Clinical Humanities
[In the following review, Bamforth comments on Coles' combined concerns for medicine and literature.]
Times of Surrender is a collection of reviews, addresses and reminiscences from the past twenty years which attests to Robert Coles's conviction that appreciation of literature is a useful adjunct to the study of medicine. Coles is Professor of Psychiatry and Medical Humanities at Harvard; literary texts have thus been his chosen means of guiding a generation of over-achieving medical students towards the ethical dilemmas awaiting them in their professional lives. Of the forty-odd essays in this collection, a large number are devoted to writers and thinkers, among them John Kennedy Toole, Georges Bernanos, Reinhold Niebuhr, Thomas Merton, Robert Jay Lifton and B. F. Skinner. Coles's stance is that of a mediator between the natural sciences and the humanities, with a sceptical interest in their hybrid, the social sciences. Although not the first commentator to notice how highly specialized dexterity may often gloss moral nullity, or to feel adrift between plodding empiricism and ballast-free theory, his advocacy of literacy for anyone with the presumption to heal and his promotion of medicine's concern for the individual share common ground with conventional wisdom and radical critiques of contemporary practices.
The professionally successful but inwardly deadened Dr. Lydgate in George Eliot's Middlemarch is referred to in more than one essay as an instructive object-lesson for intending doctors: self-scrutiny should precede any other kind of diagnosis. Times of surrender, Coles suggests, are moments of recognition prompted by the confrontation between doctor and patient; in effect a renunciation of clinical detachment. Throughout, he is quick to demolish the prolix and self-serving language of his profession, comparing it unfavourably with the genius for listening of William Carlos Williams, his own mentor. Its need for easy therapeutic triumphs and the swell of goal-directed categorizing in psychiatry inevitably quicken his suspicion. The considerable benefits of today's medicine, its rage to cure and its grandiose and seemingly invulnerable articles of faith may have been acquired, he tentatively implies, at an even greater cost.
All the essays have been lifted unchanged from their original settings: the uninformed reader could thus be forgiven for imagining that James Baldwin had returned to New York for good in 1977, or that Lillian Hellman was as "ethically sensitive" as Coles, in a disconcerting encomium, supposes she is. The most memorable essay is a partly autobiographical piece, "The Wry Dr. Chekhov", which tells of a young patient's death from cancer while under his care as a medical student. Her life almost depleted, the patient's quietly resigned and obliquely stated request that he read "Ward 6" fell on deaf ears. Later realization of the justness of her allusion marked a crucial formative experience for the young Coles, an insight both literary and existential into the shifting locus of pathology and the drastic role-change contemplated in Chekhov's story.
As a species, however, novelists have a remarkably broad angle of vision; Coles marginally weakens his case by the normalizing assumption that medicine and literature are indeed complementary. It might be thought, on the contrary, that doctors and writers are their own best antidote and that Coles's quest for edifying literature and exemplary lives has been highly selective. In reminding us of the key historical and etymological kinship between curing and caring as a "writing doctor" (Coles himself endorses this copywriter's tag), he lends a cautionary voice to what is otherwise understated or overlooked in a profession which tends, like many others, to talk only to itself. Coles's essays have the singular virtue of practising what they preach.
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