The Healing Power of Literature
“Bridges between literature and medicine would seem to be the most natural of passages…What other domains of human experience and the representation of that experience could be more naturally linked?”
– Rousseau, GS. “Bridges of Light.” Aberdeen University Review
Evidence of these bridges abounds in the form of physicians who have become famous writers— John Keats, Anton Chekhov, Sir Arthur Conan Doyle, W. Somerset Maugham, A.J. Cronin, and William Carlos Williams, to name a few—and in famous novels about illness or physicians, such as Leo Tolstoy’s The Death of Ivan Ilyich, Madame Bovary, by Gustave Flaubert, and One Flew Over the Cuckoo’s Nest, by Ken Kesey.
The benefits of reading selected works of fiction while attempting to cope with (or treat) serious illness are well documented. Formal literature and medicine courses—a category of instruction called narrative medicine—have been offered as a part of U.S. medical schools’ curricula for fifty years, to help future physicians better comprehend the personal agony and transcendent majesty of the afflicted— and to teach them how to respond in a tolerant, empathic, and moral way. The Johns Hopkins University Press even publishes a biannual scholarly journal, Literature and Medicine, to explore the “…connections between literary understanding and medical knowledge and practice.”
Literary fiction is especially well suited for this task, with its emphasis on complex, three-dimensional characters that act within the subtle context of a themed story—because every illness is a story, too, with a patient as the main character. And illness affects people in the same three dimensions that a character in a story must possess: physical, emotional, and spiritual. Each of these dimensions must be grappled with during recovery from illness, but overarching the entire recovery process is the central question of all illness: What is its meaning? What does my illness mean, for me?
The reflective nature of literary fiction allows patients to consider the meaning of illness in ways that scientific method cannot. A disease can be understood through the process of empiric research and publication; illness—the fully expressed human response to disease, as manifested by its emotional, spiritual, financial, and physical aspects—requires a different paradigm. Illness is best understood in story form, i.e. the narrative. Stories have a multi-layered, textured meaning that purely rational expression does not. And one of the most intimate forms of storytelling is the novel.
Novels have the capacity to present characters so completely rendered, that we begin to understand ourselves—and others—more profoundly simply by identifying with them. And novels have sufficient breadth to explore complex universal themes that illuminate what it means to be human—and, in the case of narrative medicine, that explore the meaning of human illness. Of all narrative forms, it is the novel that is most able to nurture and restore the empathy and compassion doctors must have for patients—and to reveal the emotional and spiritual meaning patients seek when afflicted with illness.
Literary fiction is unique in its ability to affect human behavior and increase the capacity for empathy, as assessed by scores on Theory of Mind tasks before and after reading such literature. Theory of Mind (ToM) is the ability to intuit and comprehend the minds of others through the understanding of their thoughts and actions, even though our own minds are the only ones we have direct access to. The subtle nature of literary fiction and its ability to cause readers to inhabit the minds and lives of others is responsible for this unique effect. Literary fiction fosters empathy, and in so doing, enables people to reflect upon and change themselves, as they must do in order to cope with and recover from serious illness.
I am a champion of the therapeutic power of literature, and believe the two finest callings in life are doctor and writer, one ministering to the human condition, the other enlightening it, each capable of transforming it. I use literary fiction in my own medical practice to help patients more fully comprehend the meaning of their illness by sometimes “prescribing” certain novels, selected works of literary fiction that are capable of altering the arc of illness. Sometimes, only great fiction can tell the truth in a way that is transformative; we humble doctors lack the words.
There are many such books. What follows is a list of ten, with a word or two on why each made the list. Healing hearts and souls, one book at a time.
BOOKS AS PRESCRIPTIONS
1. Everyman, by Philip Roth: aging; death
2. The Echo Maker, by Richard Powers: rare neurological illnesses; family loyalty in combating illness
3. A Journal of the Plague Year, by Daniel Defoe: epidemics; a foreshadowing of AIDS
4. Saturday, by Ian McEwan: the life of a doctor; doctors as heroes
5. The Death of Ivan Ilyich, by Leo Tolstoy: premature death; death with regret; cancer; origins of hospice
6. Middlesex, by Jeffrey Eugenides: sexual identity and gender dysfunction
7. Sin Dolor, by T. C. Boyle (short story): doctors and unusual patients; coping with pain
8. One Flew Over the Cuckoo’s Nest, by Ken Kesey: mental illness; nurses and compassion
9. Cutting for Stone, by Abraham Verghese: becoming a doctor; the practice of surgery; foreign medical graduates
10. I Know This Much Is True, by Wally Lamb: schizophrenia; sibling relations, family caregivers
Richard Barager is a physician and writer. His latest novel, The Atheist and the Parrotfish, was released in May of this year. www.richardbarager.com.