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The Literary Agenda
Is Literature Healthy?
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The Literary Agenda
Is Literature Healthy?
JOSIE BILLINGTON
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reat Clarendon
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for John and
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hreat to, the Plight of the Humanities: enter these
oogle’s search engine and there are 23 million results, in
a great fty-year-long cry of distress, outrage, fear, and melancholy.
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Series Introduction
when, for example, they start to see the world more imaginatively as a
result of reading novels and begin to think more carefully about
human personality.
t comes from literature making available much of
human life that would not otherwise be existent to thought or recog
nizable as knowledge.
f it is true that involvement in literature, so far
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ntroduction
Healthy and Unhealthy
T
tory:
iterary
arrative and
arrative Medicine
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Introduction
This book is the result of a journey which began in 2008, when as
an English Literature teacher at the University of Liverpool, I
started to work with colleagues in medicine and psychology who
were tackling mental ill health, depression in particular. ‘Research’
in my discipline had meant scholarly publications aimed exclusively
at an audience of literary specialists. For my colleagues in medicine
and psychology, Christopher Dowrick and Richard Bentall, and
latterly Rhiannon Corcoran, research was part of an urgent struggle
in relation to a worldwide epidemic. 350 million people suer from
depression globally according to World Health Organization g
and culturally deeper, than current medical understanding allows.
Since the nal decades of the last century, the inuential dictionary
ofsymptoms published by American psychiatry, the Diagnostic and
Statistical Manual of Mental Disorders (DSM), has categorized
depression as mild, moderate, or severe, according to the number of
characteristic symptoms displayed (agitation, loss of energy, dimin
ished pleasure or ability to concentrate) and how long they last. The
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it also divides mental illness from the normality of experience, or
threatens to make common human sorrows—normality under severe
strain—into an illness. A purely symptom-based diagnosis has led to
the over-medicalization of suering, ‘treating’ it with mass prescrip
tions of antidepressants, when such suering might be an unavoida
ble, even necessary aspect of normal experience. ‘Major depressive
disorder has received more research attention than any other diagno
sis in psychiatry but [the criteria] are so loose that, in everyday clinical
practice, ordinary sadness can be easily confused with clinical depres
sion.’ What is called a ‘depressive episode’ and diagnosed as ‘mental
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trauma, lack—are aspects of experience not susceptible to straightfor
ward correction or cure.
My work with colleagues in medicine and psychology has helped
me to see that depression is the awed modern denition of the deep
troubled life which, through the ages, it has been literature’s task to
express. I am not saying that literature is only about trouble; I am
saying that its other virtues of celebration, of beauty, of immersed
thought and feeling, are part of a vitality in existence. It is that vitality
in sickness and in health that makes literature humanly expressive.
But, as Dowrick insists in his own book,
Beyond Depression
, literature, in
its deeper language of experience and emotion, radically challenges
the conventional health-professional’s view that suerers diagnosed
with depression are medically ill. It oers to those suerers themselves
a representation of sadness as a human norm—as though literature
itself said implicitly ‘Nothing human is alien to me’—without merely
normalizing that experience in a reductive way.
This was a potent revelation; it was also a lifeline for me. The chief
frustration and sadness of my own teaching life was that the discipline
to which I belonged had, in part and at worst, lost a sense that litera
ture might speak to humans’ deepest needs. What mattered in English
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No doubt, looking back, one reason that I began to nd a more
congenial home in the eld, broadly speaking, of medical humanities
was that this relatively new discipline had been founded upon frustra
tions and baement analogous to those I was experiencing.
The modern medical humanities movement, which began in North
America in the 1960s, was principally a reaction against the highly
focused biomedical and laboratory-based training which had charac
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diculties—as though they were in the
; and the possibility of
expression
of trouble that is not essentially
physical.
There is of course a history to the separation of the biological and
social, psychological and philosophical, in understanding ill health.
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of literature now seemed to have its best chance of nding a meaning
ful place once again in the wider world. Still, I had reservations as to
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In her survey of four decades of medical humanities as a ‘ourish
ing interdisciplinary eld’, Johanna Shapiro cites diverse instances
ofliterature’s power to enrich the medical curriculum. Reading liter
ature can help medical trainees to gain insight and sensitivity in areas
that are ‘dicult to fully apprehend from purely didactic instruction:
the patient’s experience of illness; dicult patient–physician interactions;
breaking bad news’. Fiction can ‘engender reection in learners by
incorporating radically dierent perspectives from those normally
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if she were to die. That was the one leaving that he really feared.
As he climbed on the chair at night to wind the old, long-
pendulumed, double-weighted clock, or went nally to the front
and back door to see that they were safely shut in, it was a com
fort to know that Phoebe was there, properly ensconced on her
side of the bed, and that if he stirred restlessly in the night, she
would be there to ask what he wanted.
The group rst commented on the extent of the husband’s ‘depend
ency’ on his wife, how the couple ‘live in their own world – all they’ve
got is themselves’. One student felt there was an element of selshness
(‘he wants feed for his security’). This response was still at the surface
of what is happening—the usual language for personal relationships.
But then a student called Nicholas said:
It’s not just a matter of functional dependence. I would feel the
same – that if you lose someone on whom you depend, that is a
terrible thing. It feels almost as though you have lost half of
yourself.
Nicholas noticed how the author describes ‘common events’.
I could imagine the passage re-phrased with an emotionally
descriptive approach, using words like ‘love’ and ‘fear’. But
instead of doing that he’s made it very practical and real. These
everyday events are carried over into what is happening
emotionally.
Moore’s book is full of these small instances of tonal or emotional
‘correction’, thinking on the margins of denite concept. It is
literary
thinking. Nicholas is taking his cue from what he recognizes in the
writing: in place of straightforward or facile naming of feelings—‘love’,
‘fear’—the story’s language seems to
real’. Both reader and writer begin not with solid nouns and prior
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be required in response to the individual pain and suering encoun
tered in clinic or ward. Moore called his book
The Missing Medical
Text
The careful and personal primary reading of literature which
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anything of cases or cures. For that reason, books can help to nd
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mix of meditation, memoir, story, and photograph,
A Fortunate Man,
oered here as a paradigm for connecting medicine to literature, and
literature to life.
Christopher Dowrick and Allen Frances, ‘Medicalizing unhappiness’,
British
Medical Journal
, 2013, 347:f7140 doi: 10.1136/bmj.f7140 (Published 9 December
American Psychiatric Association Diagnostic and Statistical Manual of Mental
Disorders, fth edition (DSM-V) (2013), pp. 133–4.
Julian Barnes,
Levels of Life
(London: Jonathan Cape, 2013), p. 71.
Martyn Evans, ‘Medical Humanities: What’s in a Name?’,
Journal of Medical
Humanities,
Edward S. Reed,
From Soul to Mind: The Emergence of Psychology
(New Haven: Yale
University Press, 1997), pp. xi, 3.
Gordon S. Haight,
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Healthy and Unhealthy Thoughts
I have argued that the ‘depression’ that is deemed a form of illness is
often on the normal spectrum of human unhappiness. This chapter
considers a ‘disability’ hidden behind depression which is possibly the
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recognize, was the defences they had unconsciously erected against
their distressing experiences, in order that they did not have to suer
their distress consciously. The patients expressed optimistic ideas or
feelings of hope, diverting attention to some future event, away from
Bion’s insistence upon the immediate present: these rationalizations
and displacements ‘eected a compromise with feelings of guilt,
hatred, destructiveness, despair’. But the real crux of the matter, Bion
found, lay in the threat of any new idea or feeling to demand develop
ment and the inability to tolerate change:
There is a hatred of having to learn by experience at all, and
lack of faith in the worth of such a kind of learning. This is not
simply a negative attitude; the process of development is really
being compared with some other state
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psyche, thoughts are evaded, ejected, or stored as inert, undigested
This failure is serious because in addition to the obvious penal
ties that follow from an inability to learn from experience there
is a need for an awareness of an emotional experience, similar
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But it is as though, for Bion, ignorance is not so much greedily
willed as it is radically our suering condition, so multiple are the
obstacles to adequate, healthy thinking. In the rst place, the truth
that is the object of our thinking—the thing in itself, the really real,
which Bion designates ‘0’
—proves intolerably frustrating precisely
because it cannot be truly known except by experience or
discovery:
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language and default attitude which blots out the suering reality that
Learning
depends
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The literary examples which follow in this chapter are exclusively
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rebellion, the disorder of a life without some loving reverent
resolve, was not possible to her; but she was now in an interval
when the very force of her nature heightened its confusion.
Dorothea cannot identify the cause of her unhappiness in part
because that cause is a hidden and continuing process, not the
clearthing it might seem to be, ‘now that she was married to
[MrCasaubon]’. As George Eliot pityingly looks on, all too conscious
of being able to articulate what Dorothea cannot, the shift from girlish
ideal to married reality is happening so far inside the ‘endless minu
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healthily authentic realignment of thinking to present circumstances
is possible at all. But they are still what is happening to her. For the
really real matter—Bion’s 0—is deep inside realism’s predicament not
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level almost deliberately not making the painful connections. Bion
There are people whose contact with reality presents most di
culty when that reality is their own mental state.
People exist
who are so intolerant of pain or frustration (or in whom pain
and frustration is so intolerable) that they feel the pain but will
not suer it and so cannot be said to discover it.
These ‘un-thought’ psychic materials—proto-thoughts so painful that
the psyche cannot tolerate the thinking of them—are what Bion
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For substitutes can only displace, reproduce or repeat; they cannot
lead transformatively to realization and reconstitution. ‘
translated here as ‘salvation’ (and thus with its original religious mean
ing, derived from ‘C
’, the Saviour) is translated by Aylmer Maude
more prosaically as ‘escape’. The existence of both meanings in the
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want a divorce, and will suer from my disgrace and from my
separation from my son.’ But however sincerely Anna wanted to
suer, she did not suer. There was no disgrace. With the tact
they both had so much of, they managed, by avoiding Russian
ladies abroad, never to put themselves in a false position and
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D. H. Lawrence, thinking of his own elopement with a married
woman who left behind her children, said ‘the judgment of man’
killed Anna, not ‘the judgment of her own soul’.
Modern Trag
, Raymond Williams wrote: ‘The social convention invoked against
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entered upon family life, he saw at every step that it was not
what he had imagined. At every step he felt like a man who,
after having admired a little boat going smoothly and happily
on a lake, then got into this boat. He saw that it was not enough
to sit straight without rocking; he also had to keep in mind, not
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understood [
] it by the painful feeling of being split
, literally ‘division’—‘
’—‘into two’—‘
which he experienced at that moment.
‘Understood’, thus repeated registers, paradoxically, a kind of
stunned disbelief. It is closer to resistant admission of what he
doesnot wish to understand—‘not only
but
no longer’—than
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over the breach and keep it from growing bigger. [i] To remain
under so unjust an accusation was tormenting, [ii] but to hurt
her by vindicating himself was still worse. [i] Like a man suer
ing from pain while half-asleep, he wanted to tear o, to throw
away the sore spot and, [ii] coming to his senses, found that the
sore spot was himself.
While the (i) clauses stubbornly defend Levin’s original, and still pri
mary, sense of his own separate and absolute identity, the (ii) clauses
swing back six times to invalidate those rst impulses, saying to Levin
This
is marriage—no longer being single.’ It is vital that both remain in
the same sentence. Real thinking—realization, understanding, alpha
function—is created precisely out of the tension
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What these literary texts oer, by contrast with modern self-help
guides, is the unbalancing thought that in order to learn from
experience, the evolutionary process may well have to be gone through
again at every new life stage. For thoughts to emerge in the right way,
at the right time—for real learning to happen—even the most evolu
tionarily developed human organism might have to begin again with
the primary emotional material of experience, as from bottom-up.
George Eliot and Tolstoy are literature’s best witnesses of how there
are no shortcuts in real thinking. They exemplify literary thinking’s
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how she would devote herself to Mr Casaubon, and become
wise and strong in his strength and wisdom, than to conceive
with that distinctness which is no longer reection but feeling –
an idea wrought back to the directness of sense, like the solidity
of objects – that he had an equivalent centre of self, whence the
lights and shadows must always fall with a certain dierence.
(Chapter Twenty-two)
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Unthinkable Thoughts
At the age of forty-ve, Ivan Ilyich is enjoying midlife success as a high
court judge with all the trappings of conventional middle-class life—an
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The point here is not that Ivan Ilyich has lost his mind. It might almost
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So it is that what must come after Ivan Ilyich’s denials is that char
acteristic Tolstoyan turn where life’s brittle surfaces are forced to give
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It is not merely Ivan Ilyich’s professional forms which suffer
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Imagine for a moment that we were not reading literature here, but
a self-help book. Martin Seligman, the American psychologist who is
one of the most successful exponents of positive thinking as a self-help
tool, would probably say, in the case of Ivan Ilyich, that he has taken
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Depression, in Ivan Ilyich’s case, as some might say blithely enough, is
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from the thought of death. But – strange thing – all that had
formerly screened, hidden, wiped out the consciousness of
death now could no longer produce that eect. Lately Ivan
Ilyich had spent most of his time in these attempts to restore the
former ways of feeling that had screened him from death.
‘Strange thing’, perhaps the very strangest—Ivan Ilyich cannot con
sciously think this terrible truth nor can he
think it either. Ivan
Ilyich has not only not thought about his own death: he has learned
an alternative or substitutive mode of thought—a mode which I shall
call ‘learnt non-thinking’. The function of this mode is to screen, hide,
wipe out from consciousness just those areas of human experience for
which human beings, says Bion, have developed a capacity to think at
all. Tolstoy’s more ultimate, ancient vision is perhaps more crucial
than ever in starkly revealing the dangers of a quick-x life cure that
can seem so benignly easy, comfortable and available, and which, in
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have served them so far in life.
The Death of Ivan Ilyich
shows that
humans are least adapted to think about that most common and inev
itable thing—their own death. The objective truth of death cannot be
borne subjectively, says Thomas Nagel: the two modes will not go
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At such moments, literary language supplants the language of logic
in order to do the necessary superhuman thinking beyond normal
category—to have the thought which no human could have within
ordinary life and survive it. The novel, as a language and form of
thinking was, for Tolstoy, the one authentic alternative to rational
secular philosophy:
[The philosophers] seemed fruitful to him when he read
he had only to refer back from life itself to what had satised
him while he thought along a given line – and suddenly the
whole articial edice would collapse like a house of cards, and
it would be clear that the edice had been made [.
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stockings placed on Gerasim’s shoulders; the same candle with
its shade, and the same unceasing pain.
‘Go away Gerasim,’ he whispered.
‘Never mind, I’ll stay, sir.’
‘No, go away.’
He took his legs down, lay sideways on his arm, and felt sorry
for himself. He waited only until Gerasim went to the next
room, and then stopped holding himself back and wept like a
child. He wept over his helplessness, over his terrible loneliness,
over the cruelty of people, over the cruelty of God, over the
absence of God. [.
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his being thus beyond human help, as we come to see, is emphati
cally not the same as helplessness.
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shared world which is existent in this scene if not made articulate.
And the great unspoken reality here is not only death but love. Because
the novel’s language dares and bears to keep faith even with what is
wrong or missed in the situation itself, it registers the closeness that
helps redeem the separation in a way that the brothers themselves
cannot quite. The novel speaks for the heart more honestly than the
heart of either Konstantin or Nikolai can manage—truth’s witness in
lieu of a Gerasim.
The Death of Ivan Ilyich
sible. At the last, his young son movingly holds Ivan’s hand to say he
is not alone.
He indicated his son to his wife with his eyes and said:
‘Take him away
sorry
for you, too
’ He also wanted to
say ‘Forgive,’ but said ‘Forgo,’ and, no longer able to correct
himself, waved his hand, knowing that the one who had to
would understand. (Chapter Twelve)
Here the boy replaces Gerasim. ‘[Ivan Ilyich] responds to his son’s
gesture, feels pity for his family and so triumphs over death’, says
Psychiatrist and medical humanities Professor Robert
Coles concludes: ‘As [Ivan Ilyich] died he was born – he became for
the rst time someone who could reach out, connect with others’.
The key problem with such decent and sensible humanist paraphrases
is that no paraphrase could ever be commensurate with this instant of
reality. ‘The moment the conditions for 0 do not exist [.
.] any formu
lation felt to approximate to illumination of 0 is certain to produce an
obstructive rigidity’.
That is why Bion calls reality ‘0’, knowing that
no ordinary language will serve. Any attempted formulation—my
own included, as I nd this almost impossible to write
—appears
dry and residual since it must by denition stay stubbornly on ‘this
side’, the norm of externalized description when it is the norm itself
that is being breached here. The extra reality comes with this clause,
this thought—‘the one who had to would understand’: it does not just
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Ilyich
doesn’t
have to know his son or wife understand any more?’
These are not answers, they are gestures which point to the right place
without knowing why it is right. It is why the sensible medical human
ities approach simply will not do here. The experience must not be
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Sigmund Freud, ‘Formulations on the Two Principles of Mental Functioning’,
1911, Penguin Freud Library, Vol. 11 (Harmondsworth, Middlesex: Penguin Books
Ltd, 1991), pp. 35–6.
Adam Phillips, Introduction to
The Penguin Freud Reader
(London: Penguin Books
Ltd, 2006), p. xii.
Wilfred R. Bion,
26March 2016).
Henri Bergson,
Creative Evolution
, 1911 (New York: Dover Publications Inc, 1998),
p. 240.
Immanuel Kant,
Critique of Pure Reason
George Henry Lewes,
Problems of Life and Mind
(London: Trubner and Co., 1875),
pp. 412–15.
This translation is by Rosemary Edmonds: see Leo Tolstoy,
The Death of Ivan Ilyich
(Penguin Books Ltd: Harmondsworth, Middlesex, 1960).
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Marilyn J. Field and Christine K. Cassell (eds)
Approaching Death: Improving Care at the
End of Life
(Washington D.C.: National Academy Press, 1997), p. 2.
Atul Gawande,
Being Mortal: Aging, Illness, Medicine and What Matters in the End
(London: Prole Books Ltd, 2014), p. 1.
William James,
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Telling a New Story
Literary Narrative and Narrative Medicine
In Favour of Story
Christopher Dowrick, my Liverpool colleague, a professor of primary
care and himself a GP, describes in
Beyond Depression
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as father or restaurateur; he has no purpose to make every morning
part of a life story rather than just a matter of time after time. As
Dowrick recognizes, such suering no longer ts into the body as a
mere symptom, nor into the world as a medical diagnosis. What we
call depression is perhaps really the name we give to the problem of
a person outliving his or her sense of ‘tting’, or never having had a
place or form.
What is humanly required in such situations is precisely a
general
practitioner, one who, by contrast with the medical specialist, is
prepared to see beyond what specialist medicine alone can oer.
Generalism, here, means taking seriously the human trouble which
does not have a ready name or diagnosis. It is a willingness to enter the
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paradoxically, is a generalist
against the grain
. More specialists has
meant more diagnoses, and more diagnoses has meant that more
people previously considered relatively normal and healthy are
included within the denition of treatable or preventable disease.
At the same time, the demise of religious and philosophical justi
cation for the sheer arbitrariness of human suering has made
illness one of the few validated expressions of unhappiness. In these
circumstances, says Iona Heath, former President of the Royal
College of Physicians, a GP is tasked with ‘holding the border’
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theory, it is the theory that has to be revised or discounted, not the
patient’s experience. ‘Doctors need always to remember that what the
patient feels is the reality on which they must base their practice.’
This is what ‘primary care’ really means here.
Heath’s account of the vital importance of personal biography is at
once a description and a defence of the rationale of what has become
known as narrative-based medicine, as it is practised in the US and
UK today. Fundamentally, narrative medicine seeks the reorientation
of the doctor’s attention toward the person, not the pain. A patient
such as Ian has only symptoms to point to, and, in a secular world,
only a doctor to turn to. The doctor, in such circumstances, is as much
pastor as medic, and is listening to a personal story, not just a list of
presenting symptoms preparatory to producing a patient record.
More than anything else, says Arthur Kleinman, an early pioneer of
narrative medicine, it is the separation of the illness from its suerer
in the modern transformation of the medical care system, that has
alienated the ill from their professional caregivers and the latter from
the ancient reward of the profession—the capacity to do good for
another. Chronic illness like Ian’s is not only inseparable from a life
history: it actually
still a life, its embodied experience. Caring for the
patient’s story is not a peripheral task but constitutes the very point of
medicine.
What is more, the patient himself or herself cannot do without a
sense of story. ‘To be ourselves we must
have
ourselves – possess, if
need be re-possess, our life-stories’ says Oliver Sacks.
An extreme
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Sacks hoped the man himself might not be aware of his own lack of
continuity:
‘How do you feel?’
‘How do I feel,’ he repeated, and scratched his head. ‘I can
not say I feel ill. But I cannot say I feel well. I cannot say I feel
anything at all.’
‘Are you miserable?’ I continued.
‘Can’t say I am.’
‘Do you enjoy life?’
‘I can’t say I do
I hesitated, fearing that I was going too far, that I might be
stripping a man down to some hidden, unacknowledgeable,
unbearable despair.
‘You don’t enjoy life,’ I repeated, hesitating somewhat. ‘How
you feel about life?’
‘I can’t say that I feel anything at all.’
‘You feel alive though?’
‘Feel alive? Not really. I haven’t felt alive for a very long time.’
His face wore a look of innite sadness and resignation.
For Sacks,
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powerfully tangible tool in reshaping the expert-dependent scien
tic model of evidence-based diagnosis. Balint was a Hungarian
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The doctors who attended the discussion groups provided recent
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can the medical history bear witness to how a single, denite, generi
cally common symptom can have compressed within it the pain and
need of an entire individual life. More, it was the doctor’s communi
cated understanding, and the patient’s reciprocal recognition, of the
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illness.
Our experience has invariably been that,
if the doctor
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‘grows’, in place of an illness, an inner momentum powerful enough
to overcome the protective resistances of embarrassment or shame.
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evidence-based medicine, and, most especially, of the Randomized
Controlled Trial (RCT). ‘Evidence’, in RCTs, is derived from systemat
ically collected data and large population samples, with the aim of
deducing epidemiological laws and maximally applicable treatment
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content of a complexly particular life. An authentically engaged
understanding of that life and self might yield not answers but the
terrifying lack of them, a sense of the profound ill-ttedness of this
person’s needs to what is possible for the doctor to prescribe.
For Arthur Frank, in his seminal text,
The Wounded Storyteller
precisely because an individual’s story might not t into anything
except itself, that the ill person needs to tell it every bit as much as the
physician needs to hear it. Illness brings sudden change and often
chaos, more or less, to the suerer. Thus vulnerable as never before,
patients within the hospital system accumulate entries on medical
charts that become the ocial story of their illness and they can begin
to think of themselves as no longer people, but as cases. The question
‘How are you?’ needs a context wider than the medical report if only
to enable the patient personally to feel and to suer the loss of habit
ual routines and separation from past experience. Health care requires
recognition that this is still a personal life and not just one crippled by
incurable or progressive illness.
Substituting personal narrative for the conventional medical report
is really like putting literature into medicine in a practical way. As
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tell of the world, not of itself. When, in illness, the body’s functioning
is no longer mere background, this is not just a reversal of priorities but
a disturbance in the very structures of self-orientation. Carl Edvard
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‘There’s lots more unfortunate than us,’ she said.
The doctor laughed, and then so did she. She was still young
enough for her face to change totally with her expression. Her
face looked capable of surprise again. [.
‘Where were you living before you came here?’
‘In Cornwall. It was lovely there by the sea. Look.’
A photograph showed herself in high-heeled shoes, a tight
skirt and a chion scarf round her head with a man and a small
child walking along a beach.
‘That’s your husband?’
‘No that’s not Jack, that’s Cli and Stephen.’
The doctor nodded, surprised.
‘I’ll say that for Jack,’ she continued, ‘he never makes no dis
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‘It just doesn’t mean anything to me. It doesn’t touch me.
Iknow what real love is like, you see. With the father of
Stephen,
when I got Stephen, it was beautiful. I know what they mean
when they say it is the most wonderful thing in the world, it was
like that when I got Stephen and he wanted me like that. And
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emerged, and which by denition operates amid the particularities of
both situation and relationship, and which, as we have seen, is com
mitted to rescuing or attending to the ‘not-tting’ in human experi
ence, is itself inimical to rigid conceptual frames.
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the out-of-place-ness of the certainties of medical knowledge itself.
‘Our experience has invariably been that,
if the doctor asks questions in the
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explains in his account of the relation of narrative approaches to the
Narrative-Based Primary Care
. Narrative in medical
practice has wanted to resist the ‘paternalistic’ assumptions and inva
sive questioning and procedures used in psychoanalytic approaches
to care. It has also sought to broaden the contexts for understanding
patient health, looking beyond the psychological to include, for
example, the social and environmental conditions in which a person
lives. Narrative-based medicine has thus dened itself almost equally
against its closer partner, psychoanalysis, as against its greatest antag
onist, Evidence-Based Medicine, which seeks to derive generalizable
scientic laws from the statistical analysis of vast samples of imper
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form in work. In fact I had a nervous breakdown and my hair
fell out badly. I stayed at home for a year and gradually put on
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makes me worse, but the cause is really organic and I need medicine
to cure it—until it turns into and actually constitutes her life story.
This is in fact what happened. After four psychiatric treatments,
MissF reverted to long-term use of injections and drugs and collect
ing doctors.
For Balint, it is not only that ‘depth’ always takes absolute priority
over the linear dimension of story. It is a depth of being of which the
patient himself or herself may be ‘only dimly aware’, and by deni
tion unable to translate into straightforward causal narrative. Story,
that is to say, is not the
necessary,
and may not be the
available
form.
Indeed, as Miss F’s case shows, albeit in a narrative still inected
with the rigidities of a standard medical view, autobiographical story
may be the
wrong
mode. Intrinsically, if inadvertently, that is to say, the
stories we tend to tell of ourselves are liable to
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‘story’ wrong, to create only another stereotype in place of a medical
one. The problem of studied articulation and over-conscious knowing
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impoverished and over-simplied denition of narrative comes to
stand for all. According to Rita Charon:
When we try to understand why things happen we put events in
temporal order, making decisions about beginnings, middles
and ends or causes and eects by virtue of imposing plots on
otherwise chaotic events.
By telling stories to ourselves and
others – in dreams, in diaries, in friendships, in marriages, in
therapy sessions – we grow slowly not only to know who we are
but also to become who we are.
But these ‘decisions’ are indeed impositions. ‘Narrative’ undergoes
precisely the processes of standardization here that its incorporation
in medical practice is designed to modify. Storytelling, as illustrated
and dened here, does not belong to the literary at all, except reduc
tively. More, in making ‘story’ an imposed ction, this does wrong to
life as well as to literature. We know from Bion that deeply personal
experience—the reality of ‘who we are’—is not susceptible to facile
‘knowing’ or tidy expression, other than distortingly. There is always,
Bion says, an available terminology to be found in material that is
supercial and easily accessible to consciousness. The problem of
nding the right word, he goes on, ‘is analogous to that of the sculptor
nding his form in the block of his material, of the musician nding
the formula of musical notation within the sounds he hears, of the
man of action nding the actions that represent his thoughts’.
Form
is not applied but found; authentic story reveals the form hidden
within experience. It is hard, struggling work; it is, Bion suggests, one
of the most profoundly creative acts of being alive.
Indeed, for Balint himself, the founder of story in medicine, the
kind of ‘putting in order’ which denes Charon’s idea of story comes
far too easily to be commensurate with actual experience. ‘The mind
is multi-dimensional to an impossible degree whereas any description
is limited to one dimension’:
Language can describe only one sequence of events at a time; if
several occur simultaneously, language has to jump to and fro
among the parallel lines, creating diculties, if not confusion,
for the listener. A further, almost insurmountable complication
is caused by the fact that mental events not only take place
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simultaneously along parallel lines, but inuence each other
profoundly.
Neurologists tell us that we are programmed to tell stories, and that
the will to ‘impose’ order on chaos is part of our biological hard-
wiring.
But then our creaturely disposition, at brain level, is appar
ently at odds with our mind’s experience of what happens to us.
Experience possesses a complex simultaneity and multiplicity which is
of a wholly dierent order from the linearity and singularity of con
ventional ideas of story.
The danger of the single story, says novelist Chimamanda Adichie,
is that it
creates
stereotypes as much as it conforms to them. Born into
a conventional middle-class family in Nigeria, Adichie had always felt
pity for the family’s live-in house-boy because all she had ever been
told about him was that his family was very poor:
One Saturday we went to his village to visit, and his mother
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‘We are condemned’, says Raymond Tallis, ‘to live in a world made up
of tiny moments, linked by And Then, And Then.’
But here, just for
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history) might otherwise be lost to subterranean inwardness, and for
which there so often is no external voice or witness in ordinary life.
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common alcoholism, abuse, and depression. The scientist who admired
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then, like herself?
The softening thought was in her eyes
when he appeared in the doorway, pale, weary, and depressed.
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her far more readily than she could believe herself to be worthy of it:
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What could I speak that would not be unjust to you? Your life!
if you gave it to me and I put my whole heart into it; what
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The answer lies within the poems themselves. At the close of a son
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protected from time and the hour even in going along with it. In this
sense of created ‘place’, these poems are paradigmatic of what
Balint really means by ‘atmosphere’. They make possible a way of
thinking and a place for thinking that the world would certainly dis
courage and for which it would have no appropriate tone. Where
else might a middle-aged woman in love for the rst time securely
express her fears at the unprecedented change love has wrought in
the mode that is emotionally most tting—the fragile tones and lan
guage of a child?:
If I leave all for
thee,
wilt thou exchange
all to me? Shall I never miss
Home-talk and blessing and the common kiss
That comes to each in turn, nor count it strange,
When I look up, to drop on a new range
Of walls and oors,
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of recognition which says: ‘This is what I am now. This is what is
really happening’.
And when I say at need
I love thee
.. mark! ..
I love thee!
.. in thy sight
I stand transgured, gloried aright,
With conscience of the new rays that proceed
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narrative confession of a ‘single story’ but the sudden triggered
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Evelyn noticed how ‘owre of light’, repeated ‘brought/to light’ from
the preceding verse; and how that last line, her favourite in the poem,
came after ‘die that night’. She said: ‘It makes you still see the daytime
and the ower – you still see it even though you know it’s already
the Plant”, “A Lillie of a Day”
’. This is good reading,
because Evelyn is in tune with how the poem is holding onto some
thing that the ‘season’, in its passing, cannot. She also intuits that it is
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Christopher Dowrick,
Beyond Depression,
ed (Oxford: Oxford University Press,
2009), p. 160.
From an interview for the
Student British Medical Journal
Iona Heath, ‘Divided We Fail’: The Harveian Oration, 2011 (London: Royal
College of Physicians, 2011), pp. 8–13.
Iona Heath, ‘Following the Story: Continuity of Care in General Practice’ in
Trisha Greenhalgh and Brian Hurwitz (eds),
Narrative-Based Medicine
Books, 1998), pp. 83–92, p. 86.
Arthur Kleinman,
The Illness Narratives
(New York: Basic Books, 1988), pp. 60,
Oliver Sacks,
The Man Who Mistook His Wife for a Hat
(London: Picador, 1986),
p.105.
Oliver Sacks,
The Man Who Mistook His Wife for a Hat
(London: Picador, 1986),
pp.34–5.
Suzanne Corkin,
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Reading in Practice
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This poem, ‘Grief’, is rst read aloud by the group leader. She then
re-reads the opening:
I tell you, hopeless grief is passionless—
That only men incredulous of despair,
Half-taught in anguish, through the midnight air,
Beat upward to God’s throne in loud access
Of shrieking and reproach.
A recording and then transcript was made of the group’s subsequent
discussion. After a short pause, Ron is the rst to speak. He nds the
poem puzzling at rst:
There’s so many things. It’s, it’s disjointed. It - it’s not straight
forward is it? You don’t look at it and think oh yeah that’s that.
‘I tell you, hopeless grief is passion
passionless.’
He knows the surprise, the change of word from the obvious, and the
shift from the obvious is often a crucial starting point. The poem then
speaks not of a desert of feeling, but worse, paradoxically, of ‘full
desertness’. Then, instead of crying upward to God’s throne, this:
Deep-hearted man, express
Grief for thy Dead in silence like to death;
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What is happening here is that the group, in reading the poem, is
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Into the living sea of waking dreams,
Where there is neither sense of life or joys,
But the vast shipwreck of my life’s esteems;
Even the dearest that I loved the best
Are strange—nay, rather, stranger than the rest.
(John Clare, ‘I Am’, 1848)
Mike, a father in his thirties who is a regular attendee and always
happy to speak, leaves the room abruptly, immediately after the poem
has been read. The group leader is worried that the poem may have
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context. And she always used to say, whenever I tried to ‘place’
people and experience: ‘That’s the sociological defence’ when
ever she thought I wasn’t speaking for
. This just took me
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of book-club reading? This is the question that the interviewer instinc
tively put to Mike when he spoke of how the John Clare poem made
him feel, shorn of his sociological defence:
Interviewer
poor, and this poverty can probably be put down to the fact that in our
culture it has been little explored.’
Too often the language of personal
experience is not personal: it is over-familiar, made cliché, or tted to
contemporary vocabularies and agendas. The underlying rawness is
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relationship of contact with our own inward experience’.
It oers
what Balint struggled to provide in his doctor’s surgery: the right emo
tional atmosphere in which to hear and to speak.
The following example of this triggering by mental excitement and
emotion concerns Lois, a young woman in her early twenties who is
attending a community reading group. She is suering some signi
cant neurological impairment resulting from an accident during a stay
in South Africa where she came into devastating contact with an elec
tric fence. The group have been reading Robert Frost’s ‘The Road
Not Taken’:
Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;
Then took the other, as just as fair,
Somewhere ages and ages hence:
Two roads diverged in a wood, and I –
I took the one less travelled by,
And that has made all the dierence.
The group talk initially, and conventionally enough, about ‘life
choices’: opting for a school, university, or career; staying in a steady
job or risking starting a business. But suddenly, here, for the rst time
It could be a very minor choice or it could be a very big choice.
I mean, for example, a lot of my health problems started when
I went to South Africa
but if I hadn’t gone I would still prob
ably be like: wanting to go here, want to go there. At the same
time I wouldn’t have the same
the same problems, as I do
now. Would I have the same
mentality as now? Perhaps it
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could have been worse. I could have not gone and done some
disability meant that she often had diculty in concentrating and
occasionally had problems with uent speech. But it was here that
Lois’s intermittent speech problems came under most emotional
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People turn to formal therapy because the right context or right
thought does not occur often enough in normal life. Instead there can
often seem to be just bad thoughts, sad thoughts, going round and
round. In this sense we are all living half-lives most of the time, in
need of the good doctor or right atmosphere or whatever can give
back to us what we have missed or only half-realized. When we have
no other help—no doctor, no friend, no good moment—literature can
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decade, most psychoses were thought untreatable except by drugs.
Currently, it is coming to be widely recognized that much mental
illness is a result of trauma, of damaging experience. Low mood,
unhappiness, loss of sharpness, feeling down, belong to the same fam
ily of human experience as the disabling disorientation and suering
that psychiatric medicine treats as ‘disease’.
One of our most recent research studies took place at the Royal
Liverpool Hospital with chronic pain patients. These are people who
attend the pain clinic weekly, not in any expectation of a cure, nor
primarily for purposes of medication. In most cases there is no longer
one clear physiological cause for their pain. The consultant who runs
the clinic does not think of the regular attendees as ‘pain patients’ but
as ‘suerers’. He and his colleagues have long been aware that their
role as pain specialists is secondary to their essential one, as of more
general practitioners, seeking to help the patient’s problem by trying
to understand it as part of a human life.
What follows is an excerpt from one of the groups that the clinic
psychological treatment for chronic pain, which the consultants have
adapted for their patients’ particular needs. CBT rests on the premise
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adrenalin produced by the distress of resistance only recreates the
pain, as in a vicious circle. For the patient’s own sake, the consultant
Consultant
patients had been reading Charles Dickens’s
A Christmas Carol
. Diane,
middle-aged, and a part-time nurse who cares for her elderly parents
and grandchildren, had been attending both groups. She had been
indierently attentive over the rst few pages of the book, often need
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they go back and—and
it. The phantom is showing that
the future can be changed if it wants to change.
Group Leader
That’s a lovely way of putting it, Diane.
(quoting) ‘I hope to live to be another man.’
‘And
it’ is a message new-red, like a nerve impulse, its tone and
emphasis triggered by the text’s ‘change these shadows
by an
altered life’. Diane thought she knew Scrooge’s story as well as she
knew her own. But ‘If
wants to change’ is indeed a lovely and novel
formulation. The invisible future is itself potentially animated here—
disciplined planned stages, outside of immediate experience, to pre
nally suggested by another and then taken on by the self, may be
likely to produce only short-lived, ‘un-owned’ eects. Reading
previously, the consultant concentrated on the importance of recog
nizing and overcoming ‘negative thoughts’. ‘It reminds me of being in
the army,’ said Anthony:
They always talked about negative thoughts and when
you go into operational theatre you’re always told to think
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positively. So if you’re going down a road and the bridge has
been taken out, you were told to think the bridge was still
there.
Does anyone else have a way of thinking the bridge
is still there?
I take more painkillers so as to be able to work. I always
loved my work—catering; it was my life. I came out of an
extremely abusive relationship and was free for the rst time
thispassage towards the close of David Guterson’s short story,
Arcturus’. After many years, Carl, the protagonist, has run into
Floyd, his boyhood best friend, now ‘loused up and rusty
a fat
old man’. Carl involuntarily recalls a river trip the two had taken
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himself’; ‘Carl can’t reconcile in his mind the way things are to the
way things were’. But the emotional energy of her rst thought is the
opposite of sad or depressed, even though Carl himself feels helpless.
The categories of ‘positive’ and ‘negative’ are simply not relevant
here. She goes back in the text to read this sentence from the preced
ing paragraph about the river trip the two boys made years ago in
same person in a dierent place. Rhiannon Corcoran again:
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least eort and live by routine. Live reading removes the facility
to rely on this ‘safe system’. It triggers active happenings and
unpredictable events. Our own experiences are re-felt or
reviewed in a way which challenges habitual emotions or recov
ers them in a new form.
The power of reading to challenge, ignore, or shift default thinking is
intrinsically connected to literature’s broad human range—its abun
dant inclusion even of what is ostensibly ‘negative’.
One great advantage of the shared reading we have been witness
ing, is that people have the chance to show and to tell what is usually
private or silent in reading. It is admittedly a dierent experience from
reading on one’s own; but it is the nearest we have for research into
private acts of thinking made live during reading, since the private
here goes on within a group made unusually intimate by the presence
of the poem or short story. What the video recordings make possible
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severely limits their imaginative exploration of experience. Very often,
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failing strength, he gave up pitying his wife and fell back down
the decades into the couple of months of a summer in the Alps.
The ladder to the loft was permanently down, encumbering the
way into the little living room. A breath of cold hung over the
opening. Or the warmth of their living space, being drawn up
there, was converted into cold just above their heads. In the
mechanism of her love and duty she called him down when his
meal was on the table. But also at nights he went up there and
she heard him moving and muttering over the bedroom ceiling.
Then she wept to herself, for the unfairness. Surely to God it
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response to the same passage from the Constantine story:
ing’ was.
When I was a child I used to like it when the ice came.
I used to think the ice kept things safe.
Group Leader
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Anthony was a model CBT student, well in advance of the course in
so far he had already established a disciplined self-help regime. But
what happens here is a sign that Anthony’s real thoughts lie outside,
anterior to, the purview of self-regulation and conscious control.
to seek, in these few brief seconds, a form of realization that does not
simply freeze it and lose it again.
The things that matter to our existence ‘leap out’ at us, said
Heidegger.
So with these readers: the personal relevance reveals
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The inner life might always have to be discovered thus involuntarily,
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But hardly have we, for one little hour,
Been on our own line, have we been ourselves—
Hardly had skill to utter one of all
The nameless feelings that course through our breast,
But they course on for ever unexpress’d.
‘Hardly’, ‘hardly’, ‘one little’, ‘one of all’ ‘For ever un-.’ This sense of
the ‘nameless’ is not a failure of language merely, any more than it
was words that failed Ivan Ilyich in the face of death. The problem
here is that this namelessness is one that belongs to human life, and
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But what they made me was the repository of what was going on,
and of what was left behind, when my siblings were no longer at
home. In such circumstances, what you become is the witness—
protectively silent, not wanting to say all you see. Above all, what you
are doing is reading the situation, noticing meaning that others, unno
ticing, walk away from. This ‘reading’ or witnessing—hearing a pain
in others which was never quite expressed—became ‘my line’. It was
a submerged inner commentary, sunk down but present—the subter
ranean thinking which makes me now relish its equivalent in the free
indirect discourse of the novel.
It was much later that I realized that the witness—the one who
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has learned that he will soon die. Dorothea has oered to him her
loving pity for his sorrow, but has been coldly repulsed by her hus
band, and feels a rebellious anger stronger than any she has felt since
her marriage day. ‘Was it her fault that she had believed in him – had
believed in his worthiness? – And what exactly was he? In the misera
ble light she saw her own and her husband’s solitude – how they
walked apart so that she was obliged to survey him. If he had drawn
her towards him, she would never have said “Is he worth living for?”
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reconciliation or even for adequate reparation. The best we can say is
that what happens does no harm and that that is an achievement.
George Eliot knows it is. From ‘she felt’ in that nal paragraph, we feel
a thankfulness and sense of relief analogous to Dorothea’s own when
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arguably, whatever the insular downsides, it has been protected in uni
versity English departments for the last century. English Literature is
still the strongest recruiter in Higher Education among humanities
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Winterson is lucky in the sense that she could use her bad experience
as a writer. Those of us who are not writers still need books as she
once rawly did. The biggest risk of all is that the deeper reality, which
for
people, will be ‘inside’ nobody if the practice of serious
Wilfred R. Bion,
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Martin Heidegger,
, (Wiley-Blackwell, 1978), p. 103.
Ella Berthoud and Susan Elderkin,
The Novel Cure: An A-Z of Literary Remedies
(Edinburgh: Cannongate, 2013).
Leo Tolstoy,
What is Art?
, 1898, trans. Richard Pevear (Harmondsworth: Middle
sex: Penguin Books Ltd, 1995), p. 81.
Alexander Pope,
Wendell Berry,
(Ipswich: Golgonooza Press, 1991), p. 185.
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Reading for Life
In one way this book has been on the side of medical humanities, and
in another way it hasn’t. In its commitment to connecting literature
and life, medical humanities is in some senses a more congenial place
to reside for someone like myself, who cares about literature’s having
a place in the world but can nd no home either for literature, or for
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subject, Dr John Sassall, a GP in a remote rural practice, is a disciple
and an embodiment, Berger acknowledges, of Balint’s ‘brilliant’
understanding of what is really demanded of a general diagnostician:
that he search not for a specic condition, case or cure, but for the
whole truth about a person. To the modern day GPs whom we encoun
tered in Chapter Two—Iona Heath and Christopher Dowrick—
Fortunate Man
has oered an original model and vital reminder of rst
principles.
The second reason is that
A Fortunate Man
is a pioneer in the shift of
literature toward life. A collaboration with the photographer, Jean
Mohr, the work is a ground-breaking photo-documentary—part doc
umentary case study, part biography, part novel, part philosophical
meditation. This generic mix is the formal outcome of the real
achievement of this work.
A Fortunate Man
represents the creation of a
new hybrid. It uses the resources of ction in relation to a real-life
subject matter which is not invented as it would be in a novel. In that
way, the book cannot wholly control the material taken from the life
of Sassall, which thus keeps its raw and stubborn recalcitrance. ‘I wish
I could write a conclusion summing up and evaluating what has been
noticed,’ Berger writes at the close of
A Fortunate Man
But I cannot. It is beyond me to conclude. Sassall’s situation can
only be judged in relation to the work he does in it. And I can
not evaluate that work as I could easily do if he were a ctional
character. In ction, outcomes can be decided. Whereas now
Ican decide nothing. I am entirely at the mercy of realities
Icannot encompass.
‘I cannot’, ‘It is beyond me’, ‘At the mercy of realities’. Berger wel
comes these failures because he does not want this work to be valued
merely as a closed ction, a constraining container, as Bion might say.
His not being able to conclude is a way of leaving both the subject
matter and the artefact open.
A Fortunate Man
It is through this brave and seminal text that I try to see an image of
the kind of mixture of literature with life that is my main concern.
Early in his career, Sassall had seen himself primarily as a life-saver.
He had grown up on the books of Joseph Conrad and the doctor he
aspired to be was a kind of heroic Master Mariner, whose commanding
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authority was also in the service of the people who depended upon
him. His chief interest was in one-o practical emergencies—
performing appendix and hernia operations on kitchen tables, deliv
ering babies in caravans. He sought out accidents and crises of
dangerous illness where the patient’s condition was simplied to a
veriable external problem requiring immediate practical and precise
medical treatment.
Over time, as Sassall was called out frequently to the same homes,
the same people, he began to take a dierent view of crisis and of
illness. His patients, he found, made confessions to him for which
there was no medical reference, and where no previous explanation
would exactly t. What was wrong depended upon the history of the
patient’s particular personality and circumstances in life. He very
seldom sent a patient to mental hospital, considering it a kind of
abandonment. His principal duty, as he saw it, was rather to ‘keep that
personality company in its loneliness’. What Sassall ‘treated’ was
The unhappy patient has failed to nd any conrmation of
himself in the outside world. In the light of the world he is
nobody: by his own lights, the world is nothing. Clearly the task
of the doctor – unless he merely accepts the illness at face value
and incidentally guarantees for himself a ‘dicult’ patient – is
recognize
the man. If the man can begin to feel recognized –
and such recognition may include aspects of his character
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The older man was taller by nine inches. The doctor said
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Like the novelist, like Bion, he is translating what people are and what
they suer into thoughts that they can think:
When patients are describing their conditions or worries to
Sassall, instead of nodding his head or murmuring ‘yes’, he says
again and again ‘I know’, ‘I know’. He says it with genuine sym
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task is to persuade the host language to take in and welcome the
‘thing’ that is waiting to be articulated.
So, a book—this book of Berger’s—is like what Sassall serves as being
for his patients: it is a container to take in and recreate within itself the
human content that is in need of translated recognition, holding it for
longer than humans ordinarily can.
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story, the boy says dierently, “There is nothing I can do”.’ Jim replied
that he knew that:
But seeing the sheep in that abattoir, I don’t think I’ve come
toterms with that really, I haven’t been able to reason with it,
you see.
The memory seems to linger with him, maybe as his pain often does.
But he says: ‘That’s a great story, it brought back some good, some
bad things.’ Literature deals in what cannot be reasoned with. Its
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‘sleeping
sleeping’, ‘dying
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But what happens inside the imaginative immersion of the readers
we have witnessed is demonstrably much quicker and far less
consciously voluntary than the vicarious ‘sharing’ of a ctional char
acter’s emotions. Mike, unable to stay in the room when he rst heard
John Clare’s ‘I Am’; Lois, thinking of the life she will never have while
reading Robert Frost’s ‘The Road Not Taken’; Anthony, in relation to
the David Constantine story, ‘In Another Country’, feeling residual
grief for a past loss which he has long ‘got over’ at the level of ordi
nary functioning life. Reading the book
, happens at the same
moment, so to speak, as its reading the person
. So, with the
earliest literature, one examines the word in order to examine oneself.
‘God hath spoken
have I heard this’ (Psalm 62:11).
A close analogy for this two-in-one process is when Jim’s response
to the short story suddenly triggered the thought of the poem, ‘The
Dying Animals’ in the group leader. So it is that as a poem or a story
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The transcript of Heather’s immediate response reads:
He weeps for the boy’s loneliness when, before, he couldn’t feel
his own. The boy is forgotten by others; but the man has forgot
- he’s what’s not there.
This is Scrooge seeing himself as innocent child, whilst being himself
hard adult: the two-in-one, the reader of himself aected by the
young boy in a way that softens and reanimates the older man. What
Heather is doing here is not merely making thematic or obvious links;
rather she is hearing the story’s own second voice, the deep structure,
within its linear movements. At CRILS, we have become interested by
this process of reading the text and feeling a message within it. My
colleague, Philip Davis writes of it:
Literature’s language-within-language is formal and sophisti
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trouble nding words. The words which do nally come are always
more ‘precise’ than any default language. But still, the implicit is never
merely dened and exhausted:
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once a little boy, and she was once alive – and I was once a good
master – a good master – yes! It is all past now.’
He took up his pipe, and began to smoke afresh, and Roger,
after a silence of some minutes, began a long story about
some Cambridge man’s misadventure on the hunting-eld,
telling it with such humour that the Squire was beguiled into
hearty laughing. When they rose to go to bed, his father said
to Roger, -
‘Well, we’ve had a pleasant evening – at least, I have. But
perhaps you have not; for I’m but poor company now, I know.’
‘I don’t know when I’ve passed a happier evening, father,’ said
Roger. And he spoke truly, though he did not trouble himself to
nd out the cause of his happiness. (Chapter Twenty-three)
Angela noticed how Roger at rst uses the male tradition of smoking
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Angela is inhabiting the novel’s undramatic family space almost as
deftly as the author is doing.
Noticing this, the group leader points out how this understated
event is made even more moving for resonating with a tiny under-
event from much earlier in the novel and from the family’s far past:
When Roger caressed his mother, she used laughingly to allude
to the fable of the lap-dog and the donkey; so thereafter he left
o all demonstration of aection. (Chapter Four)
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contrast with the habitual modes of thinking of the semi-cultured,
these are people whose intelligence is triggered exceptionally by the
literary stimulus in ways that could not be predicted, even or espe
cially by themselves.
But struggle is not everything; there is happiness in this. Angela has
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there to surprise him. ‘I behold – a
rainbow’
. The excitement
burst out from his voice and he smiled and looked up at me, and
I smiled too.
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when he had taken over the family estate: ‘I waste my adult years
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I don’t want to educate readers out of that love: I want to make of
it, instead, a discipline; to put feeling to
in the way we have seen
relatively novice readers use immediate and often involuntary per
sonal responses—as the starting place for hard and serious thinking.
The teaching of university English generally misses out that rst cru
cial thing—the powerful emotional place inside the reader which,
summoned by the literary work, is in imitation and memory of the
emotional source out of which the writing itself rst comes. English
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help. Indeed, if university English became more specialized in the
good way I have described—in learning reading as a concentrated
craft—it could become less specialized in every other way. This prac
tical speciality of attention, as I have tried to show through my exam
ples of non-specialized readers, really can be taken back out into the
world where literature belongs and has its subjects and its origins.
Some English students I am teaching do exactly that: as part of
their course, they practise shared reading outside the university—in
community libraries, residential care homes, schools, and recovery
units—with people who would not normally read at all or do not
know how to read. The purpose is not to spread ‘culture’ in some
condescending imperialist manner for those supposed to be in need
even when they hardly recognize it. The work of these volunteers is
more modestly artisan—to spread, informally, the craft of excited
reading and see if it catches people. This is crucial. The modern habit
of quick scanning, of ‘light’ reading, leaves voices and thoughts
silenced. Careful and caring reading, by contrast, across the range and
depth of literary material, energizes what is otherwise kept enfolded
within books and latent inside people.
Some of these students now have careers as readers. The Reader
Organization employs literature graduates as readers in residence.
They oer weekly shared reading to residents in care homes, to
service-users in mental health hospitals and health centres, to men
and women in prison, to looked-after children; and they provide train
ing to professionals within those areas to have the condence to use a
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clinical empathy’, critical reection, improved communication skills.
The chief problem here, I have argued, is the using of ction and
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From ‘The Figure a Poem Makes’, 1939, in
The Collected Prose of Robert Frost,
ed. by
Mark Richardson (Cambridge, Mass.: Harvard University Press, 2007), p. 132.
Lisa Zunshine,
Why We Read Fiction: Theory of Mind and the Novel
(Columbus: Ohio
State University Press, 2006), pp. 159–64.
Thomas De Quincey,
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Acknowledgements
I wish to thank The Reader and its recipients for making possible the writing
of some of this book.
Copyright Acknowledgements
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Select Bibliography
The literary works which matter for this book will be apparent throughout. I list
here the works which have most inuenced my thinking around them.
Balint, Michael,
The Doctor, His Patient and the Illness
(London: Pitman Publishing
Berger, J.,
A Fortunate Man,
1967 (Cambridge: Granta Books, 1989).
Bergson, Henri,
Creative Evolution
, 1911 (New York: Dover Publications Inc,
Bion, Wilfred R.,
Experiences in Groups,
1961 (London: Routledge, 1994).
Bion, Wilfred R.,
Learning from Experience
(London: Mareseld Library, 1962).
Bion, Wilfred R.,
Transformations: Change from Learning to Growth
Bion, Wilfred R.,
Second Thoughts
(London: Mareseld Library, 1967).
Bion, Wilfred R.,
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Index
Adichie, Chimamanda
Coles, Robert
Conrad, Joseph
Constantine, David
‘In Another Country’
Corcoran, Rhiannon
Corkin, Suzanne
Permanent Present Tense
Darwin, Charles
On the Origin of Species
Darwin, Erasmus
Davis, Philip
Deleuze, Gilles
depression
1–3, 7, 10, 13, 20, 23, 26,
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de Quincey, Thomas
Diagnostic and Statistical Manual of
Mental Disorders (DSM)
Dickens, Charles
A Christmas Carol
distress
Dowrick, Christopher
Beyond Depression
Dreiser, Theodore
The Lost Phoebe
Edmundson, Mark
Why Read?
Eliot, George
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Moore, Anthony R.
The Missing Medical Text
Nagel, Thomas
narrative medicine

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