A C: A D E M I A AND C 1. 1 N I C:

Literature and Medicine: Contributions to Clinical Practice Rita Cliaron. MD; Joanne Trautmann Banks. PhD; Julia B. Connelly. MD; Aniic Hunsakcr Hawkins. PhD: Kathryn Montgomciy Hunter. PhD; Anne Htidson Jones, PhD; Martha Montello, PhD; and Suzanne Poirer, PhD

• Introduced to U.S. medical schools In 1972, the field Oick persons rely on iheir physicians for skilled diagnosis, of literature and medicine contributes methods and cflcctivc therapy, and hurnan recognition of their suffer- texts that help physicians develop skills in the human ing. AJthotigh medieine has made dazzling progress in dimensions of medical practice. Five broad goals are achieving the first two of these goals, its capacity to fulfill met by including the study of literature in medical the third goal seems to have diminished {1, 2). Medieine education: 1) Literary accounts of illness can teach has incorporated the knowledge and methods of scientific physicians concrete and powerful lessons about the disciplines sueh as molecular biology, human genetics, and lives of sick people; 2) great works of fiction about bioengineering to achieve progress in diagnosis and ther- medicine enable physicians to recognize the power and apy. Physieians are now beginning to turn to the human- implications of what they do; 3} through the study of ities, to disciplines such as literary studies, to achieve narrative, the physician can better understand patients' equally essential progress in comprehending their pa- stories of sickness and his or her own personal stake in tients' suffering so that they can accompany patients medical practice; 4) literary study contributes to physi- through illnesses with empathy, respect, and effective care cians' expertise in narrative ethics; and 5) literary theory (3-5). offers new perspectives on the work and the genres of Until the initiation of progressive educational reforms medicine. Particular texts and methods have been in the 196(Js, rnedical schools expected their students to found to be well suited to the fulfillment of each of these become empathic and attentive clinicians by watching goals. Chosen from the traditional literary canon and skilled physieians at work. Students were supposed to from among the works of contemporary and culturally absorb the human competencies of doctoring—what many diverse writers, novels, short stories, poetry, and drama call "the art of medicine"—during training (6. 7). But just can convey both the concrete particularity and the as physicians ean no longer learn Ihe scientific bases of metaphorical richness of the predicaments of sick practice in apprenticeship programs, they can no longer people and the challenges and rewards offered to their learn the human bases of practice wiihout explicit and physicians. In more than 20 years of teaching literature ongoing training. Such training is not meant to recapture to medical students and physicians, practitioners of some long-lost profieiency in compassionate doctoring literature and medicine have clarified its conceptual from generations ago but to extend the aecomplishments frameworks and have identified the means by which its of the past using knowledge that was unavailable to phy- studies strengthen the human competencies of doctor- sicians in former times. ing, which are a central feature of the art of medicine. Along with other disciplines in the humanities and along with the social and behavioral sciences, literature and literary studies contribute to this educational eftbrt. The relation between literature and science has fueled impassioned debate sinee the Victorian era. Matthew Ar- nold defended literature—he called it "criticism of life"— when Thomas Huxley proposed to replace humane letters with natural sciences in general education (8). CP. Snow's 1959 suggestion that the scientific and the literary cultures were irreparably estranged and that the future belonged to the scientists elicited profound disagreement from scientists and literary scholars alike (9-11). This historical conversation continues today in U.S. medical schools, in many of which, since 1972, literature has joined science in the curriculum. Using literary methods Ann Intem Med 1995; 122:599-606. and texts, literary scholars have been teaching medical students and physieians how to listen more fully to pa- From College of Physicians and Surgeons of Columbia Univer- tients' narratives of illness and how to better comprehend sity, New York. New York; The Pennsylvania State University illness and treatment from patients" points of view (12- College of Medicine, Hershey, Pennsylvatiia; University of Vir- 14). These skills help physicians to interview patients, to ginia School of Medicine, Cbarlottesville, Virginia; Northwestern establish therapeutic alliances with patients and their fam- University Medical School and the University of Illinois College of Medicine. Chicago, Illinois; University of Texas Medical ilies, to arrive at accurate diagnoses, and to choose and Branch, Galveston, Texas; and Harvard Medical School, Boston, work toward appropriate clinical goals. Massachusetts. For current author addresses, see end of texf. The most quickly growing area of the medical human-

© 1995 American College of Physicians 599 itics. the field of literature and medicine is a recognized disease. By reading narratives of illness written by gifted subcliscipllne of literary studies that has its own scholarly writers, physicians can more precisely fathom the fears journals, professional societies, graduate school programs, and losses of patients with serious illnesses, identifying in federally funded training programs, and research agendas fictional characters and then in their own patients the (15-17). In 1994, approximately one third of U.S. mifdical inevitable conflicts and uncertainties that sickness brings. schools taught literature to (heir students, according lo Narrative accounts of patients' experiences of illness our informal surveys of members of ihc Socicly for are regularly considered in medical school courses and in Heallh and Human Values., ;HKI the number is growing professional reflections on the patient-physician relation- quickly. Medical students in the prcclinical and clinical ship, aging, death and dying, disability, and women's years, house officers, and practicing physicians partieipiitc health (22-26). Examples of such writings var>' in period in literature courses and writing workshops. Usually co- and in genre. Dante's epic journey in The Iiifemo parallels kiughl by literary scholars and physicians, such eourscs the journey of illness; Virgil, his guide, stands for the can be either required or elective elements uf Ihc curric- patient's physician (27). Leo Tolstoy's The Death of Ivitn ulum. Physicians have joined literary scholars in writing Ifych brings the reader lo the bedside of a middle-aged about Ihc connections between literature and medieine bureaucrat who is dying of cancer and who articulates, and the beneliis that litcratuie provides to the physician; without flinching, the regrets of a selfish life and the fears this confirms the clinical relevance of such teaching ;uid of a lonely death (28-32). Tillie Olsen's -Tell Me a scholarship (18-20). Riddle'" represents the living and dying of Hva—Russian- The study of literature contributes in several ways to Jewish immigrant, revolutionary, mother, grtindmtither, achievement in the human dimensions of medicine: I) and patient with cancer whose diagnosis is withheld from [.ilcrary accounts of illness can teach physicians concrete her—amid the deceptive gambits and the caring acts of and powerful lessons about the lives of sick people; 2) her family (29, 30, 33). Henry James's aging protagonist great works of fiction about medicine enable physicians lo Dencombe in "The Middle Years" reviews his waning recognize the power and the implications of what they do; life, seeking from his physician the clianee for ""anotlier 3) through narrative knowledge, the physician can better go" but receiving instead a deep and healing eonfirmatiun understand patients' stories of sickness, thereby strength- t)f his worth (34, 35). Franz Kafka's Gregor Samsa awak- ening diagnostic acctiracy and therapeutic effectiveness ens as an inseet in "The Metamorphosis'"; this is an while deepening an understanding of his or her own per- allegory of tbe many-leveled transformations of illness lor sonal stake in medical practice: 4) literary study contrib- patients and their families and clinicians (36, 37). In his utes to physicians' expertise in narrative ethics and helps madness, the priitagonist of King Lear finds the clarity o[ physicians to perform longitudinal acts of ethical discern- vision and value that many dying persons and iheir fam- ment; and 5) literary tbcoiy offers new perspectives on ilies crave (3S. 39). the work and the genres of medicine. Allhough our dis- Besides works of lietion and imagination, pathogra- cussion of literature's contributions to medicine focuses phies—the narratives that patients write about their ill- on works of fiction, genres such as poetry, drama, and nesses—offer "case histories" of illness and treatment film art; equally valuable to the physician and ihe medical from the palients' points of view (2, 40, 41). Both bio- cdueator. graphical antl fictional writings by members of particular cultural or ethnic groups help physicians by situating Ill- ness witbin speeific cultural and spiritual understandings The Patient's Life of the body (42. 43). What do sick people worry about? How do they live Reading these and other accounts of illness and death their lives around their diseases? What sense can they deepens the physician-reader's grasp of human need. In a make of the random events of illness? How can their time when physieians and patients are often strangers physicians help them to find meaning in their experiences from different religious traditions and cultural baek- of illness and thereby facilitate participation in treatment grounds, physicians cannot rely on what they know of (ir aceeptaiiee of the inevitability of death? The asking illness from tfieir perstinal lives. LIteiaturc can supply and answering of sueh questions should permeate all as- full-bodied and profound accounts of illness and death in pects of diagnosis and treatment, yet medical training all places and among all peoples. Great works of litera- does not generally confer on physicians the skills that lure may be unsurpassed in their ability lo teaeh about make this possible. One rich source of knowledge about suffering, death, and the human condilion. the human experience of illness is litcrattire. Illuminating patients' experiences in the full, rieh, nuaneed particular- The Physician's Work ity seldom if ever available elsewhere, literary accounts of illness widen physician-readers' knowledge of the concrete Literary representations of tbe physician's work, written realities of being sick and enable these readers to appre- by nonphysicians as well as physicians, clarify (he many ciate their own patients' stories of sickness. roles and expectations of medicine anil thereby help read- By mobilizing the imagination, literary works engage ers to understand not only the responsibilities of [physi- the reader more tully than do clinical, socioiogic, or his- cians and fbe position of medicine within a culture but torical descriptions, even when the same experiences arc aiso the s

600 15 April Annals of Inlemal Medicine Volume 122 clinical implications of the physician's work (44-46). Be- Narrative Knowledge cause Ihe creative writer is often at the forefront of a culture's awareness, literaiure often heralds the under- When a physician meets a patient in the office or at ihe standing of new crises in medicine sueh as the acquired bedside, the patient lells a complex and many-staged immunodeficiency syndrome or the threat of nuclear war story. Using words and gestures, the patient recounts the (47, 48). events and sensations of the illness while his or her body Physician-writers sueh as Anton Chekhov, William Car- "tells"—in physical findings, images, tracings, laboratoiy los Williams, Walker Percy, Richard Selzer, and Oliver measurements, or biopsies—that which the patient may Siicks write with great insight about medicine. Chekhov's not yet know. If Ihe patient is a hesitanl or chaotic "Ward Number Six'" describes the inner conflicts of Dr. narrator, the physician has to be an especially alert lis- Ragin, simultaneously the paralyzed idealist and the ni- tener, leaning forward to grasp the point, to till in the hilistic stoic (49, 50), Williams's short stories about a blanks, to hear the story to the end, so that he or she can smaiMown general practitioner capture the contradictions then group the data into testable hypotheses. Evaluating of the physician's work with scathing accuracy (51). Per- paiienis requires the skills that are exercised by the care- cy's The Moviegoer follows the course of one troubled ful reader: to respect language, to adopt alien points of young man on his way to deciding lo become a physician; view, to integrate isolated phenomena (be they physical the story delineates not only the personal conflicts but findings or metaphors) so that they suggest meaning, to also the larger cultural issues that arc often involved in organize events into a narrative that leads toward their this choice (52). Oliver Sacks, in Awakenings, describes conclusion, and to understand one story in the context of the investment of physician and patient in a "miraculous" other stories by the same teller (61-64). cure (53). Physician-writers frame the events and emo- To make sense of clinical information, physicians rely tions of medicine in ways that lead physician-readers lo on skills that belong to the narrative sphere of knowledge. examine critieally their own intimate and complicated re- Unlike logieo-scientiiic knowledge, narrative knowledge lationships with their work and with their patients. configures singular events befalling human beings or hu- man surrogates into meaningful stories (65), If newspaper The teaching of such works to physicians and medical stories, myths, folktales, and novels are examples of nar- students achieves a critical goal in medical education: It ratives, then the events of illness are, in a manner of allows physicians and students to examine what they do in speaking, narratives, as are the written and oral descrip- medicine and what medicine has done to them. During a tions of these events (66). eiass on ''Ward Number Six," one interni.st found herself The humanities and the social sciences have taken a agreeing with Dr. Ragin's cyniei.sm but identifying with his narrativist turn during the past two decades, during which patient's insistence on compassionate eare, thereby show- scholars and practitioners of widely various disciplines ing Ihal her own occasional pessimism did not rule out a (literary criticism, history, sociology, and anthropology) siniultane

15 April Amials of Internal Medicine • Volume 122 • Number H 601 recognized io rely in ptirl on [larniiivc ways of knowing; tu ethies presents the iiuhvitlual events ul illness, in all The Ucvciopnicnl and confirmation of" scientilic hypothe- their contradictions and mcaningluhicss. tur iiitcrpreia- ses arc; guided hy plot and intention (78). Much uf [hu tion and understanding (98-l(lf))- physician's day is spent in telling or listening to stories— C^iiling forth the moral as well as the clmical imagina- not only at the bedside but at attending rtnmds, in grand tion, literature leads physicians k> coiifcxtuahze and par- rounds, in cnrbsiUe consults, in referral letters. These ticularize ethical Issues in health care, "ihe nicthuds ihat presentations and re-presentations of cases allow physi- are uftcn called narrative ethics center the exaniinatiun oi' eians to think through the facts and then to choose. ethical dilenmias squarely in the patient's lite (lOi. 1(12). Justify, ynd evaluate clinical actions. Devoted entirety tu Narrative ethics ulfers the kind of knuwing that the Ger- narrative and medical knowledge, a recent issue of the man neo-Kantians called Vcrslelicn—a ptnvcrful, concrele, journal Literature and Medieine reports on narrative rich sense of the Teelings. values, beliefs, and interpreta- projects in patient care and teaching ihaE span activities tions that make up the aclual experience of liie sick from hospice work tu residency training in anesthesia to person (103. 104), Like casuistic arid phcnumcnulogic ap- psychotherapy (79). pritaches to medical ethics, narrative ethics places mural Literary activities help physicians to develop and dilemmas within the framework uf a patient's culture and strengthen their narrative skills. Reading fiction or poetry biugraphy. allowing physicians to ask such questiuns as exercises the pattern-finding and meaning-making opera- "In the face of this life, what constitutes a goud dcaUi?'" tions that lead to apt clinical evaluation. Reading puts into play the mental and creative acts of imagination and The practice of narrative ethics ainis tu prevent the interpretation, reinforcing subtle competencies of empa- deveiupmcnt o!" ethical quandaries by building intu med- (hy and respect (80-85). Writing in narrative genres ical care a fully articulated reeugnitiun uf the mural di- about patients exercises the clinical imagination and taps mensions of the patient's actual life, t'thical municnts ink) deep personal sources of knowledge about patients occur not only in neonatal intensive care units or in and what ails them (86). Medical students in several heart-transplant suites but aiso in the urdinaiy. eveiyday schools arc asked to adopt their patients' voices when events of primaiy care medieal practices (108-110). A writing Ihe history of preseni illness as a means to expe- hallmark of the practiee of narrative ethics is the devel- rience, albeit vicariously, that which the paticnf is going opment of a longitudinal understanding of patients' values through (87-90). Experienced physicians, even those who and beliefs that relies when necessaiy (in home \isits, are not professional writers, have begun to value their extensive life histories, and detailed discussions with fam- own writings about their practices. Such journals as An- ily members and caregivers. Narrative skills am help the nals of Intemai Medicine, .lournai of ihe Ameriean Medieal clinician to be sensitive to moral questions as they occur. Association, .lonrnal of General Internal Medicine, and !o integrate questions about values and beliei's intu the Ameriean Jotirnal of Medicine and many of tbe journals of routines of medical care, and to make ct)iitact with ihe the state medical societies publish physicians' personal euiiflicts. tragedy, hnmur. iruiiy. and ambiguity ihal cuu- rellections about their practices. In ail of these ways, iribnte to each human life. physicians and students have discovered that allowing Literary studies contribute both texts and methods to their inner knowledge to achieve the status of language the practice uf narrative ethics. Teachers of ethics have teaches them something of clinical value about their pa- found literary narratives tct be unequaled by other so- tients or their practices, something that might otherwise cailed ethics cases in the classroom. For example, texts be ignored (9]~93). frtim elassieal drama, 19th-eentuiy realist (ictiun, and con- Narrative knowledge offers physicians self-knowledge as temporary short stories have been able tu immerse stu- well as knowledge of their patients. Many uf the current dents in the particularity of moral conllict, providing the challenges in medicine stem from physicians" inabilities to compelling pull uf the storyteller's verisimilitude within a live up to their own professional goals and ideals. Disil- fully rendered universe (1)1-113). Richard Seller's shurt lusioned and exploited, and feeling betrayed by the pro- story "Mercy" can stand as an example. In this talc, a fession, some physieians advise their children not to be- physician cares fur a icrminally ill patient in great pnin. come doctors and seek ways of leaving their own practices The patient wants to die and his family even asks, di- (94). Increasing self-knowledge through narrative can help rectly, that he be released from his misery. When a Ictha! these physicians to recapture their own satisfaction with dose of morphine fails tu bring about the patient's death, their practices (95). By helping physieians to recognize the physician cannot bring himself tu do anything further their own aifective selves, reading and writing can reorient tu cause his patient to die. Reading this stor)' brings out physicians toward the generous goals of service and ded- the emotional and professional conflicts that beset all who ication for which they entered the medical profession. care for dying patients (114). In addition tu schooling students and physicians in the legal and professional lim- its un the termination of treatment, serious reading of Narrative Ethics such stories augments a comprehension of all that is at The recognition of the importance of literature to med- stake—inteileetual. legal, existential, spiritual—in such sit- icine has contributed a new approaeh to the practice of uations. ethics (5, 96, 97). Physieians must know the principles uf Perhaps more fundamental to ethics than individual medieal ethics; they must also learn to surmise the texture literaiy texts are literature's methods. Where does the of a patient's life in all its moral complexity. Alone, the mural sense reside if not in the creative faculties? Attune- analytic approach to ethies reduces human conflicts to nicnt to the right and the good is attained by imagina- rational problems to be solved, but a narrative approach tively rendering, for oneself, the situations of others. Lit-

602 15 April 1995 • Annah of Intemai Medicine • Volume 122 • Number 8 crary scholars writing in ihe tradition of ethieai criticism For example, the clinical case history has recently been examine the morii! consequences of serious reading, and the subject of literary examination that calls attention to Ihcir Iindings speak to the medical ethicist. The relation- conflicts between the physician's and the patient's per- ship between a reader and a book—any book—implicates spectives, the chorus of voices that speak in a hospital the reader's values, beliefs, and will. A book—or, in a chart, the unforeseen limitations imposed by writing in medical context, a case—draws forth from the reader his the genre of the medical chart, and the similarities be- or her capacity to be changed by an encounter with the tween case presentations and other literary forms, such as unknown and challenges the reader to measure up to ancient bardie performances (132, 133). Rigorous exami- another's mode of comprehending the w{)rld (i 15-117). nation of physicians' narrative practices ean teach singular Medicine and bioethics can benefit directly from literary lessons about clinical detachment, presumed omniscience, insights into the confrontations between strangers over and the performance of diagnostic, prognostic, and ther- questions of goodness, justice, and the right things to do. apeutic tasks (134-136). Analytic forms cannot contain the ambiguities and sub- The feminist methods for understanding the woman tleties of meaning that arise in the moral life: literature is writer apply wilh great force to the narratives of patients, belter able to capture the complex resonance of human which are often told from a nondominant position (137). choice and human desire (118, 119). The practice of any Feminist studies offer thoughtful models for examining clhicist includes the tasks of formulating a case and in- submerged stories and silences within texts; such exami- terpreting it, and this requires the exercise of narrative nation is the very challenge facing physicians and linguists skills and even of literary capacities (12U}. As clinicians who study the oral transactions of medicine (138). The seek sustained and sensible means of arriving at fitting application of feminist literary methods to physician-pa- outcomes to the dilemmas of care, literary texts and tient interactions grants the investigator proven research methods can illuminate the nature of moral reasoning and methods and a rich tradition of understanding of tales of can serve as valuable guides for individual and collective suffering and celebratory joy (139, 140). ethical behavior (121). Although seemingly leagues apart, the practices of the psychoanalyst and the physician adopt similar methods and can be examined using similar means. Sigmund Literary Theory and Medieine Freud's case histories have never been surpassed in their In addition to the contributions of narrative theory and breadth of diagnostic creativity and depth of psychother- ethical criticism, several schools of literaiy theory address apeutic consequences, and the literary study of them has problems faced by physieians and can help them to un- unearthed fundamental features of the sick role and the derstand the texts and work of medicine. ReaJcr-rcsponsc therapeutic presence (141. 142). The relation of analyst to criticism, dcconstruetionism, feminist studies, and psycho- analysand forms the very center of analytic therapy. Phy- analytic literary crilicism, among other sehools of thought, sicians arc well served by attending closely to their trans- have shown direct practical and theoretical benefits for ference and eounter-transfcrcnce relationships with patients; the physician. doing so bolh increases their therapeutic effectiveness and Reader-response critics examine the acts of reading to maintains their own emotional health. Studies in psycho- understand the complicated and often uneasy "colleague- analytic literary criticism highlight these therapeutic as- ship" between a text and its reader. No longer satisfied pects of Freudian, neo-Freudian, and Laeanian theory by witb the New Critics' assertion that the meaning of a text reflecting on literary works and clinical cases (143-145). is a static feature of the words themselves, theorists such Recent interest in the autobiographical aspects of medical as Wolfgang Iser, Jonathan Culler, Norman Holland, and treatment testifies to the applicability of Freud's "talking Jane Tompkins examine the role of the reader—his or cure" not only to neurosis and hysteria but to the treat- her associations, memories, character traits, and life ex- ment of somatic illness and ordinary medieal disease (2, periences—in making the meaning of a text (122-125). As 41). physicians face patients, they, too, respond as would any reader to the complexity of a presentation, filling in gaps Diseussion in knowledge with highly individual surmises born of their own memories and associations (126, 127). Such findings How do we know that teaching literature to physicians about physicians' reader-like behaviors can only lead to and medical students works? Outcome studies of litera- more accurate receptions of patients' stories by turning ture and medieine courses have examined students' course physicians' unconscious reflexes into conscious and there- evaluations, post-course interviews and questionnaires, fore fully available resources for deeper understanding. and I'aeuity members' assessments and have shown that Medicine turns out to be an "interesting case" for the such courses improve students' understanding of patients' deconstruetionist scholar who studies the oral and written experiences, enrich students' capacities for dealing with transactions of medieine and, by extension, the actual ethical problems, or deepen students' self-knowledge in practices that constitute medical care. Using methods in- clinically relevant ways (22, 83, 88, 111, 146). All of these troduced by Jacques Derrida and Paul de Man, the de- researchers assume that literary knowledge extends be- construetionist looks between the lines of texts, suspicious yond that whieh ean be tested into life-long alterations of that any external coherenee hides inner chaos (128-131). the learner's modes of perception and understanding. In- Sequestered in sueh ordinary medical texts as the hospital dividual physicians describe these influences when they chart or the referral letter can be found evidence of attest to the improvements that slowly accrue in their scientistic assumptions, class and race biases, power rela- practice over a career of reading, writing, and listening to tionships, and unforeseen eonsequenees of medical care. their patients (29, 84, 86, 147).

15 April 1995 • Annals of Internal Medicine • Volume 122 • Number 8 603 Nevertheless, longitudinal outeome researeh is needed. Hawkins AH. Reconstructing Illness: Studies in Palhography. West Students and physicians should be foiiowed over pro- Lafayenc. Indiana: Purdue University Press; 199,^ Kleiaman A. The Illness Narratives: Sullering. Healing, and the Hu- longed periods of time to doeument the ways in which man Condilion, New York: Basic Books; I9SS. enhanced narrative knowledge and skills might alter and Brody H. Stories of Sickness, New Maven: Yale University Press; improve clinicai practice. Such research will inevitably be 1987. Coles R. The Call of Stories; Teaching and the Moral Imaginitlion qualitative rather than quantitative in method, for educa- Boston: Houghton Mifflin; 1989. tion in literature does not typieally result in universal, Peabody FW. Doctor and Patient: Papers on the kelalionship ol the replicable ehanges in behavior at generalizable points in Physician to Men ;md Institutions, New York: Macmillan: 1930. Casscll EJ. The Healefs An. Cambridge: MIT Press; 1985. Eime after an intervention. Not unlike numerous oUier Arnold M. Litenilure and science, ln: Discourses in America. Lon- clinical skills-—for example, the abilities to assess quality don: Macmillan: 1889:72-137. of life and to express empathy—the effects of teaehing Snow CP. The Two Cultures and the Scientilic Revolution: The Rede Lecture, 1959. Cambridge: Cambridge University Press; 1959. literature in medical schools may defy quantitative mea- Trilling L. The Leavis-Snow controversy. In: Beyotid Culture: Essays surement but may nonetheless be regarded as important on Literature anti Learning. New York: Harcourl Brace .lovariovich; contributions to medical effectiveness (148, 149). Because 1965: 126-54. literary methods may help to answer rising demands for Bishop MG. 'A new cageful of lerreisl'-mcdiciae and Ihe "iwo cul- tures' debate of the l'»5Us |F,i.iilorial!, J R Soc Med, 1991;84:637-9. improving humanistic behavior in physieians and address- Trautniann J. The wonders oi literature m medieal educalion, Mo- ing the personal, cultural, and moral lives of both patients bius, i982;2;23-3i. and their physicians, they must be evaluated along with Rabuzzi K, ed. Toward a new discipline. Lit Med. 1982;! Trautmann J, ed. Healing .Arts in Dialogue: Medicine and Literature. other reeent changes in medieal training. Carbondale: Southern Illinois Universiiy Pres:,; 1Q8L Wear D, Kohn M, Stocker S, eds. Literature and Medicine: A Claim for a Discipline, P[oceedini;s of the Northeastein Ohio Universities Conclusions College of Medicine's Literature & Medicine Conference, May 1984. Mcl^an, Virginia: Society lor Heallh and Human Values; 1987. Jones AH, ed. Tenlli anniversary relros peel ive. t.it Med, !991;ILl, The study of literature accomplishes several goals for Jones AH. Lileraiure and medicine: traditions and innovations In: medieine and medical education. Reading literary works Clarke H, Aycock W, eds. The Body and ihe Text: Comparative and writing in narrative genres allow physicians and stu- R.ssays in Literature ;iiid Medieine. ! iihhock, Texas: Texas Tech University Press: 1990:11-24. dents to better understand patients' experienee and to Baker NJ. Literary medicine. Minn Med, !99O;73( I I ):I9-2O. grow in self-understanding, and literary theory contributes Porter WG. Medicine and literature. N C Med J. 1993;54(2):96-4 to an ethieal. satisfying, and effective practice of medieine. Ri,sse GB. Literature and medicine [Editorial], West J Med, 1992; We hope that the introduction of literature and of literary 1.^6:431. Triliing 1.. On the teaching oi modern literature, in: Beyond Culture: studies to medicine will allow physieians to more accu- Lssays on Literature and Learnuig. New York: Harcciurt Brace Jo- rately render the lives of their patients and to recognize vanovich: 1965:3-27, the human dimensions of all of the experiences that occur Hillings .JA, Coles R, Keiser SJ, Stoeekle Jl). A seminar in "Piain within their gaze. Together, medieine and literature can Doctoring," ,1 Med F.due, 1985;6(l:855-9, Loughnian C. Meeting the dark: aulobiography in Hawthorne s un- modulate the potentially alienating experiences of illness linished tales, Crerontologist, iW2;32;726-32, and doctoring into a richer and more mutually fulfilling Kohn M. Donley C, Wear D, eds. Literature and Aging: An Anthol- ogy, Kent, Ohio: Kent Stale University Press; I'J92, human eneounler that better brings about healing and Ozer IJ. Images of epilepsy in iileralure. Lpilepsia, 1991:32:798-8119. alleviates suffering. Wear D, Nixon LL. 'Scoot down to ihe edge of ihe tabk. hon : women's medieal experiences porlrayed in lileraiure. Pharos, 1991: Gninl Support: In part hy ihe Heiir>' J. K;iiser I'araily I'buncialiun i-aculLy Scholar Award in General Internal Medicinu {l')89-iW2; gr;inl no. KidstT Hawkins AH. Charling Dante: the Inferno and medieal education, Lii CU504920U]) awarded in Dr. Charcin and the Kaiser Narralive-in-Mcdi- Med, l992;il:2(IO-15. cine Circle, during whose meeiings this paper was conceptualized and Christian RF. The later stories. In: rolsloy: .\ Critical introduction. wrilttin. Cambridge: Cambridge University Press: 196'). Connelly Jli. Ihe wli"ole story. Lil Med l9W:9:t.S)-61. Reqiiem lor Reprints: Riia Charon, MD, Dt-puriment oS Medicine, College Banks JT. Dealh labors. Lit Med, |99O;9;I6:-7I. of Physicians ;ind Surgeons of Columbia Llnivcrsilv. 622 West 168th Sireel. 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