restricted access 13 The Two Cultures
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chapter thirteen The Two Cultures There is a natural hesitation and resistance against the humanities among scienti fically oriented persons, many of whom choose to become physicians.1 To them, the humanities seem not only foreign to,but also of unclear relevance to,medicine. They might even note that William Osler was neither a historian, nor a novelist, nor a poet, yet he acted the part in all these areas. And his exhortation to doctors to become humanistic, to read the Great Books—the Bible, Shakespeare, Religio Medici, and so on—all this may seem like mere nineteenth-century belles lettres, the views of an anachronistic Anglophile whose world disappeared with that same Great War that killed his only child. Though stated callously,this critique is,at root: how does all this matter to medicine ? We want to explain what is happening in the body, and yes, perhaps we want to understand the suffering of the individual human being who comes to us, but why all this biblical language and versification? Robert Coles and the Call of Stories By the written humanities, we mean literature, based on stories, and poetry, based on metaphor. So an appreciation for the humanities in medicine means appreciat- ing stories and the power of metaphor. Let’s begin with stories, a tradition well expressed by psychiatrist Robert Coles (1989). As a young resident in the 1950s, Coles was anxious to translate patient’s symptoms into theories, at that time psychoanalytic. Two supervisors contrasted. One kept trying to get him to interpret patients’ experiences in terms of theory: “What are the psychodynamics at work here?” he kept pestering the young Coles (p. 6). The other urged him to listen to the stories people were telling him: “The people who come to see us bring us their stories. . . . They hope we know how to interpret their stories correctly.” Coles reflected later: “He reminded me that psychiatrists often hover over their patients, intent on ‘getting a fix’ on them: make a diagnosis; ascertain what ‘factors’ or ‘variables’ have been at work; decide on a ‘therapeutic agenda.’ He wasn’t criticizing such routine evaluative procedures, nor did he have any dramatic alternative to them. He simply wanted to remind me that I was hearing stories all day long.” Here is the crux: Appreciation of patients’ stories does not mean that we do not make diagnoses or treat them in a biomedical manner; it does mean that we understand that sometimes all of their stories can be interpreted biomedically , sometimes some of them, sometimes none. The stories are always the starting point and sometimes the ending as well. And where can we learn to hear stories, to best interpret them, to best understand them? In the works of literature, in those classic old books by dead white men and also in newer books by multicolored authors. This realization led Coles to later teach a highly successful and prized course on medicine and literature at Harvard Medical School. Coles was heavily influenced by two physician-writers,William Carlos Williams and Walker Percy.Williams, the poet who was a pediatrician, lived the life of a busy clinician and saw many kids, treating them biomedically. His appreciation for their humanity did not interfere with his medical abilities; it only made him a better physician:2 “We have to pay the closest attention to what we say,”Williams advised a young Coles. “What patients say tells us what to think about what hurts them; and what we say tells us what is happening to us—what we are thinking, and what may be wrong with us. . . . Their story, yours, mine—it’s what we carry with us on this trip we take, and we owe it to each other to respect our stories and learn from them”(p.30).In retrospect,Coles concludes:“Such a respect for narrative as everyone ’s rock-bottom capacity, but also as the universal gift, to be shared with others, seemed altogether fitting” (p. 30). 146 What Next? The Bible To bring home the power of stories, let us think about one of the most powerful books ever written, or one might say, about one of the most influential persons in the world—the Bible. Now I do not say this based on any personal belief (I come from another tradition); I state it based as a fact that Christianity,along with Islam, is a major world religion, and that the two together comprise...