Translator: Robert Tucker Reviewer: Denise RQ
Less than three weeks ago, I was visiting my uncle at the hospital
a few days before he passed away to cancer,
and heard the nurses frequently refer to him as "bimar shoma."
In English, that translates to "your patient";
not your uncle, or your husband, or your father, or your brother
but your patient.
A subtle nuance in language that reminded us all
that here in this hospital, he was nothing more than his illness.
And while this may initially seem to be an insignificant moment with words,
I think it's symptomatic of a much more significant problem in medicine:
medicine's increasing focus on science and technological advancement
at the cost of the arts and humanities,
at the cost of not being able to recognize that words really do matter.
That is not to say that science and technology are not crucial,
because they are,
but it is to say
that it should not come at the detriment of not being able to recognize
the immense value of the arts and humanities.
And more specifically, in this talk
I will be addressing the value of literature.
Medicine is not just a science but a story:
a story of illness, and health, and relationships.
To those told by the medical charts and lab results,
to those told by the patient themselves, their loved ones, and the practitioners.
And it's not just enough to recognize
that medicine is both a science and a story,
but we must be able to also acknowledge
that one's story of illness
cannot and should not be separated from the story of their life.
Illness does not affect our lives in isolation:
my uncle can never just be our patient,
because for the past 60 years he has been the protagonist of so many more stories
by virtue of being my uncle or my cousin's father or my dad's brother.
And if stories are such a significant part of the medical encounter,
then what better way is there to train medical practitioners
to recognize and interact with these stories,
than drawing upon what we do in literature classrooms every day?
Rita Charon at Columbia University developed Narrative Medicine,
which she defines as medicine practiced with narrative competence,
that is the ability to acknowledge, interpret, absorb,
and act upon the stories and plights of others.
By drawing upon narrative and literary theory,
she argues that physicians must not only be able to analyze
their patient's story at the level of content
but also at the level of form,
and that this level of narrative competence
must be trained and honed through the practice of close reading.
Imagine two physicians,
one trained in literary analysis, and the other not,
listening to the exact same story by the exact same patient.
The one without a literary analysis background
is likely to only engage with the patient's story
at the level of content.
Whereas the one who has been trained in literary analysis
has the potential to distinguish the narrating agent, the patient,
from the focalizer; that which gives the story perspective.
To understand why the patient would choose to change
the chronology or speed of events in their narrative,
to be able to unravel and understand
the meaning of the metaphors and figures used by the patient,
to recognize prevalent themes that run throughout the narrative,
and so much more.
And it is this physician, I argue,
who will be able to produce significantly more meaning from the exact same story,
and so much more.
And it is this physician, I argue,
who will be able to produce significantly more meaning from the exact same story,
and thus, one could argue, be able to reach an accurate diagnosis
and implement an effective treatment plan much sooner.
The way metaphors function:
medicine is a particularly interesting case to demonstrate this.
In 2010, Lisa Wynn, Angel Foster, and James Trussell
published a study titled,
"Would you say you had unprotected sex if ...?"
In this study, they analyzed a year's worth of emails
sent to an American emergency contraceptive website
and revealed the multiplicity of meanings
assigned to the term sex and unprotected sex
due to the variety of words and metaphors
that individuals used to understand their sexual and reproductive health.
This study powerfully demonstrates
the unstable nature of language in sexual and reproductive health,
and how this aspect of medicine requires close attention to language,
akin to the attention we give texts through literary analysis.
Yet, sexual and reproductive health are so often relegated to questions
like, "Are you sexually active?" or "Do you engage in unprotected sex?"
And if we can't even take for granted
the definitions of sex and unprotected sex,
how can we possibly hope to understand a patient's health and/or illness
through the mere "yes" or "no" answers we so often solicit?
And it is precisely here
where that physician training in literary analysis
becomes so crucial,
because it is this physician who will recognize
when it's necessary to solicit a narrative rather than a mere "yes" or "no"
in order to fully flesh out the patient's meaning
and to have a deeper understanding of their illness and health.
And this discussion doesn't just apply to sexual health.
Canadian poet and physician Shane Neilson
argues in his paper, "Pain as Metaphor,"
that in order to improve medicine's approach to pain,
we must first and foremost change
how pain is conceptualized through medicine.
He argues that current pain metaphors,
which are mainly based upon productive visual schematics,
are creating this illusion of mastery and hard knowledge in medicine
that prevents medical researchers and practitioners from seeking out
more complex and nuanced truths, answers, and understandings
about how to deal with pain.
Language thus is once again tied
to actual medical research, outcomes, and practice,
and it is shown that the study of language must not be taken lightly,
even in a discipline as deeply rooted in the science as medicine.
In "The epistemology of the metaphor," literary critic Paul de Man demostrates
how even the most simple ideas and words become metaphorical,
and how they produce a multiplicity of meanings
and elude the definitive definitions and clear communication
that we so often assume of them.
And this is so easily perceived in any literature classroom
where the same word or phrase or book
is interpreted in so many different ways
by several students in the same class at the same time.
And it is this insight, I argue,
that medical practitioners would greatly benefit from.
While I spent the last several minutes
discussing how we can get medical practitioners
to uncover the full meaning of a patient's story,
I also recognize that this needs to be done with some humility.
Or in the words of Sayantani DasGupta,
one of Rita Charon's colleagues at Columbia University,
this needs to be done with the sense of narrative humility.
We must not seek to master a patient's story
as if it fitted some fixed noble entity,
but we must seek to continuously engage with it
like the dynamic singular entity that it is.
This leads to what I believe is the most important thing
that is fostered through literary analysis for medical practitioners,
or anyone for that matter:
an ability to embrace contradictions, paradoxes,
the unknown and elusive meanings.
Anyone who engages with literary theory and analysis will recognize
that a clear meaning, or truth, or understanding
can never be distilled through language,
and the ability to embrace this kind of unknown
is precisely what a discipline like medicine needs
when it has so much yet to explain.
And even those things that science claims to have explained
are so often plagued by an unknown
that we merely choose to consciously or unconsciously ignore them.
For example, how can we come to terms
with a patient whose life is taken far too soon by cancer?
We can't.
However, we can seek to come to terms
with all that can't be justified, or explained, or understood
by engaging in literary analysis,
which thrives upon pinpointing precisely that in literature.
In "To give suffering a language,"
Harold Schweizer draws a comparison between literature and illness narratives,
between literary critics and medical practitioners.
neither illness narratives nor literature
can ever be wholly understood or reduced to a final analysis.
In the same way that literature continuously evades
the literary critic's final analysis,
suffering is not to be given
a definitive understanding or meaning by the medical practitioner.
Literature and illness narratives continuously tempt interpretation
but also elude it.
And it's precisely this irrational and paradoxical nature of literature
that Harold Schweizer argues allows medical practitioners to acknowledge
the irreducible secrecy of suffering.
In order to give language to suffering, one must tend to the aesthetic,
and the aesthetic is that
which continuously eludes a final analysis,
that which we continuously encounter in literature classrooms.
I think it's safe to say that one of the most common complaints
patients have about their medical care
is that the physician didn't care or listen enough.
But imagine the level of listening
that could be honed through literary analysis.
The attention to detail and nuance that a practitioner could not only notice
but care to notice,
as they come to recognize
the significant role it plays in building the entire narrative of the patient.
While I've spent the rest my talk
outlining the ways in which a literary education matters in medicine,
I think there's always going be a matter of importance
that cannot be pinpointed,
something that I fumble to describe;
something that I just know in my my core
about why a literary education has been immensely valuable
for myself and my peers,
and why it will continue to be immensely valuable
for other disciplines, such as medicine.
And it is precisely this elusive quality of why literary education matters
that signals to why what we do in literature classrooms every day
is so powerful in medicine and beyond.
It reveals
how what a literary education has to offer is unlimited, excessive, overwhelming,
that it permeates our lives and actions so deeply
that, rather paradoxically,
we can never hope to fully describe it with words.
Thank you.
(Applause)