Poetry and clinical humanities
Paul Valery wrote that '[Poetry] is the attempt to represent, or to restore, by means of articulated language those things, or that thing, which cries, tears, caresses, kisses, sighs, etc' (p. 147).1 Valery is here remarking on the especially close relationship between the passions and poetry, signalling the way in which poetry is a ready source of how we respond to distress, how we negotiate crises, and in what ways language can be used to obscure, disclose, disguise or dissemble feeling.
In this chapter, I will examine: a) the use of poetry by poets who have experienced emotional disturbance; and b) the writings of doctor-poets. Both categories of writings provide examples to illustrate the varying roles of literature in clinical education; giving accounts of the lives of sick people and their stories, and describing the lives of clinicians and the difficulties inherent in their roles.2
There is at present little literature on the use of poetry in clinical teaching. There is no published material on what poems might be useful and how these poems might be used. This is not to say that the place of poetry in the teaching of clinical humanities is limited in scope or peculiarly problematic, but to remark on the paucity of published material on the subject. This, despite the fact that poetry ought to have a privileged position: poems are often short and can be read at one sitting, and may also be read aloud and analysed as a joint activity within a teaching session.
The aims of the medical humanities as set out by the Association for Medical Humanities include: a) to emphasise education as distinct from training; b) to contribute to the development of students' and practitioners' abilities to listen, interpret and communicate, and to encourage their sensitive appreciation of the ethical dimensions of practice; c) to stimulate and encourage a fitting and enduring sense of wonder at embodied human nature; and d) to develop students' and practitioners' skills in thinking critically and reflectively about their experience and knowledge.3 These aims can be met by the use of poetry in clinical teaching. Since poems are not directly about clinical skills, they help to emphasise the importance of a broader education, an awareness of the rich cultural resources available to clinicians and patients alike, underpinning our common humanity. The skills required to read, comprehend and fully decode a poem are the same skills required for active listening in a clinic: apprehension of the multilayered content of language and its infinite capacity both to express and to obscure. Poetry by its nature calls attention to alternative perspectives, challenges a simple biomechanical understanding of the world, and inevitably reflects and explores the perilous fragility of the human condition.
It is unarguable that the clinician's role is both to be technically competent as well as humane in his approach. Being humane involves connecting and engaging with the patient's concerns and worries, the patient's understandings as well as misunderstandings, and drawing from the same pool of cultural motifs as the patient, so as to grasp the patient's apprehensions. Literature, and poetry by extension, provides a ready source, an insight in to what Scott calls 'the common and shared patterns of response to critical situations, or into unique and individual responses to crises',4 and may also enrich the language and thought of the clinician.
Our clinical, technical language can and does set us apart from patients. At the time when the patient is most in need of support and understanding, clinical language can create a wider gulf, thereby isolating the patient from our proper concern. John Diamond described it thus: 'When things go wrong we find ourselves hostage to men and women who use language we don't understand, talk of scientific principles we don't have the learning to grasp, who seem to be more confident than their results would allow, who offer us treatments which seem to work on some random basis which is never explained to us' (p. 31).5 What literature can do is to give access to a fund of notions and experiences not incorporated in clinical texts. Poetry can also give clinicians access to the language in which distress is mediated, expressed or controlled. This process is not appreciated enough; poetry and literature give all of us the language to express the inexpressible or the common experience that is unique when it happens to us. In practice, this means that clinicians can engage with patients using a common language to discuss the human dimension of clinical dilemmas.