The Medical Uses of Literacy

THE MEDICAL USES OF LITERACY CHARLES D. ARING, M.D.* What a gulfbetween impression and expression! That's our ironicfate—tohave Shakespearian feelings and (unless by billion-to-one chance we happen to be Shakespeare) to talk about them like automobile salesmen or teen-agers or college professors. We practice alchemy in reverse—touch gold and it turns to lead; touch the pure lyrics of experience, and they turn into the verbal equivalents oftripe andhogwash.—Aldous Huxley, The Genius andthe Goddess (New York: Harper & Bros.). So far as can at present be ascertained, verbal and written communication are among the talents that lift us a step or so above the other primates. The ability to make one's self understood and the effort expended on its development are obviously primary indications of human social adaptation . Historically, communication by speech preceded communication by writing; the communication of ideas through sound is the older racial practice. Therefore, speech has a more immediate access to the emotions than the written word. In the infant learning the fundamentals of communication, the opportunity is presented to observe the unfolding of this racial practice for all who want to see. His first communicant, usually mother (or nurse), is busy handing to him the tools. Much of this proceeds at a subconscious level. Mother's every gesture is accompanied by sounds or words until, usually within the second year oflife, words become associated with sights. Usually the infant's first word is "Mama" or some facsimile, the sight of mother eventually evoking the word symbol. The early process ofcommunication, while relying on all forms ofsensa- * Department of Neurology, University of Cincinnati College of Medicine, and the Cincinnati General Hospital. 439 tion, is essentially auditory. Later, under the direction of these auditory memories and associations, the infant attempts to utter things he has been learning. As learning progresses, the techniques ofreading and ofwriting are acquired. Visual symbols and those patterns ofinnervation that underlie writing are "grafted onto" an already acquired communication by speech or by sound or gesture. Ontogeny repeats phylogeny. So far as weknow, this sequence is followed by children learning any of the some two thousand languages of this earth. The child learns first to receive and then to reproduce orally his own language, sounds, and symbols and to understand them. But reading and writing present a more complicated task. First, the child learns the sound symbol for the object, then he must further associate the graphic symbol with the sound symbol. It was not so long ago in our history that this final step was not often taken, and the population generally was said to be illiterate. We can still find voluble persons among the citizenry of any large city who remain unable to do more in written communication than signify their intent with an X. Communication by writing being a later achievement, its neural organization is not so ingrained and for this reason is more readily subject to disintegrations. A well-turned literary effort represents the product of a more recently acquired function; when writing became literature, we were furnished with an index ofhigher reflective and integrative capacity. As a measure of the student—or of anyone else, for that matter—communication through sight better reflects intellectual development than communication through speech, where it matters less what is said than how it is said. But there is an equilibrium between them and, as usual, balance is to be striven for; the constructive utilization ofthe emotions surely is given the shorter shrift in education in general. To impart Huxley's "pure lyrics ofexperience" requires a meld ofemotion and reason. In our efforts at evaluation in medical education, we are not properly appreciative ofcommunication by writing. Rather, we have looked more and more to the acquisition oftechniques and technical information to tell us how our successors are coming along. Also, thereistacit consent thatstudents ofmedicine are beyond that stage in their development when written expression merits attention; I venture that little thought is devoted to this ability (or disability) in most schools ofmedicine. Students are permitted to express themselves in writing and speech and other symbols perhaps 440 Charles D. Aring · The Medical Uses ofLiteracy Perspectives in Biology...