Untold stories; a country doctor, Ernest Guy Ceriani, going to visit his patients in the 400 miles of remote countryside surrounding Kremmling, Colorado in 1948. Photo by W. Eugene Smith/Magnum
Literature can enthuse medicine, and medicine can inspire literature. They are complementary treatments for being human
Every month or so, I see a patient called Fraser in my primary care clinic, a soldier who was deployed in Afghanistan. Fifteen years after coming home, he is still haunted by flashbacks of burning buildings and sniper fire. He doesn’t work, rarely goes out, sleeps poorly, and to relieve his emotional anguish he sometimes slices at his own forearms. Since leaving the army, he has never had a girlfriend. Fraser was once thickly muscled, but weight has fallen off him: self-neglect has robbed him of strength and self-confidence. Prescription drugs fail to fully quieten the terror that trembles in his mind. Whenever I used to see him in clinic, he’d sit on the edge of his seat, shakily mopping sweat from his forehead and temples. I’d listen to his stories, tweak his medications, and tentatively offer advice.
When Fraser began coming to see me, I was reading Redeployment (2014) by Phil Klay – short stories about US military operations, not in Afghanistan, but in Iraq. No book can substitute for direct experience, but Klay’s stories gave me a way to start talking about what Fraser was going through; when I finished the book, I offered it to him. He found reassurance in what I’d found illuminating; our conversations took new directions as we discussed aspects of the book. His road will be a long one, but I’m convinced those stories have played a part, however modest, in his recovery.
It’s said that literature helps us to explore ways of being human, grants glimpses of lives beyond our own, aids empathy with others, alleviates distress, and widens our circle of awareness. The same could be said of clinical practice in all of its manifestations: nursing to surgery, psychotherapy to physiotherapy. An awareness of literature can aid the practice of medicine, just as clinical experience certainly helps me in the writing of my books. I’ve come to see the two disciplines as having more parallels than differences, and I’d like to argue they share a kind of synergy.
Patients spend more time with a writer than they can ever spend with their physician, and the hours it takes someone to read and reflect on a book can be time well-spent. Redeployment might have eased some of Fraser’s bewilderment and isolation, but by breaking down a boundary of experience it also helped me to understand a little more of what he had been through. There are numberless other books that do the same. William Styron’s Darkness Visible (1990) offers an eloquent testimony of how it feels to suffer severe depression, and I’ve seen it give sufferers a promise and an encouragement that they, like Styron, might find a way back to the light. The list of books I’ve discussed with patients over the years is as plural as the humanity that pours through the clinic: Ray Robinson’s Electricity (2006) when talking about life with severe epilepsy; Annie Dillard’s The Abundance (2016) while exploring the place of wonder in sustaining our lives; Andrew Solomon’s Far from the Tree (2014) on the challenges of caring for a disabled child; Ben Okri’s poem ‘To an English Friend in Africa’ (1992) in a discussion of the trials and rewards of NGO work.
There are parallels between generating and appreciating lasting stories and art, and generating and appreciating healing, therapeutic encounters. Both are helped by adopting the same attitude of open curiosity, of creative engagement, of seeking to empathise with the predicament of the other, of tapping into the wider context of human lives. The doctor, like the writer, works best when she’s alive to the subtlety of individual experience, and is able at the same time to see that individual in his or her social context.
If it’s true that readers make better doctors, and literature helps medicine, it’s worth asking if the relationship is reciprocal – does the practice of medicine have something to offer literature? Certainly, the stories doctors hear take the pulse of a society. Clinicians are often confessors, bound to confidentiality and privy to a community’s secrets in the way that priests once were. More than 300 years ago, Robert Burton in The Anatomy of Melancholy (1621) equated priests with doctors when he said that ‘a good divine either is or ought to be a good physician’; the French novelist Rabelais was both…