To Look Feelingly-the Affinities of Medicine and Literature

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^To Look Feelingly—the Affinities of Medicine and Literature* Edmund D. Pellegrino George Santayana, the most literary of modern philosophers, says that only literature "can describe experience for the excellent reason that the terms of experience are moral and literary."1 Owsei Temkin, one of the more philosophical of medical historians, says that medicine is "not only science and art but also a mode of looking with compassionate objectivity. Why turn elsewhere to contemplate man's moral nature?"2 In their emphasis on ways of looking at morality, Santayana and Temkin provide us with two conceptions that merge in medicine and literature and that ground their natural affinity for each other. For both are ways of looking at man and both are, at heart, moral enterprises. Both must start by seeing life bare, without averting their gaze. Yet, neither can rest in mere looking. To be authentic they must look with compassion. Medicine without compassion is mere technology, curing without healing; literature without feeling is mere reporting, experience without meaning. Medicine and literature are united in an unremitting paradox: the need simultaneously to stand back from, and yet to share in, the struggle of human life. They must see clearly but they must also be involved in the outcome of the struggle. Thus both of them are moral experiences. For medicine, Paul Valéry put it this way: "You doctors are the champions , the strategists in the struggle of the individual against the law of life."3 Literature, in Santayana's words, "has its piety, its conscience; it cannot long forget without forfeiting all dignity that it serves a burdened * Copyright © 1980 by Neale Watson Academic Publications, Inc. Originally published as the introduction to Medicine and Literature, ed. Enid Rhodes Peschel (New York: Neale Watson Academic Publications, 1980), xv-xix. Reprinted by permission of Neale Watson Academic Publications, Inc., and Edmund D. Pellegrino. Literature and Medicine 1 (Rev. ed., 1992) 19-23 © 1992 by The Johns Hopkins University Press 20 TO LOOK FEELINGLY and perplexed creature, a human animal struggling to persuade the universal Sphinx to propose a more intelligible riddle."4 To look compassionately is the summit of artistry for both medicine and literature; to take part in the struggle is the morality they share. Medicine and literature are linked, too, because they both tell the story of what they see. The patient's history that a physician writes is really a tale, the narrative of the patient's Odyssey in the dismal realms of disease. The writer, too, must contemplate the same perplexities of being afflicted, which are part of being human. Illness is inextricably woven into the tapestry of every human life. No serious writer can avoid it entirely. The writer's tale transcends the clinician's history because his or her language is charged with meanings. The writer of literature can evoke a vicarious experience of illness and suffering, whereas the writer of the clinical record evokes only diagnostic or prognostic possibilities. The writer's charged language forces all of us to look at human experience without averting our gaze because we are made to look with feeling for the subject of those experiences. Clinical language itself can be a thing of beauty in those rare instances in which the artist is also a practicing physician, as in the case of William Carlos Williams, Thomas Browne, Oliver Wendell Holmes, or Richard Selzer. In their hands even the lugubrious details of anatomy and pathology become instruments of poetry or evocations of the joy and peril of human embodiment. Often, physicians who become serious writers abandon the clinic wholly or visit it only intermittently. But they retain the clinician's way of looking. Their writing carries that special imprint peculiar to those who have felt, smelled, and cured among fevers, madness, blood, and abscesses. We think of Rabelais, Crabbe, Smollett, Chekhov, Maugham, Keats, Céline, or Walker Percy, who completed their medical training, or Michaux or Breton, who interrupted theirs. We think of Walt Whitman, who worked in a doctor's office and as a volunteer nurse, and whose panegyrics of the body in all its afflictions and exaltations are unexcelled for vividness. In the last decade these...

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