Literature and Medicine

A Practical and Pedagogical Guide

Ronald Schleifer, Jerry B. Vannatta

• Publisher: Palgrave Macmillan
• Year: 2019
• Print ISBN:
  9783030191276
• eBook ISBN:
  9783030191283
• Topic: Literature
• Subtopic: Modern Literary Criticism
• Index: Literature

Literature and Medicine: A Practical and Pedagogical Guide is designed to introduce narrative medicine in medical humanities courses aimed at pre-medicine undergraduates and medical and healthcare students. With excerpts from short stories, novels, memoirs, and poems, the book guides students on the basic methods and concepts of the study of narrative. The book helps healthcare professionals to build a set of skills and knowledge central to the practice of medicine including an understanding of professionalism, building the patient-physician relationship, ethics of medical practice, the logic of diagnosis, recognizing mistakes in medical practice, and diversity of experience. In addition to analyzing and considering the literary texts, each chapter includes a vignette taken from clinical situations to help define and illustrate the chapter's theme. Literature and Medicine illustrates the ways that engagement with the humanities in general, and literature in particular, can create better and more fulfilled physicians and caretakers. 

Appendix 1: Experimental Results: The Cognitive Science of Literary Reading

As we mention in Chap. 1 , in the last twenty-five years , there have been many studies, pursued with scientific rigor, that demonstrate the fact that reading literary fiction effects changes in people that increase particular forms of cognition and fellow-feeling. How these effects are brought about has until recently been analyzed and discussed, usually in literary studies, but rarely by means of scientific protocols. Over the past twenty-five years, however, data has been published, derived from rigorous testing, which shed light on this phenomenon and indeed allowed us to discern a causal relationship between reading fiction and increased empathy and vigorous enactments of Theory of Mind (ToM). Some of these studies have shown how—by means of the analysis of literary features —literary fiction goes about effecting these changes. But besides these “interpretative” analyses, many other studies have demonstrated by means of empirical, quantitative and qualitative research techniques that reading literary fiction leads to enhanced ToM, measurable transportation states ( “vicarious experiences”), and increased empathy. As we suggested in Part I of the Introduction, these phenomena are desirable for people in the healthcare field. The exciting development of this data has come about through a confluence of studies involving a number of disciplines including cognitive and social psychology, narratology (including stylistics and linguistics ), neuro-imaging , and, as we note throughout this book, literary semiotics and medical pedagogy . (“Semiotics” is the systematic study of “signs” and the manner in which meaning is generated. It grew out of linguistics and logic in the early twentieth century. For a historical and cultural account of why this is so, see Schleifer 2018a ). In this appendix, we set forth a short summary of this research by focusing on a small number of these studies that are representative of the wider empirical work of the last two decades. Taken as a whole, this work in cognitive and affective science describes how reading literary fiction (variously defined as “writerly,” “polyphonic,” and “stylistically sophisticated discourse”), creates in the reader the desirable effects of enhanced empathy , more rigorous ToM , and the vicarious experiences that Transportation Theory analyzes.

In 1994, D. S. Miall, an English professor, and Don Kuiken , a psychology professor, both from Alberta, Canada, demonstrated that “foregrounding” is systematically correlated with increased reading times and changes in affect (emotional response), and it is also correlated with readers’ judgment of “strikingness” in a series of experiments utilizing student-readers. The term “ foregrounding ” was coined in the 1930s by Jan Mukařovský , a semiotician and member of the Prague School of Linguistics . By “foregrounding” he means “the range of stylistic variations that occur in literature, whether at the phonetic level (e.g., alliteration, rhyme), the grammatical level (e.g., inversion, ellipsis), or the semantic level (e.g., metaphor, irony)” (Miall and Kuiken 1994 : 390). In Part II of Chap. 1 , we describe and examine thirteen of these “features” in relation to Grace Paley’s short story, “A Conversation with My Father.” These features, we suggest, are useful in developing the careful engagement with the literary narratives and poems of our text-anthology—and, importantly, in the careful engagement with patients’ stories in the clinic. While these features can occur in all language uses, Miall and Kuiken argue (following Mukařovský ) that they are systematically present in literary texts: foregrounding, they argue, “enables literature to present meaning with an intricacy and complexity that ordinary language does not normally allow” ( 1994 : 390). One such measure—using a term we discuss in Part II of Chap. 1 —is the ability of literature to “ defamiliarize ” experience and make it new. “ Defamiliarization ,” as we mention in Chap. 1 , is a term developed by Russian scholars in the early twentieth century to allow for the systematic study of the ways that discursive art—literary narrative—provokes effects and responses in readers/listeners. Miall and Kuiken measured the effects of foregrounding in four formal studies of readers that measure the “strikingness” of literature (i.e., the attention it arrests by means of defamiliarization), the provocation of feeling (affect), and the ways that foregrounding increases reading time.

Much work has been done on the emotive responses to reading literary fiction (Appendix 5 refers to some of this material). In 2002, Miall and Kuiken published an innovative research paper that showed that readers of literary fiction were moved emotionally by certain passages, and when they reflected on that emotion they discovered that the passages and attendant emotion had stimulated reflections in their real world lives or in other texts. (This result corresponds with the features describing the borderline between everyday life and literary fiction in Part II of Chap. 1 .) Furthermore, they found that the reflections stimulated “boundary crossing.” Specifically, they demonstrate that “the experience of feelings in one situation leads to the re-experiencing of those feelings in situations that are similar” ( 2002 : 226). This phenomenon, as we note in the vignette in Chap. 4 , precisely occurred in Dr. Vannatta’s practice when he re-experienced feelings provoked by Toni Morrison’s novel Beloved in his interchange with a patient. Miall an...

Table of contents

• Cover
• Front Matter
• Section I. Narrative and Medicine
• Section II. The Logic of Making a Diagnosis
• Section III. Professionalism
• Section IV. Building the Patient-Provider Relationship
• Section V. Everyday Ethics of Medical Practices
• Section VI. Vicarious Experiences
• Section VII. Mistakes in Medicine
• Section VIII. Death and Dying
• Section IX. Postscript: The Fulfillments of Healthcare
• Back Matter