A novel take on healing the sick

March 18, 2005

Could an understanding of literature help doctors improve treatment of patients? Anne Sebba sifts the fact from fiction.

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."

Chekhov is probably the best known of a small but illustrious group of doctors whose medical knowledge informed their literary efforts - others include Sir Arthur Conan Doyle, Somerset Maugham and William Carlos Williamss. But as the superficially radically different disciplines of literature and medicine size each other up as suitable bedfellows as part of a lecture series at King's College London, Chekhov's words have never been more apt.

Rita Charon, professor of clinical medicine at Columbia University who delivers this week's lecture in the King's "Dialogue between Disciplines" series, sees a positive role for literature in medicine. "Literature is good at tolerating uncertainties," she says. "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 their job is simply to listen."

Charon was the first doctor at Columbia University College of Physicians and Surgeons to get a PhD in English - her specialty was Henry James - and the sixth in the whole of the US. She 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 a migraine, 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?" she asks. "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.

"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."

But if medicine can learn a lot from literature, Charon, who for the past 12 years has co-edited New York-based journal Literature and Medicine , believes that literature can also benefit from being linked to a more practical subject. "At Columbia, there are members of the English department who are thrilled to help teach doctors and nurses how to read and write. They are so relieved to find a thoroughly practical use to which they can put their highly theoretical knowledge. Suddenly, abstract questions 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, doctors and nurses doing their rounds can ask the same questions when they read a note written on a patient's chart."

Charon's lecture will offer a taster of some of the issues to be tackled on an MA course starting in September at King's, offered by the department of English language and literature. The course is purported to be the first of its kind in the UK, the brainchild of Brian Hurwitz, professor of medicine and the arts, and 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 MPhil and DPhil in literature, moved across disciplines in 1991 when he became a research fellow in epidemiology at St George's Hospital Medical School and University College London. Hurwitz boasts an equally unusual career mix as a clinical academic who continues to work as a part-time GP for the National Health Service 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. King's, 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?" 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 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 vague notion that an understanding of literature will somehow make doctors more empathetic. 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 benefits may 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, C oleridge and the Doctors 1795-1806 (2004), that looks at how much Coleridge, who at 28 fell ill never to recover, and his doctors knew about medicine and how it influenced the development of his philosophy.

Hurwitz agrees that the aim is not to teach compassion or humanity. "Those can't be taught. The way people learn such things is through a role model, through seeing raw human feeling, not through literature."

But he does believe that, as has happened in the US for some time, literature and medicine courses offer an enhancement to - or, increasingly, a substitute for - Jmedical ethics, which are limited to hypothetical cases that are not drawn from real life and are often based on rather formal rules that 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 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," Hurwitz says.

It is hoped that the one-year course (which can be spread over two years) will recruit between ten and fifteen students from both disciplines.

Because 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," Vickers insists.

Both Hurwitz and Vickers are excited by the course's innovative nature and huge potential, although they accept that the term "medical humanities" is not new.

According to Hurwitz, it was 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 Kite Runner , a bestseller by Khaled Hosseini, a doctor, makes use of gripping medical details that add to the novel's visceral veracity; Alan Bennett wrote a whole play about an illness (porphyria), The Madness of George III , 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 Thomas de Quincey's Confessions of an Opium-Eater is taken into account - is another relatively recent popular phenomenon where literature and medicine collide. 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 on the MA course.

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."

Anne Sebba is the author of The Exiled Collector: William Bankes and the Making of an English Country House (John Murray, £8.99). For more information on the King's College London lectures and MA ,consult the website at www.kcl.ac.uk/hums/landm/  

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