives first to
make the participants think about what they
are doing right, and the negatives last because,
after reading the positives, I thought it would
be more striking for a person to realize the
multiple misuses of their body on a daily ba-
sis. I wanted something that required nothing
more than common sense and effort, so people
could make real change immediately with just
a little effort redirected in a positive direction.
Now let’s look at your score. This survey
is not exactly rocket science, but it makes a
point: all the little ways we treat our body
add up, whether they are positive or negative.
If your:
• Part A answers equal 2 or less and Part B
answers equal 8 or greater, please stage a
self-intervention. You need it. NOW.
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• Part A answers equal 3-5 and Part B an-
swers equal 6-8, you are not a lost cause—
yet. Try to find a strategy from Part A that
hits one or 2 items from Part B. Or try to
even the score—or even reverse them—
and see what happens.
• Part A answers equal 6-8 and Part B an-
swers equal 3-5 or less, you ROCK! But
why not try one more strategy and drop
one more habit? You are on your way to a
stress-reduction gold medal!
• Part A answers equal 8 or greater and Part
B answers equal 2 or less, please be seat-
ed—your suite in Nirvana will be ready
shortly. Perhaps you could contribute some
pointers for the next edition.
Hopefully your survey results have not
hurled you further down into the pit of despair,
but when I did this with a group of educa-
tors, the audience made some pretty startling
conclusions about their behaviors that seemed
almost inconsequential to them until put right
under their noses. In order to calm down those
who were in need of immediate intervention,
I started off asking, “How many of #1-10 do
we know are ‘good for us’?” Obviously, they
all are. I then asked my group to take a look at
those first questions—do they seem unrealistic
to do as a whole? If so, how many are realistic
to achieve in a week? More specifically, how
many are realistic to implement today, or start-
ing tomorrow? This started quite a discussion
about commitment and excuses.
Now, ask yourself those same questions—
Do they seem unrealistic to do as a whole?
If so, how many are realistic for YOU to
achieve in a week?
Write that number down: _____________
How many are realistic for YOU to imple-
ment today,
or starting tomorrow?
Write that number down: _____________
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You have made your first steps to commit-
ting to change—you have made a concrete
goal for yourself by writing down numbers
that are meaningful to you and only you. Once
you determine what strategies to try, you can
figure out how and when you want to try them.
Congratulations! Way to take a step toward
change…you have officially grasped the ties
of the cape!
Are you ready to pull those strings loose?
Not yet, but maybe more ready than before?
Hold that thought…
Take a look at Part A one more time.
Common Sense
Why do we not do some or all these activi-
ties? What gets in the way? Using a separate
sheet of paper, make a list of all the reasons
that come to mind about why you don’t do
some (or all) of these strategies. This is a
brainstorm, so be really open and honest with
yourself. This activity may be like microwave
popcorn—maybe nothing at first, but just
when you think it might be a dud, ideas will
start popping, one by one. I want you to keep
writing until your thoughts stop popping up so
fast. You can list any reason, no matter how
lame or legitimate…GO!
Example: I don’t drink enough water daily
because I’d have to keep running to the
restroom and I can’t leave my class.
Whew! Well, what do you think? Did it
feel good to get all of those reasons out in the
open and give them a good look? Look at them
again—are there any items on your list that
will really stop you from trying something
new? Circle any that might hold you back
and take a good look at them. Now, some-
where nearby, can you list 3-5 ways around
this issue? If not, then perhaps the particular

Well Teachers Teach Well
wellness strategy related to that excuse is not
for you. That is perfectly fine—one size does
not fit all. Try something else that perhaps
does work for you. Chances are you will have
reasonable success, will enjoy it, and will feel
better overall. My two favorite words describe
this selection method—COMMON SENSE.
Questions for another brainstorm, journal
entry, soul reflection: If you don’t try at least
one of the activities in Part A, what will happen
in your life? If you don’t stop doing some or all
of the activities in Part B, what will happen?
Which outcome is worse? Is it possible that
those shooting, aching pains in your neck (no,
not talking about your students here…) will
actually just go away if you ignore them? Are
massive doses of caffeine really the answer
to your daily fatigue? Or is change a better
answer—if you change one thing about the
way you care for yourself, will it really make
that much of a difference? Let’s brainstorm
on that one: take at least one item from Part
A and make a list of all the potential benefits,
obvious or otherwise. The same rules apply
as for the first brainstorm…no limits! Think
big, small, or diagonally! GO!
Find anything interesting? A change that
perhaps you wanted to make but did not know
how? I hope this exercise was beneficial in
some way, even if it did nothing more than get
you to think about the choices you make and
the reasons you often THINK you have when
choosing one direction or another. Getting past
our stock repertoire of excuses or fears is a
good thing—being honest with ourselves is
another good thing. Thinking about what we
choose and how it affects us is what is known
as a major Big Time STUPENDOUS thing!
I’m going to ask you to take a deep breath
and just relax for a minute. I’d like to share
with you why I care whether or not you make
a change in your life.
Fibro-My-What-A?
I want you to learn how to not get burned out
as a human being, not just as a teacher. I am
qualified to chat at you about this because,
while I seem (by most recent accounts) out-
wardly to be very put-together and energetic
(those, by the way, are generally the two most
frequent signs by which people judge your
mental and physical health), I have already
done the worst to myself and now must live
with the joyful (being quite sarcastic there)
fatigue syndrome that is fibromyalgia. Dr. Joe
M. Elrod, in his very informative and fabu-
lously positive book, Reversing Fibromyalgia
(1997) defines it as such:
The name ‘fibromyalgia’ means pain in the
muscles and in the fibrous connective tissues.
This condition is referred to as a syndrome
because it is a set of signs and symptoms
that occur together…Most patients with fi-
bromyalgia syndrome state that they literally
ache all over. They describe their muscles as
feeling as if they have been pulled, torn, or
overworked, sometimes twitching and at other
times burning (Elrod, p.10-11).
I was Part B on that survey for about 5
years, maybe longer, and had no idea why any
of it was happening—until I was diagnosed
first with mononucleosis and then with fibro-
myalgia in 1998, when I was 28 years old. I
was (emphasis on the “was”) a very active,
energetic person, but something was wrong,
and it was not easy to figure out at first.
Always On the Go
I was always athletic—growing up, I got into
running at an early age. I ran frequently from
my older brother, which later parlayed into a
career in track and cross country that spanned
through high school and up to my junior year
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of college, when I quit running competitively
when my coach transferred to another college.
It wasn’t the same without him, so I officially
began my coaching career as head coach at
a nearby high school while also undertaking
my first student teaching experience...because
why would I ever want to do just one major
thing at a time?! I was also a gymnast and
cheerleader throughout high school—these
talents are still sadly apparent in my teaching
delivery style as I have been known to waggle
“spirit fingers” in the air for right answers, or
turn cartwheels (when appropriately dressed)
when kids who chronically turn in material late
manage to turn something in on time. I have
never been much of a couch potato; rather, I
was always on the go.
Still Going…
After college graduation, I spent the summer
sending over a hundred resumes and cover
letters out, as well as countless applications.
I was deathly afraid to get hired somewhere,
because even though I had done student teach-
ing and had decent experience, I still felt like it
hadn’t really prepared me for “real” teaching.
The teaching gods must have heard my pleas,
because rather than teaching English like I had
been trained to do, I went right into an urban
alternative school supported by a state-funded
organization where I worked for two years
teaching job and life skills, as well as work-
ing with a summer jobs program for students
where I did remediation for participants who
were below grade level in reading or math.
It was an eye-opener to say the least, but the
experience was invaluable, and impacted me
permanently. I loved it. I was also coaching
track again, and teaching gymnastics, as well
as frequently attempting to “stay in shape.” I
lived with my parents for two years prior to
my marriage, and those scars are still healing.
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In 1994 I married my college sweetheart,
moved to a big city and started a job at a voca-
tional school, working again in a state-funded
program, again with students who had the
graduation odds stacked against them. I had
graduated with 88 students in my high school
class, 300-something in college, and was now
working in a school of 800+ students—no
pressure there. I switched jobs after a year
because the job was pretty repetitive rather
than challenging, and went to one of those
fast-food-like chains of learning centers to
be a Director of Education (read as “glorified
peon”), a time in my life that I have fondly
tried to repress. En route to leaving that little
slice of Hell, I wound up as an assistant track
coach at my current school, which turned into
a long-term sub as an English Department
Professional Assistant (read again as “glorified
peon”) that same spring, and then was asked
to be a summer school teacher, which led to a
full-time English teacher and head girls track
coach position in my first full year there.
I Am a Sponge, Therefore I Stress
One problem through all of this seemingly
normal progression of events: I was a sponge
for stress because I never made time for myself.
Literally—I went from college to working to
marriage to moving to working to teaching
and coaching to nearly killing myself. I will
not even go into the numerous funerals, family
problems, illnesses, and other traumas we all
are subject to in life at any given moment that
occurred. That is why I want to share with you
some of these very simple, common sense
approaches to reclaiming and sustaining your
health as a teacher, and more importantly as
a person.
I do not remember exactly when I started
losing my place in situations such as while I
was teaching a lesson or simply conversing

Well Teachers Teach Well
with others. There I would be, waxing pro-
phetically on the virtues of some poet, author,
or chatting about something as simple as the
latest pair of shoes I had purchased and then,
with no warning whatsoever, wherever I was
going verbally was gone—the fog would de-
scend and I would stand there gaping, gasping
for where my words had gone. I know that once
the process started, the mental lapses became
progressively worse in frequency and duration.
I began noticing that just as frequently, while
kneeling by a student’s desk to answer a ques-
tion or conference on a paper, I would have to
stay there until the dizziness and “stars” at the
edges of my vision passed. I had also somehow
developed migraines, increasing in frequency
and intensity; my neck and shoulders ached
constantly, and were painful to the touch. After
struggling though another workday, I would
have to push myself mercilessly to complete
routine tasks, and then would fall into bed
exhausted. Oddly, though I was exhausted,
I rarely slept more than three or four hours
a night, waking up several hours before the
alarm in a panic as though it was time to get
up and then I would lie there, unable to rest,
managing to get back to sleep only moments
before the alarm would go off. I was puzzled
about why I could not sleep well, but I kept
promising my body that tomorrow night or
this weekend, I would go to bed early and get
“caught up” and everything would magically
right itself.
“I’m Fine…(Not) Really.”
Of course, my failings did not go unnoticed
by others. I laughed it off when my students
(or anyone else) occasionally commented on
my confusion or lack of coordination, and I
was quick to reply that I was “tired” or “had
a touch of whatever was going around” and
assured them I would be just fine tomorrow.
However, I began to realize that the sinking,
tightening feeling that occurred in my chest
(known as my instinct) every time I used one
of my now-standard answers to explain away
some mistake was telling me that none of those
excuses were entirely the true cause for my
faltering memory and constant fatigue. I would
will myself not to make any more mistakes
lest someone might think I could not handle
my responsibilities as an English teacher in
a successful suburban high school, the head
girls track coach, and advisor to a program
that trained and organized high school students
to teach positive life skills to the fourth grade
students in our district (because I needed more
to do, right?). I would drag through each day,
thinking only of how soon I could get home
and take a nap because I again convinced
myself that I would miraculously feel better
(translation: be able to cook a dinner other
than boiling water to make pasta; actually
grade papers before the end of the quarter;
talk rather than argue with my then-husband;
in general, live like a normal human being)
if I could just rest “a little” once I got home.
…A Little Help Here?
My now ex-husband saw the changes in my
behavior and endurance and knew something
was wrong, but I gave him the same rehearsed
answers I gave everyone else—I was fine,
really. However, he was not blind; where I
once could clean the house top to bottom in
a couple of hours on the weekend—dusting,
vacuuming, mopping, and laundry all taken
care of, with time to spare to enjoy the rest of
the weekend—it now took me several hours
Friday night, most of Saturday, and all of
99

Sunday to complete those same tasks, with
several hour–long naps in between activities,
if I was feeling “good” compared to normal.
My naps became a sad joke in our house—
once I lay down, I was in a death-like state; I
prayed a fire would never happen when I was
napping because I was convinced I would per-
ish since I would neither be able to get off of
the couch, nor stay vertical and coherent long
enough to get out of the house. Climbing a
flight of stairs began winding me and making
me dizzy, and as a result I began to dread the
two flights I climbed daily to my classroom,
the main office, or the copy room from my
office. At home, we devised several methods
to get me up the stairs to bed, ranging from
me crawling up the steps like a toddler (on
my better days) to him assisting me. Looking
back, maybe it wasn’t every night, but did it
really need to happen that often for me to get a
clue I was NOT OK?!? Things went downhill
fast that year: at the far-from-advanced age of
twenty-eight, I could no longer touch my toes,
put my slippers on, or even (at my worst) bathe
and dress myself because if I bent slightly at
the waist, my back hurt intensely, and lifting
my arms to do my hair or dress resulted in
immediate pain and fatigue. Here I am, year
two of my dream job, and I think I am dying.
Fan-freakin’-tastic.
“I Don’t Have Time to Be Sick”
“What did you do about it?” is a frequently
asked question—the answer is the same that
most teachers (or other crazy humans) would
give…nothing. I did not believe that I had
time to be sick. I was a teacher, and every
teacher knows that missing one day is like
missing two or three, depending on the sub-
stitute, the class demographics, and a host of
100

Well Teachers Teach Well
other variables. I eventually made monthly
trips to the doctor, and started getting shots
at an allergist. To add insult to injury, after
lodging the same complaints each month,
consuming different antibiotics each time,
and taking allergy medicine all the while but
seeing no improvement yet continuing to feel
the same fatigue and nausea, I was quickly
approaching critical mass with depression.
Finally, after an eight month rapid decline,
it was discovered I had mononucleosis, and
had probably had it for quite some time. Yes,
I now had at least part of the answer—even if
it was the dreaded “kissing disease” known
to highschoolers (that was fun explaining to
people). Thankfully my well-informed fam-
ily doctor pondered why someone my age
and with my life-long activity level with no
previous history of mono would have it now.
She confirmed that it was something more:
fibromyalgia. It was both the worst and the
best diagnosis I could have imagined—I was
not crazy (which I truly and secretly feared),
but I had a lot of work to do on my lifestyle.
I wasn’t dying, but I wasn’t headed anywhere
much better.
Anything Sound Familiar?
Do we, as educators, really want to burn out,
become bitter, hate our jobs, and become
“that” teacher—the one that everyone can-
not wait until he or she retires? If not, then
we have to change into the person we want
to be, and become the real person within us.
The best part is, though, for once, we are the
ones who benefit the most from undertaking
such hard work. Others surely benefit from
our improved disposition and energy, but we
get to live with the satisfaction that we chose
to change, and we met the challenge. I am not

Well Teachers Teach Well
the person I was even a few years ago, and
I am so glad. Former students visit me and
tell me that I have changed somehow, that
the “edge” is gone. I tell them I am happy
now—that’s the difference.
Disclaimer #1: I am not a doctor; I am a
teacher and a person.
I have researched this information for my
own purposes and health. Items 1-10 from
the survey are how I have learned to prevent
flare-ups of this syndrome, but they also work
marvelously as ways to remotely function as
a well human being. I am sharing this only
because through my research I have learned
that teachers are a high-risk group for this
syndrome and many other health problems.
While I hope this has been a little entertaining,
please make no mistake about the sincerity
and concern behind my words—I can happily
provide the horror stories about what my life
was like before I changed it if you doubt that
it was “that bad,” but I’d rather spend your
time here on YOU.
Disclaimer #2: PLEASE read as much as
you can and check with your physician
before trying anything I suggest. It just
makes good sense.
For example, when I began researching
fibromyalgia, I found a lot of fibro web sites
(this was pre-Facebook) that made me want to
end it all right then…because there was noth-
ing very promising or positive, and not what I
needed to hear just then. The FB pages I find
now are often equally distressing. Through a
series of random coincidences, I found a LOT
of resources that agreed on what worked. And
while I know what has worked for me, it may
not necessarily work for you. My suggestions
are based on common sense, experience, and
research, but YOU have to learn what works
best for YOU.
Implementation of any of the items listed
in Part A requires, and will be facilitated by,
employing the same four strategies.
The Four Rs
(Bet you thought there were only three.)
• Recognition: Acknowledge that there is a
REAL problem in your health or well-be-
ing. Acknowledge you are worth the time
and effort.
• Record: Regularly record your habits,
thoughts, emotions, behaviors, and/or
problems to make patterns clear, and so you
have accurate records for your physician;
also useful for noting improvements and
especially successes (that part is KEY)!
• Research: Find reliable sources and prac-
tice a recommended technique or strategy
(continue recording through this point)—
but be sure to go with what “feels” right
to you, because you will be more likely to
succeed than with something that makes
you stress just reading about it!
• Reflect: Look at what you have discovered
about yourself and the issue you are deal-
ing with via recording and researching, and
determine whether what you are doing is
enough, not enough, or too much.
Repeat the cycle, in whatever order, as
needed, forever. You are worth the effort.
I hope the simple strategies suggested in
the survey and the 4 Rs will help you to fi-
nally hang up the cape and costume, and the
only time you ever wear it again will be for
Halloween. Let the journey begin.
101

REFERENCES
Bellingrath, S., Weigel, T., & Kudielka, B.
(2009). Chronic work stress and exhaustion is
associated with higher allostastic load in fe-
male school teachers. National Center for Bio-
technology Information. Retrieved from http://
www.ncbi.nlm.nih.gov/pubmed/18951244
Elrod, J. M. (1997). Reversing fibromyalgia:
How to treat and overcome fibromyalgia
and other arthritis-related diseases. Pleasant
Grove, UT: Woodland Publishing.
Gordimer, N. (1981). July’s people. New York,
NY: Viking Press.
Masini, A. (2010). Equine-assisted psychother-
apy in clinical practice. Journal of Psychosocial
Nursing and Mental Health Services, 48(10),
30–34. doi:10.3928/02793695-20100831-08
PubMed doi:10.3928/02793695-20100831-
08 PMID:20873699
Metcalf, T., Davis, S., Gonda, L., Britt, M.,
& Bird, J. (2010). Well teachers teach well:
Renewing our teaching selves. Paper presented
at the National Council of Teachers of English
Conference, New York, NY.
Starlanyl, D., & Copeland, M. E. (1996).
Fibromyalgia and chronic myofascial pain:
A survival manual. Academic Press.
102

Well Teachers Teach Well
Teitelbaum, J. (1996). From fatigued to fan-
tastic. Garden City Park, NY: Avery.
Weil, A. (2000). Spontaneous healing: How
to discover and enhance your body’s natural
ability to maintain and heal itself. New York,
NY: Ballentine.
Williams, N. R. (2003). Occupational
groups at risk of voice disorders: A review
of the literature. Occupational Medicine,
53(7), 456–460. doi:10.1093/occmed/
kqg113 PubMed doi:10.1093/occmed/kqg113
PMID:14581643
KEY TERMS AND DEFINITIONS
Allostatic Load: The effects on the body
due to either too much stress or inadequate
management of stress.
Book Challenge: An attempt to remove
or restrict materials based on the objections
of a group or individual.
Grounded: The natural connection hu-
mans share with the Earth; grounding is often
used in alternative medicine.
Vocal Cord Dysfunction: A condition
where the vocal cords close instead of open-
ing when a person tries to inhale or exhale;
this condition often mimics the symptoms
of asthma.
 103

Chapter 7
Healing through Self-Discovery
and Artistic Design Journals
Susannah Brown
Florida Atlantic University, USA

ABSTRACT
The author explores the process of healing through the use of artistic writing activities in a journal,
which promote self-discovery. Techniques that involve art making and writing are shared, such as col-
laborative drawing and writing, ekphrasis, hand-made journals, mandala drawing, marble paper ab-
stract drawing, and sensory printing. Through artistic design, the journey to better understand the self
is addressed, emphasizing management of everyday stresses such as those stemming from relationships,
roles, and change. Managing these stresses leads towards a healthy life by providing a balance between
creative drive and daily obligations. Guided exercises using various media are explained. The process is
emphasized, not the end product or artistic merit of the creation. It is through this creative process that
tension and stress are released and the joy of discovery becomes a part of life. Individuality is valued
through thoughtful reflection of the activities that are embedded in artistic design journals.

INTRODUCTION capture this moment in time. Removing the

Drip, drop, ripple, and swirl, the oil based
Suminagashi ink travels across the surface of
the water in the bucket. The ink has a will of its
own, moving and pushing through space like
people jostling across a busy New York City
street during commuting hour. I stare into the
flowing waves that evolve from the mass of
swirling colors, like a bird flying high above
the bustle of city life viewing traffic patterns as
designs. Gently, a single sheet of white paper
is placed on the top of the water to visually
sheet from its watery nest, I consider how the
marble paper guides my imagination while
setting it on the table to dry.
I often use marble paper to draw found de-
signs, which relaxes my shoulders and lets my
mind wander. The random designs (doodles)
are like cloud formations that take various
shapes, some of which are recognizable and
offer a tenuous safety line of reality. One swirl
might create an eagle with its wings spread
wide over a vast wave crested ocean. Another
swirl reminds me of dust whirls rising from

DOI: 10.4018/978-1-4666-7524-7.ch007

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

Healing through Self-Discovery and Artistic Design Journals
Figure 1. Marble paper
hooves beating a trailhead during the Geor-
gia dry season. Marble paper is the result of
transferring the swirling ink onto a sheet of
paper and can be used in a variety of artistic
work such as, collage, book end pages and
drawing. For example, guided doodles can be
drawn on marble paper as a starting point for
artistic and creative writing activities, which
promote self-discovery through imagination.
The drawing process helps to relax the mind
and body to alleviate daily stress which pro-
motes the healing process. Creating marble
paper is only one way to self-express your
ideas for healthful living. The experience of
making artistic works is the emphasis for an
artistic design journal.
104

Healthful living involves management of
diverse roles, demands, relationships, change,
and other factors of daily life. Imagination
and creativity can help balance our creative
self and daily obligations. In this chapter, I
discuss various artistic exercises that allow
for self-expression and self-awareness, which
are two important parts of self-discovery. Our
emotions, thoughts and concerns can come to
light through the art media. It is through this
creative process, that tension and stress are
released and the joy of discovery becomes a
part of life. Playful and creative exploration
of the world around you opens doors to pos-
sibilities. Having the confidence to value this
exploration is an important step on the journey

Healing through Self-Discovery and Artistic Design Journals
to self-discovery and healing. “No special
skills are needed for play; there are not any
proper techniques to learn. Play is accessible
to all…” (Szekely, 2003, p. 39). In this chapter,
I explore the use of artistic and creative writ-
ing activities which promote self-discovery
and stress management for healthful living.
Techniques that involve visual art making and
creative writing are varied (Knoeller, 2003).
Throughout my artistic and teaching career,
the combination of visual representation and
written communication include techniques
such as, collaborative drawing and writing,
ekphrasis, hand-made journals with creative
entries, mandala drawing and image/word
association, marble paper abstract drawing,
and sensory printing. As we move through this
journey together, let’s consider how guided
creative exercises can promote healing and
stress management by allowing each of us
to express our unique view of the world. Our
individuality is valued through our thoughtful
reflection of the images and words that flow
throughout our experiences.
CONNECTING FORMS
OF EXPRESSION
Ideas are naturally expressed in arts and writ-
ing forms, which are shared through social
interaction (Gardner, 1999). As an educator, I
value learning through sociocultural practice
and believe that this communication process
leads to cognitive development. Vygotsky’s
(1978) sociocultural theory supports collab-
orative learning and peer interaction as part of
learning. It is this sharing of ideas that allows
for the internalization of concepts which leads
to growth. Active engagement in a supportive
environment promotes a deeper understand-
ing of concepts and guides the journey to
self-discovery and stress management. This
is the role that visual art and writing play in
our lives by providing active engagement,
which bring our thoughts to light.
Creative writing, just like the visual arts,
can take various forms (Knoeller, 2003). The
relationship between visual arts and writ-
ing can be explored through the inspiration
of personal narratives, which influence the
process of self-discovery and stress manage-
ment. Retold stories (personal narratives)
create meaningful opportunities to learn
about ourselves and how to manage future
potentially stressful situations through the
analysis of actual experiences. This supports
the healing process as one moves forward
past obstacles that once proved unsurpassable
(Lazarus, 2006).
Personal narratives, both verbally and in
writing, play a role in our communicative
journey by strengthening connections between
cultural heritage and personal history. Blend-
ing the artistic with creative writing is not a
new concept. The paintings by prehistoric
people are evident in the Caves of Lascaux
and visually tell their stories. Fast forward
through time and imagine how Keats’ Ode
to a Grecian Urn (1820) led to his discovery
that, “beauty is truth, truth beauty, that is all
ye know on earth, and all ye need to know”
(lines 49-50). The process of writing based
upon imagery is called ekphrasis. Developed
during ancient Grecian times, ekphrasis is
writing that is so descriptive that the reader
can envision what inspired the text. This style
of writing is a unique blend of description
and imagination that involves all the senses
(Munsterberg, 2009).
The relationship between written and vi-
sual expression is strong and often channels
our thoughts and feelings. As a part of our
lives, writing and visual art involve social,
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Healing through Self-Discovery and Artistic Design Journals
philosophical, psychological and historical
aspects of one’s inspiration, spirit, thought,
intellect, messages, and emotions (Anderson
& Milbrandt, 2005; Brown, 2013). All of
these aspects are entangled in making the
product special (Dissanayake, 1992, p. 42).
These processes are not separated from life;
rather they are an integral part of the human
experience, uniting people through social and
cultural values.
Emotions guide the writer and artist to
produce new work. Expressing our emotions
through the creative avenues of writing and
visual art is a healthful path of understanding
what drives our psychological state of mind.
Artistic outlets support our journey to self-
discovery through reflection and analysis of
the end product (the artwork or written word).
Comprehension of the causes of stress in our
lives is born through this process. Once we
understand the causes, we can work towards
resolving stressful situations in a healthy man-
ner (Lazarus, 2006; Sternberg, 1985).
ARTISTIC DESIGN JOURNALS
Am I a book? Does my cover open to reveal
pages ready to receive marks of pen and
brush alike? These are questions that define
an artistic design journal. If your answers to
these questions are yes, then you already have
some conception of an artistic design journal.
Journals, notebooks and sketchbooks serve
the purposes of the creator. Artistic design
journals are a hybrid, combining the values
of a written journal and the visual elements
of the artist’s sketchbook. Hand-made books
are a favorite to use as artistic design journals,
since the time spent on binding the book is just
as exciting as filling its blank pages. Over the
years, I have learned many different techniques
106

of book binding and found that sharing how
to make a book is as valuable as writing and
illustrating one. Accordion book binding is one
of my favorite styles since it simply involves
folding the paper in a zig-zag pattern and is
easily completed. Case bound books with
hard covers and stitched signatures (groups
of folded pages), are more time consuming
to make, but the effort is greatly rewarded.
This type of book binding has strength and
stability, which promotes daily use.
Sometimes concepts can only be expressed
through visual art as other forms of expression
are not adequate. Other times the written word
is crafted to convey the author’s intentions.
Dissanayake (1992) proposes that we have a
biological need to create as evident through-
out human history, i.e. ancient petroglyphs
and contemporary graffiti. Artistic design
journals are meant to capture this art spirit
(Henri, 1923), the essence of creativity, and
communicate to the creator and others who are
willing to listen. Our journey begins with the
blank page and the courage to make a mark.
Setting the Stage
Before the curtains open and scenes begin,
each actor prepares for the role. Just as in
theatrical performances, the writer and artist
should also set the stage and be ready for the
creative release. First, gather the needed ma-
terials and arrange the space for comfortable
use. Sometimes, selections of music, books,
or visual images are helpful to provide inspi-
ration. Next, it is important to relax the mind
and body. Physical movement can relax the
mind and release the hand allowing creative
impulses to take form. Whenever beginning
a new artistic design journal entry, start with
simple relaxation techniques as follows:

Healing through Self-Discovery and Artistic Design Journals

Figure 2. Seasons, a hand-made and painted case bound journal by Susannah Brown (detail of spring)

1. Close your eyes and take three deep 2. Gently rotate the shoulders, arms and
breaths (inhale slowly and deeply, hold wrists and wiggle the fingers;
the breath for a few seconds and then 3. Straighten your posture by imagining
exhale slowly); a string pulling through the spine and

107

Healing through Self-Discovery and Artistic Design Journals
stretching upwards through the top of
the head (can be done while standing or
sitting); and
4. Open your eyes and begin to create on
the blank page.
Remember there is no judge or jury watch-
ing the creation. You are the director of the
experience and must suspend the natural
sense of evaluation by allowing the writing
and art form to lead you along the path of
self-discovery and thus provide a release from
daily stress. Poised and ready to create, let’s
begin to explore different types of entries that
comprise the artistic design journal.
Figure 3. Name art in pencil by Susannah Brown
108

Tentative Starts Equal Great Endings
A simple, yet powerful beginning starts
with writing your name in the artistic design
journal. For years, you have been expressing
a natural sense of line through this form of
expressive drawing. Begin with a signature.
Look closely at the written name and con-
sider it as an artwork. What type of emotions
or personality is expressed? Respond to the
nonverbal message of the line quality in your
signature by writing a few notes that explain
what it expresses. Next, write your name us-
ing different styles or fonts (letter designs)
and consider each one as work of art. Open

Healing through Self-Discovery and Artistic Design Journals
the mind to the characterization qualities that
a signature holds. Perhaps, these different
signatures represent different sides of the self
or do they represent new characters in a new
play that is at the beginning stage? How it is
perceived guides the understanding of what
is expressed (Edwards, 1999).
Mandalas
Another technique is to begin with a circle
to represent our never ending cycle of self-
discovery. Draw a simple circle and then
fill this shape with designs and patterns that
intuitively come to mind. The ending result
is called a mandala. Mandalas, or circle
drawings have been made for centuries in
a variety of cultures. Tibetan monks design
mandalas during religious rituals where the
patterns are sacred and rich in meaning. The
Figure 4. Mandala in markers by Susannah Brown
concentric circles enclosing various symbols
are created using colored sand. The simple
shape of a circle relates to the universe and
re-consecrates the earth and its inhabitants.
After several days of creating the mandala (the
process is laborious), Tibetan monks sweep
up the sand and place it in an urn during a
closing ceremony. The sands are emptied in
a nearby flowing body of water to allow the
healing properties to spread to the ocean and
the world (Drepung Loseling Monastery,
Inc., 2014).
Drawing mandalas in an artistic design
journal can be a step towards self-discovery.
Carl Jung (1972) advised that creating man-
dalas throughout the day can guide one’s
emotional state and improve self-awareness.
The center of the mandala is considered the
central self and the designs and colors that
extend from this center to the outer circum-
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Healing through Self-Discovery and Artistic Design Journals
ference represent various perspectives of
self. The outer rim represents the self that
is projected to others (social or public self).
Lightly draw a line that divides the circle in
half horizontally, which makes the analysis
of the design easier to complete. The top half
is said to represent the conscious self and the
bottom half represents the subconscious or
concepts that are suppressed. Jungian inter-
pretations of individual mandalas are guided
by the creator. Interpreting the mandala is a
personal journey of image and color asso-
ciation with words. After drawing the circle
design, begin to decipher the image by list-
ing all the colors and objects/shapes that are
represented. Associate each color and shape
to an emotion or expressive list of words
(descriptive adjectives). In truth, only you
can interpret the personal mandala, so don’t
be misled by typical color/word associations
such as, red means anger or passion. Once
writing is completed, look for themes or reoc-
curring concepts that can potentially further
self-discovery (Fincher, 2010).
Collaborative Drawing
Working with a friend is another technique
that promotes creative thinking. Collabora-
tion “removes the mental blinders imposed
by limited experiences and narrow percep-
tions. It makes it possible to discover personal
strengths and weaknesses learn to respect
others, listen with an open mind, and build
consensus” (Johnson, 2002, p.89). To begin,
write a simple phrase or sentence and pass it
along to a friend to add their own line to the
creation or cover part of the sentence that was
originally written with a sticky note and allow
friends to complete the sentence or phrase.
110

This can also be done with a drawing that is
begun by one person who covers most of the
started design except a few connecting lines
for the next artist to complete. This process is
often referred to as “exquisite corpse,” a term
made popular by the Surrealist artist move-
ment, using their typical sarcastic humor and
morbidity in bringing a “dead drawing” back
to life through the process of collaborative
drawing (Rubin, 1968).
Sensory Printing
Another creative start is sensory printing.
This type of printing is guided by the sense
of touch. A thin layer of paint or ink is rolled
or brushed onto a flat non-porous surface, a
plastic plate works well for this process. Next,
a thin piece of paper (newsprint paper is per-
fect) is gently laid down on top of the paint/
ink. Using the fingertips, apply pressure on
the top of the paper. Sometimes, I create the
sensory print to the tune of my favorite song
and let the music guide my fingers across the
page. When finished, pull the paper off the
inked plate and a reflection of the design is
transferred onto the page. After drying, add
other colors or line designs to emphasize areas
that catch the creative eye. This is an intuitive
way to include printmaking in your repertoire
of artistic skills.
These examples of tentative starts can
lead to great endings. The goal is to begin
and fearlessly make your mark in an artistic
design journal. Everyone can create artistic
design journals and increase their awareness
of their emotions by expressing important
thoughts. This creative outlet can unleash
limitless imagination which will guide the
journey of self-discovery.

Healing through Self-Discovery and Artistic Design Journals
Figure 5. The Kiss, a sensory print and marble paper accordion bound journal by Susannah Brown
REFLECTION AND CONCLUSION
Once you have become comfortable with
melding writing and artistic processes, try
to craft new ideas and ways of expression
using new media. Photography may inspire
great writing or billboards on the highway
may spark your imagination. Inspiration can
strike through every day experiences. I often
open the newspaper (yes, I still have the ac-
tual newspaper delivered daily) and images/
words lead to the creation of doodles, lists,
or questions on the margins. Artistic design
journals can allow for more creativity in all
areas of daily life. Frederick Franck explains
in his book, The Zen of Seeing (1973) that
one must draw something in order to reveal
the “extraordinary” nature of the object. Look
closer to more deeply understand.
Awareness is often the first step in self-
discovery. It is my hope that through the artistic
activities described in this chapter, one can
confidently take the first steps towards a more
healthful life. Once the practice of artistic de-
sign journaling becomes a natural part of daily
life, more focused and purposeful activities
can be incorporated to shed light on specific
areas of the self to be explored. For example,
if mandala drawings and written reflections
indicate over a period of time that you wish
to pursue growth of the inner self to reflect
in the outer self, then collaborative activities
might assist in this personal goal. Sharing our
creativity with others helps to strengthen the
outer self. To sustain this method of growth
and development, one might focus on a spe-
cific stressor such as, changing to a new job.
Daily written journal entries with cartoon
111

Healing through Self-Discovery and Artistic Design Journals
faces that express emotions while preparing
for the morning commute can work wonders
to soothe the nerves about new expectations.
The act of expression can alleviate the stress
and therefore emotions can be managed. It is
this ability that promotes healing (Lazarus,
2006).
Each person develops individual coping
mechanisms such as, journaling or drawing
images. Be open to new ideas that include
other forms of creative self-expression. The
process of reading, writing and illustrating
can transport one into an altered state of
consciousness or what some refer to as day-
dreaming or meditation. It is in this relaxed,
yet creative state of mind that innovative ideas
are born. Cultivating this ability through the
use of artistic design journals may result in
a deeper understanding of the self and help
manage stress through a creative outlet, which
in turn promotes a healthful life.
REFERENCES
Anderson, T., & Milbrandt, M. (2005). Art for
life: Authentic instruction in art. New York,
NY: McGraw-Hill.
Brown, S. (2013). Teaching art integration in
the schools. Mason, OH: Cengage Learning.
Dissanayake, E. (1992). Homoaesthetics:
Where art comes from and why. New York,
NY: Macmillan Inc.
Drepung Loseling Monastery. (2014). Man-
dala sand painting, healing the earth: A sacred
art by the Tibetan Lamas of Drepung Loseling
Monastery. Drepung Loseling Monastery Inc.
Retrieved from http://www.mysticalartsofti-
bet.org/mandala.htm
112

Edwards, B. (1999). The new drawing on
the right side of the brain. New York, NY:
Penguin Putnam Inc.
Fincher, S. (2010). Creating mandalas for
insight, healing and self-expression. Boston,
MA: Shambhala Publications, Inc.
Franck, F. (1973). The zen of seeing. New
York, NY: Alfred A. Knopf.
Fowler, C. (1996). Strong arts, strong schools:
The promising potential and shortsighted
disregard of the arts in American schooling.
New York, NY: Oxford University Press.
Gardner, H. (1999). Intelligences reframed:
Multiple intelligences for the 21st century.
New York, NY: Basic Books.
Henri, R. (1923). The art spirit. New York,
NY: Harper & Row, Publishers.
Johnson, E. (2002). Contextual teaching and
learning: What it is and why it’s here to stay.
Thousand Oaks, CA: Corwin Press, Inc.
Jung, C. (1972). Mandala symbolism. Princ-
eton, NJ: Princeton University Press.
Keats, J. (1820). Ode to a Grecian urn. Annals
of the Fine Arts, 15.
Knoeller, C. (2003). Imaginative response:
Teaching literature through creative
writing. English Journal, 92(5), 42–48.
doi:10.2307/3650423
Lazarus, R. S. (2006). Stress and emotion:
A new synthesis. New York, NY: Springer
Publishing Company.
Munsterberg, M. (2009). Writing about art:
Ekphrasis. Retrieved from http://writing-
aboutart.org/pages/ekphrasis.html

Healing through Self-Discovery and Artistic Design Journals
Rubin, W. S. (1968). Dada and surrealist art.
New York, NY: Harry N. Abrams, Inc.
Sternberg, R. J. (1985). Beyond IQ: A triarchic
theory of human intelligence. New York, NY:
Cambridge University Press.
Szekely, G. (2003). A retrospective: 1973-
2003 essays for art teachers. Boston, MA:
Pearson Inc.
Vygotsky, L. (1978). Mind in society. Cam-
bridge, MA: Harvard University Press.
KEY TERMS AND DEFINITIONS
Artistic Design Journals: Sketchbooks
that contain writing/journals and visual images
created by the author/artist (Brown, 2013).
Creativity: Creativity can be expressed
in human abilities to invent, see and com-
municate new dimensions of meaning, us-
ing imaginative thought processes, creating
individual visions of the world based upon
the past, present and future (Fowler, 1996).
Healing: The physical and mental health
of a person and the process to live healthful
lives (Lazarus, 2006).
Self-Discovery: The journey one makes
to find the truths about one’s self and unifies
consciousness and unconsciousness into a
whole (Jung, 1972).
Stress Management: Stress management
involves the actions (emotional, mental and
physical) one completes in order to regain or
obtain a balanced life (Lazarus, 2006).
113
114

Chapter 8
The Gift of Grief
Marnie S. Reed
Indiantown Middle School, USA

ABSTRACT
My journey began with a call that brought me to “the edge”: the farthest reaches of what any mind can
handle. I found every notion I had of myself was a fallacy, an illusion created so completely I’d fooled
even myself. The days ahead found me by my father’s side for the less than six weeks it took him to die
from pancreatic cancer. The journey toward healing my mind, however, took far longer than I could’ve
imagined. From the first days of wandering into the local Hospice building begging for help to a seem-
ingly innocuous lunch with one of my third grade students that turned into a soul-soothing balm, I have
sought more help than I once would’ve cared to admit. My story is an excursion to the deepest depths
of grief and the extended passage back to a version of mental health I could’ve in no way imagined.

DIAGNOSIS When the call came I think I was gloating.

Everyone knows that the worst kind of calls
come in the middle of the night. The pen-
etrating noise of the telephone jolts a person
immediately into wakefulness with all the
subtlety of a cherry bomb tossed into an
empty can. Such calls never come during the
best of times or on the brightest of days, so I
didn’t consider a midday call on an ordinary
weekday afternoon even remotely ominous.
In retrospect I wish I’d ignored the phone,
poured myself a cool iced tea, and parked
myself on the porch to enjoy the rest of that
beautiful day.
Well, at least doing a too-proud kind of strut
at the very least. I had, only a few minutes
before walking in my apartment door, just let
my very first class of third graders go for the
summer. No one had come out any worse for
the wear on my first turn out and their FCAT
scores had been swagger-worthy. To say I
was on top of the world would have been an
understatement.
When my cell rang I noticed the caller ID
flashed my stepmother’s number. Looking
back I really should’ve known there was a
problem. While we weren’t at odds, she never
called me if there was a way to avoid it. Still…

DOI: 10.4018/978-1-4666-7524-7.ch008

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

The Gift of Grief
the sun was shining with an early June version
of Florida intensity and I had a grin plastered
to my face that could’ve disarmed even the
biggest skeptic. I grabbed the phone, held it
firmly in place at my ear, and in a sing-song
voice slipped out, “Hellloooooo!” That’s when
the world as I knew it ceased to exist.
If asked before that particular day in June
2008 to describe myself to someone who’d
never met me my first statements would in-
clude words like ‘strong,’ ‘responsible,’ and
‘dependable.’ I’d always been proud of the
fact that, no matter the situation, I’d always
been able to rely on myself. No need to ask
for help from others. If there was a mountain
to climb I’d run toward it, arms wide, ready to
face the coming task without a single backward
glance. Because of this very firmly imbedded
view of my own self-efficacy I was completely
unprepared to discuss terms such as ‘cancer’
and ‘father’ in the middle of that bright,
shimmering day. Besides, everybody knew
calls such as the one I’d just answered were
supposed to come in the middle of the night.
I distinctly remember only one thing: moving
the phone away from my ear and bashing it on
the couch a few times, like it was a too-tight
lid on a jar in need of a few whacks on the
counter to get it moving. I had no inkling, not
the slightest bit of a clue, that the strength of
mind and spirit I consider synonymous with
myself was about to be blown away like so
much dust on a soft gust of wind.
No one in my family ever calls me by my
given name. In fact, when I hear it I know it’s
the first sign of a coming storm and I’d better
start thinking escape plans. My nickname,
Marnie Googles, hails from a cartoon from
the early part of last century. My father would
sing the jingle to me when I was little, sub-
stituting the main character’s name. “Marnie
Googles! With the goo, goo, googley eyes!”
Silly, yes, but like all things Daddy, I cher-
ished my moniker and it stuck. Eventually, as
all my father’s nicknames came to do, it was
shortened and I became Googs.
“Hey, Dad,” I said in our first conversa-
tion since I’d gotten myself somewhat under
control.
“Googs!” He replied. Like this was any
one of the many conversations we had each
week. “You okay?”
“Not really, so I’m on my way.” For once,
my Dad didn’t accuse me of overreacting. I
caught what seemed like the next flight to
Dallas. If he was going to fight this cancer,
I was going to get in there with him. I was
completely convinced my sheer strength of
will would be enough.
Even now, some five years later, I can’t
remember how I got from my house to his.
In fact, there are details that come up every
now and again that ring no familiar bells in
my head. My only clear recollection is that I
somehow ended up at the house and remained
there, save for a brief time I spent a weekend
elsewhere. It was Father’s Day, 2008. My
father looked as he always did... he looked
absolutely fine.
When walking into my father’s house and
entering the foyer, a visitor is greeted by his
office on the left and a formal living room
on the right. Since it’s rare to find Dad any-
where else, he was (predictably) working on
the computer when I walked in the door. He
looked over his outdated monster of a moni-
tor with his cheater-glasses perched on the
tip of his nose.
115

“Googs, come here and read this,” he
said in lieu of some formal greeting anyone
else might expect. He wanted me to read the
email he was sending to his best friend back
in New York.
I was in the office this past Wednesday, June
4th, around 10:30 AM when I got this incessant
pain in my left side from the belt buckle up to
my rib. No matter what position I tried, I just
couldn’t get comfortable. When I vomited, I
knew something was wrong so I looked up
kidney stones on WebMD. Except for the fact
I did not have a frequent urge to urinate, the
symptoms seemed exactly what I was suffering.
I drove myself to Rowlett (why check into a
hospital in Mesquite?) and bent over by now,
and in terrific pain, entered the ER.
Long story short, a CT scan was part of the
treatment and those results eliminated the
possibility of kidney stones. Instead, they
dropped one of two bombshells on me: the
CT scan revealed several masses on my pan-
creas, adrenal gland and liver. Preliminary
diagnosis was that I have developed metastatic
pancreatic cancer and am in need of a biopsy
as soon as possible. The second bomb was
what I thought to be health insurance cover-
age was anything but which is a story that’ll
wait for another time. Without insurance, I
needed to go to Parkland Hospital in Dallas.
This past Thursday, the 12th, Kelli and I went
to the ER at Parkland armed with the lab re-
sults, doctor notes and a CD of the four CT
scans taken at the Rowlett hospital. The ER
staff realized the seriousness of what was in
the reports and after an interminable wait; I
was admitted as an in-patient. By midnight,
116

The Gift of Grief
another CT scan was taken of the pelvic region
as well as one of my head to see is anything
had spread to my brain (I told them there was
nothing up there anyway but they didn’t think
I was funny). A biopsy of my liver was taken
the next day and by Friday evening I was
finally home. I’m on some serious pain pills
as I wait for the biopsy results forthcoming
some time by the end of next week.
That’s the history. If you look up pancreatic
cancer, you’ll find it’s the deadliest of them
all. Regardless of treatment: surgery, chemo
and or radiation, life expectancy is relatively
short, at most 3-4 years - if I’m lucky.
I only knew of Parkland Hospital as the
place JFK was taken after the assassination
and I knew even less about cancer of the
pancreas. Three to four years? My father was
63 years young and seemed to be in tip-top
shape. Given what ensued during the next few
weeks, I wish with everything I am that the
time estimate had been truth.
I vowed to stay until the situation became
stable and we knew what course of action he
was to take. Dad didn’t argue, but did have a
request for me. There were too many people
who needed to know what was happening and
I was charged with finding a way to inform
those outside the family. In the meantime, he’d
scheduled a conference call with his fantasy
baseball team. This, in my father’s world, was
the important stuff.
My father started his fantasy baseball
league, SOYPL (Seat of Your Pants League),
in 1980 and promptly became the endeared
“commish.” He took the job way past seriously;
having been both the auctioneer and Monday
night trade lady in the past I knew how hard

The Gift of Grief
the call would be for him. He stepped outside
to the patio for the conference call while I
searched for a way to blog what was going on.
I came across an incredible website that
seemed to fit the bill: CaringBridge. The
site exists to help people along their health
journeys, whatever they might be. I became
the near daily author and more than a few
people, both friends and family, signed up for
my updates. The website gave me the ability to
pass on real-time information without having
to pick up the phone. It became, in time, my
only source of release from the building pres-
sure inside me caused by my father’s rapidly
deteriorating health. I began June 15, 2008:
I’ve been in Texas now for three days, although
given the surreal factor, it could be any amount
of time at all.
My Dad deceives me; he is healthier than I
could’ve expected. He seems as strong as ever.
He hugs me and I realize all of this cancer
crap must be a big, horrible joke. But it isn’t.
After I think about it and reality reestablishes
itself the realization brings me up short and
leaves me without breath.
Last night we had a Father’s Day celebration.
We sang, danced, cried, laughed, and cried
some more. It was loud and layered with the
voices of all these people who are mine. All
the people who will surround my father with
the love he has always enjoyed. We are loud,
boisterous, and tight-knit. We yell and scream
at this injustice. We love each other uncondi-
tionally and we don’t give up easily. That’s
why this cancer stands no chance against us.
Our collective will can overcome anything.
We are Puritz people.
My own grief threatens to get the best of my
emotions. I know there can’t really be anything
that can take my father from me. I know there
isn’t anything that could possibly expect that
I should take breath in this world without my
father in it. And then I realize his fate and my
own aren’t intertwined, much as I wish they
were. What is his with God isn’t mine. I know
I’m not being punished, but I can’t help but
lament the thought of trying to live a complete
life without his voice in my ear or his finger
on my nose. How can this be?
And so, as our story evolves; we get news we
want and news we don’t. I’ll put it all here:
for better or worse. I will honor my father in
every way I know how, through this awful time
and beyond, whatever it may hold. --Excerpt
taken from website http://www.caringbridge.
org/visit/MarcPuritz.
And news, at that time, was exactly what we
weren’t getting. During the time we waited for
biopsy results I researched pancreatic cancer.
Having been warned away from the internet by
my own doctors in the past I braced myself for
a scare and decided any news I gleaned would
be decidedly less intense. I quickly came to find
that there’s nothing scarier than a diagnosis of
what my father had. It was even scarier than
the 3-4 years the doctor’s had mentioned to
my Dad. People were gone in days. I resolved
not to read anything further on the internet and
started calling Parkland for some bit of news
we needed in order to form a plan.
After an interminable amount of time in
voicemail hell I got a 24-hour nurse hotline
on the phone in hopes of finding some relief
we hadn’t thought of yet, but no such luck.
The nurse did, however, introduce me to the
117

term ‘palliative care,’ which would be of some
help to Dad as soon as we knew something
definitive. It seemed these palliative care
people manage pain in an individual manner
that allows a person to keep on living rather
than the alternative. Dad would be assigned
to someone soon, they said. Again I asked,
“WHEN?” That seemed to be an elusive
answer.
FINDING NORMAL
While everyone seemed to be running in place
and hurrying to nowhere, I went to work with
my father. Back in 1997 I started his business
with him, moving from a comfortable posi-
tion with Hewlett-Packard in Connecticut to
the seemingly backwards suburbs of Dallas.
I mentioned many times over morning coffee
with my father that we’d fallen a long and far
way from Brooklyn. When not planted in his
home office chair, the only other place a person
could find my father was in his warehouse,
working passionately on his self-started busi-
ness in weather screens. I continued to give him
daily reminders on how far his chair was from
Ernst and Ernst in the CitiCorp building. He
completely ignored me and began delegating.
We were together again, working on what we
started. He showed me how happy he was in
by assigning me organizational duties.
“Googs, if I’m sometimes unable to get to
work because of this whole thing, I want you
to be able to handle the business. How can we
accomplish that with you living in Florida?”
I introduced him to PC Anywhere and
began uploading his current orders and ac-
counting to a Cloud so I could ease his mind.
In truth, I was becoming increasingly worried
118

The Gift of Grief
about the cancer that supposedly took 3-4
years to kill him. Minute by minute the pain
in his abdomen seemed to increase and the
Hydrocodone the doctors gave him seemed
to barely make a dent. He was chewing his
medicine like candy.
After a few days like this we found ourselves
in his truck on the way back to the house. I
remember we were detouring to stop at the
bank so I could be put on his account. Dad
was driving with one hand and clutching his
midsection with the other. As we were parking
we listened to an ad on the radio extolling the
benefits of cremation.
“That’s what I want when it’s my time,
Marns! I don’t want to be laid out for everyone
to look at. That’s morbid. Can you make sure
that doesn’t happen?”
“Dad, I was thinking that I’d put your ashes
in my pockets, cut holes in the bottoms, and
sprinkle you all over Yankee Stadium.”
“Now you’re talking! I knew I could count
on you, Marnie Googs!”
Could this really be what made my father’s
day in the midst of this increasingly dire situ-
ation? The answer was, simply, yes. That’s
the kind of man he’d always been.
We arrived at the house and were imme-
diately met with news. I wrote that night to
keep from losing my mind.
And so it was just as my father told me it would
be the first time we spoke about it: pancreatic
cancer. Inoperable. After hearing the news
and then relaying it to me sans emotion, Dad
asked me to hold off on discussing his results
so we could talk about the logo machine: the
cutter still wasn’t cutting his logos correctly
and he wanted to know what I’d be doing to
rectify the situation the next morning. Can it

The Gift of Grief
be possible that I can make my father’s day
merely by quickly finding a way to cut vinyl?
The answer is (and has always been) yes. He
is that easy to please. He has always been
happy with very simple, but important things
in life. Family, friends, a house full of happy
people, and a job well-done.
I still haven’t given in to this cancer-as-a-
death-sentence manner of thinking, despite the
straight-talk Dad and I continue to share and
my pleas to go with him wherever his journey
might take him. Don’t we always hear about
the miraculous? The unheard-of? Why not
now and why not us? I still harbor unwaver-
ing hope that this part of our journey together
isn’t anywhere near over. Even so, I just don’t
know how to get this mammoth rock out of my
stomach. --Excerpt taken from website http://
www.caringbridge.org/visit/MarcPuritz.
We went on as “normal” for a few more
days when I received an invitation from my
aunt. “Come to Minnesota for a few days,”
she said. “Get a bit of a rest.” I still can’t
fathom how my father convinced me to fly
there, but he did.
A WEEKEND AWAY
So there I found myself, one day in July,
sitting with my feet in the water and watch-
ing my husband and my aunt floating in the
pool. Having never been in Minnesota I’d
never imagined 78 degrees could take place
anywhere mid-summer.
“I think I’ll call Daddy,” I said aloud. I
dialed his number as I swirled my feet in the
water, thinking I’d cheer him up with some
silly anecdote about how in a few hours I’d
hold the Stanley Cup, which really didn’t
hold a candle to the Lombardi trophy in our
universe. When my stepmother Kelli answered
I knew the next words she said would change
everything.
“He can’t talk, Marnie,” she said in the
calm manner I’d come to treasure.
“He can’t talk to me right NOW, or he
can’t talk to me at all? There’s a huge differ-
ence. Please, Kel. Put him on the phone.” I
was desperate. I was far away and desperate.
“He can’t talk. He’s in a situation that he
just can’t talk. The pain is too much right now.”
I know we must’ve had some words to
further discuss the situation but to be honest,
I still have no recollection of them. I’d just
discovered a very loud noise in my head that
overruled anyone’s words.
I’m not sure of the sequence of events after
I disconnected that call. I remember sitting in
the back of my aunt’s car and arriving at the
Stanley Cup party. I know I held my husband’s
hand and we were introduced to some of the
Detroit Red Wings that had custody of the
cup that weekend. I can’t imagine how I was
convinced to go to this party even though I
was due to fly to Dallas the next morning.
But I was there. There are pictures to prove it.
After the introductions were made my
husband and I made our way outside. It was
there I made a terrible mistake: I accepted a
vodka tonic and then took it and my husband
to a beautiful place under a shady tree and
settled into an Adirondack chair. I remember
looking around as I sipped that drink as the
noise in my head grew louder and louder. It
never occurred to me that no one else could
hear it. I mutely listened to the conversations
buzzing around me and I saw one of my cousins
making her way over to see me.
119

She crouched down next to me with an
expression of deep sadness on her face. She
said, “I’m so sorry to hear about what’s hap-
pening with your Dad. How’s he doing?”
I was able to see what happened next
because I was, somehow, outside my body. I
watched myself grab onto my cousin with the
near-death grip of someone who is certainly
drowning. I watched as this “other woman”
began howling over and over, “He’s dying!
He’s dying!”
A terrific ruckus was raised to get me
out of there and rightly so. There were too
many people there to celebrate and who re-
ally wanted to explain why I was in such a
state? I remember my aunt lifting my other
arm around her shoulder as they both tried
to take my limp body away to anywhere but
there in the midst of happy, celebratory people.
Eventually I was in the back seat of the car we
arrived in and my husband held my wracked
body in his arms.
What they didn’t know, however, was that
I wasn’t really all there. I was suspended over
an endless black pit, holding onto the rim with
just my fingertips. I remember thinking I must
be holding on to that edge very hard because
my fingers where white with effort. A very
seductive voice was trying to convince me to
let go. Let go. Just let go.
I recall thinking, “Yes. I should just let
go.” I thought it would just end that ceaseless
noise. The clamor was incessantly building
and threatening to overtake my head. It would
stop, I was sure, if I’d just let go. And then I
wouldn’t have to deal with my father’s coming
death. I’d go first.
“Listen to me,” I heard delicately whis-
pered in my ear, softly murmuring quietly
just beneath the howling in the car. “Listen.
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The Gift of Grief
If you don’t come back to me, I’m going to
have to call someone to help. Do you hear
me? Marnie, listen to me. You have to come
back. Come back with me.”
There I was, hanging by my tips and so
close to falling. Falling into a nothingness
that would give me the relief from the pain
that was wracking my body and my soul. I
could go and give up my last shred of hope
and never have to deal with what I knew I was
destined to witness.
I crawled out of that pit toward my hus-
band’s voice as surely as I put the key in my
ignition to drive to work each day. I clawed
and I pulled my body over the lip of that abyss,
into the dirt and against my will. It was his
sweet voice that called me back. Somewhere,
after lying in that dirt and crying endless
tears, I slept.
My next conscious thought after my break-
down was of my forehead leaning against the
airplane window as I bargained with God. I’d
start, “Please, God,” and then digress with a
litany of promises I’d keep if he’d just let me
switch places with my father. I’m sure it was
incoherent, but I’d meant every word.
PARKLAND
By the time I reached Dallas my father was
ensconced at Parkland. He had woken to find
the lower half his body seemingly bruised all
over, which in truth was blood leaking from
his organs as they began to shut down. All this
had been happening as I crawled out from my
self-made pit and made it to the plane. As I sat
on the runway waiting to leave Minnesota, I
reread what I had blogged just a few days prior:

The Gift of Grief
I am unable to let go of hope and I’m not
sorry. I’m a diehard for a miracle, and I’m
going to expect one.
Western medicine, eastern medicine, natu-
ropathic therapy, chemo, don’t chemo, this
drug, that drug...how can anyone think? I’m
simply going to hope and pray for peace of
mind for my Dad, for the ability to listen to
his body and God and know what he needs to
do. I will know then that the choices are clear
and be reminded they aren’t mine to make. I
will not, however, give up hope. Fight like hell
is such a better alternative.
Everyone who knows my father knows that he
has always made his own choices. The rest of
us may not have always agreed with him, but
we knew these decisions were nonnegotiable.
He always listened to us if we had a logical
alternative to present, however his choices
have always been his to make. Infuriating
when I was younger, but strangely comforting
as I got older. I know I can always count on
the oddly reassuring ability my father has for
continuing to be himself. This has allowed me
to know, without a doubt, who he is. So many
things in life are subject to change without
warning: not Dad. I love that he never gave
up hope on me. I’ll do the same. --Excerpt
taken from website http://www.caringbridge.
org/visit/MarcPuritz.
Could this have been written by the same
woman who had just learned her seemingly
robust and sturdy mental state was all just
a great, big fallacy? Had I been her just a
few short days ago?
I faced walking into Parkland with a re-
newed resolve. I’d be that woman who wasn’t
going to give up hope! I had to be strong for
my Dad and hold his hand through whatever
course of action he decided to take. I gathered
myself up, tapped into a reserve I hadn’t known
was inside me, and walked into the room.
When I saw my father I realized my last
tangles of hope were really just the frail, float-
ing puffs of an aged dandelion. The one’s I’d
made so many wishes on as a little girl, then
huffed a soft wisp of breath to send those
delicate seeds along on a sweet wind destined
to find fulfillment elsewhere. He was dying.
Without hesitation I walked in and fell back
on our best Jerry Seinfeld schtick:
“Hello, Dad.” I did my best Jerry version.
“Hello, Googs,” my father answered in his
very last “Newman.”
He was clearly wracked with pain, his beau-
tiful face stretched tight and sinking although
I’d just seen him days before.
My stepmother held my arm and thanked
me for taking over. She was clearly in need
of a break, but more importantly she knew
it was time I needed with my father. Giving
me a gift I still cherish, she left us two alone.
The next 48 hours, a mere 5 ½ weeks after
the diagnosis came, were set aside for dying.
I think I fought the idea up until it was inevi-
table and undeniable.
Oddly enough, the time I spent in that room
at Parkland was so much more than just grief.
In the midst of this horrible/beautiful dance
toward the end, the essence of my father was
still there to be found. It wasn’t hard to see,
either.
Suffice to say we spent a hard night togeth-
er, a night I wouldn’t trade for the world. Dad
and I did talk some, but in his typical fashion
(which I believe had nothing to do with the
pain meds that weren’t working very well at
the time) we spent the night together without
filling it with meaningless words. In my heart
121

I knew Dad must have taken comfort in me
being there. I know I was, and am, honored to
have spent our last time alone together doing
any small thing needed to comfort him. Dad
saved what he had to tell me by interjecting
in between the many “I love you” exchanges
we had. He simply said, “Marns, you have
to let me go.”
I simply replied, “I know, Dad. Go then,
and just wait for me there.”
I smiled at him as he winked and fell back
to an uneasy sleep. I gently took his hand and
held it ceaselessly until I was whispering my
good-bye into his ear. I asked him to save me
a seat next to him wherever he was, because
I’d be ready to take it when my time came
around. I know he heard every word.
I walked out of the hospital later that eve-
ning leaning heavily on my brother’s arm.
I’m not sure where we went, or what we did.
I was crying ceaselessly, but it was more like
I had no control over my leaking eyes rather
than the wracking sobs I’d so recently left
in Minnesota. Looking back, I must’ve been
in shock. It was July 21, 2008. I found some
time later, an hour lost to me now, to post the
following on CaringBridge:
We lost my Daddy on Monday, July 21st, at
5:30 PM. He was brave until the very last
moment, and I held his hand all the way. He
was, and always will be, the most amazing
man I ever knew. I miss him beyond reason.
Thank you to all who encouraged him along
the way. He read every message left here.
I’ll update again with more information soon.
-- Excerpt taken from website http://www.
caringbridge.org/visit/MarcPuritz.
122

The Gift of Grief
I suffered through a memorial service in
Texas where I found my father’s body exactly
where he didn’t want it: laid out for the entire
world to see. He was cold and his essence was
so far gone that the body I wept over might
never have been his. But I held my husband’s
hand and made it through. It was decided that
we’d have a memorial service in New York
City for all those who couldn’t make it to Texas.
I’m at a loss as to who made that decision as
I was still hiding my own secret: every ounce
of the strength I’d once prided myself on was
being used to hold my fragile self together.
Everyone believed I was so strong, when in
reality I was surely the weakest of all.
HOW TO GRIEVE
I left for Florida still wrapped in the soft
gauze-layered stupor of those who grieve. I
covered all of my mirrors and sat Shiva for
my father, a practice I learned was meant for
those like me. People who simply cannot get
up and make pretend all is right with the world.
I put on my black shift dress and let myself
be embraced by those who could grieve for
me and with me. I let myself be cared for; a
practice I’d always prided myself as the giver
of but never on the receiving end. I’d never
needed anybody and now it seemed I needed
more than anyone could possibly give me.
I couldn’t sleep. On the last morning of
Shiva I lay in bed and realized Mr. Sandman
and I weren’t going to be on visiting terms
anymore. I was so sad to see the clock inch-
ing along in time when I was reminded of
my non-appearing miracle. The one I’d so
fervently believed in just a few short days
ago. I began reflecting on the coming day and

The Gift of Grief
was consequently hit somewhat powerfully by
my lack of vision regarding miracles. Could I
have been both blind AND stupid to what I’d
repeatedly experienced, up close and personal?
Wrapped up in my grief, as tightly insulated as
I was ages ago as a little girl swaddled tightly
in my blankets and hiding from the noises
of the night, I’d missed the very miracle I’d
been waiting for. Me, the one “waiting and
expecting,” never considered anything but a
cure as a marvel! I missed what was right in
front of my face.
I began to listen to my beautiful husband’s
measured breathing as he peacefully slept
beside me. I decided then to stop wondering
how he loved me the way he did because there
really wasn’t any logical explanation. I won-
dered instead how he so patiently and lovingly
held me as I cried and cried, inconsolable
for the loss of my beloved father. He never
tried to ‘fix’ me. He never offered platitudes
or worn-out clichés. He simply held me and
quietly told me, in his wonderfully strong
yet gentle voice, that we’d get through life
together. That I’d always miss my Dad but
the pain would change someday and until then
I could just hang on. Hang on to him. Here
was my miracle.
I slipped out of our bed and padded silently
down the hall. I pressed my ear to my son’s door
and listened to him sleep; the sound as sweet
as the day he was born and my heart swelled
with love. Here was yet another gift from my
father: Love your child without reservation or
requirements. I’d wrapped myself so tightly
in my sorrow that I’d become oblivious to the
small, astounding miracles that surrounded
me each day.
I made my way silently back to bed and
I was thanking God once more when sleep
finally stepped up to meet me.
In the days that followed I began to realize
that no matter how I tried to calm the noise
of my own racing thoughts I was unsuccess-
ful and I needed to seek professional help. I
had no idea what ‘help’ meant, but I was due
to begin teaching another 3rd grade class by
mid-August and I needed to be at my best for
my students. I’m sure I looked much worse
than I imagined when I staggered through the
front doors of Hospice of the Treasure Coast,
a neighbor I’d heretofore ignored.
As I opened the door and stepped into a
cozy, softly-lit atrium I saw a woman look up
at me from her computer. The smile on her
face seemed to struggle to stay put as she got
up and moved toward me. She took my hand
in hers as she seemed to study my face. She
asked how she could help.
“Can you help me? I think I need help,”
is what I recall saying. It could’ve been that
I said something entirely different, but that
woman had already read my face.
“Let me see if I can get someone for you,”
she said as she led me toward a chair. She
disappeared behind some tastefully appointed
room dividers that hid a hallway beyond where
I was sitting. Soon a petite woman with a riot
of curls emerged. She had a kind face and an
open smile. Like the woman before her, she
took my hand in both of hers.
“You need some help.” She said it as a
statement rather than a question.
“I do.” I replied as my eyes did their leak-
ing thing.
She led me back to her room beyond the
dividers. It was as comfortable as any place I
might’ve cherished once; a place to feel safe.
I sat down in the chair, looked into a face
completely focused on me, and began to cry.
I sat in that chair with Laura twice a week
until I was able to stand and walk on out on
123

my own. I’ll never forget the kindness she
showed me, or the strategies she taught me
to cope with what she described as similar
to post traumatic stress disorder: a syndrome
developed when a person has experienced a
severely traumatic event. She said I needed to
find “my voice”: A unique way meant to make
sense of what I’d gone through in the almost
six weeks it took to lose my Dad and remake
the experience into something meaningful.
Given my penchant for following instructions
I tried fervently to do just that.
I had no idea, after fruitlessly scrambling
in vain to do anything and everything I could
find, what that voice was to be. I continued
to update CaringBridge as I struggled to find
my way through near-crippling grief:
It’s just started to sink in that I’m not actually
going to die from grief. That’s not to say it
doesn’t feel pretty damned close on some days.
I’ve spent the days since my father’s death
trying to ‘be better’: a better teacher, a better
wife, a better mother…a better person. Daddy
would not only want that…he’d expect it. I
can just about hear his voice urging me on.
“Googs,” he’d say, “Don’t be punitive with
your students. These kids don’t know any
better” or something along those lines. My
brother thinks it’s just my conscience giving
voice to my father but I know better. If I didn’t
feel his presence so very close to me I might
even agree. Believe me, that’s not the case.
And so, after long weeks of grieving in a
manner I can only describe as really, really
arduous, I finally did something. I signed on
to the only team fighting what killed my father:
The Pancreatic Cancer Action Network.
124

The Gift of Grief
This past week I participated in a massive con-
vergence at our country’s capital organized
by PanCan. This show of force was meant to
lobby congressional leaders for more money
allocation to cancer of the pancreas. I arrived
later than almost everyone; I had to fly in after
teaching all day. I flew into Reagan Interna-
tional and arrived at the hotel long after the
festivities had broken up and everyone had
headed for bed.
When I arrived at the check-in desk the person
on duty suggested I head up to the 2nd floor
and see if the PanCan people I needed to see
where still there. I took the lobby elevator to
the next level and was promptly greeted by
a floor-to-ceiling tribute to those lost to the
disease we were all there to fight. Without any
conscious forethought I walked over, grabbed
the closest Sharpie, and wrote the following:
“Wait for me Daddy. Save me a place next
to you. Googs”
Then I pushed the button for the 5th floor
and went to my room. I even visited innumer-
able representatives and senators the next
day and described what happened over and
over without a single tear. “We need money
for research,” I explained time and again. I
didn’t stop talking until I boarded the plane
for home. --Excerpt taken from website http://
www.caringbridge.org/visit/MarcPuritz.
After much searching prior to the Wash-
ington, DC trip I’d come across the Network;
better known as PanCan. Further, the man
who was out front on their website (www.
pancan.org) as well as on television and in
print media was Dr. Randy Pausch. I had
seen this courageous man’s now famous

The Gift of Grief
“Last Lecture” on Oprah and knew who he
was. I’d sat with Dad and watched the lecture
(which is still available on video and in print
at http://www.cs.cmu.edu/~pausch/) simply
because the man’s attitude toward life and
his impending death was so similar to my
father’s. I also learned that the woman who
created the Network had also lost her father
to the disease. I thought enmeshing myself
in this cause would be just the outlet for my
crippling grief. So, like most things I’d done
in my life before losing my father, I threw
myself in with near manic energy.
At first I thought that fundraising was the
answer I’d envisioned while attending to my
mental state with Laura, so I literally dove in
head first. Here was a group of people united
against an enemy we all shared! I threw my
power into creating on a grand scale. No slow
and easy for me! I produced a storm of activ-
ity that left no one untouched, including my
husband. Hindsight leaves me in awe at his
capacity for patience and love in the wake of
my mourning. I didn’t stop for a second until
my culminating project emerged: a golf and
gala held in my father’s honor. We raised over
$45,000 before he was gone a full year.
I wish I could say these efforts silenced my
mind and assuaged the throbbing of my grief,
but I can’t. Each and every time I visited a
senator or representative, either in Washington
or back in Florida, I prayed the noise whirl-
ing around in my head would diminish and
I’d feel my heart starting to heal over. With
each inspired charity run or memorial event
I begged for relief to no avail. I sobbed as
quietly as I could in any place I found myself
alone and continued to try negotiating with
God. “Please….” I’d start anew with each
progression of effort.
During the weeks I met with Laura I began
walking our street rather than driving to get
myself to Hospice, but soon I found myself
jogging and then running. After a while I also
ran around our community with ear-splitting
music blaring through my headphones, intent
on banishing all thought from my head. Hav-
ing never run a single step in my life I found
myself frustrated at my inability to cover
much ground. It was the only quiet I could
find and I wanted more of it. I mentioned my
annoyance at one of my sessions and Laura
recommended a local sports shop that had
a running program. I found the Galloway
method for running (one minute running, the
next walking) and I was off. In the mindless
movement of putting one foot in front of the
other I finally found a modicum of peace. I
still haven’t stopped.
FORWARD MOTION
Life has a way of going on in spite of either
heartbreak or happiness and mine was no
exception. Even as I continued to run I also
threw much of myself into my students. I’d
always believed in getting to know each and
every child, however that year I did more than
my due diligence. One particular girl, one with
a quiet demeanor and a sad smile, seemed to
need me more than most. As I had in the past
when trying to form a deeper bond, I invited
this sweetheart to lunch.
After moving quickly through the cafeteria
line Ranisha and I made our way outside to
the picnic tables in the butterfly garden of
our elementary school. It was a magnificent
day and a soft breeze wove its way through
the shade trees. I encouraged a conversation
125

that led to some insight regarding the many
absences this student was having. As I sus-
pected, her home life was not a happy place.
Ranisha took a bite of her sandwich and looked
at me thoughtfully.
“Why do you always wear that purple
bracelet? Is purple your favorite color?”
I thought about lying to her; simply gloss-
ing over the truth in lieu of an easy answer.
I found the truth blurting out from between
my lips before I even realized I was talking.
“I wear it in memory of my father. He
died from cancer last summer.” I looked at
her lovely face as she processed this informa-
tion. She was so still and poised for such a
young person.
“You must be so sad. I’m sad for you,
Mrs. Reed.”
We continued to eat in a companionable
silence until we were done, enjoying the day
and the surprising tranquility of a courtyard
surrounded by buildings full of small chil-
dren. It took me a minute to realize that the
roaring chaos of my mind was suddenly and
mercifully hushed.
I’m not saying I’ve found complete heal-
ing in the months and years since my father
passed away. That would be a lie. In fact, there
are days (fewer now, to be sure) that I can’t
seem to stop the leaking from my eyes or the
throbbing pain in my heart. It happens with
shocking severity and leaves me shaken to the
core. In response, I lace up and go when I can
and I’m quicker to give out a lunch invitation
to a struggling student. I frequently find the
quiet I seek when focused on someone else;
preferably a small person in my care. Giving
voice to the enormous emotion I feel lies in so
many small things. I’ve learned I can find the
healing I seek inside myself. Fortunately, when
I need to cry and miss my Dad, my husband’s
shoulders are as strong as ever.
126

The Gift of Grief
CONNECTED
My father’s spirit often seems so very close.
I find him in the moments before the earliest
part of dawn when the faintest blush of the
coming day is just whispering into my con-
sciousness. When I’m driving to work before
sunrise I almost feel that the softest edges of
heaven are just beyond the next bend, disap-
pearing out of reach just further than the glow
of my headlights. My heart calls out to him;
sometimes with a smile in my heart and oth-
ers with a sob in my voice. Regardless, each
day begins for an entirely different woman
than who I once was. I left her behind when I
crossed the threshold of that Parkland Hospital
room in 2008.
I understand now, five years later, that grief
might be a miracle of sorts. I also think our
lives might be about legacy. I’m certain that
the life we lead must be about honoring the
love of the person who left before us. How
else might we leave our imprint on this life?
Who will remember if we don’t? I see clearly
in the wake of my father’s death the depth
of the mark he made and I am challenged to
change who I was and become something
more; if not for myself than in honor of the
love I will always feel for him.
Should I die tomorrow I want to have moved
someone the way my father moved me. Deeply
and without the chance of returning to whom I
once was. I make a conscious effort to breathe
in the beauty of each morning, thankful and
with a grateful heart for this cherished life.
EPILOGUE
“We’ll take a table outside. We’re probably
going to camp out for a while. Is that alright?”

The Gift of Grief
The waiter nods his assent as he leads me
to the furthest reaches of the patio area. I’m
waiting for only minutes before my brother
arrives. I stand to kiss his cheek and hug him
hard. It seems each time we meet it’s been so
long since the last visit. He hugs me fiercely.
“Did you order our stuff?” he asks with a
mischievous smile. My little brother’s face is
so reminiscent of our father, his voice redolent
with the same timbre I can hear clearly in my
mind nearly six years since he left.
“Of course,” I reply. The ‘stuff’ I’ve ordered
is two Seagram’s V.O., Dad’s favorite after
work, settle-down-with-the-news beverage.
We’ve done this on his birthday, April 3rd,
five times now. In the aftermath of losing
Daddy my brother and I held on to each other
like two shipwreck survivors tossed about in
endless storm-driven waves. It took a long
time to find some measure of solace. In the
meantime, we met for coffee almost weekly.
Now, however, our get-togethers are farther
apart. We both agree that Dad’s birthday is
non-negotiable. Here, at this time, we are no
one’s parent and no one’s spouse. We are not
business owner and we are not teacher. We
are simply Marnie and John, Marc Puritz’s
children. And we miss him, together.
We sit at this table on the patio, enjoying
the breeze and the beauty of the day, sipping
V.O. and talking for nearly three hours. We
talk about how it seems we both still pretend
sometimes that Dad’s away on an extended
business trip, like the time he had to move
to Japan for a year when we were little. We
talk about how many wondrous things we’ve
learned in his absence, how much ‘better’
we are. Better parents, better spouses, better
people. Extraordinarily changed and eternally
grateful. We speak of the incredibly simple
ways we see him; the seemingly innocuous
little things that make it seem as if he’s nearby,
pleased to see we are who he’d want us to be.
As we wrap up our drinks and snacks my
cell phone chimes signaling a new email mes-
sage. My brother stands to go pay the check
as I check my inbox.
“Wait!” I tell him. “Remember the chapter
I submitted for publication? I just received an
email from the editor. I need to read it with you
here, so sit down.” He sits and holds my hand.
“It’s Daddy’s birthday, Googs. You know
what that letter will say. Open it.”
I click the message and read “Congratula-
tions!” I smile up into my brother’s face.
We laugh a little and we cry a little. Shortly
thereafter we make our way home to our fami-
lies, but not until after we thanked our father
for joining us on his 69th birthday.
REFERENCES
Galloway, J. (2013). Run walk run. Jeff Gal-
loway Training. Retrieved from http://www.
jeffgalloway.com
Pausch, R. (2007). The last lecture: Really
achieving your childhood dreams. Carnegie
Mellon University. Retrieved from http://
www.cs.cmu.edu/~pausch/Randy/paus-
chlastlecturetranscript.pdf
Reed, M. (2008). CaringBridge. Retrieved
from http://www.caringbridge.org/visit/
MarcPuritz
Pancreatic Cancer Action Network. (2013).
Retrieved from http://www.pancan.org
Web, M. D. (2013). Retrieved from http://
www.webmd.com
127

ADDITIONAL READING
Pausch, J. (2012). Dream new dreams. New
York, NY: Crown.
Pausch, R., & Zaslow, J. (2008). The last
lecture. New York, NY: Hyperion.
Lustgarten Foundation. (2009). Cure pancre-
atic cancer. Retrieved from www.lustgarten.
org
Johns Hopkins Medicine. (2014). Journey to
Johns Hopkins for expert pancreatic cancer
care. Johns Hopkins University. Retrieved
from www.hopkinsmedicine.org/ lp/prom-
ise_of_medicine/pancreatic_cancer
John Hopkins Medicine. (2014). The national
pancreas tumor registry. Johns Hopkins Uni-
versity. Retrieved from http://www.path.jhu.
edu/pc/nfptr/index.php
KEY TERMS AND DEFINITIONS
Eastern Medicine: This term is often
used to refer to types of medicine outside the
mainstream. Often this term encompasses
practices from the Orient or the East, such as
acupuncture and herbal remedies.
Inoperable: Unsuitable for a surgical
procedure. Metastasis has usually rendered
surgery useless.
Metastasis: The spread of cancer from
one part of the body to surrounding organs.
Naturopathic Medicine: This practice
generally focuses on the body’s ability to
128

The Gift of Grief
self-heal. These practitioners generally try
to remove whatever is hindering this process,
rather than just treat the symptoms, to promote
wellness. They become partners with the
patient and take a “whole-life” approach to
treatment to address all areas of life, includ-
ing spirituality.
Palliative Care: A medical approach to
care whereby symptoms are managed with
an effort to prevent or eliminate the serious
stresses of illness regardless of a patient’s
prognosis.
Pancreatic Cancer: A disease where
malignant cells in the pancreas grow in an
uncontrolled manner and form tumors. The
exact cause of this cancer is unknown and the
5-year survival rate is a mere 6%.
Shiva: Shiva, a Hebrew word meaning
seven, is the week-long Jewish period of
mourning set aside for first degree relatives
such as parents or siblings. The ritual is re-
ferred to as “sitting shiva.” The family gathers
in one home and receives visitors. Tradition-
ally a person sitting shiva covers their mirrors
to discourage personal contemplation and
heighten thought regarding man’s relation-
ship with God. Additionally, mourners will
sit either on a low stool or even the floor to
represent being brought low by grief. I chose
the floor.
Western Medicine: This term refers to
what we know as mainstream or accepted
medical practices which may include drugs,
surgery, and conventional therapies.
 129

Chapter 9
Piti, Piti, Wazo fe Nich
Li (Little by Little, the
Bird Builds its Nest):
Promoting Change and Health
Education in Post-Earthquake Haiti

Shewanee Howard-Baptiste
University of Tennessee – Chattanooga, USA

Mo Baptiste
Haitian American Caucus, USA

ABSTRACT
After the 2010 earthquake in Haiti, many people desired to help in relief efforts. Despite “good in-
tentions,” there are a number of mistakes educators, scholars, and do-gooders make in an effort to
“serve” those they determine to be “in need.” A married couple provides their individual and collective
perspective about their experiences in Haiti. They discuss the histories and cultures that influence the
structural barriers that exist between different communities. In order for relief efforts to be sustainable,
it is imperative to create a culture that puts the Haitian community and their perspectives at the center
of any change that would take place. The authors discuss personal and professional efforts to address
the need of health education standards in a school in Haiti.

MO’S STORY tough semester in my fourth year as a doctoral

On January 12, 2010, I woke up ready to tackle
the world and face my upcoming challenges.
My entire day was planned, and I was anxious
to get started. I was home in Orlando, Florida
visiting my family for winter break after a
DOI: 10.4018/978-1-4666-7524-7.ch009
student at Miami University (Oxford, OH).
My major was Educational Leadership and
my research centered on using the narratives
of historically marginalized people to better
understand how we as a society can critically
critique traditional leadership and schooling

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

Promoting Change and Health Education in Post-Earthquake Haiti
practices while suggesting new ones. During
my coursework, my research became more
focused, and I decided to use the stories of
my Haitian ancestors and the Haitian Revolu-
tion as my subjects. Based on my research, I
realized that very little scholarship has been
written about Haiti and its Revolution. Fur-
thermore, I was confident that no one has ever
used these two subjects to re-conceptualize
leadership theories. With these two notions in
mind, I was finally ready to tell a story about
my people through my dissertation.
Later that morning, I drove to a local
bookstore and decided to remain there until
I completed at least six hours of writing. As
an incentive, I would reward myself with
overpriced iced coffee and fatty desserts
throughout the day. I sat down, plugged in
my computer, and began typing. Around 5:30
p.m. that day, I received a call from a friend
living in North Carolina. She called to ask
me if my family was ok. I was confused by
her question and I asked her what she meant
as I knew my parents and siblings were fine.
She was surprised that I hadn’t heard, and her
next five words caused me even more confu-
sion: “The earthquake that hit Haiti.” My first
thought was that my friend was obviously
confusing Haiti for another island because,
as far as I knew, Haiti was not a country that
experienced earthquakes. After further dis-
cussing the validity of her story, I went online
and saw the images that confirmed her story.
I vividly remember some of the first pieces
of footage on the CNN website taken from a
camera phone, particularly a young lady yell-
ing in the background, “The world is coming
to an end.” I checked other news websites and
there were some stories of the earthquake, but
the images were limited. It was another thirty
minutes or so before the images were flood-
130

ing the Internet. I could not quite grasp the
true magnitude of the earthquake until I saw
the image of the Haitian presidential palace
in ruins, which not only represented strength
and pride to the Haitian people, but it was also
considered to be the most modern architectural
marvel in the country. At this point, I knew I
had to call my parents, inform them of what
happened, and set my writing aside. While
driving home, the images kept replaying in
my mind. I began to pray and ask God why.
Why he would allow an earthquake to hit one
of the poorest countries in the world? After
200 years of inhumane embargos and global
isolation, I felt the people of Haiti had suffered
enough and did not need this additional burden.
I pulled up to my parents’ driveway and
thought about how I was going to tell them
the terrible news. I hesitantly walked through
the door and informed my mother of the
earthquake. Needless to say, she did not take
the news well. We both sat in front of the
television to watch the seven o’clock news
while I informed her of what I knew since
she did not speak English. I tried to explain to
her the destruction of the presidential palace;
however, I could not find the right words in
Creole to truly capture the level of damage
the building sustained. After an image of the
palace flashed on the screen, she understood
the severity of the earthquake and began to
hyperventilate. She immediately began calling
family and friends in Haiti but was unsuc-
cessful because, as we later found out, the
communication infrastructure had suffered
tremendous damage. Over the next couple of
days, there were more frequent reports and the
news became more and more devastating. In
the end, approximately 200,000 people were
declared dead or missing and about 1.3 mil-
lion were homeless.

Promoting Change and Health Education in Post-Earthquake Haiti
As those numbers echoed in my mind, I
could not help but feel a sense of guilt. Here
I was, just a few days before reflecting on my
life, thinking how “difficult” it was growing
up. I was made fun of for being Haitian and
now my people had suffered one of the worst
catastrophes in human history. A million
thoughts ran through my mind and the guilt
increased. Within forty-eight hours of the
earthquake, there were reports of private and
public organizations, as well as various nations
all over the world, mobilizing to provide aide
to my stricken country. I wanted to be a part
of the relief effort, but I did not know if I had
the courage to go to Haiti or how I could assist
those in need. I decided to travel to Haiti a few
days after the earthquake, and that visit was
very informative for my dissertation in more
ways than I could have imagined.
As doctoral students, we are trained to be
experts in our area of study and society views
us as “all knowing” beings. After completing
our studies and surviving the dissertation
process, we are awarded the fancy title of
“doctor.” The undeniable timing and irony of
the earthquake and the topic of my dissertation
did not sit well with me at all. Instead, it left
many unanswered questions, such as: What
was God trying to tell me this time? Was I being
called to serve some greater purpose? Does
that greater purpose stop with my research
or are there other things I’m being called to
do? Should I meet with my dissertation chair
and other mentors and express my dilemma?
The more I reflected on the training I was
receiving, the angrier I became, and with that
came more questions, including: Was I being
trained to be a stereotypical disconnected elit-
ist who sat behind a big wooden desk with
my degrees hanging on the wall, wearing a
sports coat with patches on the sleeves, brim
glasses that sat on the tip of my nose, driving
a vintage two-seated sports car, smoking a
pipe while writing academic papers that no
one reads? How could I continue to work on,
let alone value, my research knowing it would
not help the victims of the earthquake? Would
my literature review pull people out of the de-
molished buildings? Would my methodology
bring people back to life? Would my theoretical
framework feed hungry people? Ultimately,
I decided to write a scorching letter to my
entire dissertation committee expressing my
perception of what the academy stood for as
well as my disdain for it. Though I knew I was
possibly committing academic suicide, I did
not care. I just knew at that very moment what
type of scholar/intellectual I did not want to
be, and I needed to voice my opinion.
Should the narrative above be considered
history? I cannot fully explain what it was like
to experience the earthquake on that faithful
day. I did not experience the vibrations of
the earth under my feet as buildings around
me collapsed, and I did not hear hundreds of
muffled screams of men, women and children
searching for help. Although I was not in the
earthquake zone on January 12, 2010, it does
not mean that my story is any less important
and not considered history.
The purpose of this paper is to combine my
wife’s personal narratives and mine, from two
separate trips to Haiti and develop the ideas
that came forth from working with Haitian
school teachers. These ideas may help others
understand the complexities of people, stories
and the implementation of change.
WHAT IS HISTORY?
The title of this paper is piti, piti, wazo fe
nich li, which means “Little by Little, a Bird
Builds its Nest.” We are all storytellers with
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Promoting Change and Health Education in Post-Earthquake Haiti
stories to share. Histories are collections of
narratives that should raise critical questions
such as: Is history singular or plural? Is it a
collection of facts or anthologies? Whose
stories are validated?
Stanley (2006) argues that in its most basic
and absolute sense, history is the entirety of
past human actions and occurrences that have
shaped the present and characterize its poten-
tial. As told through the eyes of the media,
historical narratives are often a mixture of
fact and imagination, made vague by outdated
concepts and principles. These narratives of
accepted histories are promoted in university
and high school textbooks and depicted as hav-
ing “sound evidence” (Stanley, 2006; Partner,
1995). The genesis of this conceptualization
of history is rooted in Western thought. Grand
narratives (Megill, 1995) of nationalism,
European modernity and colonialism are
the narratives that meet these criteria. These
grand narratives permeate Western culture
(Goldberg, 1993; Said, 1993). According
to Carr (1961), for European historians, the
nineteenth century was an ideal time for facts.
One of the leading figures of this thought was
German historian Leopold von Ranke who, in
the 1830’s, fought against the moralization of
history and instead argued that the mission of
historians was to demonstrate “the truth.” This
new frame of thought became very popular
throughout Europe and was adopted as the
standard for telling history. However, Carr
(1961) states that the ideology was so popu-
lar because he believed the historians of that
time period had a justification for not thinking
for themselves. He posits, “The Positivists,
anxious to stake out their claim for history
as a science, contributed the weight of their
influence to this cult of facts. First ascertain
the facts, said the positivists, then draw your
132

conclusion from them” (Carr, 1961, p. 5).
Carr also believed that empiricists in Great
Britain had a base in which to tell history as
fact because they already believed that em-
pirical theory assumed a complete disconnec-
tion between the subject and object. For the
empiricists, Carr (1961) suggested they felt
“facts, like sense-impressions, impinge on the
observer from outside, and are independent of
his consciousness. The process of reception is
passive: having received the data, he then acts
on them” (Carr, 1961, p. 6). Alternatively, Carr
argues that not all facts from the past are his-
torical facts. He proposed that the obligation
to entrench facts depended not on any quality
in the facts themselves, but on a decision made
by the historian. The key question is how do
historians make these decisions? In order to
answer this question, we must understand the
mentality of an academic historian.
Arguably, one of the most influential
historians of the 20th century is Howard
Zinn. One of his most famous books, A
People’s History of the United States: 1492
to Present, has gained both commercial and
academic acclaim and criticism for challeng-
ing how we conceptualize American history.
However, The Politics of History provides
a basis for understanding the psychology
of an academic who writes history. Zinn
(1970) writes:
The historian, by habit, is a passive reporter,
studying the combatants of yesterday, while
those of today clash outside his window. His
preferences are usually private. His business
is history. He may ask philosophical questions
about the past: do we find certain sequential
patterns in history? But he rarely sees himself
as helpful in changing the pattern of affect-
ing the disorder. He may believe that people

Promoting Change and Health Education in Post-Earthquake Haiti
through history have been caught in the grip
of extra human forces. Or he may see them
as free agents shaping the world. But whether
they are free or not, he himself is bounded by
-- professional commitment -- to tally but not to
vote, to touch but not to feel. Or feel but not to
act. At most, to at after hours, but not through
his writing, in his job as a historian. (p. 1)
In other words, historians have historically
attempted to be objective and disconnected
from the subject by mimicking the norms and
rules of conducting scientific research. It is
this passivity that allows historians to think
of themselves as recorders of facts of the past.
Furthermore, historians do not acknowledge
their personal role as a citizen of humanity
on a continuum that connects the past to pres-
ent and also to the future. It is imperative we
continue to challenge these concepts of history
and stories. All human beings are storytellers;
therefore, all human beings are historians. We
tell stories because we are connected to the
stories that we tell.
The Re-Conceptualization of History
There has been a strong push by modern
academic historians to venture beyond these
limited understandings of the framing of his-
tory. It is believed that Philip Roth’s The Plot
Against America (2004) does just that. This
alternative historical depiction of the United
States during the 1940s has been described as
a cultural parody that symbolizes and reflects
the United States under the George Bush
presidential administration. Siegel (2012)
contends that Roth believes historical truth
is not defined as a means to an end. Rather,
it is a range of potentially deep-rooted mo-
ments that expose what he describes as the
divided conscious mind from the politics of
the body. In other words, one can attempt to
find truth through long stints of researching
and exploring, but truth could never fully be
reached or defined (Siegel, 2012). Instead of
trying to narrowly define the past as a singular
presence, Stanley (2006) suggests we should
codify history as histories, a smorgasbord of
stories that are multi-voiced, intertwined and
multi-truthed. Thus, the popular stories that
exist about Haiti are layered with complexities
and inconsistencies.
HISTORIES OF HAITI
Similar to many histories and narratives,
Haiti’s (at one time called The Pearl of the
Antilles) stories are complicated and exten-
sive. Before 1804, the island had several
names. While under French rule, the island
was called French St. Dominique, and under
Spanish rule, the island was known as Santo
Domingo. Western historians usually begin
the history of the island with the so-called
discovery by Christopher Columbus. Centu-
ries before Columbus set foot on the island,
it was inhabited by a native group of people
called the Tainos, which was believed to be
descendants of a larger subgroup called the
Arawaks (Zephir, 2004; Arthur and Dash,
1999). The estimated 1.3 million Tainos called
their homeland Ayiti, which means “moun-
tainous place.” It is believed that most of the
natives were peaceful, while a community
of more warlike Caribs had settled on the
eastern side of the island that is now known
as the Dominican Republic (Bell, 2007). On
December 5, 1492, while onboard the Santa
Maria, Columbus named the island Hispaniola
which mean “little Spain.” After surveying the
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Promoting Change and Health Education in Post-Earthquake Haiti
land and discovering gold and other precious
minerals, Columbus introduced a European
brand of slavery to the Western hemisphere,
forced his brand of Christianity on the natives
and exploited the people through forced labor
of mineral minds (Bell, 2007). What is rarely
taught in history books is how Columbus and
his crewmen sexually assaulted women on
the island, murdered the natives and almost
eliminated the entire Tainos population by
introducing European diseases that the Tainos
natives had no immunity against. One of Co-
lumbus’s greatest supporters was a Catholic
priest named Las Casas who, like Columbus,
believed that “Christianity” and slavery was in
the best interest of the “savage natives” (Bell,
2007). By 1517, Las Casas reexamined the
Taino population and realized that through the
rates of death from disease and the inhumanity
through slavery, the native population would
not survive (Bell, 2007). It is believed that
the native population was an estimated one
million people. Due to death and disease, the
population was reduced from an estimated
several hundred thousand to approximately
60,000 in fifteen years (James, 1989). Most
Western historians argue that the Spaniards
did not intend to kill off the natives, but by
the seventeenth century, the island was worth
nothing due to the Spaniards destruction of
the Taino population and the stripping of the
minerals and resources (Girard, 2009).
Spain was not the only European nation
interested in the island. England, the Neth-
erlands, and France were also interested in
the wealth that Haiti had to offer and fought
over the land. There were a few small Spanish
settlements that remained on the eastern part
of the island (Bell, 2007). Since the French
claimed and named many Caribbean islands,
they settled on the western part of the island.
134

The early French inhabitants (called Bucca-
neers) were a radical group that attacked and
pirated neighboring islands and ships that fre-
quented the surrounding islands (Bell, 2007).
These settlers lived off the wild animals such
as pigs, goats, and cattle bought over by the
Spanish. They were able to survive because
of their meat smoking techniques that allowed
them to preserve the meat longer (Bell, 2007).
The Treaty of Ryswick between Spain and
France officially gave the French the rights
to the island and they named it St. Domingue
(Bell, 2007). Once the French legally secured
the island, they begin to shift from a pirating
and nomadic culture to that of an agricultural
economy. The French revitalized the sugar
industry left behind by the Spanish and cre-
ated an estimated 100 new plantations (Bell,
2007). They also grew indigo, coffee, cotton,
and cocoa plantations that required a very large
labor force. The French invested in the African
slave market that was created by the Spanish
a few centuries before. According to the 1791
census, there was an estimated 500,000 en-
slaved Africans on the tiny island. However,
Haitian historian Thomas Madiou estimates
there were closer to 700,000 enslaved Afri-
cans. It is believed that the plantation owners
would purposely not provide accurate figures
to the French government in fear of paying
higher taxes (Zephir, 2004).
The island was divided into a complex hi-
erarchy based on race and class. The dominant
classes consisted of the whites, but within the
group of whites, there were several subgroups.
At the top of the hierarchy were the grand
blancs (big whites), who were plantation
owners. Many of these grand blancs did not
live on the island. Instead, they lived in France
and hired plantation managers or procureus
(overseers). The second tier of whites was

Promoting Change and Health Education in Post-Earthquake Haiti
the couches moyennes or middle class, which
comprised mostly of overseers and owners of
smaller indigo, coffee, and cotton plantations.
The bottom tier of whites were the petits
blancs (little whites). This group consisted
of shopkeepers, soldiers-for-hire, criminals,
and debtors (Zephir, 2004). The middle group
on the racial and class hierarchy were the Af-
franchis (free coloreds). This group consisted
mostly of Mulattos who were decedents of
French fathers and African enslaved mothers.
Some Affranchis were able to attain capital,
land, and slaves because of their French fa-
thers. Lower-class Affranchis competed for
jobs with the petits blancs and the small group
of African Affranchis, i.e. former slaves who
bought their own freedom (Zephir, 2004). The
lowest group of the racial and class hierarchy
on the island were enslaved Africans. They
consisted of the negres commanduers (slave
driver), the negres creole (slaves born on
the island and considered “more civilized”
because they were socialized in the island’s
norms) and the bottom of the slave pecking
order, the bossal slaves (those bought from
Africa and considered “less civilized” because
they had yet to be socialized on St. Domingue)
(Zephir, 2004). The racial and class divide on
the island left many individuals marginalized
and desperate for change. The most vulnerable
group was those who were enslaved.
Few European historians explicitly de-
scribe the horrific conditions endured by the
enslaved Africans when being transported for
months via ships and then sold all over the
Western Hemisphere. The history books fail
to accurately depict the horrific environment
these enslave people were exposed to, such as
being treated like animals (working up to 20
hours a day), housed like animals and fed like
animals. Under the Code Noir (Black Code),
which King Louis XIV created in 1685, the
enslaved were to be treated in a “human”
manner, but these rules were rarely enforced
(James, 1989). The enslaved were also said
to have been malnourished, ill-clothed, and
suffered a very high mortality rate. In addition,
they were tortured and murdered by the hands
of the slave masters (Fick, 1990).
These cruel and reprehensible acts led to
many slaves running away, which was called
marronage. Some Western scholars, such as
Geggus (1983), argue that slaves ran away
because of these oppressive conditions, but
most returned back to the plantations. Others
argue that marronage was a calculated and
strategic act of resistance that slaves partook
in to not only destroy the slave system, but
also to pursue freedom (Fick, 1990). Whatever
the reason slaves adopted marronage, the end
product was the same. On the night of August
22, 1791, the twelve-year, bloody revolution
of St. Domingue began, which is also known
as the Haitian Revolution.
A few decades before what was known
as the Haitian Revolution, there was another
slave revolt attempt lead by a medicine man
name Francois Makandal. This vodou leader
(also spelled voodoo) is notable for his maroon
status as well as leading the first organized
slave revolt in St. Domingue. He is particu-
larly known for his distinguished choice of
weaponry-poison and voudou. Legend has
it that he gathered a large band of maroons
who attacked plantations and took goods and
weapons. They invoked terror primarily by
poisoning slaves who were deemed enemies,
especially slave masters, and livestock (Du-
bois, 2004). In order to carry out his attack,
Makandal developed an extensive network
among the slaves of the Northern Province,
including those who worked as merchants trav-
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Promoting Change and Health Education in Post-Earthquake Haiti
eling from plantation to plantation. Though he
was not the first freedom fighter to use poison
as a weapon in St. Domingue, the extent of
his actions and the reputation he gained was
believed to have set in motion mass hysteria
and violence that continued in St Domingue
for decades (Ott, 1973). Makandal was also
seen as a healer who was well versed in the
use of herbs and local plants to heal the sick.
He was also known for his ability to summon
supernatural forces through vodou to heal the
sick and enlighten the enslaved masses with
knowledge.
The media and Western ethnographers
often classified vodou as an evil and dark re-
ligion birthed in Africa. Outsiders believe the
practitioners stab pins into dolls and sacrifice
animals in order to call on the “devil” for power
and inspiration. Vodou has historically been
conceptualized as the antithesis of Christian-
ity, goodness, and whiteness. Many Haitian
scholars and citizens resent such a bias and
narrow classification of their beliefs. During
one of my trips to Haiti, I was introduced to
a completely different description of vodou.
Deep in the rural mountains of Haiti, the direct
descendants of the maroons practice what they
call Guinea Vodou or Racine Vodou. It is called
this because most Haitians believe that their
ancestors originated from the African country
of Guinea, and racine means “root” in the
Haitian-Creole language. The significance of
the term “root” is very important because the
practitioners believe that this type of vodou
is not a religion, but a lifestyle. They believe
that there is a direct connection between man,
earth, and the afterworld. The locals I spoke
with talked about being one with nature and
the importance of having respect for all forms
of life. Like their ancestors, they depended on
the land to produce herbs and spices needed
136

to make medicine. They did not believe in the
concept of calling on “evil spirits” to cause
harm to anyone.
Haitians today believe that this type of
vodou was practiced on August 14, 1791. On
this day, a Bo`Ko` (a person who is spiritually
chosen to be a vodou leader) named Dutty
Boukman organized a secret meeting with
enslaved Africans from a village called La
Cap and surrounding plantations (Zephir,
2004). This meeting became a ceremony
where these revolutionaries sacrificed a pig
and called to the spirits for strength and guid-
ance to fight for freedom. This ceremony was
called the Bois Caïman Ceremony, which
is named after the location of where it took
place (Zephir, 2004). As there are various
practices of vodou, it is unfortunate that many
people do not understand the practices. For
example, days after the 2010 earthquake,
the evangelical Christian televangelist Pat
Robertson declared that the earthquake was
a result of a “pact to the devil.” He went on
to say that the Haitians “were under the heel
of the French. You know, Napoleon III and
whatever and they got together and swore a
pact to the devil. They said, we will serve
you if you will get us free from the French.
True story. And so, the devil said, OK, it’s a
deal” (CNN, 2010). It is this type of limited,
ignorant, and bigoted thinking that continues
to marginalize the country of Haiti.
The historical victory by the people of St.
Domingue over Napoleon, the emperor of
France in the nineteenth century, is said to
be the result of several factors. Depending on
who is telling the story, the factors that led
to that victory vary. European sympathizers
claim that the residents of St. Domingue did
not win the war and that France only lost be-
cause Napoleon was fighting several battles in

Promoting Change and Health Education in Post-Earthquake Haiti
different parts of the world at the same time.
On the other hand, Haitian historians assert
that it was the will, commitment, and sacrifice
of the enslaved led by Toussaint Loverture,
Henry Christophe, and Jean-Jacques Dessa-
lines that resulted in Haiti’s independence in
1804. To choose just one of these considerable
determinants would lead to an incomplete
conclusion; therefore, it is likely that both
factors are relevant and contributing factors to
Haiti’s independence. However, what cannot
be denied is that the people of St. Domingue
would not have been victorious if they did not
resist through solidarity. On January 1, 1804,
the declaration of independence was formally
proclaimed and St. Domingue had ceased to
exist. A new nation of Blacks was born and
became the masters of the land now named
Ayiti or Haiti (Zephir, 2004).
Most people around the world do not know
how the people of Haiti won its independence
and defeated Napoleon’s mighty army. It
seems the story is either attenuated or ignored
all together. Trouillot (1995) states that the
Haitian Revolution entered history with the
peculiar characteristic of being unthinkable
even as it happened. He wrote:
The contention that enslaved Africans and
their decedents could not envision freedom,
let alone formulate strategies for gaining and
securing such freedom, was based not so much
on empirical evidence as on an ontology, an
implicit organization of the and its inhabitants.
Although it left room for variations, none of
these variations included the possibility of a
revolutionary uprising in the slave planta-
tions, let alone a successful one leading to
the creation of an independent state (p. 73).
According to Siegel (2012), Roth’s book
The Plot Against America articulates that the
identity of a nation cannot be summarized
in a chronicle of actual events, but that the
countless prospective plotlines that do not
come into being, largely on account of his-
torical possibility, expose the plurality that
comprises any given place at any given time.
Since the 2010 earthquake, various nations,
organizations, and citizens of the world have
expressed sympathy for Haiti. Many have
raised resources and awareness to the chal-
lenges that have plagued the nation. These
challenges are very complex and deep-rooted.
Unfortunately, Haiti is not on the front pages of
newspapers and in the media anymore because
the story is no longer entertaining or eventful
as newer issues occurring around the world.
The histories that can be told about Haiti
since gaining its independence in 1804 to the
January 2010 earthquake are insurmountable.
However, it seems the same popular narratives
continue to be told. Haitian anthropologist
Gina Ulysse (2010) expresses that “Haitians as
a subject of research and representation have
often been portrayed historically as fractures,
as fragments--bodies without minds, heads
without bodies, or roving spirits” (p. 37).
Understanding the permanence of these sto-
ries is important now more than ever before.
The day when Haitians as a people and Haiti
as a nation is not synonymous with “devil
worshipers” and the “poorest nation in the
western hemisphere” is a long ways away,
but change is possible and it starts with my
loved ones and I.
MO’S WORK IN HAITI
Since the earthquake, I have travelled to
Haiti five times, and I plan to return every
summer, if possible. I was blessed to not
only work as a relief worker four years
137

Promoting Change and Health Education in Post-Earthquake Haiti
ago, but also have opportunity to work with
an organization that provided sustainable
water filtration systems in various villages
throughout Haiti. Furthermore, I taught
students from kindergarten to high school
about the importance of water conservation,
hygiene, and general health. For the past
three years, I served as the Global Director
of Educational Development for the Haitian
American Caucus (HAC). In this position, I
assisted in the creation of an annual teacher
training conference that empowers teach-
ers in Haiti to be leaders of change as the
country continues to rebuild. One of my
main responsibilities was to develop and
evaluate curriculum and instruction as well
as school leadership and education policy
at the Shalom Community School/Center
in Croix-des-Bouquet, Haiti. One of my
proudest moments thus far has been help-
ing to coordinate the development of what
hopes to be the first teachers union in the
country’s history.
According to the Haitian American
Caucus (2014), there is a large percentage
of Haitian teachers who lack the adequate
training required to meet the basic needs of
students. The small percentages of teachers
with extensive educational training teach at
the elite and private schools. The residual
byproduct of this inequitable educational
paradigm is generations upon generations
of the majority of Haitian youth receiving
an inferior schooling experience. The HAC
recognizes these issues and has developed
a training program for teachers in order to
combat their lack of training and prepara-
tion. The annual Teacher Summer Institute
(TSI) is one of the most important initiatives
for HAC because of the potential long-term
effects on the country of Haiti and its future.
138

The purpose of this annual conference is
to assemble as many primary, middle, and
secondary teachers from all over the country
to participate in not only training practicum,
but also to engage in critical conversation
about the state of the school system and
the teaching profession as a whole in Haiti.
Furthermore, the conference provides an
opportunity for teachers from the United
States to share their experiences and present
on various topics that reflect the theme of
the conference. In 2012, my wife, Shewanee,
presented at this conference, after extensive
preparation.
SHEWANEE’S STORY
I met my husband in September 2006 in gradu-
ate school at Miami University (Oxford, Ohio).
We married in July 2011. During those years,
I learned more about Haiti than I had ever
known, realized, or honestly thought about.
My husband, Mo, is Haitian-American. His
parents, aunts, uncles, and cousins were all
born on the island of Haiti. It is located about
700 miles south of Miami, Florida. During
our courtship, I had the opportunity to meet
extended family, friends, and neighbors,
which presented me with a clearer picture of
where he grew up. Meeting these individuals
and learning the stories and traditions of his
family provided me with a sense of who Mo
was as a man, a friend, and future life partner.
Mo spoke vividly of home. Home for him
was not necessarily growing up in Miami.
Home was a true sense of connectedness to
a country he had only visited a few times as
a child. He was committed to a worthwhile
a purpose, a purpose greater than himself.
English was not his first language. His first

Promoting Change and Health Education in Post-Earthquake Haiti
language is French Creole’, the language of
the people. I vividly remember reading numer-
ous excerpts, quotes, poems, and dissertation
chapters about Mo’s Haitian experiences.
Through Mo’s work, within the academy and
outside of it, I was even more compelled to
be of service to Haitians. The more I learned
about Haiti and its rich history and people,
the more I wanted be involved. I believe my
family, friends, and students would say that
I am a thoughtful person, always going out
of my way to help others, sometimes to the
detriment of my own needs. Feeling tired or
overworked always seems to be a worthwhile
sacrifice because I know that I will be help-
ing others in some capacity. In the summer of
2012, I had an opportunity to travel to Haiti.
At the moment that I expressed true inter-
est in traveling to Haiti in 2010 with Mo, his
immediate answer was “No Shewanee, you
cannot go to Haiti. I don’t know if you will
ever be able to go to Haiti.” Mo has never
been short of words or honesty, but I did not
know why he was so adamant about me not
going. He knows my heart, my desire to help,
and my commitment to serve. I kept asking
myself “Why couldn’t I go to Haiti?” It would
be almost three years before I truly realized
why I could not go. The stories and news
articles that were spoken in English and from
a United States perspective were very easy to
understand and comprehend. The personal
narratives Mo shared with me and those that
he translated for me at family gatherings pro-
vided another perspective. The one aspect I
failed to grasp consistently was that I married
a Haitian man, which would never make me
Haitian or Haitian-American. Learning certain
phrases in French Creole’, listening to Kompa
music, identifying with Haitian foods, or lov-
ing Haitian people does not make an insider.
Despite having these experiences, it clearly
suggested that I am American first to those
who reside in Haiti or Haitians living in the
United States. At this point, I had yet to be
critical or reflective of my experiences, my
privileges, or myself.
Once I had this epiphany, Mo was open to
the idea of me going to Haiti in 2012, though
his parents were not fond of the idea at all. His
parents felt that as an American, I would not
have adjusted well to the type of living that
exists for millions of Haitians. They wanted to
protect me from the physical environment, the
land, and all of the unknowns that were very
familiar to them. After Mo convinced his par-
ents that I would be “protected” while in Haiti
because he would be there, they became more
comfortable, although they still disagreed. In
2012, I was awarded an Instructional Develop-
ment Grant. This grant allowed me to travel
to Haiti and work with the Haitian American
Caucus (HAC). Specifically I would work
with Haitian teachers in Croix-des-Bouquets
and present at the Teachers Summer Institute
Conference (TSI). In July 2012, I was on my
way to Port-au-Prince, the capital city of Haiti.
As the plane flew over the Atlantic Ocean,
I remember seeing all the shades of blue and
green that appeared so transparent from my
window seat on the airplane. I remember
Mo showing me pictures and videos of Haiti
during our courtship, and I was amazed at
the plants, trees, waterfalls, food, and smiles
that seemed genuinely organic from every
perspective. This was a different Haiti than
what I had seen from the devastation of the
earthquake and the news clippings. From
the airplane, I could see where the trees, live
vegetation, flowers, and waterfalls used to
be in the countryside. Though those pristine
scenes in nature still exist, the reality was that
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Promoting Change and Health Education in Post-Earthquake Haiti
I arrived to a different Haiti, the Haiti that few
people in the United States knew from a social,
political, economic, or personal perspective.
I was provided this privilege for which I was
more than grateful.
Mo gave me very specific instructions in an
email about a week prior to my arrival detailing
how to manage the airport, the temperature,
and the people. He also advised about how
to arrive in Haiti. The email read as follows:
Love, I know you are excited about coming to
Haiti, but please print off the directions below
and bring them with when you arrive. When
you get off the plane, do not move slowly like
you usually do and let everyone else off the
plane. Grab your personal items very quickly
and exit the plane as quick as you can. Once
you are off the plane, run to the customs line.
I know you’re nice and like to let people in
front of you. None of that nice “shit.” You
have to stand your ground and not let people
just get in front of you. Plan to be in customs
for at least an hour. Have your passport and
identification ready. Do not speak to anybody
for any reason. You don’t have to push and
shove -- just politely keep your personal items
right next to you as you proceed through the
lines. The airport is a hustle for men working
there. Once you are through customs, proceed
to immigration quickly. Get your passport
stamped and go directly to baggage claim.
Bag handlers will be trying to help you find
your bag. If you allow anybody to touch your
bag, they will expect a tip, so do not let anyone
touch your bag or try to help you in any way.
Once you get your bags, follow the people
towards the long football like tunnel. I will
be standing at the end of the tunnel ready to
greet you. Can’t wait to see you! Love you,
Mo. (Personal Email, 2010)
140

I followed Mo’s directions to a “T” and
did not have any problems at all. We greeted
each other with a big hug and kiss and started
our journey to the Shalom School, which is
about 30 minutes from Port-au-Prince. I de-
veloped two presentations for the conference.
The presentations were titled: “Developing
a Culturally Appropriate First Aid Kit for
Haitians” and “Women Helping W.O.M.E.N.:
Working on Multiple Empowerment-projects
Now.” For the purposes of this section, we
will focus on the former presentation.
The idea of developing culturally appro-
priate First Aid Kits occurred when I was
brainstorming with Mo about possible topics
to present at the conference. He suggested that
it be something related to health. Though his
suggestions were very general and seemed
somewhat vague, he was giving me the power
and space to intentionally be creative and
critical. After interpreting his vagueness as
a positive attribute, I began to think about
health from the perspective of Haitians,
specifically that of Haitian school teachers.
Health education as a national curriculum is
non-existent in Haiti. Though there is an inter-
national push towards health education, many
countries around the world lack the resources,
tools, and people to implement, develop, and
incorporate such a curriculum into schools.
According to the World Health Organization
(WHO) (2014), “Health education is any
combination of learning experiences designed
to help individuals and communities improve
their health, by increasing their knowledge or
influencing their attitudes.” (Retrieved from
http://www.who.int/topics/health_education/
en/). The WHO has taken initiatives for the last
few years to develop a comprehensive plan to
address global health education professions
with a focus on the specific needs of a country.
The WHO (2011) stated the following:

Promoting Change and Health Education in Post-Earthquake Haiti
Based on the work to date, it is clear that re-
forms will need to address, first and foremost,
the issue of coordination between different
sectors, both public and private, to align
health systems and workforce planning with
educational production and population health
needs, and to create stronger links between
education, communities and health service
delivery. Increased investment at national and
international level and support to country-led
strategies are also of paramount importance.
(p. 14)
In the United States, there are standard
health education standards that states are re-
quired to implement. According to the Centers
for Disease Control and Prevention (CDC),
there are specific characteristics that reflect
effective health education curriculum. The
fifteen characteristics include:
1. Focuses on clear health goals and related
behavioral outcomes,
2. Is research-based and theory-driven?
3. Addresses individual values, attitudes,
and beliefs,
4. Addresses individual and group norms
that support health-enhancing behaviors,
5. Focuses on reinforcing protective factors
and increasing perceptions of personal
risk and harmfulness of engaging in spe-
cific unhealthy practices and behaviors,
6. Addresses social pressures and influences,
7. Builds personal competence, social com-
petence, and self-efficacy by addressing
skills,
8. Provides functional health knowledge
that is basic, accurate, and directly con-
tributes to health-promoting decisions
and behaviors,
9. Uses strategies designed to personalize
information and engage students,
10. Provides age-appropriate and devel-
opmentally-appropriate information,
learning strategies, teaching methods,
and materials,
11. Incorporates learning strategies, teaching
methods, and materials that are culturally
inclusive,
12. Provides adequate time for instruction
and learning,
13. Provides opportunities to reinforce skills
and positive health behaviors,
14. Provides opportunities to make positive
connections with influential others, and
15. Includes teacher information and plans
for professional development and train-
ing that enhance effectiveness of instruc-
tion and student learning (Retrieved
from http://www.cdc.gov/HealthyYouth/
SHER/characteristics/).
In theory, having a strong, ethically sound
framework makes it easier to design and
implement a health education curriculum in
most schools across the United States. The
problem lies in believing that curriculum and
characteristics of a health education program
in the United States is applicable anywhere
else outside of the United States. When we
as people from the United States travel to an-
other part of the world, we take our “USian”
identity with us. This identity is inclusive
of, but not limited to, the values, beliefs, and
expectations that create customs in the United
States, which then become the “standard” that
all other measurements are compared. As a
former secondary health teacher in Missouri
and current faculty member, I am all too
familiar with the health education standards,
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Promoting Change and Health Education in Post-Earthquake Haiti
curriculum, and expectations of how health is
“done” in the United States. Before traveling
to Haiti, I had to dismiss any preconceived
notions of what health would be like in Haiti
and, therefore, not compare health in Haiti
to health in the United States. I attempted to
created culturally appropriate First Aid Kits
with the understanding that the health needs
in Haiti are very different from a health cur-
riculum in the United States.
With the grant money, I was able to pur-
chase items that would be useful in creating
the First Aid Kits for the Haitian teachers at
the conference. When people think of First
Aid Kits in the United States, they typically
think about small bandages, latex gloves,
hydrocortisone ointment, gauze, and a few
antiseptic wipes. Though most First Aid Kits
contain these items and other items such as
aspirin and adhesive tape, these items are not
necessarily helpful in Haiti. Before arriving
in Haiti, I created some basic First Aid Kits
based on the research I completed about the
needs of the Shalom School. I was able to
obtain about thirty drawstring backpacks that
included the following items: a thermometer,
a notepad, pens, pencils, hydrocortisone oint-
ment, antibacterial ointment, large gauze pads,
elastic bandages, and bottles of peroxide and
alcohol.
These items only represented the first part
of the culturally appropriate First Aid Kits.
The other necessary components were the
voices of the Haitian teachers who work with
their students every day. I needed them to tell
me what they needed instead of me bringing
useless items based on preconceived notions
of what I thought they needed as a foreigner.
The teachers were part of the process. In
fact, they were the most important part of
the process. My desire was to create a space
142

where I could learn from the Haitian teachers
as much as they could potentially learn from
me. I willingly admit that I was not the expert,
and I knew this. I wanted to create an organic
space where they felt like the experts, because
in my eyes, they were the specialists.
When I began the presentation, to say that
I was nervous was an understatement. Mo and
others were there to translate and make sure
that everything went smoothly so there should
not have been anything to worry about. With
the projector warming up and the teachers
ready to receive the information, I began the
presentation with a brief introduction. I spoke
about my educational background and the
courses I taught in the United States. Though
they knew nothing about my teaching experi-
ences or me, I instantly felt that they valued
what I was about to say to them. The projector
displayed the first slide on the screen. It read
“Developing a Culturally-Appropriate First
Aid Kit for Haitians.” After speaking about
the contents of First Aid Kits in the United
States, I realized that the contents were not
relevant to the needs of teachers and families
in Haiti today. I then asked them what they
thought was needed in their kits. The teachers
started speaking amongst themselves, discuss-
ing what I thought should be included. The
translators then explained that the teachers
wanted me to tell them what should be in the
kits. This was the exact opposite reaction I
had envisioned. I saw them as the experts
because they live and work in this community
on a daily basis. Who was I to come in as an
outsider and tell them what to do? While I
accepted my role as an outsider and educator,
the teachers did not accept their role as expert
insiders and educators. After some convincing
from the translators, the teachers believed in
the power of their voices to speak the truth.

Promoting Change and Health Education in Post-Earthquake Haiti
I learned that Haitian teachers are the first
and required elements for change to occur.
Throughout the discussions, we discovered
that the items needed included some of the
same items found in a First Aid Kit in the
United States, particularly gauze, bandages,
and various ointments. The size of the gauze
and bandages needed in Haiti are much larger
because the teachers stated that many students
would injure themselves on the “playgrounds”
due to the broken glass, trash, and objects like
bricks or metal that were around. Furthermore,
the teachers stated that they needed organic
herbs, matches, a small flashlight, a blanket,
hand sanitizer, a small knife, safety pins,
sanitary napkins, and a change of clothing.
Many of the items that people in the United
States would consider “everyday” household
items such as a lighter or blanket are scarce
for many teachers, parents, and families in
Haiti. Recognizing the value and importance
of these “everyday” items to the teachers, I
would now consider them luxury items.
One of the main takeaways that I wanted
from my presentation was to better understand
the teachers’ lived experiences and not com-
pare or contrast customs of the United States
to their lives. After some initial resistance, I
rephrased my question and asked, “What are
the biggest health challenges that you see from
your students during the school day?” This
question garnered a much stronger response.
In a group of more than 40 teachers, there
was a positive surge of energy and opinions
as teachers began to share their stories. At the
conclusion of my presentation, I was left with
more questions than answers. At that point,
I believed I had made progress. I measured
progress by my ability to engage the teachers
in a critical dialogue that addressed the issues
they believed were most prevalent at that
time. The teachers were very honest about the
contents of their culturally appropriate First
Aid kits. Facilitating the conversation about
what they felt was important was the first ac-
complishment. The teachers informed me that
the items they needed focused on injuries that
tended to be a little more serious than a scraped
knee on a playground in the United States. At
the end of my presentation, I learned that to
understand what is considered “appropriate”
in any situation, one must first understand the
situation/context itself.
As educators, we must appreciate that the
“classroom” comes in many different shapes
and spaces. Where children and families
live, grow, and learn may change from place
to place. The commitment to creating a safe
environment where children and families feel
comfortable to connect, share, and learn from
one another is a constant regardless of where
one resides. In the future, educators and practi-
tioners must include the community as part of
the solution for any issue. The Haitian teachers
that I presented to stated that we should all
work together and collaborate to ensure the
needs of the children are always met.
SEIZURES OR SEVERE
MALNUTRITION?
One of the first health stories that was shared
involved seizures. Many of the teachers stated
that one of the most reoccurring challenges is
students who suffer from frequent seizures.
One could imagine my surprise to hear that
“seizures” was the word that was translated.
I immediately went back to my comfortable
United States state of mind. In the United
States, seizures are typically not a daily oc-
currence for most school children. As the
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Promoting Change and Health Education in Post-Earthquake Haiti
teachers told stories of what happened when
their students have seizures, other teachers
echoed their sentiments and nodded their
heads in agreement. They agreed with the
stories being shared as well as the suggested
treatment or care for a child having a seizure.
As the teachers further explained about the
seizures, I had to internally monitor my facial
expressions and body language. I did not want
the teachers to think that I was discrediting
what they were saying or that I did not believe
them. I was not prepared to hear the words
and experiences that were translated. While
most teachers disagreed with the methods,
many of them had heard of such remedies for
treatment. According to the teachers, if a child
is suffering from a seizure, there are specific
steps that should be taken. The first step would
be the teacher kneeling on the ground with
the student’s back to the teacher. The teacher
would then grab the arms of the child and pull
them back towards the teacher’s back until
the teacher heard a popping sound. Some
of the teachers expressed that this was how
they were trained to handle seizures. No one
expressed that these methods actually worked.
The second health condition of importance
to the teachers was asthma.
The teachers stated that when a child has
an asthma attack, they would lay the child
down on his/her back. They would then hold
the child’s head up and take his/her shirt off.
After doing this, the teachers then burned the
shirt until it turned to ashes. Once they have
the ashes, they fed the ashes to the child and
helped him/her breath properly again. My
initial reaction was shock, and I was almost
appalled that some people would resort to such
drastic, and somewhat unrealistic, measures
to treat seizures and asthma attacks. I realize
that with my initial reaction, I was passing
judgment without fully understanding the
teachers’ circumstances.
144

My shock came from learning that some
teachers used this practice for treatment. I do
not know if I was more alarmed that people fed
ashes to children to solve breathing problems
or that this was the type of training and edu-
cation that the teachers received. Regardless
of how the translators or I reacted, the main
point was that we needed to empower Haitian
teachers with alternative methods without
judging their previous practices.
CULTURAL COMPETENCE?
IS IT POSSIBLE?
Is cultural competence possible for health and
healing professions? Scholars have debated
about whether or not this is actually possible or
even attainable. Cultural competence is a “ser-
vice provider’s degree of compatibility with
the specific culture of the population served,
for example, proficiency in language(s) other
than English, familiarity with cultural idioms
of distress or body language, folk beliefs, and
expectations regarding treatment procedures”
(McKenzie, Pinger, & Kotecki, 2012, p. 310).
Scholars, volunteers, and people with “good
intentions” believe that learning a language,
recognizing holidays, or acknowledging
particular customs of the population he/she
serve leads one to believe that he/she is cul-
turally competent. In 2001, the United States
Department of Health and Human Services
and the Office of Minority Health published
specific standards called the Culturally and
Linguistically Appropriate Services in Health
and Health Care (CLAS Standards). There
are fifteen standards that address particular
behaviors, attitudes and practices of health
care organizations in an effort to achieve cul-
tural and linguistic competence. The Office
of Minority Health stated that:

Promoting Change and Health Education in Post-Earthquake Haiti
Cultural and linguistic competence is a set of
congruent behaviors, attitudes, and policies
that come together in a system, agency, or
among professionals, that enables effective
work in cross-cultural situations. ‘Culture’
refers to integrated patterns of human behavior
that include the language, thoughts, commu-
nications, actions, customs, beliefs, values,
and institutions of racial, ethnic, religious, or
social groups. ‘Competence’ implies having
the capacity to function effectively as an indi-
vidual and an organization within the context
of the cultural beliefs, behaviors, and needs
presented by consumers and their communi-
ties. (Office of Minority Health, 2001, p. 4-5)
This definition of culture and competence
is problematic for a number of reasons. In a
paper entitled “Culture: A Critical Perspec-
tive” Quantz (1988), it is stated that “tradi-
tional scholarship tends to present culture
as something constructed by participants in
ethnic, family, neighborhood, or peer group-
ings. A culture is seen as a social construction
created by an inter-related network of people”
(p. 2). He suggests that this is a very limited
definition of a concept that is very complex
to understand. Culture is not static, fixed,
singular, or a specific characteristics based on
shared patterns and symbols in history. Quantz
(1988) argues that culture is dynamic, chang-
ing, and relational. Culture is not a category.
Creating a set of pre-arranged groups based
on language, race, ethnicity, holidays, foods,
and geographic location limits the possibilities
and opportunities that have existed throughout
histories that have constructed new voices and
new lived experiences.
To study such cultures, scholars have devel-
oped ethnographic techniques, which require
the researcher to enter into the cultural scene
and learn the patterns of life and the symbols
of interaction of the group. Such patterns
and symbols are understood to be shared by
the culture at large and taught to each new
generation which must itself reconstruct
them given their particular life experiences.
(Quantz, 1988, p. 3)
When I first had the desire to travel to Haiti,
I believed that as a researcher, I had access
to the populations I wanted to serve. I soon
realized that learning French Creole’, study-
ing the history of Haiti, and understanding
the health and racial complexities after the
earthquake did not make me an expert. At
best, it made me informed, but proficient or
competent. Having a strong passion to help
others is not enough to be competent, though
it is enough to be compassionate. However,
being compassionate is not competency. “If
we consider culture as multivoiced and histori-
cal conflicts instead of univoiced, ahistorical
entities, we are more likely to understand the
regenerative and transformative possibilities
that exist” (Quantz, 1988, p. 8). If culture
can now be understood to be “contradictory,
conflictual, dialogic, and multivoiced,” we
can now examine a more critical view of
competency (Quantz, 1988, p. 7).
To suggest that anyone is competent at any-
thing would suggest that they have achieved a
proficiency, accomplishment, or set of skills
that would make that individual an expert.
If someone studies a language or learns how
to swim, neither of these skill sets would
lead to proficiency within a short period of
time. For many people, it would take years
of studying, practicing, and making mistakes
to reach a level of proficiency. Obtaining a
level of proficiency would also suggest that
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Promoting Change and Health Education in Post-Earthquake Haiti
an individual has achieved and earned a sig-
nificant amount of respect and skill so that the
learned skill could be taught to novices. My
time in Haiti and critical reflection afterwards
leads me to believe cultural competency, as it
has been defined, is unattainable. If culture
is understood to be a relational struggle that
exists between multiple groups that equally
influence each other, then my personal experi-
ences are directly connected to every Haitian
teacher’s experiences. I would propose that
in an effort to address cultural competency,
scholars, researchers, and health care provid-
ers should aim for cultural humility. Waters
& Asbill (2013) suggest that there are three
key elements to cultural humility:
1. A lifetime commitment to self-evaluation
and self-critique;
2. A desire to fix power imbalances; and
3. The aim to develop partnerships with
people and groups who advocate for
others.
During my preparation for my trip and
afterwards, I was striving to achieve cultural
humility. Once I dismissed the idea that cul-
tural competence is attainable, particularly in
a short period of time, i.e. less than two years,
I made significant progress towards critical
self-reflection.
DEVELOPING A CULTURALLY
RELEVANT HEALTH
EDUCATION CURRICULUM
My research experience and service interests
reflect a commitment to helping others lead
healthier lives. My trip to Haiti in July 2012
was pivotal in me examining my own biases,
146

privileges, and assumptions about how people
exhibit behavior change. I also learned from
the multivoiced Haitian teachers that in order
to develop new behaviors, we all must un-
derstand the multiple factors that influence
behavior change. Some of those factors can
be learned from reading and studying primary
and secondary sources of various academic
disciplines. I would suggest that many of
these factors, particularly social determinants
of health (for example affordable housing,
transportation, and access to health care),
require much more rigorous study. “Social
determinants of health are conditions in the
environments in which people are born, live,
learn, work, play, worship, and age that affect a
wide range of health, functioning, and quality-
of-life outcomes and risks” (Retrieved from
http://www.healthypeople.gov/2020/topic-
sobjectives2020/overview.aspx?topicid=39).
Being intentional in developing clear and
critical perspectives about the conditions
that impact choices for Haitian teachers is
dependent upon how Haitian teachers view
the world. We must first understand how they
make choices about the health and well-being
of their students on a daily basis. The strength
of creating a health education curriculum
in Haiti, which currently does not exist, has
many advantages.
One of the benefits would be the ability to
create a curriculum that empowers teachers. If
teachers feel invested in the curriculum, it not
only increases their self-efficacy, but it also
increases their ability to effectively imple-
ment change. Developing a health education
curriculum cannot be adoption of a health
education curriculum that exists outside of
Haiti. The standards and knowledge deter-
mined to be crucial in the United States can-
not be determined or depicted as the “norm”

Promoting Change and Health Education in Post-Earthquake Haiti
for which all other principles are compared.
In 2013, the Centers for Disease Control and
Prevention (CDC) determined that:
Today’s state-of-the-art health education cur-
ricula reflect the growing body of research
that emphasizes: (a) teaching functional
health information (essential knowledge),
(b) shaping personal values and beliefs that
support healthy behaviors; (c) shaping group
norms that value a healthy lifestyle, (d) and
developing the essential health skills neces-
sary to adopt, practice, and maintain health-
enhancing.” (Retrieved from http://www.cdc.
gov/HealthyYouth/SHER/characteristics/)
These criteria are important in Haiti, but
they must be understood within the context of
Haiti, particularly within the confines of each
school. The physical, political, economical,
and social environment in Haiti is different
from community to community. The multiple
voices and histories must be part of not only
the conversation, but also the planning and
implementation of a health education cur-
riculum or any type of behavioral change.
Health education curriculum, strategies, and
intervention programs must be tailored to fit
the needs of each community.
In a qualitative study by Cianelli, Wilkin-
son, Mitchell, Anglade, Nicolas, Mitrani
and Peragallo (2013), researchers strived to
determine the impact of a Mental Health Train-
ing Program (MHTP) among Haitian health
care workers. Haitian health care workers at-
tended specific trainings designed to address
the particular needs of north Haiti after the
2010 earthquake. Though the earthquake did
not occur in north Haiti, many people sought
refuge, medical attention, and safety there.
The research stated:
Participants developed a better understand-
ing of common mental health symptoms and
experiences (e.g. anxiety, depression, trauma,
grief) and of the manifestation of these symp-
toms across different ages, genders, and
cultures in Haiti. They also learned effective
coping and adaptation strategies in Haitian
Creole by two Haitian psychologists and one
Haitian nurse (p. 529).
Through focus groups, the authors were
able to ascertain that mental health was a
fairly new concept that has not been histori-
cally addressed. Participants expressed that
the training changed them personally and
professionally. They were able to address
barriers regarding mental health in addition to
determining how to motivate people to learn
about mental health as an important issue.
One of the major barriers is the historical
implication about mental health issues being
associated with supernatural or evil influ-
ences (Cianelli, Wilkinson, Mitchell, An-
glade, Nicolas, Mitrani and Peragello, 2013).
Researchers developed a “train-the-trainer”
approach, where selected participants were
chosen to attend training cycles to learn how
to become a trainer.
The results demonstrated that “the Mental
Health Training Program changed the health-
care workers’ perceptions about mental health
issues and provided them with the knowledge
and skills to respond to growing community
mental health needs. The healthcare workers
trained in the Mental Health Training Program
reported feeling empowered and ready to ad-
dress mental health issues in their practice.
They also reported feeling ready to expand
their work to other communities to help change
the perception of mental health issues in Haiti.
These outcomes clearly reflect the community
147

Promoting Change and Health Education in Post-Earthquake Haiti
empowerment framework on which the Mental
Health Training Program is based” (Cianelli et
al., 2013, p. 533). This study reflects a long-
term commitment to critical self-reflection,
training, and understanding the histories that
impact how people see the world.
In another study by Knebel, Puttkam-
mer, Demes, Devirois, and Prismy (2008),
researchers partnered with other health based
organizations to assess the lack of care for
those who suffer HIV/AIDS in Haiti. Since
there is a shortage of doctors, nurses play a
pivotal role in prevention, care, and treatment
for Haitians with HIV/AIDS. Researchers
developed an HIV/AIDS curriculum that was
integrated into the nursing schools in Haiti:
Haiti has four national nursing schools,
graduating approximately 120 registered
nurses per year. These schools face under-
resourced infrastructure (few textbooks and
teaching materials and little classroom space),
variable quality of teaching with few class-
rooms instructors to educate, and few clinical
instructors and sites available for clinical
skills practice. Graduates often must do much
of their learning on-the-job during their rota-
tions, under limited supervision. (p. 2)
In developing the competency-based
education model, researchers first asked one
critical question, “What will the nurse do on
the job?” Once this question is clearly defined,
learning objectives, teaching tools, training,
assessment and evaluations can be developed.
Researchers stated three vital lessons were
learned from this project:
The first lesson was the importance in iden-
tifying the right stakeholders for both the
coordinating committee and the curriculum
148

working groups…The second lesson was the
that this activity brought different nursing
schools together to collaborate on a shared
goal that was manageable and timely using a
process that could be repeated for other as-
pects of curriculum reform…The third lesson
was that defining competencies and related
learning objectives, though absolutely es-
sential to clarifying what students must learn,
was conceptually difficult for the curriculum
committee. Even experienced educators may
find it challenging to clearly state the knowl-
edge, skills, and attitudes underpinning a
competency. (p. 6)
At the heart of this study was prevention.
Devoting energy, effort, and resources to pre-
service nursing education provides nurses with
the capabilities to educate, inform, and treat
people suffering from HIV/AIDS. Though the
appropriate treatment methods are important,
we must not deny the significance of preven-
tion. Developing a culturally appropriate
health education curriculum addresses the
healthcare needs of the teachers, families,
and children in Haiti.
CONCLUSION
The stories and studies described above reveal
that in order to develop a culturally relevant
health education curriculum that encom-
passes educators, scholars, and community
members for Haiti, Haitians must be at the
center. Recognizing a pertinent health issue
and understanding who the stakeholders are
in a community are critical to gaining access
and implementing change. Developing a new
curriculum and attempting to infuse it with
an existing curriculum is an arduous task.

Promoting Change and Health Education in Post-Earthquake Haiti
Ultimately, we must come together with in-
tentional methods to meet the Haitian people’s
most basic human needs first.
Humility is an intentional action. This is a
process, which scholars must learn about
themselves before helping others. Social
justice work is not a part-time job. Social
justice work is a lifetime commitment that
requires humility and critical self-reflection.
Scholars have the ability to positively impact
the lives of others. In order for this change to
take place, scholars must first acknowledge
that their presence is not always powerful.
In feeling vulnerable, stepping back and
listening, scholars can become the agents of
change they write about. (Howard-Baptiste
& Baptiste, 2013, p. 86)
Our trips to Haiti provided insight that
we would have never gained if we were not
amongst the people we wanted to “help.”
Helping is not serving. Instead, helping is
the ability to assist in a goal. Serving is the
ability to humble yourself in ways that leave
you vulnerable, open to critique, and feel-
ing that you may not know as much as you
think. Understanding histories and cultures is
more than reading books, memorizing facts,
acknowledging holidays, speaking another
language or eating certain foods. Our goal
was to address the challenges and barriers that
exist in creating a health education curriculum
that empowers Haitian teachers to become in-
formed and effective advocates of change. This
change is not possible if Haitians are not the
leaders of the change process from beginning
to end. As outsiders, scholars, educators, and
people committed to the humanity of others,
we must first acknowledge the ways in which
our own privileges perpetuate stereotypes,
misnomers, social norms, and belief systems
that are powerful, yet inaccurate. As beings
on this earth, let us all make a commitment
to the change we desire to become.
REFERENCES
Arthur, C., & Dash, M. (1999). A Haiti anthol-
ogy: Libète. Princeton, NJ: Markus Wiener
Publishers.
Bell, M. S. (2007). Toussaint louverture. New
York, NY: Vintage Books.
Carr, E. H. (1961). What is history? New
York, NY: Knopf.
Centers for Disease Control and Preven-
tion (CDC). (2013). Adolescent and school
health: Characteristics of an effective health
education curriculum. Atlanta, GA: Au-
thor. Retrieved from http://www.cdc.gov/
HealthyYouth/SHER/characteristics/
Cianelli, R. R., Wilkinson, C. C., Mitchell, E.
E., Anglade, D. D., Nicolas, G. G., Mitrani, V.
V., & Peragallo, N. N. (2013). Mental health
training experiences among Haitian healthcare
workers post-earthquake 2010. International
Nursing Review, 60(4), 528–535. doi:10.1111/
inr.12047 PMID:24251943
CNN. (2010, January, 10). Pat Robertson says
Haiti paying for ‘pact to the devil’. Retrieved
from http://www.cnn.com/2010/US/01/13/
haiti.pat.robertson/
Dubois, L. (2004). Avengers of the new
world: The story of the Haitian revolution.
Cambridge, MA: Belknap Press of Harvard
University Press.
Fick, C. (1990). The making of Haiti. Knox-
ville, TN: The University of Tennessee Press.
149

Promoting Change and Health Education in Post-Earthquake Haiti
Geggus, D. P. (1983). Slave resistance studies
and the Saint Domingue slave revolt: Some
preliminary considerations. Miami, FL: Latin
American and Caribbean Center, Florida
International University.
Girard, P. (2009). Rebels with a cause: Women
in the Haitian war of independence, 1802-04.
Gender, 21(1), 60–85.
Goldberg, T. G. (1993). Racist culture: Phi-
losophy and the politics of meaning. Cam-
bridge, MA: Blackwell.
Haitian-American Caucus. (2014). Teacher’s
summer institute. Retrieved from http://hacus.
org/blog/projects/teachers-summer-institute/
Howard-Baptiste, S., & Baptiste, M. (2013).
Echoes of a not so distant summer: Scholar
servant as humble leaders. In A. Normore &
N. Erbe (Eds.), Collective efficacy: Interdisci-
plinary perspectives on international leader-
ship (pp. 73–87). Emerald Group Publishing.
James, C. L. R. (1989). The Black Jacobins:
Toussaint L’Ouverture and the San Domingo
Revolution. New York, NY: Vintage Books.
Knebel, E., Puttkammer, N., Demes, A., De-
virois, R., & Prismy, M. (2008). Developing
a competency-based curriculum in HIV for
nursing schools in Haiti. Human Resources
for Health, 6(1), 1–7. doi:10.1186/1478-4491-
6-17 PMID:18759986
McKenzie, J. F., Pinger, R. R., & Kotecki, J.
(2012). An introduction to community health
(7th ed.). Sudbury, MA: Jones and Bartlett
Publishers.
Megil, A. (1995). Grand narrative and the
discipline of history. In F. Ankersmit & H.
Kellner (Eds.), A new philosophy of history
(pp. 21–39). Chicago, IL: University of Chi-
cago Press.
150

Office of Minority Health. (2001). National
standards for culturally and linguistically
appropriate services in health care: Final
report. Retrieved from http://minorityhealth.
hhs.gov/assets/pdf/checked/finalreport.pdf
Ott, T. O. (1973). The Haitian revolution,
1789-1804 (1st ed.). Knoxville, TN: Univer-
sity of Tennessee Press.
Partner, N. F. (1995). Historicity in the age of
reality-fictions. In F. Ankersmit & H. Kell-
ner (Eds.), A new philosophy of history (pp.
21–39). Chicago, IL: University of Chicago
Press.
Quantz, R. (1988). Culture: A critical perspec-
tive. Paper presented at American Education
Studies Association, Toronto, Canada.
Roth, P. (2004). The plot against America.
Boston, MA: Houghton Mifflin Co.
Said, E. (1993). Culture and imperialism.
New York, NY: A.A. Knopf.
Stanley, T. (2006). The struggle for history:
Historical narratives and anti‐racist peda-
gogy. Discourse (Abingdon), 19(1), 41–52.
doi:10.1080/0159630980190103
Siegel, J. (2012). The plot against America:
Philip Roth’s counter-plot to American his-
tory. Melus, 37(1), 131–154. doi:10.1353/
mel.2012.0015
Trouillot, M. R. (1995). Silencing the past.
Boston, MA: Beacon Press.
U.S. Department of Health and Human
Services. (2013). Healthy people 2020 top-
ics and objectives: Social determinants of
health. Washington, DC: U.S. Government.
Retrieved from http://www.healthypeople.
gov/2020/topicsobjectives2020/overview.
aspx?topicid=39

Promoting Change and Health Education in Post-Earthquake Haiti
Ulysse, G. (2010). Why representations of
Haiti matter now more than ever. NACLA
Report on the Americas, 43(4), 37.
Waters, A. J., & Asbill, L. (2013). Reflec-
tion on cultural humility: Children, youth
and families news. American Psychological
Association. Retrieved from http://www.apa.
org/pi/families/resources/newsletter/2013/08/
cultural-humility.aspx
World Health Organization. (2014). Health
topics: Health education. Retrieved from
http://www.who.int/topics/health_education/
en/
World Health Organization. (2011). Trans-
formative scale up of professional health
education: An effort to increase the number
of health professional and to strengthen their
impact on population health. Retrieved from
http://whqlibdoc.who.int/hq/2011/WHO_
HSS_HRH_HEP2011.01_eng.pdf
Zéphir, F. (2004). The Haitian Americans.
Westport, CT: Greenwood Press.
Zinn, H. (1970). The politics of history. Bos-
ton, MA: Beacon Press.
KEY TERMS AND DEFINITIONS
Ayati (Haiti): The name of the island
according to the Tainos natives. It means
mountainous land.
Critical Self-Reflection: The ability to
examine one’s biases, privileges, assumptions,
power, and limitations in regards to self in
relation to the world.
Cultural Humility: A lifetime commit-
ment to consistent critique of self in an effort
to reach a cultural understanding of a popula-
tion desired to serve.
Culturally Appropriate First Aid Kits:
Items, regardless of size, that are necessary
to meet the first aid and health demands of
a community. They should not be compared
to another “standard” as the expected norm.
Culture: A dynamic, changing, relational
web of interrelated patterns.
Histories: A smorgasbord of stories that
are multivoiced, intertwines, and multi-
truthed. It is on a continuum between past,
present, and future.
Stakeholders: Those in a community
who both formally and informally have direct
contact with a priority population.
151
152

Chapter 10
Cutting-Edge Technology
Adoption for Building
Holistic Patient Experience
Roma Chauhan
IILM Graduate School of Management, India

ABSTRACT
Internet acceptance has exponentially risen globally in the last decade with the advent of collaborative and
interactive Web technologies. E-learning techniques are extensively used by medical educators to impart
learning to their patients and caregivers. E-Learning 2.0 has appeared as amalgamation of traditional
e-learning model and capabilities of Web 2.0. It is a supplement to treatment provided by doctors, used
for educating patient and equipping them to handle preventive and disease-specific conditions result-
ing in affirmative patient experience. The contemporary medical practices emphasizes building patient
experience and not restricting patient treatment. This chapter explains the need of shifting e-learning
focus from the software product design to service design and drawing the comparative model between
the two. It reviews existing E-Learning 2.0 practices being used in medical education and recent state-
of-the-art technologies including webcasting, virtual learning environment, mobile technology, etc. The
focal point of the chapter is how to use technology to promote patient-centered culture.

INTRODUCTION mative patient experience education is a criti-

The patient experience is gained from what he
has observed, encountered or undergone. The
holistic approach to build patient experience
is not only limited to his personal encounters
but also includes patient education, care and
guidance provided by the medical practitioner,
doctor or physical therapist. For building affir-
cal factor. Building a patient experience value
adds to the patient’s personal healthcare. This
results in social transformation with respect
to advice, monitoring and patient treatment.
The education to the patient could be in the
form of preventive education and disease or
condition specific education. In preventive
education a patient gets exposed to the chances

DOI: 10.4018/978-1-4666-7524-7.ch010

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
of occurrence of a disease. Medical fitness
maintenance level is emphasized in adults
through preventive education. Lifesaving
preventive measures are helpful in controlling
occurrence of disease in future. The disease
and condition specific is physician directed
chunk of patient education.
The medical practitioners can connect di-
rectly with the patient for recommendations
and directions for the treatment. There is a
communication disconnect between doctor
and patient. Doctor being a prime resource
has limited time to cater to the complete
needs of the patient. Healing and wellness
is a continuous cycle of efforts from the part
of doctor and patient. To expedite patient
education physicians have embraced the use
of technology and gadgets. The technology
is extensively used in creative way to impart
patient education. The technology further
is used to prepare patients for pre and post-
surgical operations.
Medicine has long been considered as a
practice unreasonable to teach online. The
complexity of the human organism and the
intricacies of the patient-doctor interaction ap-
pear beyond the influence of soulless technol-
ogy. A concise glance at novel advancement
in medical education reveals a distinct picture.
The aging population demands increasing at-
tention from medical personnel, resulting in
a reduction in the time that can be devoted to
teaching activities. The recent trend towards
decreasing lengths of patients’ stays in hos-
pitals reduces the possibilities for medical
students to observe the patient’s treatment
and recover process. It is in this context that
harnessing computers to support the learning
process by simulation of clinical scenarios
may be very helpful, especially in the case of
rare conditions.
The hospitals and healthcare bodies employ
Information and Communication Technology
(ICT) to facilitate learning processes and
for disseminating digital healthcare content
worldwide. To educate patients multiple tools
and technologies are used by professionals.
Several recommendations originating from
the Institute of Medicine and analysis reports
are encouraging towards the improvement of
healthcare professional education (Greiner
& Knebel, 2003). Multiple facets of hybrid
e-learning, includes on-line digital content,
multi-media training CD, supplemental
learning content, on-line discussion and
live broadcasting that could be blended with
conventional patient education (Teng, Bonk
& Kim, 2009).
BACKGROUND
It has been mentioned that healthcare educa-
tion is converting into a competency based
approach. There is rise in usage of e-learning
technologies relevant to competencies through
emerging improved e-learning standards
(Hersh, Bhupatiraju, Greene, Smother & Co-
hen, 2006). E-Learning provides the learners
with tremendous autonomy in the sense of
choice of the time, the content and the method
they learn, consequently providing on-demand
learning and eliminating the challenges of time
and distance (Tavangarian, Leypold, Nölting
& Röser, 2004). Improvement in standards of
Web and emergence of Web 2.0 has opened
numerous possibilities to e-learning. The
education of the healthcare professionals is
depended on 100 year apprenticeship model
exemplified by the phrase “see one, do one,
teach one” (Gorman, Meier, Rawn, Krummel
2000).
153

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
Virtual reality represents a promising
area with high potential of enhancing and
modifying the learning experience: virtual
environments can provide a rich, interactive,
engaging educational context, supporting
experiential learning (Mantovani, 2001).
Second Life is a contemporary authoring tool
for virtual patients, used to embed them as
3D-characters in virtual worlds (Conradi et
al., 2009). There is a constant need to rapidly
train and retrain people in new technologies,
products, and services within the medical and
healthcare setting (Harun, 2001). Mishra and
Khan (2009) contributed the following practi-
cal definition: “Transmitting video and audio
streams over the Internet allows events such as
lectures, seminars, and webinars, to become
available to users in remote location” (p. 85).
The Empirical investigations (Giannakos et
al., 2011) have revealed that students learn
and communicate effectively through use of
words and pictures than from words alone.
There are numerous educators (Bell, 2003)
and the maximum of students (Giannakos
and Vlamos, 2012) that supports the use of
webcasts for achieving learning objectives.
The students learning experience can be en-
hanced by implementing educational webcast
as a critical tool.
Adding to this students have expressed that
they gain tremendous benefit from having the
lectures accessible to support their conceptual
perspective and to overcome the gaps (Evans,
2008). There are various optimistic responses
have been identified, in context to students’
capability to control webcasts by being able to
extract through the content, rewind and skip
content as required (Dale & Pymm, 2009).
Maag (2006) demonstrated that webcasts are
154

effective means to test reviewing and decrease
anxiety before an examination. Students con-
sider that repeated review and the capacity
to browse through lecture content is a useful
practice (Maag, 2006). Kurtz, Fenwick and
Ellsworth (2007) emphasized a compelling
rise in the final term project grades of their
students when using webcasts. Evans (2008)
believes that students are more inclined and
receptive towards learning material provided
in the form of a webcast compared to a typical
lecture or notebook. The students agree that
webcasts are more compelling revision tools
than the traditional book or their own lecture
notes in helping them to study.
Microsoft recently published chapter on
system very similar to the Virtual Director
platform for webcast (Liu, 2001). The sys-
tem developed by Microsoft, in addition to
Director Platform, provides complete automa-
tion of a video broadcast solution including
full speaker tracking and audience question
detection. Microsoft also did evaluation to
study user experience and the effectiveness
of their system. The commercial streaming
media systems in the market including Apple
QuickTime Streaming, Cisco IP/TV, Micro-
soft Windows Media, and Real Networks.
These commercial streaming systems have
led to a rapid growth in the use of streaming
media over the Internet. Huge numbers of
live webcasts are produced each week that
are viewed by a number of viewers across
the globe (Wired, 2010). “SaaS providers are
enhancing their software functionality and
improving the ease with which companies
can customize and more uniquely configure
SaaS software to meet business requirements”
(Gartner 2006).

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
E-LEARNING IN PRACTICE
There has been shift in education from conven-
tional teaching and learning towards blended
learning including face to face interaction
and self-directed learning using technology.
E-learning is emerging as prime area of inter-
est due to emergence of Web 2.0 standards
and affordability of mobile and other portable
devises. They are discussed below:
Web 2.0
E-learning refers to the use of Internet tech-
nologies to deliver a broad array of solutions
that enhance knowledge and performance
(Rosenberg, 2001; Wentling, Waight, Gal-
laher, La Fleur, Wang & Kanfer, 2000).
Web 2.0 has transformed education and
e-learning techniques, through the related
term “E-learning 2.0” (Downes, 2005), which
involves e-learning based on Web 2.0 tools.
Technological advances have made available
to healthcare professionals a wide set of inno-
vative training tools. E-learning applications
and processes include Web-based learning,
computer-based learning, virtual classrooms,
and digital collaboration (Ashmalla, Mo-
hamed & Globashy, 2001).
Web 2.0 environment provides user with
the ability to create and customize digital
content. It allows users to interact and share
information with each other in the virtual com-
munity. Social networking websites, blogs,
video sharing E-learning 2.0 is the adoption of
Web technologies to augment knowledge and
performance. The technology enable learners
to manage learning content, sequence, pace
of learning, time, and often media, permitting
to meet learning objectives.
Mobile and Portable Devices
Mobile learning (m-Learning) use technolo-
gies and gadgets such as smart phones, tablets
and other software applications result in col-
laborative, flexible, and reflective learning.
Mobile technologies are personal, always
available and proper for use in clinical settings.
A patient or caregiver can have their phone
with them at all times proving personal access
anytime. Mobile applications enable learning
materials sharing among learners, providing
convenient access to content when mobile.
With digital devices becoming smaller
and portable there is an inflating integration
between traditional computer based technolo-
gies and mobile communication. M-learning is
supported by an increasing number of medical
students and young doctors globally purchas-
ing the latest mobile smart phones for use in
a hospital or clinical environment. The bulky
workstation and laptops are being replaced by
portable devices. Due to the rapid increase of
mobile phone adoption in low income nations,
mHealth technology is aggressively growing
in countries where physical medical access
is limited. This enables improved ability to
diagnose and track diseases and gain access
to healthcare related information.
E-Learning 2.0 Techniques
E-learning 2.0 is not limited to content creation
and delivery but provides comprehensive com-
munication solutions to the medical fraternity.
The benefits are discussed as:
• It can be used for training medical experts
and patients without the expense of mov-
ing doctors from location to location across
dispersed geographic boundaries.
155

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
• It enables collaborative communications
through team meetings, briefings, online
lectures or promotional events live or on-
demand on internet.
• The portal managing the overall knowl-
edge captured through expert presentations
and project briefings to build and share
knowledge across institutions. The knowl-
edge warehouse can later be referenced for
knowledge retrieval on-demand.
• Conferences and seminars can be captured
in real time and online breakout sessions
can be organized with remote participation.
The e-learning 2.0 techniques for patient
education and training doctors are discussed
as:
Webcasting
Webcast allows delivery of software in the
form of Software as a Service (SaaS). Sch-
neider (2001) explained webcast as produc-
tion of audio or video over the Web and its
availability in real-time as a live or on-demand
for download afterwards. Lin (2004) defines
Figure 1. Webcast software screen interface showing control positions
Source: Image by Author.
156

webcast technology as a combination of mul-
tiple entities such as audio, video for generat-
ing effective communication over the web (p.
94). According to (DiMaria-Ghalili, Ostrow,
& Rodney, 2005), the webcast production
requires following entities: A camera (for
video), microphone, a personal computer or a
laptop, a media software, and Internet access.
Bell (2003) describes streaming media as
software to enable Webcasting. The software
enables transmission of audio and video from
a server through media player on a machine.
Upon request by the user, using Internet as
a medium a stream of digitized data is sent,
thus enabling a webcast.
The Webcast is an interactive technique
and the interactivity is delivered through chat
and discussion forums hyperlinked with the
supporting webcast (refer Figure 1. for soft-
ware screen). Figure 2 illustrates webcasting
framework for healthcare institutions and
professionals. The digital content production
is illustrated into following:
• Phase 1, Lecture Capture: The initial ac-
tivity is to create a platform to capture and

Cutting-Edge Technology Adoption for Building Holistic Patient Experience

Figure 2. Webcast framework for training healthcare professionals; the effective framework enables
effective communication and content dissemination to the healthcare professional.
Source: Image by Author.

re-purpose the disseminated content. The Healthcare institutions address multiple

event is captured at a source by high defini-
tion video recording devises.
• Phase 2, Digitization and Encoding of
Video Lecture: After the capture of the an-
alog event it can be digitized and encoded.
Video encoders are used for re-purposing
of videos to meet required specifications.
• Phase 3, Synchronization: After the com-
pletion of digitization and encoding phase,
the recorded videos are synchronized with
respective PowerPoint presentation. The
synchronized content is stored on stream-
ing servers for delivery.
• Phase 4, Online Delivery: The content
can be downloaded from streaming serv-
ers with internet connection on the user’s
machine.
communication solutions by adapting to the
after webcast service. Benefit includes:
• The webcast for medical fraternity can be
utilized for training doctors, nurses and
other professionals with no expense of trav-
el across dispersed geographic locations.
• Webcast enables effective collaboration in
real time with live webcast of the content.
• The portal can be used to manage capture
digital knowledge and can be referenced
later for knowledge retrieval on-demand.
• The remote participation can be effectively
encourages through question, chat and poll
feature.
• The captured event can be available to the
user live or on-demand via web browsers
anytime and anywhere.

157

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
• Webcast is a cost-effective knowledge
management mechanism for digital con-
tent storage and re-used.
• The system provides robust security; us-
ing registration or password mechanisms.
The content authors can restrict content to
known users.
The lecture captured digitally is processed
into a software application. The event produc-
tion goes through a sequence of activities
under taken by a production team compris-
ing of technicians who are required to follow
on time product delivery without delay. The
traditional e-learning solution was delivered
in the form of Software as a Product (SaaP).
Software Product Limitations
The healthcare institutions believe in the re-
quirement to harness web potential and impart
effective communication to the learners by
employing Web as an interface. The SaaP is
subjected to certain number of limitations that
makes institutions to transform from software
product to service model. The SaaP limitations
can be defined as:
• Healthcare Content Monetization: The
software product once produced limits the
option of content monetization by consid-
erable intensity for the healthcare industry.
Content monetization forms major chunk
of revenue generation for the healthcare
industry.
• Not Real-Time Based: The software prod-
uct is developed and delivered in form of
CD/ DVD to the doctors and patients with
delay of a few days or months depending
on the destination of the recipient. The
long delay is delivery may lead to lost in
interest of users.
158

• Lack Interactivity: The software product
design is more over static in nature. The
patients are unable to interact with doctors
and other experts in real manner. The syn-
chronous and engaging form of learning
cannot be implemented through the prod-
uct model.
• No Tracking and Monitoring: Tracking
and monitoring user behavior is a critical
factor in promotion of the product to the
healthcare industry. The software product
is not dynamic or real-time based, there-
fore no user tracking, monitoring and pro-
filing is possible.
• Content Distribution: The product has
inconvenience of content dissemination
across dispersed geographic locations. The
content generated through software prod-
uct (CD/ DVD) has limited scope of con-
tent monetizable.
The institutions cannot confine to SaaP
due to its limiting features. The industry seeks
to harness the power of web and leverage it
into educational processes to achieve effective
results. SaaS has following list of merits in
comparison to product design:
• Creates a new segment of online learners.
• Extends lecture life and reach.
• Monitors and tracks learner’ attendance
and participation.
• More number of content monetization of-
fers for live feeds.
The downloadable approach is favorable
in case for the end-user who expects to save
the content and replay it whenever required.
In case the author is not interested to allow
end-users to be able to save and freely distrib-
ute the content, the downloadable approach
will not solve the problem In comparison to

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
Table 1. Comparison SaaP and SaaS
Parameters Software as a Product (SaaP)
Content Dissemination Installed on a machine
Production Long development cycle.
Delivery Time Days to months depending to prepare
content CD/ DVD
Feedback from User Long cycle
Software Update Time consuming
Software Cost Buy the product
Content Monetization Limited scope
Profit Generation By selling of CD/ DVD
Compiled by Author.
traditional download, progressive download,
called pseudo-streaming, allows playback to
begin before the file is completely downloaded
from the server. Downloading using pseudo-
streaming technique allows playback of con-
tent that has been received to continue, while
the remainder continues to get downloaded.
This allows end-user to view the beginning
of the file in chunks and the remainder gets
downloaded.
Like streaming, pseudo-streaming down-
load does allow receiver to access the content
immediately as it gets downloaded. If the Inter-
net connectivity has interruptions, causing the
download to slow down, the audio and video
playback may not always stay synchronized.
The download speed needs to be maintained
at the proper rate to achieve proper playback.
Streaming allows on-demand and live trans-
mission of the content over the Web in real
time. It enables users to access the content
anywhere in the world and experience live
events as they happen.
Standard Web servers are used for tra-
ditional downloadable media files, and for
progressive download are dependent on the
Software as a Service (SaaS)
Hosted on a Streaming Server
Short development cycle
Instant delivery in form of live or on-
demand Webcast via Internet
Online
Frequent
License/ Subscription
Convenient on Internet
Continuous scope by selling in form of
online service
Internet bandwidth. Streaming facilitates the
continuous playback of synchronized audio
and video in real time and streaming media
files are encoded and optimized for different
data transfer rates. The streaming media serv-
ers intelligently deliver the appropriate version
of content package, either as selected by the
end-user manually or as default indicated by
the web browser. The specialized streaming
media server provides more efficient use of
the network bandwidth. The audio and video
quality to the user is delivered in improved
format using streaming severs. These special
servers have support for large numbers of users
with multiple delivery options. Advantages of
streaming include:
• No waiting for complete downloads to
happen.
• Streamed files cannot be copied to the disk.
They are processed, played and received,
leaving no residual copy of the content on
the receiving machine thereby alleviating
copyright concerns.
• Streaming helps distribution of live events
across the globe in real time.
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Cutting-Edge Technology Adoption for Building Holistic Patient Experience
• Streamed files supported interactivity, al-
lowing content to be packaged into mini
sessions that spans for duration of few
minutes. Video-on-demand, for example,
can be indexed, allowing users to jump to
desired portions.
In addition to this as an application, web-
cast, provide the benefits of:
• It is convenient to use. Participants don’t
need anything more than a web browser
and media viewer.
• The event can be hosted live or archived
available via web browsers.
• It’s cost-effective, where content can be
stored and re-used.
• The live lecture can be used to deliver a
message, announcement in real time with-
out any delay.
• No limits to the running of online lecture.
It just needs to be uploaded on the server
and can run as long as necessary.
• The revenue generation cycle is more
streamlined. Charging viewers to watch
the digital content online can provide easy
methods of generating revenue. The tech-
nology has geared up web to accept credit
card payments of ‘pay as you view’ in a
user friendly way.
• The system provides robust security; us-
ing registration or password mechanisms.
The content authors can restrict content to
known users.
Delivery Challenges
The webcast delivery challenges in a health-
care chain can be described in following way:
• Upstream Bandwidth: The streaming in
healthcare is not limited to transfer text
160

or graphics but heavy audio, video and
other multimedia files. The live webcast is
delivered with negligible time lag for the
packet of data to arrive on time and in ac-
ceptable condition. The streaming technol-
ogy is bandwidth dependent. The hosting
of digital content on the streaming server
requires ample upstream bandwidth to up-
load heavy files. Having an upstream high
bandwidth connection is costly in compari-
son to high downstream bandwidth.
• Downstream Bandwidth: The download
of digital content from the streaming serv-
er requires a high downstream bandwidth
connection. A file transferred over low
bandwidth connection will take long to
download. The other factors such as server
load, network congestion, etc. are points of
consideration during data transfer. A user
with a low bandwidth connection will ex-
perience choppy playback and delays.
Virtual Learning Environment (VLE)
Virtual learning Environment (VLE) is
contemporary e-learning education system
enabling learning to happen online. Second
Life (SL) a VLE enables doctor and patient
to interact in the social space. The practice
of using three-dimensional virtual learning
environments, such as Second Life, within
tertiary education is becoming popular (In-
man, Wright & Hartman, 2010). While the
use of Second Life for educational purposes
is associated with numerous advantages of in-
creased student engagement (Baker, Wentz &
Woods, 2009) and flexibility (Hansen, 2008),
it is necessary to acknowledge the multiple
issues that may be encountered while using
such technologies (Warburton, 2009).
SL learning and engaging environment al-
lows doctor and patients to create avatar that

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
enters into the virtual hospital for obtaining
treatment. It is an online virtual environment
that therapists and patients can probably utilize
to meet remotely for therapy sessions. Figure
3 illustrates Health Wellness Island on SL
provides information regarding health and
wellness support services. The island is an
attraction to the users interested to get infor-
mation about diseases, surgical procedures,
drug interaction and its effects.
VLE is cost-effective way to connect and
educate patients regarding habits of over-
weight, smoking, staying fit or managing
stress. The existing techniques for patient
education are expensive and not effective.
Patients as avatars can attend seminars and
vote in real time about their preferences. The
seminars can impart information including
how much fiber or nutrients a patient may
need to eat in a day. Cigna Healthcare has
created a virtual environment in SL to educate
community on how to improve their health.
Like many insurance companies, Cigna of-
fers healthcare advice to those it insures as
Figure 3. Health Wellness Island in Second Life
Source: www.secondlife.com.
an attempt to keep its long-term costs lower
and its insurance rates more affordable. The
Cigna Virtual Healthcare Community is an
“island” in SL where users can walk through
3-D interactive displays with their avatars,
play educational games, listen to seminars on
nutrition and health, and receive virtual health
consultations (Takahashi, 2008). There are
several projects in SL in the language learning
domain, involving the creation of environ-
ments where learners can practice languages
and meet other foreign language speakers.
The other prime occupants on SL VLE to
impart patient care includes: Mayo clinic in
SL initiates conferences, regular talk and other
event in the virtual space. American Cancer
Society provides opportunity to survivors and
caregivers to unite and share their experiences.
With increase in the number of poultry owned
by individuals, it’s increasingly essential to
spread awareness regarding bio-security mea-
sures that prevents transmission of diseases
like influenza. Eden Island on SL provides
an experiential learning environment avail-
161

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
able for community to prevent such diseases.
Biomedicine Research Lab, a health research
lab supports e-learning projects in the domain
of biology, genetic and medicine. The Point of
Care Centre (POC-CERT) designs programs
to improve health of acute neurologic patients.
In addition to offering educative and learn-
ing program to patients, SL virtual space is
adobe for hospitals, universities and other
healthcare associations. College of Medicine,
University of South Florida showcases differ-
ent nursing and public health departments.
The futuristic hospital created by Imperial
College London is used by patients to learn
about healthcare facilities. The huge animated
models of male reproductive system, explain-
ing male testis is offered by Testis virtual tour
on SL. The medical examiner office is also
located on SL that shows educational lectures
on autopsy procedures. The immersive 3D
VLE benefit includes:
• Engaging learning platform available
round the clock,
• Connect and collaborate with other online
communities,
• Self-paced learning to ease all learning
styles, and
• Global access to receive expert advice.
Delivery Challenges
Here are the following delivery challenges
to be handled for users using SL platform
for learning:
• Bandwidth: SL platform requires persis-
tent fast Internet speed. The server begins
to lag and eventually become un-respon-
sive if a user tries to access SL with low
internet speed connection.
162

• Devise Portability: The heavy multimedia
files need to be optimized to a major ex-
tent for the delivery on portable and other
hand-held devises. For an efficient health-
care eco-system, it becomes extremely
necessary to develop framework that is en-
abled with cellular access.
• User Adoption: The healthcare profes-
sionals are to be trained to effectively han-
dle and use the technology. There is con-
stant need to rapidly train the healthcare
staff with new technologies. The major
barrier can be changing the mind set and
learning culture.
Health Cloud
There is a steep rise in the demand on me-
dicinal services, while there is scarcity of
qualified healthcare professionals such as
doctors, nurses and pharmacists form one
of the difficult issues confronting healthcare
providers. Health cloud is an integrated health
records management solution available over
the Internet. It has potential to improve the
quality of healthcare delivery by proving ac-
cess to doctor and patients. The doctors will
be able to maintain comprehensive database
of patient’s medical history and take critical
decisions. Health cloud enables patients to
search for doctors online, for a specialization
and book appointment online with the doctor.
The electronic sharing of health informa-
tion among medicine experts is specifically
important during progression in patient care,
when liability for a patient’s care is passed
on from one provider to another. This situa-
tion may arise when a patient is discharged
from the hospital after the treatment or when
a primary care clinician refers a patient to a
specialist for a specific disease condition.

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
When the physician receives relevant and
timely information about a patient, the treat-
ment is better equipped to provide adequate
attention and care. The practice management
software connects doctor and patients effec-
tively. Healthcare records are captured and
managed in a standardized fashion. There
is rigorous exchange of healthcare records
for gaining expert opinion. The patients can
book appointment online and can get expert
advised on telephone call. Refer Table 2 for
list of health cloud providers.
Health provides benefit to patients and
doctors in many ways including:
• Create awareness among patients,
• Time saving,
• Useful information of doctors and hospi-
tals schedule,
• Minimize the cost of medicine and
treatment,
• Optimum utilization hospital resources,
• Access anytime, from any location.
Delivery Challenges
The healthcare cloud delivery challenge
includes:
• Technology Infrastructure: The health
cloud requires dedicated internet connec-
tion to access medical data anytime across
Table 2. Health cloud providers
No. Healthcare Provider
1 Care Cloud
2 Practo Technologies
3 Helping Doc
4 DocSuggest
5 MocDoc
6 ZocDoc
Compiled by Author.
the globe. There should be minimal hard-
ware, software or network faults for smooth
access of data.
• Security: The health cloud provides ser-
vice to different healthcare providers. The
data is saved in a virtualized pool in an
open environment requiring high security
data access. The patient records should be
protected from accidental lost or unauthor-
ized access.
CONCLUSION
Emerging technologies provide ample oppor-
tunities for doctors and patients to engage in
exciting and innovative learning experiences.
Web 2.0 interventions ensure that technology
enhances patient learning experience in addi-
tion to face to face direct interaction with the
doctor. Embracing e-learning 2.0 techniques
contributing towards educating patients will
transform the way healthcare profession-
als connect and collaborate with patients.
Webcasting, Virtual Learning Environment
(VLE), cloud based systems are cutting edge
approaches used to provide holistic healing
and wellness experience to the patients. Use
of the technologies energizes preventive
care and medical treatment for the patients
and builds up an effective platform enabling
sharing of best practices among doctors.
Website
www.carecloud.com
www.practo.com
www.helpingdoc.com
www.docsuggest.com
www.mocdoc.in
www.zocdoc.com
163

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
Increasing access to computers and portable
devises requires reliable and high speed IT
infrastructure that doctors and patients can
access in the city and remote areas of the
world for real time communication. With
technology devises becoming affordable and
as government work collaboratively to address
IT infrastructure issues, adoption of such
technologies become more prominent. The
future research direction will be on building
an effective knowledge sharing platform for
healthcare professionals, as well as measuring
how technology can be extensively used for
training and learning purpose.
REFERENCES
Ashmalla, M., Mohamed, A. A., & Globashy,
M. E. (2001). E-training: A future substitute
for C-training? Global Competitiveness, 9.
Retrieved from Gale articles.
Baker, S. C., Wentz, R. K., & Woods, M.
M. (2009). Using virtual worlds in educa-
tion: Second Life as an educational tool.
Teaching of Psychology, 36(1), 59–64.
doi:10.1080/00986280802529079
Bell, S. (2003). Cyber-guest lecturers: Using
webcasts as a teaching tool. TechTrends, 47(4),
10–14. doi:10.1007/BF02763506
Conradi, E., Kavia, S., Burden, D., Rice,
A., Woodham, L., & Beaumont, C.
et  al. (2009). Virtual patients in a vir-
tual world: Training paramedic students
for practice. Medical Teacher, 31(8),
713–720. doi:10.1080/01421590903134160
PMID:19811207
Dale, C., & Pymm, J. (2009). Podagogy:
The iPod as a learning technology. Active
Learning in Higher Education, 10(1), 84–96.
doi:10.1177/1469787408100197
164

DiMaria-Ghalili, R., Ostrow, L., & Rodney,
K. (2005). Webcasting: A new instructional
technology in distance graduate nursing edu-
cation. The Journal of Nursing Education,
44(1), 11–18. PMID:15673169
Downes, S. (2005). E-learning 2.0. eLearn
Magazine. Retrieved from http://www.el-
earnmag.org/subpage.cfm?section=articles
&article=29-1
Evans, C. (2008). The effectiveness of m-
learning in the form of podcast revision
lectures in higher education. Computers &
Education, 50(2), 491–498. doi:10.1016/j.
compedu.2007.09.016
Gartner. (2006). Gartner says 25 percent of
new business software will be delivered as
software as a service by 2011. Gartner News-
room. Retrieved from http://www.gartner.
com/it/page.jsp?id=496886
Giannakos, M. N., Chorianopoulos, K.,
Johns, P., Inkpen, K., & Du, H. (2011). Chil-
dren’s interactions in an asynchronous video
mediated communication environment. In
Proceedings of the 13th IFIP TC 13 Inter-
national Conference on Human-Computer
Interaction (vol. 1, pp. 199-206). Academic
Press. doi:10.1007/978-3-642-23774-4_18
Giannakos, M. N., & Vlamos, P. (2012).
Educational webcasts’ acceptance: Empiri-
cal examination and the role of experience.
British Journal of Educational Technology.
doi:10.1111/j.1467-8535.2011.01279.x
Gorman, P. J., Meier, A. H., Rawn, C., &
Krummel, T. M. (2000). The future of medi-
cal education is no longer blood and guts, it
is bits and bytes. American Journal of Sur-
gery, 180(5), 353–356. doi:10.1016/S0002-
9610(00)00514-6 PMID:11137686

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
Greiner, A. C., & Knebel, E. (Eds.). (2003).
Health professions education: A bridge to
quality. Washington, DC: National Academy
Press.
Hansen, M. M. (2008). Versatile, immersive,
creative and dynamic virtual 3-D healthcare
learning environments: A review of the
literature. Journal of Medical Internet Re-
search, 10(3), e26. doi:10.2196/jmir.1051
PMID:18762473
Harun, M. H. (2001). Integrating e-learning
into the workplace. The Internet and Higher
Education, 4(3-4), 301–310. doi:10.1016/
S1096-7516(01)00073-2
Hersh, W. R., Bhupatiraju, R. T., Greene, P. S.,
Smother, V., & Cohen, C. (2006). Adopting
e-learning standards in health care: Competen-
cy-based learning in the medical informatics
domain. In Proceedings of American Medical
Informatics Association Annual Symposium
(pp. 334-338). AMIA.
Inman, C., Wright, V. H., & Hartman, J. A.
(2010). Use of Second Life in K-12 and higher
education: A review of research. Journal of
Interactive Online Learning, 9, 44–63.
Kurtz, B. L., Fenwick, J. B., & Ellsworth,
C. C. (2007). Using podcasts and tablet
PCs in computer science. In Proceedings
of the 45th Annual ACM Southeast Re-
gional Conference (pp. 484-489). ACM.
doi:10.1145/1233341.1233428
Liu, Q., Rui, Y., Gupta, A., & Cadiz, J. J.
(2001). Automating camera management for
lecture room environments. Retrieved from
http://research.microsoft.com/en-us/um/
people/yongrui/ps/chi01b.pdf
Lin, C. A. (2004). Webcasting adoption:
Technology fluidity, user innovativeness,
and media. Journal of Broadcasting & Elec-
tronic Media, 48(3), 157–178. doi:10.1207/
s15506878jobem4803_6
Maag, M. (2006). IPod, uPod? An emerging
mobile learning tool in nursing education and
students’ satisfaction. In Proceedings of the
23rd Annual Conference of the Australian
Society for Computers in Learning in Tertiary
Education. Academic Press. Retrieved from
http://www.ascilite.org.au/conferences/syd-
ney06/proceeding/pdf_papers/p92.pdf
Mantovani, F. (2001). VR learning: Potential
and challenges for the use of 3D environments
in education and training. In G. Riva & C.
Galimberti (Eds.), Towards CyberPsychology:
Mind, cognition and society in the internet
age (Vol. 2, pp. 207–225). Amsterdam, The
Netherlands: IOS Press.
Mishra, P., & Khan, M. L. (2009). Webcast-
ing. In E-learning (pp. 84–87). New Delhi,
India: IGNOU.
Rosenberg, M. (2001). E-learning: Strategies
for delivering knowledge in the digital age.
New York, NY: McGraw-Hill.
Schneider, K. G. (2001). Lights! Cameras!
Action! American Libraries, 32(7), 94.
Takahashi, D. (2008). Cigna deploys a Sec-
ond Life island for health education. Venture
Beat. Retrieved from http://venturebeat.
com/2008/07/01/cigna-deploys-a-second-
life-island-for-health-education/
Tavangarian, D., Leypold, M., Nölting K. &
Röser, M. (2004). Is e-learning the solution
for individual learning? Electronic Journal
of e-Learning, 2(2), 273–280.
165

Cutting-Edge Technology Adoption for Building Holistic Patient Experience
Teng, Y. T., Bonk, C. J., & Kim, K. J. (2009).
The trend of blended learning in Taiwan:
Perceptions of HRD practitioners and impli-
cations for emerging competencies. Human
Resource Development International, 12(1),
69–84. doi:10.1080/13678860802638842
Warburton, S. (2009). Second Life in higher
education: Assessing the potential for and
the barriers to deploying virtual worlds in
learning and teaching. British Journal of
Educational Technology, 40(3), 414–426.
doi:10.1111/j.1467-8535.2009.00952.x
Wentling, T., Waight, C., Gallaher, J., La
Fleur, J., Wang, C., & Kanfer, A. (2000).
E-learning: A review of literature 2000. Re-
trieved from http://learning.ncsa.uiuc.edu/
papers/elearnlit.pdf_
Wired. (2010). The web is dead: Long live the
internet. Retrieved from http://www.wired.
com/magazine/2010/08/ff_webrip/all/1
KEY TERMS AND DEFINITIONS
E-Learning 2.0: Form of collaborative
learning using Information and Commu-
nication Technology (ICT) and Web2.0 in
education. Enabling users to create search
and collaborate in the learning process. The
learning happen using online communities,
social media, engaging video, interactive fo-
rums and virtual world. The conventional form
of e-learning is supplemented with power of
Web 2.0 to impart learning on laptop, mobile,
iPod and other portable devises.
166

Health Cloud: ‘Cloud’ is a metaphor used
for Internet. It refers to health services that
are accessed through Internet called ‘health
cloud.’ The healthcare data including: patient
records, reports, doctor comments, medicine
etc. is hosted on the internet cloud. The health
cloud enables patients and doctors to access
data via internet connection with no pre-
requisites software requirement or machine
specifications.
Virtual Learning Environment: An
online immersive 3D learning platform. It
enables communication and collaboration
among users via e-mail, chat, wiki and blog.
Content management and learner engage-
ment reflects structured learning component
in VLE.
Web 2.0: World Wide Web version 2.0
enable users to collaborate interact and create
content through a virtual community. Irrespec-
tive of conventional passive websites that
are limited to display passive content. With
emergence of Web 2.0, internet has become
participation platform leading to rich user ex-
perience, participation and dynamic content.
Webcast: It is the technique of distribution
of content over Internet using streaming media
technology simultaneously to multiple users
online live or on demand. The audio or video
is transmitted over the internet to multiple
users who will receive the same content. The
streaming technology enables transmission of
multimedia to the computer without saving the
file on disk enabling user to view the content
of the file without downloading.
 167

Chapter 11
Curing Autoimmune Naturally:
My PMR Story

Donna J. Karaba
Karaba Consulting, USA

ABSTRACT
In September 2010, Donna, an active 49-year-old woman, experienced an autoimmune attack. After
eight months of intense pain, she underwent a 10-day supervised fast at True North Health Center in
Santa Rosa, CA. Her inflammation was eliminated and she has regained an optimal level of health and
an active lifestyle including tennis, hiking, yoga, biking, and swimming. Donna also continues to prac-
tice and teach meditation. This chapter is intended to relay a case example of how one woman cured
her symptoms of Polymyalgia Rheumatica (PMR) in the hopes of reducing unnecessary suffering and
financial drain in the lives of others.

INTRODUCTION Standing in the shower, I allowed the water

It was 2:30am. I woke up in agonizing pain.
This had become my nightly routine. The pain
in my shoulders was so intense I could not lie
in bed any longer. My shoulders burned all
the way to the bone, starting at the tops of
each shoulder and moving down the sides of
my upper arms. On a scale of one to ten, with
ten being “unbearable,” my pain intensity was
certainly a level ten. I needed comfort, or at
least, distraction from the excruciating pain.
The only place I could find relief was in
the shower. The hot water helped to displace
the pain and brought some peace temporarily.
to distract my mind away from the constant
pain, until I was relaxed enough to go back
to bed. Slowly, with great effort, I would
dry off with my towel. It was a challenge to
actually reach the heavy wet towel onto the
hook where it hung to dry. My arms looked
like someone else’s, emaciated, like a very
unhealthy old woman as they barely reached
the towel hook. My shoulders were practi-
cally useless. This constant burning sensation
caused me the most discomfort between two
and three in the morning and persisted for
eight months from September 2010 to April
2011. My husband had to help me get dressed.

DOI: 10.4018/978-1-4666-7524-7.ch011

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

I felt helpless, vulnerable, and very frustrated.
Toward the end of April, through constant
searching desperate for answers, I found and
experienced a cure.
This pain had persisted for months. Some-
thing was happening to my body that seemed
outside of my control. I was scared because
I did not know how to cure myself, or even
if a cure was possible. The “experts” I saw
did not know of a cure either. Was I going
to have to endure this pain for the rest of my
life? Through my story, I wish to provide you
with hope and guidance to cure your own
symptoms of autoimmune disease and benefit
all who suffer from inflammatory disorders
in the body. If you suffer from PMR you may
relate to this story as I share the symptoms
and how I cured my body from this particular
disease. I share resources that I found helpful
in my quest for information and answers to
this mysterious illness. (See list of resources
on the references page.)
An Epidemic?
It is estimated that half of the U.S. population,
150 million people in the U.S. alone, suffer
from arthritis and other rheumatic diseases.
This includes autoimmune inflammatory
disorders like PMR. An article in the January
2008 issue of Arthritis & Rheumatism, refer-
enced the results of the study including the
estimates per disorder (www.rheumatology.
org/Research/Prevalence_Statistics/):
• Rheumatoid Arthritis: 1.3 million U.S.
adults;
• Juvenile Arthritis: 294,000 people in the
U.S.;
• Spondylarthritides: 0.6 to 2.4 million
U.S. adults over 15;
168

Curing Autoimmune Naturally
• Systemic Lupus Erythematosus: 161,000
to 322,000 U.S. adults [1.5M in the U.S.
and 5M worldwide estimated by the Lupus
Foundation of America (Lupus, 2014)];
• Systemic Sclerosis: 49,000 U.S. adults;
• Sjögren’s Syndrome: 0.4 to 3.1 million
adults;
• Clinical Osteoarthritis: 27 million U.S.
people age 25 and older;
• Polymyalgia Rheumatic: 711,000 people
in the U.S.;
• Giant Cell Arteritis: 228,000 people in
the U.S.;
• Gout: Eight million people in the U.S.;
• Fibromyalgia: Five million people in the
U.S.;
• Carpal Tunnel Syndrome: Four to 10
million people in the U.S.;
• Low Back Pain: 59 million within the
three months prior to the study;
• Neck Pain: 30.1 million within the three
months prior to the study.
AUTOIMMUNE ATTACK
The onset of my symptoms was sudden,
overnight. One morning, I got out of bed to
get ready for work and realized I could barely
walk. I was stricken with disability without
any warning it seemed. My back and hips
were sore causing me to walk with unusual
effort from my bed to my bathroom. Three
days previous I had won a women’s doubles
tournament in tennis against girls 30 years
younger than me. “I’m 49. I’m not that old.
What is going on?” I wondered. “Did I pull a
muscle in my back during the tournament?”
As the days progressed, my physical pain
worsened and began to rotate throughout my
body, up my back, stiffening my neck, burning

Curing Autoimmune Naturally
my shoulders, inflaming my hips, knees, and
jaw. I searched for expert help and answers.
I wanted to know what it was and how to
eliminate the pain.
I saw a multitude of health practitioners
from allopathic to naturopathic to Chinese
medicine. What I found was that in all of my
searching for help from doctors, the answer had
been in Dr. Airola’s book, There is a Cure for
Arthritis (Airola, 1968), a book that he wrote
almost 50 years ago which demonstrated to
me that a cure has been available for a long
time. This naturopathic doctor had studied
clinics all over Europe that were curing people
afflicted with arthritis. Fasting, Airola said, is
the fastest way to heal. If only I trusted my own
instincts after reading his passionate book, I
could have saved myself seven months of pain
and a small fortune. But it is ingrained in our
culture and minds that we must see a doctor to
tell us what to do. As a result we often ignore
our own common sense.
Do your own research; trust yourself,
because you know your body best. You must
put your health in your own hands and put
yourself and your health as your number
one priority. There is no reason you have to
suffer. It is a waste of time dealing with the
pain and debilitation of an illness that is cur-
able. Instead, you can do something about
it. However, you may be required to find the
answers yourself.
I share my pursuit for a cure in order to
help save you time, needless suffering and
expense. I roughly calculated my search for
a cure and healing process totaling more than
16 thousand dollars. Perhaps you will see
overlaps in your own quest for answers to
eliminate your pain.
Potential Factors Leading
to Autoimmune Attack
It is unknown what exactly triggers PMR. I
have read that it could be caused by infection,
physical injury, emotional stress, even metals
in the blood. Yet the mystery remains as to the
actual cause for me. Looking back, all these
factors were present in my case. I had a bladder
infection that was not treated right away due
to a pharmacy mishap. Interstitial Cystitis was
mentioned as a possibility by my gynecolo-
gist. I had a chronic sports injury, a slight tear
in my rotator cuff in my right shoulder from
tennis that had bothered me daily for a year.
I experienced emotional stress from losing a
friendship (primary stress) and economical
concerns and shifts in my business (secondary
stress). I also looked into amalgam risks and
having them all removed and replaced with
white fillings because the risk of mercury
entering the blood stream over the last thirty
years is a health risk. Dr. Airola (1968) speaks
to the cause being a “metabolic disorder” due
to environmental factors. I outline several fac-
tors I experienced including: physical injury,
infection, poor digestion and elimination, and
emotional and physical stress. It is difficult
to pinpoint one factor, and it is important to
address them all.
Airola explains,
… the empirical and practical experience of
biological therapies and their positive results
show that arthritis [an autoimmune disorder]
is caused by a metabolic disorder in the body.
The distorted or disordered metabolism, in
turn, is affected by health-destroying envi-
ronmental factors, including faulty nutrition,
overeating, emotional and physical stresses,
sedentary life, etc.
169

The prevalent observation of practitioners
is that the arthritic patient usually suffers
from general deterioration of health in the
form of sluggishness in the vital functions
of his organs; incomplete digestion and as-
similation of foods; impaired elimination of
metabolic wastes and toxins from the system;
a weakened nervous system and circulation;
etc. These systemic disturbances affect the
biochemical structure of the various tissues
of the body….[resulting in] a ‘biochemical
suffocation.’ (p. 30)
Physical Injury
Patients afflicted with arthritis are usually in
a condition of exhaustion and chronic fatigue.
Studies also reveal that most persons with
arthritis have been under severe stress for
prolonged periods before onset of the disease.
(Airola, 1968, p. 173)
I had been seeing a chiropractor for months
during the spring and summer of 2010 after
having stopped playing tennis due to both a
shoulder injury and “tennis elbow” that I had
experienced in the fall of 2009. Every morning
for the entire year I woke up with shoulder
pain. Not severe, just uncomfortable.
Infection
I had a bladder infection that came on shortly
after the tennis tournament and bothered me
slightly as I left on a business trip to Arizona.
When I returned home, I picked up the medica-
tion, or so I thought. I found out a month and a
half later when I went to pick up a prescription
for prednisone prescribed by my internist, that
I had only picked up the pain medication and
was not given the antibiotic. The antibiotic
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was still at the pharmacy. The clerk handed
me my prescription for the prednisone and
said, “Here you go, you forgot to pick this
up.” “I forgot? Why wasn’t it in the same bag,
or at least attached previously?” I thought.
The antibiotic meant to eliminate bacteria in
my bladder was still at the pharmacy when
I picked up the prescription for prednisone.
Therefore, the lingering infection may have
been a cause of the autoimmune attack.
Sedentary Lifestyle and
Chronic Constipation
Airola addresses the question of the role of
constipation in relation to arthritis [autoim-
mune disease], “Constipation is one of the
most common ailments of civilized man. It
does not exist among primitive people. It is
a result of sedentary life in combination with
denatured, refined, and devitalized foods –
conditions for which our body was not made.
It is a common observation that many
people afflicted with arthritis have a long
record of chronic constipation preceding the
onset of the disease.” (Airola, 1968, p. 169)
Emotional Distress
The breakup of a long term friendship se-
verely affected my emotions and thoughts.
Someone I admired and cared about for
many years stopped talking to me and did
not return my phone calls for months. I
trusted this friend as much as I trusted my
own family. I sensed a cold shoulder previ-
ously, but wasn’t sure what was going on,
or whether I was taking her behavior too
personally. Instead, I thought perhaps my
phone messages weren’t being passed along
to my friend until she finally called back

Curing Autoimmune Naturally
to schedule a meeting. Hearing her tone
of voice, I felt an emotional charge in my
gut. I quickly disregarded my gut reaction
not wanting to assume anything. I thought
that perhaps she wanted to meet to discuss
something that was happening in her life.
When we met, I was hit with a bombshell of
accusations derived from inaccurate hear-
say. It was a personal attack just what my
gut had tried to warn. I was not expecting
such an angry transformation in my friend’s
face. Her expression was scary and I took
the attack to heart. I was very hurt by all the
accusations. I wondered why, after all these
years, she could not give me the benefit of
the doubt and ask for my side of the story.
Instead, the verdict was in, the gavel had
come down with a bang. I felt that I was
being judged harshly and unfairly by some-
one I loved and someone whom I thought
loved me. I was very hurt and shocked. My
honesty was in question and honesty is what
I value most in relationships. This was a
character attack and caused me to question
my identity. I had given her opinion of me
too much power.
To make matters worse, when I tried to
patch things up the verbal abuse continued.
With the last insult, I could not listen any-
more. I stopped and turned toward my friend
to share my own reflections so she might see
her part in the matter. She turned and walked
away. I wondered aloud, “Why would you
push someone away that loves you?” I was
so hurt and angry over what had been said I
responded with some angry words. I felt bad
about my honest expression of thoughts and
feelings in rebuttal and my inability to hold
them in check. I had lost my cool. I wrote
apology notes, doing my best to forgive us
both (which actually took years), and read
a book on anger to try to understand what
had happened to me in that moment. How
did I let someone else’s emotional reaction
and words affect me so deeply and why did
I react so strongly? I agonized over the event
and loss of the friendship for a long time.
I had not considered my emotional
trauma to be a cause of the autoimmune
disease until others involved in my search
commented about emotions as a potential
factor. The onset of the autoimmune attack
occurred about the same time I started seeing
a therapist to explore my anger issues. In
September, a couple of sessions into starting
therapy I discovered deep feelings of grief
with actual pain in my heart that caused
me at one moment to stand up after being
seated in my counselor’s office simply to
catch my breath. The feeling I had during a
guided meditation was impacting my abil-
ity to breathe deeply. It felt as though the
weight of a crushing ball was on my chest.
“Was it grief and feelings of abandonment
that weighed so heavy, coexisting deep in
my heart?” I wondered. My parents’ death
when I was 21 years old was not only shock-
ing, pulling the rug out from under me, it
caused me to soul search deeply. I asked
myself big life questions. “Why did this
happen? What was the purpose and mean-
ing of my life?” I wondered. One counselor
noted the possibility of post-traumatic stress
by connecting the traumatic events in my
life at ages 20 and 21, which I had never
connected myself. Is it possible I had bur-
ied hurt, anger and grief at a younger age
that began bubbling to the surface in my
late forties? Or perhaps it was simply my
changing hormones with pre-menopause
that led to surprising outbursts of anger.
Therapists helped me feel the tremendous
171

pain in my heart, the loss and longing for
the unconditional love and mutual admira-
tion I shared with my parents that were cut
off abruptly, and the importance of taking
care of my inner child. Was it a coincidence
that my attack happened at the same age as
my parents’ death?
Physical Stress
During that summer and early September,
2010 I was often dehydrated and exhausted.
My oldest son was off to college, my younger
son was busy with high school, and my
husband began a full time job outside the
home. It was a big change for me not hav-
ing anyone at home while I worked and not
really interacting with family much. As my
role of mother was shifting and I didn’t feel
as needed, I began questioning, “Who am I
now?” It was too quiet at home, so I began
to explore my interests in yoga and fitness.
I started doing Bikram yoga by joining a
studio in town. The room temperature is
purposely set at 105 degrees. The class was
intense for 90 minutes, in which the body
sweats profusely through a set series of yoga
postures. It is a highly meditative movement
experience. You must replenish your body
with a large amount of water, and minerals,
daily. I also did strength conditioning includ-
ing Crossfit - also an intense workout. Then
I signed up for a tennis tournament with long
back-to-back matches. At the same time, I
was flying back and forth on client visits
from California to Arizona about twice a
month. It was difficult to keep up with the
necessary water intake with all this activity.
With a downturn in the economy, I pushed
harder to exceed client expectations while
building new relationships. On one client
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Curing Autoimmune Naturally
visit, I was so physically exhausted, I was
passing the hotel on the way to the airport
noticing a strong desire to pull into the hotel
parking lot, check back into my room and
take a nap. My higher priority was to be with
my family as much as possible and not delay.
I decided to ignore my body’s yearning for
rest and pushed on. Crawling into bed well
after midnight was becoming routine. I was
burning the candle at both ends ignoring
signals from my body to slow down.
Amalgam Fillings: Mercury Toxicity
The vapors from mercury fillings have been
linked to autoimmune disease.
In 2008, Scandinavian countries took action
and banned the use of amalgam fillings for
environmental and health reasons…
Mercury is a powerful neurotoxin and, at
certain levels, can cause neurological is-
sues, autoimmune disease, chronic illnesses
and mental disorders. The burning question
is whether an unknown quantity of mercury
vapor in our silver fillings at a constant ex-
posure poses a significant health risk…
Amalgams consist of 50% mercury along with
a combination of silver, tin, and copper. Stud-
ies have found that the amount of mercury
vapor from amalgams varies from 1- 3 µg/
day (micrograms/day), at the low estimation,
up to 27 µg/day…
What this means is that at the high level –
and with continuous exposure – we could be
at levels that OSHA says are unhealthy. The
World Health Organization (WHO) has stated
that the exposure to mercury vapor can greatly
increase beyond this number due to personal

Curing Autoimmune Naturally
habits such as grinding of the teeth, chewing
gum, and drinking carbonated drinks. This
could lead to a fivefold increase in mercury
levels after these activities. (Toxic Teeth, www.
doctoroz.com)
SEARCH FOR A CURE
As I sought help, I tried many types of healers
and doctors including chiropractic, allopathic,
physical therapy, massage therapy, emotional
therapy, naturopathic, Chinese medicine, cra-
niosacral therapy and finally a fasting clinic.
Chiropractor (March
2010 – August 2010)
A friend recommended I see her chiropractor
who worked with athletes. It seemed like an ap-
propriate referral since I had an athletic injury
both in my shoulder and elbow from tennis.
The sessions were painful as he dug his fingers
into my rotator cuff area attempting to loosen
up the muscle tissue and repair the problem.
He also adjusted my spine, specifically lower
back and neck and used a machine that shot
electrical impulses through wires strapped to
my right arm for the “tennis elbow.” When my
pain started travelling around my body, hips,
buttocks, and hamstrings I asked my doctor
what was going on. He was mystified and had
no answers. I felt frustrated not knowing what
was happening in my body.
This particular chiropractor had never
experienced my health issue and was unable
to advise me.
Surgeon (June 2010)
As my pain persisted, a fellow tennis player
suggested I see a shoulder surgeon who was
also a tennis player. “Perfect,” I thought, since
I was looking for definitive expert advice and
thought this would be helpful because he could
relate to shoulder injuries from tennis. The
doctor looked at my X-ray and listened to what
I had already been doing with chiropractic
work. He felt surgery was not required since
my issue did not appear severe and because I
was willing to take time off to heal. He wrote
me a prescription for six weeks of physical
therapy. I was relieved to hear that surgery
was not necessary.
Later as I was experiencing pain in my hips,
I went back to the surgeon for help and answers.
He said he specialized in shoulders, not hips,
and did not know what was going on in my
hips. He did suggest I see a rheumatologist.
Seeing the surgeon helped validate what
others said, and that was to take time off ten-
nis, with tennis being the cause of my injury,
in order to heal.
Physical Therapist (July
– August 2010)
The physical therapist helped me regain my
mobility after six weeks, so that I could get
back to tennis and yoga. Once my six weeks
of physical therapy ended, the therapist said
I could try some tennis. Let me underscore
the fact that he did not suggest I go out and
sign up for a tournament.
I went to the tennis club for some practice
to see how my shoulder would feel playing
tennis and chatted with the pro. He recruited
me to play with his friend who was look-
ing for a doubles partner for the upcoming
tournament. How could I say no? I was feel-
ing better and was excited to play again. I
planned to practice and gradually work up
to competitive play, but that didn’t happen. I
went on to play in six back-to-back matches
that weekend in both women’s doubles and
mixed doubles with my son. We won the 3.5
173

women’s doubles championship against girls
about 30 years younger than me (I was 49).
I thought my shoulder issue was over. I felt
great for about three days before my back and
hip trouble began.
The mistake I made was getting back in
the game too soon, playing competitively
and likely not replenishing my body during
the weekend with the water and nutrients it
required to keep up with that intense level of
activity.
Marriage and Family Therapist
(September 2010 – January 2011)
Short outbursts of anger began occurring out
of nowhere surprising me and others. In late
September 2010, I decided to see a therapist
to explore my anger to ensure I would under-
stand it and be able to be in complete control
of my emotional state. I purposely chose
this counselor because he was a meditator,
taught meditation and incorporated medita-
tion into his work. I didn’t see myself as an
angry person, yet I had experienced a few
angry outbursts with those closest to me and
a couple of times with people I was not close
to. A severe reaction to the misunderstanding
with my friend particularly bothered me. Her
verbal personal attack was shocking. I had
never experienced anything like it. The story
of this encounter, and the loss of my parents,
was discussed during therapy sessions.
Acupuncture (August,
2010 - April, 2011)
I visited four different acupuncturists for
my back and shoulder pain. When my pain
began travelling to my buttocks, hips, and
hamstrings, I asked my first acupuncturist
what might be going on. She looked at me
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quizzically with compassion as I explained
how the pain was shifting down my back and
legs. She had no answers.
I was referred by my massage therapist to
one particular acupuncturist who specialized
in dealing with chronic pain. In my first session
he relieved most of my rotator cuff pain. His
technique eventually was more painful than
I could take considering the level of pain I
was already experiencing. His style was quite
different than the others who placed needles
not far below the surface of the skin relatively
painlessly. This doctor believed it was best to
place the needles directly into the center of
the pain. This needle pressure he used went
deep into the nerve endings, similar to the
feeling you have from a dentist’s drill hitting
an exposed nerve in a decaying tooth. After
session seven I broke down in tears walking
out of his office building, got into my car, and
immediately started sobbing deeply as I drove
home. The pain I experienced on his table felt
like someone had nailed my neck to the table.
I shared my experience with a local herbalist
at the health food store who felt that I should
not purposely be causing more pain to my
body while attempting to heal. The herbalist
gave me a sample of Curcumin (Turmeric)
to help reduce my inflammation. As I began
taking these my inflammation and pain would
noticeably lessen. I decided to stop working
with the acupuncturist. When I suggested to
the doctor that I stop because I was not expe-
riencing any more progress, he said, “Maybe
your body just doesn’t have what it takes to
heal.” I didn’t believe him.
Later I saw a third generation Chinese
acupuncturist who took my pulse and made
some notes. When I asked what he had dis-
covered by checking my pulse, he said that I
had a cool wind running through me – well
that explained everything. Actually, I didn’t

Curing Autoimmune Naturally
understand his answer and later asked for clar-
ity, he wrote “fibromyalgia” on his business
card, somewhat reluctant to provide a West-
ern diagnosis. He suggested I see someone
more local because the drive for me to get to
his office was doing more harm than good.
I needed to “rest,” he said emphatically. His
office was hours from my home. At the time
I was not willing to accept that diagnosis, it
sounded worse than PMR, or arthritis. It did
seem close to the PMR diagnosis of which
I did not fully understand at the time. I still
thought I had arthritis.
The acupuncture helped some, but didn’t
provide a cure for my disease.
Internist (March 2011)
Someone recommended I see a doctor of inter-
nal medicine. When I went to my appointment
I couldn’t believe what I saw. The reception-
ist was morbidly obese and the people in
the waiting room looked like ghosts. It was
by far the unhealthiest doctor’s office I had
ever been in and it made me uncomfortable
to sit alongside the zombie-like patients. I
stayed. I was desperate for relief. He seemed
understanding, but offered no diagnosis, just a
prescription for prednisone and seemed confi-
dent that would reduce the inflammation and
pain. He didn’t spend much time explaining
anything except how to take the steroids and
follow the prescription.
This doctor provided a typical allopathic
treatment plan for PMR that did not work for
me because I was looking for a cure. A typi-
cal allopathic response is something like this
from onhealth.com (Shiel, 2014).
The treatment of polymyalgia rheumatica
is directed toward reducing inflammation.
While some patients with mild symptoms can
improve with nonsteroidal anti-inflammatory
drugs (NSAIDs) such as aspirin or ibupro-
fen (Motrin, Advil), most patients respond
best to low doses of cortisone medications
(steroid medications, such as prednisone
or prednisolone). Not infrequently, a single
day of cortisone medication eases many of
the symptoms! In fact, the rapid, gratifying
results with low dose cortisone medications
is characteristic of polymyalgia rheumatica.
The dose of prednisone is gradually reduced
while the doctor monitors the symptoms and
normalization of the blood ESR. Reactivation
of symptoms can require periodic adjustments
in the prednisone dosage. Most patients are
able to completely wean from prednisone
within several years. Some patients require
longer-term treatment. Occasionally, patients
have recurrence years after the symptoms have
resolved. The ideal prednisone dosing regimen
continues to be sought by researchers.
Rheumatologist (March 2011)
Continuing to feel desperate for expert opin-
ions, I made an appointment with the rheu-
matologist frustrated having found no cure
to my rotating bodily pain. I still thought I
had arthritis. This doctor checked my joints
for inflammation. He appeared and sounded
frustrated that I was not showing typical signs
of rheumatoid arthritis in my hands and feet
because that seemed to be what he thought I
had. He may have specialized in rheumatoid
arthritis. As I walked out of his office, I saw
a flyer on his counter about rheumatoid ar-
thritis which underscored my suspicion of his
specialization and his frustrated perspective.
The two office visits to the rheumatologist
revealed nothing, were costly and pointless.
175

Massage (September
2010 – August 2011)
I found massage an essential part of my
self-care during this time. I tried meditating
during massage, or listening to music and
particularly liked to hear monks chanting. The
spiritual songs were quite rich and soothing.
I drank in their prayers. Sometimes I enjoyed
talking about what I was going through. My
massage therapist was empathetic, extremely
gentle, and allowed me to share my story and
frustrations. She shared a referral she knew
of from a client that was getting good results
through an acupuncturist who specialized in
chronic pain.
Dealing with constant pain can be quite
lonely, because most of the time you are by
yourself in agony trying to sleep, distract your
mind with a compelling book, or diminish the
pain in the bathtub or shower. I worked at home
and my social interests were all physically
active. I couldn’t do anything active. Staying
home reduced my social interaction abruptly.
In massage you are taken care of with compas-
sion and it also helps with loneliness during
the healing process. I worked with a couple
of massage therapists who were very gentle
realizing how sensitive my body was to the
touch. Both were careful not to add to my pain,
but instead offer me a sanctuary for relief.
I highly recommend massage before, dur-
ing and after the water fast. I can’t say enough
good things about massage therapy. Find a
therapist who is gentle and compassionate
with you, your body, and sensitive to your
pain level.
Naturopath (November,
2010 – August 2013)
In November, one month into the sudden on-
set of the mysterious bodily pain around my
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joints, I came to my senses and contacted a
naturopathic doctor in town. “Why had I not
done this from the start?” I wondered. I had
been following naturopathic advice for years.
I brought the steroid prescription to my ap-
pointment with the naturopath to see what she
would advise me to do. She suggested we run
a blood panel and in the meantime, I could
begin by taking a lower dose of prednisone
along with the supplements she provided.
At my next appointment, she had the
results and a treatment plan prepared. I was
so impressed and grateful that she had taken
the time to investigate the issue thoroughly.
She explained I had an autoimmune disorder.
I pressed her for a name for the type of dis-
order. She showed me her notes - PMR. She
had done her research. I was relieved to put
a name on my symptoms with a diagnosis I
could research myself. She convinced me I
needed to start an elimination diet to clean out
my gut and provide a healthy, fertile intestinal
tract for proper nutrient absorption and heal-
ing. She explained how all disease originated
in the gut. I had had problems with my “gut”
and elimination often throughout my life, so
this made perfect sense to me. The diet was a
challenge, but pain is highly motivating, so I
carefully followed the diet and recommended
supplements. With an elimination diet, you
eliminate all known allergy foods and then
carefully introduce one food category at a time
to see if the body reacts to that particular food
(corn, wheat, barley, rye, dairy, etc.)
I began the medicine and herbs. Toward
the middle to end of the prescription, I called
the internist to let him know how I was re-
ducing the dosage and he was fine with the
new plan, saying, “If the symptoms return
[inflammation and pain], call me back and I
will refill the prescription.” When I completed
the prescription, the pain did come back and
I decided I would not call him for more pred-

Curing Autoimmune Naturally
nisone because this approach, in my opinion,
merely addressed the symptoms as opposed to
working with the naturopath and other natural
healers to address the cause.
I have trusted naturopathic medicine for
many years. I had used a naturopathic doctor’s
book, Jethro Kloss’ “Back to Eden,” (Kloss,
1992) as my chief reference manual for health
maintenance and for treating illness through-
out my children’s lives. I used his remedies for
myself and my family as my children grew up.
I seriously considered someday becoming a
naturopath myself. I had a wise and compas-
sionate naturopath in Colorado who set the
bar for the optimal healer. He took the time to
listen to me explain my issue. When I initially
met with a local naturopath in California I was
happy to hear that she too was dedicated to
helping me heal naturally.
Searching the internet I found that the
PMR diagnosis and description of the disease
matched my symptoms. Most of the medical
sites and blogs suggested that the standard
medical treatment was to use steroids. Paavo
Airola’s book There is a Cure for Arthritis
(Airola, 1968) spoke to me of a natural cure
– fasting. He convinced me that I could heal
naturally. Surprisingly, I could not find anyone
on the internet that shared a story of healing
naturally from PMR.
I ordered several more books on arthritis,
because that is what I thought I had – con-
fused about the PMR diagnosis, and found
a common theme of fasting and following a
whole foods diet. PMR and arthritis are both
autoimmune diseases. Most authors suggested
fasting was the quickest way, hence FAST-
est, to relieve the pain and inflammation that
comes from the autoimmune attack. It seemed
like every time I mentioned a ten day fast to
local health practitioners I was discouraged.
I was surprised that even my naturopath was
not excited about a prolonged fast, nor offered
resources for a supervised fast when that was
what I was looking for based on this book’s
advice.
My naturopath was supportive of a few
days fast, but did not show interest in a ten day
supervised fast as Dr. Airola advised (Airola,
1968). I believe my naturopath lacked experi-
ence and knowledge of fasting clinics. I was
surprised that my naturopath was not more
supportive of Dr. Airola’s advice since he
was a fellow naturopath. I was disappointed
and frustrated once again, hoping for answers
and needing crucial support.
My local naturopath believed in the Blood
Type Diet. I ordered the book, but was not
impressed enough to read very far. I would
have preferred to have support for my vegetar-
ian diet from my doctor.
After four months of the “elimination
diet,” a trip to Mexico for sun, sea and sand
for healing (which didn’t work), a couple of
short vegetable fasts, a multitude of doctors
and thousands of dollars already invested in
my quest for a diagnosis and cure, I broke
down in tears in my naturopath’s office. She
seemed surprised I was so upset. She flipped
through her calendar saying, “It’s only been
four months. This could take two years.” How
many seconds, minutes, and hours of pain had
I endured? She didn’t get it. She obviously had
not experienced this level of chronic pain in
her own body. If she had, I am sure she would
have been more compassionate.
I immediately began doing my own re-
search to find out what my options might be
for a cure. There was no way I was going to
put up with this pain for two years. I imme-
diately reread There is a Cure for Arthritis,
(Airola, 1968) who strongly advised against
taking steroids. I was convinced there was a
cure after reading his book and then reading
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two others with similar dietary and fasting
advice (Allen, 2009 and Garrison, 1980). Dr.
Airola’s passion leaps off every page. As you
read his book it is as if he is standing next to
you speaking, and lecturing to you personally.
He builds a convincing case in how to cure
inflammation in the body caused by autoim-
mune disease. I really wanted to try a ten
day supervised fasting program like Airola
described was happening all over Europe. He
visited a number of fasting clinics in Europe
in the 1960s and said people were walking
out of these clinics cured, no longer requiring
crutches, or wheelchairs. This health treat-
ment plan had been going on in Europe for
half a century at least! I was shocked to read
that the cure had been available for so many
years throughout Europe. Why, I wondered
were so many doctors here clueless about
inflammation and roaming pain in the body
- autoimmune symptoms? It is preposterous
that I was unable to find a solution with all the
health practitioners I saw. No one I had seen,
in my long arduous search had suggested, or
supported, a prolonged supervised fast.
I found that naturopathic help was worth-
while for diagnosis. Although I really wanted a
naturopath like Dr. Airola who would support
my diet and help me locate a fasting clinic to
undergo a supervised fast and regain my health.
I searched Airola’s (Airola, 1968) book’s list
of clinics in Europe and began contacting
them. Many were no longer in operation. I
did find two doctors I started corresponding
with via email at two different clinics. The
clinic I had planned to visit was Klinik Dr.
Otto Buchinger, in Bad Pyrmont, Germany
and was corresponding with Dr. Andreas
Buchinger, a very kind, compassionate and
helpful doctor who I hope to meet one day
to thank him in person. The other clinic I
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was considering was Buchinger-Wilhelmi
clinic and was corresponding with Dr. Stefan
Drinda. Both gentlemen were kind enough to
share their wisdom at a time I was at a loss
with direction and a plan.
Emotional Freedom Technique
(EFT) Therapist (December
2010 – February 2011)
As I continued reading more books that vali-
dated Dr. Airola’s advice in his book (Airola,
1968) stating that a prolonged fast would
quickly eliminate inflammation in the body,
I contacted the author of Conquering Arthri-
tis, Barbara Allen (Allen, 2009) who lived in
Phoenix. Barbara suggested an Alcat blood
test among other things diet related and also
talked with me about the impact of emotions
with autoimmune disease. The blood test
revealed safe foods that did not cause inflam-
mation and foods to avoid like mango, which
I had been eating dried by the bag before the
onset of the disease. Funny thing is, I am
not a mango fan and was eating it because I
thought it was a healthy snack. I am not sure
the test was necessary, or all that helpful, but
it gave me a little more information to use as
a guide. Barbara also recommended her EFT
therapist expressing how critical she was in
Barbara’s path to healing.
This EFT therapist was also somewhat
psychic or highly intuitive and specialized in
post-traumatic stress disorder (PTSD). She
impressively worked with many veterans. I
was surprised to be told in our first call to hang
up so quickly. She needed about 30 minutes
to write up a report for me and would then
call me back. Her report identified some ar-
eas that led to good discussion. How she was
able to intuit all of this in only a few minutes

Curing Autoimmune Naturally
conversation was uncanny. She also had me
identify traumatic events in my life and noted
how many happened within the same year. We
worked together several times and each time
she had me literally tapping into a deep well
of grief. I finally put a box of tissues by the
phone for our sessions. After several sessions
at a high rate, although well worth it, I decided
to stop. I was spending so much money in my
search and getting exhausted physically and
financially. I wondered if all the emotional
exploration was doing me any good.
When I visited True North Health Center,
I was offered an EFT session from the wife of
one of the volunteer nurses at no charge. We
spent about two hours together and I sobbed
uncontrollably during our session. I was shar-
ing some difficult emotional situations from
my early adulthood, my parent’s death, and
recent past. “Will I always have an outpouring
of tears when tapping this well of emotion?”
I wondered.
Colon Therapy (January
2011 – March 2011)
I sought a colon therapist after reading about
enemas being part of the treatment in the
clinics in Europe. This was just as you may
imagine, not the most pleasant experience, and
yet cleansing. The therapist was very kind and
compassionate. I was willing to try anything
that might reduce my pain. Looking back it
probably was not necessary, since I was already
on an elimination diet and eating well, but it
was worth trying and may have been helpful.
Ayurvedic Medicine
I regretfully did not try Ayurvedic medicine,
although dabbled in it afterwards with an-
other naturopath who had studied Ayurvedic
medicine. It probably would have been very
helpful, because the few Ayurvedic remedies
I have tried, have worked immediately. This
is an ancient Indian form of medicine using
natural herbs and food which has been tested
over centuries and promotes the body’s abil-
ity to heal.
Chiropractic, CranioSacral
Therapy and Visceral Manipulation
(March and April 2011)
I met with Dr. Russ Kalen, who was recom-
mended by someone I trusted. Dr. Kalen
practiced CranioSacral therapy and Visceral
Manipulation which were both new special-
ties to me. He was very kind and listened to
my story. He sincerely did his best to help.
When I shared that I was planning a trip to
Germany to attend a 28 day fasting program,
he asked, “Why would you go all the way to
Germany when you could go to Santa Rosa?”
I was surprised to hear that there was a fasting
clinic in California. He shared that he went to
chiropractic school with Dr. Alan Goldhamer
who started the clinic in Santa Rosa years ago.
Santa Rosa was just a three or four hour drive
south as opposed to Germany being quite a trip
especially in my condition! He wrote down
Dr. Goldhamer’s name and phone number and
suggested I give him a call.
I was thrilled to be given hopeful direction
and compassionate expert support. The gift
this particular doctor provided was compas-
sion and a pointer to my cure. I cancelled my
plans for Germany and gathered information
via the web about True North Health Center
in Santa Rosa, CA.
Fasting Clinic (April 2011-May 2011)
On my next trip home from work in Arizona,
Thursday afternoon, April 14, 2011, I sat on
the plane talking with Dr. Goldhamer about
179

the program and what might be best for me.
I was getting excited and wondered when I
would be able to attend his clinic. “When
would there be space available?” I wondered.
He said, “Why don’t you check in tomorrow?”
I looked at my calendar appointments for the
following week. My son was going to get his
driver’s license and I was planning to take
him to the department of motor vehicles. I
had other appointments on my calendar that
seemed important as well. I was sharing the
reasons why I could not check in that soon. He
took each objection one by one and countered
with how someone else perhaps could handle
it. After all, wasn’t I in a lot of pain? He said,
“The sooner you get started in the program
the sooner you will start to heal.” He was very
convincing and helped me put myself first. It
is not easy for a mom to put herself first. He
also convinced me that a water fast, instead
of a juice fast, would be a lot quicker where
the results of fasting would show up sooner.
All this made sense to me. Convinced I would
be better off starting right away, I decided to
go as soon as possible.
It took me a couple of days to prepare and
pack all the things I might need for however
long I was going to stay there. I remember
the emotion in my husband’s eyes as I left
home not able to say exactly when I would
come back. I drove out of the driveway with
my clothes, water, and steamed vegetables for
the drive down, and enough books to read for
a lifetime. On my drive to the clinic my pain
was about a level four, on a scale of one to
ten with ten being the highest level of pain
one has experienced. I checked in to True
North Health Center that following Monday
afternoon.
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Curing Autoimmune Naturally
Fasting Experience
I began the water fast as soon as I arrived at
True North Health Center. I drank their dis-
tilled water for eight days, fruit juice on day
nine, vegetable juice on day ten and gradually
started refeeding for five more days before my
departure. You must stay half the time of the
fast to refeed. Therefore, for my ten day fast
I needed to stay an additional five days fol-
lowing my fast and begin eating gradually to
ensure I had the energy to drive home safely.
True North Health Center:
Water Fast, Day 1
When I arrived at True North Health Center
on April 18, 2011, I attended Dr. Goldhamer’s
lecture where I noted him saying, “No one has
died here on a water fast,” (good news!) and
“We’ve had good results with water fasting
and arthritis.” (More good news.) I felt I was
at home here, comfortable to be in good hands
with experts I trusted and a place I might actu-
ally find relief from my constant pain. It was
encouraging to me, and again at that time, I
thought I was suffering from arthritis.
My pain level was a seven upon checking
into my room having carried my suitcase up
the stairs. I weighed in at 130.4 pounds which
was at least 15 pounds lighter than from the
onset of my autoimmune symptoms in late
September of the previous year. This weight
loss was due to the strict adherence to the
elimination diet.
I was met by a True North Health Center
staff nurse in my room that first evening.
The nurse instructed me to read through the
binder on the dresser that explained the whole

Curing Autoimmune Naturally
process. I asked if I could request a particular
doctor and he said, “Sure, everyone does.”
Excited, I requested Dr. Klaper. There is a
history behind that request and the emotion.
My Initial Introduction to
Dr. Michael Klaper
In 1993, I lived in Fort Collins, Colorado and
joined a vegetarian group that met monthly
for potlucks and brought in a variety of speak-
ers. I was a dedicated vegetarian, mother of
two young boys, and I wanted to be sure they
were getting all the nutrition they needed for
optimal health. I studied many books includ-
ing “Nutrition for Vegetarians” (Thrash and
Thrash, 1982), “Diet for a New America”
(Robbins, 1998) and “The Peaceful Palate”
(Raymond, 2004) among others. I was ambi-
tious and enthusiastic to get it right. A couple
of years later, my friend, who had been leading
the group, recruited me to take on the leader-
ship role. I accepted and thus became more
involved in the “tabling events” that the Veg-
etarian Society participated in, such as Earth
Day. I also hosted and promoted speakers like
Howard Lyman, a former cattleman and Hu-
mane Society official and activist who speaks
about Mad Cow Disease. After appearing on
Oprah in 1996, he and Oprah were sued by
the cattle industry after a statement she made
to never eat another burger. I also recruited
speakers to our group like Daniel McKibben
from Eden Valley. He was the director of the
lifestyle center in this Seventh Day Adventist
community. Daniel is an excellent speaker.
I enjoyed his “White Bread, You’re Dead”
talk where he would squish together a whole
loaf of white bread and then bounce the ball
of bread against a wall, demonstrating the
gluten content and what it does in the colon.
The Vegetarian Society produced materials
and promoted books and other resources for
vegetarians and those curious to learn more
about vegetarianism. We also sold cookbooks
including Dr. Klaper’s. I bought two of his
books: “Vegan Nutrition Pure and Simple”
(Klaper, 1987), and “Pregnancy, Children and
the Vegan Diet,” (Klaper, 1991). Dr. Klaper’s
photo is on the cover, so I often saw his kind
face when reaching for his books from my
kitchen shelf when seeking help and guid-
ance. He felt like a friend and kindred spirit.
I also had read John Robbins’ book, “Diet for
a New America” (Robbins, 1998), a Pulitzer
Prize winning book. Robbins’ book changed
my thinking and way of consuming food
overnight. I bought the corresponding video
and watched it several times and shared the
resource with others who were exploring a
vegetarian diet. Dr. Klaper was a presenter in
the video and was quite memorable and con-
vincing in his depiction of the quantity of grain
required to produce a pound of hamburger
meat. Dr. Klaper was famous in my world.
Those cookbooks moved with us from
Colorado in 1993, to Ohio in 2003, and to
California in 2007 always landing on a kitchen
shelf. It wasn’t until 2011, when I was research-
ing True North Health Center and watched
their website video, when I discovered Dr.
Klaper was working there. “Dr. Klaper works
at True North Health Center?” I thought. It
seemed too good to be true! What are the odds
of me having a disease and needing a doctor
and finding the only vegan doctor I know to
help me heal from this debilitating disease?
This was no accident. This seemed extraor-
dinary, synchronistic, even divinely inspired.
True North Health Center:
Water Fast, Day 2
I had a personal appointment with Dr. Klaper
on Tuesday, day two of my fast. Dr. Klaper
listened intently as I shared my experience and
181

frustrations trying to find a cure and a fasting
clinic. He was kind and patient. He had the
“bedside manner” you imagine a great doctor
to possess, compassionate and empathetic. He
told me I did not have arthritis and explained
that my diagnosis of PMR was likely accurate.
Then he began teaching me the difference by
showing me diagrams on his computer screen
of the body and muscle tissue surrounding
the joints. My inflammation was occurring
in the muscle tissue.
I had brought with me all the supplements I
had been taking and asked him which supple-
ments I should continue taking. He glanced
at a few from my overflowing shoebox of
plastic bottles and tinctures and said, “None
of them. Put them away.” This was wonderful
news to me after choking down supplements
for so many months from so many different
practitioners I had been seeing. He suggested
that I stop using the word “arthritis” because
I would just confuse people.
Tuesday night I had several vivid night-
mares and restless sleep.
True North Health Center:
Water Fast, Day 3
I lost another four pounds. I had trouble
sleeping at night feeling a lot of pain in my
shoulders at a level eight or nine in the right
and six to seven in the left. I couldn’t wait
until morning when I could get up and not
feel the pain in my shoulders.
True North Health: - Water Fast, Day 4
I lost three more pounds and slept two to three
hours. It was another rough night. I was feel-
ing a lot of abdominal pain under my left rib
cage which felt like a very strong heartbeat.
The doctor said it is a throbbing artery which
is normal.
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Curing Autoimmune Naturally
True North Health Center:
Day 5, Water Fast
I lost one and a half pounds. I am not experi-
encing much pain at all, one to two level pain
in my shoulders and three to four level pain
in my stomach plus an acid gurgling feeling.
I am hungry in the morning. I feel like my
inflammation is gone!
I spoke with Dr. Klaper. Everything is fine!
Two more days on the water fast is likely. My
husband, Rob, and son, Cole, are visiting today.
I might be on the path to recovery!
True North Health Center:
Day 6, Water Fast
I lost almost two and a half pounds. My shoul-
der pain is one to three upon movement. I have
slight hip, less than one pain level, and some
lower back pain about three to four pain level.
True North Health Center:
Day 7, Water Fast
I lost a little less than a pound today which
makes me feel better since I was losing about
two pounds a day. I have some slight back
pain, level three, but no other pain in shoul-
ders or hips.
Today is Easter, and the chef hid two golden
eggs in the courtyard. Someone found one and
it turned out to be a golden beet. I meditated
with the group in a guided meditation which
felt wonderful.
My husband, Rob, and I Skyped with our
son Ty in Abu Dhabi and I showed him my
concave stomach. Ty was shocked at the sight
and the fact that I was on my seventh day of
water only. But, he shared, “It’s a good idea to
clean out the body once in a while and detox.”
Yesterday, I felt good until my nap. I had
five and a half hours of sleep Friday night

Curing Autoimmune Naturally
when my husband, Rob, and son, Cole, were
visiting. I was really hopeful. I thought I was
out of the woods, like the PMR was leaving.
I felt so good, and didn’t have a lot of pain
during the night.
Last night I was in a lot of pain. My shoulder
pain, the burning in the fronts of my shoulders,
came back. My back was constricted and tight
especially up the left side, but I was able to get
ten hours of sleep. I was surprised to see the
clock when I woke up read 8:13am. I normally
wake up at two or four in the morning. In the
course of three nights, I had two hours, then
five and a half hours, then ten hours of sleep
– amazing! Dr. Klaper came in to check on
me this morning on his day off! He was very
happy commenting that I was doing really well.
He suggested I continue a little bit longer on
the fast. He thought that perhaps the reason
my shoulders were in pain as well as my back
might be from sleeping on the soft surfaces
and by lying flat on the floor and lifting my
knees would help align my spine.
I feel really good about being here. This
is a wonderful environment, very supportive,
with people going through different issues,
and either water fasting, or juice fasting, or
they have come off a fast and they are eating
again. They are eating this super healthy diet
here, vegan, gluten free, salt free, oil free, sugar
free, and a whole foods, plant-based diet. Dr.
Klaper has been a vegan quite a while, more
than thirty years. As he entered my room this
morning I noticed he had a sweatshirt on that
said, “Got Kale?” He was in sweat pants and
it was his day off. He said, “Well I just wanted
to check in with you because I’m about to go
on my bike ride.” I said, “Oh, how far are you
going?” He said, “About 50 miles.” He is 63
years old. Very inspiring!
Things are going well overall. I am weak,
and that is normal for a fast. I cannot stand
up too long without feeling nauseous, or a
little light headed. My stomach is continually
bothering me with a kind of acidic feeling. I
am not really that hungry anymore. It’s just
a burning sensation.
I am excited to try this new diet, prepar-
ing healthy food. It’s going to be fun to start
eating again and eating food that I know is
good for me.
I’ve never been around so many doctors,
who are so knowledgeable, and fit. They are
all so healthy looking, energetic and happy.
They all know about nutrition and they provide
knowledgeable information. I can see any of
the doctors by making an appointment at the
front desk, or going to their lectures, or sit-
ting with them in the dining room. I feel like
I am getting a solid foundation in nutrition
and health causing me to be more confident
in what I am doing. I will not second guess
myself. I am very confident that I will be able
to keep this up. I am happy to eat an organic
whole foods diet.
True North Health Center:
Day 8, Water Fast
I am down another pound. My shoulder pain
is a level two and I have not had hip or back
pain. I slept nine hours and fifteen minutes!
I enjoyed a massage with Gracie Yuen, a
chiropractor. She assessed my shoulder mo-
bility and determined where the pain was
originating.
She started with my rotator cuff, which is
the worst area on my right shoulder, and went
deep into the source of the pain, the point that
is the most tender and did some trigger point
massage. Then she worked on my left jaw, be-
cause I noticed during meditation this morning
that my left jaw was throbbing. She worked
the very tender spot. She also worked on my
back a little bit, and I was not aware I had some
lower back pain. As she touched that area just
183

above my left hip, it was very tender, so she
worked in that area as well. She also found
some ropey tissue through the deltoid, and
said that was probably why I am unable to lift
my arms to the sides easily. When I was done,
we reassessed my mobility. She asked me to
lift my arms to the side again and we noticed
that there was a lot more mobility. Originally,
I could lift my arms about 45 degrees. After
the massage and chiropractic evaluation, I
could lift my arms 80 to 90 degrees. What a
huge difference she had made in my body in
one hour. Maybe I can do a few more days,
or whatever it takes, because this pain in my
left jaw and my back needs to go away. The
progress I am making now is phenomenal.
This clinic and fast is a life saver. I trust that
by not eating and only drinking water, I am
giving my body the time it needs to focus on
healing itself. If I were to introduce juice or
food right now, I would inhibit that process,
and take it down 70 percent or so.
You can cure yourself too, but it is best
to do it in a supervised environment because
there is so much knowledge available and so
many resources for support and healing.
I have been filling my brain with education.
This is a lifestyle change. I will be vegan when
I leave this place [well, actually, close to it]
and so happy to know that this is going to keep
me pain free for life. I will need to follow this
diet and do strength training and exercise in
moderation in order to regain muscle tissue.
We are instructed not to get up too fast and
move slowly to avoid fainting. My roommate
had the heat up so high in our room today
which was too extreme for comfort. I got up
off the couch to turn down the heat and forgot
about the instructions to proceed slowly. As
I turned around to head back to the couch
everything went white. I heard my roommate
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Curing Autoimmune Naturally
say, “Whoa” as I hit the floor. I regained my
sight and crawled to my bed. I told Dr. Klaper
and he said that is a red flag and it is best to
start with juice in the morning. “Too bad,” I
thought, “I should have heeded the instruc-
tions to get up slowly in order to continue my
water fast.” I was disappointed with myself
for having to cut it short because I forgot the
instructions.
True North Health Center:
Day 9, Fruit Juice Fast
I lost a little over half a pound. I slept seven
hours, waking up from 1:30-2:30am. My
shoulder pain level is two to three when lying
on sides and the pain in my buttocks is a level
two. We added fruit juice today. It has been
almost impossible to finish one glass before
the next one arrives.
True North Health Center: Day
10, Vegetable Juice Fast
I gained one pound exactly. I slept seven hours
waking up from 1:30 am to 3:30 am due to
the stomach acid bothering me. We added
vegetable juice today.
My hips felt slightly inflamed walking
back to the room after the cooking demon-
stration. My knees felt slightly swollen on the
meditation bench and my back hurt too, with
a sharp pain on the right side of my spine in
the middle of my back.
True North Health Center: Day
11, Refeed Day 1, Raw Food
I gained .2 pounds. Today I am having raw
food. My pain level in my hips rose at 9:00pm
and they were hot to the touch.

Curing Autoimmune Naturally
True North Health Center:
Day 12, Refeed Day 2
I slept eight hours and fifteen minutes soundly!
The pain in my shoulders was a level six when
I woke up. I gained one pound exactly. My
hip pain is a level three to five when walking
and moved to a six after sitting for a while.
I do not have the appetite I thought I would
have after not eating for so many days. Most
of the food I put on my plate goes in the re-
frigerator for later.
True North Health Center:
Day 13, Refeed Day 3
I gained one pound exactly. I made the mistake
of overextending myself and walked a couple
of miles with a group of women who wanted
to do some shopping. I stood for several hours
indulging myself at the local thrift stores. I
noticed my inflamed hips when we started
heading back to the clinic and I thought I prob-
ably should call a taxi. I was embarrassed to
share my level of pain and cause others to wait
on me, so I pushed through the pain leading
the way back to True North Health Center.
When we returned my hip pain was a level
eight to nine. Sitting on an ice pad helped. I
was scared that the monster was back.
Tearing up, feeling disheartened and help-
less once again, I shared my relapse with Dr.
Goldhamer while sitting in the cafeteria. He
said, “It is normal. People often do this when
they are feeling better. It is not as important
how much pain you are experiencing right
now from overdoing it, but how quickly you
rebound.” I felt relieved to hear this because
I was worried that I may not be getting rid of
the disease after all.
True North Health Center:
Day 14, Refeed Day 4
I lost a little over a pound. My hip pain is a
four to five level, shoulders and bursa down
the sides of my arms is a four to five pain level.
True North Health Center:
Day 15, Refeed Day 5
I gained almost a pound and a half and slept
seven hours soundly. I have to leave to make a
client meeting in Phoenix. Otherwise, I would
like to stay one more week to learn more about
eating a strict whole foods diet. [It turned out
my client needed to cancel last minute. I was
doing my best to keep my commitment even
at the expense of my health. This was after
being so determined to put my health first.
I could have easily rescheduled the meeting
out by one week and stayed at the clinic. I
missed my family terribly, yet I wanted to
ensure that I would come home 100 percent
available to them.]
A PLEASANT SURPRISE
As I was driving from the airport in Phoenix
and wearing my driving glasses, I noticed my
vision was blurred. I thought something was
wrong with my glasses. I took them off, put
them on and at one point looked up over the
rim at the green street sign on the pole above
me and noticed that I could read it clearly. I
finally realized I could see clearly without my
glasses. My eyesight was 20/20!
I couldn’t believe my eyes – literally! I
could see all the signs on all the buildings,
crisply and clearly without my glasses. Was
185

it true? I had it checked out when I returned
home and indeed the doctor reported that my
eyesight was 20/20. The doctor was amazed
by my story.
The clear eyesight lasted a couple of weeks
and gradually went back to the way it was as
I began eating outside the strict dietary envi-
ronment I had at True North. I was practicing
what I had learned although it wasn’t easy
to prepare all my meals the way the chef did
at True North. It became close to a full time
job. Maintaining a vegan, gluten free, no salt,
sugar or oil diet has been quite challenging
for me as I have my own habits and favorite
foods that are not easy to give up when you
are feeling healthy. I also do not believe I need
to be that strict all the time, so I occasionally
use dairy, cheese, eggs, salt (although I have
switched to Himalayan salt) and oil (mainly
olive, sometimes canola, or coconut).
My experience at True North Health Center
saved my life. I can’t imagine living with that
autoimmune disorder and allowing it to take
over my body for any longer. For optimal
health, annual retreats back to True North
Health Center would be ideal. It is important
to be reminded to take optimal care of your
body and mind, your overall health, and treat
yourself with love by consciously choosing
your food, your thoughts, your friends, and
your clients.
The fasting clinic was my salvation, the
answer to my prayers for a cure. The clinic
staff and structure provided me the support
I needed to allow the space and time for my
body to heal itself. True North Health Center
provides expert care, supervision and guid-
ance.
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Curing Autoimmune Naturally
SUMMARY
If you want to cure yourself of autoimmune
disease of any kind, PMR, fibromyalgia,
lupus, arthritis, etc., you need to take care of
yourself in four areas:
1. Nutritious diet,
2. Proper rest,
3. Managed thinking, and a
4. Balanced lifestyle.
If I had to do this over again, I would seek
the advice of a naturopathic doctor, and/or
Ayurvedic practitioner, for nutrition and seek
out a fasting clinic sooner that specializes in
helping people heal from autoimmune dis-
ease. Fasting is not easy, especially on your
own, but it beats the alternative – drugs, side
effects, and pain. True North Health Center
makes the fasting process much easier because
they are well informed and experienced with
a proven track record of success in providing
quality supervision for prolonged fasts. I found
professional help by attending a fasting clinic
and hope you find the solution that works best
for you. I wish you a happy and healthy life!
REFERENCES
Airola, P. (1968). There is a cure for arthritis.
West Nyack, NY: Parker Publishing Com-
pany, Inc.
Allen, B. (2009). Conquering arthritis: What
doctors don’t tell you because they don’t know
(9 secrets I learned the hard way). Saint Louis,
MO: Shining Prairie Flower Productions.

Curing Autoimmune Naturally
American College of Rheumatology. (2008).
Prevalence statistics. Arthritis & Rheuma-
tism. Retrieved from https://www.rheumatol-
ogy.org/Research/Prevalence_Statistics/
Craig, G. (2008). The EFT manual. Santa
Rosa, CA: Energy Psychology Press.
Garrison, M. (1980). I cured my arthritis you
can too. North Largo, FL: Uptown Pub.
Klaper, M. (1991). Pregnancy, children, and
the vegan diet. Maui, HI: Gentle World, Inc.
Klaper, M. (1987). Vegan nutrition: Pure and
simple. Maui, HI: Gentle World, Inc.
Kloss, J. (1992). Back to eden. Loma Linda,
CA: Back to Eden Publishing Company.
Levine, J. (2013). Toxic teeth: Are amalgam
fillings safe? Dr. Oz. Retrieved from http://
www.doctoroz.com/videos/toxic-teeth-are-
our-amalgam-fillings-safe
Lupus Foundation of America. (2014). Un-
derstanding lupus: Frequently asked ques-
tions. Retrieved from http://www.lupus.org/
answers/entry/what-is-lupus
Naturopathic Physicians. (2011). Defini-
tion of naturopathic medicine. Retrieved
from http://www.naturopathic.org/content.
asp?contentid=59
Raymond, J. (2004). Peaceful palate. Honey-
dew, CA: Heart and Soul Publications.
Robbins, J., & Macy, J. (1998). Diet for a
new America. Tiburon, CA: H. J. Kramer
Incorporated.
Rolf Institute of Structural Integration. (2014).
Rolfing structural integration and Rolf move-
ment integration. Retrieved from http://rolf.
org/
Shiel, W. C. (2014). Giant cell arteritis (tem-
poral arteritis). Medicine Net. Retrieved from
http://www.onhealth.com/polymyalgia_rheu-
matica/page2.htm
Thrash, A. M., & Thrash, C. L. (1982). Nutri-
tion for vegetarians. Seale, AL: NewLifestyle
Books.
Tidy, C. (2010). Interstitial cystitis. Patient.
co.uk. Retrieved from http://www.patient.
co.uk/doctor/interstitial-cystitis
ADDITIONAL READING
Campbell, T. C., & Campbell, T. M. (2006).
The China study: Startling implications for
diet, weight loss and long-term health. Dallas,
TX: BenBella Books, Inc.
Gerson, C. (2010). Healing the Gerson way,
defeating cancer and other chronic diseases.
Carmel, CA: Gerson Health Media.
Lisle, D., & Goldhamer, A. (2006). The
pleasure trap: Mastering the hidden force
that undermines health and happiness. Sum-
mertown, TN: Healthy Living Publications.
Furhman, J. M. D. (2011). Eat to live: The
amazing nutrient-rich program for fast and
sustained weight loss. New York, NY: Little,
Brown and Company.
Robbins, J. (1992). May all be fed: Diet for
a new world. New York, NY: William and
Morrow Company.
KEY TERMS AND DEFINITIONS
Allopathy: Webster defines as, “treatment
of disease by remedies that produce effects
187

different from or opposite to those produced
by the disease: loosely applied to the general
practice of medicine today, but in strict us-
age opposed to homeopathy.” Webster online
defines as, “a system of medical practice that
aims to combat disease by use of remedies (as
drugs or surgery) producing effects different
from or incompatible with those produced by
the disease being treated.”
Ayurveda: Webster defines as, “a tradi-
tional Hindu system of medicine practiced in
India since the first century A.D. and using
combinations of herbs, purgatives, rubbing
oils, etc. in the treatment of diseases.” Diction-
ary.com defines as, “the ancient Hindu art of
medicine and of prolonging life.”
Bursa: Webster defines as, “a small serous
sac between a tendon and a bone.”
Chiropractic: Webster defines as, “A
method of treating disease based on the theory
that disease is caused by interference with
nerve function, and employing manipulation
of the body joints, especially of the spine, in
seeking to restore normal nerve function.”
Vertebrae that are displaced are put back in
proper alignment for optimal functioning of
the body.
Craniosacral Therapy: Webster defines
as, “a system of gentle touch designed to
enhance the functioning of the membranes,
tissues, fluids, and bones surrounding or as-
sociated with the brain and spinal cord.”
Emotional Freedom Technique (EFT):
Wikipedia defines, “Emotional Freedom
Techniques (EFT) is a form of counseling
intervention that draws on various theories
of alternative medicine including acupunc-
ture, neuro-linguistic programming, energy
medicine, and Thought Field Therapy(TFT).
It is best known through Gary Craig’s EFT
Handbook, published in the late 1990s, and
related books and workshops by a variety of
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Curing Autoimmune Naturally
teachers. EFT and similar techniques are often
discussed under the umbrella term energy
psychology.”
Homeopathy: Webster defines as, “A
system of medical treatment based on the
theory that certain diseases can be cured by
giving very small doses of drugs which in
a healthy person and in large doses would
produce symptoms like those of the disease.”
Interstitial Cystitis: Webster defines as,
“A disorder that causes the bladder wall to
become swollen and irritated, leading to scar-
ring and stiffening of the bladder, decreased
bladder capacity, and, in rare cases, ulcers in
thebladder lining. IC is also known as painful
bladder syndrome.” Patient.co.uk defines as,
“Interstitial cystitis is a chronic bladder condi-
tion of unknown cause characterised by pelvic
pain, dysuria, urinary frequency, urgency of
micturition, and pressure in the bladder and
pelvis. Some believe the condition to be an
autoimmune reaction.”
Naturopathy: Naturopathic.org defines as,
“Naturopathic medicine is a distinct primary
health care profession, emphasizing preven-
tion, treatment, and optimal health through the
use of therapeutic methods and substances that
encourage individuals’ inherent self-healing
process. The practice of naturopathic medicine
includes modern and traditional, scientific,
and empirical methods.” Dictionary.com
defines as a system or method of treating
disease that employs no surgery or synthetic
drugs but uses special diets, herbs, vitamins,
massage, etc., to assist the natural healing
processes.” Naturopathic doctors training
emphasize nutrition and the causes of disease.
Some naturopaths specialize in homeopathy.
Polymyalgia Rheumatica (PMR): Wiki-
pedia defines as, “(which takes its name from
the word “polymyalgia” which means “pain
in many muscles” in Greek followed by the

Curing Autoimmune Naturally
term “rheumatica”) abbreviated as PMR, is
a syndrome with pain or stiffness, usually in
the neck, shoulders, and hips. The pain can
be very sudden, or can occur gradually over
a period of time. It may be associated with
temporal arteritis, an inflammatory disease
of the arteries, particularly those in the ca-
rotid distribution.” From rheumatology.org,
“Recent research suggests that inflammation
in PMR involves the shoulder and hip joints
themselves, and the bursa (or sacs) around
these joints. So pains at the upper arms and
thighs, in fact, start at the nearby shoulder and
hip joints. This is what doctors call “referred
pain.”
Rolfing: The Rolfing Institute defines as,
“Rolfing Structural Integration is a form of
hands-on manipulation and movement edu-
cation developed by Dr. Ida P. Rolf over 50
years ago. It works on the web-like network
of connective tissues, called fascia, to release,
realign and balance the whole body, potentially
resolving discomfort, reducing compensations
and alleviating pain. Rolfing SI aims to restore
flexibility, revitalize your energy and leave
you feeling more comfortable in your body.”
Vegetarian: A diet that consists of veg-
etables, fruits, grains, legumes, nuts, seeds
and possibly dairy products and eggs.
Yoga: Webster defines as, “1. Hinduism
a mystic and ascetic discipline by which one
seeks to achieve liberation of the self and
union with the supreme spirit or universal
soul through intense concentration, deep
meditation, and practices involving prescribed
postures, controlled breathing, etc. 2. A system
of exercising involving the postures, breathing,
etc. practiced in yoga.”
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APPENDIX A: HOW TRUE NORTH HEALTH CENTER

HELPS AUTOIMMUNE SUFFERERS

There are several potential causes of autoimmune disorders that True North Health Center ad-
dresses:

1. Poor nutrition,
2. Chronic injury,
3. Chronic emotional disturbance, and
4. Fast-paced lifestyle.

Poor Nutrition/Diet

True North Health Center is set up to help correct people’s poor nutritional habits. You do not
have temptations at True North Health Center. Food from their kitchen is healthy. There is no
need to ask what are in the meals, because there is nothing harmful. They are careful to avoid
typical food allergens and foods that cause dis-ease in the body. The food is organic, and as
much as possible, locally grown.
The wonderful thing about True North Health Center is that you don’t have to do anything,
except lounge around and drink their amazing tasting distilled water, which tastes better every
day you are there. Staff takes care of laundry, and nurses and doctors come by your room to
check on your progress at least twice a day. Staff makes the food and even delivers glasses of
juice once you start a juice fast. There is as much social activity and interaction as you like. Each
doctor gives a talk each week. You will always see someone lounging in the courtyard. You can
choose to room with someone, or not. You can check out health topics on DVD in the library
(dining room). All the doctors and some nurses provide their services, chiropractic, naturopathic,
allopathic, psychiatry, sports chiropractic, massage, and Rolfing. There is meditation, exercise
guidance, and cooking demonstrations with food samples for the class of eaters. It was not easy
to watch the cooking demos during the fast, but I watched them anyway, wrote down recipes,
and saved the food in my refrigerator to eat when my fast ended.
Some people choose to only do the juice fast and others are there to get a recharge by eating
the vegan fare and resting in the sunshine. One gentleman that I met from Australia came to
fast, but was not experiencing any health problems. For him, it is an annual retreat and a way
of staying healthy. When I asked him why he chose to come to True North, versus a clinic in
Australia, he said, “Because True North is the best.” I also met two people from England. I was
impressed that these folks travelled to the U.S. when I had planned to go to Germany to locate
a clinic because I didn’t know that we had supervised fasting clinics in the U.S., until I spoke
to Dr. Kalen.
The food provided at True North Health Center is vegan, gluten free, no added salt, oil or sugar.
There is no caffeine either. They practice a whole foods diet, which means they suggest eating
food in its natural state instead of eating processed, or “refined” food. They have patients there
with many different issues, including autoimmune diseases, diabetes, and high blood pressure.

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Curing Autoimmune Naturally

In addition, Dr. Klaper provided me a one page “Health Supporting Eating Plan” that he
put together for his patients. It is a simple guide to follow when in doubt as to what to eat to
maintain optimal health.

Chronic Injury

True North Health Center promotes rest, sunshine, and relaxation. They also offer chiropractic,
physical therapy, exercise, fitness classes, massage and bodywork. There are several chiroprac-
tors on-site to help with regaining mobility. I saw them all because I wanted to take advantage
of everything they had to offer to give my body what it needed to heal. One particular session I
had with Dr. Goldhamer was extremely therapeutic and opening for my shoulders. He did great
work, slightly painful, but well worth the gift of improved mobility.

Chronic Emotional Disturbance

The opportunity to address emotions is available as well. Dr. Lisle, Dr. Goldhamer’s lifelong
friend, is a psychiatrist who provides a weekly talk and private appointments to work through
emotional issues. I met with him privately and found his input wise and insightful. I had planned
to talk with him about a number of things and found I only talked about the breakup of a long
term relationship with my friend and neighbor. I remember that he advised me to move about
four miles away because the constant reminder was not healthy. True North Health Center also
has guided meditation on-site and a variety of massage therapists and body workers that come
on-site by appointment.

Fast-Paced Lifestyle

Another possible cause is stress from burning the candle at both ends, morning and night, not
taking the time to rest, or sleep properly. True North Health Center suggests that you sleep be-
tween eight and ten hours each night while staying there. This is not easy to do when you are
fasting, but it offers a good guideline. Rest is mandatory because all you can really do is lounge
around when you are on a water fast. Your energy is zapped, the mind becomes extraordinarily
clear, and the body becomes very weak.
My lifestyle had been quite stressful during the year prior to my stay at True North Health
Center. I had reduced my work with my main client and tried to do the same amount of work in
half the time. I remember driving from my client meeting toward the airport and passing the hotel
longing to take a right turn into the driveway and check in for a long nap. I was exhausted, yet
instead I pushed on. I took my flight home, drove an hour and a half to then crawl into bed past
midnight. If I had lost my mind and common sense, True North Health Center brought it back.

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APPENDIX B

Recovery

The recovery process takes at least as long, and longer, than the time of the attack itself. You
must build mobility and muscle tissue lost during the timeframe of the autoimmune disorder.
I kept up my attention to a whole foods diet (no gluten), exercise, massage, Rolfing and natu-
ropathic oversight.

Diet

Most of my pain and inflammation was gone when I left True North Health Center. I still had a
big diet and lifestyle adjustment to make at home on my own. My family was not always keen
on my experimentations and vegan meal options. Some worked and some didn’t. I did not want
to obsess about what to eat, but for a while it was necessary in order to make a real change,
especially having to avoid gluten. White bread and butter was my favorite food as a kid and over
time I switched to whole grain wheat bread as I became health conscious.

Yoga

I started practicing gentle yoga. I didn’t have the strength to lift my arms, but had to properly
stretch my muscles to regain my mobility. I had to replace my normal yoga classes I enjoyed
attending and try the gentle classes. Surprisingly, I really enjoyed the more gentle classes, which
truly honored my body where it was in the moment. In addition, I worked with one yoga teacher
privately, who teaches Iyengar and is strict about proper alignment. This teacher used straps to
help me regain proper posture and feel what it is supposed to feel like while lying down on the
floor. He also sent me a customized set of postures to practice on my own. I really enjoyed my
yoga classes. I was fortunate to have a number of great yoga teachers available locally.

Massage

Cheri Neal, yoga instructor and massage therapist, also provided me support as my massage
therapist. She worked on my ropey and damaged muscle tissue. She was one of my favorite
yoga teachers and did a wonderful job with massage, seeing me through my transformation and
healing process.

Strength Training

Dr. Klaper suggested I work to rebuild my muscle tissue. I worked with a personal trainer and
fitness educator, Sabrina Fairchild at In Motion Fitness, who was knowledgeable about the
body, and physical fitness. She taught at the university and community college levels while
maintaining a private practice. She was an excellent person to help me regain strength. I felt
really fortunate to work with someone so talented and enthusiastic.

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Rolfing (September 2011-2013)

Rolfing is a form of bodywork that works with the connective tissue of the body to restore proper
alignment. I worked with Jean Louise Green, an excellent Rolfer. I went through her “ten session
series,” a set of sessions designed by Dr. Ida P. Rolf, the founder of Structural Integration, and
came out of it fully mobile. During one of the later sessions, I had an emotional release, cry-
ing uncontrollably for a while. The outpouring of emotion surprised me. Jean Louis explained
that emotional release can happen in the process of integrating the body. Her compassion and
expertise helped me immensely. I continued with periodic sessions.
Jean Louise grows her own organic vegetables and is very knowledgeable about health in
general. Jean Louise and I enjoyed smoothies with ingredients from her garden. She advised I
start using Himalayan rock salt water daily as she does herself – a teaspoon of salt water that I
mix with Ionic Fizz, by Pure Essence Labs, a magnesium supplement she also recommended.
Jean Louise shared a story about a client who was hunched over with stiff muscle tissue and in
ten sessions along with the salt water, her muscles softened and Jean Louise helped her walk
upright again.
I started using Himalayan rock salt water daily while seeing her to help replenish essential
minerals I may have lost due to dehydration. I have replaced my table salt with Himalayan. She
was a life saver in helping me regain mobility and living my normal active lifestyle.

Naturopath (May 2012-August 2013)

As I was recovering I began seeing my third naturopath. Dr. David Finn suited my personality.
He is gentle, wise, compassionate and an excellent listener. He is a true healer and expert in his
field. David saw me regularly, per my request, to monitor my health and provide homeopathic
remedies and supplements to keep my health optimal. He even helped my son cure quickly
from a bad case of poison oak (an overnight recovery). David helped me tremendously and I
am deeply grateful. He guided me in my questions about health food making recommendations
and helped nip health issues in the bud, like ongoing bladder infections, with his homeopathic
and naturopathic remedies. He did the proper research and was very accurate and flexible to
change the remedy based on my body’s reaction.

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194

Chapter 12
The Advantages of
PsychoSpiritual Psychotherapy
Elizabeth Caparros
The Odyssey Foundation, USA

ABSTRACT
The purpose of this chapter is to educate those interested in the value of understanding psychological
theories and how they may contribute to the mental and emotional healing of individuals, personally,
socially, spiritually, and universally. It also examines some principles that relate to one’s search for
meaning.

INTRODUCTION Campbell’s lecture enlightens us to the fact

Joseph Campbell (1988) stated the following
in The Power of Myth:
People say that what we’re all seeking is a
meaning for life. I don’t think that’s what we’re
really seeking. I think that what we’re seeking
is an experience of being alive, so that our
life experiences on the purely physical plane
will have resonance within our own innermost
being and reality, so that we actually feel the
rapture of being alive. (p. 1)
In my private practice most individuals
seeking help express their desire to know
and understand their purpose in life. Dr.
that meaning and purpose seem to equate to
the desire to experience our life in a passion-
ate manner.
The study of psychology and its applica-
tions have been gaining enormous recognition
as people attempt to give meaning and purpose
to their existence. We individuals have ex-
pressed our need to find our identity within the
diverse and numerous roles we must control
in order to live a happy and productive life.
The decline of society from tribal to nuclear
family units has seriously interfered with our
human need for bonding and belonging to a
social structure that offers us a well-defined
identity. This inability to define or be defined
by a specific social structure has created

DOI: 10.4018/978-1-4666-7524-7.ch012

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

The Advantages of PsychoSpiritual Psychotherapy
disturbances within our state of mind that
have proven to be distressing. Consequently,
we are often mentally void of belonging to
anyone or anything. The result can become
an emptiness within our being that causes a
great deal of suffering. This very discomfort
has led many of us to seek professional help,
mentally and emotionally.
Once upon a time we humans lived in tribes
where there was no concept of ‘me’ or ‘I.’ The
tribe itself was ‘I.’ Each individual had its re-
sponsibility to the tribe for its survival. Some
were hunters and others were responsible for
preparing a safe environment for the well
being of all. As civilization developed com-
munities developed. There were grandparents,
parents, children, siblings, cousins, friends,
and acquaintances who worked, played, and
attended community activities together as a
nucleus. Meaning and purpose was found
in serving our places of worship. Erikson
(1964) explains in Insight and Responsibility
that, “True identity depends on the support
which the young individual receives from the
collective sense of identity characterizing the
social groups significant to him, his class, his
nation, his culture” (p. 93).
With the birth of the Industrial Revolu-
tion, these like-minded groups began spread-
ing out in order to find prosperous work to
support individual families. The groups that
worshipped together became fragmented into
smaller family-sized groups to find their own
meaning and purpose. Examining this issue,
Jaynes (1976) explains how the mind of in-
dividuals developed, reflectively, along with
the structures of changing cultural norms and
social arrangements.
Technology has contributed a great deal
to our society, but it has also hindered per-
sonal social interaction within groups and
among people. A survey of one’s immediate
surroundings demonstrates that, whether in
a group on an elevator, in a waiting room, or
a check-out line, everyone’s focus is on their
mobile device so that interactions are limited.
This constant fragmentation of families and
groups leaves us devoid of the opportunity
to define ourselves as part of a universal
consciousness. There seems to be so much
more desire for independence and less inter-
dependence and there is no one to whom we
are truly bonded in a common effort. Once
we were “the tribe” and now we have become
an isolate with very few mirrors to reflect us.
Every man and woman has individuated to
seek personal definition, to find themselves,
yet have gone so far as to lose themselves in
the process. A search for identity has become
the cornerstone of psychotherapy. Counseling,
Psychotherapy, and PsychoSpiritual healing
have attempted to become a remedy to our
fragmented personalities. (Caparros, unpub-
lished manuscript)
It appears that our microcosmic state of
being (an individual) is a reflection of our
macrocosmic state of being (a world-view),
whether it is individual, vocational, familial,
social, economic, or religious. Unfortunately,
none of these aforementioned institutions are
considered the secure structure upon which
we can depend for guidance. Psychotherapies
and psychological modalities have become
the new guru.
Consequently, there is no social core
for individuals upon which to depend, and,
subsequently, there is no core within the
individual. At one time, the family returned
home after schooling or work and a mom
was there with dinner. Everyone sat around
195

The Advantages of PsychoSpiritual Psychotherapy
the table and discussed their day with each
other, having the opportunity to interrelate.
Presently, however, moms and dads both must
work to support the modern household with
some homes consisting of just one parent to
whom children return. The idea of interrelat-
ing suffers and, therefore, our internal being
suffers the peril of fragmentation and loss of
identity. It is evident that a spiritual death is
lingering over all of our institutions due to this
fragmentation beginning with family. There
is no longer the integrity needed for there to
be healthy cohesion among individuals and
their personal, social, political, educational,
and religious institutions. This spiritual death
and healing is pertinent to PsychoSpiritual
healing.
Some of the psychotherapeutic healing
modalities that have become available to
remedy these problems have at least brought
knowledge and/or understanding to the situ-
ations that have left many of us experiencing
a serious void within our being that, in turn,
has caused much despair. Erikson’s (1964)
theory of the Life-Cycle attempts to examine,
analyze, and explain most of the character-
istics of our development, individually and
collectively, which has contributed to a sense
of integrity, diminishing the pain of despair.
To achieve this purpose, some specific forms
of therapeutic healing apply.
Counseling
One form of mental and emotional healing is
referred to as counseling. Counseling focuses
on problem solving. Issues may be part of one’s
past but still cause problems in the present.
Counseling centers upon patterns of behaviors
that contribute to the discomfort of one’s state
of mind. Counseling examines belief systems
196

that have been developed throughout one’s
life and it attempts to review the authenticity
of these belief systems.
Individuals grow up throughout their life
being assigned many labels. Some common
ones are smart, stupid, beautiful, ugly, fat,
and brilliant. These labels begin to define
us. Therefore we believe these references
and begin to validate these beliefs about our
self. The beliefs about our self have had the
power to mold us to such a degree that severe
internal conflict develops. Somewhere within
we know these labels are not true but we will
accept them just to be bonded to those people
who are telling us this because they “love us.”
For example, being labeled as “fat” by one’s
caretakers, peers, and mentors can create
such a persona for the individual receiving
the label so much so that whether overweight
or not, he or she sees him or herself as such.
Although these are not healthy situations or
relationships, the individual has some sort
of connection, or bond, with those doing the
labeling and may choose to believe them or
agree with them for the aforementioned rea-
son of needing to be loved. This creates the
needed bond. Should the individual not agree
with the one doing the labeling, diversity and
repercussions manifest. This may cause a feel-
ing of not being bonded to the one assigning
the labels, which can be more fearful than the
belief of being fat. Such a state of mind can
surely drive an individual to develop serious
mental problems. Counseling may be the
most prudent and efficient way of correcting
a mental disturbance.
Counselors will focus upon particular
recurring patterns of behavior that are con-
sequential and destructive to an individual,
family, friends and colleagues. Counselors are
most inclined to utilize a cognitive approach

The Advantages of PsychoSpiritual Psychotherapy
to challenging self-destructive behaviors.
Counseling concentrates on how the brain
perceives and it attempts to alter perceptions
that can cause thinking seen as disturbing
to an individual, a relationship or a family.
Accordingly, it focuses on cause and effect.
The benefits of counseling are that it is
short-term and that it focuses upon the situa-
tion at hand without incorporating a myriad
of factors that, for some, dilute the primary
purpose for treatment. Counseling offers many
tools that can be utilized to avoid particular
situations that may potentially cause mental
and emotional disorders. It teaches the most
logical ways to reframe and rise above much
of the complexities that complicate one’s life.
Most simply, it defines the problem and exam-
ines solutions that will remedy the situation.
Some popular forms of counseling include:
• Cognitive Behavioral Therapy: Alters
thoughts, perceptions and therefore beliefs
about one self.
• Person Oriented: Posits that each of us
has the tools for wellness. It provides posi-
tive regard, empathy and congruence to as-
sist an individual toward this goal.
• Rational Emotive Behavioral Therapy:
An aggressive approach to challenging
shame based conditions.
• Dialectic Behavioral Therapy (DBT):
Increases awareness of emotional and cog-
nitive regulation by learning the triggers
that lead to reactive states.
Figure 1. No Understanding resulting in No Resolution
(Diagram designed by the author)
• Eye Movement Desensitization and
Reprocessing (EMDR): Designed to al-
leviate the distress associated with trauma.
Psychotherapy
Calvin S. Hall (1954) explains that psycho-
therapy is a form of psychoanalysis based
upon the teachings of Sigmund Freud. Psy-
choanalysis, Hall explains, concentrates on
the consciousness aspect of our mind, but
unlike counseling it includes acknowledge-
ment of our subconscious and unconscious
mind as well.
The fundamental process of psychotherapy
is to analyze mental and emotional thoughts
and experiences in order to alter the negative
effects they might have on one’s life. Although
mental and emotional thoughts and experi-
ences can be the principle expression of one’s
discomfort, there are innumerable reasons that
can be attributed to depression or anxiety. For
example, the belief that one has a disease as-
sociated with a particular personality trait or
disorder can cause depression and/or anxiety.
Psychotherapy has focused its concentration
on personality disorders as a disease of the
mind.
Psychotherapists search for the rudiments
of the culprit that is antagonizing one’s mental
state of being. Thus, it seems that psycho-
therapy seeks and defines depression and
anxiety as negative forces that cause some sort
of disease with which to be reckoned and sets
197

The Advantages of PsychoSpiritual Psychotherapy
its focus upon expelling these negative forces
from the mind. Grave efforts to eliminate these
negative forces are efforts that have nothing
but failure attached to them due to the fact
that its opposite effect might also become
the result, which is the loss of the positive
along with the negative. For example, those
individuals who have been abused mentally,
physically, verbally, and/or sexually often
fear getting close to another. Closeness might
put one in proximity to another that can be
interpreted as the same pain of abuse. One can
often repress the memories of the abuse by
not allowing closeness and thus not becoming
vulnerable to the potential abuse of others.
Forfeiting closeness to another for fear of the
negative consequences that may come with
it will most definitely cause one to forfeit
the opportunity for positive experiences that
may come with bonding. Repression of very
serious and formerly experienced occurrences
may cause some individuals to forfeit positive
life-conditions so as not to experience any
forthcoming negative life conditions. The fear
has become so severe that they just won’t be
happy, no matter what. That in and of its self
is depressing, especially because it is a choice.
Figure 2. Closed system of thought offers definition of issues resulting in knowledge and understanding
(Diagram designed by the author)
198

Psychotherapy focuses upon personality
traits and disorders that might be defined
as defective disorders that need to be fixed
or adjusted. Understanding the fundamental
ideas of psychotherapy leads theorists to the
original hypothesis that its application is for
the purpose of healing the mind. Psycho-
therapy, in general, has become a profession
designed to analyze these life forces in order to
manage their effects on one’s mental comfort.
Mental comfort is most necessary for being
able to live a happy, healthy, productive life
that enhances one’s self worth.
The progression of psychotherapy usually
begins with mental and emotional states af-
fected by fear. These alert us to negative life
issues. We seek treatment which often leads
to more fear since we gain realization (knowl-
edge) that does not lead to revelation (under-
standing). The cycle continues as we discover
the myriad of issues involved in the discovery
process. More and more knowledge can be
disturbing if it does not offer understanding.
This cycle can continue indefinitely with a
lack of understanding (see diagram below).
The most common forms of Psychotherapy
are:

The Advantages of PsychoSpiritual Psychotherapy
• Psychoanalysis: Utilizes verbalization of
all thoughts to formulate the nature of the
conscious, subconscious, and unconscious
mind.
• Psychodynamic: A form of deep therapy
focusing on present life situations that have
originated during development.
• Existential Psychotherapy: Explores
the challenges and paradoxes of human
existence.
• Humanistic Psychotherapy: Is concerned
with the development of the person fo-
cused on subjective meaning.
• Gestalt Therapy: This theory asserts that
no value is ever perceived except in rela-
tionship to a background of its opposite.
• Object Relations Psychotherapy: Seeks
to explore the individual’s discomforts by
examining him/her through his/her rela-
tionship with important people in his/her
life.
• Systemic Psychotherapy: Focuses on
people in relationship, groups, and their
patterns of behavior.
This author intends to promote the con-
cepts of PsychoSpirituality as an alternate,
if .you will, form of psychological treatment
for emotional and mental well-being. Its sig-
nificance addresses not only the homeostasis
of one’s body, mind, and spirit, but it also
recognizes that such balance is necessary for
the enhancement of one’s being (microcosmic
view) and the being of human consciousness
(macrocosmic view). Counseling and psycho-
therapy address an individual’s mental and
emotional well being with little or no attention
to addressing spirituality.
PsychoSpiritual Psychotherapy
PsychoSpiritual healing should not be im-
posed on everyone. Some individuals are not
interested in this particular effort while others
prefer a more personal focus upon their own
being and their own personal issues.
While counseling addresses the “solving
of problems” and psychotherapy focuses on
“analyzing personality” to achieve mental and
emotional health, PsychoSpirituality expands
these concepts of healing oneself mentally and
emotionally to include not only a transcendent
understanding of our personal purpose and
meaning, but also an understanding of how our
personal wellness includes our responsibility
to the wellness of other individuals, families,
society, and the world at large.
PsychoSpiritual healing appreciates the
relational aspects of negative and positive
forces and sees them as essential contribu-
tors to the wholeness of one’s human con-
sciousness and condition. In other words, it
is realized within this modality that positive
forces cannot exist without negative forces
since they have no possible way of being
defined as positive without the reflection of
their negative counterpart. To believe one can
have a positive life-cycle without negative life
forces, interrupting the pleasure of this state
of being, can only insight despair. Despair
is the most horrifying way in which one can
experience their life. The joy of living with
integrity cannot be achieved within the belief
systems that teach us that pleasure is the goal
of healthy living. Negative and positive forces
within the body are equally valuable. There-
fore to expel the negative would include the
elimination of anything recognized as positive.
PsychoSpirituality seeks to alter the percep-
tion of negative and/or positive, not eliminate
it, as if it were possible. The understanding
of this universal reality, that positive cannot
exist without negative, is the very quality that
is healing to one’s own being and the being of
human consciousness. Learning to understand
these traits and not to see personality traits
199

The Advantages of PsychoSpiritual Psychotherapy
and disorders as a disease could be the very
element in the personality required to pro-
mote success at every level. If the individual
possessing such a condition were taught to
embrace these traits or disorders, they might
learn to use them productively rather than
destructively.
The progression of PsychoSpirituality usu-
ally begins with treatment that will explore life
issues and offer a thorough understanding with
regard to their positive and negative effects on
our mental and emotional life. The focus of
the treatment is in the “realization” (gaining
knowledge) of one’s life issues and how they
can manifest a “revelation” (understanding)
of the positive and negative forces. Through
the interrelation of realization and revelation,
wisdom is gained, as exhibited in Figure 3.
For clarification, realization in treatment
is gaining knowledge of the life issues that
are disturbing one’s mental and emotional
health while revelation is the process of
sharing these issues with another (bonding)
Figure 3. Transformation (“Wholly Union of Selves”)
(Diagram designed by the author)
200

in order to gain understanding so that we can
transcend the positive and negative issues in
order to achieve wisdom.
This concept is the most germane to
PsychoSpiritual healing. For instance, being
controlling can be exercised to the point of
one’s own destruction, which either classifies
it as an obsessive personality disorder or it can
become a productive personality trait. Some
individuals can be taught to examine it and
allow it and its natural process to emerge and
then develop it into a skill that is necessary
for leadership.
PsychoSpiritual healing promotes the con-
cept that each individual must be responsible
for his/her personal health which will con-
tribute to the health and well-being of others.
PsychoSpiritual healing considers it most
important to heal one’s self for the purpose
of contributing that healing to mankind as a
whole. Although this may be seen as a massive
undertaking to consider this expanded view
of healing, a great deal of personal comfort

The Advantages of PsychoSpiritual Psychotherapy
is found in embracing this idea. In and of its
self, just considering this responsibility to
others is healing because it contributes to the
development of one’s integrity. It is accepted
that within the principles of such healing that
the contribution to the wellness of others
becomes the very reflection that we desire in
order to recognize the meaning and purpose of
our own self. This is easily achieved for those
willing to learn, teach, and incorporate these
principles of living with this level of integrity.
In contrast to psychotherapy, PsychoSpiri-
tuality considers depression and anxiety a gift
of/from the body. Just as a fever tells us that
there is an infection somewhere in the body
and that it needs a remedy for that infection,
depression and anxiety tells us that there is
an imbalance, a disturbance, or a conflict
within the body that needs resolution. We
PsychoSpiritual psychotherapists do not seek
to extinguish depression and/or anxiety until
its effects have taught us why they exist. They
are each magnificent physical expressions
that are necessarily included in and important
to the healing process. Without embracing
their presence, usually experienced by the
body, they can dwell in the mind alone, take
possession of all other thoughts, and haunt
an individual to death. The demonic appears
within once again. Our resistance to accepting
pain was taught with the first bandage that
covered our first injury. Ever since pain has
been defined as “bad.”
The applications of PsychoSpiritual Heal-
ing require the health of one’s body, mind, and
spirit. Within this modality, the homeostasis
of these three parts is considered an essential
requirement for mental health. Several mo-
dalities in psychotherapy focus on the mental
state of our being, only, and do not give equal
importance to the body. It is our body that
offers us the fever that alerts us that there is
something physically wrong inside. It is also
our body, which is capable of experiencing the
gift of depression and anxiety that alerts us that
there is something mentally wrong inside. It
is the body that conveys more language than
our words. We know when one’s words are
untrue by the way the body expresses itself.
PsychoSpiritual healing theorizes that each
is equal, body, mind, and spirit. Each plays
a part in the balance of life, personally and
cosmically. Each, body, mind, and spirit has
its purpose in the delivery of meaning and pur-
pose for all organisms, who in turn, have their
meaning and purpose, and on throughout the
cosmos. Have you ever seen a movie entitled
The Butterfly Effect? It is most important to
this concept. Simply stated, a butterfly will
flutter its wings in one location and it will have
an effect upon the entire world. It only takes
a thought to affect the world’s energy field.
The unification of our body and our spirit
is what needs be in order to reach the essence
of our soul. In the words of Pierre Teilhard de
Chardin, we “are not humans beings having a
spiritual experience; we are spiritual beings
having a human experience.” So many awe-
some experiences are conveyed through our
body, which communicates with our spirit.
For example, artistic depictions of pain and
pleasure, beauty and the grotesque, freedom,
dance, and musical expressions of romance,
love, hate, and fear are among the few emotion-
al states that elicit the mind, body, and spirit
to recognize “the rapture of being alive in our
bodies” as aforementioned by Campbell. The
relative value of their reflection of each other
can never be experienced without the presence
of the other. Love could not be identified as
201

The Advantages of PsychoSpiritual Psychotherapy
love without the knowledge and understanding
of our fear. Life would not be precious without
the knowledge of death. Just as God, who is
known to most, offers us guides that come in
the form of angels and devils, we have been
given the freedom to choose our path. Each
is of utmost importance in the development
of human consciousness. We are a polarity of
opposites, yet try to achieve the good without
the bad. We suffer to achieve this feat rather
than embrace our polarity and use it to gain
knowledge and, most important, understand-
ing about who we are. I find it interesting that
humans seem to be the only organisms that
have a concept of the demonic. Perhaps it is
all in our mind. Perhaps it is our mind.
BROKEN CIRCLE INDICATES
POSITIVE AND NEGATIVE DIVIDED
A broken circle, indicating positive and nega-
tive forces, demonstrates limitations in our
Figure 4. The divided self. Broken circle indicates
positive and negative parts of self separated.
(Diagram designed by the author)
202

ability to be able to roll about freely. This is
indicative of a divided self. This model would
ensure despair as it leaves the individual
presenting only a portion of who they really
are in the light and hiding the rest from him/
herself and others.
COMPLETE CIRCLE INDICATES
POSITIVE AND NEGATIVE UNIFIED
A complete circle, indicating the interrelation-
ship of positive and negative forces, demon-
strates the capability to roll about freely. This is
indicative of a unified self. This model would
insure the integrity of one’s self as it allows
the individual to present who they really are
in the light and dark aspects to themselves
and others.
Figure 5. Wholistically united self. Completed
circle indicates positive and negative aspects of
self unified.
(Diagram designed by the author)

The Advantages of PsychoSpiritual Psychotherapy
CHARACTERISTICS OF
HUMAN NATURE
There are five characteristics of human nature
that are considered of most importance to the
clinician offering a PsychoSpiritual approach
to healing. Primary importance is placed on the
whole person when considering this modality
as appropriate to specific cases. Therefore,
serious evaluation of a client’s physical, psy-
chological, mental, emotional, and spiritual
self is assessed in order to holistically mend
disturbances that could affect one’s character
(core), therefore, personality and behaviors. In
contrast, counseling and psychotherapy focus
upon mental and emotional issues. The follow-
ing descriptions will aid us in understanding
the comprehensive concepts that are necessary
for there to be holistic healing, or as I like it
call it wholiness, as depicted in the circles just
defined as our divided or whole self.
Physical: It is important to involve the
body in the healing process. The body must
be active and responsive to the brain and
its expectations. Movement in all forms of
purposeful work and play contribute a great
deal to one’s mental, emotional, and spiritual
state of being. It is important for a clinician
to know if there are any physical ailments,
limitations, or diseases that must be considered
in setting goals toward achieving wholiness.
For instance, Diabetes and such diseases as
Hepatitis, or immune disorders, cause a great
deal of depression. Additionally, some medi-
cations can be the origin of serious anxiety.
Addressed properly, these conditions must
be considered in the process of achieving
knowledge and understanding about what
these negative and positive forces might have
upon an individual.
The clinician can, then, proceed to offer
activities that would encourage the brain to
communicate with the body and the body to
communicate with the brain. Exercise could
be one example. As much as we might com-
plain about exercise, most of us can admit to
how wonderful we feel after a good workout.
Sexual activity may be considered the most
primary activity that unites the body and the
mind (brain) and the spirit. Sexual surrender
of the self to the communications of the body,
and the mind activate the spirit within us to
levels that may be considered the very tri-
adic condition that grants us aforementioned
wholiness. We transcend the mundane and
our consciousness and evolve toward another
plane of self-awareness. Knowledge and un-
derstanding our strengths and weaknesses will
accomplish the transcendence necessary to
live thoroughly, even with limitations.
Psychological: Translated, psychology is
the study of the psyche and is at the heart of
all analysis. The willingness to study, analyze,
and interpret one’s personal life at the deepest
level of privacy is crucial. At its deepest level,
the soul contains the lightness and the dark-
ness of our inner being or the good and the
evil aspects of human nature. Healing, from
this perspective, requires the holistic unifica-
tion of all facets of our inner being. Like a
puzzle, all pieces must fit together in order for
the image to be complete. The poem written
by Saint John of the Cross (1578), The Dark
Night of the Soul, emphasizes the importance
of exploring duality in one’s self in order to
achieve wholiness. It is important to recognize
that there is no clinician who can travel down
to the depths of their client’s “dark night” un-
less they have been there, themselves. Once
there, a clinician will know how to travel with
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The Advantages of PsychoSpiritual Psychotherapy
their client back to the light, which can be far
more frightening and painful than the dark-
ness. Once back within the light, all is clear;
sometimes too clear. Knowing is the process
of traveling to the darkness, but understanding
is the courage to travel to the light.
PsychoSpiritual Healing requires that the
client does not only gain knowledge about
one self but must understand their knowledge.
We can explore the pain of abuse but we
must understand how it has permeated every
aspect of our development. To just know it
may cause an individual to remain a victim.
To understand it and its effects upon our life
may allow us the freedom from its possession.
Mental: The knowledge and understanding
construed by our incredibly complex brain is
so primary to finding meaning and purpose in
life. The brain’s omniscient power is at the root
of all knowledge and understanding. Sigmund
Freud (1915) wrote about the conscious mind,
the preconscious mind, and the unconscious
mind. He describes that all that is realized is
equivalent to the tip of an iceberg submerged
in the deepest of oceans. Yet, he explains how
this buried portion drives us more forcefully
than the portion of us that is exposed.
Mentality is contained in the left hemi-
sphere of the brain’s cerebral cortex. It is the
part of the brain that is capable of deductive
reasoning. The logic of deductive reasoning is
important to information that is construed by
clients and experienced by them painfully; all
of which can be caused by distorted thinking.
Our mentality is a very cause and effect form
of thinking. Belief systems are developed out
of the labels that have been placed upon us
since childhood to describe who we are and
who we are not. Descriptions of our behav-
iors and attitudes by others begin to define
204

us, unfortunately for the control of others.
There is no realization that these labels could
be the distorted thinking of those who have
placed the labels upon us. We, each, develop
accordingly. The accumulated labels create
our belief systems about our self, others,
and our world. Counseling can restore more
accurate beliefs about one’s when clinicians
help clients to utilize the logic of reasoning
that can reinterpret these labels, and the belief
systems developed around them.
Emotional: Within the PsychoSpiritual
concept of healing, there are only two emo-
tions, love and fear (i.e. bonded and not-
bonded). Love is an emotion that allows us
to bond to our self through another. Fear is
an emotion that creates a feeling of being
unbonded to another and thus causes us to
avoid the other. Feelings are concepts that
are categorized within these two emotions.
Emotions are experiential (have an affect
which cannot be controlled) while feelings
are conceptual (can be controlled based on
life circumstances).
I wish to offer you my definition of love
and fear to demonstrate that they are separate,
yet not different. One cannot exist without
the other. They require each other to define
us, in order to delve into the deepest parts of
each other. Avoiding one for the preference
of the other only deprives us of the true es-
sence of each.
Love is the emotion that encompasses every
emotion from agony to ecstasy. Love is the
most sensational experience of pleasure and
pain. In spite of what we have been taught,
love is the most frightening, painful, blessed,
and magnificent emotion experienced by
the human spirit. (Caparros, unpublished
manuscript)

The Advantages of PsychoSpiritual Psychotherapy
Fear is the emotion that encompasses every
emotion from agony to ecstasy. Fear is the
most sensational experience of pleasure and
pain. In spite of what we have been taught,
fear is the most frightening, painful, blessed,
and magnificent emotion experienced by
the human spirit. (Caparros, unpublished
manuscript)
The emotions of love and fear cannot be
controlled. One can exercise every rational
reason why not to love someone with no ca-
pability. No matter how frightening that love
might be. Fear consumes us when we least
expect it and also takes on many forms such
as hate, prejudice, bigotry and judgment.
Spiritual: We seek bonding with others ev-
ery minute of every day since the very moment
we left the womb. Since the moment we are
“cast out” of paradise, the womb, our search
for self becomes essential to our existence.
This state of perfection is the first imprint upon
the human brain since it is our first relative
experience. The brain of the fetus was once
a blank slate only to become inscribed with
the most horrifying and painful experiences
at birth. At this moment we know Heaven
and Hell (Caparros, unpublished manuscript).
At birth we are squeezed through a birth-
ing canal, pulled toward a bright, and blind-
ing light, prodded, poked and pierced with
needles, and we are cold. We are tossed around
as if we were an entity without consciousness,
emotions, or feelings. The pain of this experi-
ence compared to the solitude of the womb is
torture. Forevermore, pain and fear become
linked. We fear pain and feel pain when we are
in fear, each associated with being unbonded.
But our struggle to survive is comforted by our
savior/caretaker. Once again, we are bonded
and know the difference. Being swaddled in
warmth, gazed upon, rocked, orally stimulated
with the nurturance of food, kissed, and cooed
with is that magnificent reflection that we will
search for throughout our lifetime. It will be
found when the rapture of being in love saves
us once again. In love, we are swaddled, gazed
upon, rocked, and orally stimulated with the
nurturance of kisses and the cooing sounds of
love-making. In the refection of the other, we
can begin to find our lost paradise and suffer
the fear of its loss gain and again.
The Bicameral Mind
Understanding the duality of our brain’s
hemispheres is necessary to comprehend the
opposites within our human nature. The term
‘bicameral mind’ was what Julian Jaynes
(1976) used to describe the dualism of our
human nature. One most pertinent reason for
dualism is that our brain is comprised of two
independent hemispheres that are responsible
for very different functions and interpretations.
For this reason, a great deal of our internal
conflict can be attributed to the responsibilities
assigned to either hemisphere. For this very
reason, a discussion of the brain’s complex
system of interpreting life is significant in
the process toward PsychoSpiritual healing.
The right hemisphere of the brain observes
the internal self, subjectively, while the left
hemisphere of the brain observes the external
self and world, objectively. The right hemi-
sphere is only capable of comprehending the
present, the “now,” the moment; yet it stores
each and every experience of its life. For some
this includes memories while in utero.
When recalled, the right hemisphere of
the brain can observe anything as if it were
present and happening at the moment of its
205

The Advantages of PsychoSpiritual Psychotherapy
recollection. There is no yesterday; everything
remembered exists in the “now.” The right
hemisphere also has no relative knowledge of
up or down, dark or light, hot or cold, heaven
or hell, love or fear, self and other. The left
hemisphere compares, judges, and organizes
everything. It is the portion of the brain that
analyzes everything to extremes.
The left hemisphere has its equal grandeur,
though. When images, feelings, or sounds
frighten us to death it defines the objects,
and labels them with names. The act of nam-
ing, defining, and labeling takes the image’s
power out of its overwhelming, all-consuming
strength. By offering this ability to define,
objectify, and categorize, the image is broken
down into portions that can be analyzed, and,
hopefully, controlled.
The left hemisphere of the brain thinks
while the right hemisphere of the brain experi-
ences. You can describe the process of erosion
with a clear explanation or you can build a sand
hill and demonstrate the process of erosion
by blowing on the sand hill. The knowledge
of the left hemisphere and experience of the
right hemisphere offer an understanding that
cannot be gained from simply the explanation
or demonstration, alone. The frontal lobes of
the hemispheres have the ability to unite the
knowledge of the left hemisphere and the
experiences of the right hemisphere; it under-
stands. It comprehends meaning not purpose,
being not doing, knowing not thinking.
So, the language in the left hemisphere of
the brain (body and flesh) is as equally im-
portant as the right hemisphere of the brain.
The integration of both is required for the
knowledge and understanding that both are
necessary for each of them to have the power
206

and courage to enter the realm of the frontal
lobes. There in the frontal lobes of the brain
lies Almighty Wisdom.
CONCLUSION
It is wisdom that heals; the transcendence
that comes with realization and revelation.
Wisdom harbors our spiritual essence and
grants us the courage to explore our knowl-
edge and understanding about who we truly
are and who we truly are not. This spiritual
journey toward discovering our knowledge
and understanding of our self will grant us the
true ability to live with the utmost integrity.
Remaining divided will truly cause us to suffer
the perils of despair. Until we become more
capable of taking the two different parts of
our self, positive and negative, and develop
the courage to unit them into a wholistic un-
derstanding of self, we will remain paralyzed
in the life-long process of knowing that we
will never understand.
REFERENCES
Campbell, J., Moyers, B., & Flowers, B. S.
(Eds.). (1988). The power of myth. New York,
NY: Doubleday.
Caparros, E. (n.d.). Beyond the looking glass:
A spiritual journey. Unpublished manuscript.
Erickson, E. H. (1964). Insight and responsi-
bility: Lectures on the ethical implications of
psychoanalytic insight (1st ed.). New York,
NY: W. W. Norton.

The Advantages of PsychoSpiritual Psychotherapy
Freud, S. (1915). The unconscious. In The
standard edition of the complete psycho-
logical works of Sigmund Freud (Vol. 14, pp.
159–204). Academic Press.
Hall, C. S. (1954). A primer of Freudian
psychology. New York, NY: Harper & Row.
doi:10.1037/10640-000
Jaynes, J. (1976). The origins of consciousness
in the breakdown of the bicameral mind. New
York, NY: Houghton Mifflin.
Saint John of the Cross. (2007). The dark night
of the soul. Shippensburg, PA: Destiny Image
Publishers. (Original work published 1578)
KEY TERMS AND DEFINITIONS
Cognitive Behavioral Therapy: Alters
thoughts, perceptions and therefore beliefs
about one self.
Dialectic Behavioral Therapy (DBT):
Increases awareness of emotional and cogni-
tive regulation by learning the triggers that
lead to reactive states.
Existential Psychotherapy: Explores the
challenges and paradoxes of human existence.
Eye Movement Desensitization and Re-
processing (EMDR): Designed to alleviate
the distress associated with trauma.
Fear: The emotion that encompasses every
emotion from agony to ecstasy. Fear is the
most sensational experience of pleasure and
pain. In spite of what we have been taught,
fear is the most frightening, painful, blessed,
and magnificent emotion experienced by
the human spirit. It is laden with everything
that exists on earth and I would venture to
say, beyond earth (Caparros, unpublished
manuscript).
Gestalt Therapy: This theory asserts that
no value is ever perceived except in relation-
ship to a background of its opposite.
Humanistic Psychotherapy: Is concerned
with the development of the person focused
on subjective meaning.
Love: The emotion that encompasses every
emotion from agony to ecstasy. Love is the
most sensational experience of pleasure and
pain. In spite of what we have been taught,
love is the most frightening, painful, blessed,
and magnificent emotion experienced by the
human spirit. It is laden with everything that
exists on earth and I will venture to say, beyond
earth (Caparros, unpublished manuscript).
Object Relations Psychotherapy: Seeks
to explore the individual’s discomforts by ex-
amining him/her through his/her relationship
with important people in his/her life.
Person Oriented: Posits that each of us
has the tools for wellness. It provides positive
regard, empathy and congruence to assist an
individual toward this goal.
Psychoanalysis: Utilizes verbalization of
all thoughts to formulate the nature of the con-
scious, subconscious, and unconscious mind.
Psychodynamic: A form of deep therapy
focusing on present life situations that have
originated during development.
Rational Emotive Behavioral Therapy:
An aggressive approach to challenging shame
based conditions.
Systemic Psychotherapy: Focuses on
people in relationship, groups, and their pat-
terns of behavior.
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Chapter 13
Truly Nourished
Christine Bandy-Helderman
Jupiter First Church, USA

ABSTRACT
A nutritionist presents case studies of patients who learned not only lessons about nutrition but also
lessons about life. Details about the patients’ stories are fictionalized, but the life lessons learned by
the patients and the nutritionist lead to reflection on healthy choices. The nutritionist uses her faith and
conversations with God to guide her as she helps patients.

To my Heavenly Father, first and foremost. INTRODUCTION

Thank you for your master plan and my place
in it. You and everything about you blows my
mind. You and how you work are awesome
and amazing. I am on your Public Relations
(PR) team, Lord. My mission is to continue
to declare and reflect your glory at all times.
May your light and love work through me and
be an extension and connection to everyone
that I come in contact with. Your Spirit truly
nourishes me. Help me nourish others. In
Christ Jesus, Amen.
I am the living bread that came down from
heaven. Whoever eats this bread will live
forever. This bread is my flesh which I will
give for the life of the world. (John 6:51 NIV)
When most people come for a consultation
in my office they have expectations of being
counseled and educated on health and nutri-
tion. The Registered, Licensed Dietitian/Nu-
tritionist (RD, LD/N) is the only health care
professional specifically educated and trained
in the science and application of nutrition.
Nourishing our bodies to help treat or even
prevent a variety of health-related diseases is
the focus. Nutritionists need to have training
and education on a variety of disease condi-
tions, anatomy & physiology, medication in-
teractions, diagnostic procedures, counseling
and behavior modification, laboratory tests,
and work with a variety of different health

DOI: 10.4018/978-1-4666-7524-7.ch013

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

Truly Nourished
professionals. I studied in college for seven
years receiving a Master’s degree in 1991
and then other advanced certifications and
ongoing training. It has not been until the
past few years, however, that I feel my true
training has really begun. What I call my true
nourishment and the true nourishment that I
bring to others.
Food and the eating experience are highly
individualized. We celebrate with food. We
mourn with food. We manipulate food with
our emotions. Some overeat when they are
depressed. Others eat less when depressed. We
have specific childhood memories of foods.
Some of these memories may include having
to choke down Brussels sprouts at dinner
before you can leave the table. Yep, that was
me and I have not eaten a sprout since! An-
other memory may be that fantastic smelling
and tasting sweet potato pie that Grandma is
known for and how it reminds you of feeling
loved and safe. I have also learned about and
enjoy working with a variety of different food
cultures and customs.
The main focus of my education and
counseling is a whole food, balanced focus.
This means focus on what came right from
the earth most often. More of the best (real,
whole food) and less of the rest (sweets, snack
chips…). The foundation of eating vegetables,
fruits, low fat dairy, lean proteins, whole
grains and healthy oils, nuts and seeds. Once
in a while we can enjoy special holiday and
celebration treats and meals or “wiggles” as
I explain in my office. Balancing a week of
eating should start with a foundation of real,
whole food and then we can balance with
some “wiggles” throughout the week. This
is a good and realistic balance. I see how
extremes with dieting and very unhealthy
extreme restriction lead to negative emotional
and physical health. The most healthy food
choices, the whole food choices are the real
deal. All the vitamins, minerals, protein and
other components necessary for health. The
processed, non-real-foods, are devoid of
anything of long-term substance. We do not
need these foods to survive. I think of the true
bread of life, our savior and Lord Jesus Christ
when I think of this type of true nourishment.
He is the whole food, the real truth to our true
nourishment. And since I am to reflect His
character, I must give all of me when I am
interacting with people. I can’t just give part
of me, or the processed, non-nutritious stuff.
I want to express to others a “whole me” like
the whole foods perspective. The true me, the
important part of me, all of me.
Every hour is a new adventure. My day may
start with a diabetic, move on to a family with
a three year old picky eater, switch to a forty-
something bulimic, a migrant farm working
family who all have high cholesterol, a few
more digestive conditions, some weight loss
education, and the day may finally close with
a sixteen year old with anorexia. Through-
out my day, I also receive random texts and
emails from clients with questions or press-
ing concerns. I often receive requests to just
send them some encouragement or words of
wisdom because they are stuck in their food
and nutrition planning. Or in some cases with
eating disorders and patients in recovery for
addictions, I receive panic texts of fear and
anxiety. Yes, food and eating related. These
clients are also working with professional
therapists and physicians and are encouraged
to talk to them and I am in constant communi-
cation with these professionals as well. There
is nothing better than a team of sensitive and
smart people!
209

I spend most of my counseling in individual
client and family sessions. I also enjoy speak-
ing in groups and giving lectures. I did a lot
more workshops and public speaking when
my time was more flexible. This was before I
was a mom! I love to share information in new
and interesting ways. I feel very comfortable
facilitating groups. It comes naturally. It feels
best, of course, when I am God-centered. I
really enjoy bringing out the best in people. I
get such a kick out of seeing a person’s reac-
tion when they understand a concept. When
they get that light bulb moment. I clearly feel
the most reward when I can help someone
make a God connection; not only a nutrition
connection.
I absolutely love working with all differ-
ent types of people and personalities. I truly
respect each and every person that I meet as a
unique individual. I think that God wired me
with a personality that was made to be a coun-
selor. I feel deeply and I am highly intuitive. I
do not always express my feelings, however.
I can discern when expressing my feelings
are appropriate. Kind of like a poker face. An
absolute non-judgment zone. I think that this
is what makes me a good, active listener. Very
little actually surprises me anymore. I have
heard it all. Just some recent tidbits include;
the twelve year old who told me her mom gave
her some of her diet pills to help her lose some
weight for her to fit in her Bat-mitzvah dress,
the sixteen year old who randomly during
our session rolled up the sleeve of her shirt
to show me recent self-induced cuts on her
arm that she had been hiding from everyone,
the sixty-two year old married woman who
shared with me that she just recently ended
an affair with a man half her years, the fifty-
something couple that could barely speak
about anything other than the tremendous grief
210

Truly Nourished
they felt after recently losing their daughter to
breast cancer, the thirteen year old girl who
told me in confidence that the only reason she
is not starving herself anymore is so that her
parents will let her stay in her private school
and buy more new clothes, the thirty-nine
year old childhood diabetic with two small
children who told me she does not take her
life-sustaining insulin sometimes when she
feels like she has gained weight and needs
to diet, and on and on and on. Real life, real
people, real stories.
Give them words of wisdom? Am I seri-
ously equipped for that? I think that all of
my forty-four years are still too young and
inexperienced for that! Doesn’t everyone
remember that I am a trained Nutritionist?
Seriously? And I don’t want anyone to think
that I am a know-it-all. Then I sit and ponder
a bit. Don’t I have a story? Don’t I have life
experiences that I have learned from and I
can draw from? This is especially true when
what a patient shares with me is relevant to
my own life experiences. I never give advice. I
do empathize with others and lend a listening
and understanding ear. I help others make their
own connections and to facilitate their own
behavior awareness and behavior change. I
definitely refer to mental health professionals,
addiction centers, support groups and medi-
cal physicians when appropriate. When my
eyes are open to where God is working and
my ears are open to what the Holy Spirit is
truly telling me and my heart is soft enough
to receive it all; well, yes then, I am able to
perhaps provide a few words of comfort and
wisdom from my perspective and experiences.
And if this is what God has equipped me to do,
to be open and listen, then He will provide the
tools I need and the strength and the wisdom
to do the assignment correctly. I trust Him.

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GRIEF-CONNECTION
I know grief far too well. I lost my hero, my
father, when he was 57 years old to metastatic
cancer. He went to the doctor one day and
two days later received the terminal diagnosis
and died in six months. I was pregnant at the
time. Talk about a hormonal and emotional
roller coaster ride! My heart will always be
broken to know that my kids will never be
able to have known their grandfather. At least,
not on this earth. I lost my best friend from
my youth Eric (37 years old), his father, and
his father-in-law in a tragic plane crash about
five years later. Eric was an integral part of
my life when I started my walk with Jesus as
a teenager. I re-committed my life to Christ
and completely surrendered to Him a few
days after Eric’s death. I believe that God
came to me in an amazingly vivid dream.
You must know that I very rarely remember
any dreams. This dream was so real that I
could not shake it for the next few days. The
impression that I received from this dream
was an incredible love and warmth and the
Spirit centering me.
I felt an overwhelming peace. I also felt
a need to go and use my gifts and do God’s
work. To work on my one-on-one with God
my Creator and Master. It made more sense
to me to use this tragedy to strengthen my
faith and my relationship with God. I just
felt as if I was wasting time trying to figure
out the “why did this happen?” For me, it
was more “what do I do now with what has
happened?”
Eric’s wife was pregnant at the time of the
accident with a one year old daughter. Those
babies will never know their dad. I still have
a difficult time believing that both of these
men that were so important to me and were
so critical in shaping the person I am today
are no longer here. These men left a legacy of
caring, love, feistiness, and intelligence that
I will always respect and treasure. There will
always be a hole in my heart for them. I felt
as if I re-lived my father’s death when Eric
died. I must have numbed out in the years
between as I was so busy “doing”; having
babies, running a business, etc. I was cop-
ing by “doing.” Eric’s death woke me back
up and re-directed me to God. I know we
will have an awesome conversation about it
when I see him again! I understand the grief
process. I totally get it. I get people’s grief.
DEPRESSION-CONNECTION
I know depression far too well. I have seen
it in my family, friends, and I see it almost
daily in many of the clients I work with.
Depression and anxiety seem to be par-
ticularly high due to the state of the world
we currently live in. Normal transitions
in life bring seasons of depression: death,
job change or loss, marital problems, sick-
ness, financial issues and more. There are
the normal life depression events and the
more unusual life depression events. These
unusual events are perhaps the made-for-TV-
movie, Desperate Housewives-type situa-
tions: men living two lives with families in
different towns, the adulteress showing up
at the front door of the cheating husband’s
home, the alcoholic soccer mom in denial
who gets arrested for DUI, the sociopathic
secretary who stole her bosses’ identity and
charged hundreds of thousands of dollars
in the bosses’ name or the cross-dressing
211

local doctor. Yes, these are just the tip of
the iceberg life situations that people have
shared with me. I also work with people
who have mental health disorders and for
them even normal life experiences take on a
whole different meaning. I sometimes work
with various personality disorders including
borderline personality disorder, dissociative
identity disorder (formerly multiple person-
ality disorder), bipolar disorder, Obsessive-
compulsive disorder, trauma abuse, etc.
With regular, and often intense, professional
mental health therapy and or medications
many people are able to function and work
through the anxiety and depression. Then
there are the saddest times when the depres-
sion is so severe that people just check out
from reality to cope. Some want to kill or
have attempted to kill themselves. I have
unfortunately worked with clients that have
done both. I will never forget the twenty-
two year old trauma victim, Sally. I worked
with her about seventeen years ago for help
with the eating disorder bulimia. She also
had a dissociative, or multiple personality,
disorder. Her pain was so great that she shot
herself in the head while in her car outside
of her psychologist’s office.
Heartbreaking pain. I see the pain that
depression and anxiety brings to the person
experiencing it, to their family and their
friends. I see how this can even translate
to a community feel of negativity. Do you
feel it too? It seems as if everywhere I go
recently that there is a negativity cloud, a
lack of joy. I see it in faces at the grocery
store, at my kids’ schools and after school
activities, at the mall, even at my church. It
is palpable to me and I feel it very strongly at
times. I get people’s depression and anxiety.
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IMAGE/PERFECTION-CONNECTION
I know what it is like to feel tired and what I call
“fuzzy-headed.” You have to understand this is
coming from someone with a ridiculously high
energy level. I am talking energizer-bunny
energy level. Multi-tasking, no problem! Be
the best, well, everything, no problem! Be a
super-student, super-Nutritionist, super-wife,
super-mom, super-friend, super-volunteer,
super-body, super-everything… Houston,
we have a problem! Super-Crash! My own
high expectations and perfectionism basically
burned me out. I have never had a clinical eat-
ing disorder. I get that question often. What I
had, I believe, was worse. When a client comes
to me with an eating disorder it is their way
of controlling life situations that are out of
control. It is a coping mechanism. When I went
through a period in college through my twen-
ties of controlling my weight it had nothing
to do with coping. It was all about pride and
vanity. I can control my weight and my body
right where I want it to be so that I could look
perfect. Not too thin, just thin enough that I
controlled every bite that went into my mouth.
I could not be “average” of course. I had to be
thin and lean, but not sick thin. Because then
how could I be the super-Nutritionist? This
had nothing to do with anxiety, simply pure
vanity. This tight control faded a bit after a
few years of marriage and then wouldn’t you
know I was diagnosed when I was thirty-five
years old, after my second pregnancy with
Hashimoto thyroid disease. My thyroid does
not behave the way I would like it to! Weight
gain, or difficulty controlling weight, can be
a result. I gained and subsequently lost about
sixty pounds with each of my two pregnan-
cies. The obstetrician loved teasing me, the

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Nutritionist, about it! Fatigue is also an issue
with thyroid conditions. This thyroid condi-
tion is controlled with medication but there
are days when I really need the extra cup of
coffee if you know what
I mean. I am a naturally thin, small-boned,
body type and I do take care of myself. The goal
now is to take care of the Temple of God and
not the temple of Chris. I get people’s issues
with weight control and fatigue. Interesting
how God works, isn’t it? I tried it my way and
attempted to control things and then in His
perfect timing, He steps in and steers me back
to Him. I get people’s issues with self-image
and expectations.
So, let me share a funny thing about per-
fection. My office is in a small professional
building with a variety of signs of our business
names and organizations on the outside wall.
Living in Palm Beach County Florida, there
is the occasional tropical storm or, thankfully
not as often a hurricane that manages to cause
the letters of the names to get misaligned.
I have particularly noticed that for the past
three years the letter “N” in “NutritioNal”
on my sign that reads “Christine Bandy, RD
Nutritional Consulting” has been obviously
slanted. I look at that sign every time I pull
up and park outside my office. The first few
months I would look at it and just get irri-
tated. I even mentioned it to my husband and
suggested that maybe he could come and fix
it soon. Well, that never happened! Months
passed and I assumed the office building
manager would probably have it corrected.
Nope, nothing. A few years passed and I found
myself looking at that letter N which appears
about to fall off and I smile. I think of that
sign when I think of myself and my attitude
about always having to get things “perfect.”
How the little things, what I call fluff-stuff,
could be so annoying and I would let myself
get so worked up about it. Oh my goodness,
the pressure I put on myself! Now I look at
that sign as a reminder of how perfectly im-
perfect I am. It is a daily dose of humility. If
that sign should ever get fixed that would be
just fine, but it will not be initiated by me! By
the way, the minivan that I have been driving
for the past six years with the unique bumper
scratches and numerous dings also helps my
dose of reality and I now giggle and just shake
my head when I look at it. That kind of fluff
stuff would have made me totally nuts in the
past. Not to mention the fact that I drive an
image-killing minivan! “Thank you, God for
not allowing me to be too caught up in the
comparison game. Continue to make me a
wiser woman. Thank you for equipping me
for my good and my bad and not equipping
me for anybody else’s.” I refuse to let myself
be defined by what I drive! And, remember
I shared with you that I giggle when I look at
my vehicle. Well, that is called contentment.
And for me, contentment is joy. It feels good
to not take myself so seriously. What a relief!
Yes, I definitely get people’s perfectionism
and image consciousness.
ADDICTION-CONNECTION
I know what it is like to have a family member
with an addiction. My father smoked ciga-
rettes since he was a teen. I never knew him
without multiple, daily smoke breaks. Luckily
he respected us enough to never smoke in the
house. He tried many times throughout his
life to quit and the addiction proved to be too
much for him. As heart-breaking as it was to
learn that he had terminal lung cancer, it was
not really a shock. Ironically, his mother, my
213

grandmother, smoked like a chimney until
she passed away at 90 years of age from non-
smoking-related issues. I am so sensitive to
any cigarette smoke that I call myself “the
bionic nose.” My children see people smok-
ing and immediately relate it to their health.
It can be quite embarrassing when they say
in a loud voice,
“Mommy look; they are smoking and they
are going to die!” They know that they never
met their grandfather because he died from
complications of smoking. Good life lesson
learned, but still heartbreaking. My daughter
looks at the picture of her grandpa Fred and
cries because she never got to meet him. So do
I. I have other family members that struggled
with alcohol and drug addictions in their youth.
The emotional strain on the family cannot be
put into words. Praise God they are recovered
and healthy today. I get people’s addictions
and addictive tendencies.
I have learned to switch gears quickly and
assimilate information even quicker. I also
have learned to be a keen observer. Isn’t it
interesting how food and meal planning brings
people together? Everyone has to eat! I have
been counseling and coaching people on their
health for twenty years. The past five years I
have observed that many of the clients and their
circumstances have been more challenging and
their stories have been more extreme. Then, a
thought hit me (or should I say, the Holy Spirit)
during my weekly Bible study exercises. The
circumstances in my work have not really been
changing. It is God changing me and working
in and through me! The more God-centered I
am, or as I call it having my “God antennae”
on, the more in-tune I feel in my connection
to the clients I am working with. The more
confident I feel in asking spiritual questions
or making comments. The more I connect to
impressions on my heart that I feel are Spirit-
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lead. As a younger health counselor who was
also less mature in my spiritual journey, I
would hesitate to talk about my faith for fear
of not being “PC” professionally correct. Or
even “politically-correct.”
So what happens when an experienced,
health and nutrition counselor begins to realize
that as she grows in her faith and connection
to the Spirit’s gentle nudging, that a new di-
mension to her health counseling emerges. A
deeper, more meaningful type of nourishment.
More than just the food planning and the nutri-
tion education that is typically provided in a
counseling session. What happens when this
professional Nutritionist opens all of herself
up and is fully present in the session? What
happens when she is actively listening to the
Spirit to guide and direct her in the session?
What happens when she no longer ignores a
heartfelt impression to say something or to act?
What happens when Christ in me is expressed
as an integral part of this interaction? True
nourishment, that’s what happens! My client
is truly nourished on a spiritual level because
a Christ-connection was made. I am rewarded
as the counselor with a true nourishment and
blessing as well. I have always known that
god has given me special talents and gifts.
There is no better affirmation than knowing
that how I use this talent is my special gift
back to God. Glorify His name! The more
I choose to be authentic and give all of me,
the more I receive and the more nourished I
become. This type of bread of life interaction
is life-changing for all involved when you feel
the Spirit directing and then you act.
People often just seem to open up to me.
One day, the kindest elderly woman caught
me off guard as we were finishing our session
together. “Doctor Christine” she says, (I ask
her to just call me Chris, I am not a doctor)
but she sternly corrects me and continues

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“Oh but you are my doctor, my food doc-
tor. And my blood sugars will be better now
thanks to you. And thank you for listening
to me go on and on and tell you about how
lonely I have been since my husband died
last year; I feel better talking about it. And
by the way, may I ask you… what is it with
you? Are you always this happy and positive?
I believe you are contagious!” I tell her it is
God in me that lights me up. She gives me
that all-knowing smile and nods and hugs
me before she leaves. Now that’s what I call
being truly nourished! An interaction that
started as strangers and about an hour later we
end with a hug and smiles. I am so thankful
that some clients feel trusted and respected
enough to share their stories with me. There
are times when they have even commented
that they didn’t expect to share what they did
especially since they thought it would only
be a “food” conversation. Guess they were
not anticipating some spiritual fuel or food!
I often will receive voicemails from clients
and they only leave their first name because
they feel so comfortable with me and they
assume I know who they are. I can usually
figure it out although it may take a little time
and backtracking into my agenda research! I
smile every time that happens because I know
that they feel that I cared about them and they
made a personal connection. That’s what hap-
pens when God is working. Real conversations
between people build real relationships. Even
if this is a professional type of relationship
there is a connection that takes place. An
interaction between people that is authentic.
My mission is to reflect God’s glory in every
interaction I have.
It is incredible to see how God works in the
wake. You know, that ripple effect that happens
when you connect with someone in a very
deep way and change that person in a positive
way somehow. By a word of encouragement,
a pat on the back or a high-five, a listening
heart. That person is changed for the better,
has been built-up and if even for that moment
or for the next few days feels that someone
empathizes with them and was understanding
or even actively and intentionally makes a life
change because of their interaction with you.
They are changed and then every person that
they may come in contact with experiences
their positive change and so on and so on. God
is working in that wake. He is there; in every
relationship and human interaction. There is
that body-of-Christ connection. I save letters
and notes from clients and professionals that
are expressions of gratitude for making a dif-
ference in clients’ lives. Helping them prevent
or treat a health condition or even a thank you
for exceptional encouragement and motivation
are so rewarding to receive. The notes that I
find to be most joyful and meaningful to me
are those that thank me for making a heart-
connection or God-connection in their life.
A thank you for helping to strengthen their
faith. There is truly no better affirmation for
me than that.
Father, I present myself to you today, a
living sacrifice, holy and pleasing to you.
Guide me and direct me though your Spirit.
Open my eyes so that I truly see where you
are working. Open my ears so that I truly hear
and understand what the Spirit is telling me.
Soften my heart so I am receptive. Purify my
motives so it is all about you and not about
me. Help me to do your good. Help me to
reflect your glory. Amen. This is part of my
conversation with God before I begin my day
of work. This is my daily dose of joy every
morning along with my nice cup of coffee. I
need His strength to get me through the day…
and the caffeine doesn’t hurt! And yes, I am
a Nutritionist and I won’t give up my coffee!
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The following stories describe interactions
with a few clients. The purpose in sharing is to
seek good nutrition but even more so healthy
spiritual nutrition in order to focus on spiri-
tual nourishing and connecting. Their names
and personal identifying details have been
changed for privacy. The stories you read are
composites and are not one hundred percent
true due to protecting patient confidentiality;
specific identifying facts have been fictional-
ized and several patients’ experiences have
been combined into one story. The stories are
told with the intent of illustrating experiences
common to multiple patients without describ-
ing the personal story of any specific patient.
My purpose in sharing the lessons learned is
for you as a reader to apply healthy nutrition
to your life and ask for help when needed.
A list of references from websites such
as www.apa.org from the American Psycho-
logical Association and www.allianceforeat-
ingdisorders.com follow the narratives and
provide more specific information about the
medical conditions such as multiple personal-
ity associative identity disorder experienced
by the patients in the stories.
This would be a typical day of counsel-
ing for me. Everyone I meet has amazing
stories. I see some patients only once or just
a few times. I work with others on an ongo-
ing regular basis. What I have included in
parenthesis within these interactions are what
I am thinking, what I am experiencing being
in the moment and the impressions that I am
feeling from the Spirit while I am in session
with my client. The true nourishment exchange
is when I am fully aware of God’s presence
and He is centering me and I am using my
gifts and talents that He has given me to
serve and love whom I am with and give this
as a gift back to God in the hope of pleasing
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Him and glorifying His name. It is a win-win
interaction. I can almost hear Him whisper
in my ear softly, yet very clearly “Well done,
my good and faithful servant, well done.” My
heart automatically smiles. There is no better
affirmation for me than that! The following
patients remind me of Christ’s example of
true nourishment. My hope is that you will
feel inspired by the genuine interactions that
we share and you, in turn, will feel inspired
to share some spiritual nourishment with
those that God has put in your path as well.
This is reinforced in 1Timothy 4:6 (NIV); “If
you point these things out to the brothers and
sisters, you will be a good minister of Christ
Jesus, nourished on the truths of the faith and
of the good teaching that you have followed”.
The generous will themselves be blessed, for
they share their food with the poor. (Proverbs
22:9 NIV)
Zora
Zora is a sweet African-American woman
from the Island of Antigua. Her island accent
is so pretty that it sounds as if she sings when
she speaks. She is almost five feet tall and is
put together from head to toe. She is wearing
a burgundy and floral tailored skirt outfit and
matching hat. She is freshly lipsticked with a
bright, beautiful smile. She is about to have
her 87th birthday. She was referred to me to
help her with a diabetic meal plan. I also
noticed that she was carrying about three or
four large bags. I wondered to myself why
she didn’t just leave these things in the car.
She also appeared to be limping a bit as she
entered my counseling office. Was it because
of the bags she was carrying? We would get
to that later in our conversation.

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“I just want you to know from the start that
I live alone,” she tells me in a matter-of-fact
tone. “I do not cook, I do not want to start
cooking, and I am just too old and tired to
spend a lot of time preparing food.” (I hear you
loud and clear. I feel the need to ask about her
family and friends). I respond by reassuring
her that we can put a healthy plan together for
her that will require limited preparation and
cooking. She was pleased and I felt her relax
a bit. I ask her if she has any close family or
friends that help her. She tells me that she
has never married and she came to the states
to train as a nurse. She spent most of her life
working as a nurse helping sick people. Her
only family is an ill sister in England and an
estranged brother who lives in the Islands.
She is, in fact, on her own.
We finish working out a basic diabetic meal
plan for her. I finally ask this kind, gentle lady
why she is carrying so many bulky bags. “I
told you that I don’t cook” she laughs,
“Well, I don’t drive either! I take the bus
everywhere,” she continues, “I was ready three
hours before our appointment today so that I
could get to the bus stop and then get dropped
off at the mall down the street to be here on
time.” I am calculating that she walked about
a half mile to get here from the mall. This
beautifully dressed, independent 87 year old
lady! She does this routine to get to all of her
doctors and appointments. She also takes the
bus to the grocery store and somehow manages
to carry the items back on the bus and then
walks back home. Of course she doesn’t cook!
She is always on a bus or walking to a bus!
I am really liking this lady. (I feel a genuine
warmth and connection to her).
I find out she only lives about ten minutes
away from where I live. The route would take
me from my office and only a few minutes
off my normal route home. (I feel such a deep
impression within me to offer more of me to
her). “You know, Ms. Zora,” I explain, “You
live right in the middle of the route from my
home to my office,” I tell her that it would
be no trouble at all to swing by and drop off
things to her from the grocery store now and
then if she ever needed it. She looked shocked
when I told her this. I could tell that she did
not want to inconvenience me.
We finish our counseling session and com-
plete a practical meal plan for her lifestyle.
She tells me that she would like a follow-up
appointment but that she is having a knee
replacement procedure in one month and
will be unable to get around for a short time.
Now I understand why she was limping into
my office. We close by scheduling a follow-
up appointment for three weeks. Ms. Zora
leaves my office on route to her walk back
to the bus stop. I have to admit that I was left
with a feeling that I could not shake. I would
have driven her home if I did not have back
to back appointments that morning. She left
an impression on my heart and I just knew
that I would be seeing her again sooner than
our next scheduled meeting. I remember tell-
ing my husband about her later that evening.
There was just something about her!
My week of counseling continues normally.
Three days after meeting Ms. Zora, I get a
call from her. I am between sessions so I can
actually pick up the phone and speak without
the usual voicemail retrieval. She asks me if
it would not be too much trouble to bring a
few items by her home on my way home from
the office today. She explains that her knee
was really uncomfortable and the thought of
hiking it on the bus was too exhausting. I was
so happy that she called me. I also knew that
she must really be hurting for her to reach out
to me. Did she have the same impression that
I did when she left my office? Did she feel a
217

heart connection? I write down her food list:
milk, bread, cheese, peanut butter. She tells
me that she can wait for the vegetables and
fruits until next week.
I leave my office that afternoon and drive
straight to the grocery store. The timing was
perfect to drop the items off to Ms. Zora and
then pick up my kids from school. I find her
apartment easily. There are very few low
income housing areas in our town. This was
a small section of apartment buildings a few
blocks from the local hospital and close to
medical offices. I remember her sharing that
she lives in close proximity to her medical
doctors. I arrive at her apartment. She lives in
a corner unit with a small front covered patio
area. She has a chair, a few potted plants and
other nick-nacks. The front door and window
of her apartment displays a variety of pictures,
writings and signs. Most of these were expres-
sions of faith, praise to Christ Jesus, and other
joyful and positive affirmations. My heart
smiles as I read all of them and wait for her
to answer the door.
She opens the door and I have to con-
centrate harder to recognize the lady that I
met at my office just a few days earlier. She
is without her makeup, hairpiece and fancy
clothing. But I definitely recognized the bright
eyes and big smile. I bring the food bags in
with a few extra items, fruits, vegetables and
other staples that she could freeze for later.
I look around the tiny home. There are piles
of household items everywhere. She shows
me around and we put the food away in her
kitchen. While we are unpacking we have a
wonderful conversation and we learn more
about each other. I tell her about my family
and she tells me more about her younger
years. Currently, she is trying to organize for
her knee replacement procedure. She plans to
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go to a rehabilitation facility and is not sure
when she will return home. She has also been
attempting to find a nursing home facility to
move to as she requires more assistance and
she finally admits that she needs more help.
I would have liked to stay longer but it was
time for me to leave and pick up the kids. I tell
her to call any time as I pass near her home
often. “Ms. Christine,” she states in a quiet,
serious voice, “I am between my assistance
payments and will you please not deposit
this check for the food until next week?” “No
problem, Ms. Zora,” I answer knowing full
well that I will not be depositing the check at
all (it simply feels wrong to take her money
from her). There are many times, most times, I
feel the need to pray about something and get
direction from the Holy Spirit before making a
quick decision. And then, there are those times
when I feel in the moment what direction the
Spirit is leading me. No question, just act.
I see Ms. Zora a few weeks later for her
follow-up appointment. Instead of her spend-
ing half of her day to come to my office I decide
to make a home visit. Her diabetes is stable
and she is ready for her knee procedure. She
is obviously anxious. I stay a little longer and
we just visit. The conversation shifts to faith.
I tell her about how important my faith is to
me and I talk about my church family and she
shares her faith in Jesus with me as well. She
is familiar with my church as it is only a few
minutes from her home. She asks if she can
come to church with my family some time.
“Want to come this Sunday?” I ask her. “I
would love to,” she answers. You know how
some conversations are so natural and easy?
This was one of those conversations.
That Sunday my husband, myself, and our
two kids pile in the car and pick up Ms. Zora
for church. She is perfectly dressed with a big,

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bright smile. We enjoy the sermon and fellow-
ship together. I have a chance to introduce her
to some friends and she actually reconnects
to an elderly lady friend that she had not seen
in a long time. Was this out of our comfort
zone as a family a bit? Escorting an elderly
African-American little lady to our affluent,
mainly Caucasian church? Yes, it was! It was
a wonderful learning moment for our kids
as well as for my husband and for myself.
Isn’t it always in the moments that we make
ourselves more intentionally vulnerable and
get out of our comfort circles the times when
we inevitably grow the most. This was one
of those times. It was a blessing for us and it
most certainly was a blessing for Ms. Zora.
Ms. Zora had an unremarkable knee re-
placement with subsequent long-term reha-
bilitation and was away from her apartment
for about two months. The rehabilitation was
longer than anticipated. We spoke on the phone
a few times during this time. She called again
when she was settled back in her apartment
for a week. My daughter and I brought a few
groceries to her and visited. This time she was
noticeably upset and anxious. She was hav-
ing a difficult time calling and coordinating
her continued care at home and she was in
desperate need of assistance with basic needs
such as bathing. I felt her desperation. I was
frustrated for her as I listened to her struggles.
It only took a few hours of my time, but I was
able to make some calls for her to coordinate
home care, doctor questions, transportation
and medication needs. She was so grateful and
it was a pleasure to be able to help her. As we
were leaving she looked at me with her smiling
eyes and told me that she saw Jesus in me. Of
course my eyes then filled with tears at her
sincerity. Honestly, it was the least I could do
but it made all the difference in the moment.
Wasn’t I seeing Jesus in her though? Then, I
think of the scripture, “whatever you did for
one of the least of these brothers of mine you
did for me.” (Matt.25:40 NIV).
I was looking at Jesus when I looked into
Zora’s eyes! Many people who come to my of-
fice are poor to some degree; poor financially,
poor in health (physical or mental), or poor
in spirit. When you think of that exchange as
taking place between you and Jesus, it really
changes perspective! Another bread of life
exchange. I call it part of my circle of joy!
Today, Ms. Zora is still in her apartment
on a waiting list for a skilled nursing facility.
Her new knee gets her to the bus stops more
efficiently and with less pain. She gets together
with neighbor friends more often and is less
isolated. We speak on the phone and to each
other’s voicemails often. When I hear her
beautiful island accent it always makes me
smile. She is to call as soon as she hears that
she has found a space in a nursing facility.
My family plans to help her pack and she has
already showed me what items she wants us to
bring to charities. She is still sharp and funny.
We are planning another Sunday church time
together now that the New Year has begun.
And to think this relationship started months
ago at my office like any other normal consult.
The prompting that I felt from the Spirit and
my subsequent acting is what made the ordi-
nary become extraordinary. Truly nourished!
A poor man’s field may produce abundant
food, but injustice sweeps it away. (Proverbs
13:23 NIV)
Eduardo
I was introduced to Eduardo when I received
a referral from an insurance agency asking if
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I would help to evaluate one of their patients.
This was a workman’s compensation consult.
I rarely work with these cases as nutrition is
not usually relevant. I basically knew that
this must have been some sort of accident or
injury related situation.
The insurance representative explained
that Eduardo was a paraplegic and has had a
history of unresolved skin breakdown or skin
ulcers on his lower backside. This can happen
in paralysis cases due to lack of mobility and
long periods of inactivity. He also suffers from
recurrent urinary tract infections. This cycle
of chronic infections as well as skin break-
down puts him in and out of the hospital for
long periods of time. The insurance company
asked that I consult on this case to evaluate
Eduardo’s nutritional status. Proper nutrition
is critical in wound and skin healing as well
as for optimal immune system support.
The agency coordinated his transporta-
tion to my office. I was not prepared for him
to actually arrive lying belly side down on
a stretcher. He told me later that he was not
allowed to be sitting and the doctor wanted
him to be in this position to allow for better
skin healing. I have a very small counseling
office so I immediately re-arranged some
chairs to clear a path for him and we spent the
consult talking. I am sitting next to his head
as he is turning to speak with me while lying
in that position.
I know very little about the details of his
accident. I only was told that he was working
for a roofing company and one day on a job
he fell off a roof and was left as a paraplegic.
Eduardo is a 25 year old, Latino, soft-spoken,
young man with noticeable tattoos up and
down both arms, shoulders and up his chest
and neck. I even noticed one tattoo behind
his ear along his hairline only because of the
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Truly Nourished
position he was in while speaking to me. His
face lights up with a big toothy smile. He tells
me that he lives by himself and has a home
health aide that comes daily to assist him
with activities of daily living. He was quite
independent, able to cook for himself and do
other things around his apartment. However,
due to the skin breakdown he is unable to do
any of these things now.
Our conversation reviews in detail what a
typical day of eating is like for him. He tells
me that after he wakes up his aide prepares
a hot meal of eggs, bacon or other meat, and
bread. His lunch currently is take-out food
from a close Spanish restaurant and is usually
beef, rice and beans. His aide leaves about four
o’clock in the afternoon but puts food near
his bed for him to eat for the remainder of
the day. He may have some lunch meat sand-
wiches and snack chips. Throughout the day
he snacks on chips, crackers, breads, and des-
serts like cookies. His main beverage is soda
and some milk. He was prescribed to drink a
fruit-flavored drink that is for skin integrity
although he does not drink it consistently. I
also learn that he takes no vitamin or mineral
supplements. He also shares with me that his
budget is very tight and his attorney is helping
to provide him with more long-term support.
Eduardo is a charmer and he gets a mis-
chievous look in his eye when he tells me that
I am a pretty lady and asks if he can take a
picture to put in his phone. I smile and tell
him to take it quickly so we can get back to
work! He laughs. (It hits me at this time how
heartbreaking this situation is and I am deeply
moved and feel overwhelming empathy for
him.) This young man was probably hanging
out with his buddies and meeting girls and just
starting his life when the accident happened.
His friends don’t come around as often now

Truly Nourished
and he is flirting with his Nutritionist who is
more than fifteen years older than him. His
day consists of just trying to get through the
basics; cleaning, dressing, eating, etc. He
needs to use a catheter to be able to urinate
and has constant urinary tract infections. He
tells me how depressed he is. All I can do is be
there to listen. Believe me, I did the absolute
best listening that I could do. Heart, body,
soul and mind listening!
We finish our meeting and I explain my
concerns for his nutritional status. The great-
est concern was the lack of any nutrient-dense
foods in his diet. His diet was totally lacking in
healing vitamins and minerals that are mainly
found in fruits, vegetables and whole grains.
These nutrients are crucial for skin healing
and immune support. And to make matters
worse, he was never prescribed or recom-
mended to take multivitamin and mineral
supplements in addition to wound healing
antioxidant supplements. This is nutrition 101
for this type of case. We schedule a follow-up
consult for a few weeks and I work on putting
a consultation report together with my treat-
ment recommendations. My heart breaks as
the transportation personnel come to wheel
Eduardo out on the stretcher out of my office
and through my small waiting room in which
my next client and family is waiting. Everyone
is moving out of the way and clearing a path.
He waves to me and gives a shy wink as he
is pushed out the door and is lifted into the
medical van. Before meeting my next client, I
need to be still in my office and talk to God a
bit. (Father, how may I best serve this young
man?) I could not shake the memory of him
lying on that stretcher.
I immediately send my consultation report
out to the referring agency as well as to Edu-
ardo’s physician. Little did I know that this
would start a litigious chain of events that I
have never dealt with or been exposed to be-
fore in my work. A few days later I receive a
call from Eduardo’s attorney asking to review
my impressions and recommendations. I am
happy to explain the nutritional needs and
treatment recommendations as I want him to
receive help as soon as possible. We speak
for about a half hour and review Eduardo’s
nutritional goals.
A few weeks pass and it is time to follow-
up with Eduardo. He comes to the office via
stretcher procedure as before. After reviewing
his diet and interviewing him again I learn
that none of my recommendations have been
put into practice. Everything has remained
exactly as it had been when we saw each other
initially. The skin breakdown is the same and
apparently he is just coming off another round
of antibiotics from another urinary tract infec-
tion. I send another report. Eduardo seems
much more depressed today. I try to remain
positive and encouraging for him. I also tell
him “Eduardo, I want you to know that I am
here for you, not for any attorneys or agencies,
just for you. I really want to help you in any
way I can.” He smiles back at me and tells me
how much he sincerely appreciates that and
it means a lot to him. I see a little more light
in his eyes now before he leaves.
The following week I receive a message
from a consulting physician regarding Edu-
ardo’s case. I return the call hoping that this
physician will be able to get some positive
action. As it turns out, the physician is calling
to understand and clarify my recommenda-
tions and to actually warn me that it looks as
if what I have recommended is excessive. He
also warns me that it looks as if I am trying
to “milk the system,” I am dumbfounded. He
continues to explain that Eduardo’s attorney
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put a package of recommendations based on
my conversation with him. To say that he
embellished a bit would not do this justice!
Apparently, the attorney recommended, based
on what he stated was my recommendation,
that Eduardo receive home-delivered gourmet
meals from a private chef, nutrition follow-up
consultations monthly, high-end supplements,
continued personal home health care, an exces-
sively high food budget, and other “padding’s.”
All of these requests were also extrapolated
to basically cover his entire lifetime which
amounted to millions of dollars. Furthermore,
the attorney gets paid according to the percent-
age of what the settlement amounts to. The
larger the settlement, the larger the law firm’s
paycheck. I could not believe what this case
was becoming. I was also feeling very naïve.
I clarified with this physician what my basic
recommendations were and he documented
this in his report as well. I was under the im-
pression that Eduardo’s attorney was request-
ing extra help until his wounds healed. It turns
out that he was estimating costs for the rest
of his life. This physician was also there, in
part, as an expert for opposing counsel. Was
anyone truly on Eduardo’s side?
The next week I received a call from
Eduardo’s opposing attorney. They were also
calling to clarify what my actual recommen-
dations were. I was put in the middle of op-
posing counsels. I was a pawn. Eduardo was
a bigger pawn. One side wanted the biggest
settlement they could obtain and the other
was attempting to give the least amount as
possible. Yes, I know, not surprising but I
had never experienced this before and I felt
in over my head. And my thoughts come right
back to the client, Eduardo. No wonder he is
depressed! Look what he has to deal with. I
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want him to get what he deserves and requires
but I know that he does not need a personal
gourmet chef to heal!
So what do I need to do to obtain clarity?
I talk to God. (How do I help serve Eduardo
with the most integrity?)
What came to me next was a very clear im-
pression. This case is all about money. (Chris,
be a consultant for this case and don’t make it
about money at all. Be truly on Eduardo’s side).
Another week passes. Then I am visited by a
representative of the court. Yes, I was served
legally to be an expert witness at a deposition
for this case. These attorneys could not negoti-
ate without an actual formal deposition. This
drags out the case even further. Eduardo, by the
way, is still not eating any fruits, vegetables,
enough protein or consuming any immunity
supporting supplements.
The deposition day finally arrives. This is
my only deposition that I have been served in
my twenty years of counseling. I have been
served many subpoenas requesting medical
records but it has never come to a deposition.
It is Eduardo’s primary counsel that requests
the formal deposition. His associates are in
the deposition via speaker phone. Opposing
counsel is represented there as well. The
questions keep coming to me. We review
my education, certifications and experience.
Finally, long-term care cost questions come
up. “Eduardo will be seeing you monthly
for consultation,” the attorney states. “How
much do you estimate that to cost?” he asks.
“Nothing,” I answer. “There is no charge for
my services”. Everyone is quiet and they just
look at each other. “Eduardo is unable to have
food prepared correctly with his home health
aide so we are recommending a private chef
for daily meal preparation,” he continues. He

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asks me, “Do you agree with this recommen-
dation?” “No, I do not feel that a private chef
is necessary. If Eduardo’s aide is educated on
nutrition requirements and practical menu
planning there should be no reason that he
can’t get what he needs,” I answer. The at-
torney continues his questioning, “What do
you estimate the cost of working with the
aide to be?” “Nothing,” I answer. “There is no
charge for my services and I would be happy
to work with the aide and any translators to
work out a healthy plan for Eduardo”. Now,
the transcriptionist is smiling as she is record-
ing the conversation. The deposition finally
ends cordially after the other requests were
all reviewed. The settlement, I believe, will
probably fall in the middle of both counsels’
requests but it will certainly not be slanted
anymore to either extreme. I left there with a
sense of peace knowing that my services were
not caught up in the money battle and I felt
that I was a true patient advocate.
I am happy to report that Eduardo’s nutri-
tional plan has changed for the positive. He is
eating more balanced, nutrient-dense foods.
He has the appropriate immune and wound
healing supplements and protein supplements.
It took a few hours of my time to work with
translators, Eduardo and his home health aide
but it was fairly simple and straightforward to
accomplish. I remain a consultant for Eduardo
and his agency, pro bono, if they should require
nutritional consulting services in the future.
Maybe I am naïve to think that my actions
would help change the way people think about
their actions. Maybe that transcriptionist will
tell the story of her day because it made an
impression on her and then that ripple effect
will continue. Well, I can hope it may have!
It was just the right thing to do, you know?
To God, I give the glory! Truly nourished!
For the kingdom of God is not a matter of
eating and drinking, but of righteousness,
peace, and joy in the Holy Spirit. (Romans
14:17 NIV)
Dan
I worked with Dan for two years before his
recent move to Connecticut with his family. He
was referred to me by his psychologist. Dan
is a very successful CEO in his mid-fifties.
He is soft-spoken, handsome, intelligent, tall,
well-dressed and always ahead of schedule.
Dan has a very unassuming energy about him
considering he is in the high finance field
and is responsible for a multi-billion dollar
organization. He travels often for his work and
because of his demanding schedule we have
consultations about every one to two months.
The referral for nutrition counseling was
due to the fact that Dan had begun a weight
reduction program on his own but was con-
tinuing to lose weight when he should be
maintaining his new healthy weight range.
Dan has only recently started seeing the psy-
chologist as well. He shared with me that he
sought psychological help when he realized
that his eating was not normal. He reached out
for help when he could not change this eating
behavior on his own. He was also saturated
with anxiety.
Dan grew up in a family that loved food
and everything about food and eating. He
was overweight most of his early years and
became quite overweight as an adult. On and
off dieting, weight loss and subsequent weight
regain became an ongoing pattern throughout
his adult life. He started another weight loss
diet nine months ago and lost fifty pounds.
His weight was 185 pounds. A very healthy
weight for his six foot frame that he has not
223

seen for a very long time. Something was dif-
ferent this time though. He continued to keep
losing weight. He checks his weight and he
is now down to 175 pounds. A few months
later his weight hits 168 pounds. People begin
asking him if he has an illness or cancer. None
of his clothes are fitting. He recognizes that
this is not a healthy place for him to be but
he simply cannot bring himself to change the
strict eating regimen that he put himself on.
He was also exercising in the gym for at least
one to two hours daily.
Dan recorded a food journal for me so
that I could get a more accurate account of
his intake. He had a very small variety of
foods that he felt comfortable eating. Most
of his choices were pre-packaged food items
so that he could be absolutely certain of the
nutritional breakdown. He totally avoided fats
such as oils, butter, mayonnaise, and salad
dressings. He also avoided foods containing
fat such as cheese and nuts. His dessert treat
every evening was an unusual concoction that
he made for himself. Fat free Cool Whip, a
little sliced fresh fruit and topped with fat free
chocolate syrup. He said it helped with his
sweet tooth but did not leave him feeling guilty
after eating it. His comfort circle was limited
to fat free milk, fat free yogurt, egg whites,
skinless poultry, most fruit and vegetables,
low fat granola bars, low fat cereal, oatmeal
and other limited whole grains in very small
portions. He grazed throughout most of his
work day, eating a little something every hour
or so and then had a dinner meal at home with
his wife and high school aged daughter. Their
two other children are in college. I remember
thinking to myself that this food recall reminds
me of some of my adolescent anorexic patients
that are barely one hundred pounds.
Traveling did not really seem to bother
Dan’s plan because he found it fairly easy to
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Truly Nourished
select his safe foods while out in restaurants.
Grilled fish or chicken, dry salad and veg-
etables was a constant choice. He would just
bring his safe granola bars with him and rely
on fruit until dinner. What did bother Dan,
however, was any special occasion dinner
with his family or even worse, a work related
fixed dinner where he could not modify the
choices. He explained to me that he would
have panic attacks and become paralyzed
with anxiety. If he did in fact eat more than
what he thought was reasonable, he would
beat himself up later that evening and for the
next few days. He told me that the guilt and
shame that he feels is suffocating. He loves his
family dearly and they are a great support to
him but even they were losing their patience
with his compulsive behaviors. I remember
this conversation in particular because his
face lights up when he talks about his family
and having them all together.
We have this following conversation almost
every time that we meet together. He is such
a rational, logical thinker. He tells me that
he feels ludicrous coming to see me and he
hears how ridiculous his behavior sounds.
He is learning with the help of his therapist
that recent and past life circumstances have
contributed to his overwhelming anxiety and
he has been using food to cope. He is very
committed and is one of the most compliant
and motivated clients that I have ever had.
Every meeting we would modify his eating
plan gradually and begin adding to his food
variety and improving the balance of his plan.
His goal planning consisted of small risk-
taking trials and over a short period of time
he regained his weight back to the healthy
185-190 pound range and felt much more
comfortable with the process. Now we have
the challenge of helping him to continue to
normalize his eating and take more risks with

Truly Nourished
food choices. He also challenged himself by
being more spontaneous with choices and was
even feeling better in the fixed social dinner
environments and often over-did it and was
able to be more at peace with it. He always
checked in with me and only had weight checks
at my office so as to desensitize the hold that
the scale and the numbers have on him. I see
this CEO visibly shaking with anxiety at times
when he first gets to my office so that we can
get his weight check over with. If we did not
complete the weight check at the beginning
of the consult, he has told me that he would
not be able to concentrate on one word that
I say to him.
Then just when things seem to be moving
forward I get a voicemail from Dan that he
has to cancel his follow-up and he will call
back to reschedule. That is not like him. He
usually asks for another time slot immediately.
(I am feeling like I should call him and talk
in person). I called him right back and he
admitted to me that he backslid and was too
ashamed to see me. We set up a time to meet
in one week. I don’t think that I would have
heard from him for at least a few months if I
hadn’t called him then. I probably would not
have seen him until after his family reunion
and he would have missed a great growth
opportunity.
At our next consult we get the forward
momentum back in gear. He has his nutritional
goals and strategies back in full force. His next
big social event is his nephew’s Bar-Mitzvah.
His whole family will be there for a reunion
and he seems very excited to see his college
kids. He reminisces by sharing with me some
stories about his own kids’ ceremonies. I had
recently been to a family friend’s Bar-Mitzvah
and had a wonderful time. The conversation
turned to the religious meanings and parts
of the ceremony that were particularly heart-
felt for both of us. He was surprised when I
told him that I have a Jewish heritage. My
mother’s family is Jewish and I know that
one grandparent migrated from Lithuania. His
eyes opened wide as he told me that it is the
mother’s bloodline that determines it and he
has the same ancestry. I think I am somewhat
of an enigma when I share this with Jewish
clients. I have many close Jewish friends who
tease me a little about my heritage as well.
They really don’t know quite what to make of
it because they know that my Christian faith
is very important to me. We sometimes refer
to the Hebrew Bible stories that are common
to us all. I have overheard our kids chatting
together at family get-togethers about what
they both learned in Sunday school and once
they studied and learned the same scripture!
I also have celebrated with them on various
holidays and broke fast with some close
friends during last year’s Yom Kippur, the
high holy day of the year. I look at it as a neat
witnessing opportunity. What is very palpable
in my experience with my Jewish friends is
their expression of great joy and celebration
during these ceremonies as well as when we
are gathered together socially. I feel their
strong bond, their hope, and their expression
of community and it is very beautiful.
I felt that our religious conversation natu-
rally lead me to probe his thoughts a bit more.
(This isn’t about food. Ask him what brings
him joy, I felt a prompting) “Dan”, I ask, “What
is your joy?” Without hesitation he answered
that his joy was his wife, children and family.
I continue to ask some follow-up questions.
“How much time and energy do thoughts of
food and eating distract you from being fully
present with them and enjoying your fam-
ily and your time together?” We ended that
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session with a risk goal. Dan was going to
try to be as present as possible at the family
reunion, eat any food that he really wanted,
and make it all about the ambiance and the
people. Not the food.
Just for this one particular time. He was
then going to process the event and his feel-
ings at his next therapy session.
Dan accomplished this risk goal. It was
not at all easy and uncomplicated but he
definitely pushed himself and gave the food
much less focus. He beamed when he told me
about the great time he had with his family
and close friends. His wife told him later that
he seemed more relaxed and he acted like
his old, happy self. The best part was that he
was able to let the evening go the next day.
There were no checks and balances and there
was no guilt. For every three steps forward,
Dan will probably have a few steps backward
here and there. What he shared with me that
was the best part of this risk challenge was
that he put all of his energy into people and
relationships. Being together, great laughter,
fun and meaningful conversations. “Isn’t that
what living is all about?” he comments with
a big smile. I think back to the anxiety-ridden
man that I first saw in my office almost two
years ago. What a wonderful transformation!
Dan gave me a giant goodbye hug on our
final meeting before he packed up and relo-
cated due to his company’s restructuring. This
was a positive move for him and his family.
He promises to send an email update when
he can. “Thanks for your constant encourage-
ment” he says as he is leaving. “You have a
strange job, you know. I work with concrete
facts and numbers every day. You have to deal
with trying new methods and being flexible.
I‘ve thought a lot about your joy question. I
make sure to think about it every day. Thank
you.” As he is leaving I think, no, thank you
Dan. And thank you God. Truly nourished!
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He upholds the cause of the oppressed and
gives food to the hungry. The Lord sets pris-
oners free. (Psalm 146:7 NIV)
Tina
Earlier in this manuscript I mentioned that very
little surprises me anymore in my counseling
experiences. Well, this is one story that is an
exception. I am still getting more chapters of
this story as I continue to work with Tina.
But the chapters I have heard thus far have
seriously shocked me to my core.
I met Tina as she was referred to me by
her long-term psychologist. He recommended
that she have a consultation with me as she is
struggling with the eating disorder bulimia.
She was quiet and slightly guarded at our first
meeting and I could tell she was seriously
checking me out. She presented as overweight
and slightly disheveled. She looks much older
than her forty two years. I discover that she
has lived by herself for the past few years and
is on disability assistance due to her physical
and mental conditions. She appears very pale
and her eyes are bloodshot. I later come to
find out that she probably appears that way
because she purged (self-induced vomiting)
her lunch an hour before our consultation. We
concluded our initial visit and her assignment
was to keep a food journal of everything she
eats, the time, and the quantity and bring
that back to review in one week. I also asked
her to journal any time that she purged. The
meeting was fairly unremarkable but I had a
sense that she was holding back, as most of
my new clients do until they get to know me
and feel more comfortable with the process. I
had not spoken to Tina’s psychologist yet as I
wanted to review her journal first to have more
details to discuss with him. The clear message
that I did get at this initial consultation was
that Tina was in great emotional pain and her

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active bulimic behaviors were also adding to
significant physical pain. Her limited finances
also made it challenging for her to receive
thorough and regular medical care. To add
fuel to the fire, most of Tina’s scarce monthly
budget is spent on large volumes of food due
to the nature of this condition. She may eat
large volumes of food and then immediately
purge it and go on to consume more later. This
may lead to her falling short on her budget at
the end of the month and unable to buy fuel
for her car so she can’t make any scheduled
appointments or important meetings.
Tina returns one week later with her com-
plete food journal. She appears to be more
talkative and is wearing nice clothes and fresh
makeup. She shares with me that just keeping
the food journal and trying to follow some
of the guidelines that we discussed helped to
make her feel a little better. She still struggled
with a large amount of purging this week.
Throughout our discussion I learn more about
her daily routine and weekly schedule. I learn
that she attends a small church that is led by
a young pastor. She sometimes works at the
church and helps with small jobs. She also
has a dear friend that she meets with regu-
larly who is a spiritual support person. She
has no family that she keeps in contact with
and I learn that most of her family, including
daughters, grandchildren and parents are out
of state. She was divorced from her husband
a few years ago and that is when she went on
disability. The conversation diverts back to
her meal plan and food journal. She explains
that she is going through a particularly dif-
ficult time emotionally right now because
of the time of the year. It happens to be the
week before Halloween. “People talk about
their kids trick-or-treating and what costumes
they will be wearing” she says, “But they have
no idea what is really going on.” Tina’s eyes
start to well up and tears fall down her face. I
bring her tissues and listen. “Halloween is the
most horrible day of the year,” she continues,
“This day is celebrated by certain groups of
people. I used to be the person who celebrated
this day.” After she is able to compose herself
she goes on to tell me that she grew up as a
child in a satanic cult in the western states.
There were satanic customs, ceremonies and
“sacrifices” throughout the year but espe-
cially on Halloween. She also tells me how
heart breaking it was for her to learn that her
daughter recently had a baby boy and her
ex-husband, the baby’s grandfather, was the
only other person there for the delivery. It was
the satanic custom to dedicate the new birth
to satan. I did not even know, nor did I want
to know exactly what that meant. Her entire
family was part of this cult and her father
was a leader in it. Her marriage was arranged
within the cult and her entire family remains
a part of it today.
I am sitting there and actively listening to
her. Quite honestly I felt like I could have been
in a candid camera show or one of the newer
“punked” shows. I felt as if at any moment
someone would jump out from behind a curtain
and tell me that I was on a show and everything
was made-up and “ha-ha” wasn’t that funny.
There aren’t really satanic cults around, are
there? I am thinking, isn’t that all movie and
book stuff? That couldn’t possibly be true?
My thoughts are spinning as she is telling me
these things. Then my thoughts shift to her
mental health. Maybe she is a histrionic and
she is embellishing a bit? Maybe she is just
delusional? I remain poised with my profes-
sional poker face. She continues to tell me
some more memories. She remembers being
a teen and her mother actually brought her
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to a local church counseling pastor. She was
brought there for help with depression. She
confirms my surprise at how her satanic fam-
ily would bring her to a church for counseling
but she did tell me that they would never step
foot in the worship center. They only went
to the office section. Then she tells me that
for the next year, this male pastor sexually
abused her during the regular “counseling”
sessions. She never told anyone at the time.
OK, when is the camera guy going to jump
out and tell me it is all a made-up story? I’m
waiting. I cannot even wrap my head around
what she is sharing with me. And honestly,
I am not even sure it is true. So, I listen and
empathize with the pain that I see her express
in the moment. It really is not my place to
determine if this is true or not. We finish our
session, establish continued nutritional goals
and plan on another follow-up in one week.
I make it a priority to speak with her psy-
chologist as soon as possible. I need to process
this with him and determine how I may best
be able to help with her treatment. So, I fi-
nally hear back from the psychologist and he
confirms that these are true stories. He goes
on to tell me that Tina’s abuse history is the
worst he has heard in over twenty five years
of practice. You name it, it happened! This
therapist continues by saying that despite it all,
Tina has found a way to live and grow; mostly
due to her relationship with the Lord and her
strong determination. What complicates her
case even more is that she has major Bor-
derline Personality Disorder characteristics
in addition to her trauma abuse, alcoholism,
drug addiction, eating disorder issues, bipo-
lar disorder, anxiety, major depression and
Dissociative Identity Disorder. She has only
recently integrated her personalities in therapy.
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We end our conversation with him expressing
that Tina is truly a testament of God’s grace
and the human will to survive. I have not yet
had a chance to discuss when she found the
Lord and made that amazing transformation.
You can bet I will though; when the time is
right. I cannot even imagine what Tina has
witnessed and experienced in her life. And
what a reality check for me! Evil is alive in
this world. It is not just in the supernatural
realm. It is alive in ways that I truly could
never imagine as I live in a normal, sheltered
slice of suburbia.
I feel better equipped when I meet with
Tina for our next follow-up session. I am no
longer distracted with the details of what she
is sharing with me. I am focused on listen-
ing to her and helping her to figure out how
she will best meet her nutritional goals. We
review her food journal together. Every day
of the week she has purged about seventy five
percent of any food consumed. This means
that she is purging at least three to four times a
day every day. Her throat is hurting, her back
and neck are hurting. Her voice is horse. She
tells me how hopeless she is feeling. She is
alone, broke and isolated. She is full of painful
memories and nightmares. Then she just sits
and breathes deeply and lets out a big, ugly
sigh. She is looking at me, eyeball to eyeball.
What am I supposed to say? I sit silently look-
ing right back at her. (The prompting I feel
from the Spirit is palpable) I calmly ask her,
“Tina, have you prayed about this?” “What?”
she asks back. “You are asking me that? My
pastor asked me the same thing!” I continue
gently. “Well, have you?” She answers me
with a shy smile, “No, I haven’t,” I tell her
that I will be praying for her as well. This is
the conversation that has started a wonderful

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bond and relationship. I believe that this was
also the conversation that pushed me totally
outside of my comfort zone for what was yet
to come.
I often have clients call and leave messages
regarding schedule changes or quick questions.
I normally do not return calls over weekends
and clients are aware of this. The weekend after
my last consult with Tina I noticed that she
left me a message when I was getting ready
for bed. It was late on a Friday night (I felt the
deepest impression to listen to the voicemail).
The message simply stated to please return the
call when I was able. Nothing more (I knew
that I had to call her; it was my voice in my
head telling me to call her now). I called her
back and she was very quiet at first. I imme-
diately sensed that something was not right.
She said that if she told me something she
was not sure what I would do. I knew it. I felt
it right then and there. And then she said it.
“I am having thoughts about killing myself,”
she tells me. I remain very calm. (I feel the
Spirit’s calming presence). She continues by
telling me she has a plan in mind (the Spirit
is strong). I immediately direct her and give
her exact and specific things to be doing. I tell
her to call her psychologist and her pastor and
911 herself and that if I do not hear back from
her in exactly 2 minutes, that I will be calling
911 to her home. She does what I ask and I
hear right back from her. In the meantime I
have also called her psychologist.
During our next phone call she tells me
that her pastor is on his way to pick her up
and bring her back to his home with his young
family for the weekend. Until he got there, I
just continued to keep her talking and I kept
giving her specific directions and I helped
her pack her bags by phone. Tina ended up
having a very nice, therapeutic weekend with
her pastor’s family. Although she was a little
anxious to go back to her home and be alone
she shared with me that it actually felt good
to have her space back. For the first time she
told me that it felt more like coming home
when she returned. Crisis resolved!
I have to admit that my adrenaline was still
pumping two days later! “Why me?” I asked
God. I had only met with Tina a few times. I
am the Nutritionist, remember? I remembered
the last time I met with her. I asked her if she
prayed about her situation. Was that the con-
nection that made her think of me? I wrestled
with God on this one a bit. I was totally out
of my comfort zone and I felt inadequate. I
finally threw my hands up, shaking my head,
and said “OK, God. If this is where you want
me, bring it!”
Two nights later I received a text message
from a fifteen year old client’s mother. I actu-
ally heard my phone chirping from the other
room. I was already in bed. (I feel a strong
prompting to get out of bed and go check it
out) This is what I read: “Lisa just swallowed
some pills and told me that all she wants to do
is go to sleep and never wake up. What do I
do?” Are you kidding me? Seriously? This is
what I am saying in my head. This particular
incident was not as scary because my client
was a minor and her family was there. I call
her and tell her to go directly to the emergency
room, call her therapist and her doctor! This
teen stayed in the hospital for the next few
days. “OK, God. What are you trying to tell
me? Did you need to put this situation in my
path so that I knew you were really working
here and in the crisis with Tina? Did I need
this invisible slap across the face to actually
hear you speaking to me and telling me to
get outside of my comfort zone and act on
the impressions that I was feeling?” My head
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was spinning. I also remember speaking to
this mother about faith and I knew that they
had a church family.
Is that why they thought of me and reached
out to me? “OK, God. I hear you loud and
clear. I’m in. Your will be done.”
I have not seen Tina for a few weeks.
It turns out that during one of her purging
episodes she fell in her bathroom directly on
her face and actually broke her nose. She has
not purged since because the pain is unbear-
able. Distancing herself from this purging
behavior will really help her because it is
such an addictive and unhealthy cycle. I text
her knowing that what I wrote would make
her smile, “OK, God, whatever it takes!” She
writes back, “Thanks a lot, it hurts a little
when I laugh too. Ha ha!” We have another
follow-up scheduled soon.
I received a Christmas letter from Tina and
it is an honor to share part of it:
Dear Christine, There are no words to thank
you for all you’ve done for me. Your guidance,
teaching me, patience, compassion, even guid-
ing me to the Lord. You brought light into my
life in a very dark time, you still are. I pray the
Lord brings you abundant blessings. Merry
Christmas. Love, Tina.
Reading that letter was like hearing God
speak directly to me. “Yes, God. If this is
where you want me, bring it!” Truly nourished!
I will be fully satisfied as with the richest of
foods; with singing lips my mouth will praise
you. (Psalm 63:5 NIV)
Liz
Some stories are great testimonies to the
absolute faithfulness and grace of God. This
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is one of those stories. My main role in this
client connection was to be an active listener
and to be totally inspired. Liz was referred to
me by her gastroenterologist due to her recent
diagnosis of Irritable Bowel Syndrome. Her
symptoms of chronic diarrhea, bloating and
pain were slowly resolving and she wanted
nutritional counseling and education on a
long-term approach to help in controlling this
condition. Liz, her husband Sam, and three
children ages five, seven and ten recently
moved here from North Carolina. Liz is a
Licensed Mental Health Therapist and they
relocated for Sam’s new engineering job. I
liked her immediately and felt a connection
right away. They are in their mid-forties. She
shared with me that they were settling into
their new Florida surroundings very well
and had family and close friends in the area
as they visited the state often. They have also
already found a church home. We review the
nutrition education information fairly quickly
and have a lot of the hour remaining. The last
educational tidbit that I reinforced with her
was to be careful with too much stress as that
may aggravate the syndrome. “Stress?” She
laughs, “Let me tell you about some stress that
changed my life before our move!”
About a year ago, Sam was experienc-
ing a lot of anxiety at work. That is one of
the reasons they relocated. He was able to
find a new position, actually a promotion,
in Florida with the same organization. Dur-
ing this anxiety period Sam started to have
insomnia. The fatigue factor seemed to fuel
the anxiety so he finally went to his doctor
who prescribed sleeping medication. Sleep
was better regulated but Sam was still expe-
riencing job-related anxiety. Liz also shared
that she thought he was having some mid-life
issues as well. This was just fuel to the fire.
After discussing this at his next doctor’s visit

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Sam agrees to try an antidepressant medica-
tion that is also indicated for anxiety. He took
this medication daily for about four months
but felt that it made him too drowsy during
the day and the anxiety was still lingering.
The medication was not really helping the
situation. The doctor suggested switching
to a new medication but Sam decided to just
stick to the sleep medication and go off of
the antidepressant. Liz worked with many
clients, as a professional therapist, who did
well with this medication but also told me
that there is such an individual tolerance and
many clients trial a variety of medications
and combinations until they experience relief.
I see this in my practice as well. With Liz’s
complete support, Sam decided that he would
not pursue any more meds.
The next chain of events as Liz continues
her story, was an emotional roller coaster. A
few weeks after stopping the antidepressant,
Sam begins to feel very energetic and his
outlook is very positive and strong. He sleeps
less hours, even while still taking the sleep
medication, but does not feel tired. He starts
doing all of these jobs around the house that
he was putting off. He even tackles new jobs
like redoing and renovating the garage and
installing recess lighting in the kitchen. He
is more boisterous and at times even annoy-
ing. His normal soft spoken voice is loud.
Liz tells me that Sam has always been a very
laid-back, reserved and sweet man. Think of
an intelligent, absent-minded professor type
with attention deficit tendencies. His aggres-
sive behavior is starting to get on her nerves
but she enjoys his new assertiveness and take-
charge attitude as she normally performs that
role. This new, take-charge behavior continued
for another few months.
Then things began to change. It was subtle
at first. Sam’s aggressive behavior faded and
he seemed to present more like his normal self.
He was back to not doing much around the
house anymore! But something was different.
He actually became even more quiet, reserved
and started isolating himself. Liz noticed him
pacing more and rubbing his head in a nervous
manner. He would not open up to her.
Sam and Liz are connected on a very
spiritual level. They plan a weekend retreat
together at a Christian center a few hours from
their home in North Carolina. Liz is thinking
that the timing is perfect and maybe Sam
can take this time to relax and get spiritually
renewed. The trip was even his idea. They
begin the drive and are about two minutes out
of their driveway when Sam turns to look at
Liz and tells her he can’t go. He feels as if he
can’t breathe and his heart is pounding. He
looked scared. Liz thinks he is having a panic
attack. They turn around and go home and sit
and talk calmly. Then together holding hands
they both got on their knees and prayed for
strength and guidance.
Sam told her that he felt better just talking
with her and connecting to God together. They
decide to continue their trip. The weekend
turns out to be a beautiful retreat. They were
both engaged in the lectures and participated
in the small group experiences. Sam even
chose the prayer focused small group which
was surprising to Liz because he is normally
introverted. He told her that it was where he
felt the Spirit leading him. Liz reads scripture
and inspirational readings aloud as Sam drives
them back home when the retreat ended. Two
days later Liz notices Sam doing that weird
pacing thing again and mumbling. He isolates
again. She is very concerned. They discuss
this and Sam agrees to see a mental health
therapist for counseling.
A month goes by. Sam has seen the coun-
selor, who is also a minister, two times. His
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anxiety remains high; it has become toxic.
He still continues to function but any work
related thoughts shoot his anxiety through the
roof. His home, family and faith are his peace.
Throughout this year Sam has been training
in prison ministry with his cousin, Chuck,
who has been involved for many years. They
attend weekly studies together and plan on a
weekend visit to a local prison to meet and
witness to the inmates. As introverted as Sam
is, he is open to the leading of the Spirit, and
intentionally gets out of his comfort zone. He
has been looking for opportunities to serve
and when a potential opportunity did not
work out at his church he put his time and
energy into the prison ministry program. The
morning Sam and Chuck were planning to
meet the ministry group at the prison he had
another panic attack. The computer system at
his national office crashed and it completely
paralyzed Sam. He is extremely professional
and felt, even though other associates could
step in to help, that he should stay until the
problem was resolved. After an hour of intense
work and coordinating, Sam still went on the
weekend. The weekend proved to be extremely
therapeutic for the prison inmates and espe-
cially for Sam. At the end of the program Sam
began to open up and be honest with the group
and poured out his anxieties. Liz told me that
the ministry team saw this as an exceptional
gift to the inmates, who were all believers.
Many of whom will never be released. They
were given the opportunity to actually sup-
port Sam! Think how rewarding that must
have been for them. These prisoners, crimes
unknown to the group, were providing words
of comfort and scripture that was meaningful
to them during their incarceration. Aren’t we
all at some point, prisoners and slaves? The
Lord sets the prisoners free!
Now the reality check part of Liz’s story.
While driving home from the ministry week-
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end, Chuck called Liz to say they were on their
way and that he needed to speak with her as
soon as they got there. Liz immediately felt
her heart pound out of her chest. She sensed
that something was off. They arrive at her
home and Chuck immediately asks where
they can talk while Sam quietly walks into
their bedroom. Liz notices him curling up
and just lying in the bed. Chuck explains
that the weekend can be very emotionally
and physically exhausting. He adds that, in
Sam’s circumstance, it had been exceptionally
demanding because he shared a secret that he
had been keeping to himself for the past two
years. Liz told me she felt the room they were
in closing in on her. Chuck then tells her how
much Sam puts her on a pedestal and how she
is his life. “Remember Liz,” he continues, “It’s
all about love. It’s not about material things.
Love is everything”. Liz told me she was
thinking, yes, of course I know that, what is
he telling me? Chuck continues to report that
Sam told them that he was a failure and that
he did not do a project at work correctly and
he thinks it is only a matter of time before he
is found out and he will probably lose his job.
Because Sam is in a very small field and he
has a high paid position, he will probably not
be able to find a comparable job. He also has
a non-compete clause in his contract. “Liz,
be prepared to lose this house, your savings
and probably your retirement.” “Make sure
you tell Sam how much you love and forgive
him.” Liz told me that she felt like she was
being “punked.” I laughed when she said this
because I have often used this description.
Chuck left and Liz went straight in to talk to
Sam. Sam told her more about the report that
he did not complete and that he felt as if he
was a total imposter. Liz told Sam that they
would get through this together and that she
did love and forgive him. “What are we going
to do?” Sam asks her like a small child.

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Liz immediately goes into “fix it” mode.
For the next forty eight hours Liz educates
herself on engineering equipment policies and
protocols and actually puts what little informa-
tion Sam has gathered for the past few years
together into a completely organized report.
Her anger grew as she shouted orders to Sam
to do this part of the report and follow-up on
those emails! Sam seemed to implode. The
more Liz pushed him, the more he went into
his own world. He did not even attempt to
do the things she asked him. He kept telling
her it was too hard and it wouldn’t make any
difference and what if it isn’t good enough?
Liz is thinking that he has become her fourth
child. She is also thinking very unkind things
about her husband. She did not sign up for
this! She confides that she can forgive and
love but he is not even making an effort to
fix anything. He is not even willing to help
his family try to salvage any shred of dignity
they may have left. “That I cannot forgive!”
she tells me. Sam regresses further into now
what seems to be a twilight zone of behaviors.
They barely talk to each other for the next few
days. Liz’s cold shoulder toward him is obvi-
ous. Liz finally gets a call from Sam’s boss.
He says how concerned he was after speaking
on the phone with him. Sam was speaking in
broken sentences and he wasn’t even sure that
it was him because he sounded so odd. Liz is
desperate. She asks about the report. His boss
has no idea what she is talking about. Sam
is a superstar in their eyes and he keeps the
company afloat! He goes on to explain that
that particular assignment is in the planning
process and Sam is not even responsible for
it! Liz feels that she is smack in the middle of
a twilight zone. Why in the world was Sam
behaving this way? Sam’s boss said he would
drive to their office and speak with Sam di-
rectly. Liz went home. Her head is spinning.
She immediately feels guilt for acting the way
she did toward Sam when he was in obvious
pain. Liz told me that she was alone in her
house, dropped to her knees and prayed. She
completely surrendered herself to the Lord and
His will. She asked for forgiveness when she
tried to fix this mess on her own and closed
Him out. She was completely broken. She
asked Him what she should do. She remained
there on the floor on her knees and told me
that she felt a thought, heard her voice in her
head, saying “pack a bag,” She immediately
packed a few clothes, toiletries and a Bible.
After speaking with Sam’s doctor and
therapist, she met Sam and his boss at their
office. Sam was barely speaking. He asked
her where they were going. Liz answered that
they were getting more help. They drove to
the local hospital emergency room which is
standard procedure to rule out any medical
reason for his bizarre behavior. Nothing medi-
cally significant was revealed and Sam went
voluntarily to the psychiatric facility on the
hospital grounds. He remained there for four
days. He was put on mood stabilizing medi-
cation and taken off his sleeping meds. Sam
rested as best as he could in the facility but
he really could not relate to any of the other
patients or their situations. These patients, all
ages, had long term psychiatric conditions
that they were struggling with for their whole
lives. Sam had always had a stable, secure,
non-eventful mental health history. After a
thorough psychiatric evaluation this is what
the doctors determined. Sam had a very rare
medication induced mixed episode reaction,
like a bipolar event, when he was taken off
the antidepressant months ago. It was like a
rebound effect. He experienced a milder manic
episode, which makes more sense during the
time of his unusual assertiveness, and then
as the doctors described it, when you go that
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high you can inevitably crash back down. And
Sam certainly crashed. His mind fixated on a
project at work and for some reason twisted
it and escaped from reality for a short time
to cope.
The doctor told Liz, who also knows her
professionally, that this has only happened to
one other patient that she has worked with.
She reassured Liz that this was most likely an
isolated event and for Sam to stay away from a
certain class of antidepressants. The hospital
was not the best therapeutic environment for
him. He needed to be with Liz and his family.
Liz brought him back home and he took off
work for the next two weeks. They prayed
together daily and Sam was able to recuperate
and try to wrap his head around the chain of
events that they had experienced. His work
was totally supportive of him as well. In time,
life returned to a normal rhythm again. Sam is
currently thriving and taking no medications;
not even for sleep. Medications are critical
for so many individuals. Most of the patients
with eating disorders that I work with would
not recover without them. For Sam, however,
these meds were like poison.
Liz has been able to meditate on and pro-
cess the events of the past six months. Sam
is still processing it. Liz shared with me that
her marriage has never been stronger. They
have both been spiritually renewed as well. Liz
was able to tell me some intriguing thoughts
that she discovered while looking back at
the entire situation. She pointed out that the
closer she and Sam drew near to God, the
weekend retreat and Sam’s prison ministry,
it seemed as if the evil one lashed out even
stronger. During both of these times, when
Sam was paralyzed with panic, they prayed
and surrendered to the Lord. They did not let
evil in. They could have easily not gone on the
retreat or participate in the ministry weekend.
But that was what the evil one wanted. Don’t
mess with the children of God!
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Liz also thought about the variety of dif-
ferent outcomes they could have experienced.
Sam could have, in fact, screwed up at work
and lost everything. Would their marriage have
survived? Where would they be living? Would
Liz have to try and be the main breadwinner
for her family? Or maybe Sam would keep
his job but mentally never be the same person
again. Would she be strong enough to handle
that? Did Sam actually have an underlying
mental condition that did not express itself
until he was in his forties? What would have
happened if Sam did not go away and open up
and talk during the prison weekend? Would
he eventually have become so depressed that
he would not have been able to voluntarily
check into the hospital? That would have had
a negative impact on his professional future
for sure. But, nope, none of the above. God
was merciful and faithful and His grace was
absolutely amazing. Not only did the worst
case scenario not even come close to happen-
ing, nothing even potentially negative resulted.
Apart from a very large piece of humble pie
for them both, and Sam still trying to get over
the feeling of embarrassment caused by his
behavior, God closed this chapter in the best
possible way.
They are both better for it and hopefully,
in time, they will be able to share their story
with more people as an example of the faith-
fulness of God. Without question, their story
had a great, positive and inspiring effect on
me. Maybe this was God’s master plan all
along! Surely it was. A wake up call to rein-
force having a complete dependence on God
and relying on Him for everything, especially
when you feel as if your life and everything
you thought was real was suddenly pulled out
from under you.
Before Liz leaves my office we pray to-
gether, a prayer of praise and thankfulness to
God. Was I expecting this consult to end this
way? Not at all. Was I surprised that we spent

Truly Nourished
most of the time talking and sharing stories
of faith? Not really. That is how God works.
Truly nourished!
CONCLUSION
So this is only a sampling of some of the
clients that I see. Each of these clients is
being encouraged and listened to, and then
each interacts with others and so on and
so on. The God ripple continues. I work
part-time at my office and see about 20-30
clients a week. This is a lot of connections!
What would have happened if I did not
act on the impressions that I was feeling?
The nutrition counseling sessions would
have probably continued. Would they have
been reflective of all of me? Absolutely not.
Would the outcomes have been different?
Only God can answer that. From my per-
spective, however, opening my whole self
up has made me a much better counselor
and person. I know myself better than I
ever have (the good, the bad, and the ugly!)
Without hesitation, I now know my place in
the body of Christ better than I ever have.
I need less and less affirmation from this
world because the affirmation that I get
from God is most meaningful to me. That is
what motivates me. I still constantly remind
myself to slow down and be still and yield
to God’s will all the time. I still struggle
with my motivations. Am I doing this to
look good or am I doing this for God’s
glory? This is a slippery slope for a high-
achieving personality! I constantly ask the
Spirit for guidance on this one. I still mess
up often. The mess up times are when I am
not God-centered of course!
Wouldn’t anyone benefit by wearing
their God antennae wherever they spend
their time? The accountant, financial plan-
ner, doctor, secretary, teacher, technician,
waitress, etc. Being fully present in every
human interaction and making a God con-
nection. Look into the face of everyone
who comes across your path as if you are
looking right into the eyes of Jesus. That
is what motivates me beyond measure. An
extra conversation with the secretary at your
kid’s doctor’s office because she seemed a
little down, making the extra effort to have
eye contact with your cashier at the grocery
store, a friendly smile and conversation with
the elderly neighbor walking his dog, a more
intentional and meaningful interaction with
the moms at the bus stop, actually stopping
to say hello and thank you to your lawn care
worker, you get the point I hope.
Don’t be fearful or hesitant. Get out of
your comfort zone. Be a little more vulner-
able. Be intentional. It is a joyful ride. I live
every day with the expectation of God’s
goodness. There is no better encouragement
for an encourager like me than that truth.
Who knows what God will bring? For me,
the joy circle is amazing and I am so very
thankful. Truly nourishing!
My Father, Abba, I present myself to you
as a living sacrifice. Holy and pleasing to
you. Help me to declare and reflect your
love, your light, and your glory. Spirit, work
with me and through me, guide and direct
me. Open my eyes to see where you are
truly working. Open my ears to truly hear
and discern your voice. Soften my heart
and purify me so that my motives are not
about me but all about You, pleasing You
and following Your will. Help me to love
completely like your son, my savior, my
Lord, Christ Jesus. Amen.
235

REFERENCES
Alliance for Eating Disorders Awareness. (2014).
What are eating disorders? Retrieved from http://
www.allianceforeatingdisorders.com/portal/
what-are-eating-disorders#.U77gwGdOXcs
American Psychological Association. (2014a).
Anxiety. Retrieved from http://apa.org/topics/
anxiety/index.aspx
American Psychological Association. (2014b).
Depression. Retrieved from http://apa.org/topics/
depress/index.aspx
American Psychological Association. (2014c).
Eating disorders. Retrieved from http://apa.org/
topics/eating/index.aspx
American Psychological Association. (2014d).
Personality. Retrieved from http://apa.org/topics/
personality/index.aspx
American Psychological Association. (2014e).
Stress. Retrieved from http://apa.org/topics/stress/
index.aspx
236

Truly Nourished
KEY TERMS AND DEFINITIONS
Emotional Hunger: Evaluating your S.E.T.
(situation, emotions, thoughts) to nurture yourself
without food.
Registered Licensed Dietitian/Nutritionist:
The only health care professional specifically
educated and trained in the science and applica-
tion of nutrition.
Physical Hunger: Identifying where you are
on the hunger scale, assessing when you last ate,
and exploring healthy eating options to satisfy
the hunger.
Processed Foods: Foods devoid of any nu-
trients of long-term substance.
Whole Foods: The foundation of eating veg-
etables, fruits, low fat dairy, lean proteins, whole
grains, and healthy oils, nuts, and seeds.
Wiggles: Special holiday celebration treats
and meals.
 237

Chapter 14
Strength from Spirituality
Eric T. Wanner
Palm Beach Sports Medicine & Orthopaedic Center, USA

Jennifer Lynne Bird

Florida Atlantic University, USA

ABSTRACT
How does spirituality inform research, writing, and life? What chain of events led the authors to write
this chapter? Some readers may view the experiences survived by the authors as a series of random
coincidences, but because religion plays a large role in the lives of both authors, they believe that their
experiences happened for a reason. They are not trying to convert you to a certain religion but simply
want to show the power religion can have. It is recommended to take out all prejudgments on this issue
and read the chapter as is. After that, take out of it what you wish. The more you read into this the more
you will realize that everything truly does happen for a reason and there is a greater power amongst us.

CHOOSE TO SHARE YOUR STORY
This chapter symbolizes the strength of spiri-
tuality and what it can do from the perspective
of two people who had near death experiences
and life changing events. People might refer
to a situation like this as a “Godwink” since
they happened to collaborate in this writing.
These are each very unique situations and the
authors prepare you to ride first class in their
experiences.
Godwinks are coincidences that symbolize
signposts from God showing people the right
path. Rushnell (2012) defines a Godwink as,
“your destiny will not arrive in a limo to pick
you up. Determining where you want to go
in life is your job. And once you do – once
you pull yourself from the curb and head in
whatever direction your inner compass is tell-
ing you to head – the signposts will unfold…
godwinks, all along the way. That’s a promise”
(p. 73). Godwinks enable people to see patterns
in their lives. Godwinks can also provide hope
for people unsure where the path of life may
lead next or why certain things happen. Hale
(2014) believes, “call it synchronicity or fate
or, as I call it, divine order; every moment of
your life pushes you toward your greater call-

DOI: 10.4018/978-1-4666-7524-7.ch014

Copyright © 2015, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.

ing” (p. 12). In a moment we may not know
why something happens, but the reason why
it happened becomes clear later.
Life can feel stressful and chaotic at times,
and Godwinks bring order to the chaos. As
Heard (1995) writes, “synchronicity draws
recognizable patterns on a sometimes cha-
otic universe. Writers need to pay attention
to these synchronistic moments and events”
(p. 104). These Godwink moments provide
faith that the puzzle pieces of life will even-
tually fit together, maybe not in the current
moment, but someday soon. Zimmermann
(2002) reminds us to trust the journey because
“the stars have lined up, and we had nothing
to do with it. Some call it grace; some call it
synchronicity; some call it serendipity; some
call it a connection with the divine; some
call it coincidence; some call it luck. If we
stay open to life, unexpected gifts begin to
appear” (p. 160). Sometimes we don’t know
why things happen. We don’t get something
we want, or a prayer goes unanswered. But
looking back and mapping the Godwinks
of an experience can show that perhaps not
getting the thing we originally wanted led to
something better down the road. Or as Hale
(2013) powerfully states, “on the journey of
life, sometimes it takes losing our way to find
ourselves” (p. 177).
And sometimes losing our way can help
us find our greater purpose in life. As Warren
(2012) believes, “you will be most effective
when you use your spiritual gifts and abili-
ties in the area of your heart’s desire, and in a
way that best expresses your personality and
experiences. The better the fit, the more suc-
cessful you will be” (p. 246). He elaborates,
“this custom combination of capabilities is
called your SHAPE:
Spiritual gifts
Heart
238

Strength from Spirituality
Abilities
Personality
Experience” (p. 234).
For both of us as the authors of this chapter,
we have used the SHAPE theory to inform
our practice of research and writing. We find
strength in spirituality and possess a passion
for research. Eric’s abilities as a physical
therapist and Jen’s abilities as a college English
professor enabled us to learn from each other
as we designed unique interdisciplinary re-
search. We have the common personality trait
of compassion for people, as Eric has made a
positive difference in the lives of his patients
just as Jen has made a positive difference in
the lives of her students. And our individual
life experiences led us to see research as part
of a greater life’s purpose.
Because we as the authors advocate the
sharing of stories, we each share a story of how
following the advice we share in this chapter
helped us. Both of us have strong religious be-
liefs, and by telling our stories from a spiritual
perspective we do not tell anyone else what
to believe. Because research and writing feels
like a larger purpose instead of just work, it
translates into appreciating the moments when
the puzzle pieces of ideas click into place to
form projects that will help people. As part
of our research we asked physical therapy
patients and college students to write their
stories, so we need to feel willing to write
ours. Both of us survived incredible ordeals
and our paths crossed so we could share our
knowledge and help others.
Eric
As a Christian myself, I see the beauty of
believing in God and what He can do. I was
actually in a near death situation the summer
after I graduated from The Ohio State Uni-

Strength from Spirituality
versity in 2008. I will tell you a very quick
overview of my experience as I could actually
write an entire book about this. I mainly just
want you to realize the impact and beauty
religion (God) can have for you. I went on a
mountain climbing trip to the Grand Tetons
with my dad. I climbed with a guide while
my dad recorded me. The first day I climbed
several mountain faces without falling one
time. The climbs I did were several hundred
feet at a time. But the next day, that is when
my “magical” experience happened.
Day two of the climb my guide and I decided
to climb one of the most challenging mountain
faces in the Grand Tetons called the Open
Book. My dad, my guide, and I started hiking
to this mountain face at 6am. It took around
3-4 hours to get to the bottom of where the
climb began. The mountain face was 1500 feet
and completely vertical. No gradual incline at
all. Also, there wasn’t really anything to hold
onto but cracks. This was crack climbing at its
finest. To be able to climb this face you must
use different techniques, such as finger locks
and hand locks to proceed up the mountain
face. The rope was around 200 feet long, so
about every 150 feet we would have to redo
the belay device (the lifesaver which helps
stabilize the rope with which one climbs) so
that we could continue spotting each other.
My guide would climb first while putting in
the holds, put the rope through it, and I would
take them off while climbing. Then he would
reattach us to allow us to belay each other,
and we would start over again.
Once we got to 1000 feet up the mountain
face went backwards. This means that the
slope was to the point where your back was
facing the ground. My guide climbed up this
without a problem. Now it was my turn. To
get past this point I would have to use a di-
agonal crack, but when it stopped, swing my
body around to reach the cleft that was six
feet away (the next hold). There was no foot
hold and the backwards incline went about 20
feet back. When my guide made it to the top
of it he re-belayed and was ready for me to
begin. I made it past the crack, but now was
my turn to swing my body to the cleft. Keep in
mind I don’t have a great reach for this move.
I went to do this and my feet slipped out from
underneath me. I was swung around on the
rope about 30-40 feet away from the moun-
tain face and was facing the other mountain
range. While I was swinging from the fall I
looked down and could see several thousand
feet below me and noticed the absolute verti-
cal of nothing but rocks at the bottom of this
mountain face. Once my momentum stopped
from the fall I was still around 20 feet away
from the mountain face. To get back to climb-
ing I actually had to swing myself toward the
starting point and grab onto the wall.
When I made it back to climbing position
I was pretty shaken up. That was absolutely
the scariest thing I have ever experienced. I
tried to mentally block it out, but knew that
I had to make it on the next attempt or my
grip strength would be shot. Every time you
try to do a big move it takes a lot out of your
grip strength.
So, I started back up again. My hands were
shaking a little bit, grip strength was becoming
worse, but I was determined. I made it to the
same spot as the previous time. I went for it
again, but again my right foot slipped at the
same spot and I missed the cleft. Immediately
I was swung back 30-40 feet from the moun-
tain face. When this happened I looked up
and the rope was fraying. Yes, FRAYING!!!!
The part that went backward that the rope had
to go over was a very big and sharp rock. I
239

realized that I had to get back to the climb-
ing position as quick as possible or the rope
might break. This immediately became a life
or death situation. I swung myself back to
the spot to start but was holding on to a rock
to prevent myself from swinging back again.
There was not enough slack in the rope and
my body was completely horizontal with my
legs unable to touch. After what seemed like
a minute of screaming to my guide to get me
more rope I finally got more and was able
to put my feet down. I couldn’t blame him
since it was really hard to hear each other at
all. Because of where we were in relation to
each other, it was a cave effect which pretty
much muted each other out.
At this point I looked at my hands which
were covered in blood. Apparently my skin
got cut from the rock on my last attempt. I
wiped the blood off on the mountain face and
started praying. This was the first time in my
life I truly did not think I would make it out
alive. I prayed to God that he would either
help me out with this situation if I was meant
to live, or if the alternative was my destiny
then so be it. Keep in mind that where I was,
it was not possible to save me. A helicopter
wouldn’t be able to fly close enough to me
without running into the sharp rock above,
and the rescuers would have to swing back
and forth from a bungee several feet to even
come close to me (which could have brought
down the helicopter due to the instability and
increased risk). There was also nobody else
at all who was climbing the same mountain
face that day. I didn’t know what else to do so
I just kept praying and waiting about half an
hour. I had to build up some more strength to
make my best attempt for what could be the
last attempt ever.
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Strength from Spirituality
Suddenly I heard voices. A man out of
nowhere poked his head up making it to
where I was. He asked me if I was having
troubles and if I needed help. I told him that
I was pretty much stuck and couldn’t get
past where I was. I never had to climb with
a backpack before this trip since I was from
Ohio. The man and his friend informed me
on how to pull myself up on the rope if I fell
on the next attempt since they saw the rope
was fraying. He also grabbed my backpack
and told me he was going to give it to me at
the top. Suddenly I heard another voice. “Eric,
I’m going to pull you up!” It was my climb-
ing guide. He actually detached himself from
where he originally was to help me up. He did
this knowing something was wrong. Keep in
mind I didn’t really fall the entire trip until
this point. I told my guide to wait as the men
I just met were telling me how to pull myself
up in case I couldn’t make it past on my next
attempt. We had to yell back and forth until
we came to the agreement that I had one more
shot, and if I didn’t make it the guide would
pull me up. He didn’t realize the rope would
actually completely break if he did since it
was already fraying on the sharpest part of
the rock. The man and his friend next to me
grabbed my backpack and wished me luck.
On my last and final attempt I began climb-
ing. I knew if I fell I was dead, but also knew I
couldn’t think that way to make it all the way.
The weight off of my back helped a lot and I
felt like I was climbing Ohio style again. As I
was climbing my legs and arms were shaking
more than they ever have. Even though I knew
I had to stay calm, my body wouldn’t listen.
I made it to the spot I couldn’t get past and
all of my fingers but my index finger slipped
out of the crack. I felt a sudden bolt of power

Strength from Spirituality
through my body and somehow threw myself
on top of the cleft with one finger. I made it!
My guide was amazed by the move although I
felt like I was going to have a heart attack, and
we ended up making it to the top. We received
my backpack at the top from the men I met at
the mountain and then they just disappeared.
Call it dumb luck, call it adrenaline, call it
being at the right place at the right time, call
it anything else. I call it as I saw it. I believe
that man and his friend were Angels sent from
above to help me get past a deadly situation.
I don’t think it was just a coincidence. This
is why I believe that if you choose religion,
it can do wonders.
Meanwhile, my dad was at the bottom of
the mountain face. He was told to go over on
the other side of the river. Yes, it was a frozen
river and not really cold on that side so luckily
the ice didn’t break through. He actually was
unable to see us since the guide didn’t tell
him to go in the right spot since they never
had anyone try to film from the bottom at that
mountain face before. My dad didn’t see us
the entire time, so he went back to where we
started. He left a note on the guide’s car that
said if he didn’t hear from us he would have
the troopers find us by 6pm since it got dark
a little after that. Luckily we made it back in
time and got ahold of him and he was okay.
Again, I am not saying you have to believe
what I took out of my real life experience. I
am not saying that you should believe in what
I do or another type of religion. What I can
tell you is that if you believe in something,
it can really help calm your nerves and help
you more than you ever dreamed.
Jen
I too could write a book about my experiences.
Sometimes I wonder if the tone of that book
would be too sad, or if I should make it happier.
But I can’t write book chapters telling people
to own their stories and not follow my own
advice. I experienced heartbreaking moments
in my life, but I experienced more moments
of joy, when I felt at peace with the world
and grateful for all the wonderful gifts and
people in my life. Through everything, both
good and bad, I’ve felt God with me. Faith
means letting go and knowing things will be
okay even when the road map disappears or
prayers go unanswered. Even if I can’t always
see the purpose of my life, I believe God does.
Each semester in class I give my students a
small candle and remind them they can be
the light in the lives of others, and if they are
going through a difficult time a little light is
enough to light the way until things get better.
I am a woman who survived the death of her
mom and an autoimmune disease, but I am
also a Christian, a teacher, a writer, a singer,
a dancer, and a researcher. I belong to an
incredibly supportive family who encourage
me to fly fast and far because they will always
catch me if I fall. I hope my stories light the
way for others.
Sometimes people who are not medical
professionals can diagnose your health issues.
My hairstylist ordered me to go to the doctor
when large amounts of my hair fell out into her
hands as she styled it. I soon began a medical
odyssey that resulted in a quest to heal as I
climbed my own metaphorical mountain of
survival.
Sjogren’s Syndrome is an autoimmune
disease where the body’s white blood cells
forget their purpose and attack a person’s own
cells and tissues. If Sjogren’s sounds familiar
to you, tennis star and athlete Venus Williams
has it and made the public more aware of the
condition when she discussed her own case.
There is no cure, and symptoms vary from
241

person to person. Some patients only suffer
from dry eyes and a dry mouth, while others
endure complications in various organs.
I remember sitting on my couch staring at
the wall after a discouraging doctor’s visit.
I secretly suspected the lab technician was
a vampire because of the large amount of
blood she took from me. I discovered I was
more likely than the general population to get
cancer. My doctor wasn’t sure if I could ever
have children. I was seeing a specialist for
every part of my body and taking more pills
than my grandma took. I couldn’t even cry
because my eyes wouldn’t produce tears. The
doctors said nothing I did or didn’t do caused
this autoimmune condition; it just happened.
But the fact that I experienced physical health
issues a couple years after an emotional trauma
did not shock me.
My mom died suddenly of a carotid artery
aneurism a few days before Thanksgiving in
2003. Earlier that day I remember thinking
how incredibly happy I felt. My graduate stud-
ies at Miami University challenged me but I
loved my classes and research, and I looked
forward to the holiday break and spending
time with my family. In one horrific moment,
my life changed. I couldn’t stop thinking that
if anything had been different about that day
maybe my mom would still be alive even
though such thoughts wouldn’t bring her back.
I wrote extensively about losing my mom to
cope with my feelings. Sometimes I wondered
if I wrote too much about it. I started to put my
life back together with the support of friends,
family, and an emotional therapist. However,
my immune system was compromised due to
all the stress and no matter how many people
I told I felt fine, my body told me otherwise.
I find beauty and grace in religion because
when I hurt so much I couldn’t even think,
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Strength from Spirituality
I knew I was not alone. So I had a nice long
chat with God. Actually it was a screaming
rant at God for letting my mom die and letting
me get sick, but letting everything go made
me feel better. A wise minister told me my
behavior was healthy because I was being
honest and still talking to God. I remember
wanting to live and feeling that I still had
something to accomplish with my life. So I
turned the out of control things over to God
to worry about and changed the parts of my
life I could control. A dancer my entire life, I
took a dance seminar with professional danc-
ers and pushed my body through exercise. I
reworked my diet and became a vegetarian. I
tossed items from my endless “to do” list and
spent the time stretched out on my bed listening
to music that inspired me. I spent more time
with my family. I prayed several times a day.
And I wrote about my experiences as well as
poetry, songs, and a novel when writing my
thoughts hurt too much. And one day when
watching a really sad movie, I started crying.
My eyes were producing tears again!
Remission happens infrequently for auto-
immune diseases. It happened to me. Being
healthy again feels like someone waved a
magic wand over me, made my symptoms
disappear, and gave me my life back. I don’t
take it for granted. My treatment plan worked
for me, but I’m not a medical doctor so I can’t
tell other people to follow it and have the same
results. I know there are hundreds of people
who try various treatments without success,
and I’m grateful there are specialists to help
anyone who suffers from an autoimmune dis-
ease. I always say a prayer each year before I
get my blood test results, feel lucky the only
inconvenience in my life is taking a couple
pills a day, and know I proved I can deal with
whatever life throws at me. I knew if I survived

Strength from Spirituality
the death of my mom and my health issues I
needed to do something meaningful with my
life, and writing chapters like this one to help
others is part of my life’s purpose.
RESEARCH REFLECTIONS
Eric
When writing my story I thought about the
angels that I encountered. I keep trying to
remember exactly what they looked like but
cannot. All I remember is that they were
around six feet tall, close to 200 lbs, wearing
a helmet, backpack, harness, all the climbing
essentials. They both had on sunglasses and a
climbing jacket. There was so much adrenaline
in my body that I had a hard time remember-
ing more about their features. All I remember
is how I suddenly felt comfort when I saw
them. I remember that not only did they have
to climb up the hardest part of the mountain
after meeting up with me but climbed with
my backpack as well (along with their back-
packs). Once they met up with me at the top
they gave me my backpack and climbed away
the other part of the mountain. My guide and
I went down the opposite side of where we
climbed up since it actually had an angle to it
(along with snow). We had to hurry down the
mountain since it was supposed to rain and
the clouds were moving in. With rain it would
make the climb down much harder. We didn’t
have time to see exactly where they went but
I just remember them suddenly disappearing
into the mountains.
I remember praying to God that if I survived
then I will be certain that He has more planned
for me in life and that I still had a purpose for
him. I think that is why I care so much about
what I do and helping others get better in
life. Whether physical therapy, research, or
writing, I want to help people achieve their
goals and come up with ways to continually
improve their quality of life. I continually
remind myself that if I help as many people
as possible perhaps that is one of my purposes
in life. Jen and I shared the same perspective
about the research and writing which makes
this a unique situation. It brought two com-
pletely different fields together and has lead to
groundbreaking results in both of our fields.
Jen
Helping as many people as possible is one
of my purposes in life too. I feel grateful
every day that on my last day of physical
therapy treatment Eric suggested we still
work together and use writing to help other
patients. I smile whenever I think of all the
people we have helped and will continue to
help in the future.
I fell in love with the topic of using writ-
ing as healing when I wrote my doctoral
dissertation about writing leading to emo-
tional healing, but it never occurred to me
that writing could help people heal physi-
cally, and the idea intrigued me. I felt one of
life’s full circle moments; my research came
together in my hometown when I returned
to Ohio from Florida in order to work with
one of Eric’s former professors. Even though
my dad’s career as a city planner took him
to Indiana, he and my stepmom met me in
Dayton so Dad could check on some buildings
and projects he implemented there. After a
successful research day, I left the University
of Dayton and went to the cemetery to tell my
mom the good news. I know she’s not really
there and knows what is going on in my life
243

anyway. As if to prove that point, when I got
to the cemetery, it started raining. Mom never
wanted me to dwell on sad things and was
telling me to leave the cemetery and get on
with my life. When I shared the news with
Eric about our research discovery, without
even knowing my cemetery story he said the
quick thought that I had must have come from
my mom. It wasn’t the first time I thanked my
parents for helping me achieve my dreams.
This research journey helped other people,
but also helped me discover my purpose in
life. I process my experiences through writ-
ing, so in my role as a teacher, writer and
researcher, I realized I could help others
through difficult experiences because I sur-
vived one myself. Beck (2012) believes that
“all these people can help others back from
hell because they’ve found their own way
back from internal, infernal experiences” (p.
244). Instead of falling apart after my mom’s
death, I wanted to use the pain to make a
difference in the lives of other patients. As
Warren (2012) writes, “In fact, your greatest
ministry will most likely come out of your
greatest hurt” (p. 244). My research and
writing became intertwined with my story.
When I remember my mom, I smile
thinking of the time we once went to the
Kettering, Ohio bookstore, Books & Com-
pany, three times in one day for “the thrill
of the magazine hunt.” I remember our close
relationship and her goal of getting me to
enjoy life; whenever she saw me spending
too much time studying, she would bring out
a yellow cat puppet named Buttons to make
me laugh. I don’t want to define my life by
her death and before this writing becomes
too poignant perhaps I should prop Buttons
up against the computer screen to remind
myself to lighten up a little bit. Mom would
love that.
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Strength from Spirituality
My grandpa, a kinematics professor,
discussed physics principles in his book
such as, “dynamics deals with motion and
the effects of forces acting on rigid bodies
in motion” (Kepler 1973, p. 1). The same
philosophy applies to both physics and life:
A force causes things or people to move. I
want to become a force for change. Using the
power of my words to help others through
pain has become part of my life’s purpose;
by doing so I hope to share enough of my-
self for people to know who I am. And that
means stepping out in faith even if the path
is unconventional for an English professor.
I am reminded of the novel Shoeless Joe
(which later became the baseball movie Field
of Dreams), where Ray Kinsella follows his
dream of building a baseball field in the
middle of his Iowa cornfield no matter what
anyone else thinks because he knows he is
doing the right thing. For a moment, I am a
kid again sitting next to my grandma in the
stands at a Cincinnati Reds baseball game
as I think of Kinsella (1982) describe life as
“Heaven on earth, indeed” (p. 211). I love
to teach students about the power of dreams
in the scene from The Great Gatsby where
Fitzgerald (1925) has Nick the narrator watch
his friend staring at a light in the distance
and observe, “I thought of Gatsby’s wonder
when he first picked out the green light at
the end of Daisy’s dock” (p. 189). No matter
where life takes me, I can’t tell students to
reach for their dreams if I’m not willing to
reach for my dreams too.
It seemed every book or magazine article
I found referenced the research of James Pen-
nebaker. The most powerful example of this
was when I reread a writing book by Susan
Zimmermann that my cousin Robin found and
my Aunt Susie bought for me on one of our
beloved shopping trips years before I knew

Strength from Spirituality
I would ever research writing as healing.
When I began this research, I remembered
that book. What I didn’t remember was that
it referenced the exact study by Pennebaker
I was investigating. It became another full
circle moment that made me feel God knew
what I was supposed to do with my life years
before I did.
As a result of my research experience, I
enrolled in a seminar at Duke University that
referenced Pennebaker’s research and began
the journey to become a health coach using
writing therapy to help heal people. Brown
(2007) describes the feelings many patients
have and shares, “there is nothing more
frustrating, and sometimes frightening, than
feeling pain and not being able to describe it
or explain it to someone. It doesn’t’t matter
if it’s physical pain or emotional pain. When
we can’t find the right words to explain our
painful experiences to others, we often feel
alone and scared” (p. 155). I dream about
helping patients find the right words. I envi-
sion a future research project where patients
at Eric’s physical therapy clinic will write
answers to The Wanner Bird Healing Survey
for Pain Recovery, Eric will use their answers
to adjust their treatment plans and help them
heal physically, while I read their answers
and counsel them to heal emotionally so
they have a holistic approach to healing that
achieves elite results.
Some people may say everything hap-
pened as a series of coincidences, but I
prefer to see them as Godwinks affirming
that even if at the time I don’t understand
why things happen, I end up exactly where
I am supposed to be.
GODWINKS IN RESEARCH
Bringing multigenre writing to the field of
medicine began with Jen’s neck pain. When
Jen needed physical therapy for neck pain,
she kept a journal of her symptoms to show
Eric, her physical therapist. Part of the journal
is included as an appendix at the end of this
chapter, in case you would like to use the
model for any pain you might be experiencing
and share it with your doctor. Jen’s pain level
seemed all over the place. Why was it better
or worse at certain times? Between treat-
ment sessions, she wrote notes so she would
remember what to tell Eric about her pain
and decided to reorganize everything into a
chart. Eric looked at Jen’s notes and instantly
diagnosed a pattern. He used the insights from
her writing to adjust her treatment plan.
Multigenre papers find patterns in the form
of narrative threads. Putz (2006) explains,
“whereas traditionally a researcher begins with
a premise and looks for evidence to support
it, the multigenre researcher begins with an
interest and discovers a unifying element along
the way. It is this emergent theme that often
suggests a thread with which the writer may
create cohesion among the separate pieces of
writing” (p. 2). In the case of Jen’s neck pain,
she lacked the expertise to find the narrative
thread that explained the pattern to her symp-
toms. She needed to rely on Eric’s expertise to
find the unifying element that would explain
her pain. Romano (1995) writes, “admitting
people into the process of our writing, how-
ever, is a greater act of faith and fearlessness
than writing about what we feel strongly but
cannot yet envision” (p. 174). When Jen took
a leap of faith and found the fearlessness to
share her writing, she was happy Eric read it.
Eric’s goal became to help Jen find strategies
to relax more (she’s still working on that)
and celebrate slow and steady progress in a
theory he called “thinking like a turtle.” So
Jen found artifacts that made her happy, such
as a playlist of her favorite songs, pictures of
the beach, and a flyer for an upcoming con-
cert. Her medical chart began to look like a
245

multigenre project. Allen (2001) writes, “the
best way I can describe a multigenre paper is
to say that each piece in the paper utilizes a
different genre, reveals one facet of the topic,
and makes its own point” (p. 2). Each piece of
writing Jen showed Eric provided one facet of
the topic of her pain, which incidentally was
caused by the facet joints in her neck.
After Jen healed and collected a few turtle
necklaces and statues along the way, we
decided to use her neck pain journal to help
other patients. As Goldberg (2000) explains,
“I believe that this is a primary commitment
a writer makes to her writing, an essential
commitment she makes to her reader: a will-
ingness to be open to encounter, to experi-
ence – and to the suffering this may bring”
(p. 86). By sharing their stories, some patients
fear they will suffer more if they do not have
a supportive audience; however, there are
supportive clinicians who will hear what they
have to say and help them heal. We believe in
integrative medicine that encourages patients
to collaborate with clinicians and create their
own multigenre healing journals. We encour-
age readers of this chapter who experience
physical and emotional pain to share their
stories with supportive medical professionals,
and for clinicians to value patients’ voices and
listen to stories shared so that a multigenre
approach to medicine can provide education,
hope, and healing.
We began our research by designing an
original survey called The Wanner Bird Heal-
ing Survey for Pain Recovery that included
short answer writing questions. We gave the
survey to physical therapy patients at Eric’s
clinic, and thirteen patients completed the
survey. After finishing data collection at the
physical therapy clinic, we met with one of
Eric’s former professors in the DPT (Doctor
246

Strength from Spirituality
of Physical Therapy) program at the Univer-
sity of Dayton, Dr. Claudia Jayne Brahler, in
a Skype session to discuss the results. Her
expertise in both the fields of research and
physical therapy would help us with our re-
search. Jayne wanted to study the data more
closely, so Jen got on a plane to Dayton so
our team could get the best results possible.
Her Godwinks on this trip started as soon as
she arrived in her hometown of Dayton, the
same city where Jayne taught and where Eric
attended grad school. Eric supported Jen’s plan
of taking all of the research files with her on
the trip and said to say hi to Jayne and all of
his former professors at UD.
Jen teaches her college students the concept
of positive interdependence, which means that
a great team makes its members stronger than
they could be on their own. That description
fit our research trio. Jayne needed the scores
from the objective physical therapy measures
patients answered converted into a common
scale in order to make a comparison to the
original survey Eric and Jen designed. Eric
frequently checked in with Jayne and Jen
during conference calls, and converted the
numbers we needed in a matter of minutes.
Jen felt proud of herself for adding new vo-
cabulary terms like DASH, LEFS, NDI, and
Modified Oswestry (all objective physical
therapy measures) to her vocabulary during
this research study, but could never have
completed Eric’s impressive work with the
numbers on her own.
We still needed one more piece of the
puzzle. Jayne felt there was something missing
with the data because it seemed to have a ceil-
ing effect. All the writing scores on the short
answer questions Eric and Jen designed were
similar, but why? Jayne told Jen to think like
the English teacher, not a physical therapist,

Strength from Spirituality
because that was Jen’s strength and what she
brought to the research. And in that moment,
Jen had a sudden inspiration. Voice is the
concept that drives writing. It means having
a conversation with the writer when the writer
isn’t even in the room because the words re-
flect the writer’s personality. Lamott (1994)
describes writing voice as, “and the truth of
your experience can only come through in
your own voice” (p. 199). When Jen was a
grad student in Tom Romano’s class at Miami
University, he stressed the importance of two
dimensions of writing, artistic and technical.
Romano (2013) describes the scoring process
and elaborates, “to arrive at a holistic grade,
I read the paper through without making a
mark on the rubric, without any interruption
of my reading. I relied upon my experience
as a teacher, writer, and reader, on my judg-
ment of the paper’s demonstration of writing
craft“ (p. 160). Writing craft focuses on voice
and the way the writer’s personality becomes
reflected through writing.
As a lifelong figure skater and dancer, Jen
loved the concept. Ice skaters receive two
scores, artistic and technical. When Charlie
White and Meryl Davis won their recent
Olympic gold medal in ice dancing, they
received a technical score for the required
number of lifts and spins they completed, but
they also received an artistic score for their
creative interpretation of the routine and the
way it resonated with the judges. Of course
the writing had a ceiling effect; any decent
writer can string together a sentence for the
technical dimension of writing, just like any
decent dancer or skater can do a spin to a series
of eight counts. It’s the artistic dimension that
highlights personality, tone and voice, whether
it appears on an ice rink, a dance floor, or a
piece of paper.
Jen is her own worst critic, and she couldn’t
believe the professor who encourages students
to share their writing voices almost stole the
physical therapy patients’ voices from them.
Jayne seemed impressed that Jen grabbed
the surveys, curled up on a couch outside
the office, and let the patients speak to her.
When scoring voice in writing, here’s the
secret: Don’t think, just score. Trust the first
impression. As Conner (2008) writes, “first
thought is a precious gift. It is an impetus
from deep within your soul that wants to be
seen and heard. Honor it” (pp. 92-93). For
once Jen didn’t overthink things; she got into
a zone where it was just her listening to the
voices of the patients through their writing.
She handed the numbers over to Jayne; the
numbers fit with the numbers Eric converted
from the objective physical therapy measures
to achieve research significance. While the
writing rubric for The Wanner Bird Healing
Survey for Pain Recovery focused on both the
technical and artistic dimensions of writing,
the holistic, or artistic component, provided
the correlations with existing objective sur-
veys. We proved our hypothesis: patients who
demonstrated a strong positive outlook and
positive writing voice experienced greater
healing gains on existing objective physical
therapy measures.
Another Godwink happened when Jen
emailed her former professor Tom Romano
to tell him how she applied a writing theory
she learned in his class to a medical setting.
He wrote back and said his upcoming book
contained a chapter on the two dimensions of
a writing rubric. He included a draft of the
chapter, and his writing supported everything
Jen told Jayne. Jen knew intuitively about the
practice of scoring writing during numerous
class sessions, but now she had the academic
247

theory from its leading expert to prove it. She
felt as if all her knowledge and experiences
led her to that exact place and time. All of
the puzzle pieces fit together to create a re-
search result that will help people and make
a groundbreaking contribution to the field of
patient education.
It became fun to see the puzzle pieces
continue to fit together for this project as we
continued looking for references to support
our research. Whenever you hit a roadblock
it feels good to have a sign that tells you
that you are still on the right path. Jen found
a book by Dr. Hilary Tindle in which she
discussed her research and said that doctors
knew positive outlook could lead to healing,
but they wondered how to know what patients
were thinking. When discussing how outlook
influences healing, Tindle (2013) discovered,
“how we manage our responses to the world
influences our health, both in the short and
long term” (p. 17). The answer? Ask them
to write it! The idea of managing responses
to the world connected to the philosophy by
writing teacher Julia Cameron (1998) because,
“writing gives us a place to say what we need
to say, but also to hear what we need to hear”
(p. 83). Except for innovative programs at the
medical schools at Columbia University and
Duke University, writing teachers usually
don’t work with doctors, so it made sense
that the connection wouldn’t be common
knowledge. Writing in a journal provides a
place for people to manage their responses
to the world and say what needs to be said.
This became a beautiful connection between
the fields of writing and medicine.
Jen learned about the work of medical
doctor Dr. Lissa Rankin and vulnerability
researcher Dr. Brene Brown during a Bible
study focusing on wellness; their words
248

Strength from Spirituality
provided similar sentiments. Interestingly,
around that time the ministers at church began
a series of messages about Godwinks and for
every Sunday for a month encouraged the
congregation to look for Godwinks in life.
Rankin (2013) feels, “if it’s true that the mind’s
positive beliefs can heal the body, everyone
has an equal chance of benefitting from this
phenomenon” (p. 10). In order for writing to
become healing, it helps to acknowledge the
words of Brown (2012), who provides the
reminder, “vulnerability is the core, the heart,
the center, of meaningful human experiences”
(p. 12). Because Jen found the courage to
share her neck pain journal with Eric, we
designed research to help people. Because the
physical therapy patients and college students
who participated in the two research projects
we designed found the courage to share their
writing voices, we will design research that
will help even more people.
Having a positive artistic writing voice
helped both physical therapy patients and col-
lege students. Learning the truth of people’s
experiences as told in their own voices will
lead to additional research as well as program
implementation to help as many people as
possible heal both physically and emotionally
through writing. During our research, Eric
found the work of Dr. James Pennebaker, a
psychologist who studied writing as healing.
Jen was intrigued by the study of twenty-five
years ago discussing that writing can lead to
healing with college students. Research by
Pennebaker (1997) that led to the second re-
search study we designed revealed, “not only
are there benefits to health, but writing about
emotional topics has been found to reduce
anxiety and depression, improve grades in
college, and, as we have seen, aid people in
securing new jobs” (p. 40). Jen teaches college

Strength from Spirituality
students who write in journals every semester
and are part of a class community of writers
just like Erin Gruwell and the Freedom Writ-
ers. It was possible to create a new version
of this classic study. Every college classroom
needs a strong writing community like the
one described by Gruwell and the Freedom
Writers (1999) where “the students continued
to write and began to forge stronger identities
and to create a sense of community and an
outlet for expression” (p. 275). Community
means we are not alone and we have a place
to share our stories.
Jen designed a writing survey and con-
nected it to the HRQOL (Health Related
Quality of Life) Survey Eric recommended and
we implemented another research study using
writing, this one with Jen’s college students
instead of Eric’s physical therapy patients.
This research project led to an unexpected
twist. Since the surveys were anonymous and
the sixty-four students who completed them
didn’t put their names on the surveys, the
students felt they could be honest about their
experiences. On the HRQOL, most students
reported high anxiety. But why did they feel
stressed? Eric reminded Jen to look at every
question on the surveys. As she did, she had
writing teacher Natalie Goldberg’s voice stuck
in her head. In writing, first thoughts and im-
pressions are the truest ones; most writers tend
to censor themselves if they have too much
time to think about what they write. When we
write our stories, we need to trust the value
of first flashes of insight in writing. Writing
teacher Goldberg (2013) tells writers, “say
what you want to say, not what you think you
should say” (p. 22). In order to write what is
truly on our minds and in our hearts, Goldberg
gives the advice, “in the face of all inner – and
outer – resistance and opposition, just write.
Pick up the pen and face yourself” (p. 179).
And in facing ourselves through writing we
find our voices.
Once again, voice was the answer. Just
like with the physical therapy patients, the
key became listening to the stories students
wanted to tell. Jen scored the word students
used to describe their first writing topic and
the correlation became clear. Students who
demonstrated a more positive writing voice
showed lower anxiety. We shared the informa-
tion from a stress management presentation
we designed and it helped students. Helping
college students reduce anxiety became an
unexpected detour on this research road, but it
is one worth following. Zimmermann (2002)
believes, “the soul knows what it needs to
heal. Through writing, it will lead you where
you need to go” (p. 18). Jen wants writing to
take her students where they need to go and
she wants to be a role model for them as they
write. Many students feel like DeSalvo (1999)
who writes, “I use my writing as a way of fix-
ing things, of making them better, of healing
myself” (p. 7). As much as Jen likes to play the
role of fairy godmother in her students’ lives
and encourage them to live their dreams, she
knows she can’t wave a magic wand and make
their problems disappear. She can, however,
give them time in class to write and process
their thoughts.
In two separate research studies, we dis-
covered that a strong positive writing voice,
indicating positive attitude, can help people
heal both physically and emotionally. Physi-
cal therapy patients using a positive writing
voice throughout their treatment interventions
demonstrated higher recovery gains. College
students using a positive writing voice during
249

journal writing demonstrated lower anxiety.
It’s amazing that the two studies dovetailed
together beautifully. We learned from Eric‘s
physical therapy patients that people who write
with a strong artistic voice have greater heal-
ing gains, and we learned from Jen’s college
students that people who write with a strong
artistic voice have less anxiety.
Multigenre writing provides a writer with
an opportunity to write a personal story in his
or her own writing voice and support it with
academic research. As Zimmermann (2002)
discusses, “write about ways you can light
a candle. You can learn from your sorrow
and somehow help others to better endure
their own. You can grow from the pain you
have experienced and share with others what
you’ve learned” (p. 180). On the first day of
every new class Jen teaches, she gives each
student a candle and reminds them they can
be the light in the lives of others and if they
are going through a difficult time a little bit
of light is all they need until life gets better.
Sometimes everyone needs that reminder.
Handler (2013) also uses the light metaphor
and writes, “many writers have gone across
that bridge before you. Their experiences and
the ways in which they chose to write about
their loss shine a light on your path” (p. 5).
Through research, we can use our experiences
to reach back across the bridge and light the
way for others to follow.
Since this chapter highlights Godwinks
and the concept of voice led to discoveries
for both research studies, one additional
Godwink occurred when reading a passage
by Conner (2008) who believes, “pick up a
pen with the intention of connecting with that
extraordinary Voice within, and your life will
start rumbling, shifting, and moving” (p. 9).
For her, the word voice is capitalized because
it not only represents writing voice, but also
connection with the Voice, or God, through
250

Strength from Spirituality
writing as prayer. And another piece of this
research, this work that has purpose and mean-
ing, clicks into place. Beck (2001) writes that
the word synchronicity “is sometimes used to
mean a coincidence so remarkable it seems
beyond chance” (p. 234). So just remember
the next time something happens in your life
that seems like a coincidence, consider seeing
such moments of synchronicity as Godwinks.
GODWINK LESSONS
Sometimes we get lost in life. Even if you
program your route into your GPS, you still
find yourself in a different location. Detours
become part of life, both when literally driving
down an actual road or metaphorically driv-
ing down the road of life. Maybe you didn’t
get the thing you thought you wanted, but
that detour can lead you to something better.
One of our research studies began with the
intent of adding to the literature discussing
the connections between writing and health
with college students. We accomplished that
goal, but also discovered that the same stu-
dents shared high levels of stress and anxiety.
So a detour developed into successful stress
management presentations. The other research
study began when an English professor took a
detour from the world of literature and learned
about medicine, while a physical therapist
learned how to score writing rubrics. When
faced with a detour in life, enjoy the scenery
and take some pictures. What may seem like
the wrong road at the time can take you to the
right place or lead to new dreams.
REFERENCES
Allen, C. A. (2001). The multigenre research
paper. Portsmouth, NH: Heinemann.

Strength from Spirituality
Beck, M. (2001). Finding your own North
Star. New York, NY: Three Rivers Press.
Beck, M. (2012). Finding your way in a wild
new world. New York, NY: Free Press.
Brown, B. (2007). I thought it was just me.
New York, NY: Gotham Books.
Brown, B. (2012). Daring greatly. New York,
NY: Gotham Books.
Cameron, J. (1998). The right to write. New
York, NY: Tarcher/Putnam.
Centers for Disease Control and Prevention.
(2011). Health related quality of life. Health
Related Quality of Life Surveillance Program.
Retrieved from http://www.cdc.gov/hrqol/
hrqol14_measure.htm
Conner, J. (2008). Writing down your soul.
San Francisco, CA: Conari.
DeSalvo, L. (1999). Writing as a way of heal-
ing. Boston, MA: Beacon Press.
Fitzgerald, F. S. (1925). The great Gatsby.
New York, NY: Scribner.
Goldberg, N. (2000). Thunder and lightning.
New York, NY: Bantam.
Goldberg, N. (2013). The true secret of writ-
ing. New York, NY: Atria.
Gruwell, E., & The Freedom Writers. (1999).
The freedom writers diary. New York, NY:
Broadway.
Hale, M. (2013). The single woman. Nashville,
TN: Thomas Nelson.
Hale, M. (2014). I’ve never been to Vegas
but my luggage has. Nashville, TN: Thomas
Nelson.
Handler, J. (2013). Braving the fire. New York,
NY: St. Martin’s Griffin.
Heard, G. (1995). Writing toward home.
Portsmouth, NH: Heinemann.
Kepler, H. B. (1973). Basic graphical kinemat-
ics (2nd ed.). New York, NY: McGraw Hill.
Kinsella, W. P. (1982). Shoeless Joe. New
York, NY: Ballantine.
Lamott, A. (1994). Bird by bird. New York:
Anchor Books.
Pennebaker, J. W. (1997). Opening up: The
healing power of expressing emotions. New
York, NY: The Guilford press.
Putz, M. (2006). A teacher’s guide to the
multigenre research project. Portsmouth, NH:
Heinemann.
Rankin, L. (2013). Mind over medicine.
Carlsbad, CA: Hay House.
Romano, T. (1995). Writing with passion.
Portsmouth, NH: Heinemann.
Romano, T. (2013). Fearless writing. Ports-
mouth, NH: Heinemann.
Rushnell, S. (2012). Divine alignment. New
York, NY: Howard Books.
Tindle, H. (2013). Up: How positive outlook
can transform our health and aging. New
York, NY: Hudson Street Press.
Wanner, E.T., & Bird, J.L. (2013). The Wan-
ner Bird healing survey for pain recovery.
Original work copyrighted by the authors.
Warren, R. (2012). The purpose driven life:
What on Earth am I here for? Grand Rapids,
MI: Zondervan.
Zimmermann, S. (2002). Writing to heal the
soul. New York, NY: Three Rivers Press.
251

KEY TERMS AND DEFINITIONS
Artistic and Technical Writing: Artistic
writing focuses on the writer’s tone of word
choice, also known as voice, while technical
writing focuses on the writer’s specificity of
word choice. English teachers design rubrics
that incorporate both artistic and technical
writing.
Godwink: A moment where synchronicity
occurs in the form of a coincidence; instead of
being interpreted as a coincidence the event
is perceived as a message from God.
Multigenre Healing Project: Jen and Eric
designed a multigenre project where Jen wrote
about her neck pain and Eric provided the
end notes analysis. This different perspective
on multigenre projects connects the fields of
education and medicine and leads to greater
patient awareness.
Multigenre Writing: A multigenre pa-
per consists of two parts: creative writing in
multiple genres and the writer’s analysis of
the genres.
Narrative Medicine: The field of medi-
cine, used by programs such as the ones at
Duke University and Columbia University,
which encourages medical practitioners to
use theories from the fields of literature and
composition to enhance comprehension of
the stories patients share.
Neck Pain Journal: Jen created a journal
of what she was doing when her neck felt
252

Strength from Spirituality
pain. Eric read the journal and adjusted Jen’s
treatment plan to make her neck feel better.
Spirituality: Regardless of religion, spiri-
tuality and a belief in a higher power can lead
to increased health and provide both hope and
strength for patients.
Synergistic Collaboration: Adapted from
the dictionary definition of “synergistic,” this
process describes a team that works together
and accomplishes more than they could when
working alone. It can also be referred to as
positive interdependence.
Thinking Like a Turtle: This philosophy
means taking on one task at a time, which can
lead to less stress.
Wanner-Bird Healing Survey for Pain
Recovery: An original survey designed by
Dr. Eric Wanner and Dr. Jennifer Bird. This
survey features a combination of numerical
subjective questions, where patients are asked
to respond to statements by circling a number
from 1-5, and written subjective questions that
evaluates patients on a rubric with a score
of 1, 3, or 5 to incorporate the technical and
artistic dimensions of writing.
Writing Voice: Voice in writing describes
how a writer uses word choice and tone when
writing a journal entry or other composition
that reflects the personality of the writer. Just
like each person has a unique speaking voice,
each writer has a unique writing voice.

Strength from Spirituality

APPENDIX

Table 1. Jen’s neck pain journal

Date Pain Level 1=Low, 10=High Observations

Summary Left side pain is gone and I have my range of motion back. I’m doing my exercises twice a day. I added meditation, more
The right side pain has been a roller coaster this week. laughter, and a turtle necklace as my personal symbol to slow
The numbers below are the average for each day; there are down. I checked in with a therapist to talk about my mom’s death.
moments when it is better or worse but neither lasts very long. I love my life and am peaceful with it. Okay, neck, what more
do you want from me?!
Mon 4/2 Right Side Pain Level = 3 Better after physical therapy. No rehearsal tonight so time off
and rest helped.
Tues 4/3 Right Side Pain Level = 1 High stress day at work with student registration for new semester
and lots of stressed out students and colleagues. Doing what
feels like 100 things per hour but my neck is better. Scary that
neck likes stress!!
Wed 4/4 Right Side Pain Level = 4 Two days of constant stress = neck pain worse. That’s kind of a
no brainer. Still doing my exercises but feeling frustrated that the
pain is worse today. Sleep on my side and know I’m not helping
myself but I’m physically and emotionally exhausted.
Thurs 4/5 Right Side Pain Level = 5 Today is the day I wonder if I can live with pain. That lasts for
about 10 minutes before I tell myself that I’m not giving up and
Eric is not going to let me give up. See news story that meditation
helps with pain. Motivate self to keep going.
Fri 4/6 Right Side Pain Level = 2 Feeling better today. Leave work early and hang out at the nursing
home with Grandma, who feels that since she is almost 90 she
no longer needs to censor anything she says. She always makes
me laugh.

253
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Related References
To continue our tradition of advancing medicine, healthcare, and life sciences research, we have compiled
a list of recommended IGI Global readings. These references will provide additional information and
guidance to further enrich your knowledge and assist you with your own research and future publications.
Abu-Faraj, Z. O. (2012). Bioengineering/
biomedical engineering education. In Z.
Abu-Faraj (Ed.), Handbook of research
on biomedical engineering education
and advanced bioengineering learning:
Interdisciplinary concepts (pp. 1–59). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-0122-2.ch001
Achehboune, A., & Driouchi, A. (2014). Potential
skilled labor migration, internationalization of
education with focus on medical education: The
case of Arab countries. In A. Driouchi (Ed.), La-
bor and health economics in the Mediterranean
region: Migration and mobility of medical doctors
(pp. 83–122). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4723-7.ch004
Adomi, E. E., Egbaivwie, E., & Ogugua, J. C.
(2013). Use of the internet by medical practitioners
in private hospitals in Warri, Delta State, Nigeria.
In A. Cartelli (Ed.), Fostering 21st century digital
literacy and technical competency (pp. 213–221).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-2943-1.ch015


Afolabi, M. O., Babalola, O. O., & Ola-Olorun,
O. J. (2012). Counselling in pharmacy practice:
Exploring the use of online counselling interac-
tions to improve medicine use among people living
with HIV/AIDS (PLWHA). In B. Popoola & O.
Adebowale (Eds.), Online guidance and counsel-
ing: Toward effectively applying technology (pp.
91–103). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-61350-204-4.ch007
Ahmad, Y. J., Raghavan, V. V., & Martz, W. B. Jr.
(2011). Adoption of electronic health records. In
Clinical technologies: Concepts, methodologies,
tools and applications (pp. 132–146). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-561-2.ch109
Al-Dossary, S., Al-Dulaijan, N., Al-Mansour,
S., Al-Zahrani, S., Al-Fridan, M., & Househ,
M. (2013). Organ donation and transplantation:
Processes, registries, consent, and restrictions in
Saudi Arabia. In M. Cruz-Cunha, I. Miranda, & P.
Gonçalves (Eds.), Handbook of research on ICTs
for human-centered healthcare and social care
services (pp. 511–528). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-3986-7.ch027
Related References
Al-Khudairy, S. (2014). Caring for our aging
population: Using CPOE and telehomecare sys-
tems as a response to health policy concerns. In C.
El Morr (Ed.), Research perspectives on the role
of informatics in health policy and management
(pp. 153–166). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4321-5.ch010
Albert, A., Serrano, A. J., Soria, E., & Jiménez,
N. V. (2010). Clinical decision support system to
prevent toxicity in patients treated with Digoxin. In
A. Shukla & R. Tiwari (Eds.), Intelligent medical
technologies and biomedical engineering: Tools
and applications (pp. 1–21). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61520-977-4.ch001
Alexandrou, D. A., & Pardalis, K. V. (2014).
SEMantic PATHways: Modeling, executing, and
monitoring intra-organizational healthcare busi-
ness processes towards personalized treatment.
In Software design and development: Concepts,
methodologies, tools, and applications (pp.
1036–1062). Hershey, PA: Information Science
Reference; doi:10.4018/978-1-4666-4301-7.
ch050
Alhaqbani, B., & Fidge, C. (2013). A medical
data trustworthiness assessment model. In User-
driven healthcare: Concepts, methodologies,
tools, and applications (pp. 1425–1445). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-2770-3.ch071
Ali, S., Abbadeni, N., & Batouche, M. (2012).
Multidisciplinary computational intelligence
techniques: Applications in business, engineer-
ing, and medicine (pp. 1–365). Hershey, PA: IGI
Global; doi:10.4018/978-1-4666-1830-5
Alonso, J. M., Castiello, C., Lucarelli, M., &
Mencar, C. (2013). Modeling interpretable fuzzy
rule-based classifiers for medical decision support.
In Data mining: Concepts, methodologies, tools,
and applications (pp. 1064–1081). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-4666-2455-9.ch054
Alonso-Barba, J. I., Nielsen, J. D., de la Ossa, L.,
& Puerta, J. M. (2012). Learning probabilistic
graphical models: A review of techniques and ap-
plications in medicine. In R. Magdalena-Benedito,
E. Soria-Olivas, J. Martínez, J. Gómez-Sanchis, &
A. Serrano-López (Eds.), Medical applications of
intelligent data analysis: Research advancements
(pp. 223–236). Hershey, PA: Information Science
Reference; doi:10.4018/978-1-4666-1803-9.ch015
Anderson, J. G. (2010). Improving patient safety
with information technology. In K. Khoumbati, Y.
Dwivedi, A. Srivastava, & B. Lal (Eds.), Handbook
of research on advances in health informatics and
electronic healthcare applications: Global adop-
tion and impact of information communication
technologies (pp. 144–152). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60566-030-1.ch009
Anderson, J. G. (2011). Regional patient safety
initiatives. In Clinical technologies: Concepts,
methodologies, tools and applications (pp. 1491–
1503). Hershey, PA: Medical Information Science
Reference; doi:10.4018/978-1-60960-561-2.ch506
Andonegui, J., Serrano, L., & Eguzkiza, A. (2010).
E-health applications in ophthalmic diseases: Ongo-
ing developments. In M. Cruz-Cunha, A. Tavares,
& R. Simoes (Eds.), Handbook of research on
developments in e-health and telemedicine: Tech-
nological and social perspectives (pp. 1088–1115).
Hershey, PA: Medical Information Science Refer-
ence; doi:10.4018/978-1-61520-670-4.ch052
255

Andrés, A. R. (2014). Understanding the migration
of medical doctors in the context of Europe. In A.
Driouchi (Ed.), Labor and health economics in
the Mediterranean region: Migration and mobil-
ity of medical doctors (pp. 139–157). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-4723-7.ch006
Ann, O. C., & Theng, L. B. (2014). A facial expres-
sion mediated natural user interface communica-
tion model for children with motor impairments. In
G. Kouroupetroglou (Ed.), Assistive technologies
and computer access for motor disabilities (pp.
254–284). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4438-0.ch009
Anselma, L., Bottrighi, A., Molino, G., Mon-
tani, S., Terenziani, P., & Torchio, M. (2011).
Supporting knowledge-based decision making
in the medical context: The GLARE approach.
[IJKBO]. International Journal of Knowledge-
Based Organizations, 1(1), 42–60. doi: 10.4018/
ijkbo.2011010103
Apostolakis, I., Valsamos, P., & Varlamis, I.
(2011). Quality assurance in evidence-based medi-
cine. In A. Moumtzoglou & A. Kastania (Eds.),
E-health systems quality and reliability: Models
and standards (pp. 86–99). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61692-843-8.ch008
Archibald, D., MacDonald, C. J., Hogue, R., &
Mercer, J. (2013). Accessing knowledge from
the bedside: Introducing the tablet computer to
clinical teaching. In C. Rückemann (Ed.), Inte-
grated information and computing systems for
natural, spatial, and social sciences (pp. 96–109).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-2190-9.ch005
Aspradaki, A. A. (2013). Deliberative democracy
and nanotechnologies in health. [IJT]. Interna-
tional Journal of Technoethics, 4(2), 1–14. doi:
10.4018/jte.2013070101
256
Related References
Assis-Hassid, S., Reychav, I., Pliskin, J. S., &
Heart, T. H. (2013). The effects of electronic
medical record (EMR) use in primary care on the
physician-patient relationship. In M. Cruz-Cunha,
I. Miranda, & P. Gonçalves (Eds.), Handbook of
research on ICTs for human-centered healthcare
and social care services (pp. 130–150). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-3986-7.ch007
Atanasov, A. (2011). Quality and reliability aspects
in evidence based e-medicine. In A. Moumtzoglou
& A. Kastania (Eds.), E-health systems quality and
reliability: Models and standards (pp. 100–117).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-61692-843-8.ch009
Attalla, D. S. (2011). Health hazards of mobile
information communication technologies. In A.
Abdel-Wahab & A. El-Masry (Eds.), Mobile infor-
mation communication technologies adoption in
developing countries: Effects and implications (pp.
237–251). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-61692-818-6.ch016
Au, S., & Gupta, A. (2011). Gastrointestinal mo-
tility online educational endeavor. In A. Moum-
tzoglou & A. Kastania (Eds.), E-health systems
quality and reliability: Models and standards
(pp. 163–182). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-61692-
843-8.ch014
Azar, A. T. (2013). Overview of biomedical engi-
neering. In Bioinformatics: Concepts, methodolo-
gies, tools, and applications (pp. 1-28). Hershey,
PA: Medical Information Science Reference. doi:
10.4018/978-1-4666-3604-0.ch001
Azar, A. T., & Eljamel, M. S. (2014). Medical
robotics. In Robotics: Concepts, methodologies,
tools, and applications (pp. 1116-1147). Her-
shey, PA: Information Science Reference. doi:
10.4018/978-1-4666-4607-0.ch054
Related References
Bagheri, F. B. (2013). eSelf or computerized
self network: A tool for individual empower-
ment & implementation of optimal healthcare.
[IJUDH]. International Journal of User-
Driven Healthcare, 3(2), 20–32. doi: 10.4018/
ijudh.2013040103
Baharadwaj, N., Wadhwa, S., Goel, P., Sethi,
I., Arora, C. S., Goel, A., & Parthasarathy, H.
et al. (2014). De-noising, clustering, classifica-
tion, and representation of microarray data for
disease diagnostics. In R. Srivastava, S. Singh,
& K. Shukla (Eds.), Research developments in
computer vision and image processing: Meth-
odologies and applications (pp. 149–174).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-4558-5.ch009
Baijou, A. (2014). A descriptive overview of
the emigration of medical doctors from MENA
to EU. In A. Driouchi (Ed.), Labor and health
economics in the Mediterranean region: Mi-
gration and mobility of medical doctors (pp.
192–218). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4723-7.ch008
Bauer, K. (2010). Healthcare ethics in the
information age. In J. Rodrigues (Ed.), Health
information systems: Concepts, methodologies,
tools, and applications (pp. 1761–1776). Her-
shey, PA: Medical Information Science Refer-
ence; doi:10.4018/978-1-60566-988-5.ch114
Bauer, K. A. (2013). Caught in the web: The
internet and the demise of medical privacy. In
User-driven healthcare: Concepts, methodolo-
gies, tools, and applications (pp. 1252–1272).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-2770-3.ch063
Bayona, S., Espadero, J. M., Fernández, J. M., Pastor,
L., & Rodríguez, Á. (2011). Implementing virtual
reality in the healthcare sector. In N. Rao (Ed.),
Virtual technologies for business and industrial
applications: Innovative and synergistic approaches
(pp. 138–163). Hershey, PA: Business Science
Reference; doi:10.4018/978-1-61520-631-5.ch009
Begg, M., Dewhurst, D., & Ross, M. (2010). Game
informed virtual patients: Catalysts for online learn-
ing communities and professional development of
medical teachers. In J. Lindberg & A. Olofsson
(Eds.), Online learning communities and teacher
professional development: Methods for improved
education delivery (pp. 190–208). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60566-780-5.ch011
Bennett, E. E., Blanchard, R. D., & Fernandez, G.
L. (2012). Knowledge sharing in academic medical
centers: Examining the nexus of higher education
and workforce development. In V. Wang (Ed.), En-
cyclopedia of e-leadership, counseling and training
(pp. 212–232). Hershey, PA: Information Science
Reference; doi:10.4018/978-1-61350-068-2.ch016
Bera, T. K., & Nagaraju, J. (2014). Electrical im-
pedance tomography (EIT): A harmless medical
imaging modality. In R. Srivastava, S. Singh, & K.
Shukla (Eds.), Research developments in computer
vision and image processing: Methodologies and
applications (pp. 235–273). Hershey, PA: Informa-
tion Science Reference; doi:10.4018/978-1-4666-
4558-5.ch013
Berler, A., & Apostolakis, I. (2014). Normal-
izing cross-border healthcare in europe via new
e-prescription paradigms. In C. El Morr (Ed.),
Research perspectives on the role of informatics in
health policy and management (pp. 168–208). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-4321-5.ch011
257

Beswetherick, J. (2012). Health care information
systems and the risk of privacy issues for the
disabled. In Cyber crime: Concepts, method-
ologies, tools and applications (pp. 870–890).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-61350-323-2.ch411
Bhattacharya, P., Asanga, A. P., & Biswas,
R. (2011). Stomodeum to proctodeum: Email
narratives on clinical problem solving in
gastroenterology. In R. Biswas & C. Martin
(Eds.), User-driven healthcare and narrative
medicine: Utilizing collaborative social net-
works and technologies (pp. 34–53). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-097-6.ch003
Biswas, R., & Martin, C. M. (2011). User-driven
healthcare and narrative medicine: Utilizing
collaborative social networks and technologies.
Hershey, PA: IGI Global; doi:10.4018/978-1-
60960-097-6
Biswas, R., Martin, C. M., Sturmberg, J.,
Mukherji, K., Lee, E. W., & Umakanth, S.
(2011). Social cognitive ontology and user
driven healthcare. In Clinical technologies:
Concepts, methodologies, tools and applications
(pp. 1996–2012). Hershey, PA: Medical Infor-
mation Science Reference; doi:10.4018/978-1-
60960-561-2.ch710
Biswas, R., Sturmberg, J., Martin, C. M., Ga-
nesh, A. U., Umakanth, S., & Lee, E. W. (2011).
Persistent clinical encounters in user driven e-
health care. In Clinical technologies: Concepts,
methodologies, tools and applications (pp.
1030–1046). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
561-2.ch403
258
Related References
Black, N. P., Fromme, H. B., Maniscalco, J., Fer-
rell, C., Myers, J., & Augustine, E. … Blankenburg,
R. (2013). Innovation in patient care and medical
resident education: Using blended instruction to
transform nighttime patient care from a service
model into an educational model. In A. Ritzhaupt,
& S. Kumar (Eds.) Cases on educational technology
implementation for facilitating learning (pp. 161-
176). Hershey, PA: Information Science Reference.
doi: 10.4018/978-1-4666-3676-7.ch010
Blatt, A. J. (2013). Geospatial applications in disease
surveillance: Solutions for the future. [IJAGR]. In-
ternational Journal of Applied Geospatial Research,
4(2), 1–8. doi: 10.4018/jagr.2013040101
Boaduo, N. A., & Boaduo, N. K. (2012). ICTs for
enhanced use of indigenous medicinal plants by the
Ashante speaking people of Ghana. In R. Lekoko
& L. Semali (Eds.), Cases on developing countries
and ICT integration: Rural community development
(pp. 16–24). Hershey, PA: Information Science
Reference; doi:10.4018/978-1-60960-117-1.ch002
Boboc, C., & Titan, E. (2014). Inputs from the
new economics of migration of medical doctors in
eastern and central Europe. In A. Driouchi (Ed.),
Labor and health economics in the Mediterranean
region: Migration and mobility of medical doctors
(pp. 241–266). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-4723-
7.ch010
Boboc, C., & Ţiţan, E. (2014). Migration of medical
doctors, health, medical education, and employment
in eastern and central Europe. In A. Driouchi (Ed.),
Labor and health economics in the Mediterranean
region: Migration and mobility of medical doctors
(pp. 158–191). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-4723-
7.ch007
Related References
Bolsin, S., & Colson, M. (2010). IT benefits in
healthcare performance and safety. In J. Rodrigues
(Ed.), Health information systems: Concepts,
methodologies, tools, and applications (pp.
71–88). Hershey, PA: Medical Information Sci-
ence Reference; doi:10.4018/978-1-60566-988-5.
ch006
Bongers, B., & Smith, S. (2014). Interactivating
rehabilitation through active multimodal feed-
back and guidance. In Assistive technologies:
Concepts, methodologies, tools, and applications
(pp. 1650–1674). Hershey, PA: Information Sci-
ence Reference; doi:10.4018/978-1-4666-4422-9.
ch087
Borges, A. P., & Laranjeira, E. (2013). Why and
how did health economics appear? Who were
the main authors? What is the role of ITCs in its
development? In M. Cruz-Cunha, I. Miranda, & P.
Gonçalves (Eds.), Handbook of research on ICTs
and management systems for improving efficiency
in healthcare and social care (pp. 971–987). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-3990-4.ch051
Bourgeois, S., & Yaylacicegi, U. (2012). Elec-
tronic health records: Improving patient safety
and quality of care in Texas acute care hospitals.
In J. Tan (Ed.), Advancing technologies and intel-
ligence in healthcare and clinical environments
breakthroughs (pp. 18–32). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-1755-1.ch002
Brandt, R., & Rice, R. (2012). Dermatological
telemedicine diagnoses and andragogical training
using web 2.0 mobile medicine video conferenc-
ing. In V. Dennen & J. Myers (Eds.), Virtual
professional development and informal learning
via social networks (pp. 276–293). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-4666-1815-2.ch016
Brzezinski, J., Kosiedowski, M., Mazurek, C.,
Slowinski, K., Slowinski, R., Stroinski, M., &
Weglarz, J. (2013). Towards telemedical centers:
Digitization of inter-professional communication
in healthcare. In M. Cruz-Cunha, I. Miranda, & P.
Gonçalves (Eds.), Handbook of research on ICTs
and management systems for improving efficiency
in healthcare and social care (pp. 805–829). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-3990-4.ch042
Carlén, U., & Lindström, B. (2012). Informed
design of educational activities in online learn-
ing communities. In A. Olofsson & J. Lindberg
(Eds.), Informed design of educational technolo-
gies in higher education: Enhanced learning and
teaching (pp. 118–134). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-61350-
080-4.ch007
Carrigan, E., Ugaz, A., Moberly, H. K., Page, J.,
Alpi, K. M., & Vreeland, C. (2013). Veterinary
medicine: All collections great and small. In S.
Holder (Ed.), Library collection development for
professional programs: Trends and best practices
(pp. 248–268). Hershey, PA: Information Science
Reference; doi:10.4018/978-1-4666-1897-8.
ch015
Caruana, C. J. (2012). The ongoing crisis in
medical device education for healthcare profes-
sionals: Breaking the vicious circle through online
learning. [IJRQEH]. International Journal of
Reliable and Quality E-Healthcare, 1(2), 29–40.
doi: 10.4018/ijrqeh.2012040103
Catapano, G., & Verkerke, G. J. (2012). Artificial
organs. In Z. Abu-Faraj (Ed.), Handbook of re-
search on biomedical engineering education and
advanced bioengineering learning: Interdisciplin-
ary concepts (pp. 60–95). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-0122-2.ch002
259

Chandra, S., Shah, N. K., & Sriganesh, V. (2011).
The cochrane students journal club and creating
a secondary learning resource for gathering and
appraising evidence: An example of rational use
of medicines to prevent malaria relapse. [IJUDH].
International Journal of User-Driven Healthcare,
1(4), 31–41. doi: 10.4018/ijudh.2011100103
Chang, A. Y., Littman-Quinn, R., Ketshogileng,
D., Chandra, A., Rijken, T., Ghose, S., & Kovarik,
C. L. et  al. (2012). Smartphone-based mobile
learning with physician trainees in Botswana.
[IJMBL]. International Journal of Mobile and
Blended Learning, 4(2), 1–14. doi: 10.4018/
jmbl.2012040101
Charissis, G., Melas, C., Moustakis, V., & Zam-
petakis, L. (2010). Organizational implementation
of healthcare information systems. In M. Cruz-
Cunha, A. Tavares, & R. Simoes (Eds.), Handbook
of research on developments in e-health and tele-
medicine: Technological and social perspectives
(pp. 419–450). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-61520-
670-4.ch020
Chaudhuri, A., Young, J., Martin, C. M., Sturm-
berg, J. P., & Biswas, R. (2011). Hematology: The
river within. In R. Biswas & C. Martin (Eds.),
User-driven healthcare and narrative medicine:
Utilizing collaborative social networks and
technologies (pp. 16–33). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60960-097-6.ch002
Chen, J. Y., Xu, H., Shi, P., Culbertson, A., &
Meslin, E. M. (2013). Ethics and privacy con-
siderations for systems biology applications in
predictive and personalized medicine. In Bio-
informatics: Concepts, methodologies, tools,
and applications (pp. 1378-1404). Hershey, PA:
Medical Information Science Reference. doi:
10.4018/978-1-4666-3604-0.ch071
260
Related References
Cherian, E. J., & Ryan, T. W. (2014). Incongru-
ent needs: Why differences in the iron-triangle
of priorities make health information technology
adoption and use difficult. In C. El Morr (Ed.),
Research perspectives on the role of informatics
in health policy and management (pp. 209–221).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-4321-5.ch012
Chetioui, Y. (2014). Perception by Moroccan
physicians of factors affecting their migration
decisions. In A. Driouchi (Ed.), Labor and health
economics in the mediterranean region: Migration
and mobility of medical doctors (pp. 337–375).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-4723-7.ch014
Chorbev, I., & Joksimoski, B. (2011). An in-
tegrated system for e-medicine (e-health, tele-
medicine and medical expert systems). In Clinical
technologies: Concepts, methodologies, tools and
applications (pp. 486–507). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60960-561-2.ch218
Ciufudean, C., Ciufudean, O., & Filote, C. (2013).
New models for ICT-based medical diagnosis. In
M. Cruz-Cunha, I. Miranda, & P. Gonçalves (Eds.),
Handbook of research on ICTs and management
systems for improving efficiency in healthcare and
social care (pp. 892–911). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-3990-4.ch046
Clark, J. M. (2014). Implementation of electronic
records in a medical practice setting. In J. Krueger
(Ed.), Cases on electronic records and resource
management implementation in diverse environ-
ments (pp. 211–225). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-4666-
4466-3.ch013
Related References
Clark, T. (2011). Health and health care grid
services and delivery integrating eHealth and
telemedicine. In E. Kldiashvili (Ed.), Grid tech-
nologies for e-health: Applications for telemedi-
cine services and delivery (pp. 36–64). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-61692-010-4.ch003
Claster, W., Ghotbi, N., & Shanmuganathan, S.
(2010). Data-mining techniques for an analysis
of non-conventional methodologies: Deciphering
of alternative medicine. In W. Pease, M. Cooper,
& R. Gururajan (Eds.), Biomedical knowledge
management: Infrastructures and processes for e-
health systems (pp. 82–91). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60566-266-4.ch006
Condaris, C. (2012). Scales to scalpels: Doc-
tors who practice the healing arts of music and
medicine. [IJUDH]. International Journal of User-
Driven Healthcare, 2(3), 84–84. doi: 10.4018/
ijudh.2012070109
Corrigan, D., Hederman, L., Khan, H., Taweel,
A., Kostopoulou, O., & Delaney, B. (2013). An
ontology-driven approach to clinical evidence
modelling implementing clinical prediction rules.
In A. Moumtzoglou & A. Kastania (Eds.), E-
health technologies and improving patient safety:
Exploring organizational factors (pp. 257–284).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-2657-7.ch016
Crisóstomo-Acevedo, M. J., & Aurelio Medina-
Garrido, J. (2010). Difficulties in accepting
telemedicine. In J. Rodrigues (Ed.), Health
information systems: Concepts, methodologies,
tools, and applications (pp. 1628–1639). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60566-988-5.ch104
Danforth, D. R. (2010). Development of an in-
teractive virtual 3-D model of the human testis
using the second life platform. [IJVPLE]. Inter-
national Journal of Virtual and Personal Learn-
ing Environments, 1(2), 45–58. doi: 10.4018/
jvple.2010040104
Daniel, V. M. (2011). Genomics and genetic
engineering: Playing god? In S. Hongladarom
(Ed.), Genomics and bioethics: Interdisciplinary
perspectives, technologies and advancements (pp.
111–129). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-61692-
883-4.ch008
Daskalaki, A. (2010). Informatics in oral medi-
cine: Advanced techniques in clinical and diag-
nostic technologies. Hershey, PA: IGI Global;
doi:10.4018/978-1-60566-733-1
Davis, S. A. (2013). Global telemedicine and
eHealth: Advances for future healthcare – Using
a systems approach to integrate healthcare func-
tions. In V. Gulla, A. Mori, F. Gabbrielli, & P.
Lanzafame (Eds.), Telehealth networks for hospital
services: New methodologies (pp. 15–32). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-2979-0.ch002
de Leeuw, E. (2012). The politics of medi-
cal curriculum accreditation: Thoughts, not
facts? [IJUDH]. International Journal of User-
Driven Healthcare, 2(1), 53–69. doi: 10.4018/
ijudh.2012010108
De Luca, S., & Memo, E. (2010). Better knowledge
for better health services: Discovering guideline
compliance. In J. Rodrigues (Ed.), Health informa-
tion systems: Concepts, methodologies, tools, and
applications (pp. 233–255). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60566-988-5.ch017
261

DeSimio, T., & Chrisagis, X. (2012). Medical
e-reference: A benchmark for e-reference publish-
ing in other disciplines. In S. Polanka (Ed.), E-
reference context and discoverability in libraries:
Issues and concepts (pp. 116–125). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-61350-308-9.ch011
Dhakal, B., & Ross, S. D. (2011). Medical student
perspectives: Journey through different worlds.
In R. Biswas & C. Martin (Eds.), User-driven
healthcare and narrative medicine: Utilizing
collaborative social networks and technologies
(pp. 125–133). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
097-6.ch009
Dong, Y., Lu, H., Gajic, O., & Pickering, B. (2012).
Intensive care unit operational modeling and
analysis. In A. Kolker & P. Story (Eds.), Manage-
ment engineering for effective healthcare delivery:
Principles and applications (pp. 132–147). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-872-9.ch006
Doyle, D. (2011). E-medical education: An over-
view. In A. Shukla & R. Tiwari (Eds.), Biomedical
engineering and information systems: Technolo-
gies, tools and applications (pp. 219–238). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-61692-004-3.ch012
Driouchi, A. (2014). Introduction to labor and
health economics: Mobility of medical doctors in
the Mediterranean region. In A. Driouchi (Ed.),
Labor and health economics in the Mediterranean
region: Migration and mobility of medical doctors
(pp. 1–22). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4723-7.ch001
262
Related References
Driouchi, A. (2014). Medical knowledge, north-
south cooperation, and mobility of medical
doctors. In A. Driouchi (Ed.), Labor and health
economics in the Mediterranean region: Migration
and mobility of medical doctors (pp. 376–395).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-4723-7.ch015
Duan, X., Wang, X., & Huang, Q. (2014). Medi-
cal manipulators for surgical applications. In
Robotics: Concepts, methodologies, tools, and
applications (pp. 608-618). Hershey, PA: Infor-
mation Science Reference. doi: 10.4018/978-1-
4666-4607-0.ch030
Dyro, J. F. (2012). Clinical engineering. In Z.
Abu-Faraj (Ed.), Handbook of research on bio-
medical engineering education and advanced
bioengineering learning: Interdisciplinary
concepts (pp. 521–576). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-0122-2.ch012
El Morr, C., & Subercaze, J. (2010). Knowledge
management in healthcare. In M. Cruz-Cunha,
A. Tavares, & R. Simoes (Eds.), Handbook of
research on developments in e-health and tele-
medicine: Technological and social perspectives
(pp. 490–510). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-61520-
670-4.ch023
Eleni, A., & Maglogiannis, I. (2010). Adoption of
wearable systems in modern patient telemonitor-
ing systems. In M. Cruz-Cunha, A. Tavares, & R.
Simoes (Eds.), Handbook of research on develop-
ments in e-health and telemedicine: Technological
and social perspectives (pp. 1004–1023). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-61520-670-4.ch048
Related References
Epstein, J. H., Goldberg, A., Krol, M., & Levine, A.
(2013). Virtual tools in medical education. In Y. Kats
(Ed.), Learning management systems and instruc-
tional design: Best practices in online education
(pp. 364–380). Hershey, PA: Information Science
Reference; doi:10.4018/978-1-4666-3930-0.ch019
Eskeland, S., & Oleshchuk, V. (2010). Informa-
tion security and privacy in medical application
scenario. In K. Khoumbati, Y. Dwivedi, A. Sriv-
astava, & B. Lal (Eds.), Handbook of research
on advances in health informatics and electronic
healthcare applications: Global adoption and im-
pact of information communication technologies
(pp. 274–287). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60566-030-
1.ch017
Esposito, A. (2013). The impact of social media on
scholarly practices in higher education: Online en-
gagement and ICTs appropriation in senior, young,
and doctoral researchers. In B. Pătruţ, M. Pătruţ,
& C. Cmeciu (Eds.), Social media and the new
academic environment: Pedagogical challenges
(pp. 342–367). Hershey, PA: Information Science
Reference; doi:10.4018/978-1-4666-2851-9.ch017
Facelli, J. C., Hurdle, J. F., & Mitchell, J. A. (2012).
Medical informatics and bioinformatics. In Z. Abu-
Faraj (Ed.), Handbook of research on biomedical en-
gineering education and advanced bioengineering
learning: Interdisciplinary concepts (pp. 577–604).
Hershey, PA: Medical Information Science Refer-
ence; doi:10.4018/978-1-4666-0122-2.ch013
Fairchild, K. D., & Moorman, J. R. (2012). Heart
rate characteristics monitoring in the NICU: A new
tool for clinical care and research. In W. Chen, S.
Oetomo, & L. Feijs (Eds.), Neonatal monitoring
technologies: Design for integrated solutions (pp.
175–200). Hershey, PA: Medical Information Sci-
ence Reference; doi:10.4018/978-1-4666-0975-4.
ch008
Fakhar, A. (2014). Beyond brain drain: A case
study of the benefits of cooperation on medical
immigration. In A. Driouchi (Ed.), Labor and
health economics in the Mediterranean region:
Migration and mobility of medical doctors (pp.
294–313). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4723-7.ch012
Farrell, M. (2011). Use of handheld computers in
nursing education. In Clinical technologies: Con-
cepts, methodologies, tools and applications (pp.
1504–1517). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
561-2.ch507
Ferrer-Roca, O. (2011). Standards in telemedicine.
In A. Moumtzoglou & A. Kastania (Eds.), E-
health systems quality and reliability: Models and
standards (pp. 220–243). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61692-843-8.ch017
Fiaidhi, J., Mohammed, S., & Wei, Y. (2010). Im-
plications of web 2.0 technology on healthcare: A
biomedical semantic blog case study. In S. Kabene
(Ed.), Healthcare and the effect of technology:
Developments, challenges and advancements
(pp. 269–289). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-61520-
733-6.ch016
Fialho, A. S., Cismondi, F., Vieira, S. M., Reti,
S. R., Sousa, J. M., & Finkelstein, S. N. (2013).
Challenges and opportunities of soft computing
tools in health care delivery. In M. Cruz-Cunha,
I. Miranda, & P. Gonçalves (Eds.), Handbook of
research on ICTs and management systems for
improving efficiency in healthcare and social care
(pp. 321–340). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
3990-4.ch016
263

Freitas, A., Brazdil, P., & Costa-Pereira, A. (2012).
Cost-sensitive learning in medicine. In Machine
learning: Concepts, methodologies, tools and
applications (pp. 1625–1641). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60960-818-7.ch607
Freitas, A., & Costa-Pereira, A. (2010). Learning
cost-sensitive decision trees to support medical
diagnosis. In T. Nguyen (Ed.), Complex data
warehousing and knowledge discovery for ad-
vanced retrieval development: Innovative methods
and applications (pp. 287–307). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60566-748-5.ch013
Freitas, L., Pereira, R. T., Pereira, H. G., Martini,
R., Mozzaquatro, B. A., Kasper, J., & Librelotto,
G. (2013). Ontological representation and an ar-
chitecture for homecare pervasive systems. In R.
Martinho, R. Rijo, M. Cruz-Cunha, & J. Varajão
(Eds.), Information systems and technologies for
enhancing health and social care (pp. 215–234).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-3667-5.ch015
Frigo, C. A., & Pavan, E. E. (2014). Prosthetic
and orthotic devices. In Assistive technologies:
Concepts, methodologies, tools, and applications
(pp. 549–613). Hershey, PA: Information Science
Reference; doi:10.4018/978-1-4666-4422-9.
ch028
Frunza, O., & Inkpen, D. (2012). Natural language
processing and machine learning techniques
help achieve a better medical practice. In R.
Magdalena-Benedito, E. Soria-Olivas, J. Mar-
tínez, J. Gómez-Sanchis, & A. Serrano-López
(Eds.), Medical applications of intelligent data
analysis: Research advancements (pp. 237–254).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-1803-9.ch016
264
Related References
Fung-Kee-Fung, M., Morash, R., & Goubanova,
E. (2011). Evaluating CoPs in cancer surgery. In
O. Hernáez & E. Bueno Campos (Eds.), Hand-
book of research on communities of practice for
organizational management and networking:
Methodologies for competitive advantage (pp.
456–466). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-60566-802-4.ch025
Gabbrielli, F. (2013). Telemedicine R&D in-
fluencing incoming strategies and organization
models. In V. Gulla, A. Mori, F. Gabbrielli, & P.
Lanzafame (Eds.), Telehealth networks for hospital
services: New methodologies (pp. 250–264). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-2979-0.ch017
Ganz, A., Schafer, J., Yu, X., Lord, G., Burstein,
J., & Ciottone, G. R. (2013). Real-time scalable re-
source tracking framework (DIORAMA) for mass
casualty incidents. [IJEHMC]. International Jour-
nal of E-Health and Medical Communications,
4(2), 34–49. doi: 10.4018/jehmc.2013040103
Gao, X. W., Loomes, M., & Comley, R. (2012).
Bridging the abridged: The diffusion of tele-
medicine in Europe and China. In J. Rodrigues,
I. de la Torre Díez, & B. Sainz de Abajo (Eds.),
Telemedicine and e-health services, policies, and
applications: Advancements and developments
(pp. 451–495). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
0888-7.ch017
Gavgani, V. Z. (2011). Ubiquitous information
therapy service through social networking librar-
ies: An operational web 2.0 service model. In R.
Biswas & C. Martin (Eds.), User-driven healthcare
and narrative medicine: Utilizing collaborative
social networks and technologies (pp. 446–461).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-60960-097-6.ch030
Related References
Germaine-McDaniel, N. S. (2013). The emerg-
ing hispanic use of online health information in
the United States: Cultural convergence or dis-
sociation? In User-driven healthcare: Concepts,
methodologies, tools, and applications (pp.
1607–1621). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2770-3.ch079
Ghalib, N. (2014). The design and implementation
of paperless medical system (PMS) for offshore
operating company: A structured approach. In
Software design and development: Concepts,
methodologies, tools, and applications (pp. 1064-
1072). Hershey, PA: Information Science Refer-
ence. doi: 10.4018/978-1-4666-4301-7.ch051
Gill, S., & Paranjape, R. (2010). A review of recent
contribution in agent-based health care modeling.
In J. Rodrigues (Ed.), Health information systems:
Concepts, methodologies, tools, and applications
(pp. 356–373). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60566-
988-5.ch024
Gilligan, J., & Smith, P. (2014). A formal represen-
tation system for modelling assistive technology
systems. In G. Kouroupetroglou (Ed.), Disabil-
ity informatics and web accessibility for motor
limitations (pp. 1–42). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-4442-7.ch001
Goldberg, E. M. (2014). Business continuity and
disaster recovery considerations for healthcare
technology. In Crisis management: Concepts,
methodologies, tools and applications (pp. 1455–
1462). Hershey, PA: Information Science Refer-
ence; doi:10.4018/978-1-4666-4707-7.ch073
Gonçalves, F., & David, G. (2013). Definition of
a retrospective health information policy based on
(re)use study. In M. Cruz-Cunha, I. Miranda, & P.
Gonçalves (Eds.), Handbook of research on ICTs
and management systems for improving efficiency
in healthcare and social care (pp. 1130–1155).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-3990-4.ch059
Gopalakrishnan, R., & Mugler, D. H. (2010). The
evolution of hermite transform in biomedical appli-
cations. In A. Shukla & R. Tiwari (Eds.), Intelligent
medical technologies and biomedical engineering:
Tools and applications (pp. 260–278). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-61520-977-4.ch013
Goyal, R. K., O’Neill, M., Agostinelli, N., & Wyer,
P. (2011). Critical illness and the emergency room.
In R. Biswas & C. Martin (Eds.), User-driven
healthcare and narrative medicine: Utilizing
collaborative social networks and technologies
(pp. 63–74). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
097-6.ch005
Graham, I. W. (2011). The nature of nursing work.
In A. Cashin & R. Cook (Eds.), Evidence-based
practice in nursing informatics: Concepts and
applications (pp. 51–63). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60960-034-1.ch005
Greenshields, I., & El-Sayed, G. (2012). Aspects of
visualization and the grid in a biomedical context.
In Grid and cloud computing: Concepts, method-
ologies, tools and applications (pp. 1686–1701).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-0879-5.ch710
265

Grimnes, S., & Høgetveit, J. O. (2012). Biomedi-
cal sensors. In Z. Abu-Faraj (Ed.), Handbook of
research on biomedical engineering education
and advanced bioengineering learning: Inter-
disciplinary concepts (pp. 356–436). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-0122-2.ch009
Guedouar, R., & Zarrad, B. (2012). Forward
projection for use with iterative reconstruction.
In A. Malik, T. Choi, & H. Nisar (Eds.), Depth
map and 3D imaging applications: Algorithms
and technologies (pp. 27–55). Hershey, PA: In-
formation Science Reference; doi:10.4018/978-
1-61350-326-3.ch003
Gullà, V. (2013). Leading the technological in-
novation in healthcare systems: The telematic
medicine approach. In V. Gulla, A. Mori, F.
Gabbrielli, & P. Lanzafame (Eds.), Telehealth
networks for hospital services: New methodologies
(pp. 134–153). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2979-0.ch009
Guo, R., Wang, Y., Yan, H., Li, F., Yan, J., & Xu, Z.
(2011). Pulse wave analysis of traditional chinese
medicine based on hemodynamics principles. In
L. Liu, D. Wei, & Y. Li (Eds.), Interdisciplinary
research and applications in bioinformatics, com-
putational biology, and environmental sciences
(pp. 194–203). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
064-8.ch017
Gupta, A., Goyal, R. K., Joiner, K. A., & Saini,
S. (2010). Outsourcing in the healthcare industry:
Information technology, intellectual property,
and allied aspects. In M. Khosrow-Pour (Ed.),
Global, social, and organizational implications
of emerging information resources manage-
ment: Concepts and applications (pp. 18–44).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-60566-962-5.ch002
266
Related References
Gupta, S., Mukherjee, S., & Roy, S. S. (2013).
Modernization of healthcare and medical diag-
nosis system using multi agent system (MAS): A
comparative study. In S. Bhattacharyya & P. Dutta
(Eds.), Handbook of research on computational
intelligence for engineering, science, and busi-
ness (pp. 592–622). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-4666-
2518-1.ch023
Ha, S. H. (2011). Medical domain knowledge
and associative classification rules in diagnosis.
[IJKDB]. International Journal of Knowledge
Discovery in Bioinformatics, 2(1), 60–73. doi:
10.4018/jkdb.2011010104
Haheim, L. L., & Morland, B. (2010). Health
technology assessment: Development and future.
In J. Rodrigues (Ed.), Health information systems:
Concepts, methodologies, tools, and applications
(pp. 26–41). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60566-
988-5.ch003
Hai-Jew, S. (2010). An elusive formula: The IT
role in behavior change in public health. In T.
Yuzer & G. Kurubacak (Eds.), Transformative
learning and online education: Aesthetics, dimen-
sions and concepts (pp. 347–373). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-61520-985-9.ch022
Haida, M. (2013). Implications of NIRS brain
signals. In J. Wu (Ed.), Biomedical engineering
and cognitive neuroscience for healthcare: Inter-
disciplinary applications (pp. 120–128). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-2113-8.ch013
Haidegger, T. (2012). Surgical robots: System de-
velopment, assessment, and clearance. In T. Sobh
& X. Xiong (Eds.), Prototyping of robotic systems:
Applications of design and implementation (pp.
288–326). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-4666-0176-5.ch010
Related References
Hajiheydari, N., Khakbaz, S. B., & Farhadi, H.
(2013). Proposing a business model in healthcare
industry: E-diagnosis. [IJHISI]. International
Journal of Healthcare Information Systems and
Informatics, 8(2), 41–57. doi: 10.4018/jhi-
si.2013040104
Hanada, E. (2013). Effective use of RFID in
medicine and general healthcare. In T. Issa, P.
Isaías, & P. Kommers (Eds.), Information systems
and technology for organizations in a networked
society (pp. 335–352). Hershey, PA: Business
Science Reference; doi:10.4018/978-1-4666-
4062-7.ch018
Hara, H. (2013). Women and health in Japan:
The rise and obstacles of gender and sex-specific
medicine. In M. Merviö (Ed.), Healthcare manage-
ment and economics: Perspectives on public and
private administration (pp. 203–207). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-3982-9.ch016
Harnett, B. (2013). Patient centered medicine and
technology adaptation. In User-driven healthcare:
Concepts, methodologies, tools, and applications
(pp. 77–98). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2770-3.ch005
Hatton, J. D., Schmidt, T. M., & Jelen, J. (2013).
Adoption of electronic health care records: Physi-
cian heuristics and hesitancy. In R. Martinho, R.
Rijo, M. Cruz-Cunha, & J. Varajão (Eds.), Infor-
mation systems and technologies for enhancing
health and social care (pp. 148–165). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-3667-5.ch010
Heaberg, G. (2011). Case study: Research match-
maker, an advanced nursing practice informatics
application. In A. Cashin & R. Cook (Eds.),
Evidence-based practice in nursing informatics:
Concepts and applications (pp. 217–236). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-034-1.ch017
Hegde, B. (2011). Learning medicine: A personal
view. In R. Biswas & C. Martin (Eds.), User-driven
healthcare and narrative medicine: Utilizing col-
laborative social networks and technologies (pp.
184–190). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
097-6.ch014
Heilman, J. (2012). Creating awareness for using
a wiki to promote collaborative health profes-
sional education. [IJUDH]. International Journal
of User-Driven Healthcare, 2(1), 86–87. doi:
10.4018/ijudh.2012010113
Heinzel, A., Fechete, R., Söllner, J., Perco, P.,
Heinze, G., Oberbauer, R., & Mayer, B. et  al.
(2012). Data graphs for linking clinical pheno-
type and molecular feature space. [IJSBBT].
International Journal of Systems Biology and Bio-
medical Technologies, 1(1), 11–25. doi: 10.4018/
ijsbbt.2012010102
Hernández-Chan, G. S., Rodríguez-González,
A., & Colomo-Palacios, R. (2013). Using social
networks to obtain medical diagnosis. In M.
Cruz-Cunha, I. Miranda, & P. Gonçalves (Eds.),
Handbook of research on ICTs and management
systems for improving efficiency in healthcare and
social care (pp. 306–320). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-3990-4.ch015
267

Hine, M. J., Farion, K. J., Michalowski, W., &
Wilk, S. (2011). Decision making by emergency
room physicians and residents: Implications for
the design of clinical decision support systems.
In J. Tan (Ed.), New technologies for advancing
healthcare and clinical practices (pp. 131–148).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-60960-780-7.ch008
Hoonakker, P., McGuire, K., & Carayon, P. (2011).
Sociotechnical issues of tele-ICU technology. In D.
Haftor & A. Mirijamdotter (Eds.), Information and
communication technologies, society and human
beings: Theory and framework (festschrift in honor
of Gunilla Bradley) (pp. 225–240). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60960-057-0.ch018
Hopper, K. B., & Johns, C. L. (2012). Educational
technology in the medical industry. In Wireless
technologies: Concepts, methodologies, tools
and applications (pp. 1306–1322). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-61350-101-6.ch511
Hsu, P., Tsai, W., & Tsai, C. (2013). Patient
safety concerns among emergency medical staff
and patients. [IJPHIM]. International Journal of
Privacy and Health Information Management,
1(1), 29–52. doi: 10.4018/ijphim.2013010103
Huang, K., Geller, J., Halper, M., Elhanan, G., &
Perl, Y. (2011). Scalability of piecewise synonym
identification in integration of SNOMED into the
UMLS. [IJCMAM]. International Journal of Com-
putational Models and Algorithms in Medicine,
2(3), 26–45. doi: 10.4018/jcmam.2011070103
Hughes, B. (2012). Managing e-health in the age
of web 2.0: The impact on e-health evaluation.
In E-marketing: Concepts, methodologies, tools,
and applications (pp. 1268-1288). Hershey, PA:
Business Science Reference. doi: 10.4018/978-
1-4666-1598-4.ch074
268
Related References
Hyde, A., Nee, J., Butler, M., Drennan, J., &
Howlett, E. (2011). Preferred types of meno-
pause service delivery: A qualitative study of
menopausal women’s perceptions. [IJHDRI].
International Journal of Healthcare Delivery
Reform Initiatives, 3(1), 1–12. doi: 10.4018/
jhdri.2011010101
Ilie, V., Van Slyke, C., Courtney, J. F., & Styne,
P. (2011). Challenges associated with physicians’
usage of electronic medical records. In J. Tan
(Ed.), New technologies for advancing healthcare
and clinical practices (pp. 234–251). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-780-7.ch014
Inomata, C., & Nitta, S. (2013). Nursing in in-
tegrative medicine and nurses’ engagement in
caring-healing: A discussion based on the prac-
tice and study of music therapy and nursing care
for patients with neurodegenerative disorders.
In J. Wu (Ed.), Technological advancements in
biomedicine for healthcare applications (pp.
235–239). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2196-1.ch025
Inthiran, A., Alhashmi, S. M., & Ahmed, P. K.
(2012). Medical information retrieval strategies:
An exploratory study on the information retrieval
behaviors of non-medical professionals. [IJHISI].
International Journal of Healthcare Informa-
tion Systems and Informatics, 7(1), 31–45. doi:
10.4018/jhisi.2012010103
Isern, D., & Moreno, A. (2010). HeCaSe2: A
multi-agent system that automates the applica-
tion of clinical guidelines. In R. Paranjape & A.
Sadanand (Eds.), Multi-agent systems for health-
care simulation and modeling: Applications for
system improvement (pp. 113–136). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60566-772-0.ch007
Related References
Ishaq, G. M., Hussain, P. T., Iqbal, M. J., & Mush-
taq, M. B. (2013). Risk-benefit analysis of com-
bination vs. unopposed HRT in post-menopausal
women. In Bioinformatics: Concepts, method-
ologies, tools, and applications (pp. 1424-1440).
Hershey, PA: Medical Information Science Ref-
erence. doi: 10.4018/978-1-4666-3604-0.ch073
Iwaki, S. (2013). Multimodal neuroimaging to
visualize human visual processing. In J. Wu (Ed.),
Biomedical engineering and cognitive neurosci-
ence for healthcare: Interdisciplinary applications
(pp. 274–282). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2113-8.ch028
James, R. (2011). Practical pointers in medicine
over seven decades: Reflections of an individual
physician. In R. Biswas & C. Martin (Eds.), User-
driven healthcare and narrative medicine: Utiliz-
ing collaborative social networks and technologies
(pp. 173–183). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
097-6.ch013
Janczewski, M. (2010). Healthcare transformation
in a net-centric environment. In S. Ghosh (Ed.),
Net centricity and technological interoperability
in organizations: Perspectives and strategies (pp.
99–114). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-60566-854-3.ch007
Jesus, Â., & Gomes, M. J. (2013). Web 2.0 tools
in biomedical education: Limitations and possi-
bilities. In Y. Kats (Ed.), Learning management
systems and instructional design: Best practices
in online education (pp. 208–231). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-4666-3930-0.ch011
Ji, Z., Sugi, T., Goto, S., Wang, X., & Nakamura,
M. (2013). Multi-channel template extraction for
automatic EEG spike detection. In J. Wu (Ed.),
Biomedical engineering and cognitive neurosci-
ence for healthcare: Interdisciplinary applications
(pp. 255–265). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2113-8.ch026
Jifa, G., Wuqi, S., Zhengxiang, Z., Rui, G., &
Yijun, L. (2012). Expert mining and traditional
Chinese medicine knowledge. In W. Lee (Ed.),
Systems approaches to knowledge management,
transfer, and resource development (pp. 239–251).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-1782-7.ch016
Johnson, D. E. (2012). Electronic medical records
(EMR): Issues and implementation perspectives.
In A. Kolker & P. Story (Eds.), Management
engineering for effective healthcare delivery:
Principles and applications (pp. 333–351). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-872-9.ch016
Johnson, K., & Tashiro, J. (2013). Interprofessional
care and health care complexity: Factors shaping
human resources effectiveness in health informa-
tion management. In User-driven healthcare:
Concepts, methodologies, tools, and applications
(pp. 1273–1302). Hershey, PA: Medical Informa-
tion Science Reference; doi:10.4018/978-1-4666-
2770-3.ch064
Jose, J. (2012). Pharmacovigilance: Basic con-
cepts and applications of pharmacoinformatics.
In T. Gasmelseid (Ed.), Pharmacoinformatics
and drug discovery technologies: Theories and
applications (pp. 322–343). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-0309-7.ch020
269
 Related References

Juzoji, H. (2012). Legal bases for medical super- Kalantri, S. P. (2012). On being a patient. [IJUDH].
vision via mobile telecommunications in Japan. International Journal of User-Driven Healthcare,
[IJEHMC]. International Journal of E-Health 2(4), 1–4. doi: 10.4018/ijudh.2012100101
and Medical Communications, 3(1), 33–45. doi:
Kaldoudi, E., Konstantinidis, S., & Bamidis, P.
10.4018/jehmc.2012010103
D. (2010). Web 2.0 approaches for active, col-
Juzwishin, D. W. (2010). Enabling technologies laborative learning in medicine and health. In S.
and challenges for the future of ubiquitous health Mohammed & J. Fiaidhi (Eds.), Ubiquitous health
the interoperability framework. In S. Mohammed and medical informatics: The ubiquity 2.0 trend
& J. Fiaidhi (Eds.), Ubiquitous health and medical and beyond (pp. 127–149). Hershey, PA: Medical
informatics: The ubiquity 2.0 trend and beyond Information Science Reference; doi:10.4018/978-
(pp. 596–622). Hershey, PA: Medical Information 1-61520-777-0.ch007
Science Reference; doi:10.4018/978-1-61520-
Kannry, J. L. (2011). Operationalizing the science.
777-0.ch028
In Clinical technologies: Concepts, methodolo-
Kabene, S., & Wolfe, M. (2011). Risks and gies, tools and applications (pp. 1600–1622). Her-
benefits of technology in health care. In Clinical shey, PA: Medical Information Science Reference;
technologies: Concepts, methodologies, tools and doi:10.4018/978-1-60960-561-2.ch601
applications (pp. 13–24). Hershey, PA: Medical
Karayanni, D. (2010). A cluster analysis of physi-
Information Science Reference; doi:10.4018/978-
cian’s values, prescribing behaviour and attitudes
1-60960-561-2.ch102
towards firms’ marketing communications.
Kabene, S. M. King, Lisa, & Gibson, C. J. (2010). [IJCRMM]. International Journal of Customer
Technology and human resources management in Relationship Marketing and Management, 1(4),
health care. In S. Mohammed, & J. Fiaidhi (Eds.) 62–79. doi: 10.4018/jcrmm.2010100104
Ubiquitous health and medical informatics: The
Kastania, A., & Moumtzoglou, A. (2012). Quality
ubiquity 2.0 trend and beyond (pp. 574-595). Her-
implications of the medical applications for 4G
shey, PA: Medical Information Science Reference.
mobile phones. [IJRQEH]. International Journal
doi: 10.4018/978-1-61520-777-0.ch027
of Reliable and Quality E-Healthcare, 1(1), 58–67.
Kabene, S. M., Wolfe, M., & Leduc, R. (2012). doi: 10.4018/ijrqeh.2012010106
Recruitment and retention of healthcare profes-
Kastania, A. N. (2013). Evaluation considerations
sionals for the changing demographics, culture,
for e-health systems. In User-driven healthcare:
and access in Canada. In Human resources
Concepts, methodologies, tools, and applications
management: Concepts, methodologies, tools,
(pp. 1126–1140). Hershey, PA: Medical Informa-
and applications (pp. 276–290). Hershey, PA:
tion Science Reference; doi:10.4018/978-1-4666-
Business Science Reference; doi:10.4018/978-
2770-3.ch057
1-4666-1601-1.ch017
Kaufman, D. (2010). Simulation in health pro-
Kadiri, M., & Zouag, N. (2014). The new eco-
fessional education. In D. Kaufman & L. Sauvé
nomics of skilled labor migration: The case of
(Eds.), Educational gameplay and simulation
medical doctors in MENA. In A. Driouchi (Ed.),
environments: Case studies and lessons learned
Labor and health economics in the Mediterranean
(pp. 51–67). Hershey, PA: Information Science
region: Migration and mobility of medical doctors
Reference; doi:10.4018/978-1-61520-731-2.
(pp. 267–292). Hershey, PA: Medical Information
ch003
Science Reference; doi:10.4018/978-1-4666-
4723-7.ch011
270
Related References
Kazandjian, V. A. (2013). Learning to accept
uncertainty as a quality of care dimension. In A.
Moumtzoglou & A. Kastania (Eds.), E-health
technologies and improving patient safety: Explor-
ing organizational factors (pp. 1–12). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-2657-7.ch001
Kearns, W. D., Fozard, J. L., & Lamm, R. S.
(2011). How knowing who, where and when can
change health care delivery. In C. Röcker & M.
Ziefle (Eds.), E-health, assistive technologies and
applications for assisted living: Challenges and
solutions (pp. 139–160). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60960-469-1.ch007
Khan, T. (2013). Transformation of a reluctant
patient to a proactive health advocate. [IJUDH].
International Journal of User-Driven Healthcare,
3(1), 71–74. doi: 10.4018/ijudh.2013010109
Khetarpal, A., & Singh, S. (2012). Disability stud-
ies in medical education. [IJUDH]. International
Journal of User-Driven Healthcare, 2(2), 44–51.
doi: 10.4018/ijudh.2012040105
Kim, J. (2011). The development and implementa-
tion of patient safety information systems (PSIS).
In Clinical technologies: Concepts, methodolo-
gies, tools and applications (pp. 2054-2072). Her-
shey, PA: Medical Information Science Reference.
doi: 10.4018/978-1-60960-561-2.ch804
Kldiashvili, E. (2011). The application of virtual
organization technology for eHealth. In E. Kldi-
ashvili (Ed.), Grid technologies for e-health: Ap-
plications for telemedicine services and delivery
(pp. 1–17). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-61692-
010-4.ch001
Kldiashvili, E. (2012). The cloud computing as
the tool for implementation of virtual organiza-
tion technology for eHealth. [JITR]. Journal of
Information Technology Research, 5(1), 18–34.
doi: 10.4018/jitr.2012010102
Kldiashvili, E. (2013). Implementation of tele-
cytology in Georgia. In V. Gulla, A. Mori, F.
Gabbrielli, & P. Lanzafame (Eds.), Telehealth
networks for hospital services: New methodologies
(pp. 341–361). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2979-0.ch022
Klemer, D. P. (2010). Advances in biosensors
for in vitro diagnostics. In A. Lazakidou (Ed.),
Biocomputation and biomedical informatics: Case
studies and applications (pp. 178–186). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60566-768-3.ch011
Kotwani, A. (2013). Transparency and account-
ability in public procurement of essential medi-
cines in developing countries. In Supply chain
management: Concepts, methodologies, tools,
and applications (pp. 1437–1452). Hershey, PA:
Business Science Reference; doi:10.4018/978-1-
4666-2625-6.ch085
Kuehler, M., Schimke, N., & Hale, J. (2012). Pri-
vacy considerations for electronic health records.
In G. Yee (Ed.), Privacy protection measures and
technologies in business organizations: Aspects
and standards (pp. 210–226). Hershey, PA: In-
formation Science Reference; doi:10.4018/978-
1-61350-501-4.ch008
Kukar, M., Kononenko, I., & Grošelj, C. (2013).
Automated diagnostics of coronary artery disease:
Long-term results and recent advancements. In
Data mining: Concepts, methodologies, tools,
and applications (pp. 1043–1063). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-4666-2455-9.ch053
Kumalasari, C. D., Caplow, J. A., & Fearing,
N. (2013). Simulation followed by a reflection
and feedback session in medical education. In
L. Tomei (Ed.), Learning tools and teaching ap-
proaches through ICT advancements (pp. 68–81).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-2017-9.ch007
271

Kumar, R., & Srivastava, R. (2014). Detection
of cancer from microscopic biopsy images us-
ing image processing tools. In R. Srivastava, S.
Singh, & K. Shukla (Eds.), Research develop-
ments in computer vision and image processing:
Methodologies and applications (pp. 175–194).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-4558-5.ch010
Kuruvilla, A., & Alexander, S. M. (2010). Predict-
ing ambulance diverson. [IJISSS]. International
Journal of Information Systems in the Service
Sector, 2(1), 1–10. doi: 10.4018/jisss.2010093001
Kyriazis, D., Menychtas, A., Tserpes, K.,
Athanaileas, T., & Varvarigou, T. (2010). High
performance computing in biomedicine. In A.
Lazakidou (Ed.), Biocomputation and biomedical
informatics: Case studies and applications (pp.
106–118). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60566-
768-3.ch006
LaBrunda, M., & LaBrunda, A. (2010). Fuzzy
logic in medicine. In M. Khosrow-Pour (Ed.),
Breakthrough discoveries in information technol-
ogy research: Advancing trends (pp. 218–224).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-60566-966-3.ch017
Lagares-Lemos, Á. M., Lagares-Lemos, M.,
Colomo-Palacios, R., García-Crespo, Á., &
Gómez-Berbís, J. M. (2011). DISMON. In
Clinical technologies: Concepts, methodologies,
tools and applications (pp. 995–1007). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-561-2.ch324
Lagares-Lemos, Á. M., Lagares-Lemos, M., Co-
lomo-Palacios, R., García-Crespo, Á., & Gómez-
Berbís, J. M. (2013). DISMON: Using social web
and semantic technologies to monitor diseases
in limited environments. In M. Khosrow-Pour
(Ed.), Interdisciplinary advances in information
technology research (pp. 48–59). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-4666-3625-5.ch004
272
Related References
Lappas, K. (2014). Functional assessment of per-
sons with motor limitations: Methods and tools. In
G. Kouroupetroglou (Ed.), Disability informatics
and web accessibility for motor limitations (pp.
43–74). Hershey, PA: Medical Information Sci-
ence Reference; doi:10.4018/978-1-4666-4442-7.
ch002
Lazakidou, A., & Daskalaki, A. (2012). Quality
assurance in healthcare service delivery, nursing
and personalized medicine: Technologies and pro-
cesses. Hershey, PA: IGI Global; doi:10.4018/978-
1-61350-120-7
Leal, S., Suarez, C., Framinan, J. M., Parra, C. L.,
& Gómez, T. (2010). Virtual reality for supporting
surgical planning. In M. Cruz-Cunha, A. Tavares,
& R. Simoes (Eds.), Handbook of research on
developments in e-health and telemedicine: Tech-
nological and social perspectives (pp. 614–635).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-61520-670-4.ch029
Lemma, F., Denko, M. K., Tan, J. K., & Kassegne,
S. K. (2011). Envisioning a national e-medicine
network architecture in a developing country:
A case study. In J. Tan (Ed.), Developments in
healthcare information systems and technolo-
gies: Models and methods (pp. 35–53). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-61692-002-9.ch003
Li, G., You, M., Xu, L., & Huang, S. (2012).
Personalized experience sharing of Cai’s TCM
gynecology. In A. Lazakidou & A. Daskalaki
(Eds.), Quality assurance in healthcare service
delivery, nursing and personalized medicine:
Technologies and processes (pp. 26–47). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-61350-120-7.ch002
Lim, V. K. (2012). The process of medical cur-
riculum development in Malaysia. [IJUDH].
International Journal of User-Driven Healthcare,
2(1), 33–39. doi: 10.4018/ijudh.2012010105
Related References
Lin, H. (2013). Cultivating chan as proactive
therapy for social wellness. In M. Cruz-Cunha,
I. Miranda, & P. Gonçalves (Eds.), Handbook of
research on ICTs for human-centered healthcare
and social care services (pp. 151–170). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-3986-7.ch008
Liu, Q., Poon, C. C., & Zhang, Y. T. (2012).
Wearable technologies for neonatal monitoring. In
W. Chen, S. Oetomo, & L. Feijs (Eds.), Neonatal
monitoring technologies: Design for integrated
solutions (pp. 12–40). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-0975-4.ch002
Llobet, H., Llobet, P., & LaBrunda, M. (2011). Im-
aging advances of the cardiopulmonary system. In
Clinical technologies: Concepts, methodologies,
tools and applications (pp. 2183–2190). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-561-2.ch812
Logeswaran, R. (2010). Neural networks in
medicine: improving difficult automated detection
of cancer in the bile ducts. In R. Chiong (Ed.),
Nature-inspired informatics for intelligent appli-
cations and knowledge discovery: Implications in
business, science, and engineering (pp. 144–165).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-60566-705-8.ch006
Logeswaran, R. (2011). Neural networks in medi-
cine. In Clinical technologies: Concepts, meth-
odologies, tools and applications (pp. 744–765).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-60960-561-2.ch308
Long, L. R., Antani, S., Thoma, G. R., & Deserno,
T. M. (2011). Content-based image retrieval for
advancing medical diagnostics, treatment and
education. In J. Tan (Ed.), New technologies
for advancing healthcare and clinical practices
(pp. 1–17). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
780-7.ch001
Lueth, T. C., D’Angelo, L. T., & Czabke, A.
(2010). TUM-AgeTech: A new framework for
pervasive medical devices. In A. Coronato & G.
De Pietro (Eds.), Pervasive and smart technolo-
gies for healthcare: Ubiquitous methodologies
and tools (pp. 295–321). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61520-765-7.ch014
Lui, K. (2013). The health informatics profes-
sional. In User-driven healthcare: Concepts, meth-
odologies, tools, and applications (pp. 120–141).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-2770-3.ch007
Lui, T., & Goel, L. (2012). A framework for con-
ceptualizing the current role and future trends of
information systems in medical training. [IJHISI].
International Journal of Healthcare Information
Systems and Informatics, 7(1), 1–12. doi: 10.4018/
jhisi.2012010101
MacDonald, C. J., McKeen, M., Leith-Gudbran-
son, D., Montpetit, M., Archibald, D., & Rivet,
C. … Hirsh, M. (2013). University of Ottawa
department of family medicine faculty develop-
ment curriculum framework. In K. Patel, & S. Vij
(Eds.) Enterprise resource planning models for the
education sector: Applications and methodologies
(pp. 197-215). Hershey, PA: Information Science
Reference. doi: 10.4018/978-1-4666-2193-0.
ch014
MacGregor, R. C., Hyland, P. N., & Harvie, C.
(2010). Associations between driving forces to
adopt ICT and benefits derived from that adoption
in medical practices in Australia. In M. Cruz-
Cunha, A. Tavares, & R. Simoes (Eds.), Handbook
of research on developments in e-health and tele-
medicine: Technological and social perspectives
(pp. 652–668). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-61520-
670-4.ch031
273

Mackert, M., Whitten, P., & Holtz, B. (2010).
Health infonomics: Intelligent applications of
information technology. In J. Rodrigues (Ed.),
Health information systems: Concepts, method-
ologies, tools, and applications (pp. 117–132).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-60566-988-5.ch008
Malik, A. S., & Malik, R. H. (2012). Ado-
lescent medicine curriculum at faculty of
medicine, Universiti Teknologi MARA, Ma-
laysia. [IJUDH]. International Journal of User-
Driven Healthcare, 2(1), 40–48. doi: 10.4018/
ijudh.2012010106
Martin, C. M., Biswas, R., Sturmberg, J. P.,
Topps, D., Ellaway, R., & Smith, K. (2011).
Patient journey record systems (PaJR) for pre-
venting ambulatory care sensitive conditions:
A developmental framework. In R. Biswas &
C. Martin (Eds.), User-driven healthcare and
narrative medicine: Utilizing collaborative
social networks and technologies (pp. 93–112).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-60960-097-6.ch007
Masayuki, K., Eiji, K., Tetsuo, T., & Nozomu,
M. (2013). Evaluation of olfactory impairment
in Parkinson’s disease using near-infrared spec-
troscopy. In J. Wu (Ed.), Biomedical engineer-
ing and cognitive neuroscience for healthcare:
Interdisciplinary applications (pp. 293–302).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-2113-8.ch030
Mazzanti, I., Maolo, A., & Antonicelli, R.
(2014). E-health and telemedicine in the el-
derly: State of the art. In Assistive technologies:
Concepts, methodologies, tools, and applica-
tions (pp. 693–704). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-4666-
4422-9.ch034
274
Related References
Medhekar, A., Wong, H. Y., & Hall, J. (2014).
Innovation in medical tourism service marketing:
A case of India. In A. Goyal (Ed.), Innovations in
services marketing and management: Strategies
for emerging economies (pp. 49–66). Hershey, PA:
Business Science Reference; doi:10.4018/978-1-
4666-4671-1.ch003
Medhekar, A., Wong, H. Y., & Hall, J. (2014).
Medical tourism: A conceptual framework for an
innovation in global healthcare provision. In A.
Goyal (Ed.), Innovations in services marketing and
management: Strategies for emerging economies
(pp. 148–169). Hershey, PA: Business Science
Reference; doi:10.4018/978-1-4666-4671-1.ch009
Memmola, M., Palumbo, G., & Rossini, M. (2010).
Web & RFID technology: New frontiers in cost-
ing and process management for rehabilitation
medicine. In J. Symonds (Ed.), Ubiquitous and
pervasive computing: Concepts, methodologies,
tools, and applications (pp. 623–647). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60566-960-1.ch039
Menciassi, A., & Laschi, C. (2014). Biorobot-
ics. In Robotics: Concepts, methodologies, tools,
and applications (pp. 1613-1643). Hershey, PA:
Information Science Reference. doi: 10.4018/978-
1-4666-4607-0.ch079
Mika, K. (2010). Cybermedicine, telemedicine, and
data protection in the United States. In J. Rodrigues
(Ed.), Health information systems: Concepts, meth-
odologies, tools, and applications (pp. 274–296).
Hershey, PA: Medical Information Science Refer-
ence; doi:10.4018/978-1-60566-988-5.ch019
Mirbagheri, A., Baniasad, M. A., Farahmand, F.,
Behzadipour, S., & Ahmadian, A. (2013). Medical
robotics: State-of-the-art applications and research
challenges. [IJHISI]. International Journal of
Healthcare Information Systems and Informatics,
8(2), 1–14. doi: 10.4018/jhisi.2013040101
Related References
Miscione, G. (2013). Telemedicine and develop-
ment: Situating information technologies in the
Amazon. In J. Abdelnour-Nocera (Ed.), Knowl-
edge and technological development effects on or-
ganizational and social structures (pp. 132–145).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-2151-0.ch009
Mobasheri, A. (2013). Regeneration of articular
cartilage: Opportunities, challenges, and perspec-
tives. In A. Daskalaki (Ed.), Medical advance-
ments in aging and regenerative technologies:
Clinical tools and applications (pp. 137–168).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-2506-8.ch007
Monzon, J. E. (2012). Bioethics. In Z. Abu-Faraj
(Ed.), Handbook of research on biomedical en-
gineering education and advanced bioengineer-
ing learning: Interdisciplinary concepts (pp.
198–237). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
0122-2.ch005
Morais da Costa, G. J., Araújo da Silva Nuno,
M., & Alves da Silva Nuno, S. (2010). The hu-
man centred approach to bionanotechnology
in telemedicine: Ethical considerations. In M.
Cruz-Cunha, A. Tavares, & R. Simoes (Eds.),
Handbook of research on developments in e-health
and telemedicine: Technological and social per-
spectives (pp. 311–335). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61520-670-4.ch015
Morgade, A. T., Martínez-Romero, M., Vázquez-
Naya, J. M., Loureiro, M. P., Albo, Á. G., & Lou-
reiro, J. P. (2011). Development of a knowledge
based system for an intensive care environment
using ontologies. [JITR]. Journal of Information
Technology Research, 4(1), 21–33. doi: 10.4018/
jitr.2011010102
Morita, A. (2013). The quantitative EEG change
in Parkinson’s disease. In J. Wu (Ed.), Biomedi-
cal engineering and cognitive neuroscience for
healthcare: Interdisciplinary applications (pp.
225–234). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2113-8.ch023
Moumtzoglou, A. (2011). E-health as the realm of
healthcare quality: A mental image of the future.
In A. Moumtzoglou & A. Kastania (Eds.), E-
health systems quality and reliability: Models and
standards (pp. 291–310). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61692-843-8.ch022
Moumtzoglou, A. (2011). E-health as the realm
of healthcare quality. In Clinical technologies:
Concepts, methodologies, tools and applications
(pp. 73–92). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
561-2.ch105
Moumtzoglou, A. (2011). E-health: A bridge to
people-centered health care. In A. Moumtzoglou
& A. Kastania (Eds.), E-health systems quality and
reliability: Models and standards (pp. 47–63).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-61692-843-8.ch005
Moumtzoglou, A. (2013). Health 2.0 and medi-
cine 2.0: Safety, ownership and privacy issues. In
User-driven healthcare: Concepts, methodologies,
tools, and applications (pp. 1508-1522). Hershey,
PA: Medical Information Science Reference. doi:
10.4018/978-1-4666-2770-3.ch075
Moumtzoglou, A. (2013). Risk perception as a
patient safety dimension. In A. Moumtzoglou &
A. Kastania (Eds.), E-health technologies and im-
proving patient safety: Exploring organizational
factors (pp. 285–299). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-2657-7.ch017
275
 Related References

Mourtzikou, A., Stamouli, M., & Athanasiadi, Nakajima, I. (2012). Cross-border medical care
E. (2013). Improvement of clinical laboratory and telemedicine. [IJEHMC]. International Jour-
services through quality. [IJRQEH]. International nal of E-Health and Medical Communications,
Journal of Reliable and Quality E-Healthcare, 3(1), 46–61. doi: 10.4018/jehmc.2012010104
2(2), 38–46. doi: 10.4018/ijrqeh.2013040103
Nakayasu, K., & Sato, C. (2012). Liability for
Muriithi, M. K., & Mwabu, G. (2014). Demand telemedicine. [IJEHMC]. International Journal
for health care in Kenya: The effects of informa- of E-Health and Medical Communications, 3(1),
tion about quality. In P. Schaeffer & E. Kouassi 1–21. doi: 10.4018/jehmc.2012010101
(Eds.), Econometric methods for analyzing eco-
Narasimhalu, D. (2010). Redefining medical
nomic development (pp. 102–110). Hershey, PA:
tourism. In S. Becker & R. Niebuhr (Eds.), Cases
Business Science Reference; doi:10.4018/978-1-
on technology innovation: Entrepreneurial suc-
4666-4329-1.ch007
cesses and pitfalls (pp. 267–285). Hershey, PA:
Murugan, B. O., & Sornam, S. A. (2013). Internet Business Science Reference; doi:10.4018/978-1-
and online medical journal access skills of the 61520-609-4.ch014
medical practitioners of Tamilnadu: A study. In S.
Naulaers, G., Caicedo, A., & Van Huffel, S. (2012).
Thanuskodi (Ed.), Challenges of academic library
Use of near-infrared spectroscopy in the neonatal
management in developing countries (pp. 75–82).
intensive care unit. In W. Chen, S. Oetomo, & L.
Hershey, PA: Information Science Reference;
Feijs (Eds.), Neonatal monitoring technologies:
doi:10.4018/978-1-4666-4070-2.ch006
Design for integrated solutions (pp. 56–83). Her-
Nadathur, S. G. (2010). Bayesian networks in shey, PA: Medical Information Science Reference;
the health domain. In A. Ali & Y. Xiang (Eds.), doi:10.4018/978-1-4666-0975-4.ch004
Dynamic and advanced data mining for progress-
Nokata, M. (2014). Small medical robot. In I.
ing technological development: Innovations and
Management Association (Ed.),Robotics: Con-
systemic approaches (pp. 342–376). Hershey, PA:
cepts, methodologies, tools, and applications (pp.
Information Science Reference; doi:10.4018/978-
638-646). Hershey, PA: Information Science Ref-
1-60566-908-3.ch014
erence. doi: 10.4018/978-1-4666-4607-0.ch032
Naidoo, V., & Naidoo, Y. (2014). Home telecare,
Noteboom, C. (2013). Physician interaction with
medical implant, and mobile technology: Evolu-
EHR: The importance of stakeholder identifica-
tions in geriatric care. In C. El Morr (Ed.), Research
tion and change management. In S. Sarnikar, D.
Perspectives on the role of informatics in health
Bennett, & M. Gaynor (Eds.), Cases on health-
policy and management (pp. 222–237). Hershey,
care information technology for patient care
PA: Medical Information Science Reference;
management (pp. 95–112). Hershey, PA: Medical
doi:10.4018/978-1-4666-4321-5.ch013
Information Science Reference; doi:10.4018/978-
Najarian, S., & Afshari, E. (2010). Applications 1-4666-2671-3.ch005
of robots in surgery. In A. Shukla & R. Tiwari
Noury, N., Bourquard, K., Bergognon, D., &
(Eds.), Intelligent medical technologies and
Schroeder, J. (2013). Regulations initiatives in
biomedical engineering: Tools and applications
France for the interoperability of communicating
(pp. 241–259). Hershey, PA: Medical Information
medical devices. [IJEHMC]. International Journal
Science Reference; doi:10.4018/978-1-61520-
of E-Health and Medical Communications, 4(2),
977-4.ch012
50–64. doi: 10.4018/jehmc.2013040104

276
Related References
O’Hanlon, S. (2013). Avoiding adverse conse-
quences of e-health. In A. Moumtzoglou & A. Kas-
tania (Eds.), E-health technologies and improving
patient safety: Exploring organizational factors (pp.
13–26). Hershey, PA: Medical Information Science
Reference; doi:10.4018/978-1-4666-2657-7.ch002
O’Leary, D. E. (2012). An activity theory analysis of
RFID in hospitals. In Z. Luo (Ed.), Innovations in lo-
gistics and supply chain management technologies
for dynamic economies (pp. 148–166). Hershey,
PA: Business Science Reference; doi:10.4018/978-
1-4666-0267-0.ch010
O’Neill, L., Talbert, J., & Klepack, W. (2010).
Physician characteristics associated with early
adoption of electronic medical records in smaller
group practices. In J. Rodrigues (Ed.), Health
information systems: Concepts, methodologies,
tools, and applications (pp. 1503–1512). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60566-988-5.ch096
Ogawa, T., Ikeda, M., Suzuki, M., & Araki, K.
(2014). Medical practical knowledge circulation
based on purpose-oriented service modeling. In
M. Kosaka & K. Shirahada (Eds.), Progressive
trends in knowledge and system-based science for
service innovation (pp. 400–424). Hershey, PA:
Business Science Reference; doi:10.4018/978-1-
4666-4663-6.ch022
Oliveira, T. C., Oliveira, M. D., & Peña, T. (2013).
Towards a post-implementation evaluation frame-
work of outpatient electronic drug prescribing. In
M. Cruz-Cunha, I. Miranda, & P. Gonçalves (Eds.),
Handbook of research on ICTs and management
systems for improving efficiency in healthcare and
social care (pp. 133–155). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-3990-4.ch007
Orizio, G., & Gelatti, U. (2012). Human be-
haviors in online pharmacies. In Z. Yan (Ed.),
Encyclopedia of cyber behavior (pp. 661–670).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-0315-8.ch056
Otero, A., Félix, P., & Barro, S. (2010). Current
state of critical patient monitoring and outstand-
ing challenges. In M. Cruz-Cunha, A. Tavares,
& R. Simoes (Eds.), Handbook of research on
developments in e-health and telemedicine:
Technological and social perspectives (pp.
981–1003). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-61520-
670-4.ch047
Ozturk, Y., & Sharma, J. (2013). mVITAL: A
standards compliant vital sign monitor. In IT
policy and ethics: Concepts, methodologies,
tools, and applications (pp. 515-538). Her-
shey, PA: Information Science Reference. doi:
10.4018/978-1-4666-2919-6.ch024
Pal, K., Ghosh, G., & Bhattacharya, M. (2014).
Biomedical watermarking: An emerging and
secure tool for data security and better tele-
diagnosis in modern health care system. In
R. Srivastava, S. Singh, & K. Shukla (Eds.),
Research developments in computer vision and
image processing: Methodologies and applica-
tions (pp. 208–234). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-4666-
4558-5.ch012
Paolucci, F., Ergas, H., Hannan, T., & Aarts, J.
(2011). The effectiveness of health informatics.
In Clinical technologies: Concepts, methodolo-
gies, tools and applications (pp. 25–49). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-561-2.ch103
277

Parasher, A., Goldschmidt-Clermont, P. J., &
Tien, J. M. (2012). Healthcare delivery as a
service system: Barriers to co-production and
implications of healthcare reform. In A. Kolker
& P. Story (Eds.), Management engineering for
effective healthcare delivery: Principles and ap-
plications (pp. 191–214). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60960-872-9.ch009
Parry, D. (2010). Coding and messaging systems
for women’s health informatics. In J. Rodrigues
(Ed.), Health information systems: Concepts,
methodologies, tools, and applications (pp.
2192–2205). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60566-
988-5.ch139
Parry, D. (2012). Computerised decision sup-
port for women’s health informatics. In Machine
learning: Concepts, methodologies, tools and
applications (pp. 1404–1416). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60960-818-7.ch513
Payne, G. W. (2011). The role of blended learn-
ing in 21st century medical education: Current
trends and future directions. In A. Kitchenham
(Ed.), Blended learning across disciplines: Models
for implementation (pp. 132–146). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60960-479-0.ch008
Penchovsky, R. (2013). Engineering gene control
circuits with allosteric ribozymes in human cells
as a medicine of the future. In Bioinformatics:
Concepts, methodologies, tools, and applications
(pp. 860-883). Hershey, PA: Medical Information
Science Reference. doi: 10.4018/978-1-4666-
3604-0.ch047
278
Related References
Pestana, O. (2014). Information value and quality
for the health sector: A case study of search strate-
gies for optimal information retrieval. In G. Jamil,
A. Malheiro, & F. Ribeiro (Eds.), Rethinking the
conceptual base for new practical applications
in information value and quality (pp. 116–133).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-4562-2.ch006
Peterson, C., & Willis, E. (2011). Social con-
struction of chronic disease: Narratives on the
experience of chronic illness. In R. Biswas & C.
Martin (Eds.), User-driven healthcare and nar-
rative medicine: Utilizing collaborative social
networks and technologies (pp. 395–409). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-097-6.ch027
Petoukhov, S., & He, M. (2010). Biological evolu-
tion of dialects of the genetic code. In S. Petoukhov
& M. He (Eds.), Symmetrical analysis techniques
for genetic systems and bioinformatics: Advanced
patterns and applications (pp. 50–64). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60566-124-7.ch003
Petty, G. C., & Joyner, D. H. (2012). The efficacy
of continuing education technology for public
health physicians practicing in remote areas. In V.
Wang (Ed.), Encyclopedia of e-leadership, coun-
seling and training (pp. 453–467). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-61350-068-2.ch033
Phua, C., Roy, P. C., Aloulou, H., Biswas, J., Tol-
stikov, A., & Foo, V. S. … Xu, D. (2014). State-
of-the-art assistive technology for people with
dementia. In Assistive technologies: Concepts,
methodologies, tools, and applications (pp. 1606-
1625). Hershey, PA: Information Science Refer-
ence. doi: 10.4018/978-1-4666-4422-9.ch085
Related References
Portela, F., Cabral, A., Abelha, A., Salazar,
M., Quintas, C., & Machado, J. … Santos, M.
F. (2013). Knowledge acquisition process for
intelligent decision support in critical health
care. In R. Martinho, R. Rijo, M. Cruz-Cunha,
& J. Varajão (Eds.) Information systems and
technologies for enhancing health and social care
(pp. 55-68). Hershey, PA: Medical Information
Science Reference. doi: 10.4018/978-1-4666-
3667-5.ch004
Postolache, O., Girão, P., & Postolache, G.
(2013). Seismocardiogram and ballistocar-
diogram sensing. In A. Lay-Ekuakille (Ed.),
Advanced instrument engineering: Measure-
ment, calibration, and design (pp. 223–246).
Hershey, PA: Engineering Science Reference;
doi:10.4018/978-1-4666-4165-5.ch017
Premkumar, K. (2011). Mobile learning in
medicine. In A. Kitchenham (Ed.), Models
for interdisciplinary mobile learning: Deliv-
ering information to students (pp. 137–153).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-60960-511-7.ch008
Price, M. (2011). A bio-psycho-social review
of usability methods and their applications in
healthcare. In Clinical technologies: Concepts,
methodologies, tools and applications (pp.
1874–1899). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
561-2.ch704
Prigione, A. (2012). Stem cell-based person-
alized medicine: From disease modeling to
clinical applications. In Computer engineering:
Concepts, methodologies, tools and applications
(pp. 1855–1866). Hershey, PA: Engineering
Science Reference; doi:10.4018/978-1-61350-
456-7.ch803
Quinaz, F., Fazendeiro, P., Castelo-Branco, M.,
& Araújo, P. (2013). Soft methods for automatic
drug infusion in medical care environment. In M.
Cruz-Cunha, I. Miranda, & P. Gonçalves (Eds.),
Handbook of research on ICTs and management
systems for improving efficiency in healthcare and
social care (pp. 830–854). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-3990-4.ch043
Quoniam, L., & Lima de Magalhães, J. (2014).
Perception of the information value for public
health: A case study for neglected diseases. In G.
Jamil, A. Malheiro, & F. Ribeiro (Eds.), Rethinking
the conceptual base for new practical applications
in information value and quality (pp. 211–232).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-4562-2.ch009
Raghupathi, W. (2010). Designing clinical deci-
sion support systems in health care: A systemic
view. In M. Hunter (Ed.), Strategic information
systems: Concepts, methodologies, tools, and
applications (pp. 652–661). Hershey, PA: Infor-
mation Science Reference; doi:10.4018/978-1-
60566-677-8.ch043
Raghupathi, W., & Nerur, S. (2012). The intellec-
tual structure of health and medical informatics.
In J. Tan (Ed.), Advancing technologies and intel-
ligence in healthcare and clinical environments
breakthroughs (pp. 1–16). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-1755-1.ch001
Räisänen, T., Oinas-Kukkonen, H., Leiviskä,
K., Seppänen, M., & Kallio, M. (2010). Manag-
ing mobile healthcare knowledge: Physicians’
perceptions on knowledge creation and reuse. In
J. Rodrigues (Ed.), Health information systems:
Concepts, methodologies, tools, and applications
(pp. 733–749). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60566-
988-5.ch046
279

Raval, M. S. (2011). Data hiding in digitized medi-
cal images: From concepts to applications. In A.
Daskalaki (Ed.), Digital forensics for the health
sciences: Applications in practice and research
(pp. 29–47). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
483-7.ch003
Ravka, N. (2014). Informatics and health services:
The potential benefits and challenges of electronic
health records and personal electronic health
records in patient care, cost control, and health
research – An overview. In C. El Morr (Ed.),
Research perspectives on the role of informatics
in health policy and management (pp. 89–114).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-4321-5.ch007
Reyes Álamo, J. M., Yang, H., Babbitt, R., &
Wong, J. (2010). Support for medication safety
and compliance in smart home environments. In
J. Rodrigues (Ed.), Health information systems:
Concepts, methodologies, tools, and applications
(pp. 2091–2110). Hershey, PA: Medical Infor-
mation Science Reference; doi:10.4018/978-1-
60566-988-5.ch133
Ribeiro, C., Monteiro, M., Corredoura, S., Can-
deias, F., & Pereira, J. (2013). Games in higher
education: Opportunities, expectations, chal-
lenges, and results in medical education. In S. de
Freitas, M. Ott, M. Popescu, & I. Stanescu (Eds.),
New pedagogical approaches in game enhanced
learning: Curriculum integration (pp. 228–247).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-3950-8.ch012
Rocci, L. (2010). Biomedical technoethics. In R.
Luppicini (Ed.), Technoethics and the evolving
knowledge society: Ethical issues in technological
design, research, development, and innovation (pp.
128–145). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-60566-952-6.ch007
280
Related References
Rockland, R., Kimmel, H., Carpinelli, J., Hirsch, L.
S., & Burr-Alexander, L. (2014). Medical robotics
in k-12 education. In Robotics: Concepts, method-
ologies, tools, and applications (pp. 1096-1115).
Hershey, PA: Information Science Reference. doi:
10.4018/978-1-4666-4607-0.ch053
Rodrigues, J. J. (2012). Emerging communication
technologies for e-health and medicine. Hershey,
PA: IGI Global; doi:10.4018/978-1-4666-0909-9
Rodrigues, J. J. (2013). Digital advances in medi-
cine, e-health, and communication technologies.
Hershey, PA: IGI Global; doi:10.4018/978-1-
4666-2794-9
Rodrigues, J. J. (2014). Advancing medical prac-
tice through technology: Applications for health-
care delivery, management, and quality. Hershey,
PA: IGI Global; doi:10.4018/978-1-4666-4619-3
Rodríguez-González, A., García-Crespo, Á.,
Colomo-Palacios, R., Gómez-Berbís, J. M., &
Jiménez-Domingo, E. (2013). Using ontologies
in drug prescription: The SemMed approach. In
J. Wang (Ed.), Intelligence methods and systems
advancements for knowledge-based business (pp.
247–261). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-4666-1873-2.ch014
Rojo, M. G., & Daniel, C. (2011). Digital pa-
thology and virtual microscopy integration in
e-health records. In Clinical technologies: Con-
cepts, methodologies, tools and applications (pp.
1235–1262). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
561-2.ch415
Rompas, A., Tsirmpas, C., Anastasiou, A., Ilio-
poulou, D., & Koutsouris, D. (2013). Statistical
power and sample size in personalized medicine.
[IJSBBT]. International Journal of Systems Biol-
ogy and Biomedical Technologies, 2(2), 72–88.
doi: 10.4018/ijsbbt.2013040105
Related References
Rosiek, A. B., & Leksowski, K. (2011). Quality
assurance and evaluation of healthcare reform
initiatives: Strategy for improving the quality of
health care services in public health care units,
management model that allows the providing
of high quality health care and efficient brand-
building. [IJHDRI]. International Journal of
Healthcare Delivery Reform Initiatives, 3(3),
42–53. doi: 10.4018/jhdri.2011070104
Ross, S. (2011). A lexicon for user driven health-
care. [IJUDH]. International Journal of User-
Driven Healthcare, 1(1), 50–54. doi: 10.4018/
ijudh.2011010107
Ross, S. D. (2011). Multiple paths in health care.
In R. Biswas & C. Martin (Eds.), User-driven
healthcare and narrative medicine: Utilizing
collaborative social networks and technologies
(pp. 113–124). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
097-6.ch008
Rosu, S. M., & Dragoi, G. (2014). E-health sites
development using open source software and
OMT methodology as support for family doc-
tors’ activities: A Romanian case study. In M.
Cruz-Cunha, F. Moreira, & J. Varajão (Eds.),
Handbook of research on enterprise 2.0: Techno-
logical, social, and organizational dimensions (pp.
72–88). Hershey, PA: Business Science Reference;
doi:10.4018/978-1-4666-4373-4.ch004
Ruiz-Fernandez, D., & Soriano-Paya, A. (2011).
A distributed approach of a clinical decision
support system based on cooperation. In Clini-
cal technologies: Concepts, methodologies, tools
and applications (pp. 1782–1799). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-561-2.ch612
Ryan, P. (2012). Paying for performance: Key
design features and the bigger picture. [IJPPHME].
International Journal of Public and Private
Healthcare Management and Economics, 2(2),
1–16. doi: 10.4018/ijpphme.2012040101
Sainz de Abajo, B., & Ballestero, A. L. (2012).
Overview of the most important open source soft-
ware: Analysis of the benefits of OpenMRS, Open-
EMR, and VistA. In J. Rodrigues, I. de la Torre
Díez, & B. Sainz de Abajo (Eds.), Telemedicine
and e-health services, policies, and applications:
Advancements and developments (pp. 315–346).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-0888-7.ch012
Salcido, G. J., & Delgado, E. C. (2013). Intelli-
gent agent to identify rheumatic diseases. In M.
Cruz-Cunha, I. Miranda, & P. Gonçalves (Eds.),
Handbook of research on ICTs and management
systems for improving efficiency in healthcare and
social care (pp. 451–473). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-3990-4.ch023
Schallenberg, S., Petzold, C., Riewaldt, J., &
Kretschmer, K. (2013). Regulatory T cell-based
immunotherapy: Prospects of antigen-specific
tolerance induction. In A. Daskalaki (Ed.),
Medical advancements in aging and regenerative
technologies: Clinical tools and applications (pp.
112–136). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2506-8.ch006
Scheepers-Hoeks, A., Klijn, F., van der Linden,
C., Grouls, R., Ackerman, E., & Minderman, N.
… Korsten, E. (2013). Clinical decision support
systems for ‘making it easy to do it right. In
Data mining: Concepts, methodologies, tools,
and applications (pp. 1461-1471). Hershey, PA:
Information Science Reference. doi: 10.4018/978-
1-4666-2455-9.ch076
Seçkin, G. (2012). Cyber behaviors of self health
care management. In Z. Yan (Ed.), Encyclopedia
of cyber behavior (pp. 722–734). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-4666-0315-8.ch061
281

Serrano, M., Elmisery, A., Foghlú, M. Ó., Don-
nelly, W., Storni, C., & Fernström, M. (2013).
Pervasive computing support in the transition to-
wards personalised health systems. In J. Rodrigues
(Ed.), Digital advances in medicine, e-health,
and communication technologies (pp. 49–64).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-2794-9.ch003
Shachak, A., & Reis, S. (2010). The computer-
assisted patient consultation: Promises and chal-
lenges. In S. Kabene (Ed.), Healthcare and the ef-
fect of technology: Developments, challenges and
advancements (pp. 72–83). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61520-733-6.ch005
Shachak, A., & Reis, S. (2011). The computer-
assisted patient consultation. In Clinical tech-
nologies: Concepts, methodologies, tools and
applications (pp. 160–171). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60960-561-2.ch111
Shankar, P. R. (2011). Medical Humanities. In R.
Biswas & C. Martin (Eds.), User-driven healthcare
and narrative medicine: Utilizing collaborative
social networks and technologies (pp. 210–227).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-60960-097-6.ch016
Shanmuganathan, S. (2010). A stroke information
system (SIS): Critical issues and solutions. In W.
Pease, M. Cooper, & R. Gururajan (Eds.), Bio-
medical knowledge management: Infrastructures
and processes for e-health systems (pp. 177–191).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-60566-266-4.ch012
Shegog, R. (2010). Application of behavioral
theory in computer game design for health behavior
change. In J. Cannon-Bowers & C. Bowers (Eds.),
Serious game design and development: Tech-
nologies for training and learning (pp. 196–232).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-61520-739-8.ch011
282
Related References
Shendge, S., Deka, B., & Kotwani, A. (2012). A
cross-sectional evaluation of illness perception
about asthma among asthma patients at a refer-
ral tertiary care public chest hospital in Delhi,
India. [IJUDH]. International Journal of User-
Driven Healthcare, 2(3), 32–43. doi: 10.4018/
ijudh.2012070104
Shimoyama, I., Shimada, H., & Ninchoji, T.
(2013). Kanji perception and brain function. In J.
Wu (Ed.), Biomedical engineering and cognitive
neuroscience for healthcare: Interdisciplinary ap-
plications (pp. 266–273). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-2113-8.ch027
Shrestha, S. (2013). Clinical decision support sys-
tem for diabetes prevention: An illustrative case.
In S. Sarnikar, D. Bennett, & M. Gaynor (Eds.),
Cases on healthcare information technology for
patient care management (pp. 308–329). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-2671-3.ch017
Shukla, A., Tiwari, R., & Rathore, C. P. (2011).
Intelligent biometric system using soft computing
tools. In A. Shukla & R. Tiwari (Eds.), Biomedical
engineering and information systems: Technolo-
gies, tools and applications (pp. 259–276). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-61692-004-3.ch014
Sibinga, C. T., & Oladejo, M. A. (2013). Bridging
the knowledge gap in management and opera-
tions of transfusion medicine: Planning, policy
and leadership issues. [JCIT]. Journal of Cases
on Information Technology, 15(1), 69–82. doi:
10.4018/jcit.2013010105
Slavens, B., & Harris, G. F. (2012). Biomechanics.
In Z. Abu-Faraj (Ed.), Handbook of research on
biomedical engineering education and advanced
bioengineering learning: Interdisciplinary
concepts (pp. 284–338). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-0122-2.ch007
Related References
Sliedrecht, S., & Kotzé, E. (2013). Patients with
a spinal cord injury inform and co-construct
services at a spinal cord rehabilitation unit. In
User-driven healthcare: Concepts, methodologies,
tools, and applications (pp. 1054–1072). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-2770-3.ch053
Sood, R., & Ananthakrishnan, N. (2012). Reform-
ing medical curriculum in India in recent years:
Conflicts of political, regulator, educationist
and professional natures and strategies for their
resolution. [IJUDH]. International Journal of
User-Driven Healthcare, 2(1), 1–13. doi: 10.4018/
ijudh.2012010101
Springer, J. A., Beever, J., Morar, N., Sprague, J.
E., & Kane, M. D. (2011). Ethics, Privacy, and
the future of genetic information in healthcare
information assurance and security. In M. Dark
(Ed.), Information assurance and security ethics
in complex systems: Interdisciplinary perspec-
tives (pp. 186–205). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-61692-
245-0.ch009
Srivastava, S. (2011). Medical transcription a
pioneer in the healthcare informatics. In A. Shukla
& R. Tiwari (Eds.), Biomedical engineering and
information systems: Technologies, tools and ap-
plications (pp. 239–258). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61692-004-3.ch013
Srivastava, S., Sharma, N., & Singh, S. (2014).
Image analysis and understanding techniques for
breast cancer detection from digital mammograms.
In R. Srivastava, S. Singh, & K. Shukla (Eds.),
Research developments in computer vision and
image processing: Methodologies and applica-
tions (pp. 123–148). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-4666-
4558-5.ch008
Stanescu, L., & Burdescu, D. D. (2010). Medical
hybrid learning tools. In F. Wang, J. Fong, & R.
Kwan (Eds.), Handbook of research on hybrid
learning models: Advanced tools, technologies,
and applications (pp. 355–370). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60566-380-7.ch022
Staudinger, B., Ostermann, H., & Staudinger,
R. (2011). IT-based virtual medical centres and
structures. In Clinical technologies: Concepts,
methodologies, tools and applications (pp.
2035–2046). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
561-2.ch802
Stefaniak, J. E. (2013). Resuscitating team roles
within Wayburn health system. In A. Ritzhaupt &
S. Kumar (Eds.), Cases on educational technol-
ogy implementation for facilitating learning (pp.
130–145). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-4666-3676-7.ch008
Stein, R. A. (2012). Direct-to-consumer genetic
testing: Interdisciplinary crossroads. [JITR].
Journal of Information Technology Research, 5(1),
35–67. doi: 10.4018/jitr.2012010103
Stergachis, A., Keene, D., & Somani, S. (2013).
Informatics for medicines management systems
in resource-limited settings. In Supply chain
management: Concepts, methodologies, tools,
and applications (pp. 634–645). Hershey, PA:
Business Science Reference; doi:10.4018/978-
1-4666-2625-6.ch037
Stevens, D., & Kitchenham, A. (2011). An analysis
of mobile learning in education, business, and
medicine. In A. Kitchenham (Ed.), Models for
interdisciplinary mobile learning: Delivering
information to students (pp. 1–25). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60960-511-7.ch001
283

Stolba, N., Nguyen, T. M., & Tjoa, A. M.
(2010). Data warehouse facilitating evidence-
based medicine. In T. Nguyen (Ed.), Complex
data warehousing and knowledge discovery
for advanced retrieval development: Innova-
tive methods and applications (pp. 174–207).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-60566-748-5.ch008
Sugaretty, D. (2014). Risk management in a
pandemic crisis at a global non profit health
care organization. In Crisis management: Con-
cepts, methodologies, tools and applications
(pp. 1253–1270). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-4666-
4707-7.ch063
Sugi, T., Goto, K., Goto, S., Goto, Y., Yama-
saki, T., & Tobimatsu, S. (2013). Topography
estimation of visual evoked potentials using
a combination of mathematical models. In J.
Wu (Ed.), Biomedical engineering and cogni-
tive neuroscience for healthcare: Interdisci-
plinary applications (pp. 129–141). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-2113-8.ch014
Sujan, H., Borrero, S., & Cranage, D. (2014).
Good treats: Eating out not just for joy but also
for well-being. In A. Goyal (Ed.), Innovations
in services marketing and management: Strate-
gies for emerging economies (pp. 118–135).
Hershey, PA: Business Science Reference;
doi:10.4018/978-1-4666-4671-1.ch007
Swennen, M. H. (2011). The gap between what
is knowable and what we do in clinical practice.
In R. Biswas & C. Martin (Eds.), User-driven
healthcare and narrative medicine: Utilizing
collaborative social networks and technologies
(pp. 335–356). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
097-6.ch024
284
Related References
Szewczak, E. J., & Snodgrass, C. R. (2011). Busi-
ness associates in the national health information
network: Implications for medical information
privacy. In I. Lee (Ed.), E-business applica-
tions for product development and competitive
growth: Emerging technologies (pp. 186–198).
Hershey, PA: Business Science Reference;
doi:10.4018/978-1-60960-132-4.ch009
Tabrizi, N. T., Torabi, Z., Bastani, P., Mokhtarkhani,
M., Madani, N., Parnian, N., & Hajebrahimi, S.
(2013). Assessing the perception of pain and dis-
tress of female patients undergoing routine urethral
catheterization in cesarean delivery. [IJUDH].
International Journal of User-Driven Healthcare,
3(2), 78–84. doi: 10.4018/ijudh.2013040109
Tanaka, H., & Furutani, M. (2013). Sleep manage-
ment promotes healthy lifestyle, mental health,
QOL, and a healthy brain. In J. Wu (Ed.), Bio-
medical engineering and cognitive neuroscience
for healthcare: Interdisciplinary applications (pp.
211–224). Hershey, PA: Medical Information Sci-
ence Reference; doi:10.4018/978-1-4666-2113-8.
ch022
Tang, X., Gao, Y., Yang, W., Zhang, M., & Wu, J.
(2013). Audiovisual integration of natural auditory
and visual stimuli in the real-world situation. In J.
Wu (Ed.), Biomedical engineering and cognitive
neuroscience for healthcare: Interdisciplinary ap-
plications (pp. 337–344). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-2113-8.ch035
Tashiro, M., Okamura, N., Watanuki, S., Furu-
moto, S., Furukawa, K., & Funaki, Y. … Yanai,
K. (2011). Quantitative analysis of amyloid ß
deposition in patients with Alzheimer’s disease
using positron emission tomography. In J. Wu
(Ed.), Early detection and rehabilitation technolo-
gies for dementia: Neuroscience and biomedical
applications (pp. 220-230). Hershey, PA: Medical
Information Science Reference. doi: 10.4018/978-
1-60960-559-9.ch029
Related References
Taylor, B. W. (2014). Decision-making and deci-
sion support in acute care. In C. El Morr (Ed.),
Research perspectives on the role of informatics
in health policy and management (pp. 1–18). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-4321-5.ch001
Thatcher, B. (2012). Intercultural rhetorical di-
mensions of health literacy and medicine. In In-
tercultural rhetoric and professional communica-
tion: Technological advances and organizational
behavior (pp. 247–282). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-61350-
450-5.ch009
Tiwari, S., & Srivastava, R. (2014). Research and
developments in medical image reconstruction
methods and its applications. In R. Srivastava,
S. Singh, & K. Shukla (Eds.), Research develop-
ments in computer vision and image processing:
Methodologies and applications (pp. 274–312).
Hershey, PA: Information Science Reference;
doi:10.4018/978-1-4666-4558-5.ch014
Toro-Troconis, M., & Partridge, M. R. (2010).
Designing game-based learning activities in
virtual worlds: Experiences from undergraduate
medicine. In Y. Baek (Ed.), Gaming for classroom-
based learning: Digital role playing as a motivator
of study (pp. 270–280). Hershey, PA: Information
Science Reference; doi:10.4018/978-1-61520-
713-8.ch016
Trojer, T., Katt, B., Breu, R., Schabetsberger, T., &
Mair, R. (2012). Managing privacy and effective-
ness of patient-administered authorization poli-
cies. [IJCMAM]. International Journal of Com-
putational Models and Algorithms in Medicine,
3(2), 43–62. doi: 10.4018/jcmam.2012040103
Übeyli, E. D. (2010). Medical informatics: Pre-
ventive medicine applications via telemedicine.
In M. Cruz-Cunha, A. Tavares, & R. Simoes
(Eds.), Handbook of research on developments
in e-health and telemedicine: Technological
and social perspectives (pp. 475–489). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-61520-670-4.ch022
Übeyli, E. D. (2011). Telemedicine and biotelem-
etry for e-health systems. In Clinical technologies:
Concepts, methodologies, tools and applications
(pp. 676–692). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
561-2.ch304
Vahe, M., Zain-Ul-Abdin, K., & Türel, Y. K.
(2012). Social media as a learning tool in medical
education: A situation analysis. In V. Dennen &
J. Myers (Eds.), Virtual professional development
and informal learning via social networks (pp.
168–183). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-4666-1815-2.ch010
Vivekananda-Schmidt, P. (2013). Ethics in the de-
sign of serious games for healthcare and medicine.
In S. Arnab, I. Dunwell, & K. Debattista (Eds.),
Serious games for healthcare: Applications and
implications (pp. 91–106). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-1903-6.ch005
von Lubitz, D. (2010). Healthcare among the
people: Teams of leaders concept (ToL) and the
world of technology-oriented global healthcare.
In S. Kabene (Ed.), Healthcare and the effect of
technology: Developments, challenges and ad-
vancements (pp. 145–177). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61520-733-6.ch010
285

von Lubitz, D. (2011). The teams of leaders (Tol)
concept: The grid, the mesh, and the people in the
world of information and knowledge-based global
healthcare. In E. Kldiashvili (Ed.), Grid technolo-
gies for e-health: Applications for telemedicine
services and delivery (pp. 65–104). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-61692-010-4.ch004
Vouyioukas, D., & Maglogiannis, I. (2010).
Communication issues in pervasive healthcare
systems and applications. In A. Coronato & G.
De Pietro (Eds.), Pervasive and smart technolo-
gies for healthcare: Ubiquitous methodologies
and tools (pp. 197–227). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-61520-765-7.ch010
Walczak, S., Brimhall, B. B., & Lefkowitz, J. B.
(2010). Nonparametric decision support systems
in medical diagnosis: Modeling pulmonary em-
bolism. In M. Hunter (Ed.), Strategic informa-
tion systems: Concepts, methodologies, tools,
and applications (pp. 1483–1500). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-60566-677-8.ch095
Walczak, S., Brimhall, B. B., & Lefkowitz, J. B.
(2011). Diagnostic cost reduction using artificial
neural networks. In Clinical technologies: Con-
cepts, methodologies, tools and applications (pp.
1812–1830). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-60960-
561-2.ch614
Wang, G., Cong, A., Gao, H., Zhang, J., Weir, V.
J., Xu, X., & Bennett, J. (2012). Medical imaging.
In Z. Abu-Faraj (Ed.), Handbook of research on
biomedical engineering education and advanced
bioengineering learning: Interdisciplinary
concepts (pp. 634–712). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-0122-2.ch015
286
Related References
Watanabe, Y., Tanaka, H., & Hirata, K. (2013).
Evaluation of cognitive function in migraine pa-
tients: A study using event-related potentials. In J.
Wu (Ed.), Biomedical engineering and cognitive
neuroscience for healthcare: Interdisciplinary ap-
plications (pp. 303–310). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-2113-8.ch031
Watfa, M. K., Majeed, H., & Salahuddin, T. (2012).
Healthcare applications for clinicians. In M. Watfa
(Ed.), E-healthcare systems and wireless com-
munications: Current and future challenges (pp.
49–69). Hershey, PA: Medical Information Science
Reference; doi:10.4018/978-1-61350-123-8.ch003
Weigel, F. K., Rainer, R. K., Hazen, B. T., Cegielski,
C. G., & Ford, F. N. (2012). Use of diffusion of
innovations theory in medical informatics research.
[IJHISI]. International Journal of Healthcare In-
formation Systems and Informatics, 7(3), 44–56.
doi: 10.4018/jhisi.2012070104
Whitaker, R. (2013). Securing health-effective
medicine in practice: A critical perspective on
user-driven healthcare. In R. Biswas (Ed.), Clinical
solutions and medical progress through user-driven
healthcare (pp. 35–50). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-4666-1876-3.ch005
Wilkowska, W., & Ziefle, M. (2011). User diversity
as a challenge for the integration of medical technol-
ogy into future smart home environments. In M.
Ziefle & C. Röcker (Eds.), Human-centered design
of e-health technologies: Concepts, methods and
applications (pp. 95–126). Hershey, PA: Medical
Information Science Reference; doi:10.4018/978-
1-60960-177-5.ch005
Xuan, X., & Xiaowei, Z. (2012). The dilemma and
resolution: The patentability of traditional Chinese
medicine. [IJABIM]. International Journal of Asian
Business and Information Management, 3(3), 1–8.
doi: 10.4018/jabim.2012070101
Related References
Yamamoto, S. (2010). IT applications for medi-
cal services in Japan. In W. Pease, M. Cooper,
& R. Gururajan (Eds.), Biomedical knowledge
management: Infrastructures and processes
for e-health systems (pp. 327–336). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60566-266-4.ch024
Yan, B., Lei, Y., Tong, L., & Chen, K. (2013).
Functional neuroimaging of acupuncture: A
systematic review. In J. Wu (Ed.), Biomedical
engineering and cognitive neuroscience for
healthcare: Interdisciplinary applications (pp.
142–155). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
2113-8.ch015
Yang, J. (2014). Towards healthy public policy:
GIS and food systems analysis. In C. El Morr
(Ed.), Research perspectives on the role of in-
formatics in health policy and management (pp.
135–152). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4321-5.ch009
Yang, W., Gao, Y., & Wu, J. (2013). Effects of
selective and divided attention on audiovisual
interaction. In J. Wu (Ed.), Biomedical engineer-
ing and cognitive neuroscience for healthcare:
Interdisciplinary applications (pp. 311–319).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-4666-2113-8.ch032
Yap, K. Y. (2013). The evolving role of pharma-
coinformatics in targeting drug-related problems
in clinical oncology practice. In User-driven
healthcare: Concepts, methodologies, tools,
and applications (pp. 1541–1588). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-2770-3.ch077
Young, J. W., Thapaliya, P., & Sapkota, S. (2013).
Caught in the middle: The divide between con-
ventional and alternative medicine. In R. Biswas
(Ed.), Clinical solutions and medical progress
through user-driven healthcare (pp. 26–34). Her-
shey, PA: Medical Information Science Reference;
doi:10.4018/978-1-4666-1876-3.ch004
Yu, J., Guo, C., & Kim, M. (2010). Developing
a user centered model for ubiquitous healthcare
system implementation: An empirical study. In
J. Rodrigues (Ed.), Health information systems:
Concepts, methodologies, tools, and applications
(pp. 1243–1259). Hershey, PA: Medical Infor-
mation Science Reference; doi:10.4018/978-1-
60566-988-5.ch077
Yu, J., Guo, C., & Kim, M. (2011). Towards a
conceptual framework of adopting ubiquitous
technology in chronic health care. In J. Tan
(Ed.), Developments in healthcare information
systems and technologies: Models and methods
(pp. 214–231). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-61692-
002-9.ch015
Zaheer, S. (2014). Implementation of evidence-
based practice and the PARIHS framework. In C.
El Morr (Ed.), Research perspectives on the role
of informatics in health policy and management
(pp. 19–36). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4321-5.ch002
Zhang, H. H., Meyer, R. R., Shi, L., & D’Souza,
W. D. (2012). Machine learning applications in
radiation therapy. In S. Kulkarni (Ed.), Machine
learning algorithms for problem solving in com-
putational applications: Intelligent techniques (pp.
59–84). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-4666-1833-6.ch005
287

Zhang, W. (2011). YinYang bipolar quantum
bioeconomics for equilibrium-based biosystem
simulation and regulation. In YinYang bipolar
relativity: A unifying theory of nature, agents and
causality with applications in quantum comput-
ing, cognitive informatics and life sciences (pp.
266–297). Hershey, PA: Information Science Ref-
erence; doi:10.4018/978-1-60960-525-4.ch009
Zhang, Z., Gao, B., Liao, G., Mu, L., & Wei, W.
(2011). The study of transesophageal oxygen
saturation monitoring. In Clinical technologies:
Concepts, methodologies, tools and applications
(pp. 2191–2200). Hershey, PA: Medical Infor-
mation Science Reference; doi:10.4018/978-1-
60960-561-2.ch813
Zhao, B., Zhang, D. S., & Zhao, Y. Z. (2013).
Construction competitiveness evaluation system
of regional BioPharma industry and case study:
Taking Shijiazhuang as an example. In T. Gao
(Ed.), Global applications of pervasive and
ubiquitous computing (pp. 80–88). Hershey, PA:
Information Science Reference; doi:10.4018/978-
1-4666-2645-4.ch009
Zheng, K., Padman, R., Johnson, M. P., & Hasan,
S. (2010). Guideline representation ontologies for
evidence-based medicine practice. In K. Khoum-
bati, Y. Dwivedi, A. Srivastava, & B. Lal (Eds.),
Handbook of research on advances in health in-
formatics and electronic healthcare applications:
Global adoption and impact of information com-
munication technologies (pp. 234–254). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60566-030-1.ch015
Zhou, F., Yan, J., Wang, Y., Li, F., Xia, C., Guo,
R., & Yan, H. (2011). Digital auscultation system
of traditional Chinese medicine and its signals
acquisition: Analysis methods. In L. Liu, D. Wei,
& Y. Li (Eds.), Interdisciplinary research and ap-
plications in bioinformatics, computational biol-
ogy, and environmental sciences (pp. 183–193).
Hershey, PA: Medical Information Science Ref-
erence; doi:10.4018/978-1-60960-064-8.ch016
288
Related References
Zijlstra, W., Becker, C., & Pfeiffer, K. (2011).
Wearable systems for monitoring mobility
related activities: From technology to applica-
tion for healthcare services. In C. Röcker & M.
Ziefle (Eds.), E-Health, assistive technologies
and applications for assisted living: Chal-
lenges and solutions (pp. 244–267). Hershey,
PA: Medical Information Science Reference;
doi:10.4018/978-1-60960-469-1.ch011
Zimmer, J., Degenkolbe, E., Wildemann, B., &
Seemann, P. (2013). BMP signaling in regen-
erative medicine. In Bioinformatics: Concepts,
methodologies, tools, and applications (pp.
1252-1281). Hershey, PA: Medical Information
Science Reference. doi: 10.4018/978-1-4666-
3604-0.ch064
Zouag, N. (2014). Patterns of migration of
medical doctors from MENA and ECE to EU
economies with descriptive analysis of rela-
tives wages. In A. Driouchi (Ed.), Labor and
health economics in the Mediterranean region:
Migration and mobility of medical doctors (pp.
124–138). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4723-7.ch005
Zouag, N., & Driouchi, A. (2014). Trends
and prospects of the moroccan health system:
2010-2030. In A. Driouchi (Ed.), Labor and
health economics in the Mediterranean region:
Migration and mobility of medical doctors (pp.
314–336). Hershey, PA: Medical Information
Science Reference; doi:10.4018/978-1-4666-
4723-7.ch013
Zybeck, K. L. (2013). A question of degrees: Col-
lecting in support of the allied health professions.
In S. Holder (Ed.), Library collection develop-
ment for professional programs: Trends and best
practices (pp. 145–163). Hershey, PA: Informa-
tion Science Reference; doi:10.4018/978-1-
4666-1897-8.ch009.

Compilation of References
Adams, W., & Ferguson, S. (2010). Whenever [Recorded
by The Black Eyed Peas]. On The beginning [CD]. Santa
Monica, CA: Interscope Records.
Airola, P. (1968). There is a cure for arthritis. West Nyack,
NY: Parker Publishing Company, Inc.
Alexander, G., Brisebois, D. A., & Holland, D. (2002).
Someday we’ll know [Recorded by Mandy Moore and
Jonathan Foreman]. On A walk to remember [CD]. New
York, NY: Epic/Sony.
Alexander, E. (2012). Proof of heaven. New York, NY:
Simon and Schuster.
Allen, B. (2009). Conquering arthritis: What doctors
don’t tell you because they don’t know (9 secrets I learned
the hard way). Saint Louis, MO: Shining Prairie Flower
Productions.
Allen, C. A. (2001). The multigenre research paper.
Portsmouth, NH: Heinemann.
Alliance for Eating Disorders Awareness. (2014). What
are eating disorders? Retrieved from http://www.al-
lianceforeatingdisorders.com/portal/what-are-eating-
disorders#.U77gwGdOXcs
American College of Rheumatology. (2008). Prevalence
statistics. Arthritis & Rheumatism. Retrieved from https://
www.rheumatology.org/Research/Prevalence_Statistics/
American Psychological Association. (2014a). Anxiety.
Retrieved from http://apa.org/topics/anxiety/index.aspx
American Psychological Association. (2014b). Depres-
sion. Retrieved from http://apa.org/topics/depress/index.
aspx
289
American Psychological Association. (2014c). Eating
disorders. Retrieved from http://apa.org/topics/eating/
index.aspx
American Psychological Association. (2014d). Person-
ality. Retrieved from http://apa.org/topics/personality/
index.aspx
American Psychological Association. (2014e). Stress.
Retrieved from http://apa.org/topics/stress/index.aspx
Anderson, T., & Milbrandt, M. (2005). Art for life: Au-
thentic instruction in art. New York, NY: McGraw-Hill.
Angner, E., Miller, M. J., Ray, M. N., Saag, K. G., & Al-
lison, J. J. (2010). Health literacy and happiness: A com-
munity-based study. Social Indicators Research, 95(2),
325–338. doi:10.1007/s11205-009-9462-5 doi:10.1007/
s11205-009-9462-5
Arthur, C., & Dash, M. (1999). A Haiti anthology: Libète.
Princeton, NJ: Markus Wiener Publishers.
Ashmalla, M., Mohamed, A. A., & Globashy, M. E.
(2001). E-training: A future substitute for C-training?
Global Competitiveness, 9. Retrieved from Gale articles.
Austen, J. (1981). Emma. New York, NY: Bantam. (Origi-
nal work published 1816)
Austen, J. (1984). Persuasion. New York, NY: Bantam.
(Original work published 1818)
Bailey, M. (2014) The mindful physician. Lorice Coaching
& Consulting, LLC. Retrieved from http://www.drmichel-
lebailey.com/about.html



Baker, D. W., Williams, M. V., Parker, R. M., Gazma-
rarian, J. A., & Nurss, J. (1999). STOHFLA: Short test
of functional health literacy in adults: Development of
a brief test to measure functional health literacy. Patient
Education and Counseling, 38(1), 33–42. doi:10.1016/
S0738-3991(98)00116-5 PubMed doi:10.1016/S0738-
3991(98)00116-5 PMID:14528569
Baker, D., Gazmararian, J., Sudano, J., & Patterson,
M. (2000). The association between age and health
literacy among elderly persons. Journal of Gerontology,
55(6), 368–374. doi:10.1093/geronb/55.6.S368 PubMed
doi:10.1093/geronb/55.6.S368 PMID:11078114
Baker, D., Gazmararian, J., Williams, M., Scott, T., Parker,
R., Green, D., et al. (2002). Functional health literacy
and the risk of hospital admission among Medicare man-
aged care enrollees. American Journal of Public Health,
92(8), 1278–1283. doi:10.2105/AJPH.92.8.1278 PubMed
doi:10.2105/AJPH.92.8.1278 PMID:12144984
Baker, D., Parker, R., Williams, M., & Clark, W. (1998).
Health literacy and the risk of hospital admission. Jour-
nal of General Internal Medicine, 13(12), 791–798.
doi:10.1046/j.1525-1497.1998.00242.x PubMed
doi:10.1046/j.1525-1497.1998.00242.x PMID:9844076
Baker, D., Parker, R., Williams, M., Clark, W., & Nurss,
J. (1997). The relationship of patient reading ability to
self-reported health and use of health services. American
Journal of Public Health, 87(6), 1027–1030. doi:10.2105/
AJPH.87.6.1027 PubMed doi:10.2105/AJPH.87.6.1027
PMID:9224190
Baker, S. C., Wentz, R. K., & Woods, M. M.
(2009). Using virtual worlds in education: Second
Life as an educational tool. Teaching of Psychol-
ogy, 36(1), 59–64. doi:10.1080/00986280802529079
doi:10.1080/00986280802529079
Barbieri, M. (1995). Sounds from the heart. Portsmouth,
NH: Heinemann.
Beck, M. (2001). Finding your own North Star. New
York, NY: Three Rivers Press.
Beck, M. (2003). The joy diet. New York, NY: Crown.
Beck, M. (2012). Finding your way in a wild new world.
New York, NY: Free Press.
290
Compilation of References
Bell, M. S. (2007). Toussaint louverture. New York, NY:
Vintage Books.
Bell, S. (2003). Cyber-guest lecturers: Using webcasts as
a teaching tool. TechTrends, 47(4), 10–14. doi:10.1007/
BF02763506 doi:10.1007/BF02763506
Bellingrath, S., Weigel, T., & Kudielka, B. (2009). Chronic
work stress and exhaustion is associated with higher al-
lostastic load in female school teachers. National Center
for Biotechnology Information. Retrieved from http://
www.ncbi.nlm.nih.gov/pubmed/18951244
Bennett, C., Ferreira, R., Davis, T., Kaplan, J., Weinberger,
M., Kuzel, T., et al. (1998). Relation between literacy,
race, and stage of presentation among low-income patients
with prostate cancer. Journal of Clinical Oncology, 16(9),
3101–3104. PubMed PMID:9738581
Biondi, D. M. (2005). Cerviogenic headache: A review
of diagnostic and treatment strategies. The Journal of the
American Osteopathic Association, 105(4), 16S–22S.
Retrieved from http://www.jaoa.org/content/105/4_
suppl/16S.full PMID:15928349
Blair, S., Kohl, H., Paffenbarger, R., Clark, D., Cooper,
K., & Gibbons, L. (1989). Physical fitness and all-cause
mortality: A prospective study of healthy men and women.
Journal of the American Medical Association, 262(17),
2395–2401. doi:10.1001/jama.1989.03430170057028
PMID:2795824
Bolton, G. (2005). Reflective practice: Writing and profes-
sional development. Thousand Oaks, CA: Sage.
Bourne, E. (2011). The anxiety and phobia workbook.
Oakland, CA: New Harbinger Publications, Inc.
Brown, S. (2013). Teaching art integration in the schools.
Mason, OH: Cengage Learning.
Brown, B. (2007). I thought it was just me. New York,
NY: Gotham Books.
Brown, B. (2010). The gifts of imperfection. Center City,
MN: Hazelden.
Brown, B. (2012). Daring greatly. New York, NY: Go-
tham Books.
Buller, J. L. (2012). The essential department chair. San
Francisco, CA: Jossey-Bass.
Compilation of References
Cameron, J. (1998). The right to write. New York, NY:
Tarcher/Putnam.
Campbell, J., Moyers, B., & Flowers, B. S. (Eds.). (1988).
The power of myth. New York, NY: Doubleday.
Caparros, E. (n.d.). Beyond the looking glass: A spiritual
journey. Unpublished manuscript.
Carr, E. H. (1961). What is history? New York, NY: Knopf.
Centers for Disease Control and Prevention (CDC). (2013).
Adolescent and school health: Characteristics of an effec-
tive health education curriculum. Atlanta, GA: Author.
Retrieved from http://www.cdc.gov/HealthyYouth/SHER/
characteristics/
Centers for Disease Control and Prevention. (2011).
Health literacy: Accurate, accessible, and actionable
health information for all. Retrieved from http://www.
cdc.gov/healthliteracy/
Centers for Disease Control and Prevention. (2011).
Health related quality of life. Health Related Quality of
Life Surveillance Program. Retrieved from http://www.
cdc.gov/hrqol/hrqol14_measure.htm
Chopin, K. (1981). The awakening. New York, NY:
Bantam. (Original work published 1899)
Chulack, C., Crichton, M., Wells, J., & Zabel, D. (1994-
2009). ER [Television series]. Burbank, CA: Warner
Brothers.
Cianelli, R. R., Wilkinson, C. C., Mitchell, E. E., Anglade,
D. D., Nicolas, G. G., Mitrani, V. V., & Peragallo, N. N.
(2013). Mental health training experiences among Haitian
healthcare workers post-earthquake 2010. International
Nursing Review, 60(4), 528–535. doi:10.1111/inr.12047
PubMed doi:10.1111/inr.12047 PMID:24251943
Cipriano, R. E., & Riccardi, R. (2010). What is unique
about chairs? A continuing exploration. Department
Chair, 20(4), 26–28.
Clandinin, D. J., & Connelly, F. M. (2000). Narrative
inquiry. San Francisco, CA: Jossey-Bass.
Cleaver, J. (2002). Immediate fiction. New York, NY:
St. Martin’s Press.
CNN. (2010, January, 10). Pat Robertson says Haiti pay-
ing for ‘pact to the devil’. Retrieved from http://www.cnn.
com/2010/US/01/13/haiti.pat.robertson/
Coleman, C., Kurtz-Rossi, S., McKinney, J., Pleasant,
A., Rootman, I., & Shohet, L. (2009). Calgary charter
on health literacy, 2009. Retrieved from www.centrefor-
literacy.qc.ca/Healthlitinst/Calgary_Charter.htm
Connelly, F. M., & Clandinin, D. J. (1988). Teachers as
curriculum planners. New York, NY: Teachers College.
Conner, J. (2008). Writing down your soul. San Francisco,
CA: Conari.
Conradi, E., Kavia, S., Burden, D., Rice, A.,
Woodham, L., Beaumont, C., et al. (2009). Vir-
tual patients in a virtual world: Training para-
medic students for practice. Medical Teacher, 31(8),
713–720. doi:10.1080/01421590903134160 PubMed
doi:10.1080/01421590903134160 PMID:19811207
Craig, G. (2008). The EFT manual. Santa Rosa, CA:
Energy Psychology Press.
Croft, J. (1980). Interviewing in physical therapy. Physical
Therapy, 60(8), 1033–1036. PMID:7403279
Dale, C., & Pymm, J. (2009). Podagogy: The iPod as a
learning technology. Active Learning in Higher Educa-
tion, 10(1), 84–96. doi:10.1177/1469787408100197
doi:10.1177/1469787408100197
Davidoff, M. (1997). Time. Annals of Internal Medi-
cine, 127(6), 483–485. doi:10.7326/0003-4819-127-6-
199709150-00011 PMID:9313007
Davidson, J. (2003). The anxiety book: Developing strength
in the face of fear. New York, NY: Riverhead Books.
Davis, T., Meldrum, H., Tippy, P., Weiss, B., & Williams,
M. (1996). How poor literacy leads to poor health care.
Patient Care, 30(16), 94–98,100, 103.
DeSalvo, L. (1999). Writing as a way of healing: How
telling our stories transforms our lives. Boston, MA:
Beacon Press.
DiMaria-Ghalili, R., Ostrow, L., & Rodney, K. (2005).
Webcasting: A new instructional technology in distance
graduate nursing education. The Journal of Nursing Edu-
cation, 44(1), 11–18. PubMed PMID:15673169
291

DiNovi, D. (Producer), & Shankman, A. (Director).
(2002). A walk to remember [motion picture]. United
States: Warner Brothers Pictures.
Dissanayake, E. (1992). Homoaesthetics: Where art comes
from and why. New York, NY: Macmillan Inc.
Dosa, D. (2010). Making rounds with Oscar. New York,
NY: Hyperion.
Downes, S. (2005). E-learning 2.0. eLearn Magazine.
Retrieved from http://www.elearnmag.org/subpage.cfm
?section=articles&article=29-1
Drepung Loseling Monastery. (2014). Mandala sand
painting, healing the earth: A sacred art by the Tibetan
Lamas of Drepung Loseling Monastery. Drepung Loseling
Monastery Inc. Retrieved from http://www.mysticalart-
softibet.org/mandala.htm
Dubois, L. (2004). Avengers of the new world: The story
of the Haitian revolution. Cambridge, MA: Belknap Press
of Harvard University Press.
Duke Integrative Medicine Staff. (2010). Personalized
health plan manual. Durham, NC: Duke Integrative
Medicine.
DuMaurier, D. (1938). Rebecca. New York, NY: Avon.
Edwards, B. (1999). The new drawing on the right side of
the brain. New York, NY: Penguin Putnam Inc.
Elmore, W. H. (2006). Administrator as interposer: He-
licopter parents vs. alleged malevolent professors. The
Department Chair, 17(2), 18–19.
Elrod, J. M. (1997). Reversing fibromyalgia: How to treat
and overcome fibromyalgia and other arthritis-related
diseases. Pleasant Grove, UT: Woodland Publishing.
Erford, B. T. (2010). Thirty-five techniques every coun-
selor should know. Upper Saddle River, NJ: Pearson.
Erickson, E. H. (1964). Insight and responsibility: Lectures
on the ethical implications of psychoanalytic insight (1st
ed.). New York, NY: W. W. Norton.
Essortment, Your Source of Knowledge. (2011). What is
lupus disease? Retrieved from http://www.essortment.
com/lupus-disease-63919.html
292
Compilation of References
Evans, C. (2008). The effectiveness of m-learning
in the form of podcast revision lectures in higher
education. Computers & Education, 50(2), 491–498.
doi:10.1016/j.compedu.2007.09.016 doi:10.1016/j.
compedu.2007.09.016
Evans, J. (2010). Wellness & writing connections: Writing
for better physical, mental, and spiritual health. Enum-
claw, WA: Idyll Arbor.
Farber, B. A. (Ed.). (1983). Stress and burnout in the
human services professions. New York: Pergamon Press.
Farrar, J. (1975). Have you never been mellow [Recorded
by Olivia Newton-John]. On Have you never been mellow
[CD]. Universal City, CA: MCA.
Ferguson, S., Sandstrom, R., Ridel, S., & Boldt, R. (2006).
Losing my ground [Recorded by Fergie]. On The dutchess
[CD]. Santa Monica, CA: A&M Records.
Fick, C. (1990). The making of Haiti. Knoxville, TN: The
University of Tennessee Press.
Fincher, S. (2010). Creating mandalas for insight, healing
and self-expression. Boston, MA: Shambhala Publica-
tions, Inc.
Fish, S. (2004). The party’s over. The Chronicle of Higher
Education, 51(2), C1–C4.
Fitzgerald, F. S. (1925). The great Gatsby. New York,
NY: Scribner.
Fletcher, R. (2013). What a writer needs (2nd ed.). Ports-
mouth, NH: Heinemann.
Fowler, C. (1996). Strong arts, strong schools: The
promising potential and shortsighted disregard of the
arts in American schooling. New York, NY: Oxford
University Press.
Fox, M. J. (2009). Always looking up. New York, NY:
Hyperion.
Franck, F. (1973). The zen of seeing. New York, NY:
Alfred A. Knopf.
Frankl, V. (2006). Man’s search for meaning. Boston,
MA: Beacon Press.
Compilation of References
Fredrickson, B. (1998). What good are positive emo-
tions? Review of General Psychology, 2(3), 300–319.
doi:10.1037/1089-2680.2.3.300 PMID:21850154
Fredrickson, B. (2009). Positivity. New York, NY: Three
Rivers Press.
Freud, S. (1915). The unconscious. In The standard edition
of the complete psychological works of Sigmund Freud
(Vol. 14, pp. 159–204). Academic Press.
Frew, D., & Bruning, N. (1988). Improved productivity
and job satisfaction through employee exercise programs.
Hospital Materiel Management Quarterly, 9, 62–69.
PMID:10287092
Galloway, J. (2013). Run walk run. Jeff Galloway Training.
Retrieved from http://www.jeffgalloway.com
Gardner, H. (1999). Intelligences reframed: Multiple intel-
ligences for the 21st century. New York, NY: Basic Books.
Garrison, M. (1980). I cured my arthritis you can too.
North Largo, FL: Uptown Pub.
Gartner. (2006). Gartner says 25 percent of new business
software will be delivered as software as a service by
2011. Gartner Newsroom. Retrieved from http://www.
gartner.com/it/page.jsp?id=496886
Gaudio, B., & Parker, J. (1995) December 1963 (oh what
a night) remix [Recorded by the Four Seasons]. On Oh
what a night [CD]. Nashville, TN: Curb Records.
Gazmararian, J. A., Baker, D. W., Williams, M. V.,
Parker, R. M., Scott, T. L., Green, D. C., et al. (1999).
Health literacy among Medicare enrollees in a managed
care organization. Journal of the American Medical As-
sociation, 281(6), 545–551. doi:10.1001/jama.281.6.545
PMID:10022111
Gazmararian, J. A., Curran, J. W., Parker, R. M., Bernhart,
J. M., & DeBuono, B. A. (2005). Public health literacy
in America: An ethical imperative. American Journal
of Preventive Medicine, 28(3), 317–322. doi:10.1016/j.
amepre.2004.11.004 PMID:15766622
Geggus, D. P. (1983). Slave resistance studies and the
Saint Domingue slave revolt: Some preliminary con-
siderations. Miami, FL: Latin American and Caribbean
Center, Florida International University.
Giannakos, M. N., & Vlamos, P. (2012). Educational
webcasts’ acceptance: Empirical examination and the role
of experience. British Journal of Educational Technology.
doi:10.1111/j.1467-8535.2011.01279.x
Giannakos, M. N., Chorianopoulos, K., Johns, P., Inkpen,
K., & Du, H. (2011). Children’s interactions in an asyn-
chronous video mediated communication environment.
In Proceedings of the 13th IFIP TC 13 International
Conference on Human-Computer Interaction (vol. 1,
pp. 199-206). Academic Press. doi:10.1007/978-3-642-
23774-4_18
Girard, P. (2009). Rebels with a cause: Women in the Hai-
tian war of independence, 1802-04. Gender, 21(1), 60–85.
Goldberg, T. G. (1993). Racist culture: Philosophy and
the politics of meaning. Cambridge, MA: Blackwell.
Goldberg, N. (2000). Thunder and lightning. New York,
NY: Bantam.
Goldberg, N. (2007). Old friend from far away. New
York, NY: Free Press.
Goldberg, N. (2013). The true secret of writing. New
York, NY: Atria.
Goleman, D. (1988). The meditation mind. Los Angeles,
CA: Tarder.
Golembiewski, R. T., Munzenrider, R. F., & Stevenson,
J. G. (1986). Stress in organizations: Toward a model of
burnout. New York, NY: Praeger.
Gordimer, N. (1981). July’s people. New York, NY:
Viking Press.
Gorman, P. J., Meier, A. H., Rawn, C., & Krummel, T. M.
(2000). The future of medical education is no longer blood
and guts, it is bits and bytes. American Journal of Surgery,
180(5), 353–356. doi:10.1016/S0002-9610(00)00514-6
PMID:11137686
Grant, A., & Kirkpatrick, W. (1997). Takes a little time
[Recorded by Amy Grant]. On Behind the eyes [CD].
Hollywood, CA: A&M Records.
Grant, A. (2007). Mosaic. New York, NY: Doubleday.
Graves, D. H. (1994). A fresh look at writing. Portsmouth,
NH: Heinemann.
293

Greenberg, M. A., Wortman, C. B., & Stone, A. A. (1996).
Emotional expression and physical health: Revising
traumatic memories or fostering self-regulation. Journal
of Personality and Social Psychology, 71(3), 588–602.
doi:10.1037/0022-3514.71.3.588 PMID:8831163
Greiner, A. C., & Knebel, E. (Eds.). (2003). Health pro-
fessions education: A bridge to quality. Washington, DC:
National Academy Press.
Gruwell, E., & The Freedom Writers. (1999). The Freedom
Writers diary. New York, NY: Broadway.
Guglielmino, L. M. (1978). Development of the self-
directed learning readiness scale. (Doctoral dissertation,
University of Georgia, 1977). Dissertation Abstracts
International, 38, 6467A.
Guglielmino, L. M. (2008). Why self-directed learning? In-
ternational Journal of Self-Directed Learning, 5(1), 1–14.
Guroff, M. (2010). America’s most trusted doctor. AARP
Magazine, 53(3A), 34–37.
Hackney, H. C., & Cornier, L. S. (2001). The professional
counselor. Boston, MA: Allyn and Bacon.
Hagen, P. T. (Ed.). (2001). Mayo clinic guide to self-care.
Rochester, MN: Mayo Clinic.
Haitian-American Caucus. (2014). Teacher’s summer
institute. Retrieved from http://hacus.org/blog/projects/
teachers-summer-institute/
Hale, M. (2013). The single woman. Nashville, TN:
Thomas Nelson.
Hale, M. (2014). I’ve never been to Vegas but my luggage
has. Nashville, TN: Thomas Nelson.
Hall, C. S. (1954). A primer of Freudian psychology.
New York, NY: Harper & Row. doi:10.1037/10640-000
Hambrick, D., Finkelstein, S., & Mooney, A. (2005). Ex-
ecutive job demands: New insights for explaining strategic
decisions and leader behavior. Reading of Measurements
Review, 3, 472–491.
Handler, J. (2013). Braving the fire. New York, NY: St.
Martin’s Griffin.
294
Compilation of References
Hansen, M. M. (2008). Versatile, immersive, creative and
dynamic virtual 3-D healthcare learning environments:
A review of the literature. Journal of Medical Internet
Research, 10(3), e26. doi:10.2196/jmir.1051 PubMed
doi:10.2196/jmir.1051 PMID:18762473
Hansman, C. A. (2008). Adult learning in communities
of practice: Situating theory in practice. In C. Kimble, P.
Hildreth, & I. Bourdon (Eds.), Communities of practice:
Creating learning environments for educators (Vol. 1).
Charlotte, NC: Information Age Publishing, Inc.
Hart, J. (2007). Clinical application for meditation: A
review and recommendation. Alternative and Complemen-
tary Therapies, 13(1), 24–29. doi:10.1089/act.2006.13104
Harun, M. H. (2001). Integrating e-learning into the
workplace. The Internet and Higher Education, 4(3-
4), 301–310. doi:10.1016/S1096-7516(01)00073-2
doi:10.1016/S1096-7516(01)00073-2
Heard, G. (1995). Writing toward home. Portsmouth,
NH: Heinemann.
Heisler, M. (2006). Building peer support programs to
manage chronic disease: Seven models for success. Oak-
land, CA: California Healthcare Foundation.
Henri, R. (1923). The art spirit. New York, NY: Harper
& Row, Publishers.
Hersh, W. R., Bhupatiraju, R. T., Greene, P. S., Smother,
V., & Cohen, C. (2006). Adopting e-learning standards
in health care: Competency-based learning in the medi-
cal informatics domain. In Proceedings of American
Medical Informatics Association Annual Symposium (pp.
334-338). AMIA.
Hill, L. H. (Ed.). (2011). Adult education for health and
wellness. San Francisco, CA: Jossey-Bass.
Hill, L. H., & Ziegahn, L. (2010). Adult education for
health and wellness. In C. E. Kasworm, A. D. Rose, & J.
M. Ross-Gordon (Eds.), Handbook of adult and continu-
ing education. Thousand Oaks, CA: Sage.
Howard-Baptiste, S., & Baptiste, M. (2013). Echoes of a
not so distant summer: Scholar servant as humble lead-
ers. In A. Normore & N. Erbe (Eds.), Collective efficacy:
Interdisciplinary perspectives on international leadership
(pp. 73–87). Emerald Group Publishing.
Compilation of References

Hughes, R., Garnett, R., & Curphy, G. (2009). Leadership Kalichman, S., & Rompa, D. (2000). Functional health
(6th ed.). Boston, MA: McGraw-Hill Irwin. literacy is associated with health status and health-related
knowledge in people living with HIV-AIDS. JAIDS Jour-
Ibsen, H. (1958). A doll’s house. In Four great plays.
nal of Acquired Immune Deficiency Syndromes, 25(4),
New York, NY: Bantam. (Original work published 1879)
337–344. doi:10.1097/00126334-200012010-00007
Inman, C., Wright, V. H., & Hartman, J. A. (2010). Use PMID:11114834
of Second Life in K-12 and higher education: A review of
Keats, J. (1820). Ode to a Grecian urn. Annals of the
research. Journal of Interactive Online Learning, 9, 44–63.
Fine Arts, 15.
Institute of Medicine. (2004). Health literacy. Retrieved
Kepler, H. B. (1973). Basic graphical kinematics (2nd
from http://www.iom.edu/Activities/PublicHealth/
ed.). New York, NY: McGraw Hill.
HealthLiteracy.aspx
Kinsella, W. P. (1982). Shoeless Joe. New York, NY:
James, C. L. R. (1989). The Black Jacobins: Toussaint
Ballantine.
L’Ouverture and the San Domingo Revolution. New York,
NY: Vintage Books. Klaper, M. (1987). Vegan nutrition: Pure and simple.
Maui, HI: Gentle World, Inc.
James, R. X., & Gilliland, B. E. (2005). Crisis interven-
tion strategies. Independence, KY: Cengage Learning. Klaper, M. (1991). Pregnancy, children, and the vegan
diet. Maui, HI: Gentle World, Inc.
Jaynes, J. (1976). The origins of consciousness in the
breakdown of the bicameral mind. New York, NY: Kleisinger, F. (2003). Understanding noncompliant be-
Houghton Mifflin. haviour: Definitions and causes. The Permanente Journal,
7(4). Retrieved from http://xnet.kp.org/permanentejour-
John, E., & Taupin, B. (2001). This train don’t stop there
nal/fall03/behavior.html
anymore [Recorded by Elton John]. On Songs from the
west coast. New York, NY: Universal. Kloss, J. (1992). Back to eden. Loma Linda, CA: Back
to Eden Publishing Company.
Johnson, B., & Christensen, L. (2012). Educational re-
search: Quantitative, qualitative, and mixed approaches Knebel, E., Puttkammer, N., Demes, A., Devirois, R.,
(4th ed.). Los Angeles, CA: Sage Publications, Inc. & Prismy, M. (2008). Developing a competency-based
curriculum in HIV for nursing schools in Haiti. Human
Johnson, E. (2002). Contextual teaching and learning:
Resources for Health, 6(1), 1–7. doi:10.1186/1478-4491-
What it is and why it’s here to stay. Thousand Oaks, CA:
6-17 PMID:18759986
Corwin Press, Inc.
Knoeller, C. (2003). Imaginative response: Teaching lit-
Jung, C. (1972). Mandala symbolism. Princeton, NJ:
erature through creative writing. English Journal, 92(5),
Princeton University Press.
42–48. doi:10.2307/3650423 doi:10.2307/3650423
Kabat-Zinn, J. (1996). Mindfulness meditation: What it
Koh, K., Berwick, D., Clancy, C., Baur, C., Brach, C.,
is, what it isn’t, and its role in health care and medicine.
Harris, L., & Zerhusen, E. (2012). New federal policy
In Y. Haruki, Y. Ishii, & M. Suziki (Eds.), Comparative
initiatives to boost health literacy can help the nation
and psychological study on meditation (pp. 161–170).
move beyond the cycle of costly “crisis care”. Health
Eburon Publishers.
Affairs, 31(2), 1–10. doi:10.1377/hlthaff.2011.1169
Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe PMID:22262723
living: Using the wisdom of your body and mind to face
Kominars, S. (2010). Write for life: Healing body, mind,
stress, pain, and illness. New York, NY: Random House
& spirit through journal writing. New York, NY: Kaplan.
LLC.

295

Kurtz, B. L., Fenwick, J. B., & Ellsworth, C. C.
(2007). Using podcasts and tablet PCs in computer
science. In Proceedings of the 45th Annual ACM
Southeast Regional Conference (pp. 484-489). ACM.
doi:10.1145/1233341.1233428
Lake, R. (2006). Heart failure cited in Bristow’s death. The
Clarion-Ledger. Retrieved from http//clarionledger.com
Lamott, A. (1994). Bird by bird. New York: Anchor Books.
Landy, F. (1992). Work design and stress. In Work &
well-being[Washington, DC: American Psychological
Association.]. Agenda (Durban, South Africa), 1990s,
119–158.
Lawrence, J., & Lee, R. E. (1955). Inherit the wind. New
York, NY: Bantam.
Lazarus, R. S. (2006). Stress and emotion: A new synthesis.
New York, NY: Springer Publishing Company.
Lepore, S. J., Greenberg, M. A., Bruno, M., & Smyth, J.
M. (2002). Expressive writing and health: self-regulation
of emotion-related experience, physiology, and behavior.
In S. J. Lepore & J. M. Smyth (Eds.), The writing cure
(pp. 99–117). Washington, DC: American Psychological
Association. doi:10.1037/10451-005
Lepore, S., & Smyth, J. (2002). The writing cure: How
expressive writing promotes health and emotional well-
being. Washington, DC: APA. doi:10.1037/10451-000
Levine, J. (2013). Toxic teeth: Are amalgam fillings safe?
Dr. Oz. Retrieved from http://www.doctoroz.com/videos/
toxic-teeth-are-our-amalgam-fillings-safe
Levy, M. (2000). Just like heaven. New York, NY: Pocket
Books. (Originally published as If only it were true).
Lin, C. A. (2004). Webcasting adoption: Technology
fluidity, user innovativeness, and media. Journal of
Broadcasting & Electronic Media, 48(3), 157–178.
doi:10.1207/s15506878jobem4803_6 doi:10.1207/
s15506878jobem4803_6
Lindau, S., Tomori, B., McCarville, B., & Bennett, C.
(2001). Improving rates of cervical cancer screening and
pap smear follow-up for low-income women with limited
health literacy. Cancer Investigation, 19(3), 316–323.
doi:10.1081/CNV-100102558 PMID:11338888
296
Compilation of References
Liu, Q., Rui, Y., Gupta, A., & Cadiz, J. J. (2001). Automat-
ing camera management for lecture room environments.
Retrieved from http://research.microsoft.com/en-us/um/
people/yongrui/ps/chi01b.pdf
Lovelace, K. J., Manz, C. C., & Alves, J. C. (2007).
Work stress and leadership development: The role
self-leadership, shared leadership, physical fitness and
flow managing demands and increasing job control.
Human Resource Management Review, 17(4), 374–387.
doi:10.1016/j.hrmr.2007.08.001
Lupus Foundation of America. (2013). Research. Re-
trieved from http://www.lupus.org/research
Lupus Foundation of America. (2014). Understanding
lupus: Frequently asked questions. Retrieved from http://
www.lupus.org/answers/entry/what-is-lupus
Lupus Research Institute. (n.d.). Retrieved from http://
www.lupusresearchinstitute.org/
Maag, M. (2006). IPod, uPod? An emerging mobile learn-
ing tool in nursing education and students’ satisfaction.
In Proceedings of the 23rd Annual Conference of the
Australian Society for Computers in Learning in Ter-
tiary Education. Academic Press. Retrieved from http://
www.ascilite.org.au/conferences/sydney06/proceeding/
pdf_papers/p92.pdf
Mahoney, S. (2013). Jump start your weight loss. Good
Housekeeping (New York, N.Y.), 256(4), 38–43.
Mantovani, F. (2001). VR learning: Potential and chal-
lenges for the use of 3D environments in education and
training. In G. Riva & C. Galimberti (Eds.), Towards
CyberPsychology: Mind, cognition and society in the
internet age (Vol. 2, pp. 207–225). Amsterdam, The
Netherlands: IOS Press.
Martin, L. T., Ruder, T., Escarce, J. J., Ghosh-Dastidar, B.,
Sherman, D., Elliott, M., & Lurie, N. (2009). Developing
predictive models of health literacy. Journal of General
Internal Medicine, 24(11), 1211–1216. doi:10.1007/
s11606-009-1105-7 PMID:19760299
Masini, A. (2010). Equine-assisted psychotherapy in clini-
cal practice. Journal of Psychosocial Nursing and Mental
Health Services, 48(10), 30–34. doi:10.3928/02793695-
20100831-08 PMID:20873699
Compilation of References
Matzke, B. R. (2007). Rural care registered nurses’
interpretation of health literacy and its effect on patient
care. (Doctoral Dissertation). Available from ProQuest
Dissertation and Thesis database. (UMI No. 3256340)
Mayo Clinic Staff. (2011). Generalized anxiety disorder.
Retrieved from http://www.mayoclinic.org/diseases-
conditions/generalized-anxiety-disorder/basics/lifestyle-
home-remedies/con-20024562
McKenzie, J. F., Pinger, R. R., & Kotecki, J. (2012). An
introduction to community health (7th ed.). Sudbury, MA:
Jones and Bartlett Publishers.
Megil, A. (1995). Grand narrative and the discipline of
history. In F. Ankersmit & H. Kellner (Eds.), A new phi-
losophy of history (pp. 21–39). Chicago, IL: University
of Chicago Press.
Menasche, D. (2013). The priority list. New York, NY:
Touchstone.
Merriam, S. B., Caffarella, R. S., & Baumgartner, L. M.
(2007). Learning in adulthood: A comprehensive guide
(3rd ed.). San Francisco, CA: Jossey-Bass Higher and
Adult Education.
Metcalf, T., Davis, S., Gonda, L., Britt, M., & Bird, J.
(2010). Well teachers teach well: Renewing our teaching
selves. Paper presented at the National Council of Teach-
ers of English Conference, New York, NY.
Minogue, K., Poole, K., & Kurstin, G. (2008). Wow
[Recorded by Kylie Minogue]. On X [CD]. Hollywood,
CA: EMI.
Mishra, P., & Khan, M. L. (2009). Webcasting. In E-
learning (pp. 84–87). New Delhi, India: IGNOU.
Munsterberg, M. (2009). Writing about art: Ekphrasis.
Retrieved from http://writingaboutart.org/pages/ekph-
rasis.html
Murray, D. M. (1985). A writer teaches writing (2nd ed.).
Boston, MA: Houghton Mifflin.
National Institute of Mental Health. (n.d.). Anxiety dis-
orders. Retrieved from http://www.nimh.nih.gov/health/
topics/anxiety-disorders/index.shtml
Naturopathic Physicians. (2011). Definition of naturo-
pathic medicine. Retrieved from http://www.naturopathic.
org/content.asp?contentid=59
Neal, M. C. (2012). To heaven and back. Colorado Springs,
CO: WaterBrook Press.
Nicole, B., Muckala, D., & Cates, J. (2012). Gold [Re-
corded by Britt Nicole]. On Gold [CD]. Brentwood, TN:
Capitol.
North American Spine Society. (2014). Whiplash and
whiplash associated disorder. Knowyourback.org.
Retrieved from http://www.knowyourback.org/Pages/
SpinalConditions/Injuries/Whiplash.aspx
NYU Langone Medical Center. (2014). Cervicogenic
headache. Center for the Study and Treatment of Pain.
Retrieved from http://pain-medicine.med.nyu.edu/patient-
care/conditions-we-treat/cervicogenic-headache
O’Brien, T. (1990). The things they carried. New York,
NY: Broadway Books.
Office of Minority Health. (2001). National standards for
culturally and linguistically appropriate services in health
care: Final report. Retrieved from http://minorityhealth.
hhs.gov/assets/pdf/checked/finalreport.pdf
Ott, T. O. (1973). The Haitian revolution, 1789-1804
(1st ed.). Knoxville, TN: University of Tennessee Press.
Paasche-Orlow, M. K., & Wolfe, M. S. (2007). The causal
pathways linking health literacy to health outcomes.
American Journal of Health Behavior, 31(1), 19–26.
doi:10.5993/AJHB.31.s1.4 PMID:17931132
Paasche-Orlow, M. K., Parker, R. M., Gazmararian, J.
A., Nielsen-Bohlman, L. T., & Rudd, R. R. (2005). The
prevalence of limited health literacy. Journal of General
Internal Medicine, 20(2), 175–184. doi:10.1111/j.1525-
1497.2005.40245.x PMID:15836552
Pancreatic Cancer Action Network. (2013). Retrieved
from http://www.pancan.org
Parikh, N., Parker, R., Nurss, J., Baker, D., & Williams,
M. (1996). Shame and health literacy: The unspoken con-
nection. Patient Education and Counseling, 27(1), 33–39.
doi:10.1016/0738-3991(95)00787-3 PMID:8788747
297

Parker, R., & Kreps, G. (2005). Library outreach: Over-
coming health literacy challenges. Journal of the Medi-
cal Library Association: JMLA, 93(4), 81–58. PubMed
PMID:16239962
Partner, N. F. (1995). Historicity in the age of reality-
fictions. In F. Ankersmit & H. Kellner (Eds.), A new
philosophy of history (pp. 21–39). Chicago, IL: University
of Chicago Press.
Partnership for Clear Health Communication. (n.d.). Do
you know? Which of the following is the strongest predictor
of an individual’s health status? Retrieved from http://
www.askme3.org
Pausch, R. (2007). The last lecture: Really achieving
your childhood dreams. Carnegie Mellon University.
Retrieved from http://www.cs.cmu.edu/~pausch/Randy/
pauschlastlecturetranscript.pdf
Pausch, E. J. (2012). Dream new dreams. New York, NY:
Crown Archtype.
Pausch, R., & Zaslow, J. (2008). The last lecture. New
York, NY: Hyperion.
Pehrsson, D. E., & McMillen, P. (2002). The bibliotherapy
education project. College of Education and Human
Services at Central Michigan University. Retrieved from
http://bibliotherapy.ehs.cmich.edu/
Pennebaker, J. (2002). Emotion, disclosure, and health.
Washington, DC: APA.
Pennebaker, J. W. (1997). Opening up: The healing power
of expressing emotions. New York, NY: The Guilford press.
Pennebaker, J. W., & Evans, J. F. (2014). Expressive
writing: words that heal. Enumclaw, WA: Idyll Arbor.
Perry, K., Eriksen, M., Hermansen, T., Wilhelm, S., &
Dean, E. (2010). Firework [Recorded by Katy Perry]. On
Teenage dream [CD]. New York, NY: Capitol.
Pew Internet and American Life Report. (2011). Peer-
to-peer healthcare. Retrieved from http://www.pewin-
ternet.org/~/media//Files/Reports/2011/Pew_P2PHealth-
care_2011.pdf
Pines, A., & Aronson, E. (1988). Career burnout: Causes
and cures. New York, NY: Erie Press.
298
Compilation of References
Porth, C. M. (2007). Essentials of pathophysiology con-
cepts of altered health states (2nd ed.). Philadelphia, PA:
Lippincott Williams & Wilkins.
Putz, M. (2006). A teacher’s guide to the multigenre
research project. Portsmouth, NH: Heinemann.
Quantz, R. (1988). Culture: A critical perspective. Paper
presented at American Education Studies Association,
Toronto, Canada.
Quindlen, A. (2004). Loud and clear. New York, NY:
Ballantine.
Randall, K. E., & McEwen, I. R. (2000). Writing patient-
centered functional goals. Physical Therapy, 80(12),
1197–1203. PMID:11087306
Rankin, L. (2013). Mind over medicine. Carlsbad, CA:
Hay House.
Raymond, J. (2004). Peaceful palate. Honeydew, CA:
Heart and Soul Publications.
Reed, M. (2008). CaringBridge. Retrieved from http://
www.caringbridge.org/visit/MarcPuritz
Richie, L. (2012). Sail on [Recorded by Lionel Richie
and Tim McGraw]. On Tuskegee [CD]. Nashville, TN:
Mercury.
Robbins, J., & Macy, J. (1998). Diet for a new America.
Tiburon, CA: H. J. Kramer Incorporated.
Rolf Institute of Structural Integration. (2014). Rolfing
structural integration and Rolf movement integration.
Retrieved from http://rolf.org/
Romano, T. (1987). Clearing the way. Portsmouth, NH:
Heinemann.
Romano, T. (1995). Writing with passion. Portsmouth,
NH: Heinemann.
Romano, T. (2000). Blending genre, altering style. Ports-
mouth, NH: Heinemann.
Romano, T. (2004). Crafting authentic voice. Portsmouth,
NH: Heinemann.
Romano, T. (2008). Zigzag. Portsmouth, NH: Heinemann.
Compilation of References
Romano, T. (2013). Fearless writing. Portsmouth, NH:
Heinemann.
Rosenberg, M. (2001). E-learning: Strategies for de-
livering knowledge in the digital age. New York, NY:
McGraw-Hill.
Rostand, E. (1950). Cyrano de Bergerac. New York, NY:
Bantam. (Original work published 1898)
Roth, P. (2004). The plot against America. Boston, MA:
Houghton Mifflin Co.
Routman, R. (2003). Reading essentials. Portsmouth,
NH: Heinemann.
Rubin, W. S. (1968). Dada and surrealist art. New York,
NY: Harry N. Abrams, Inc.
Rushnell, S. (2012). Divine alignment. New York, NY:
Howard Books.
Saeed, S., & Rasden, R. (1994). Hearing loss. The Prac-
titioner, 238, 454–460. PubMed PMID:8208663
Said, E. (1993). Culture and imperialism. New York,
NY: A.A. Knopf.
Saint John of the Cross. (2007). The dark night of the soul.
Shippensburg, PA: Destiny Image Publishers. (Original
work published 1578)
Sandberg, S. (2014). Lean in for graduates. New York,
NY: Alfred A. Knopf.
Schecter, S., & Lynch, J. (2010). Health learning and
adult education: In search of a theory of practice. Adult
Education Quarterly, 60(4), 1–18.
Schneider, K. G. (2001). Lights! Cameras! Action!
American Libraries, 32(7), 94.
Seligman, L. (2001). Systems, strategies, and skills of
counseling and psychotherapy. Upper Saddle River, NJ:
Merrill Prentice Hall.
Seligman, M. (2012). Flourish. New York, NY: Free Press.
Shallcross, L. (2012). Bringing work home. Counseling
Today., 54(10), 32–38.
Shapiro, S. L., Schwartz, G. E., & Santerre, C. (2002).
Meditation and positive psychology. In C. R. Snyder &
S. Lopez (Eds.), Handbook of positive psychology (pp.
632–645). Oxford, UK: Oxford University Press.
Shiel, W. C. (2014). Giant cell arteritis (temporal arteritis).
Medicine Net. Retrieved from http://www.onhealth.com/
polymyalgia_rheumatica/page2.htm
Siegel, J. (2012). The plot against America: Philip Roth’s
counter-plot to American history. Melus, 37(1), 131–154.
doi:10.1353/mel.2012.0015
Smith, P. (2010). Following the ten commandments of
nutrition. In Well-being for dummies. Indianapolis, IN:
Wiley.
Solomon, B., & Donnenfeld, E. (2003). Recent advances
and future frontiers in treating age related cataracts.
Journal of the American Medical Association, 290(2),
248–251. doi:10.1001/jama.290.2.248 PMID:12851280
Sonan, M. (2013). Feel better from 9 to 5: Lower your
stress and increase you fitness-it’s all in a day’s work.
Good Housekeeping (New York, N.Y.), 256(4), 100–101.
Spandorfer, J., Karras, D., Hughes, L., & Caputo, C.
(1995). Comprehension of discharge instructions by
patients in an urban emergency department. Annals of
Emergency Medicine, 25(1), 71–74. doi:10.1016/S0196-
0644(95)70358-6 PMID:7802373
Sparks, N. (1999). A walk to remember. New York, NY:
Warner.
Spragins, E. (Ed.). (2006). What I know now: Letters to
my younger self. New York, NY: Broadway.
Stanley, T. (2006). The struggle for history: Historical
narratives and anti‐racist pedagogy. Discourse (Abingdon),
19(1), 41–52. doi:10.1080/0159630980190103
Starlanyl, D., & Copeland, M. E. (1996). Fibromyalgia
and chronic myofascial pain: A survival manual. Aca-
demic Press.
Sternberg, R. J. (1985). Beyond IQ: A triarchic theory
of human intelligence. New York, NY: Cambridge Uni-
versity Press.
299

Stockdale, B. (2009). You can beat the odds: The surpris-
ing answers behind chronic illness and cancer. Boulder,
CO: Sentient.
Swift, T. (2010). Back to December [Recorded by Taylor
Swift]. On Speak now [CD]. Nashville, TN: Big Machine
Records.
Szekely, G. (2003). A retrospective: 1973-2003 essays
for art teachers. Boston, MA: Pearson Inc.
Takahashi, D. (2008). Cigna deploys a Second Life island
for health education. Venture Beat. Retrieved from http://
venturebeat.com/2008/07/01/cigna-deploys-a-second-
life-island-for-health-education/
Tavangarian, D., Leypold, M., Nölting K. & Röser, M.
(2004). Is e-learning the solution for individual learning?
Electronic Journal of e-Learning, 2(2), 273–280.
Teitelbaum, J. (1996). From fatigued to fantastic. Garden
City Park, NY: Avery.
Teng, Y. T., Bonk, C. J., & Kim, K. J. (2009). The trend
of blended learning in Taiwan: Perceptions of HRD
practitioners and implications for emerging competen-
cies. Human Resource Development International, 12(1),
69–84. doi:10.1080/13678860802638842
Thrash, A. M., & Thrash, C. L. (1982). Nutrition for
vegetarians. Seale, AL: NewLifestyle Books.
Tidy, C. (2010). Interstitial cystitis. Patient.co.uk. Re-
trieved from http://www.patient.co.uk/doctor/interstitial-
cystitis
Tindle, H. (2013). Up: How positive outlook can transform
our health and aging. New York, NY: Hudson Street Press.
Trouillot, M. R. (1995). Silencing the past. Boston, MA:
Beacon Press.
U.S. Department of Health and Human Services. (2000).
Healthy people 2010: General data issues. Retrieved from
http://www.cdc.gov/nchs/healthy_people.htm
300
Compilation of References
U.S. Department of Health and Human Services. (2013).
Healthy people 2020 topics and objectives: Social deter-
minants of health. Washington, DC: U.S. Government.
Retrieved from http://www.healthypeople.gov/2020/
topicsobjectives2020/overview.aspx?topicid=39
Ulysse, G. (2010). Why representations of Haiti matter
now more than ever. NACLA Report on the Americas,
43(4), 37.
Vygotsky, L. (1978). Mind in society. Cambridge, MA:
Harvard University Press.
Wanner, E.T., & Bird, J.L. (2013). The Wanner Bird
healing survey for pain recovery. Original work copy-
righted by the authors.
Warburton, S. (2009). Second Life in higher education:
Assessing the potential for and the barriers to deploy-
ing virtual worlds in learning and teaching. British
Journal of Educational Technology, 40(3), 414–426.
doi:10.1111/j.1467-8535.2009.00952.x
Warren, D. (2001). There you’ll be [Recorded by Faith
Hill]. On Pearl Harbor [CD]. Burbank, CA: Hollywood
Records/Warner Brothers.
Warren, R. (2012). The purpose driven life: What on
Earth am I here for? Grand Rapids, MI: Zondervan.
Waters, A. J., & Asbill, L. (2013). Reflection on cultural
humility: Children, youth and families news. Ameri-
can Psychological Association. Retrieved from http://
www.apa.org/pi/families/resources/newsletter/2013/08/
cultural-humility.aspx
Web M. D. (2013). Retrieved from http://www.webmd.
com
Weil, A. (2000). Spontaneous healing: How to discover
and enhance your body’s natural ability to maintain and
heal itself. New York, NY: Ballentine.
Weir, P. (Director). (1989). Dead poets society [motion
picture]. United States: Touchstone Pictures.
Compilation of References
Weiss, B. D., Blanchard, J. S., McGee, D. L., Hart,
G., Warren, B., Burgoon, M., & Smith, K. J. (1994).
Illiteracy among Medicaid recipients and its relation-
ship to health care costs. Journal of Health Care for
the Poor and Underserved, 5(2), 99–111. doi:10.1353/
hpu.2010.0272 PMID:8043732
Wentling, T., Waight, C., Gallaher, J., La Fleur, J.,
Wang, C., & Kanfer, A. (2000). E-learning: A review
of literature 2000. Retrieved from http://learning.ncsa.
uiuc.edu/papers/elearnlit.pdf_
Wharton, E. (1920). The age of innocence. New York,
NY: Collier.
Whitman, W. (1993). O me! O life! In Leaves of grass
(p. 341). New York, NY: Random House. (Original
work published 1855)
Williams, M. V., Davis, T., Parker, R., & Weiss, B.
(2002). The role of health literacy in patient-physician
communication. Family Medicine, 34(5), 383–389.
PubMed PMID:12038721
Williams, M., Baker, D., Honig, E., Lee, T., & Nowlan,
A. (1998). Inadequate literacy is a barrier to asthma
knowledge and self-care. CHEST: The Cardiopulmo-
nary and Critical Care Journal, 114(4), 1008–1015.
doi:10.1378/chest.114.4.1008 PMID:9792569
Williams, M., Baker, D., Parker, R., & Nurss, J.
(1998). Relationship of functional health literacy to
patient’s knowledge of their chronic disease. Archives
of Internal Medicine, 158(2), 166–172. doi:10.1001/
archinte.158.2.166 PMID:9448555
Williams, M., Parker, R., Baker, D., Parikh, N., Pitkin,
K., Coates, W., & Nurss, J. (1995). Inadequate functional
health literacy among patients at two public hospitals.
Journal of the American Medical Association, 274(21),
1677–1682. doi:10.1001/jama.1995.03530210031026
PMID:7474271
Williams, N. R. (2003). Occupational groups at risk of
voice disorders: A review of the literature. Occupational
Medicine, 53(7), 456–460. doi:10.1093/occmed/kqg113
PMID:14581643
Wilson, F., & McLemore, F. (1997). Patient literacy
levels and discharge education. Rehabilitation Nursing,
22(6), 311–317. doi:10.1002/j.2048-7940.1997.tb02124.x
PMID:9416192
Wired. (2010). The web is dead: Long live the internet. Re-
trieved from http://www.wired.com/magazine/2010/08/
ff_webrip/all/1
World Health Organization. (2011). Transformative
scale up of professional health education: An effort
to increase the number of health professional and to
strengthen their impact on population health. Retrieved
from http://whqlibdoc.who.int/hq/2011/WHO_HSS_
HRH_HEP2011.01_eng.pdf
World Health Organization. (2014). Health topics: Health
education. Retrieved from http://www.who.int/topics/
health_education/en/
World Health Organization. (2014). The atlas of heart
disease and stroke. Retrieved from http://www.who.int/
cardiovascular_diseases/resources/atlas/en/
Wright, K. B. (2005). Researching internet-based popu-
lations: Advantages and disadvantages of online survey
research, online questionnaire authorizing software
packages, and web survey services. Journal of Computer-
Mediated Communication, 10(3), 1–19.
Zéphir, F. (2004). The Haitian Americans. Westport, CT:
Greenwood Press.
Zimmermann, S. (2002). Writing to heal the soul. New
York, NY: Three Rivers Press.
Zinn, H. (1970). The politics of history. Boston, MA:
Beacon Press.
Zolli, A., & Healy, A. M. (2012). Resilience: Why things
bounce back. New York, NY: Free Press.
301
302

About the Contributors

Jennifer Bird, PhD, teaches reading and writing classes for current and future teachers at Florida
Atlantic University in Jupiter, Florida. She received her Bachelor of Science in Education in Secondary
English Education, Master of Education in Secondary English Education, and Doctor of Philosophy
degrees from Miami University in Oxford, Ohio. She is choosing not to add more to this biography
because if you have read this entire book, you already know her life story!

***

Christine Bandy-Helderman, MS, RD, LD/N, received her MS from the University of Florida. She
is a registered, licensed dietitian/nutritionist and a nutrition therapist. Chris is also an Assistant Minister
at Jupiter First Church and is currently attending Lexington Theological Seminary in the MDiv Program
to become an Ordained Minister. She is a gifted speaker and counselor who loves spending time with
her husband and two children.

Mo Baptiste is a Haitian-American originally from Miami, FL currently living in Chattanooga, TN.

He currently serves as the Director of Educational Affairs for the Haitian American Caucus. He has
taught collegiate classes such as “Education and Society,” “Youth Culture, Resistance and Education,”
“Social and Cultural Foundations in Education,” and “The Mis-Education of Haiti.” Dr. Baptiste’s research
agenda explores how traditional leadership and organizational theories have been conceptualized and the
intricate ways they are used to maintain systems of domination. He has constructed a leadership theory
that he has coined “Leadership from the Margins Theory” which assumes social conflict theory rather
than systems theory, and he has identified characteristics that make up these marginalized leaders. As
a proud member of Alpha Phi Alpha Fraternity Inc., Dr. Baptiste continues to work with the citizens of
Haiti by addressing issues of community organizing and teacher education development. Dr. Baptiste
received an A.A at Kemper Military Academy, B.A (Communications) and M.S (Business Education)
from Robert Morris University, and a Ph.D. from Miami University in Education Leadership.

Casey M. Brown, Department of World Languages, is currently teaching French at Centerville High
School. She also acts as the advisor to the school’s Key Club organization which organizes community
service events for the club’s 200+ members. Casey is a certified teacher of both French and English.
She earned her B.S. in French Education from Miami University and her Masters degree in Education
from Indiana Wesleyan University.



About the Contributors

Susannah Brown is currently an Associate Professor of Art Education at Florida Atlantic University.
She has been inspiring creativity throughout her twenty-four years of teaching in grades Kindergarten
through twelve and at the university level with undergraduate and graduate students completing teacher
certification degrees. Primarily a watercolor artist, she also loves to sculpt with clay. Recently, she has
been training with premier book artists through the Jaffe Center of Book Arts to learn traditional printing
and binding methods. Sharing her passion for the arts drives her teaching and personal work.

Kristin Brittain, M.Ed., is a doctoral candidate at Florida Atlantic University in the Educational
Leadership and Research Methodology department’s Adult and Community Education program. Her
research interests include health and chronic illnesses, self-directed learning, and utilizing adult learn-
ing strategies for health management. Additionally, Kristin is a graduate research assistant for FAU’s
Educational Leadership and Research Methodology Department and a Program Director for FAU’s
Chinese Leadership Academy. Recently, Kristin has published book chapters in other IGI publications,
presented at the local, national, and international level.

Valerie C. Bryan is a Charles Stewart Mott Eminent Scholar, Professor in Educational Leadership &
Research Methodology, & Program Coordinator for Adult and Community Education at Florida Atlantic
University. She has been recognized with awards for distinguished teaching at all levels; leadership at lo-
cal, state, national levels, international levels; distinguished service for local communities, state/national
organizations, and three universities; student mentoring at three institutions; excellence in presenta-
tions, web design, virtual learning communities, online course design by international organization and
national organizations.She has published 50 international, national, and state refereed journal articles;
two books; 25 book chapters; 75 refereed conference presentations; over 200 conference presentations;
training manuals; and over 70 Blackboard courses/webinars. She has also chaired over 70 disserta-
tions and served as Director of Grants in the millions. She has recently received approval for a Chinese
Leadership Academy, an executive leadership program housed in Florida. She served as a consultant
for executive search firms; chambers of commerce; municipal recreation and parks departments; state
park systems; fitness coalitions; restaurant chains; municipal/state human resource departments; library
system; nonprofit agencies for the aged and varied disabilities; religious boards; elementary, secondary
schools, colleges/university continuing education. She created the Governor’s Outdoors Event in NC,
coordinated the Mountain-to-the-Sea Trail and was recognized by Department of Transportation with a
state award. She has served on strategic planning initiatives in four states.

Elizabeth Caparros, L.C.S.W.. prior to moving to Florida in 1985, was the Administrative Director
of a facility in New Jersey for many years, supervising the psychotherapists on staff and administrating
to the daily needs of the business. She was also the Logistics Coordinator and Lecturer of a 48-hour
seminar entitled “The Experience.” Upon moving to Florida, she opened The Odyssey Foundation, Inc.,
where she lectures and conducts seminars on the advantages of psycho-spiritual healing. Elizabeth is
also a Certified Qualified Supervisor for Registered Interns preparing for their licensure as a clinical
psychotherapist.Elizabeth is a licensed Clinical Psychotherapist. She earned her Master’s Degree in
Social Work in 1987 from Barry University. Her post-graduate studies have been in the discipline of
Psychology and Religion. She is in the final stage of her book, Beyond The Looking Glass: A Spiritual
Journey. Her dedication to psychological healing with a spiritual approach is the premise of her book.

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 About the Contributors

Roma Chauhan is an Assistant Professor in the Department of Information Technology at IILM

Graduate School of Management, Greater Noida, India. Prior to her academic career, Chauhan acquired
a comprehensive work experience with IT corporate giants as a Software Developer and Consultant. She
is active in professional service, serving conference program committees, organizing workshops and
industry engagements. She is an Indian national who is amicable to international culture and practices.
She is an innovative self-starter who enjoys learning new things from diverse cultural and social settings.

John F. Evans, MAT, MA, Ed.D, is a Writing Clinician and Certified Integrative Health Coach who
works with both groups and individuals, teaching them how to use writing for better physical, emotional,
and spiritual health. He primarily works with health care professionals, including physicians, nurses,
therapists, counselors, psychologists, social workers, educators, personal coaches, and alternative health
care practitioners. Evans is the founder and Executive Director of Wellness & Writing Connections,
LLC and provides individual, group, and institutional life course guidance programs. With James Pen-
nebaker, Evans co-authored Expressive Writing: Words that Heal (2014). His book, Wellness & Writing
Connections: Writing for Better Physical, Mental, and Spiritual Health (2010), is a collection of essays
from the Wellness & Writing Connections Conference Series.

Shewanee Howard-Baptiste is currently an Assistant Professor at The University of Tennessee

at Chattanooga in the Department of Health and Human Performance. She teaches courses related to
Health Promotion, Health Behavior Change, Community and Environmental Health, Worksite Health
Promotion, and the Sociology of Sport. She has also taught and studied abroad in Denmark, Switzerland,
France, the Dominican Republic, and Haiti. Dr. Howard-Baptiste has been teaching at the secondary
and collegiate level for over twelve years. She is currently President of the Ithaca Alumnae Chapter of
Delta Sigma Theta Sorority, Incorporated, an international service organization founded in 1913. Her
research interests examine the Black female faculty experience teaching in the Black female body. She
received her B.S. in Exercise Science, M.S. in Health Appraisal and Enhancement, and Doctorate in
Educational Leadership from Miami University.

Irene H. Johnson is a Professor and former Chair of Counselor Education at Florida Atlantic Uni-
versity, Boca Raton, Florida. Johnson received her B.S degree in Biological Science from Hampton
University (Virginia). She completed her M.S. in Counseling (with an emphasis in College Student
Personnel) and her PhD in Counselor Education through Purdue University, West Lafayette, IN. Since
then, she has taught at Southern Illinois University, Carbondale, IL, Northern Illinois University, Dekalb,
and Jackson State University (Mississippi). She has served in administration for 18 years. She is the
former Dean of the Graduate School at Alcorn State University (Mississippi) and Board Member of the
Council of Graduate Schools, Washington, D.C. Johnson has published in Multicultural Counseling and
Minority Student Retention in STEM Postsecondary Education, including the resource book “Leveling
the Playing Field: Promoting academic success for students of color (Jossey-Bass).” Johnson’s interests
include multicultural counseling, stress management, minority student retention in STEM postsecondary
education, and spirituality in counseling. In her spare time she enjoys gardening and music.

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About the Contributors

Karen Jooste is a pediatrician, teacher, coach, and workshop leader. She completed her Pediatric
Residency Training at The Children’s Hospital of New York (Columbia Presbyterian Medical Center)
and is a Fellow of the American Academy of Pediatrics. She received her Master of Public Health
degree from the Mailman School of Public Health (Columbia University) and completed her Integra-
tive Health Coach Professional Training Program at Duke Integrative Medicine. She teaches medical
students in the Practice Course (Clinical Skills and Medical Humanities) at Duke University’s School
of Medicine and practices as a pediatrician at Duke Pediatrics Primary Care. Born and raised in South
Africa, she became intrigued by the resilience of the human spirit while growing up during Apartheid.
She is the founder of Storia International PLLC, an organization designed to facilitate vibrant wellness
and resilience. Through Storia International, she fuses her passions for medicine and writing, utlizing
workshops rooted in both narrative and integrative medicine.

Donna Karaba, MA is the President of Karaba Consulting, an executive coaching firm in Santa Fe,
New Mexico that develops and encourages authentic transformational leaders. Karaba coaches CEOs and
senior level leaders of large companies, combining her Fortune 500 experience with a personal desire to
help others maximize their full potential. Applying her teachings to a business environment, Karaba’s
clients have expanded their influence while inspiring others. Their care and compassion is evolving our
business world, generating a powerful ripple effect.

Tammy Metcalf, M.Ed., M.S.E. has been an educator for almost twenty years in both public and
private schools. In addition to her day job as an English teacher, Tammy also serves as an Adjunct Instruc-
tor in a Career Technical Education Licensure and Graduate Program at Wright State University. In her
free time she enjoys spending time with her husband—JB--and her dog—Sophie--reading, napping, and
visiting the spa. She is eternally grateful for her friends, family, and mentors, who continually provide
her with strength, opportunities, and wisdom. She also supports the Oxford Comma.

Marnie Shaw Reed (née Puritz) was born in Brooklyn, NY, in 1967. A series of adventures took her
and her son through several states before they set permanent roots down on the Treasure Coast area of
South Florida. When her son began school, Reed quickly became frustrated with the education system’s
inability to adapt to his unique learning style, feeling teachers and administrators wanted him to fit into
a mainstream education-shaped box. She went back to college in an effort to change what she viewed
as a broken system and received her Bachelor’s Degree in Education from Florida Atlantic University.
Marnie Reed currently works in the migrant town of Indiantown, FL, a large bilingual community that is
frequently mired in poverty. She taught for several years within the town’s only elementary school before
moving to the middle school in 2013. She is extremely passionate about differentiating her instruction
to ensure that each child has the opportunity to learn. She and her husband, Russ, continue to find the
beauty in each day and surrender to a new adventure whenever possible.

Robin Perry graduated from Florida Atlantic University and teaches second grade at Rolling Green
Elementary in Boynton Beach, FL. She is completing her internship as a Behavioral Analyst for children.
She is also passionate about helping the Big Dog Ranch Rescue find forever homes for dogs since her
dog, Hurley, prefers to be her only pet.

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 About the Contributors

Elizabeth Swann earned a Doctor of Philosophy degree in Adult and Community Education from
Florida Atlantic University in 2014. She wrote her dissertation on “Adult Learning for Healthy Aging:
An Investigation of Health Literacy and Technology Use in Older Adults.” An associate editor of the
International Journal of Self-Directed Learning, Dr. Swann is also active in the community, working as
a grants writer and reviewer for the Whole Child of Indian River. Her current scholarly interests include
health literacy, self-directed learning, and aging studies.

Ryan Urenda, DPT, is a Physical Therapist at D1 Sports Medicine in Jupiter, Florida. He received
his Bachelor of Health Science degree from the University of Florida and his Doctor of Physical Therapy
from the University of North Florida.

Eric Wanner, DPT, is the Physical Therapy Director at Palm Beach Sports Medicine & Orthopaedic
Center in West Palm Beach, Florida. He received his Bachelor of Science in Exercise Science degree
from The Ohio State University in Columbus, Ohio and his Doctor of Physical Therapy from The Uni-
versity of Dayton in Dayton, Ohio.

Liz Wrocklage-Gonda, M.Ed., has survived being an educator for twenty-two years in the public
school system and has worked in both traditional and alternative education programs. She has also been
a high school track coach for almost twenty years because she can’t quite get enough of watching teen-
agers working hard and being awesome. She has used her journey with fibromyalgia to educate others
in a variety of settings, ranging from staff professional development sessions to seminars for pre and
post-service student teachers. When not in the classroom or out on the track, she can be found laughing
hysterically with her daughter at their own ridiculousness, re-reading her favorite books or discovering
new ones, running/walking, and dreaming about living on a lake in Michigan. She tries to give thanks
numerous times a day for all the blessings she has received from her friends, family, her cats, and perfect
strangers.

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Index
A E
Adult Learning 60, 76
Affirmative Writing 25, 28, 30-31
Allopathy 173
Allostatic Load 80, 85-87, 96
Anti-Depressant 46-47, 80
Anxiety 32-33, 35, 37-38, 40, 42-43, 46-47, 49-50,
53, 55, 79-81, 83, 89, 136, 142, 182, 185, 187,
194, 196-197, 206-207, 210, 212-213, 228-230
Artistic and Technical Writing 231
Artistic Design Journals 97, 100, 103, 105-106
Ayati (Haiti) 139
Ayurveda 173
B
Bibliotherapy 15, 22
Book Challenge 79, 83-84, 96
Burnout 48, 51, 57-58, 89
Bursa 171, 173-174
C H
Chiropractic 160, 166, 170, 173, 175-176
Chronic Illness 61, 63, 68, 70, 76-77
Cognitive Behavioral Therapy 42, 47, 192
college students 2, 219, 226, 228-230
Community of Practice 68-69, 72, 76-77
Craniosacral Therapy 160, 166, 174
Creativity 1-2, 98, 100, 103, 105-106
Critical Self-Reflection 135-137, 139
Cultural Humility 135, 139
Culturally Appropriate First Aid Kits 130-132, 139
D I
Dialectic Behavioral Therapy (DBT) 192
307
Eastern Medicine 113, 119
E-Learning 2.0 140, 142-143, 151, 153
Emotional Freedom Technique (EFT) 165, 174
Emotional Hunger 217
Existential Psychotherapy 192
Expressive Writing 25-27, 30-31
Eye Movement Desensitization and Reprocessing
(EMDR) 192
F
Fear 32, 35, 42, 46-47, 53, 125, 182, 186, 189-190,
192, 194, 198, 226
G
Gestalt Therapy 192
Godwink 11, 22, 218-219, 227, 229, 231
Grounded 81, 96
Health Cloud 150, 153
Health Education 60, 65, 76, 120, 130-131, 135-137
Health Information 60-61, 63, 65, 76-77, 135, 150
Health Literacy 61-64, 70, 77
Health Management 60-63, 65, 68, 77
Higher Education 48-49, 56
high school 3, 11, 16, 38, 42, 84, 92-93, 122, 127,
159, 207
Homeopathy 173-174
Humanistic Psychotherapy 192
Inoperable 111, 119
Integrative Health Coach 23
Integrative Medicine 7-8, 12, 23-24, 226
Interstitial Cystitis 157, 174
 Index

L S
leadership development 49, 57 Self-Directed Learning 60, 63, 65-68, 70-72, 77,
Legacy Writing 25, 29-31 142
Lupus 65-66, 68, 71-72, 77, 172 Self-Discovery 97-100, 102-103, 105-106
Self-Talk 59
M Serotonin 38, 47
Shiva 114, 119
Meditation 55, 58, 105, 155, 159, 161, 169-170, Spirituality 3, 8, 16, 119, 183, 218-219, 231
174-176 SSRI 47
Metastasis 119 Stakeholders 137, 139
Miami University 78, 120, 128, 222, 226 Story-Truth and Happening-Truth 23
Migraines 6, 8-10, 12, 23, 89, 93 Stress Management 12, 48, 79, 99, 106, 229-230
Mindfulness 24-25, 31 Stressor 53, 59, 105
Multigenre Healing Project 231 Synergistic Collaboration 231
Multigenre Writing 1, 3-4, 23, 225, 229, 231 Systemic Psychotherapy 192
N T
Narrative Inquiry 3-5, 18, 23 Thinking Like a Turtle 11, 23, 225, 231
Narrative Medicine 231 Transactional Writing 25, 27, 30-31
Naturopathic Medicine 119, 163, 174 True North 155, 165-172, 175-177
Naturopathy 174
Neck Pain Journal 8, 10, 226, 228, 231 V
O Vegetarian 164, 167-168, 174, 223
Virtual Community 65-66, 68-69, 72, 77, 142, 154
Object Relations Psychotherapy 192 Virtual Learning Environment 140, 148, 151, 153
Visual Imagery 55, 59
P Vocal Cord Dysfunction 80, 96
Palliative Care 110, 119
Pancreatic Cancer 107-111, 116, 119 W
Panic Attack 47, 213-214 Wanner-Bird Healing Survey for Pain Recovery 23,
Person Oriented 192 231
Physical Hunger 217 Web 2.0 140-142, 151, 153-154
physical therapy 1-2, 8-15, 18, 23, 85, 160-161, 176, Webcast 142-148, 154
219, 223, 225-229 Wellness Management 60, 63, 77
Physical Therapy Interview 23 Western Medicine 113, 119
Poetic Writing 25, 28, 30-31 Whole Foods 164, 169, 171, 175, 177, 194, 217
Polymyalgia Rheumatica (PMR) 155, 174 Wiggles 194, 217
Processed Foods 217 Writing Voice 2, 12, 23, 226-229, 231
Progressive Muscle Relaxation (PMR) 54, 58
Psychoanalysis 182, 192 Y
Psychodynamic 192
Yoga 155, 159, 161, 174, 177
R
Rational Emotive Behavioral Therapy 192
Registered Licensed Dietitian 217
Rolfing 174-175, 177-178

308