The Politics of Narrative Form

Abstract

Φ-The Politics of Narrative Form T. Hugh Crawford "That whosoever professeth himself a physician, is straightwaies beleeved , say what he will: and yet to speake a truth, there are no lies dearer sold or more daungerous than those which proceed out of a Physician's mouth" -Pliny1 In a sense, the literature-and-medicine movement is the continuation of the nineteenth-century medical reformer's debate about whether medicine is a science or an art. Even a brief examination of the material published in the last fifteen years demonstrates strong concern for humanizing medical education. Proponents recognize the potential narrowness of an overly scientific curriculum that tends to suppress imaginative responses to deeply personal human situations. Literature and medicine has been offered as, among other things, a way of countering physicians' patriarchal attitudes, the treatment of patients as objects (or symptoms), and the loss of a sense of the broader cultural implications of disease and healing, and as a way of addressing the need for nurturing rather than professional brusqueness. I would add that studying literature in medical school can also repair the image of today's medical professionals who no longer live up to the great humanist figures of earlier centuries.2 Although most educators agree that simply reading some fiction will not heal these ills, many see literature as an important way of reinscribing a form of moral philosophy in the medical curriculum and developing a sensitivity to narrative as well as scientific ways of knowing. Nevertheless, advocates of such programs should not naively assume that literature transcends the problems that accompany an overly scientific medical education. Literature can (possibly) promote sympathetic responses to human situations and consequently help to humanize medical practitioners; but, on another level, narrative form produces, influences, shapes, and constrains knowledge in some very particular, Literature and Medicine 11, no. 1 (Spring 1992) 147-162 © 1992 by The Johns Hopkins University Press 148 THE POLITICS OF NARRATIVE FORM striking, and, often, coercive ways.3 Basically, the structure of narrative — who gets to tell whose story when and where—is bound up with social privilege. Therefore, to use literature as a blandly humanizing tool may be to ignore the role it plays in the production of cultural consensus. But to study narrative form as a way of producing knowledge (or moral philosophy4) and as a way of organizing the space and objects of knowledge can benefit all members of our culture—particularly physicians, who are caught up in the production of narratives through diagnostic interviews and case histories and are consequently constrained by narrative form. It comes down to this: all efforts to use literature as a teaching tool must come to grips with cultural attitudes toward narrative form and specific cultural uses of it, both within and outside the medical profession. A useful way to get at this problem is through William Carlos Williams's "Mind and Body," which, although not a case history, has the pedagogical advantage of being a short story, written by a physician, that creates the illusion of an office visit in which a case interview is being taken. Although case histories tell the tale of the patient, they do so, to a great extent, from the perspective and with the language of the medical professional—in this case, Williams's narrator. All narrators steal voices, displace marginal languages, and, on the whole, provide monological accounts of any set of events.5 Therefore, "Mind and Body" is particularly useful because it both dramatizes the scene of the case history and exhibits the control embedded in narrative form. Given our culture's increasing reliance on scientifically produced knowledge, it is not surprising that narrative has been given secondary status in medical education. At least since Plato, producers of literary texts have been excluded from the mainstream of true knowledge production . Historically, Western culture has viewed narrative as either potentially subversive lies or trivial entertainment. Jean-François Lyotard voices the scientific perspective in this way: "The scientist questions the validity of narrative statements and concludes that they are never subject to argumentation or proof. He classifies them as belonging to a different mentality: savage, primitive, underdeveloped, backward, alienated, composed of opinions...