The Narrative Link:
Stories in Medicine, Psychoanalysis, and Creative Writing
The first thing that I would like to muse on today is how narrative is vital
to all of our separate endeavors—medicine, psychoanalysis, scholarship,
writing, of course. That’s not really a new argument to those of us here,
though we continue to have to argue it outside of this interdisciplinary rubric,
and so, although I can’t leave it behind, there’s another issue
I’d like to try to get at a little bit as well. We label our interdisciplinary
work in a number of different ways: Medical Humanities, Literature and Medicine,
Literature and Illness, Cultural Studies of Medicine, CS of Health and Illness,
the list goes on—and perhaps we are best thought of as working in a variety
of overlapping fields. But one of the things that has fascinated me since I’ve
been involved in this world has been the ways in which conversations so often
return—over and over again—to the question of what the humanities
can do for the practice of medicine and the training of physicians. All very
well and good, and I want to emphasize that I do not mean this commentary as
critical, but from my position—as a humanities scholar, as a writer, as
a patient—I have begun to wonder why I am drawn to this work. I have been
needing to come to grips with this issue in order not to feel like something
akin to a trophy wife—lovely and even needed to make life complete, but
not the main point and, in fact, not an equal partner. I have had so much to
offer in this “relationship,” but what am I getting out of it? In
other words, I understand why physicians, nurses, and psychoanalysts are drawn
to the use of narrative frameworks and awareness with their patients and as
a form of stress relief for themselves, but what does medicine do for a humanist?
So, those are the issues that inform my comments here. I only have a few stories to tell—and the connections between them may not all be clear, but I believe they resonate, and they have certainly helped me reaffirm my own interest in the healing arts, though I am not a physician, psychologist, or nurse, not even a shaman or a priest.
Each of us as individuals and the types of work we each do all fall somewhere
along a spectrum between two contrasting impulses—the impulse to tell
a story and the impulse to measure or theorize, between the particular and the
abstract. Each of these impulses has its own form of power—nothing moves
us quite like the tale of one person’s experience complete with vivid
details, and yet the patterns of numbers often give us vital information, the
story of phenomena that cannot be seen with the naked eye as you stand on a
street corner in Manhattan. Each without the other creates a form of blindness.
And yet, we live in a time when the quantifiable, countable, and statistical modes are vastly privileged and the meaning and significance of storytelling are contested in a variety of ways. This may be more obvious in the realm of medicine, where, during the past twenty years, traditional Western medicine has shifted its focus to verifiable, testable symptoms and away from doctor-patient conversations in diagnosis and where mental health treatments have turned from psychoanalysis to pills. But this trend is also strong in universities in general and in humanities programs and English departments more specifically, where we have shifted attention and resources from literature to theory (i.e., philosophy) and cultural studies, and where we have been increasingly asked to provide quantitative data for the claims that we make and for the results of our teaching. Even in what is usually thought of as the stronghold of narrative, the legitimacy of stories is constantly on the line.
I want to be clear that I don’t think there’s anything wrong with bloodwork, with SSRIs, or with Foucault, or even with professor accountability; they have all helped me at certain points. And I also want to note that there have been counter-moves in all of our fields, too, I think: the rise of the medical humanities, the wider availability and lessened stigma of psychotherapy, and the introduction of creative writing into academic programs: all of these are movements that testify to the continued recognition of the importance of narrative. However, we all know what the general trends have been—the five-minute doctor’s appointment, the easy access to anti-depressants and other psychotropic drugs, and English departments where all students are required to read Derrida but not to try their own hand at a sonnet and where quantifiable exam questions have largely replaced essay writing.
In one of my classes not long ago, in a discussion of a short writing assignment about early memories, a student noted her childhood disappointment that she did not gain the magical powers of Wonder Woman when she donned her new, strongly advertised super-power underwear. She waited, expectant, but her days stumbled along as usual. Transformation, we know as adults, doesn’t happen that way. But, what I wondered in class, as we laughed at her anecdote, was what she had been hoping to do with her magical powers. Did she want to heal her sick mother (whom she’d written about earlier in the semester), or merely to be able to fly? Did she want to be prettier or did she want to travel the world? As her teacher rather than her friend, I didn’t have time to ask her, and classroom conversations like these often stop short. However, I am glad that I do not feel the need to reject such conversations as irrelevant to my students’ learning. In fact, I consider them vital, whether they are about childhood dreams, youthful triumphs, or adult sorrows.
In spite of the fact that students in course evaluations frequently comment that this ability to connect their learning to their personal experiences makes creative writing courses important to them, not all people approve of this as a part of our mission. A few weeks ago, I had a student come to me in tears at the end of class, apologizing for not being able to discuss a story that contained scenes of child molestation. “I could help her [the author] with some things that would make it more realistic, but I just can’t talk about it,” she squeaked out, trembling. Later, after I had talked with this student for a while and was back in the office mail room, another faculty member casually asked me how my day was going. When I told her about my student’s disturbing need to apologize, her response was, “They really need to toughen up, don’t they?”
Well, no, that was not exactly the reaction I’d had. After a moment of silence, I mumbled something and then slunk off as quickly as I could, not really wanting to share air with such a sentiment. In fact, my students telling me is in many ways a form of toughening up—coming to grips, facing what has happened, risking self-exposure. I never question the appalling statistics on rape, because they are in my office and in my classroom—as I am sure if you are a physician or a psychologist they are also in yours. Once or twice a year, sometimes more often, a student of mine will sob out or whisper to me that she has been sexually assaulted. Painful as it is, I am glad that they tell me, for I know how odd it is to feel so forever changed and to have hardly anyone else even notice. While every horrible thing shouts at us from the TV, in real life, such traumas just embarrass other people, who fear that you might want something from them, as though you might try to sue the world—or them in particular—for your rape. Really, though, all these young women want is the same thing that most everyone wants—to be seen in their reality. So, I provide them a witness; I only wish that I had a magic wand I could touch to their shoulders that would coat them in a mantle of powerful glitter, a dramatic purple cape, a glowing force field, some hallmark of survival.
And it is not just rape that I hear about. My students over the years have told me about their experiences with alcoholic parents, their own addictions, being in traumatic car accidents, having insomnia, losing their eyesight, getting tubal ligations, having babies, and having abortions, and they have written in essays about suffering from seizures after a horseback riding accident, suffering from seizures after too much football, watching a relative suffer from multiple sclerosis or Alzheimer’s or schizophrenia, watching a sister killed by a hit-and-run driver in front of their eyes, learning of a brother’s suicide, witnessing a friend’s murder, discovering that their parents allowed a disabled sibling starve to death, starving themselves, cutting themselves, having their husbands leave them when they got breast cancer, leaving their husbands when they got breast cancer, losing a friend to a drug overdose, and, perhaps most horrible of all, losing a daughter to a drug overdose that the fourteen-year-old’s father had provided and then slept through. It has never once occurred to me that they need to toughen up, as they seem pretty tough already. It seems pretty clear that what my colleague meant was that she doesn’t consider it her job to be faced with such unpleasant stories.
And this is where I get back to that link between medicine and the humanities and that question of what it is that the “medical humanities” do for me as a humanist and a writing teacher. I’m sure, again, that the list of things my students have talked and written about in my courses is very familiar to physicians, nurses, and psychologists here. We have all heard these stories. Probably, though, among the general population of physicians, psychologists, and writing teachers, only the psychologists have sought out the details and listened patiently to these horror stories. Physicians and nurses have concentrated on healing the physical damage, and writing teachers have often drawn discussions away from the therapeutic aspects of these confessions lest they overwhelm the artistic endeavor.
Sometimes, indeed, I find myself on thin ice, worrying that I am not a priest or a psychologist and that it is “not my job” to listen to and read these endless tales of trauma. This has been an issue for me for quite some time. In 1999 I published a memoir about growing up with diabetes, and for a while I was frequently asked to lead writing seminars for patient groups. Because of my fear of confusing art and therapy, I almost always said “no.” I envisioned myself sitting in a group of ill women and wanting to say, “Well, I’m sorry you are dying of breast cancer, but your poem stinks.” In addition, I didn’t want to be practicing therapy without the proper expertise, and I didn’t want to have to contend with accusations that I was. For many years of teaching writing and of hearing student confessions, I had mostly said, “I hope you are getting professional help.”
Mind you, I still say that to my students who confess, in person or in writing, their difficult experiences. At the beginning of each semester, I announce to my creative writing classes that we may be opening some cans of worms, and that if anyone is disturbed to let me know. I keep all the university brochures on medical, psychological, and crisis services handy, and I make referrals, as well as recommending parents as a source of support and wisdom. But I have also come to realize that these stories have existed long before and exist far outside of the professional purviews to which we so often banish them. Most of my students who write about trauma are, in fact, already under the care of a psychologist. Often, that therapy has allowed them to move to a stage where they are willing to be more public about what has befallen them. Often, my class is the next necessary step in the healing process.
And so I am coming to the conclusion that while a physician provides the means to physical healing, and while a psychologist provides new ways of looking at and dealing with life events, one of the most important things that creative writing teachers do is to provide a forum for witness to students’ personal lives. From this follows the activity of shaping and re-shaping experience through writing, a means of personal as well as intellectual transformation of both events and self. Often, they learn to write—and even to speak in class—about what has happened to them, sometimes they transform its meaning in this process, sometimes they even influence how others think about statistics, and sometimes I see them develop power over their own victimization. Maybe I do have a magic wand after all, and maybe, just maybe some of my students will find their own glitter, cape, or force field.
This is why most people who write, write. This is why so many students continue to flock to creative writing classes even though there will be nothing they can do with it after graduation. It is why physicians and nurses find writing such a helpful technique to recommend to suffering patients and to each other in their stressful lives. We all write, in a sense, in order to tell the world about our rapes and in order to change their meaning in our lives. We all write in order not to be merely a statistic, though most of us are well aware that we are that too in whatever context.
But is it art?
What I began to notice after some years of teaching both fiction and nonfiction creative writing is that students who write about terrible personal trauma usually are doing the highest quality writing that I am getting. This is by no means universally true, of course, and I have had students win awards for a humorous fictional piece about making movies and an essay about politics. But what moves us all the most, and the subjects about which students in general write the most carefully, precisely, vividly, and compassionately are the ones about their mother’s multiple sclerosis, about the experience of a seizure, about lying on a couch after chemo with one’s husband leaving town for a conference, about seeing a sister be run down by a car.
This brings me around to what medicine can do for the humanities, or at least what it as an intellectual concern does for me and my work. In an academic world where the drama tends to be rather tame as compared to that in an emergency room, it legitimizes for me those powerful issues of life and death. It reminds me that those issues are not merely the bizarre and unusual complaints of neurotic and negative individuals, but rather the common, everyday center of the human struggle. In a society where the cheerful sound-bite and the positive spin are the sine qua non of communication, my link with the medical world keeps me devoted to what I would call “reality.”
And this in turn, I think, comes back around to why storytelling is important in all of our fields, even as they exist separately. Our era is one of the beautiful illusion. As a society, we find it easy to turn away from what is painful, and we do so by many means and with the support of some important realities. Life expectancy is longer, poverty is on the other side of the globe—or at least the other side of town, liposuction and exercise will eliminate unsightly aging, George Leary has been frozen so that he can ultimately live forever. It is, however, also important to allow for, to link to, to remind people of the physical and emotional truth of all human experience, including illness, disability, death, and sorrow.
Let me tell you about a relevant recent controversy in the literary world. Just a couple of Sundays ago, the New York Times reviewed the new novel by Nobel-winner J. M. Coetzee, Elizabeth Costello, and with astonishment, I report that the reviewer made it out that Coetzee has argued in this book that some things should just not be written. More specifically, he gives his title character, a writer and critic herself, an obsession with a real, living writer, who happens to be my old writing mentor, Paul West. (Just to acknowledge my personal loyalty and my heritage here.) Costello delivers a ferocious critique of one of West’s real-life books, in which he describes a scene of torture and execution in great detail and she concludes that this is “[o]bscene because such things ought not to take place, and then obscene again because having taken place they ought not to be brought into the light but covered up and hidden forever in the bowels of the earth.” In the weeks after the novel first came out, this passage was widely quoted and widely interpreted as though Coetzee meant it literally.
Now, I have since read the novel, and I think that the reviewers are mostly just poor readers trying to create a tempest in a teapot—what Coetzee was up to was clearly much more complex—but none of the reviewers quoted the passages in which his character states that West’s book was also the most brilliant and only interesting one she had read in years. Nonetheless, it is a strange thing for a Nobel-Prize-winning writer to say, and in its literal form it bears contradicting. Such an attitude reveals a willingness to hide in a privileged and false gentility that limits our understanding of human experience. Looking at unspeakable things and bringing them into the light is an unavoidable duty of physicians, nurses, and psychotherapists. But it is also one of our very most key responsibilities as writers. That anyone would think otherwise is unconscionable.
This willingness to take a stab at curing the ills of the world, even though we know we will not fully succeed, is one of the things that ties us all together in our endeavors. And as those of us associated with the “medical humanities” understand, to do so requires an attention to narrative, to the individual stories of ourselves, our colleagues, our patients, and our students. A medicine without stories, like a humanities or a psychology based strictly on abstract theory, is blind to its own significance.
And so I return once again to an argument for the importance of narrative modes. I do not think that storytelling is a cure-all, but I do think that a lack of listening to stories is a destructive disease. And I think we also need reminders of one of the most important aspects of narrative—that it is a two-way street. With narrative there always must be a teller and a listener. This is one of the reasons that I think narrative is politically and socially powerful and why it is currently so controlled in our society and particularly in our idealistic professions by insurance-company demands for reduced patient time and increasing class sizes, among other things.
For instance—follow my chain of thoughts—it is often a lack of listening that leads to rape—“I thought she meant ‘yes’ when she said ‘no.’” Take it one step further and it is this lack of listening that leads to subterranean stories of violence that people need, but are often hesitant, to tell. I know there are complaints about the current popularity of memoir, there are comments that we live in a horrifyingly confessional age. What is odd is that this doesn’t seem to translate into ordinary people’s lives: they still live with these secrets. The published works about such topics, even the grotesque public airings on The Doctor Phil Show, don’t translate to my students’—or your patients’—lives. In fact, I think that the craving for such spectacles stems in part from the fact that for “normal” people, there is no one much who wants to listen to our less bizarre stories, and so we listen to the bizarre ones on TV instead of telling our stories to each other.
It’s not difficult to observe this same sense of distraction and lack of listening in almost every context—at the doctor’s office, talking to your kids and family members, trying to have a conversation with a friend. We are interrupted constantly, sometimes from the outside, sometimes by our own preoccupations, and this makes it hard to listen well. I notice this problem increasingly in the classes I teach—several students may protest that they didn’t hear me give the homework assignment, while several others say, yes, they did hear me give it. And it’s not like it’s the same lazy students every time—it happens to almost all of them over the course of a semester. Fortunately, they still seem to be able to quote me, chapter and verse, on any amusing, deep, and more philosophical things that I say, but in practical terms these listening gaps can be a serious pain: homework undone can a disastrous class make. I have tried various means of improving communication with my students, short of Power Point, which I think trains us to be poor listeners, and I have decided that instead of talking more loudly, I need to work on training my students—and myself—to listen. We are, after all, in writing courses, and that should be a place where people attend to words, both written and spoken, as well as spewing them out into the air and onto the page by the thousands.
We can be trained to listen, often to listen in specific modes. Last year I taught a freshman seminar for pre-med students. One of our first activities was for each student in the class to draw and then describe out loud an illness or injury experience of his own or that of a family member. Each student was paired with another, and as one told her story, the other took notes. The next class, each student brought in two written narratives—his own and that of his counterpart. As students read these written narratives aloud, it became clear that our listening skills were far from perfect—the counterparts had often misinterpreted or forgotten parts of the stories they’d heard, even though they had taken notes during its telling. What interested me most, however, was what in particular was missed. Freshmen managed very well to capture their peers’ emotional reactions, the effects on lives and family, and any long-term implications of illness and injury. What they messed up on was whether it was the left or right foot that had been sliced open, how old someone had been when he’d been in the hospital, what the first symptoms had been, which precise tests and treatments were administered. For those who eventually do become physicians, as you may know better than I do, this pattern will be almost completely inverted, through training to listen for particular types of information, and in the order prioritized in the standard format of a “patient history.”
If this is so, then, we can be trained to be better listeners in general, and this is why when my students tell me things—these truly urgent stories that they have to tell—I try to make the space in my busy life to stop and listen to them. I try to listen to young women so that they can practice their own strength of voice. And I try to listen to young men so that perhaps they will feel generally recognized enough not to need to force themselves on someone, so that somewhere in the backs of their minds will perhaps reside a belief in language and a respect for words. I do well now with talking, with telling even uncomfortable things that need to be told, even with saying the proverbial things that men don’t want to hear. I am still working on my listening skills.
It is in this very way that I think our continued struggle keep narrative central to each of our professional milieux is a political act. It is in this exchange of stories that personal transformation and healing occur, and it is in that experience that hope for wider change and the improvement of the human lot may grow. Any forces that push us toward a strictly numerical orientation is one that edges us toward the abyss of politically convenient omissions and misrepresentations, and, perhaps even worse, an acceptance of the status quo. My own mother once wrote a poem called “You Just Can’t Count on Numbers,” in which she noted that even the most objective sounding statistic can be twisted. This is true of any abstraction without an individual narrative attached. And, as Edna St. Vincent Millay has said,
It well may be that in a difficult hour,
Pinned down by pain and moaning for release,
Or nagged by past resolution’s power,
I might be driven to sell your love for peace,
Or trade the memory of this night for food.
It may well be. I do not think I would.
The ineffable does exist, we are fools who ignore it, and it is found only in our stories.