Deeksha Puri
Language is a faculty inexplicably essential to human life, the contours of which are moulded by poetry. In evoking language in such a way, poetry uses metaphors, rhymes and imagery as an avenue for self-expression, and is often heralded as a form of ‘healing’. To investigate this perspective’s validity, it is imperative to explore poetry’s intersection with linguistic neuroscience, and to raise a poignant question—can the abstractions of poetry have concrete neuro-clinical implications? Keeping this in mind, this blog post aims to first elucidate the mechanisms of language processing in the brain, and how these mechanisms can become compromised in the case of schizophrenia, particularly manifesting as semantic processing deficits. It then focuses on the metaphor processing mechanisms underlying poetry therapy and their alleviation of these symptoms.
Building on this, it is pertinent to first understand how language is processed in the brain. Linguistic processing is primarily organized in the left hemisphere, specifically concentrated in the Broca’s area and Wernicke’s area (Barker et al., 2012). Broca’s area, in the left Frontal lobe, is essential to language production, whereas Wernicke’s area, in the left Temporal lobe, is involved in grammar processing (Barker et al., 2012). Individuals with damage to Broca’s area tend to have difficulties in producing spontaneous speech (Nishitani et al., 2005). Additionally, damage to Wernicke’s area causes deficits in comprehending words (Saffran, 2002), suggesting that the integrity of both areas is crucial to the understanding and production of language. Hence, this draws a fundamental picture of the main brain structures contributing to language processing.
From this, one can piece together the organization of the brain’s linguistic pathways, and how a compromise in the same can manifest as language-related deficits in psychopathological contexts. This is further exemplified by occluded linguistic processing in the case of schizophrenia. Research suggests individuals with schizophrenia tend to have less-intact structural integrity in the white matter tracts in their linguistic pathways, and also a lower Broca’s area volume (De Boer et al., 2020; Fillman et al., 2016). Disconnectivity between Wernicke’s and Broca’s areas has also been implicated in auditory-verbal hallucinations, and erroneous emotional-speech comprehension (Blake et al., 2013). Hence, this articulates how marked structural changes in the brain can contribute to language processing difficulties.
Linguistic processing impairments in schizophrenia foremostly include deficits such as those in lower acoustic and phonetic levels, as well as functionally relevant higher semantic and syntactic levels (Meyer et al., 2021). One such prominent deficit is the loosening of semantic associations, referring to significant difficulties in processing meanings and concepts (Meyer et al., 2021; Tonelli, 2014). Schizophrenia patients also tend to show weaker functional connectivity in the language network comprising the left Inferior Frontal Gyrus (IFG) and the left Superior Temporal Sulcus/Middle Temporal Gyrus (Jeong et al., 2009). Out of these, the IFG is responsible for semantic processing, and processing difficult metaphors (Shafi, 2010). The IFG is also linked to “concretism”, a symptom of schizophrenia demonstrating an inability to understand non-literal language (Shafi, 2010). This implicates the IFG specifically in difficulties pertaining to semantic processing in individuals with schizophrenia.
Therefore, two questions arise—can strengthening connections in the IFG allow for a greater semantic processing capacity in individuals with schizophrenia? If yes, then how can these connections be strengthened in a therapeutic setting? This is precisely where poetry therapy can be beneficial, especially alongside psychotherapy. Shafi (2010), while reviewing the neuro-clinical implications of poetry therapy, defines it as a “clinical tool that incorporates poem writing in order to facilitate psychological awareness, creativity and personal meaning.” This elucidates that poetry therapy allows for self-expression and meaning-making. The model of poetry therapy used most widely in research and clinical settings is called the RES model, which focuses on the receptive, expressive and symbolic aspects of poetry (Alfrey et al., 2021). In this, the practitioner introduces poetry into the session (receptive), post which clients write their response (expressive), and lastly, the practitioner evokes emergent metaphors (symbolic) (Alfrey et al., 2021). Thus, the emphasis on the symbolic centralizes evoking metaphors within the therapeutic setting.
This focus on metaphor processing and creation can then significantly aid patients with schizophrenia, who show deficits in the processing of figurative language due to concretism. Mashal et al. (2013), using functional Magnetic Resonance Imaging (fMRI) data present that when provided with novel metaphors, patients with schizophrenia tend to show an over-activation of the left IFG and the Middle Frontal Gyrus (MFG). Poetry therapy’s emphasis on the patients’ discussion and creation of metaphors, can therefore, allow for the activation of the left IFG, leading to increased functional connectivity over time. Since the IFG is also responsible for other types of semantic processing, it can help alleviate communication-related symptoms particularly around the use of other types of figurative language.
In addition to these neural implications, Shafi (2010) also maintains that poetry therapy helps patients create a “cognitive landscape” for the clinician in the therapeutic context. This allows the clinician to gain a greater insight into the client’s symptoms, and then map out effective means of treatment. Poetry therapy has also been shown to increase feelings of safety, self-expression and can aid social interaction in clinical settings, making it an integral area of study, particularly with schizophrenia (Maanmieli & Ihanus, 2021).
Therefore, poetry therapy can be effective alongside psychotherapy, aiding the alleviation of language processing deficits particularly in schizophrenia. It can accomplish this by evoking metaphor processing, which leads to the activation and strengthening of the left IFG, the weakened connectivity of which is implicated in concretism. That being said, it is also imperative to note that there still exists a relative dearth of literature investigating the neurophysiological implications of poetry therapy, which remain to be addressed by the scientific community, prompting further inquiry. If more evidence supports its efficacy, it can be extended to the treatment of other pathologies exhibiting language-related deficits such as Aphasia, Dementia as well as Alzheimer’s disease. Henceforth, the claim that poetry has a ‘healing’ power, may have some merit to it, after all.
References
Alfrey, A., Field, V., Xenophontes, I., Holttum, S. (2021). Identifying The Mechanisms Of Poetry Therapy And Associated Effects On Participants: A Synthesised Review Of Empirical Literature. The Arts in Psychotherapy, 75, 1-13. doi: 10.1016/j.aip.2021.101832.
Barker, R.A., Cicchetti, F. & Neal, M.J. (2012). Neuroanatomy and Neuroscience at a Glance (4th ed.). Wiley-Blackwell.
Blake, B.C., Liemburg, E., Vercammen, A., Swart, M., Knegtering, H., Bruggeman, R. & Aleman, A. (2013). When Broca Goes Uninformed: Reduced Information Flow to Broca’s Area in Schizophrenia Patients With Auditory Hallucinations. Schizophrenia Bulletin, 39(5), 1087-1095. doi: 10.1093/schbul/sbs107.
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Maanmieli, K. & Ihanus, J. (2021). Therapeutic Metaphors And Personal Meanings In Group Poetry Therapy For People With Schizophrenia. Journal of Poetry Therapy, 34(4), 213-222. doi: 10.1080/08893675.2021.1951900.
Mashal, N., Vishne, T., Laor, N., Titone, D. (2013). Enhanced Left Frontal Involvement During Novel Metaphor Comprehension In Schizophrenia: Evidence From Functional Neuroimaging. Brain and Language, 124(1), 66-74. doi: 10.1016/j.bandl.2012.11.012.
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Nishitani, N., Schürmann, M., Amunts, K. & Hari, R. (2005). Broca’s Region: From Action to Language. Physiology, 20, 60-69. doi: 10.1152/physiol.00043.2004.
Saffran, E.M. (2002). Wernicke’s Area. In V.S. Ramachandran (Ed.), Encyclopedia of the Human Brain (pp. 805-818). Academic Press. doi: 10.1016/B0-12-227210-2/00369-1.
Shafi, N. (2010). Poetry Therapy And Schizophrenia: Clinical And Neurological Perspectives. Journal of Poetry Therapy, 23(2), 87-99. doi: 10.1080/08893675.2010.482811.
Tonelli, H.A., (2014). How Semantic Deficits In Schizotypy Help Understand Language And Thought Disorders In Schizophrenia: A Systematic And Integrative Review. Trends in Psychiatry and Psychotherapy, 36(2), 75-88. doi: 10.1590/2237-6089-2013-0053.
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