Aesthetic Model of Literature & Medicine

Today's installment of the Lexicon will explore the aesthetic model in literature & medicine ("L&M").  L&M as a formal scholarly pursuit has only existed since the early-mid 1970s at the earliest, but I tend to think it has contributed richly to the analysis of biomedicine from a humanistic perspective.  Dr. Rita Charon, one of the leaders of the L&M movement, maintains an excellent web resource on all matters L&M at the web site for Columbia University's Program in Narrative Medicine.

Though this is a painfully crude oversimplification, L&M has featured two central models of thought in explaining the impact that a study of L&M may have on medical practitioners, and, by extension, on the culture of biomedicine in general.  Anne Hudson Jones, also a leader of the study of L&M (in the interests of full disclosure I should mention that Dr. Jones is both a faculty member at the Institute for Medical Humanities at UTMB, where I attend graduate school, and also is the Graduate Program Director), authored an excellent article (PDF) that analyzes the contributions of L&M, and succinctly explains these models.

(Jones, A.H. Narrative in medical ethics.  BMJ 1999:253-256.)

The first model of L&M (and I use "first" in the temporal, not the normative sense) is the ethical model of L&M.  As Dr. Jones notes in her article, L&M courses were introduced into U.S. medical schools based upon the notion that they could serve as a tool in teaching medical ethics.  Ibid., 254.  In addition to its curricular and pedagogical function, L&M could also serve as a "moral guide for living a good life."  Ibid.  This function of L&M is most associated with Robert Coles, whose 1979 NEJM article, entitled, "Medical ethics and living a life," advanced the idea that reading works like Sinclair Lewis's Arrowsmith and George Eliot's Middlemarch can provide medical students with lessons on the character and virtue conflicts that attend professional life as a physician.  Ibid.  The process, for Coles, is itself a study in medical ethics.

More recently, perhaps within the last 10-15 years, a second model of L&M has been advanced, termed the aesthetic model.  This model submits that L&M is not only useful as a method of teaching and reflecting upon important aspects of medical ethics, but that the methodology of literary analysis itself can have significant salutary effect on actual clinical practice.  The idea, quite simply, is that the same kinds of questions literary scholars use in analyzing literature can be of great assistance in humanizing and "ethicizing" clinical practice.  Some of these questions basic to literary analysis, according to Dr. Jones, are: "who is the narrator? is the narrator reliable? from which angle of vision does the narrator tell the story? what has been left out of the narrative? whose voice is not being heard and why?"  Ibid., 255.

The argument is that a facility with asking, and attempting to work through some of the plausible responses to, such questions, is easily translatable to the "clinical work of listening to and interpreting patients' stories."  Ibid.  The "About Us" link at the Narrative Medicine web site contains an excellent description of the theory behind and objectives of the aesthetic model of L&M:

Through rigorous and disciplined training in such narrative skills as close reading of literary texts and clinical texts, narrative writing about patients, and reflection on one's own clinical experiences, doctors can learn to attend accurately to what their patients tell them (in words, silences, gestures, and physical findings), can reconcile the multiple contradictory versions of any given clinical story, can interpret their own emotional responses to patients, can imagine robustly each patient's plight, can adopt
the patient's or family's perspective on the events of illness and-as a result of all these-can offer singularly fitting care.

I should mention here that the phrase "aesthetic model" is not the exclusively applicable term to the constellation of concepts I can give only the poorest justice to in a blog format.  The Columbia web site refers to the notion of "narrative medicine," and Dr. Jones discusses "narrative ethics," both of which, I tend to think overlap significantly with the notion of the "aesthetic model" of L&M.

Comments

[Giskin Day]

This blog is a very exciting contribution to the blogosphere. A tremendous amount of work has obviously already gone into all the linked resources. Thanks, Daniel, for providing such a wonderful nexus for medical humanities. I look forward to participating in discussions about the concepts elucidated here. It will be very interesting to compare and contrast the British and American paradigms.

For a start, so much of L&M seems to be aimed at enhancing the 'literary attentiveness' of doctors. Can the discipline stand on its own two feet outside the medical school?

[Daniel Goldberg]

Giskin,

Thanks for all of the kind words. I agree with you on the hope to get some very interesting cross-talk going on between the British and the American perspectives on the medical humanities.

Your observation on the ways in which L&M is targeted at doctors seems quite astute. In some ways, it mirrors the early days of American bioethics, which had to focus its rhetoric and discourse on the gatekeepers to the medical paradigm (the physicians).

I tend to think that is a major factor in the success of the principlist paradigm of bioethics, that the methodology and modality of bioethics were presented in a way that would (hopefully) be minimally threating, and maximally familiar, to physicians.

I wonder if, in wanting to get L&M into medical schools (and into clinical settings), an analogous kind of targeted rhetoric and discourse was needed or wished for.

Of course, as you note, L&M is most certainly a worthwhile pursuit on its own, even outside the medical school and clinical paradigms.

Again, thanks for all of the kind words, and I look forward to much blogversation.