Vol. 33, No. 5 349

Literature and the Arts in Medical Education

Johanna Shapiro, PhD Feature Editor

Editor’s Note: In this column, teachers who are currently using literary and artistic materials as part of their curricula will briefly summarize specific works, delineate their purposes and goals in using these media, describe their audience and teaching strategies, discuss their methods of evaluation, and specu- late about the impact of these teaching tools on learners (and teachers). Submissions should be three to five double-spaced pages with a minimum of references. Send your submissions to me at University of California, Irvine, Department of Family Medicine, 101 City Drive South, Building 200, Room 512, Route 81, Orange, CA 92868-3298. 949-824-3748. Fax: 714-456-7984. [email protected].

Only Connect: Musings on the Relationship Between Literature and Medicine

Helle Mathiasen, PhD; Joseph S. Alpert, MD

In the late 1960s, while in graduate humanistic arts. They resemble pleasure to those enjoying poetic school (English and American Lit- each other in their objects, effects, art. Finally, the aim of both disci- erature) and medical school, respec- and aims. The object of medicine plines is victory, however tempo- tively, we began a discussion that is the study of human life. In the rary, over death, the enemy of hu- continues today: how can one know laboratory, the medical scientist mankind. Both the poet and the the truth? Was truth only discover- uses the abstract symbols of science physician expend extraordinary able by means of controlled experi- to pinpoint the laws governing the amounts of time and energy to ward ments, or was there truth contained human organism. By the patient’s off and thus transcend death. in a Shakespearean or a bedside, the practicing physician The objective of our course in lit- Mozart concerto? translates these abstract symbols to erature and medicine is to interest This debate, carried on over fit the case of human need before members of the health professions many months, led to the formula- him/her. In one way, workers in and university undergraduates in tion of a course on literature and medicine seek to expand the limits literature and to inspire them to in- medicine that we have taught con- of human self-knowledge. Litera- crease their nonprofessional read- tinuously on three campuses for the ture, too, has the human being for ing. We use literary masterworks as last 22 years. The philosophy un- its object. The poet, using words as a springboard for discussions of the derlying this educational venture is tools, demonstrates and communi- human issues involved in the study that both medicine and literature are cates the individual’s awareness of and practice of medicine. We teach the complexity of his or her situa- this course at the undergraduate tion. Like the physician, the poet level and at the medical school. (Fam Med 2001;33(5):349-51.) tries first to grasp, then to control, The relationship between medi- the reality of the human predica- cine and literature is seen through ment. The effect of medicine when selected works of fiction. In our dis- From the Humanities Department (Dr Mathiasen) and the Department of Medicine applied is to confer pleasure by re- cussion of each work, we comment (Dr Alpert), University of Arizona. lieving pain. The poet, too, gives on the literary and medical context 350 May 2001 Family Medicine of the period to which that work reflect on the medical profession. (4) Medical ethics within the pro- belongs. Then, we consider the ethi- Suggested reading—Alexander fession. The pros and cons of loy- cal, social, and political aspects of Solzhenitsyn: Cancer Ward. This alty within the medical profession. the work as these issues relate to the novel is based on the author’s own What happens when doctors dis- study and practice of medicine, the experience as a patient in a Russian agree about diagnosis or treatment? experience of illness, death, and the cancer ward. The role of politics, What’s the definition of a “good” dying process. emotional states, and interpersonal or an “evil” doctor? To what extent Certain works of literature, espe- relationships in the daily life of the should a physician profit from the cially those written by physicians cancer hospital are clearly delin- misfortune of his/her fellow crea- or patients, offer insight into those eated. tures? Readings—Robert Lewis aspects of the art of medicine not (2) The patient experiences ill- Stevenson: Doctor Jekyll and Mr dealt with in medical textbooks. For ness. What changes occur in one’s Hyde. This short novel is one of the instance, ’s Ward 6, self-image due to illness? How does best known works of literature in a novella written by a Russian doc- the patient cope with paternalism on the world. Important questions are tor, shows the impossibility of the part of the medical profession raised, such as what constitutes an medical progress, even of effective and with feelings of powerlessness ethical experiment, and what kinds medical care, in an environment of and dependence? Denial, hostility, of scientific questions are worth pettiness, corruption, and igno- and regression in the patient will asking? rance. Solzhenitsyns’ novel Cancer sometimes be followed by accep- (5) Medical ethics outside the Ward, a fictionalized account of the tance of illness and reassessment of profession. What is the physician’s author’s own experience as a patient values. What is a “good” patient? moral obligation to society and to in a cancer hospital in Russia, dra- A “bad” one? What is the distinc- individual patients? What happens matizes the terror and helplessness tion between pain and suffering? when the physician’s conscience felt by the patient with a corrosive Readings—Leo Tolstoy: “The urges a plan of action that conflicts disease. In a lighter vein, Jules Death of Ivan Ilych.” This long with the law? How far does “Do Romain’s Doctor Knock, a French short story or short novella de- unto others as you would have them comedy, portrays the country doc- scribes the personal experience of do unto you” apply in medical prac- tor as a confidence man, using the Ivan Ilych (Russian for John Doe tice and/or research? Where do the gullibility of his community to build or Everyman) as he slowly dies of doctor’s rights end and the patient’s himself a position of money and cancer. Ivan Ilych’s isolation, even rights begin? What moral and ethi- power. Finally, Dea Trier Moerch’s in the midst of his own family, is cal issues surround the use of pa- novel, Winter’s Child, depicts the emphasized. tients and live animals in medical feelings of a group of high-risk, (3) Doctor-patient relationships. research? Readings—Henrik Ibsen: pregnant women in a Danish ma- How do doctors and patients relate An Enemy of the People. Ibsen and ternity ward. on a human level? By virtue of be- Chekhov are the cofounders of the These literary works, along with ing human, doctors can find it dif- modern theater. This play asks a others by Camus, de Beauvoir, ficult to maintain their professional simple question: “What should the Sontag, Moliere, Defoe, Ibsen, distance from the patient. How and individual do when faced with a Plath, and many additional authors when do such breakdowns in pro- serious ethical dilemma, ie, should have served as the basis for our fessionalism occur, and what posi- the good of the community take course over the years. Some of our tive or negative consequences do precedence over the good of the in- best-known authors were also phy- they have for the doctor-patient re- dividual? sicians who recognized the value of lationship? Should the doctor tell (6) Physicians as literary artists. medical practice as a rich source of the truth to a dying patient? Read- How do physician/ manage material for writing. Examples in- ings—Anton Chekhov: “Ward No. to pursue their dual professions as clude , Anton Six.” This short story by the world’s writers and doctors? How do the Chekhov, and William Carlos Wil- best known physician- de- two professions impinge on each liams. scribes an intellectually lazy physi- other? How can each profession Selected examples of topics dealt cian at a provincial Russian county benefit from the other? Readings— with are: hospital. Eventually, the wheel comes William Carlos Williams: Selected (1) Changing attitudes toward full circle, and the physician, Dr Rea- poetry and prose. William Carlos physicians and their therapeutic gin, finds himself a patient in his Williams was one of the marvels of endeavors from the Renaissance to hospital’s psychiatric ward. Only then our profession during the 20th cen- the present. Representative authors does he truly empathize with the tury. He had two full-time careers such as Moliere, Romains, and patient’s experience. as a practicing physician and a Solzhenitsyn ridicule, criticize, or writer/artist. He wrote novels, poems, Literature and the Arts in Medical Education Vol. 33, No. 5 351 and short stories and was a painter typhus have played important roles the interaction of human values and as well. He won a Pulitzer Prize for in art and history. Readings— scientific achievement. Many of our his poetry. The themes for many of Albert Camus: The Plague. This students and physician participants his poems and short stories are work is a personal favorite. Dr have felt that this intellectual exer- taken from his experience as a phy- Rieux battles insurmountable odds cise had an important and enlight- sician during the great depression. as an epidemic of bubonic plague ening effect on their lives and on (7) Literature inspired by dis- devastates his city, Oran in colonial their careers. ease. Bubonic plague, above all French Algeria. His response to this other diseases known to us, has cap- catastrophe is “to do his job as it Corresponding Author: Address correspondence to Dr Mathiasen, University of Arizona, Humani- tured the imagination of writers, ought to be done.” ties Department, Harvill Building, PO Box from Boccaccio to Camus. Plague In conclusion, the course on lit- 210076, Tucson, AZ 85721. 520-621-1235. epidemics have changed the course erature and medicine has provided [email protected]. of history. In addition, leprosy, an important forum for students and syphilis, tuberculosis, typhoid, and physicians to learn firsthand about

Selected Bibliography, Literature and Medicine

1. Trautmann J, Pollard C. Literature and medicine: topics, titles, and notes. Philadelphia: Society for Health and Human Values, 1975.

2. Mathiasen H, Alpert JS. Medicine and literature in the medical curriculum. JAMA 1980;244:1491.

3. Davenport WH. The good physician: a treasury of medicine. New York: The Macmillan Company, 1962.

4. Ceccio J. Medicine in literature. New York: Longman, Inc, 1978.

5. Moore AR. The missing medical text. Carlton, Victoria, Australia: Melbourne University Press, 1978.

6. Ober WB. Boswell’s clap and other essays—medical analyses of literary men’s afflictions. Carbondale and Edwardsville, Ill: Southern Illinois University Press, 1979.

7. Peschel ER. Medicine and literature. New York: Neale Watson Academic Publications, Inc, 1980.

8. Trautmann J, ed. Healing arts in dialogue—medicine and literature. Carbondale and Edwardsville, Ill: Southern Illinois University Press, 1981.

9. Rabuzzi KA, ed. Literature and medicine, volume 1, 1982; volume 2, 1983. Albany, NY: State University of New York Press.

10. Cousins N, ed. The physician in literature. Philadelphia: The Saunders Press, W.B. Saunders Company, 1982.

11. Sandblom P. Creativity and disease—how illness affects literature, art, and music. Philadelphia: George F. Stickley Company, 1982.