A Novel take on Healing the Sick: Could an Understanding of Literature help Doctors improve Treatment of Patients
“Medicine”, according to Anton Chekhov, “is my lawful wife and literature my mistress. When I get fed up with one, I spend the night with the other.”
Checkhov may be the best known of a small but illustrious group of doctors turned writers – Sir Arthur Conan Doyle, Somerset Maugham and William Carlos Williams are three others who also put their medical knowledge to literary use. But as literature and medicine, superficially two radically different disciplines, are currently sizing each other up as suitable bedfellows, his famous words have never been more apt.
“Literature is pretty good at tolerating uncertainties”, says Rita Charon, Professor of Clinical Medicine at Columbia University.
“Literature makes us understand that when a patient comes into our office there is a narrative thread to be found. It helps when the doctors and nurses understand that the patient is the one to tell the story and part of my job is simply to listen. To listen seriously and gravely and to bear witness.”
Charon is currently in London to give a lecture at King’s College entitled: “What can Medicine learn from Literature.” * Charon was the first doctor at Columbia University College of Physicians and Surgeons to get a Ph d in English – her specialty was Henry James – and the sixth in the whole of United States. Charon is convinced that doctors can learn from great writing in their struggle to make sense of very complex human stories. “How do I know when I see a young woman who has migraine headache, asthma, depression and manic disorder, whether the asthma got worse and made her more anxious or whether the anxiety got worse and made her short of breath? We don’t know which one caused which we just know they are related. There has been a slow realisation that sickness is not just a mechanical breakdown and those who see sick people have to know about emotions, suffering, defeat, death, hope and all those things. We can’t afford to treat the body as if it were separate from the rest.”
Charon, who for the last twelve years has co-edited the New York based journal, Literature and Medicine, believes firmly that the two disciplines have much to offer each other. “If a professional develops a skill to dwell on what has happened to you and puts it into words then you have given form to a formless experience. You can walk around it, see it from the other side. In this way doctors and social workers can reach out to each other and help. What we find on a very practical level is that medicine really needs what literary studies has to offer.
“At Columbia there are members of the English Department who are thrilled to help teach doctors and nurses how to read and write,” Charon explained when I met her recently at her Greenwich Village studio.
“They are so relieved to find a thoroughly practical use to which they can put their highly theoretical knowledge. Suddenly concepts such as ‘what makes a novel work?’ ‘ Where is the narrative voice?’ ‘What is the genre’ and ‘what are the tropes or the governing images?’ all have a use. They are relieved to find that this very abstract knowledge can help with ordinary problems in the world. At the same time, for the doctors and nurses doing their rounds, this understanding really helps when they read a note written in the chart they can ask the same questions.”
Charon’s talk, in the Dialogues between Disciplines series, will offer a taster of some of the issues to be tackled in a new MA course at King’s, starting in September 2005, offered by the department of English Language and Literature. It is the first of its kind in the UK and was the brainchild of Brian Hurwitz, D’Oyly Carte Professor of Medicine and the Arts, Neil Vickers, Lecturer in Literature and Medicine at King’s. David Ricks, Senior lecturer in the School of Byzantine Studies was also involved in the initial concept.
Vickers, who has an M Phil and D Phil in literature, moved across disciplines in 1991 when he became a Research Fellow in Epidemiology at St Georges and UCL. Hurwitz boasts an equally unusual career mix as a clinical academic who continues to work as a part time NHS GP in an inner London practice and sits on the council of the UK Association of Medical Humanities. He will oversee and steer the project.
The MA is part of a much broader picture to put more scientific content into humanities subjects generally. Kings, for example, in a determined effort to offer more interdisciplinary graduate courses marrying arts and sciences, already offers an MA in Digital Culture and another in Cultural and Creative Industries. The specific proposal for the Literature and Medicine MA poses the question: “Can literary theory of narrative illuminate the project of narrative- based medicine?” and the core course aims to introduce students to the similarities and differences in the methods adopted by both disciplines. Lectures and seminars, which will be taught by both Vickers and Hurwitz, will include some of the following topics: The uses and abuses of medical concepts in the study of literature, literature and the body, illness and the nature of artistic experience, literature and pain, the patient as text and is scientific writing literature?
Vickers is wary of the rather vague notion that an understanding of literature will somehow make doctors more empathetic, fearing there might be some confused thinking here. As he points out, however keen doctors may be to enlarge their narrative competence the average length of a consultation with a GP is still only seven minutes. He believes the real benefits lie the other way round. “I think what will be grasped is the shaping role of science in culture.” Vickers has written a critically acclaimed study, Coleridge and the Doctors 1795-1806 ( Oxford University Press 2004), which looks at how much Coleridge, who fell ill at twenty eight, never to recover, and his doctors knew about medicine and how they used that knowledge.
Hurwitz agrees that the aim is not to teach compassion or humanity. “Those can’t be taught. The way people learn that is through a role model, through seeing raw human feeling, not through reading literature.” But he does believe that, as has been happening in the US for some time, literature and medicine courses do offer an enhancement, or, increasingly, a substitute for medical ethics, which are limited to hypothetical cases are not real life and are often based on rather formal rules which may not reflect the complexity of human problems.
“Educationally the arts and humanities develop a range of skills and capacities from observation argument and analysis to self awareness; capabilities that are insufficiently nurtured by school science courses and conventional medical curricula. Caring for sick people frequently confronts nurses and doctors with intense questions about the meaning of life and exposes them to human tragedies and comic absurdities sometimes simultaneously the arts can tackle such issues with an immediacy and range of response often lacking in medicine, ” explains Hurwitz.
The one year course (with an option to spread it over two) is aiming at approximately 10- 15 students from both disciplines. Since the aim is to generate a conversation between the two, it will be predicated on there being two distinct activities: Literature and Medicine. ” People imagine that there will be a great confluence but each discipline will retain its own character,” insists Vickers. It is, he admits, something of a risk. Hurwitz describes it as an act of faith. Both are excited by its innovative nature and huge potential.
The term ‘medical humanities’ is not new; it was, according to Brian Hurwitz, first coined in 1976 by an Australian surgeon, A R Moore. But writers of all genres are relying on medical understanding as never before. Ian McEwan’s latest novel, Saturday, takes a day in the life of an eminent neurosurgeon grappling with a complex world and his responsibility in it; the latest bestseller, The Kite Runner, written by Khaled Hosseini, a doctor, makes use of gripping medical details adding to the novel’s visceral veracity; Alan Bennett wrote a whole play about an illness, (Porphyria), The Madness of George lll and no self-respecting biographer can get to grips with his or her subject without a huge understanding of their subject’s medical history. Writing about one’s own illness – not altogether new if de Quincey’s Confessions of an Opium Eater is taken into account – is yet another relatively recent popular phenomenon where literature and medicine collide and John Diamond’s C Because Cowards get Cancer Too and Ruth Picardie’s Before I say Goodbye will be the basis for at least two lectures and two seminars.
As Charon writes in the preface to the latest edition of her journal: “Narrative is the medium we exist in, the air we breathe it is how the mind makes sense of things, interprets stimuli…. Narrative like art itself is consolation; but its power to heal arises from its power to connect us… “Isn’t it exciting?” she says as I leave.
* for further information email brian.hurwitz@kcl.ac.uk or neil.Vickers@kcl.ac.uk or consult the website at www.kcl.ac.uk/hums/landm/
Anne Sebba is the author of The Exiled Collector; William Bankes and the Making of an English Country House