May 3, 2024

As we have so many times, we begin with what could be called the Creation myth of the modern era: the awakening of the subject, or ego, to consciousness, an act that brings into being a world around it of objects and other people.  This coming to awareness is a creation, yet it is also a fall, since the subject is separated from the objective world, and therefore in a state of isolation and alienation.  But there is an interface between subjective and objective, for the body is both and neither:  a strange, mysterious borderland, and our experience of it is ambiguous and variable.  When we are feeling in good  health and good spirits, we feel one with the body, but when we are in pain, or attacked by physically-based emotions such as depression and anxiety, the body may seem an alien other.  And the older you get, even if you are still healthy, the more likely you are to look in the mirror and say, “Who in the hell is that?”  Yeats in old age cries out:

What shall I do with this absurdity—
O heart, O troubled heart—this caricature,
Decrepit age that has been tied to me
As to a dog’s tail?      (“The Tower)

The first thing a doctor is likely to ask a patient is, “How do you feel?” But it is uniquely hard to describe bodily experience even if the patient is adept with language, as many are not.   And there is an art of listening: if you look at patients’ evaluations of doctors, one of the things that matters most to them is feeling that the doctor actually listened to them.  The word “conversation” means back and forth, and another thing that matters is how the doctor in turn spoke back to them, explaining, calming, inspiring morale.  The practice of medicine turns out to be the practice of language, in contradiction of an old stereotype.  In Star Trek, Captain Kirk refers to Dr. McCoy as “Bones,” short for the old nickname “sawbones.”  In other words, the doctor is a glorified butcher who hacks meat and saws bones.  But since the late 1990’s, a new discipline called “narrative medicine” has grown up to challenge that stereotype, and thereby change both the medical system and perhaps those doctors who really are more comfortable dealing with meat and bones than they are interacting with patients.  I want to make clear at the outset that I have no medical expertise whatsoever, and one of my goals in this discussion will be to guide readers towards authors who have the credentials to speak with authority from within medical theory and practice.  But since our subject is the intersection of medicine and the humanities, I hope my grounding in the latter will enable me to contribute something to an interdisciplinary conversation that I find full of possibility. 

Remarkably, the discipline of narrative medicine seems to have been largely created by one person, Dr. Rita Charon, founder and executive director of the Program in Narrative Medicine at Columbia University.  Charon, who was a peace activist when she was young, was driven from the first to bring about change.  She began practicing internal medicine, then began teaching at the Columbia University College of Physicians and Surgeons, also earning a Ph.D. in literature from Columbia in 1999 with a dissertation on Henry James.  Why Henry James?  A very useful introduction to what she was then calling “literature and medicine,” published the following year, quotes him:  “To ‘put things,’ as Henry James suggests in his preface to The Golden Bowl, “is very exactly and responsibly and interminably to do them.” James can certainly be interminable, especially in a late novel like The Golden Bowl, but it is because he felt that the exact way we “put things” produces insight, and insight guides action.  The way we use language changes the world.  That principle is common in a literary context, but also in other disciplines such as speech-act theory and narratology that study the power of language to make a difference, for better or worse, which is why the name of the discipline has shifted in recent years from “literature and medicine” to the more inclusive “narrative medicine.” 

The doctor uses language not only in conversation with patients but in medical texts such as hospital charts.  Doctors are trained to write charts according to certain conventions that demand a detached, fact-based style that reduces a human being and a human situation to something “objective.”  While this may to some degree be necessary, it is good to be aware of what is going on, and what is going on is the transformation, through language, of the human situation to a “case” and a person to a “patient,” who might as well, in the old days, have been a specimen under a microscope.  Moreover, the chart used to be private.  The patient could not see or question the way the godlike doctor defined the “case,” and had no voice, because the doctor’s expertise could not be challenged.  Being of an older generation, I am still startled by being able to read the doctor’s comments on MyChart.  Yes, in one way it is an efficiency device and spares the doctor having to take time to explain everything to the patient, but it is also a way of giving patients input into their own story.  There is an old tag from the Roman poet Horace, de te fabula, the story is about you.  But the full quotation says: change the name and the story is about you.   When we become doctor’s notes in the chart, our name is changed into a client number, and we do suffer a sea change, though not into, as Shakespeare’s song says, something rich and strange.  Rather, the opposite: we are reduced to data and interpretation, assimilated in part to certain conventions of scientific language. We are to some degree objectified and at least partly quantified, turned into a set of numbers.  It is not necessarily dehumanizing, but weird, like hearing our voice on a recording.  It can become dehumanizing, however, to the extent that this reduction of person into patient is not counterbalanced by the doctor’s conversation with the full human being and their feelings, both physical and emotional. 

And dehumanizing reductionism has been a tendency of medicine for well over a century.  The article cited above, “Literature and Medicine: Origins and Destinies” (2000) includes a historical overview called “Move Towards Specialization and Reductionism” explaining how, from its beginnings with the discovery of germ theory in the 19^th century, modern medicine moved towards a kind of materialism in which, “Instead of singular occurrences in individual human lives, diseases were understood to be repetitive phenomena no matter who was the host.”  The patient’s experience was irrelevant: diseases had material causes and material treatments.  As a result, Charon says,

Medical practice moved gradually from being a narrative and personal activity that took place at the bedside, where the doctor listened to and touched the patient, to a technical, impersonal activity that took place in laboratories and reading rooms remote from the patient. As doctors were freed—by their diagnostic equipment, x-ray machines, electrocardiograph machines, bacteriology cultures, and chemical laboratories—from the necessity to “attend” the patient, their medicine was transformed from a language-based intersubjective endeavor to a data-based instrumental activity. Although this transformation need not spell the demise of humanism, powerful economic and cultural forces could not help but push individual physicians and their profession toward valuing the latter activities over the former.

That last sentence needs unpacking.  One such cultural force was a positivism at work in the sciences themselves, the attitude that anything truly “scientific” is objective, based on repeated experimental data, preferably quantifiable.  All this talking stuff is artsy fartsy babble, not true science.  In the social sciences, this has meant an attack on any kind of talk therapy.  The tough-minded say, “Show us empirical results proving that all this talk actually works and is not just a way for the therapist to make money.”  The standard view of academic psychology is that, although Freud and Jung had a few useful insights, their psychology is unscientific, not so much because of the actual theories but because depth psychology is an interpretive discipline.  Science deals in empirically verifiable facts, not interpretations.  Go major in English if you like endless interpretation in which no single view is unequivocally correct.  However, when asked by an interviewer how storytelling has acted as medicine in her own life, Charon is refreshingly candid:

I have had deep relationships with my family and close friends that have always been the settings for those first, chaotic tellings of things that I don’t know until I tell them to my intimates. I have been in intensive psychotherapy over the years, demonstrating to me the absolute need for the fully committed, skilled, and “indifferent” listener as a witness to what one says when free to tell.

Charon’s field is internal medicine, but “internal” has traditionally meant internal organs, not the chaotic internal self. 

Moreover, the development of psychotropic drugs, for psychosis since the 1950’s and for depression and anxiety since the 1980’s, has sometimes been seen as an alternative to the take-it-on-faith results of talk therapies.  This colludes with a certain type of public attitude:  “Give me a pill that will make it better.”  A third kind of pressure towards medical materialism, as Charon has noted, is economic.  Insurance companies pay for medications, but may resist paying for something  whose results are as intangible as those of talk therapy. 

We have not really changed topics by shifting to psychotherapy from conversations with patients by internists or orthopedic surgeons.  The human interaction is the same, and has the same purpose, the purpose that impels English professors to make their students write essays—essays in their own voice, not in thus-we-see formal style.  The underlying principle is that we come to know what we think, what we feel, even what we experience physically, by the act of putting it into language—all the “things I don’t know until I tell them,” as Charon says in the quotation above.  In the narrative medicine program at Columbia,  doctors are asked to write:

When doctors write, they too experience the discovery of learning what they know. It continues to astonish me that writing is an avenue to the “unthought known”—that is, the part of knowledge that sits under awareness. I think there are only two other ways to get there: dreaming and psychoanalysis. As I began to give medical students and colleagues permission to write about their practice, I saw that they, too, “caught” their own thoughts in ways they could not without the creative practice.  

This is a form of meditation, really (the particular interview is conducted by a Center for Yoga and Health).  But, in addition to being shown a means of understanding better their own subjectivity, doctors are being trained in the art of paying attention to their patients’ attempts to put their experience into language:

What do I do with the paradoxes, the ambiguities, the contradictory stories from a family member, the gaps in memory, the fact that the stories changed from month to month? What do I do with my own doubt about the meaning of what I am hearing? Without what I learned as a literary scholar, I fear I would simply have learned to ignore accounts given by my patients as tangential to my work or, as the biostatistician would say, “noise.” It ain’t noise. It is the center of the event of healing.

I knew I could not be the only one struck by the “coincidence” of Charon’s last name, and, sure enough, in one of several interviews available online, Charon tells the story of how, when she was just starting medical practice, a patient looked at her name tag and was devastated, assuming it was a diagnosis.  Charon is the name of the ferryboat operator in Greek mythology who ferries souls to the underworld.  She thought briefly of changing it, but rightly didn’t, for it fits beautifully.  Language is the ferryboat that makes the passage between the daylight realm of consciousness and the dark realm in which the mind melds with the body.  For those interested, Charon published a landmark book in 2008, Narrative Medicine: Honoring the Stories of Illness.  In 2016, she and her team at Columbia collaborated on a handbook, The Principles and Practice of Narrative Medicine.

Ironically, although modern medicine has given us the useful term “psychosomatic,” the actual practice has been to divorce the body from its mental connections and treat it materialistically.  Illness was “organic,” that is, a disease of one of the organs, to be treated by physical means.  Freud had to demonstrate that, if someone came to the doctor with a paralyzed arm and tests showed that there was no organic cause, that did not mean there was nothing wrong.  The paralysis could be psychosomatic, a symptom trying to signal the source of distress.  It was, in other words, a form of language, the language of the body. 

By an even further irony, the medieval and Renaissance medical theory that preceded modern germ theory was thoroughly psychosomatic in its basis.  It is at this point that I may hopefully contribute to the conversation by widening the perspective, helped by an address by Northrop Frye presented at Mt. Sinai Hospital in Toronto in 1989, called “Literature as Therapy.”  Frye retails some of the common lore of the medieval and Renaissance period, some of which I have to provide as background when teaching Shakespeare or other early literature.   The system was based on “temperament,” which means human personality types that are associated with certain body types.  What accounts for the association is a predominance of one of the four humors, or bodily fluids:  blood, phlegm, yellow bile, and black bile.  If you have a preponderance of blood, you are a “sanguine” type, meaning you are like Santa Claus, big, ruddy, and cheerful.  A preponderance of phlegm means you are “phlegmatic,” a cold fish.  A preponderance of yellow bile means you are choleric, like Shakespeare’s Hotspur or Pistol.  And, most importantly, a preponderance of black bile means melancholia, which we would call clinical depression.  Hamlet, who first appears on stage dressed in black, is famously melancholic.  A temperament gives you not just a disposition but a view of life.  A sanguine personality thinks, like Dickens’s Mr. Micawber, that, not to worry, something will always “turn up.”  It is clear to us, if not to him, that Hotspur’s obsession with war and glory is driven less by his high-minded idealism than by his irritable temper.  And, as we still agree, melancholia is not just a feeling but a philosophy, which is the theme of Robert Burton’s Anatomy of Melancholy (first edition 1621), expounded in 700 pages. 

The fact that this theory has given us four adjectives that we still use—sanguine, phlegmatic, choleric, melancholic—tells us that we still in fact give it credence in some manner or other.  We all know that such personalities actually exist, and that they really do tend to have some association with body types.  The idea that people often run to type is resisted by those who say that it denies human individuality, but it doesn’t:  we are unique individuals within the parameters of our type.  Two pieces of music in the key of C do not necessarily sound alike, but the key signature will give them something in common.  Jung developed a system of personality types based on the basic perspectives of introversion and extraversion, as they interplay with four other functions:  intuition, sensation, thinking, and feeling.   This was developed into the Meyers-Briggs personality test, and its widespread use indicates that, scientific or not, many people find it useful,  especially when it is a question of relating to very different types.  An introverted doctor dominated by sensation (the sense of factuality) and thinking may have to learn how to understand and communicate with an extraverted intuitive feeling type of patient, who might at first seem to be from an alien planet. 

In “Literature as Therapy,” Frye assures the doctors he is speaking to that he is not trying to revive the theory of the four humors, but his reason for bringing it up anticipates what Charon would be saying a few years later:

But my central point in trying to trace out this intertwining of literary and medical references is that there was a medical tradition unifying mind and body long before modern psychology.  The doctors of the nineteenth century, for example, while they may have lacked a good deal of what we would consider scientific training, may have made up for it partly by their close personal relations with their patients and their familiarity with both the physical and the mental constitution of their patients. |  This inseparability of body and mind naturally leads to the question of whether such imaginative constructs as literature and the other arts would have a direct role to play in physical health.  (26-27)

He begins with music, whose charms to soothe the savage breast have been well known since David calmed the melancholy of King Saul by playing his harp.  When an interviewer remarks that she has been “passionate about the role of music in the healing process,” Charon's response is indeed passionate:

All I can say is that, when my two hands are able, very primitively, to play Bach’s Partita #4 and some parts of “The Well-Tempered Clavier,” I come into a kind of “knowing” like nothing else. It is a wordless knowing that somehow is necessary alongside the heightened attention that I always pay to words and what they do. The composer and the performer are able to convey some kind of signal or thought through music that cannot be spoken or intellectually thought. It is not just the emotional weight of the music, nor just the harmonies and disharmonies and tempos. It is a matter of being in another realm altogether—an embodied one, from the realm of words and thought, a realm with its own demand and complexity and reward and profound beauty.

While for most people it is listening to music that can be therapeutic, Charon is speaking as a player, and thereby touches my own passion.  When I play acoustic guitar, “very primitively,” it is exactly “a matter of being in another realm altogether—an embodied one.” John Donne complimented a woman by saying “That one might almost say her body thought.”  He was not speaking of a musician, but Yeats asked, speaking of a dancer, “How can we know the dancer from the dance?” Frye was himself a trained classical pianist and would have understood. 

But Frye’s discussion inevitably swings around to drama.  The dramatic tradition took up the theory of humors: Ben Jonson has a play called Every Man in His Humour, in which his friend Shakespeare acted.  In the theatre, the number of humors was expanded far beyond four:  a humor was in effect redefined as any kind of neurotically compulsive behavior pattern—hypochondria, for example, in Molière’s Le Malade Imaginaire.  Such humors are scripts, roles people play, often unconsciously.  When the novel emerged in the 18^th century, it developed in two directions.  The tradition exemplified by Henry James, that of the great realists, is one of an interiority unprecedented in literature.  Tools were developed to explore the dark continent of human inwardness, from symbolism to stream of consciousness to the kind of exhaustive analysis typical of the narrators in George Eliot, in James, and in some of Faulkner, such as Absalom, Absalom.   But there was another, extraverted branch of the novel that took up the comedy of humors conventions from the theatre.  This runs from Fielding in the 18^th century through Dickens in the 19^th—Frye has another article titled “Dickens and the Comedy of Humours—to the sitcom and comic strip types that we all know today.  The cantankerousness of Archie Bunker, the laziness of Beetle Bailey, the parasitism of Wimpy in Popeye all have centuries-old precedents.  The comedy of humors tradition is often dismissed by the serious realists, but the types would not have their perennial appeal without corresponding to something in human nature.  Aristotle’s Poetics defines the tragic hero as having a “tragic flaw,” or hamartia, but it seems to me that the idea of human beings trapped in compulsive roles fits tragedy just as much as comedy.  Othello’s humor is jealousy, Macbeth’s is ambition.  Antony and Cleopatra are titanic sex addicts, and Lear is a titanic version of Archie Bunker’s irascibility. 

The Poetics defines tragedy in terms of a medical theory, that of “catharsis,” or purging.  It is actually a theory pertaining to what happens to the audience rather than the characters.  The viewing of a tragedy raises the negative emotions of “pity” and “terror,” which are cast out in the end, leaving the audience in a state of, as Milton put it, “calm of mind, all passion spent,” or, in banal but accessible language, the relief we feel after a good cry.  Aristotle left no surviving theory of comedy, but surely the catharsis in comedy is the release of characters from their neurotic humors, or the release of the other characters from the negative influence of the humor characters.  As Frye frequently points out, the audience in a comedy is invited, at least implicitly, to share in the release signified by the happy ending, a release that results in festivity, dancing, and, in Shakespeare, a lot of weddings.  Whereas in tragedy, the tragic heroes are destroyed by their humors, their tragic flaws, often taking a good portion of the cast down with them, while the audience remains looking on, like Milton’s angels watching the Fall of the first three tragic heroes, Satan, Adam, and Eve. 

Let me suggest that all three of the major genres or categories of literature are relevant to medical practice:  lyric poetry, fiction, and drama.  In a program like Columbia’s, I’m sure that lyric poetry can be used to deepen sensitivity to verbal nuance and texture, and also to verbal patterns, what is usually called “imagery” whether it is visual or just an element of repetition.  It is not only poets whose language is characterized by what a famous critical study called “seven types of ambiguity.”  What if someone had had the sensitivity to probe why Citizen Kane kept babbling about “Rosebud”?   Fiction is relevant because fiction is narrative, and narratives have narrators.  In a clinical interaction, both doctor and patient are narrators.  The patient produces a narrative; the doctor tries to understand it, and produces a narrative that is a response to the patient’s narrative.  I’m sure that in family therapy the doctor comes to learn about what critics call limited point of view, which can result a work like Browning’s The Ring and the Book, Faulkner’s As I Lay Dying, or Kurosawa’s Rashomon, in which the same events are recounted in utterly different ways by different narrators. 

And of course there are the outright “unreliable narrators,” who are often mad or well along the way to it, as in some famous stories of Poe and Charlotte Perkins Gilman’s “The Yellow Wallpaper,” a tale that should be required reading for all future doctors, about a woman being treated by her husband, a doctor who not only does not listen to her but tries to keep her from writing—that is, from narrating—because writing involves her imagination and it is imagination, her husband is convinced, that is making her ill.  The husband is a scientific positivist who does not believe in anything but material causes.  The story is based on Gilman’s own experience of post-partum depression.  The husband, with the best of intentions, imposes his narrative upon her, one in which she is weak and needs to be protected from the world.  He knows best.  It does not end well.  If I were asked to speak to doctors about literature and medicine, I might begin with this story as a worst-case scenario. 

Mind you, unreliable narrators, especially the mad ones, should still be listened to.  That is in fact what Jung did at the outset of his medical career at the Burghölzli Psychiatric Clinic.  Where everyone else dismissed the talk of the psychotic patients in the clinic as mere disconnected rambling, Jung listened, and began to realize that there is method in madness.  Freud taught people to listen for the “Freudian slips” in people’s speech, the moment in which something escapes from its repression in the unconscious.  Jung began to realize that what escapes in the “narratives” of psychotics comes from a level below that of the personal unconscious.  If you listen, you are listening to something that is not personal but mythical.  Something else is in the room beyond you and another human being.  I speak as one who listened to a paranoid schizophrenic mother spout conspiracy theories concerning my father, her ex-husband who had become a demonic figure in her imagination.  I have tried to learn about listening, not at all sure I’ve succeeded.  When I was only 21 years old, I became for 5 years the live-in caretaker of the Clarkson Building in downtown Canton, Ohio, now being demolished, as I wrote in my newsletter about invisible buildings.  On my own, I formulated my own job description.  Half my job was practical—cleaning the floors, disposing of the garbage, fixing the plumbing, electrical, windows, all the material problems.  The other half of my job was to listen.  The entire building was filled with senior citizens, many of them completely isolated.   Many, if not most of them wanted to talk.  I had no qualms about writing these down as billable hours.  My listening helped stabilize our clientele, if you wanted to be coldly practical about it.  But what I was really doing was something else.  I listened to the woman who thanked Jesus for the warm draft of air that cured her constipation, followed by a voice that told her not to worry.  I listened to the woman who adored and overfed the 22-pound cat that roamed the halls but regarded the sister that showed up regularly to take care of her as a mortal enemy.  I listened to Jack, the stroke patient who taught me more than anyone about listening, because I had to wait patiently for him to articulate the disconnected words and phrases that I then tried to construe into communication.  He taught me to be comfortable about just waiting, as a poet waits for the words to arise from that deeper place.  I will never forget him. 

But I have gone the long way around, and have come back to the third genre, theatre.  Jaques in Shakespeare’s As You Like It, says that all the world’s a stage, and that we play different roles in each of the seven ages of man.  We all know that this is at once a rhetorical set speech and yet so, so true.  When we refer to the dysfunctionality of our families, our marriage, our workplace as “soap operas,” we are saying something real.  When, on the dating site, someone says, “I don’t do drama,” we understand.  So does Rita Charon, whose early experience with literature included the powerful impact of theatre:

I remember stumbling into a rehearsal of an on-the-road production of The Fantasticks when I was a sophomore in high school, and I just kept going back. Somehow, the stagehands let me into the cavernous theater downtown. I had no idea that all of that existed. I don’t know how many times, years later, I brought friends to see that play.

I knew that for much of my life The Fantasticks (1960) was the longest-running musical of all time.  I did not know anything more about it.  But now I find that it is based on an 1894 play, The Romancers, by Edmond Rostand, author of Cyrano de Bergerac.  That very useful resource Wikipedia informs me that it is about two fathers who manipulate their children into falling in love by pretending to feud.  Which means that the fathers are deliberately reversing Romeo and Juliet, turning it from tragedy into comedy, and in doing so they are becoming what Northrop Frye calls “deputy dramatists”—characters in a play who manipulate the other characters in a way that creates a kind of play-within-a-play scenario.  Shakespeare is enormously fond of this pattern.  In Taming of the Shrew, Petruchio cures Katerina of her humor of shrewishness by putting her through various disorienting ordeals.  Hideously sexist, yes, but it works.  In two plays I have just finished teaching, Measure for Measure and The Tempest, two characters, the Duke and Prospero, cast other characters into roles and put them through ordeals for the purpose of changing them for the better, and by doing so making a communal happy ending possible.  We pretend to believe in Star Trek’s Prime Directive: never, ever interfere, you have no right.  But in fact without the interventions of the Duke and Prospero the other characters would remain unchanged, locked into lives of sterile, dysfunctional behavior.  When is intervention justified?  When is playing with people’s heads the only way to change them? 

For the third week now I have found something valuable in anthropologist Mary Douglas’s book Purity and Danger.  This one was quite unexpected.  It is the description of a shaman’s healing ritual among the Ndembu in south-central Africa.  Douglas is summarizing an article by another famous anthropologist, Victor Turner, “An Ndembu Doctor in Practice” (1964).  The patient complained to the doctor of palpitations, weakness, and back pain.  But “The patient was also convinced that the other villagers were against him and withdrew completely from social life.  Thus there was a mixture of physical and psychological disturbance” (70).  Douglas’s summary is as follows:

The doctor proceeded by finding out everything about the past history of the village, conducting seances in which everyone was encouraged to discuss their grudges against the patient, while he aired his grievances against them.  Finally the blood-cupping treatment [an ancient practice involving cups that create suction on the skin] dramatically involved the whole village in a crisis of expectation that burst in the excitement of the tooth from the bleeding, fainting patient.  Joyfully they congratulated him on his recovery and themselves for their part in it.  They had reason for joy since the long treatment had uncovered the main sources of tension in the village.  In the future the patient could play an acceptable role in their affairs.  Dissident elements had been recognized and shortly left the village….|  In this absorbing study we are shown a case of skilful group therapy.  The back-biting and envy of the villagers, symbolized by the tooth in the sick man’s body, was dissolved in a wave of enthusiasm and solidarity.  As he was cured of his physical symptoms they were all cured of social malaise.  (70-71)

“Can’st thou not minister to a mind diseased?” Macbeth asks the doctor who is treating his wife after her mental breakdown.  The doctor claims that he can do nothing, that in such cases the patient must minister to herself.  Perhaps Macbeth should have requested a second opinion from an Ndembu doctor.  Or have himself and Lady Macbeth transplanted into the cast of a comedy.   If the magic trick performed by the doctor of palming and producing a tooth seems hokey, consider the method invented by a priest in Much Ado about Nothing.  A woman falsely accused of infidelity hides out of sight, and her friends pretend she has died.  After the villain who contrived the false appearances is discovered, the groom submits, out of guilt for his false accusation, to the punishment of marrying an unknown, veiled lady, who of course turns out to be the original woman “come back to life.”

Turner comments on the Ndembu story, “Ndbembu therapy may well offer lessons for Western clinical practice” (71).  However, he immediately walks his conclusion back:  “But it is likely that nothing less than ritual sanctions for such behaviour and belief in the doctor’s mystical powers could bring about such humility and compel people to display charity towards their suffering neighbour” (71).  This is true as well in Shakespeare:  such happy endings could only happen in a comedy.  The Duke in Measure for Measure has total political authority but also “ritual sanctions”—he is disguised as a friar for much of the play.  And Prospero in The Tempest can perform real magic tricks, though in fact they seem to be mostly illusions.  Real doctors and therapists have only one magical power, that of language, of the “talking cure” that nonetheless can sometimes alleviate both physical and mental illnesses.  And a good deal of the reason is the enormous power of suggestion that envelopes a healing situation.  Frye quotes a passage from Burton’s Anatomy of Melancholy about a woman “that had such strange passions and convulsions, three men could not hold her” (24).  Moreover:

[S]he purged a live eel, which he saw, a foot and a half long, and touched himself, but the eel afterwards vanished; she vomited some 24 pounds of fulsome stuff of all colours twice a day for 14 days; and after that she voided great balls of hair, pieces of wood, pigeons’ dung, parchment, goose dung, coals…. (24) 

The list goes on, as my students says.  In the end, Burton says, “They could do no good on her by physick, but left her to the Clergy” (24).  As well they might, for the gross-out symptoms sound much like those of demonic possession in The Exorcist.  Frye comments dryly, “Well, it is clear that Burton knows he is describing a case of hysteria, but what he does not know is whether it was the doctor or the patient that had it” (25).  That happens too:  the depth psychologists call it transference.   And yet talking cures, whether with a therapist or an internist having a conversation with a patient, can have their own magic.  I was glad to see that in The Principles and Practice of Narrative Medicine there is a section on Alison Bechdel’s graphic novel Fun Home. No one shows the healing power of talk therapy more movingly than Bechdel, both in Fun Home and its sequel, Are You My Mother?  A moving part of the latter concerns object relations therapist D.W. Winnicott, who listened closely to the language of children and had conversations with them as equals. 

For those who lack a doctor or a therapist, however, reading may be a form of self-therapy.  Frye tells a lovely story about this:

I remember my mother telling me of undergoing a very serious illness after the birth of my sister, and in the course of the illness she became delirious.  Her father, who was a Methodist clergyman, came along with the twenty-five volumes of Scott’s Waverley novels and dropped them on her.  By the time she had read her way through them she was all right again.  What impressed me about that was her own conviction that the Scott novels were in fact the curative agent.  (33)

Frye goes on to say that he “would not be surprised if the plots of Scott’s novels did not form a kind of counter-delirium which had to do with her own recovery” (33).  This is a way of stating the thesis of his address, that “the arts form a kind of counterenvironment, setting something up which is really antipathetic to the civilization in which it exists….It seems to me that at a certain point of intensity what literature conveys is the sense of a controlled hallucination…where things are seen with a kind of intensity with which they are not seen in ordinary experience” (33).  The Ndembu doctor created a “controlled hallucination.” In The Tempest, Prospero creates controlled hallucinations through his magic, which he refers to as “my art.”

But when we read alone, we become our own Prosperos, and summon our own hallucinations.  In The Productions of Time I spoke of the presence of a mysterious Otherworld in mythology and literature, a “counterenvironment” that is the other side of ordinary reality.  The genre in which the Otherworld is most evident is the romance—the genre that Sir Walter Scott wrote in, the tale of wonders and marvels.  The Tempest is one of four Shakespeare plays called romances.  Fairy tales are a form of romance, and their “once upon a time” counterenvironment has a powerful effect on both children and adults.  The Lord of the Rings, Harry Potter, and Star Wars are all romances, and each has had readers for whom reading and re-reading them endlessly, dwelling in them, has been a form of therapy helping them to survive.  I understand, because reading enabled me to keep my sanity while growing up in a dramatically dysfunctional family environment.  It is not only a universal prescription for patients, but recommended for those physicians who want to follow Jesus’s advice, “Physician, heal thyself,” according to Luke (4:23), who is said himself to have been a physician.  Reading is what Ray Bradbury called “a medicine for melancholy,” and so is writing.  Burton said that he wrote Anatomy of Melancholy as a cure for his own melancholy.  Reading is what everyone has been looking for, a hallucinogenic drug with no side effects, and it is available to heal us even when there is no doctor in the house. 

References

Douglas, Mary.  Purity and Danger: An Analysis of the Concepts of Pollution and Taboo.  Routledge, 1991.  Originally published 1966.

Frye, Northrop.  “Literature as Therapy.” In The Eternal Act of Creation:  Essays, 1979-1990.  Edited by Robert D. Denham.  Indiana University Press, 1993.  21-36.  Also in “The Secular Scripture” and Other Writings on Critical Theory, 1976-1991.  Edited by Joseph Adamson and Jean Wilson. Volume 18 of The Collected Works of Northrop Frye. University of Toronto Press, 2006.  463-76.