When you have a conversation with someone, it is always a roll of the dice. You could find yourself intrigued or bored, cheered or sobered, distracted or reflective. Or you could walk away feeling absolutely unchanged – the least desirable, in my opinion. On the afternoon of my interview with Dr. Allison Crawford, I entered her office with the desire to write a good column, but even more so, I wanted to leave the room with some new colours on my palette. The next hour or so was not only a delight, but a chance to discover the incredible personality and creative spirit that Dr. Crawford channels in every aspect of her life. Truly inspiring.
This is not my first time meeting Dr. Crawford: I have had the great privilege of participating in her IPE elective, Visualizing the Body at the Art Gallery of Ontario. I was already inspired by the sheer creativity required to design a program that innovative. I have a hunch that this small glimpse into Dr. Crawford’s mind was just the tip of the iceberg.
Shara Nauth: I guess I’ll start by with why I’m here! ArtBeat is a health interprofessional student-run blog whose main goal is to facilitate engagement with the humanities. I organize a column that reaches out to faculty, which gives our readers the opportunity to learn about what kinds of opportunities and stories are out there, and might inspire them to continue pursuing uniting the arts with their health education. I would love to hear your story – of what you do, and how you headed down this path.
Dr. Allison Crawford: That’s a very relevant point. One of the challenges we all face when we bring the humanities into our work is that we need space for reflection. And no one is going to protect your time for reflection, so it has to be important enough, and you have to honour it. That’s the space that gets squeezed out first when I’m busy with the administrative side of my role, and then I go from activity to activity, not really thinking about integrating. And that depletes your satisfaction with work and… well, it can make you feel a bit like an automaton, doesn’t it?
SN: (laughs) That’s a great way to put it.
AC: I mean, over the years I’ve developed ways to weave reflection through my day, even though I don’t have time to sit and meditate. But it’s not often you get to sit down and reflect on how you got to where you are, and what the key events were.
As for who I am – well, I am a psychiatrist at the Centre for Addictions and Mental Health, and I direct the Northern Psychiatric Outreach Program and Telepsychiatry. We do work in Northern Ontario and Nunavut. It is centred around increasing access to health care, and I am also very interested in culturally-specific health care to First Nations and Inuit communities; how we can create equitable access to healthcare, and make it more culturally relevant.
SN: And you recently came back from Nunavut, right?
AC: Yes, I travel a lot to Nunavut – I lived there as well, from 2009-2011. Living there made me feel very connected to the culture, and my two children are adopted from Nunavut as well.
SN: Wow, that’s incredible.
AC: In addition to doing clinical work in the North, I’m also involved in policy; for example, I am involved in developing the National Inuit Suicide Prevention Strategy. A lot of my work focuses on cultural adaptation of psychological interventions for psychological trauma, and that is actually a very practical way of bring arts and humanities into psychiatry. Many peoples and cultures don’t necessarily create a separation between the ‘treatment of health’ and ‘mental health’ and other things that are important to them, especially in Nunavut, where family, community and engaging with the land is very important. So if we came in with a treatment that didn’t address what is important to them, it would never succeed. Instead, we’ve adapted our treatment to use cognitive behavioural therapy, which uses narrative and arts. I work especially with Inuit men who were victims of sexual abuse as children. and also with cultural mentors to create on-the-land treatments.
SN: Incredible. To us, that seems like an unconventional way to solve the problem, but I almost think that to them it might be the inherent way to solve the problem.
AC: That’s correct and in fact, its also a part of their culture that they were cut off from. So it feels natural, but it also feels like an opportunity to re-engage rather than doing a mandated treatment. The narrative work is quite new; we use it explicitly in treatment context, but also to create an environment that respects spirituality, artistic relationship to the land, hunting, and so many relationships rather than focusing on the biomedical. We use Inuit narrative forms and storytelling, so it has cultural roots when we introduce it to them. I will say that if I didn’t have a background in humanities, I don’t know that I would have wanted to pursue these approaches in the same way.
SN: Yes, let’s talk about your education and how you ended up in medicine – it’s a pretty amazing path! You did an undergraduate degree in English, then did medical school at McMaster and somehow managed to do a Masters in English Literature and are now a PhD Candidate in the Department of English as well. Not your typical science student!
AC: (laughs knowingly) That was a very interesting and honestly, a very difficult decision. I did a double major in English and Psychology, but it was neuropsychology – you know, with the little rat pups and everything. I loved both and was finding it impossible to decide what to do. I did a year of research at SickKids to decide whether I was interested in that, but I wasn’t sure I wanted to be a teacher. But I still just loved English and psychology so much.
I had a really wonderful mentor who I talked to about this dilemma, and she said, ‘You know, maybe there is a way you can do both together’. And I thought of psychiatry. But I do sometimes wonder if that was the best move. Afterwards, all through medical school I found myself looking back down the path and wondering if it was the right decision.
SN: Did it feel like part of you was missing while in medical school?
AC: Yes, exactly. In undergrad, I had my balance there. I would grow my little rat pups up into adult rats, and then I would slice them open and put them on slides and take a look (laughs). And then I would go and read TS Eliot, and would feel like both parts of me were being engaged. So in medical school, I did question things. And it was not until my second year of residency when I ended up doing my masters that I breathed a sigh of relief and thought, ‘aaah, I’m back’.
SN: And you felt complete again.
AC: But individually. I felt a bit isolated, as though I did not have a community. Of course there were like-minded people but you would bump into them randomly, there wasn’t a group. So I felt like part of two very separate communities. I was very lucky to be at Mount Sinai, where you had people like Dr. Ruskin and Dr. Peterkin who fostered that community. But I did find it challenging to juggle, even the fields of study themselves. On one hand, I would need to be using core literary theory which is highly specific, but I wanted to view things from a more broad lens and make different connections. My PhD supervisor once told me that I’m actually a sociologist (laughs). And the same way, in medicine they encourage you to ‘pick one clinical focus’ and I thought ‘hmm, well I have three’.
SN: It must be challenging even now to incorporate it all into one career.
AC: Absolutely. Although you have people like Dr. Peterkin who have created a large core of their career from the medical humanities, the rest of us are trying to do it on the side. It just isn’t viewed as having the same weight as say, transcranial magnetic stimulation is.
SN: Do you have any particular strategies or approaches for dealing with the challenges your faced?
AC: I have learned the real importance of team. Team thinking, and having that community. Your teams fill in those blanks, take care of the parts you can’t, and each person views it in their own way.
SN: Definitely. What about individually – do you do anything to help you get inspired, to help you work through, around, over the problem?
AC: I’m a highly curious person – I love to learn, to make connections and create models in my mind to connect and explain things, or to find different lenses and shift perspectives. That’s how the most interesting projects start. When I was in Nunavut, I really wanted to understand the role of psychological trauma in the Inuit culture. And I thought, what better way to understand than through their art? So I went to the print press for days, and I interviewed the artists, and eventually I wrote a paper about it. It was just an amazing way to engage and understand that topic. I find links between everything, and it’s almost overwhelming, there are too many to ever complete.
I do think that inspiration is so important. In fact, I did very poorly in high school – they threatened not to pass me in grade 12 because I hadn’t attended enough classes! I just wasn’t engaged. It wasn’t until university that I really found my stride, because I found topics that inspired me and things I really wanted to learn about.
SN: Is there a project you’re working on right now that you’re most excited about?
AC: I recently reconnected with my own art and writing. I create digital narratives. I use a bit of poetry and prose, images that I make or find and manipulate, music, elements of interactivity… all sorts of artistic elements. It is incredibly revitalizing to have that creative space. When I’m there, I feel more access to humanity, to the universe. It is almost spiritual, and it makes everything else I do feel more important and connected to the world.
SN: That sounds like something so precious.
AC: I felt very disconnected without it. It was something I had lost when I started doing my masters, because I was spending so much time in scholarship and medicine. Students often tell me they have similar interests and ask me about my experiences, and I think it is important to recognize that in my case it did mean losing this part of me for a while, without even realizing it.
SN: And I can’t imagine how you have time for all of your work, your personal art, and to raise two children as well!
AC: Well, I don’t know if I mentioned that I’m in my seventh year of my PhD? (laughs and cringes). That’s partially because I adopted my two children, from infancy, and it that takes a little of your time! But being with them, having that opportunity to be playful and silly – it’s a similar kind of artistic space. And it has taught me so much. It’s just always a matter of time restraints, of course. I’ve learned to really value sleep. Make sure you get 8 hours!
SN: (laughs) Speaking of good advice and lessons learned – do you think that your experiences with uniting the humanities with medicine have helped you improve as a physician in clinical encounters? Are there any pieces of advice you should share with our readers?
AC: That’s an excellent question, one that is so hard to answer because those things become part of your being as you grow and change and learn. I think it first goes back to what I said about reflection and creating that space. There is so much to understand in a clinical encounter, and if students reflect they will gain so much from it. It is an intensely aesthetic experience for the patient – what it looks like, smells, tastes and feels like. And as physicians, as people in general, we constantly categorize our visual experiences: beautiful/ugly, repulsive/enticing. It is important for us the understand that lens or bias. I am really big on mindfulness and being present in the encounter, which speaks to a similar idea.
Of course, it has also influenced my empathy. I do not think of empathy as something that can be taught or trained, but by learning to access those different parts of yourself, and channel them into your work – to engage those different perspectives, you develop a much greater sense of empathy from uniting that. I had a clinical encounter today that really got me thinking. A woman came in and told a story I had heard a thousand times before from different people, but I think it was something I had just written that caused me to really engage with it. I think as you practice, you’ll find yourself engaging differently with the same things over time. And similarly I am very fascinated with the idea of truth, and ‘ways of knowing’ – this idea that experience brings out truth, and what I experience as truth is not necessarily what you do. It all connects to the idea of different perspectives.
(Pause). And play – how crucial it is to have that space. Lightheartedness, laughter. Even for yourself – humanities could be incorporated into practice at a personal level.
SN: Like a surgeon who goes home and loves taking photographs.
AC: Or even just appreciates them.
SN: Well, thank you so much Dr. Crawford. This has been a truly inspiring and thought-provoking conversation, and I think our readers will be very interested in the fascinating work you do.
AC: It is my pleasure – I really love doing things like this. Sometimes I ask myself: if you love art so much, why don’t you just go off and do it on your own and not worry about sharing it? But it is because of things like this, because of students like you, who are so interested and are continuing to build that community. I think we could really change medicine if we do more things like this, and it becomes more and more normal. It is really nice to have this reminder about how important it is to communicate with students – I’m going to remember that.
Dr. Allison Crawford is a Psychiatrist and Assistant Professor at the University of Toronto, where she is faculty with the Healthcare, Arts and Humanities Program. She has developed a course, Visualizing the Body, for medical students and residents at the Art Gallery of Ontario, and is interested in fostering a critical understanding of the personal, historical and cultural lenses we bring to looking and representing. She is also a PhD candidate in the Department of English at the University of Toronto, where she is completing a dissertation involving the role of the visual in narrative, particularly humanitarian narratives.