Editor's Column

Abstract

^Editor's Column Literature and Medicine concludes its first year of semiannual publication with this general issue. The special excitement of preparing a general issue comes, in large part, precisely from not knowing in advance what shape the issue will take. The form emerges gradually, as essays are submitted, reviewed, and accepted, and similarities of theme or approach become apparent. Even though there was no declared theme for this collection, the essays seem to fall naturally into two clusters. In the first cluster, three essays and a group of drawings deal in different ways with the doctor-patient relationship—more specifically, with the difficulty of developing and maintaining, simultaneously, the objective, scientific gaze and the subjective, empathie understanding that are essential to good medical practice. In the second cluster, three essays explore the boundaries between literature and psychiatry by examining literary representations of alcoholism, sexual impotence, and transference-countertransference love. The first cluster opens with "Patient Stories, Doctor Stories, and True Stories: A Cautionary Reading," an essay in which Nancy M. P. King and Ann Folwell Stanford borrow the concepts monologic and dialogic from the literary theorist M. M. Bakhtin to identify their concerns about ethical issues that arise in interpreting patients' stories. As illustrations of these concerns, they examine two stories by well-known physicianwriters —Richard Selzer's "Brute" and William Carlos Williams's "A Face of Stone." One text, they argue, presents a monologic reading because it reflects only the physician's voice during an encounter with a patient; the other develops from monologic to dialogic. King and Stanford caution that interpretation of patients and their stories should be a collaborative process involving physician and patient; it should emerge through a dialogue reflecting a more equitable, shared relationship than the traditional , paternalistic one. How to prepare medical students for their encounters with patients is the concern of the next essay, "Charting Dante: The Inferno and Medical Education," by Anne Hunsaker Hawkins. She argues that the journey through Dante's Inferno and the journey through medical school are analogous in important ways and that reading the Inferno can help medLiterature and Medicine 11, no. 2 (Fall 1992) vii-ix © 1992 by The Johns Hopkins University Press EDITOR'S COLUMN ical students master the antithetical skills that are essential for good medical practice: "the objective gaze and the subjective understanding" (p. 204). Both Dante the pilgrim and contemporary medical students must learn about the abstract categories of sin or disease by encountering the suffering "of the actual human beings who embody" those abstractions (p. 201). Achieving the appropriate detached concern, as it has become known in medical education, is the task of Dante the pilgrim just as much as it is of medical students.1 In "Seeing Patients," Mary G. Winkler expresses the same concerns but discusses them in relation to the visual arts. She traces the development of two opposing traditions in Western history, both beginning in the Renaissance: the ideal of rational, scientific observation that led to the objective medical gaze and technological imaging; and the concept of the individual as it is expressed in the subjective art of portraiture. Winkler believes that the physician-artist Alan Blum reconciles these two historical traditions when he sketches his patients. Literature and Medicine continues its commitment to the visual arts by presenting a selection of Blum's sketches as a special feature of this issue. The essays in the literature-and-psychiatry cluster are ordered chronologically according to the literary works they discuss. In the first essay of this section, "Tragedy of the Commonplace: The Impact of Addiction on Families in the Fiction of Thomas Hardy," Timothy M. Rivinus looks at three late-nineteenth-century novels, The Mayor of Casterbridge , Tess of the d'Urbervilles, and Jude the Obscure, through the lens of contemporary knowledge of alcoholism and its effects on families, especially the adult children, of alcoholics. By considering many of Hardy's characters as victims of alcoholism, he provides clinical validation for the accuracy of Hardy's characterizations. In so doing, he implicitly takes to task those literary critics who have regarded the characterizations in these novels as flawed. More important to Rivinus, however , is the role that...