Articles, Blog

Why Medicine needs Literature | Maryam Golafshani | TEDxUniversityofStAndrews

January 3, 2020

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)


  • Reply Lenny Susskind July 16, 2016 at 9:36 am

    What a ridiculous speech. Arts and humanities can vanish completely. No one has time for that, it does no good. Why waste doctors' valuable time learning garbage? Stupid English literature student, what a waste of space.

  • Reply Jay Rich July 16, 2016 at 2:40 pm

    I'm sorry I fell asleep mentally and with my eyes open, so what's your point?!

  • Reply John Flynn July 16, 2016 at 4:34 pm

    Arts and humanities are a valuable asset to medicine, especially in regards to ethics and diagnosis. If a doctor is not trained in literary analysis he/she will not be able to critique the patients history beyond that of just understanding the words. As doctors hold the lives of patients, they must dig deeper and understand the underlying meaning of patient's history to correctly diagnose them.

  • Reply ununoctiumamor July 16, 2016 at 6:04 pm

    This is nothing new. In India, the first thing they teach when we enter clinical years is to take patients history. My prof always insisted that patient history (story) alone can help in speculating the diagnosis 70% of times!

  • Reply Thistlebug July 17, 2016 at 8:41 am

    You look like a mouse who snuck on stage. No public speaking ability with zero charisma. Maybe the content will make up for it …… lol
    Words have power blah blah blah every stupid regressive liberal is obsessed with micromanaging language believing it will bring about paradise on earth.

  • Reply Jgigas July 18, 2016 at 1:28 am

    She's hot as hell.

  • Reply Dr. Ramona Hyman January 3, 2018 at 12:32 am


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