Medicine and self-image in literature

Abstract

Iain Bamforth (Oct 20, p 1361)1Bamforth I Literature, medicine and the culture wars..Lancet. 2001; 358: 1361-1364Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar is curious that medicine is seeking a self-image in literature. In particular, he is exasperated by the consequences of relativism, the collapsing distinction between high culture and culture in the anthropologists' sense, between the aesthetic and non-aesthetic, the literary and, well, and the medical narrative. It is a familiar question: if everything is relative, then what has value? The principle of a commitment to form is something Bamforth wants, reasonably, to shore against the ruin. But his further argument, that ostensible formal simplicity–he mentions Hemingway–is a convention that conceals resourcefulness, quickly leads to fairly sterile debate, as he will surely know. Picasso (simply) rearranged a bicycle saddle and handlebars to resemble a bull's head. Is this art, if Picasso does it? But at least Picasso was capable of technical sophistication. What of Rothko's simple slabs of colour? He wasn't even a great draughtsman. And so on, and endlessly on. An alternative starting point is to recall that all language occasions are characterised by rules of use,2Hymes D On communicative competence..in: Pride JB Holmes J Sociolinguistics: selected readings. Penguin Books, Harmondsworth1972: 269-293Google Scholar conventions of which we may not even be conscious. How, we might then ask, do those of medical narratives differ from what all but the most supine of what relativists call great literature? Of relevance here, I would argue, are the formal similarities between Victorian academic medical writing and Dr Conan Doyle's development of the detective story. Both genres share the convention that they offer a narrative puzzle with one solution. The patient died of emphysema, we deduce: the butler killed Her Ladyship. But it is only genre fiction that is normally like this. Great literature is open-ended. Thereby is raised the issue of Keatsian negative capability,3Gittings R The letters of John Keats: a selection. Oxford University Press, Oxford1970: 43Google Scholar which Bamforth discusses. No-one knows exactly what this term means, and probably Keats, at age 22 years, was uncertain too. He mentions Shakespeare. Perhaps he had in mind Shakespeare's ability to get inside his characters. He mentions Coleridge, whose poetry is limpid and frequently profound, whose theoretical work is turgid and sometimes shallow. So, perhaps he was disparaging the intellect, because Keats for all the formal brilliance of the Odes which are his masterpieces, valued touch and feel4Jones J John Keats's dream of truth. Chatto and Windus, London1969Google Scholar above reflection. Or perhaps he was reaching after what we now call tolerance of ambiguity, the ability to cope with the irreducibly contradictory nature of much that we experience. Surely this is the point at which the study of medical narratives differs from the study of great literature. Greenhalgh5Greenhalgh T Narrative based medicine: narrative based medicine in an evidence based world..BMJ. 1999; 318: 323-325Crossref PubMed Scopus (328) Google Scholar gives an example, intended, apparently, as prototypical, of the virtues of narrative-based medicine. She recounts that a mother telephoned to say her child was behaving strangely and, perhaps hearing that word strangely surface in the narrative, her family physician went at once to visit. The child had meningitis. An inspirational piece of medicine, possibly enabled by sensitivity to language convention (the unconventional use of strangely), but not at all by a sense of the aesthetic. Sifting language for unique solutions to complex puzzles is quite unlike reading literature of absolute value.