Physical Diagnosis and the Arts

When a colleague heard last month thata book of my poems and drawingshad just been published,¹ he askedwhat, if anything, these pursuits hadto do with physical diagnosis. Surprisedat his response, I set about trying to articulate whyI see the arts as essential spiritual nourishment for all ofus in medicine.Poetry celebrates life. So, on good days, does thepractice of medicine. In drawing, mere recording is notthe critical element: if it were, photography would haveeliminated the need for painting. Rather, the artist'sunique attributes form his or her individual creative responseto the subject. The sketch does more than depictan image: it expresses the artist's personality.If this echoes something half-remembered, I believeit is the analogy from psychiatry: the therapist is not anautomaton but rather a vulnerable second human being inthe encounter. The same applies in "regular physical illness"as one unique person tries to heal another.² Theclinician, even if self-effacing, is inseparable from the patient'srecovery--or, for that matter, deterioration. Thefact that, under layers of scientific detachment and objectivity,we are impressionable human beings also meansthat patients can get under our skin. Psychiatric nomenclatureacknowledges this phenomenon in the termstransference and countertransference.Poetry represents a sharing of feelings. It is therapeuticto the writer as well as to the reader. In trying tosay something meaningful in a poem, one teeters betweenthe physical sensations of this world³ and the emotionalreactions that each object or creature evokes. Long ago, Iattended an anatomy laboratory to offer the medical studentsmy pathologist's perspective on the hearts theywere dissecting: to describe and name what was specialabout each, in parallel to the anatomists' demonstratingwhat all human hearts have in common. Poetry offers thesame opportunity to generalize and to particularize withour figurative human hearts.Close and perceptive observation is indispensable forsuccessful physical diagnosis. Observation is primary; interpretation,secondary. So, too, for the artist, whether visual⁴or verbal: to see is foremost. Technique in art isoften subordinate to feeling. Most people find an excellenttechnician, such as Ingres, less compelling than a feelingobserver, such as Rembrandt. A violinist who is merelytechnically brilliant touches us less than the soulful onewhose facial expression and vibrato speak to us, even if heor she cannot produce the notes quite as flawlessly as thewizard. In the same way, the aloof diagnostician or opera-tor who gives nothing of himself is a far less effective healer(regardless of outcome) than the one who approacheseach patient with sincere warmth.Art as sustenance. Impulses to make and savor artare inborn: as children, we all sing songs (the root of poetry)and we all draw.In the work of medicine, we witness too much sufferingand death. We are at constant risk for demoralizationand burnout. Art provides a buoyant life preserver. I recommendthe sustenance of the arts to you--whether youmake pictures or stories or music; whether you dance orcrochet; or whether you simply take pleasure in others'artistry.⁵As physicians, we also risk adopting a mechanisticview of human beings, forgetting that the PET scanprovides no insight into the fundamental issue of what ahuman life is about. Shakespeare's words of 400 yearsago succinctly announce what we miss if we adhere to aconcept of human nature that focuses too heavily on thephysical:"There are more things in heaven and earth, Horatio,/Than are dreamt of in your philosophy."⁶Please regard what I have written here as profoundlysuspect. If you enjoy looking at my poems and drawingsfor yourself, you will have employed an essential strengthof clinicians: putting primary "data" before your own eyes.Then you can judge with no layers between you and thework, and with nobody explaining and confounding. If weneed a footnote, the joke isn't funny and the poem is a failure.Nor does every poem have an explanation, let alone aneat one, regardless of what our high school Englishteachers preached. If you don't find in my book some momentsof sharp recognition, a few tears, and some bellylaughs, please throw it aside with a good "Zwammo!"⁷ Iwould enjoy your feedback. And please let me know whatinspiration you have found in your own exploration of theconnections between physical diagnosis, creative writing,and visual art.

References:

REFERENCES:

1.

Schneiderman H. Father, Doctor, and the Great City: Poems and Drawings 1964-2003. Lincoln, Neb: iUniverse; 2003. Available from iUniverse (www.iUniverse.comor toll-free 877-823-9235), Barnes & Noble online (BN.com), and Amazon.com.

2

. Auden WH. The art of healing: in memoriam David Protech 1923-1969. In:Mendelson E, ed. Collected Poems of W H Auden. New York: Vintage International/Vintage Books; 1991.

3.

Williams WC. No ideas but in things. In: Litz AW, MacGowan C, eds. CollectedPoems of William Carlos Williams. New York: New Directions; 1991.

4.

Taylor JC. Learning to Look: A Handbook for the Visual Arts. 2nd ed. Chicago:University of Chicago Press; 1981.

5.

Coles R. The Call of Stories: Teaching and the Moral Imagination. Boston:Houghton Mifflin Company; 1989.

6.

Shakespeare W. The Tragical History of Hamlet, Prince of Denmark. In: BraunmullerAR, ed. The Pelican Shakespeare. New York: Penguin; 2001.

7.

Sendak M. Getting to know Maurice Sendak. In: The Maurice Sendak Library[videotape]. Weston, Conn: CC Studios (Weston Woods); 1990.