I have been a physician for 35 years and a literary critic for 14. I have gradually come to understand that the care of the sick is an art form.

Beethoven, Rembrandt, and Henry James created art. Listening to the Razumovsky string quartets, looking at a Rembrandt self-portrait, or reading The Wings of the Dove are also creative acts that transport the listener, the viewer, or reader. One mobilizes ones capacity to perceive, to appreciate, to think about, and to be moved by the music, painting, or novel so as to understand itor, more simply and profoundly, to undergo it. These acts of creative perception summon the witness into complex actions and states of attention. They admit the witness into a state he or she did not inhabit before that act of perception. The dividends of such acts of aesthetic witnessing include some new comprehension of the work itself. The dividends also, inevitably, include the witnesses comprehending themselves in a new way.

For centuries, medicine has looked to philosophy, literature, history, and the visual arts for some sort of nourishment, although it has remained obscure to many exactly why these fields have something to contribute to clinical practice. I see now that the inclusion of the humanities and the arts within clinical training permits an essential development of the aesthetic capacity to behold and to be moved by the presence of another. What occurs in beholding the work of art, I believe, occurs in beholding another person, and certainly in beholding a patient under ones care.

In 1999, I completed a Ph.D. in English at Columbia, and wrote about Henry James under the supervision of professor Steven Marcus. By the time I started graduate school, I was already an associate professor of clinical medicine, seeing patients in the medicine clinic in Presbyterian Hospital uptown. What had driven me to the English department was the happy suspicion that learning how stories are built, how they work, and what to do with them would make me a better doctor. I think it has. As I brought my humanities studies into the medical school at Columbia, the phrase narrative medicine came to mind. I leapt happily to it, for it seemed a much better name for what was otherwise called humanities and medicine or, worse, medical humanities. The name seemed to me to propose that medicine is saturated to its core with narrativityin its teaching, its research, and its practice.

By 2002, I invited several University faculty members to join me in a National Endowment for the Humanities project to figure out why narrative training might benefit clinicians. Maura Spiegel from the English department, David Plante from creative writing, Sayantani DasGupta from pediatrics, Eric Marcus from the Columbia University Center for Psychoanalytic Training and Research, Craig Irvine (a philosopher on staff in family medicine), and I taught one another about our own disciplines and passions to conceptualize why narrative theory, texts, and methods might enter into and improve clinical practice. We realized that literary and aesthetic study might let doctors see multiple perspectives, might equip them to represent and therefore perceive the complex events of illness, and might attune them to the beautiful, unusual, or awesome in their work. The curiosities developed by close reading and creative writing might dispose the doctor or medical student to attend closely to the situation of a patient in his or her care. We thought, perhaps, that doctors might be more ready to behold the mysteries present whenever a patient sits down in the clinical office to give an account of the self. We wanted to provide these doctors and students with the wherewithal to attend to, to perceive, to represent, and ultimately to make contact with the patients in therapeutic affiliation. The narrator in Wings of the Dove describes what the doctor, Sir Luke Strett, does on first meeting his dying patient Milly Theale: So crystal clear the great empty cup of attention that he set between them on the table. That was the attention we sought to develop for our doctors and nurses and social workers, the attention any sick person needs. Since then, the program has grown exponentially: narrative medicine training programs throughout the medical center, a Master of Science in narrative medicine degree program at Columbia, required courses at the medical school, international narrative medicine training workshops, outcomes research projects, and the International Network of Narrative Medicine to launch next spring.

When the clinician is equipped with narrative capacities to receive the accounts that patients give of themselves, the story is heard, the patient is beheld, the situations narrative world is entered. The participants join by virtue of this entry. The membranes between them become permeable. The doctor is moved by the situation of the patient, moved not just to feeling, but to action. And so narrative medicine begins.

The author is professor of clinical medicine and executive director of the Program in Narrative Medicine at Columbia University College of Physicians and Surgeons. She graduated from Harvard Medical School in 1978 and received a Ph.D in Columbias English department in 1999.

To respond to this professor column, or to submit an op-ed, contact opinion@columbiaspectator.com.

Created: Thursday 29 November 2012 07:24pm

Updated: Friday 30 November 2012 12:51am

More here:

When narrative and medicine collide