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When I began medical school in 1972, there were few doctors who were also successful writers. Medicine was considered a science, and there was a clear boundary between the sciences and the humanities. Of course, I could look back a century to Anton Chekhov and more recently, to William Carlos Williams, and P&S alumnus Walker Percy but doctors who wrote literary works were still an anomaly. Today, that boundary has come down and it is acceptable for doctors to express their thoughts and feelings in various literary genres.
But why do doctors feel the urge to write? In many ways, writing is like practicing medicine. Doctors often write to console, just as they console while doctoring. Much of my clinical practice consists of consoling patients whose illnesses I cannot cure. The philosopher Nietzsche, who was chronically ill, observed that we sometimes suffer more from our ideas about illness than from the actual physical symptoms. Chekhov's Doctor Korolyov "soothed" his patient "not with drugs, not with advice, but with simple, kind words."
I sometimes read Kafka's "A Country Doctor" with the medical students and residents I teach because this story is packed with insights about medicine and healing. In his story, Kafka writes that a physician's duty is "to come to an understanding with people." This miraculously concise statement suggests that there is considerable overlap between the doctor's vocation and the writer's vocation.
Doctors write to experience empathy. Writing about illness, apart from being a powerful emotional catharsis, also gives doctors the chance to express empathy.
The author Cynthia Ozick has written, "through metaphorical concentration, doctors can imagine what it is to be their patients. Those who have no pain can imagine those who suffer." Through this form of imagination, doctors can help patients make sense of their suffering. They can also impart clarity, and courage, and hope.
Doctors write to educate and inform. The vast majority of medical writing comprises reports on scientific research that describe new diseases, their pathophysiology, their epidemiology, and, hopefully, their cure. The Internet has added an enormous amount of medical information (much of it anonymous, lacking medical authority and sometimes inaccurate). But doctors' writing can do more than simply inform; medical writing can also transform. By educating patients, we empower them to choose better doctors, to seek out effective treatments, and to select better hospitals. Transformative writing leads to action. It increases human choice and allows individuals to live freer, less limited, and healthier lives. It gives patients more control over their own lives.
A good physician treats his or her patient as an individual and pays attention to the unique psychological, constitutional and social factors that influence that person. The medical case history, because it involves this level of specificity, is almost like a literary genre. Freud was a doctor who elevated the case history to the level of art. He used the case history — essentially a description of one individual — to draw broader conclusions and devise general theories. Freud's work exemplifies the power of transformative writing. By writing about his patients' inner lives, he was able to give them the tools to live healthier lives. But Freud acknowledged the limits of his theories. Medical Science can teach us how to live freer, healthier lives, but not necessarily better, more meaningful ones.
Paul Tillich (a theologian who taught at Columbia University) wrote that medical science is separate from the "other concerns of life." By "other concerns" Tillich meant moral concerns. Illness is personal and individual, but not only indivdual. The challenge to make sense of human suffering requires connecting our individual lives to our communal moral traditions. And this, I suspect, is the main reason why physicians are drawn to literature and the humanities.
In the pre-scientific era, the purpose of reading and studying important texts was not only to live happier and healthier lives but also to learn how to live morally better lives. Thus, we read, and write, to come to an understanding, first with ourselves in the form of increased self-awareness and self-recognition, and then to discover which choices are worth making. It is absurd, and sometimes tragic, when we gain the power to choose freely without the wisdom to choose well. One of the functions of great literature is to teach us what we ought — and ought not — to choose. In the end, then, we write to learn how to live more meaningful lives.
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