Why Literature and Medicine?

Abstract

A Why Literature and Medicine? Larry R. Churchill As a teacher of humanities in a medical school, I am impressed that freshman medical students are more profoundly affected by reading John Berger's A Fortunate Man than Talcott Parsons's definition of the sick role. Why this is so provides reason for celebrating this initial issue of Literature and Medicine. If this is surprising, it is only because we in the Western world have perpetuated a studied ignorance of the role and place of humanistic learning over the past three hundred years. The typical academic bifurcations of sciences and humanities (hard data and soft; knowledge and opinion; fact and value; cognitive and affective) have dominated our ways of thinking and perceiving. Narratives such as A Fortunate Man are seen as "interesting" but hardly essential to a physician's education. Perhaps freshman medical students know something that professionals have forgotten. In spite of the spectacular success of scientifically based medicine, many of the problems that physicians are called upon to treat do not yield to technical, scientific solutions. Suffering, depression , alienation, chronic disease, disability, and death are non-technicalsolution problems—problems of the human condition. They call less for the mastery of quantifiable factors in formal knowledge than for depth of insight, acuity of perception, and skills in communication—namely, the sort of expertise that is traditionally associated with literature. Too frequently the well-trained professional is not well educated; too frequently the professional is uprooted from any real appreciation of the human condition—both that of patients and his or her own. The experience of alienation is the psychic price many medical students pay for scientific "enlightenment" and technological prowess. Perhaps Literature and Medicine can remind us of what freshman medical students still know but which professionalization teaches us to forget. Yet, serving as a corrective is only a beginning. Beyond recognizing false bifurcations and the idolatry of scientism, literature can provide what Clifford Geertz calls "thick descriptions" of our human situation, Literature and Medicine 1 (Rev. ed., 1992) 35-36 © 1992 by The Johns Hopkins University Press 36 WHY LITERATURE AND MEDICINE? and the space to imagine how it might be otherwise. Imagination frees us from the immediate and allows the unusual, the other, to appear. Literature evokes and stimulates the imagination, permitting us to change places with the patient and dwell in his or her ambience. James Dickey's poem "Diabetes" is worth a thousand sociological descriptions of "noncompliance," precisely because it allows us to see what the diabetic sees at breakfast and what it means to long for the forbidden beer at campsite. Such imaginative abilities are basic to ethics as well, since the power to see clearly and from diverse perspectives is the sine qua non for choice and decision. As Stanley Hauerwas and others have argued , our sense of morality in medicine is ultimately grounded in the persuasive power of stories of helping and healing, not in the clarity of our thinking about principles. The parable of the Good Samaritan is to the principle of beneficence as Fort Knox is to a quarter. It is the narrative power of the parable that makes it compelling—that is, the knitting together of events, motives, and actions that together form a story. Put differently, narrative has the power to show us, rather than tell us about, the profound mystery of medical encounters. Literature makes this narrative available to us, displays it, rather than recasting, cloaking, or analyzing it beyond recognition. Literature at its best lets be, for its own sake, and on its own terms, the human realities of medicine. Far from being artificial, the conjoining of literature and medicine is natural and even essential. ...