Poetry and medicine.

Abstract

POETRY AND MEDICINE JAMES G. BRUEGGEMANN* Contemporary medical practice, incorporating massive technological support, has the potential to supply society with more efficient health care than has been possible in the past. Whether this care can be made inexpensive enough to do the majority of the population good without creating economic hardship is an unsolved sociologie problem that physicians cannot address without alteration of society's expectation of what constitutes a desirable level of health care. Meanwhile, physicians and patients continue to relate to each other clinically in a way filled with personal messages and private nuances comprising the "art of medicine ." Although technological advance in medicine has not displaced "the art," erosions here and there tend to weaken the humane aspect of the profession in the eyes of patients. It is essential that, in the face of burgeoning technology and major alterations in methods of providing and paying for health care, society (physicians themselves particularly) not lose that sense of personhood that constitutes the physician-patient relationship. To explore this notion it will be helpful to compare the practice of medicine with the art of poetry. The opinion of Wendell Berry, a Kentucky farmer-poet-essayist, is that we now have "a 'professional' study of poetry that is useless to everybody but students of poetry, and that a mercenary job-keeping usefulness; and we have a poetry that is less and less useful to anybody but poets, and its usefulness to them, too often, is also a mercenary, jobkeeping usefulness .... I gather that we now have as a norm a mode of poetry that . . . involves a severely attenuated awareness, most noticeably, of the moral implications of words, thoughts, and acts, and of the consequences of those, both practical and spiritual" [I]. Similarly, well-founded demands for accurate diagnostics and The author expresses appreciation to Kate Basham for helpful criticism. *Department of Neurology, The Duluth Clinic, Ltd., 400 East Third Street, Duluth, Minnesota 55805; and associate clinical professor of neurology, University of MinnesotaDuluth , 2400 Oakland Avenue, Duluth, Minnesota 55812.© 1985 by The University of Chicago. All rights reserved. 003 1 -5982/85/2803-043 1 $0 1 .00 370 I James G. Brueggemann ¦ Poetry and Medicine efficient treatments have engendered such attention to the technological aspects of the health care system that communication between patient and physician is impaired and a demand for "tests" is substituted. A transformation occurs of physicians into technocrats and of patients into shoppers, a role unacceptable to either. Varieties of allied health care personnel are created as a reaction, to attempt restoration of human, moral elements to the encounter. Pellegrino and Thomasma state that "the art of medicine lies in the degree of perfection each clinician exhibits in history-taking, physical examination, performance of manipulative techniques such as surgery, and various diagnostic maneuvers . . . the work done" [2]. The work done. The writing, if you will, of the poem. Poetry is defined by Babette Deutsch as "the art which uses words as both speech and song, and more rarely as typographical patterns, to reveal the realities that the senses record, the feelings salute, the mind perceives, and the shaping imagination orders" [3, p. 126]. W. H. Auden is said to have called it "the clear expression of mixed feelings" [3, p. 127]. Poetry operates on both intuitive and cognitive levels; there can hardly be a practicing clinician who would not recognize the same factors operating in the art of medicine. Clinical situations are rarely those of "textbook" disease presentations—thus arise "mixed feelings"; words are the descriptive method, perceptive minds the tool, and informed imagination (clinical intuition) the substance of the diagnostic algorithm. Berry suggests that poetry "must be used for something, must serve something, greater and higher than itself. It is a way to learn, know, celebrate and remember the truth . . ." [I]. In terms of his statement quoted earlier, it needs a moral consequence. Likewise, medicine, the more it is viewed as essentially technological, strays into amorality. Poetry viewed by society as an academic exercise is about as useful to society as the technology of medicine without clinical perspective. Society has been blinded by the brilliance of technological advance to the essentially human art of clinical...