Dr. Rita Charon

Jefferson Lecture

2018

Dr. Rita Charon
Photo caption

Dr. Rita Charon

Vincent Ricardel / National Endowment for the Humanities

Rita Charon, scholar, physician, and originator of the burgeoning field of narrative medicine, will deliver the 2018 Jefferson Lecture in the Humanities.

The lecture is the highest honor the federal government bestows for distinguished intellectual achievement in the humanities.

The National Endowment for the Humanities (NEH), a federal agency created in 1965, selects the lecturer through a formal review process that includes nominations from the general public. NEH awards more than $120 million in annual grants that support understanding and appreciation of cultural topics including art, ethics, history, languages, literature, law, music, philosophy, religion, and others. The Jefferson Lecture in the Humanities is the agency’s signature annual public event.

Charon will deliver the lecture, titled “To See the Suffering: The Humanities Have What Medicine Needs,” on Monday, October 15, at the Warner Theatre in Washington, D.C., at 7:30 p.m. The lecture is free and open to the public and will stream online at Facebook.com/nehgov.

Tickets to the lecture are free of charge and distributed on a first-come, first-served basis. Tickets will be available starting on Wednesday, September 19, at www.neh.gov or (202) 606-8340.   

“In her pioneering work in narrative medicine, Rita Charon has shown the amazing power of the humanities in healing both mind and body,” said NEH Chairman Jon Parrish Peede. “She has played an essential role in reminding us that the humanities also enrich the lives of caregivers, not just their patients. Her scholarship gets to the very core of the human condition.”

A Harvard-trained physician with a PhD in English literature, Charon is the founding Chair and Professor of Medical Humanities and Ethics and Professor of Medicine at the Columbia University Irving Medical Center. The new department is home to the discipline of narrative medicine, which seeks to improve patient care by putting the act of storytelling at the heart of medical practice. Medical students and health care professionals in the program learn from models of literature, creative writing, and literary theory how to elicit and interpret patients’ stories in order to treat the whole person.

The practice of narrative medicine, Charon has said, helps health care professionals develop a tolerance of uncertainty, improves the functioning of health care teams, decreases professional burnout, and deepens understanding between patients and their doctors. “To talk with a seriously ill person about his or her near future brings both conversationalists straight toward what it means to be alive,” Charon wrote in 2017. Her work in narrative medicine has been recognized by the Association of American Medical Colleges, the American College of Physicians, the Society for Health and Human Values, and the Society of General Internal Medicine.

Charon is the recipient of a Rockefeller Foundation Bellagio Residence and a Guggenheim Fellowship. Her work has also received support from the National Endowment for the Humanities. A 2003 NEH grant supported curriculum development by Charon and her colleagues, who explored the potential benefits of bringing literary and creative processes to medical education.

A general internist who has practiced primary care medicine at Presbyterian Hospital in New York City, Charon teaches at Columbia University in both the Vagelos College of Physicians and Surgeons and on the Arts & Sciences campus. She is the author of Narrative Medicine: Honoring the Stories of Illness(Oxford University Press, 2006), co-author of Principles and Practice of Narrative Medicine (Oxford University Press, 2017), and co-editor of Psychoanalysis and Narrative Medicine (SUNY Press, 2008) andStories Matter: The Role of Narrative in Medical Ethics (Routledge, 2002). She completed an MD at Harvard in 1978 and a PhD in English at Columbia in 1999, concentrating on the works of Henry James.

NEH’s Jefferson Lecture is the Endowment’s most widely attended annual event. Past Jefferson Lecturers include Martha C. Nussbaum, Ken Burns, Anna Deavere Smith, Walter Isaacson, Martin Scorsese, Wendell Berry, Drew Gilpin Faust, John Updike, Henry Louis Gates, Jr., Toni Morrison, James McPherson, Barbara Tuchman, and Robert Penn Warren. The lectureship carries a $10,000 honorarium, set by statute.

 

Engage or follow the Jefferson Lecture social conversation:
        Facebook: National Endowment for the Humanities
       Twitter and Instagram: @NEHgov #jefflec18

Announcement

WASHINGTON, D.C. (September 4, 2018) — Rita Charon, scholar, physician, and originator of the burgeoning field of narrative medicine, will deliver the 2018 Jefferson Lecture in the Humanities.

The lecture is the highest honor the federal government bestows for distinguished intellectual achievement in the humanities.

The National Endowment for the Humanities (NEH), a federal agency created in 1965, selects the lecturer through a formal review process that includes nominations from the general public. NEH awards more than $120 million in annual grants that support understanding and appreciation of cultural topics including art, ethics, history, languages, literature, law, music, philosophy, religion, and others. The Jefferson Lecture in the Humanities is the agency’s signature annual public event.

Charon will deliver the lecture, titled “To See the Suffering: The Humanities Have What Medicine Needs,” on Monday, October 15, at the Warner Theatre in Washington, D.C., at 7:30 p.m. The lecture is free and open to the public and will stream online at neh.gov.

“In her pioneering work in narrative medicine, Rita Charon has shown the amazing power of the humanities in healing both mind and body,” said NEH Chairman Jon Parrish Peede. “She has played an essential role in reminding us that the humanities also enrich the lives of caregivers, not just their patients. Her scholarship gets to the very core of the human condition.”

A Harvard-trained physician with a PhD in English literature, Charon is the founding Chair and Professor of Medical Humanities and Ethics and Professor of Medicine at the Columbia University Irving Medical Center. The new department is home to the discipline of narrative medicine, which seeks to improve patient care by putting the act of storytelling at the heart of medical practice. Medical students and health care professionals in the program learn from models of literature, creative writing, and literary theory how to elicit and interpret patients’ stories in order to treat the whole person.

The practice of narrative medicine, Charon has said, helps health care professionals develop a tolerance of uncertainty, improves the functioning of health care teams, decreases professional burnout, and deepens understanding between patients and their doctors. “To talk with a seriously ill person about his or her near future brings both conversationalists straight toward what it means to be alive,” Charon wrote in 2017. Her work in narrative medicine has been recognized by the Association of American Medical Colleges, the American College of Physicians, the Society for Health and Human Values, and the Society of General Internal Medicine.

Charon is the recipient of a Rockefeller Foundation Bellagio Residence and a Guggenheim Fellowship. Her work has also received support from the National Endowment for the Humanities. A 2003 NEH grant supported curriculum development by Charon and her colleagues, who explored the potential benefits of bringing literary and creative processes to medical education.

A general internist who has practiced primary care medicine at Presbyterian Hospital in New York City, Charon teaches at Columbia University in both the Vagelos College of Physicians and Surgeons and on the Arts & Sciences campus. She is the author of Narrative Medicine: Honoring the Stories of Illness(Oxford University Press, 2006), co-author of Principles and Practice of Narrative Medicine (Oxford University Press, 2017), and co-editor of Psychoanalysis and Narrative Medicine (SUNY Press, 2008) andStories Matter: The Role of Narrative in Medical Ethics (Routledge, 2002). She completed an MD at Harvard in 1978 and a PhD in English at Columbia in 1999, concentrating on the works of Henry James.

NEH’s Jefferson Lecture is the Endowment’s most widely attended annual event. Past Jefferson Lecturers include Martha C. Nussbaum, Ken Burns, Anna Deavere Smith, Walter Isaacson, Martin Scorsese, Wendell Berry, Drew Gilpin Faust, John Updike, Henry Louis Gates, Jr., Toni Morrison, Arthur Miller, James McPherson, Barbara Tuchman, and Robert Penn Warren. The lectureship carries a $10,000 honorarium, set by statute.

Tickets to the lecture are free of charge and distributed on a first-come, first-served basis. Tickets will be available starting on Wednesday, September 19, at www.neh.gov or (202) 606-8340.   

 

Engage or follow the Jefferson Lecture social conversation: 

Facebook: National Endowment for the Humanities

Twitter and Instagram: @NEHgov #jefflec18

Video: 2018 Jefferson Lecture

Video: Dr. Rita Charon on Who Joins the Narrative Medicine Program

Click here to watch Rita Charon discuss who joins the Narrative Medicine Program. 

Appreciation

Click here to read Attending Physician: Rita Charon by Dr. Rita Charon, an appreciation of the 2018 Jefferson Lecturer by Craig Irvine. 

Interview Text

Click here to read an interview between Dr. Rita Charon and NEH Chairman Jon Parrish Peede in Humanities Magazine. 

Lecture Text

DR. CHARON:

Thank you. Thank you so, so much. Chairman Peede, National Endowment for the Humanities, National Council on the Humanities, National Trust for the Humanities members, and colleagues, scholars, friends, students, citizens, all of us here in this gorgeous theater, let us spend an evening thinking exactly about what Chairman Peede just said. The other thing that Henry James says that I try to live up to is, “Try to be one of those people up upon whom nothing is lost.” Is that not what you want your doctor to be? This evening also lets me salute the many clinicians, scholars, teachers, students all over the U.S. and the world who are joined with me in developing narrative medicine, medical humanities as the most surprising phenomenon. What I will tell you tonight is that bridging the chasms between the arts and sciences, between literature and medicine, quite remarkably improves the care of the sick. This is remarkable. This is what we are developing and now proving.

I dedicate this lecture to Steven Marcus, Delacorte Professor of English at Columbia University and my former supervisor, whose death this year is for us all a tragic loss. He was the one at Columbia to envision medicine’s need for the humanities and to equip me to do the work I have been able to do. It was with Steven’s guidance that we at Columbia developed the branch of medical humanities that we’ve called narrative medicine.

I am going to tell you stories tonight. I begin with one story. This is a planet. You may or may not recognize it, it is Uranus. I open with a story about it. Astronomer and musician William Herschel and his sister Caroline search the night skies. They invent and construct larger and larger optical instruments so as to scan the skies of the English Lake Country. Herschel proposes an anti-Newtonian astronomy, not Newton's stable, predictable, symmetrical, and knowable universe, but a universe of dark spaces, never ending, always changing, boundless.

Who were the Herschels’ teachers and colleagues? Wordsworth, Keats, and Shelley. They were together in the late eighteenth century at the Royal Society of London, these artists and scientists together teaching one another. Wordsworth teaches Herschel the mystery of the stars, do you see? While John Dalton, who invented atomic theory, Humphry Davy, who discovered potassium and chloride, are writing poetry with Keats. Do you see? The Herschels discover Uranus in 1781. Wordsworth publishes his Lyrical Ballads in 1798. And Herschel's universe, the universe that Herschel imagined, is close to what we today believe about the skies.

We call this period the Age of Wonder. It encouraged a fusion of horizons, between the sciences and the arts, leading to the major discoveries of their time. I propose we are embarking today on our present age of wonder, perhaps more consequential than the first. Musicians and neuroscientists together discover how the brain interprets sound. Landscape artists and oceanographers work together to expose the seashore of the Boston cityscape. Novelists teach pediatric oncologists how to accompany their young dying patients with care and hope. This is not a dream. This is real.

I hope it is dark enough in the room for you to see this charcoal gray sea. It is wrinkled, a gray sky uniform in matte light. I want you to stare at this sea if you can. I hope perhaps you see it moving. It is swelling gently, this sea. This is Hiroshi Sugimoto's Marmara Sea, Silivri. You notice, please, the scene is bisected immediately, exactly at the center of the frame, by an absolutely straight horizontal line. A line which is identical with the horizon! Do you see? This is funny, this is the wit of Sugimoto, to assert that what we call “horizon” is neither only concrete nor only abstract, but both. That a thing can be concrete and abstract at once.

This image is highly denotative. It points to the Sea of Marmara in Silivri, Turkey, yet what it denotes seems pale compared with what it connotes. As you look at this, it will depend on each viewer, some might see an expansive plenitude, an openness to the sea. Where others might see an emptiness or an unidentifiable absence. I first saw the photo in the Hirshhorn Museum, I hope some of you saw it too. The installation was called “What Absence Is Made of." With or without that directive from the curator, I do not think it is possible to look at this image and think only of the Sea of Marmara.

How can I not show you a Mark Rothko’s bars of color after that? This is Blue, Green, and Brown, 1952. Rothko accomplishes the same gesture without the sea and sky, but still sectioning the vertical distance with a series of horizontals. If you stare enough at these zones of color, they move. As you gaze at them, the blue blurs into the green. The brownish at the bottom, it almost looks like Earth to me, and maybe there’s something rooting around in there. Like the Sea of Marmara, there is no character here, there’s no plot. But neither is there a “here,” here. Unlike Sugimoto’s sea, that points to a specific location, Rothko’s bars of color are a fantasy. They sprang from within him. He created them, they visited him. If you will, he made them up. They are not denotative, they are highly connotative. In another way of speaking, they are not real. Rothko writes in his manifesto, The Artist's Reality, that the artist’s “chief preoccupation is the expression in concrete form of their notions of reality,” do you see? Expanding for us what counts as real.

If you sit in the Rothko Chapel in Houston or if you sit in the Seagram room at the Tate Modern in London, you will see that Rothko paid exquisite attention to even how the paintings are installed. He not only governed the height of the paintings on the wall, but the benches, the seating, the lighting. And he says that he wanted the viewer to be able to absorb the paintings. I think he wants us to be absorbed by the paintings, as he was absorbed in creating them. He wanted us to be summoned into these paintings and in the process, to be transformed.

I show you these images in order to invite you to meditate with me on things abstract and concrete, denotative and connotative. What things count as “real”? What is the status of the things we call “imagined”? Scientists and artists might think that they each deal with only one or the other of those poles—yet I want to show you how permeable are the membranes that seem to separate them.

I spend my working days in a hospital, surrounded by persons seeking help with their health. I can tell by what floor someone gets off the elevator what is wrong with them. 14th floor is organ transplantation unit, 12th floor is the suite for troubled pregnancy. So that person’s intimate facts and secrets of themselves become visible, somewhat transparent, to those of us who work there? We are attuned to, some think we are indifferent to, but we are attuned to the views, the persons who are bleeding, seizing, breathless. We are always ready to act because we know in particular situations what to do. We have all answered calls of “Is there a doctor on board?" We know, within limits, that we can do something useful; that is the bequest of our training. So we learn to look for things that can be fixed.

I am here to suggest that there is much beyond the fixable that doctors must learn to see. Beyond the bleeding and the seizing, we need to see the complex lived experience of the person as they face health problems. If we do not see this complex lived experience, we miss the very reasons they’ve come to us. It is not just their symptoms or abnormal lab test, but rather their fears and their awareness of their own fragility. I am convinced, with evidence to support my conviction, that study and practice in the humanities is the most direct way to enable doctors to see this suffering that surrounds them.

What does it take to see the complex human suffering? Or the suffering phenomena, it is not just the suffering we see. There is a great deal of joy, as well. But what does it take to see this complex lived experience? I am proposing it takes what we just did in looking at these images that I showed you. As we looked closely at them, what did we do? We took in simultaneously the composition, the tableau, the context, the content of what we see. We noticed the sensory details, the color, the contrast, the proportions. We could imagine the sounds and the smells of that ocean. We pay attention to our own affective responses, our emotional responses to what we see. We notice what associations we have to what we are looking at. We wonder about the many possible contradictory meanings, both denotative and connotative, and we surrender ourselves to the experience of beholding what is in front of our eyes. It is as if we asked W. J. T. Mitchell’s question, “What Do Pictures Want?” So we’re saying, what does this scene want, and in the medical idiom, what does this person want?

Of course, we do similar things as close readers, where we are paying attention to the formal elements of a text—the temporality, the space, the metaphor, the voice, the narrative situation and diction. We assess the ideas and the quality of the work while, at the same time, experiencing the work as a whole, including these multiple contradictory meanings. We critique and analyze the work at the same time that we are summoned into its world and moved by its meanings. How similar this is to my medical work. I pay attention as an internist to signs and symptoms of disease, ruling in or out their possible causes and deciding what to do. At the same time, I open myself to behold the patient's singular situation, to hear the story, to imagine the narrative world being described, into which I am being invited as a guest. I catch the denoted and the connoted, the abstract and the concrete, the real and imagined. It is that that allows the patient to feel heard and recognized, to enter whole into care. The question I ask is not W. J. T. Mitchell’s, it is Simone Weil's question, the philosopher. She writes, “The love of our neighbor in all its fullness means simply being able to say to him: ‘What are you going through?’"

Training in the humanities equips one to do this, and to do it all at once.

Let me show you more. This is Whistler. It is a small painting. It’s like 28 by 18 inches. He calls it Sea and Rain: Variations in Violet and Green. The palette seems at odds with the scale. The palette is very soft, the palette is very subdued, and the scale is enormous! He’s got all that sea and all that sky. Can you see it? It is a very subtle painting. Notice what reaches you, what you find yourself wondering about. Here there is a character, right? There’s not really a plot, but there is a character. I want you to wonder, what is the mood of the painting? Where does it bring you as you look at it?

I imagine some of the words that come to mind are things like vastness or magnitude, maybe solitude or loneliness. Maybe independence, maybe mastery. I hope you can tell that the human figure is kind of translucent. Do you see that? You can see through it, especially the legs. We're not sure what that means. Is it not finished, the painting? When I look at it, as I stood in front of the painting, I had two conflicting senses. The first was that all this sea and sky and strand for this one guy. It seemed so munificent. At the same time, I was wondering, is he being erased? Is he an afterthought? Is he expendable? Do you see the tension there? I had to hire a painter through a website in London to copy this painting, because I wanted to live with that question. Which is it? All of this universe, for me? Or is the human figure expendable, being erased? This is the question I felt I needed to live with and the answer changes for me from day to day.

Unlike Sugimoto and Rothko, Whistler gives us a body to contemplate. Medicine treats bodies, and bodies are not things. I mean, they are things, but they are also more than things. In committing a Jefferson Lecture to medicine and the humanities, the Endowment is making a powerful statement about the centrality to the culture, not just to medicine and science, of the problem and the gift of the body. We in the humanities are, and I think this is subversive, re-appropriating the body from the sciences, who have kidnapped it. Not only is the human body a piece of biological equipment, fixable sometimes, to be discarded when it reaches the end of its functional lifespan. It is the singular expression of the time/space coordinates of one being, whose very identity is exhaled with each breath. It’s another way of saying the body is where we live.

Whistler shows us this very tense relation between the singular body and its inanimate surroundings. The temporality of the body conflicts with the temporality of the sea and sky, which is enveloping it, it’s eternal and timeless. If I send a vial, my biochemistry professor tells me, if you send a vial of seawater to the hospital chemistry lab, it looks identical to human serum. Seawater runs in our veins, all right? Be that as it may, what this painting shows is that the human scale of physicality, the cosmic scale of the oceans and all of relativity, and the existential dilemma of meaning are together in the universe and in each individual human body.

Now I complicate it. I give you two bodies. The problems of embodiment now become the problems of intersubjectivity, communication, love, sex, violence, duty, pleasure, protection, difference. This is a pastel by Mary Cassatt and it came to me, or I found it, as my group and I were describing the three movements of narrative medicine. We try to conceptualize why it was that reading and writing are good for doctors. Our three movements were attention, representation, and affiliation. This seemed an icon of attention. How can one person absorb what another says and be absorbed into that teller's narrative world? How can the listener achieve the attention required to appreciate what the sufferer undergoes?

The listener here is in the shadow, the teller is illuminated. The listener’s expression is not pity or sympathy but, rather, thoughtfulness, openness, curiosity. As I sit with my patients, I do all I can to donate my full attention to them, intentionally putting aside distractions and other concerns. I wheel my chair away from the computer. I put my hands in my lap. I do not type. I do not write. What I say is “Please tell me, what you want me to know about your situation."

I then listen to the plot of the story and the form of the story. The course of events in whatever order the patient tells me. I notice the images, the temporality, the spaces described, the stuttering, the silences, the tears. I am not identifying with this person, I am not saying, “What would it be like for me to be in this situation?” That is self-involved. Instead, the question is, “What must it be like to be there? What governs this strange narrative world that I’m hearing about for the first time? What is its climate? What are the habits? What are the rules? How can I take in everything being offered by this person?” As literary critics ask of the reader's responsibility to the work, “How can I fulfill the duties I incur by virtue of hearing this account?"

After this intensive listening, we call it “radical listening,” and after examining the patient, checking the clinical information, and making decisions with the patient, I write down what I think we did. The second movement is called representation. It is when we represent, when we confer form on what has been perceived, that we can actually perceive it. We teach our students, we teach our colleagues to not only write perfunctorily in their medical chart, but to write fully what it is they hear.

I write in order to find out what I’ve perceived. After I finish writing for the electronic medical record, I have gotten into the habit of turning the monitor around to the patient, so she can read what I have written. I also turn the keyboard around and invite the patient to add what she might want to add, because this is a story about you. They are very enthusiastic about doing that. So what it means is we both can share in this experience of writing toward the discovery of what it is we are telling, letting both of us learn something new by virtue of the representation.

Sometimes I will write beyond the chart, simply if I am still brooding about a patient, I will write what I think is going on. These writings don’t go into the hospital chart, they’re just for me and the patient. When the patient reads what I have written, they will say, you got the names wrong or the date was wrong. But they will say, we left something out. That is when I hear about losses, stillborns, childhood trauma, violence, a lot of death. And also hopes and desires and dreams. So that all of this has a way of getting into the medical work that we do. Without my narrative medicine routines, these aspects would not become part of our care.

I am coming up to the question of, here we are in my office and there are two bodies. We do not talk just about the bodies, but what are bodies for? Or even, what are bodies? When persons get off of the elevator toward the organ transplant unit, they are not just passively bringing their bodies in for care, but they are, rather, becoming with every step. We have learned from the phenomenologists, from Husserl, from Merleau-Ponty from Paul Ricoeur, who challenged Cartesian dualism, that it is through the body that we creatures are able to live in the world. We interact with the world only through our bodies, our senses, our perceptions, and our physical capacity to move through the world not only as passive observers but as dynamic agents who, like Rothko, create our realities by making or interacting with what surrounds us. We create our reality. The reality is not pre-formed before we get to it. We create the reality.

It makes me ask, what is it that gives us the right and privilege and perhaps the burden of existing in space? These are all ways we have found to be existing in space. We have a location in the world. It is through the body that we are placed that gives us, if you will, our GPS. Even before GPS, we all had a global position that is second by second, integral to our definition of self. So we know that our bodies do not just carry us around. They are not just vehicles, but rather they hold and curate our past toward that dynamic, fleeting, ever-changing-in-the-light thing that is the self, the person, the identity, the me. As the memories and the scars and the pleasures that we have experienced incarnate what we have lived through, so this body, this self is all we have at Augustine's razor-thin present trajected toward the blooming unknown future.

Now you see I have turned from space to time. Hasegawa Tohaku, it’s called Pine Trees, it’s from 1595. I showed this to a group of Japanese clinicians in Tokyo. In Japan, the pine tree is a symbol of vitality, virility, strength, masculinity. I look at this and I see some healthy pine trees, some seem to be falling, some are enshrouded in mist, some look like ghosts of pine trees. One of the Japanese doctors corrected me. He says, “no, they are all the same tree." Yes? So we are reminded here, both the inevitability of the flower and the decline in a life in time, but also the timelessness, the synchronic “all-at-oneness” of the living. I still have the heart that I had when I was three. This impresses me. So the time and the timelessness are together in this image. Medicine can sometimes be mistaken for the science that will deliver us from time, expand the lifespan: If you die before there is a cure for your disease we can freeze you and thaw you when there is a cure. If I may paraphrase what literary scholar, George Lucaks said about the novel, “we might almost say that the entire inner action of medicine is nothing but the struggle against the power of time.”

Here is a story about time and space. “What had the man had, to by the loss of it so bleed and yet live?” A man stands at the graveside of the woman who loved him. May Bartram has to die her hematological death in order for our man, John Marcher, to recognize her love and his failure to have loved her back. Not until he sees the face, ravaged by grief at the neighboring gravesite in London, does he realize what he has wasted. Henry James's savage short story, “The Beast in the Jungle” shocks its reader into attention. The couple looks ordinary to the outside, and yet they tiptoe their days around a maniacally held conviction that some absolutely terrible, grand thing will befall Marcher, that he has to be saved for something less banal than love and marriage. The reader gradually recognizes Marcher as a weak, deluded man, afraid of true emotion, and May as a woman who, to her tragic misfortune, has, as the narrator puts it, a screw loose for him.

Having myself a screw loose for Henry James, I have been hounded by the story while marveling at its perfection. As I read this 1903 tale written by my neighbor of over a century ago in New York's Greenwich Village, I surrender myself to this man and woman, this death, this relation. The story does not boil down to some local realization about one's own life and loves and losses but instead enlarges the attentive reader to simply see more, to rail more against stupidness, to accept more of necessary weakness. Maybe, to feel more for the other, to admit more about the self. Reading this story, or any great text, exposes the possibility of the life of consciousness, the singular consciousness. By virtue of the form as well as the content, the story gives the reader means by which to utter the unutterable, thereby expanding both the inner life and that which can be shared with others. This is what words do. This is what reading does, at least the kind of reading we in our humanities tribe call close reading.

Every day in our hospitals, people routinely witness the grief of others. Doctors, nurses, therapists, all of us who work around the sick and dying are engulfed by grief. We walk by the waiting rooms of the intensive care unit, of the operating rooms gazing matter-of-factly at groups huddled together, weeping in the wake of a white-coated stranger who has just delivered horrible news. We are often the ones to have borne it. We take classes in how to “break” bad news. We don't take classes in how to comprehend the force of that news.

A former student of mine, Anna DeForest, an accomplished fiction writer before she came to medical school, describes a scene she witnessed in an intensive care unit somewhere during her training. I will read you what she wrote, this was published in JAMA:

I think of a meeting in the intensive care unit. A man in his 30s has crashed his car into a tree and was brain dead. His family was Spanish speaking, and when the attending physician had finished his speech the man's father asked through an interpreter, “How did it end?" The physician described at length the effects of swelling on the brainstem. The father just asked again, “But how did it end?" “It was painless,” I said, before the doctor could recite more physiology.

What did Dr. DeForest do that the other doctor could not do? Both she and the other doctor cared for this patient throughout the intensive care unit. They knew how catastrophic the injury had been. They knew the sheer impossibility that he had been conscious through any of it. Yet, she knew or could imagine what the father was asking. It was her literary skill, I suggest, that gave her the capacity to read and respond to the father's ravaged face.

“What had the man had, to by the loss of it so bleed and yet live?”

This story enacts the third movement of narrative medicine, affiliation, which is the goal of care. These narrative skills of attending and of representing equip us to accompany the patient, to ally with the patient, to be on the patient's side, instead of solving one problem and then moving on. It lets us be invested in the whole of the patient's predicament, even, in this case, after the death. We refuse to abandon the patient. Remember John Donne's words in Devotions Upon Emergent Occasions, “As sicknesse is the greatest misery, so the greatest misery of sicknesse is solitude.”

I bring you back to Mary Cassatt, just to remind us now that this situation, one person giving an account to another, is the obligatory site of health care. It does not matter how many professionals are on the team, how many people in the patient’s family, this is where the work, the diagnostic, the therapeutic, the existential, the spiritual work is accomplished.

This meeting between self and other is also, in addition to being diagnostic and therapeutic, it is for us all a node in the ethical life. It is not a meeting between objects, but as phenomenologist and Holocaust survivor, Emmanuel Levinas, writes, the encounter with the Other is both the source of the ethical life and the creation of the individual. He says, “a calling into question . . . is brought about by the other . . . . The strangeness of the Other, his irreducibility to the I, to my thoughts and my possessions, is precisely accomplished as a calling into question of my spontaneity." I want you to understand that he is saying such a radical thing, that it is the other that brings myself into being. This is true for both the patient and the provider.

We have to make sure, and we bring the weaponry of the humanities in to protect this inviolate ability, this strangeness of the patient, even in a time of telemedicine and virtual medicine and artificial intelligence and robots. It is the humanities that will protect that singularity against the facelessness that some of medicine seems to be headed for.

By now, over 80 percent of the U.S. medical schools do have some form of teaching of the humanities. We actively recruit the writers, artists, and composers, because we know that they are able to do things, like my Anna DeForest, that others cannot do. At Columbia, and other schools, too, narrative medicine training is required through all four years. The students can take a Master’s degree, they can continue this kind of training throughout their medical school. We have found in the research we have been doing all along, that this kind of training increases the self-awareness of the students, it increases what they are able to learn and comprehend and value about individual patients that they are seeing. It improves the function of the health-care team, which is not always able to work well together. It decreases the kind of dissolution, the kind of burn-out, the emotional exhaustion that is driving doctors and nurses away from practice. We asked the students what they got out of this. They told us, “it gave us pleasure. It gave us pleasure.”

We are also working directly with patients, doing artwork, doing music, doing writing and doing reading, and there are lots of outcome studies looking at that. What we are asserting is that the humanities training, before or during medical school, equips our students and clinicians to recognize human suffering.

It is not as if the humanities training guarantees attention to other suffering. Look around your English department or your philosophy department. But I am raising the potential of these disciplines to develop the skills necessary for attention, to awaken an attunement to others’ plights, to equip our students to see beyond the body as object toward the body as incarnation of an individual at one and only one location in time and space. We hope they come to know to ask the patient not only, “what is the matter, but what matters to you.”

Before, we said this human body looked translucent. Let me re-suggest that the human body might be transparent, letting us see into its workings. I cannot leave the stage without reminding you and celebrating with you the dazzling work going on now in bioscience, in human biology. We know so much more than we did a month ago, a week ago. Please, keep track of what it is we are learning. In treating cancer, for example, we are able to identify the very genetic mutation that has caused the tumor to grow uncontrollably. Instead of cutting the tumor out, instead of radiating it or poisoning it with chemotherapy, we are increasingly able to turn on the body's native defenses that have, because of the mutation, been turned off. It is stunning. We did not know this a few years ago. Philosopher and pathologist Georges Canguilhem writes somewhere, “Ce n’est pas le médecin, c’est la santé qui guerit le malade..” It is not the doctor who heals the sick, it is health.

Our sciences are returning health to the sick. Stem cells are able to create needed tissues, maybe pretty soon needed organs. Precision medicine can identify these genetic defects and then really prescribe exactly what each individual person needs for the kidney failure or heart failure. Genetic editing of individual mutations may eventually repair disease-causing mutations. But all of this confronts us with profound fundamental choices and challenges. If the body is time space location for that singular individual, what happens when you transform it, as we are so fundamentally transforming the human body today?

So, we face questions that will determine what constitutes a human being. These are the questions that genomic precision medicine forces us to face. What is identity? What is personhood? Who defines personhood? Who defines health? What happens to memory? What is personal freedom? Who will have access to an individual's thoughts, to an individual’s cells, to an individual’s tissue?

I go back to Rothko to remind me to tell you that he was a Jewish Russian émigré to the U.S. He came to the U.S. in the teens. Throughout his life, here in the U.S., he battled anti-Semitism, was treated as an outsider at Yale, where he studied very briefly, and was denied admission to elite institutions in New York. He died of suicide before he knew how grand, how magnificent his work was.

The darkness behind his light reminds me to discuss the dark sides of science and medicine. We know that health disparities exist based on race, class, and gender, sexual orientation. We know of the financial conflicts of interest and greed and how they deform the science. We know that corporate considerations control much of the science and the science agenda. We know the lack of diversity in the leadership, still. All of these considerations, these dark sides of our science about social justice and equity become part of our work together in both the medical humanities and in medicine itself.

You can see from my very short description of the dazzling science right now, the need for ethical safeguards in aspects of the sciences that raise moral concerns. To protect patient privacy, to assure fair access to new treatments, to align research with actual health needs, to preserve freedom in an era of encroaching surveillance. These problems cannot just be given an ethicist at the very end of the study. Rather, ethical attunement of the scientist is needed at every stage. To do the science, the scientists have to grapple with complex and noncalculable problems. Can we foresee a time when skills and perspectives in the ethics of moral choice, in the ethics of the moral compass, are built into the very training of scientists and engineers and physicians?

The National Endowment for the Humanities, the National Academy of Sciences, the Association of American Medical Colleges are all working very hard at that question. We are finding ways to bring aspects of science and sciences, ways of thinking and knowing, into the training for the humanities. The National Academy of Sciences recently released their first report on this project. They call it “Branches from the Same Tree,” which is how Einstein described the arts and the sciences. The report strongly recommends we continue this work of interweaving, of intersecting the humanities and the sciences, even at the college, undergraduate, and graduate school level.

What we are coming to see is that training in the humanities frees the physician and scientist from the bias of the observer, achieving a position outside of one's own loyalties to adopt the perspective or subjectivity of another. This is not to say that the humanities are free from bias. They have, or we have, their own dark side. But to move toward freedom from what novelist Richard Powers calls the “straitjacket of the self” and to awaken the capacity to see the other is the hope and goal of the inclusion of humanities in health care and science. To see that suffering—at the bedside or the laboratory—is to have the chance to be unconditionally committed to relieving it.

By coincidence, two weeks ago I was in Istanbul, and I said to my host, “where is the Sea of Marmara?” I was in Turkey, it’s somewhere in Turkey. They said, “You are on it.” I discovered—I did not know this—Istanbul is bisected by an inlet of the Sea of Marmara and there is a bridge and the trains go over the bridge from one side to the other. One side is Europe and the other side is Asia. I did not know that. This photograph takes on so much more significance. It now includes the paradox of belonging and not belonging, of leaving and arriving, being or not being at home. It raised to me the slender optimism that perhaps there is a way of unifying disparate cultures toward shared goals. Do you see?

It made me think maybe our medicine and science are forms of diplomacy, able to bridge divides, to transcend the interior conflicts among those of us with human bodies. We share the body, don't we? We share the diseases. We are all going to die of the same ones. Maybe health care can become the planet's State Department. By virtue of our commitment to human health, perhaps we can fuse these horizons between continents, between ideologies, between states, and to envision and articulate a universal commitment to safeguard human health and to safeguard our planet.

So we are back to Uranus. I want to say, in closing, please notice what the humanities derive from medicine. These things I have been talking about are indeed the urgent agenda of the humanities today. Epistemological questions about evidence, questions about narrativity and identity, relationality, of inter-subjectivity. Embodiment is what we do in women and gender studies, in queer studies, in disability studies. Intersectionality, it is ultimately social justice. And of course, senescence and mortality is our daily work in medicine and our daily work in the humanities, as well. For the humanities, medicine becomes kind of a laboratory. I offer it to you as a laboratory that dramatizes many of the questions we are asking.

So I think medical humanities are the best exemplar and promise of the necessity of crossing these chasms. Maybe even a model for chasm-crossing in nonhealth-care fields. From the private conference in an ICU with this grieving family to setting the NIH agenda, the perspectives of the humanities are indispensable for ethical and equitable health care. Can it be that learning how to enter the narrative worlds of our literary texts and visual images can deepen our awareness of patients' subjective lives? Can it be that the humanities not only humanize but make more effective the care we provide to others? It can be. By virtue of the power of our knowledge, the richness of our cultural products, the tenacity of our efforts and the commitments we share toward freedom. This unity, this precision, this beauty is what can become our present age of wonder. Thank you.

 

[APPLAUSE]

 

Thank you.

About the Jefferson Lecture

The Jefferson Lecture in the Humanities, established by the National Endowment for the Humanities in 1972, is the highest honor the federal government confers for distinguished intellectual achievement in the humanities.

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