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The world is experienced with the body: the art of medicine and creative writing

 

According to Hippocrates, the art of medicine was the special ethically driven ability to balance sensations, observations, experience, and theory and can only be practiced if the doctor "wins the patient's trust with kindness and care". For Hippocrates it was not possible to practice medicine without making mistakes. We need the ability to reflect, and the ability to understand when we have made a mistake. But how to reflect in a busy clinical everyday life?



The authors of this article, a writer and a doctor, have co-taught creative writing to different groups of doctors, as a method to cultivate reflection and a safeguard against caregiving fatigue. How to continue to be professional "kind, careful, and comforting" in a busy, medical zero-defects culture, but also with a myth about the doctor as a kind of superhero and a myth that psychiatry is a positivist science? But without a biological marker or an objective test that can identify a curable pathological agent. Communication is particularly important in psychiatry, because we depend on the language and the trust of our patients.


Here we can benefit from including artistic elements such as fiction in our practice. The practice of medicine is experience-based. Art as fiction deals with aesthetics, not only with the beautiful, but with aistesos, with the sensible, with the surfaces of the world. In some ways, the writer and the doctor are similar in that, in their professional way, with the help of all their senses, they form images of the world that others must be able to see and understand. By doing this, they can make what is invisible to the layman, visible to others. A spot on the skin is not just a spot, but a sign of a malignant cancer. A particular gait and a change of speech can reflect a person's otherwise invisible character traits. It is the doctor and the writer who must be extra good connoisseurs of the ordinary and common - to be able to see the deviant and describe it in detail and with precision.


Our senses are at work during every waking hour, even when we are not aware of it. At night, the senses are active in our dreams. There are similarities between the experience of space we have in dreams, and the experience of the world we have when awake. We process, interpret and predict the happenings of our world through our sensory experiences, intero- as well as exteroceptive. Our bodies tumble through life and collect an incredible number of impressions packed as memories in our consciousness, in our unconscious, and in our bodies as perceptions and events. And we constantly must make sense of it all to find a path in life. All of this is recalled in the writing process which focuses on the surroundings, on the space, and the creatures inhabiting it. The world is understood with the body, and this understanding is re-established by writing about everything surrounding us.


 In some ways, the writer and the doctor are similar in that, in their professional way, with the help of all their senses, they form images of the world that others must be able to see and understand. Image by Wix Media
In some ways, the writer and the doctor are similar in that, in their professional way, with the help of all their senses, they form images of the world that others must be able to see and understand. Image by Wix Media

It is about emotions, but emotions rendered without a body are intellectual abstractions without much of the strength and richness of nuance and composition of which human reality consists. What else could be the object of the psychiatrist’s assessment? Reality as it is experienced by another human being. For example, what is the word "complex" compared to the reality of which the doctor's world is constituted?


It is not the "complexity" in itself that challenges the doctor, but the patients' looks, tone of voice, the relentless ticking of the clock, the attempt to control one's own signals, the breathing space in the toilet, the lunch break. The doctor's senses are at work all the time. It is into this collection of sensory perceptions that the work of fiction wedges itself and which it tries to expand so that the doctor recognizes his own situation; not as a concept or report, but via the body, the bodily recognition of an immensely complex reality.


When the doctor reads his own text created using sensory elements, he or she gets a bodily experience of the lived life, just like in a dream. Reading is like being in a fictional dream that not only resembles and recreates the real world, but also evokes and accentuates emotional attachments. In its sensory form, the text is a clearer mirror of reality than reality itself. The sensory text is a catalyst for understanding what it is that the doctor finds himself in. No one can grasp their own being completely, the body's paradox is that it is both subject and object in the world in which it is immersed. The text can be the reflective mirror we can use to see the back of our heads, to look behind and below the cognitive registers.


Reading is like being in a fictional dream that not only resembles and recreates the real world, but also evokes and accentuates emotional attachments. Image By Wix media
Reading is like being in a fictional dream that not only resembles and recreates the real world, but also evokes and accentuates emotional attachments. Image By Wix media

The text work in the writing workshop with fellow doctors aims to get the writer to understand what sensory text is and what it can do in contrast to abstract text, which in its form is both reminiscent of everyday speech and academic vernacular. Slowly, the writer uses the text that focuses on the sensory, on the things we surround ourselves with, and people and other living beings. For most people, this is a big effort because we are so used to talking in abstractions and using concepts to communicate efficiently. The sensory use of text is slower and more careful and follows the body, which, as we know, is always tied to itself, around the world.


We cannot escape from the body, not even if we put our minds to it. We are at the mercy of our senses. This is good when it's nice to be in the body, bad when it's a stressful experience. The sensory use of text seeks to recreate the experiences that the body is exposed to and evoke them for our inner gaze when we read. Through this we get a deeper experience of others and ourselves than we would get if we settled for the concepts that tend to be very superficial, like when we ask how things are going (“Fine”), and what is the most important thing in the world (“Love”). Everyone agrees, no one is affected. To be touched, we need literature in its most sensory form, namely in the form of fiction.

Here a critical medical reader would object: it is not professional medical practice to be affected by the story of our patients, we have to be “objective” in order to be good and fair.


But the task of the psychiatrist is to assess the problem at hand in a bio-psycho-social framework. As Hippocrates states: “It’s far more important to know what person the disease has than what disease the person has”. We have to be able to see patterns and connections across the individual particularities and elevate them cross-sectional to something general and situated. It is a pattern recognition sense that can separate the characteristic from the deviant, which requires the ability to understand phenomena through the senses in their context.


No matter how "objective" a symptom or paraclinical finding is, it is embedded in a body, a mind, a social and cultural context, and one of Hippocrates's points is that a doctor must first study the outside world the patient is in to understand the illness. And the world is understood with the body: it is the starting point for both the doctor and the author.


And art is the place where this can be trained. Art can be used as a simulator, whose scientific theory of embodied cognition indicates that our mirror neurons are activated, not only when we perform an action ourselves, but also when we hear about others doing it, when we are affected by stories we read or hear. It is a way of training to put yourself in other people's shoes. You must familiarize yourself with other people's world of life, their sensations, and thoughts, even when completely different from your own. Thus, to be a medical professional according to Hippocrates you must allow yourself to be affected, to put yourself in the shoes of the patient, but you must also be able to use your sensual experiences as a kind of intelligence by reflecting on them and your actions, including the mistakes you make – to keep on practicing with care and kindness. And in this, reading and writing literary fiction can be efficient clinical tools. □

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