From Reading to Healing

Teaching Medical Professionalism through Literature

Susan Stagno, Michael Blackie

• Publisher: The Kent State University Press
• Year: 2019
• ISBN:
  9781631013553
• Topic: Medicine
• Subtopic: Medical Education

Selected readings and commentary for the medical humanities

Learning how to behave and engage professionally can be one of the most challenging parts of embarking on a career in the medical field. But using the "power of stories" can teach, heal, and enlighten; encourage the development of empathy; and help healthcare providers "be with suffering" and appreciate who their patients are, not just what disease they have. The humanities offer knowledge and skills that may move students toward becoming better physicians. The incorporation of the humanities into the traditional medical education curriculum can truly make a difference.

In this expansive anthology, Susan Stagno and Michael Blackie assemble an insightful group of contributors to discuss the ways in which medical professionals can powerfully engage with their students through a variety of literary texts. Examples as diverse as Charles Bukowski, Leo Tolstoy, William Carlos Williams, Sherwood Anderson, Mary Shelley, Stephen King, the comic strip Pearls Before Swine, and the sayings of Buddha will provide both teachers and students a rich cache of stories for discussion and inspiration.

PART I

The Humanities in Medical Education
Some Key Texts

Why Analyze a Sonnet?

Avoiding Presumption through Close Reading

DEVON MADON

In the first session of my Introduction to Shakespeare course, I always teach one of Shakespeare’s best-known sonnets: Sonnet 130, “My mistress’ eyes are nothing like the sun.” I open with this sonnet because students frequently think that they know what the poem is about. When I ask the class, someone will usually give me the most common misreading of the sonnet: the speaker tells his mistress that she does not look like other women, but he loves her all the same. Rather than dismissing this reading, I ask many questions. How did you reach this conclusion? What do you already know about Shakespeare that leads you to this conclusion? What do you know about sonnets? I explain that this type of reading, which asks the reader to focus on “the main idea,” is something that we have all been trained to do. We project what we already know about a text onto our reading of that text.

Then I switch gears. I ask them to read Jane Gallop’s article, “The Ethics of Reading.” This ten-page article can either be assigned to be read at home or can easily be read in class. Its conversational tone and vocabulary makes it appropriate for students at diverse levels. We discuss the article, focusing specifically on Gallop’s thesis about the problematic assumptions that readers bring to their reading. She claims, “Most of the time most people read not what is in front of them but what they expect to find in front of them.”¹ My students usually have many expectations about Shakespeare, about sonnets, and about the purpose of poetry. Their projections can be very useful. However, they can also be limiting. As Gallop explains, projection allows us only to find what we already know. It limits the extent to which we allow a text to surprise us. Gallop urges her readers fight these prejudgments through a practice of close reading, a reading that encourages slowing down, letting go of projections, and focusing on each individual word. According to Gallop, “Unlike customary reading, close reading is a method to help the student notice what does not conform to her stereotypes.”²

Since we expect Sonnet 130 to be a love poem, we read it as a love poem. When we go back and practice a close reading of the text as a class, stripping away our presumptions and analyzing the meaning and significance of every single word in that sonnet, we can come to understand the poem differently. After completing the close reading exercise, my students usually find that the poem is not about “the mistress” at all, but is about the absurdity of the analogies that are so often used in poetry.

Why does the ability to analyze a four-hundred-year-old poem matter to the student who is interested in using literature to improve professionalism? What does this lesson teach a medical student about how to interact with patients?

To answer this, I again quote Jane Gallop. She claims:

I believe it is our ethical obligation to fight against our tendency to project our preconceptions, that it is our ethical duty to attempt to hear what someone else is really saying. Ultimately, close reading is not just a way of reading but a way of listening. It can help us not just to read what is on the page, but to hear what a person really said. Close reading can train us to hear other people. In fact, I would argue that that is the most important benefit of close reading.³

Too often, especially in classes featuring texts by Shakespeare, students either come in thinking, “Shakespeare is a great writer,” or “Shakespeare is a dead white man from the seventeenth century who wrote racist, misogynistic texts.” Or, if the course is offered at a medical or health-professions school, that Shakespeare is not relevant. Gallop discusses the danger of these assumptions. “Either we assume a book is great, wise, admirable, and read it lovingly looking for instances of its wisdom, ignoring those things that seem wrong or off to us. Or we assume a book is bad, stupid, dangerous, and read it aggressively looking for examples of its stupidity, ignoring those things that we might actually like or agree with.”⁴ What we don’t do enough is look at what the words on the page actually say, rather than what we expect it to say.

It is much easier for us to “closely read” (going back over each and every word to make sure that we are really understanding what the text says rather than what we assume it says) than it is for us to “closely listen.” However, the skills are transferable. Learning to dignify the words of the authors can lead to a habit of slowing down and attending to the words we hear in conversation. If we can strip ourselves of presumptions when we read, we can become more aware of the presumptions we bring to conversations. “Close listening,” like “close reading,” allows us to avoid our inadvertent yet dangerous tendency to force our patients’ words into false, prescripted narratives.

NOTES

1.Gallop, “The Ethics of Reading,” 10.

2.Gallop, “The Ethics of Reading,” 14.

3.Gallop, “The Ethics of Reading,” 12.

4.Gallop, “The Ethics of Reading,” 16.

The Ethics of Reading

Close Encounters

JANE GALLOP

No matter what course I’m teaching, I always teach the same thing—close reading. I teach a range of different courses: Women’s Studies, Freud, Literary Theory, Feminist Theory, Deconstruction. We read a range of different texts: Virginia Woolf’s A Room of One’s Own, Sigmund Freud’s Interpretation of Dreams, Jacques Derrida’s Of Grammatology, Alice Walker’s In Search of Our Mothers’ Gardens, Freud’s Three Essays on a Theory of Sexuality. The books cover a wide range of topics: art, race, literature, sex, discrimination against women. No matter the text, no matter the topic, I always teach the same thing—close reading.

You might notice that none of the books I mentioned, none of the courses, are, properly speaking, literature. In the courses I teach, we don’t read poetry, drama, or fiction; we read nonfiction prose, stuff that could be loosely called theory. I work in an English department, and all the courses I offer are English courses. For me, what makes them English courses are not the books we read, but the way we read the books we read. Sometimes I think I could teach any text in an English course, because what matters to me, what makes me sure I’m teaching English, is how we read. In my English classes, I call the way we read “close reading.”

I usually tell my students that “close reading” means looking at what is actually on the page, reading the text itself, rather than some idea “behind the text.” It means noticing things in the writing, things in the writing that stand out. To give you some idea of what this means, I’ve made up a list of five sorts of things that a close reading might typically notice: (1) unusual vocabulary, words that surprise either because they are unfamiliar or because they seem to belong to a different context; (2) words that seem unnecessarily repeated, as if the word keeps insisting on being written; (3) images or metaphors, especially ones that are used repeatedly and are somewhat surprising given the context; (4) what is in italics or parentheses; and (5) footnotes that seem too long. This list is far from complete—in fact, no complete list is possible—but the list is meant to begin to give you an idea of what sorts of things we notice when we’re doing close reading.

What all five of my examples have in common is that they are minor elements in the text; they are not main ideas. In fact, your usual practice of reading which focuses on main ideas would dismiss them all as marginal or trivial. Another thing they have in common is that, although they are minor, they are nonetheless conspicuous, eye-catching: they are either surprising or repeated, set off from the text or too long. Close reading pays attention to elements in the text which, although marginal, are nonetheless emphatic, prominent—elements in the text which ought to be quietly subordinate to the main idea, but which textually call attention to themselves.

Most of you have been educated to ignore such elements. You have been taught to seek out and identify the main ideas, dismissing the trivial as you go. This has had to be trained into you: read to a young child sometime, you will notice she has the annoying habit of interrupting the flow of the story to draw attention to some minor thing. Close reading resembles the interruptions of that child. It is a method of undoing the training that keeps us to the straight and narrow path of main ideas. It is a way of learning not to disregard those features of the text that attract our attention, but are not principal ideas.

My third example above—images or metaphors—recalls one of the most classic sorts of reading done in college English classes, the image study. For generations now, students have learned in English classes to find the images in a work of literature and think about those images as a way of enhancing their understanding of the text. This might help you see why close reading would belong in an English class, how it connects to what is traditionally taught in English classes.

Traditionally, however, we have been taught to do image studies of literary texts, whereas in my classes we study the images in expository prose. You might say that I am taking the sort of reading developed as a way to more fully appreciate literature and applying it to a wider range of texts. You could describe the sort of close reading of all texts that I teach as a generalizing of literary reading so that, rather than a way to read a particular kind of text, it becomes a particular way to read all texts.

Students often tell me that my class has changed the way they read everything: newspapers, travel brochures, signs in shop windows. Their tone is frequently that of complaint (“your class is ruining me, making me hyperaware where once things went without saying”). But it is that special kind of complaint which carries a lot of pride. I hear such complaints as the most common evidence of what I call “education”—that is, when a student encounters something in class that affects the way she lives in the world. It makes sense to me that the experience of having learned something, of being in some way changed by that learning, would be expressed with this peculiar combination of resentment and pride (“Your class has contaminated all my reading”).

In explaining what I mean by close reading, I often tell my students to read NOT what SHOULD BE on the page but what is. Over the years since first learning to read, we acquire the habit of reading what we think OUGHT TO be there rather than what actually is. You can test this by seeing how few people notice small typographical errors, how difficult in fact it is for people to catch all the typos in a text. (Even a text proofread by several people will generally still have a couple of errors.) The problem is that people automatically correct what they’re seeing without being conscious of it. So to ask people to read what is actually on the page, is to ask people to alter this pattern of automatic correction, to learn to become conscious of what they usually remain unconscious of, what is actually on the page.

This pattern of reading what ought to be there rather than what is can most easily be seen in relation to typos. While close reading is not primarily about noticing typographical errors, that is a useful side effect. Students trained in close reading generally become very good at catching typos. Even in this day of spell-check programs, this is still helpful, since the best spell-checker cannot catch typos that turn words into different words.

A more substantial benefit of close reading is the effect it can have upon the student’s reading of her own writing. When we read our own writing, we are even more than usually prey to reading what ought to be there rather than what is. Often we don’t notice that we’ve actually left words out or used words that don’t mean what we mean or not explained something in a way anyone could follow. And that’s because we know what ought to be there: we know what we were trying to say, and we read, not what we actually managed to get down on paper, but what we were trying to say.

More often than not, when I’m talking with a student about his paper, I find we’re talking about two different objects. He is talking about the paper he thinks he wrote, which is the one he intended to write; I am talking about the paper he actually wrote. As a result, if I don’t think the paper is very good, he thinks it means that I don’t think his ideas are good, whereas in fact I am critical because I can’t tell very well what his ideas are. When he reads his paper, he sees his ideas; when I read his paper, I see his words, which unfortunately don’t manage to convey his ideas.

A student trained to close read would be more likely to read what she actually wrote. And thus she would be more able to see how it differs from what she intended to write. Practically, that means she would be better equipped to revise her writing, to make it correspond more closely to her intention. That close reading can help students write better is another reason it belongs in an English class. Besides teaching students to read better, the other central task of English is teaching students to write better.

Helping students write better is a substantial benefit and argues strongly for the value of close reading. But it is not actually the argument I want to make here. I have bigger fish to fry.

While a world that writes better is a world I’d certainly like to see, the sort of improvement in writing we’re talking about is merely instrumental. Whatever thought a student might have, close reading will help him express it more clearly. As a teacher of writing, that is my simple, though by no means easy, goal. But as a teacher, I would not only like my students to become technically more proficient; I have more ambitious goals.

While I pride myself on my ability to get students to write better, regardless of what they want to say, I want to resist the instrumentalism that would turn the teaching of English into the mere transmission of some amoral technical ability. Close reading can make students write better, but as much as I value good writing, that is simply not enough.

If we only read things written by ourselves, close reading wouldn’t be very important. It is when we read things written by others that we begin to grasp the real value of close reading.

In concentrating on how close reading is useful in getting us to see the faults in our own writing, we focus on the difference between what we actually write and what we intend to write. And as good as it is to learn to hear what we actually say, as opposed to what we thought we said, in such a situation we generally have the advantage of knowing our intentions, even when we’re not very adept at expressing them.

When we read our own writing, we tend to see, not what we actually wrote, but what we intended to write—that is, we read not the words on the page, but our thoughts. Likewise, I’m sorry to say, when we read what someone else wrote, we tend to see, not what he actually wrote, but what we think he would have written. Once again rather than seeing what is there in front of us, we see our thoughts.

Whereas in reading our own writing, we merely fail to see our own inadequate expression, in reading the writing of others, our failure is much more serious: we read our own ideas in place of what the other person has written. There’s a technical term for this: it’s called projection. Rather than read what the other person has actually written, we project onto the page what we think he would have written.

It’s amazing how much reading is really projection. In fact, I would say that most of the time most people read not what is in front of them but what they expect to find in front of them.

Often the difference doesn’t matter that much. Often what is in front of us is pretty similar to what we expect to find. A letter from Mom is generally similar to previous letters from Mom; this week’s People magazine is very much like last week’s; a novel by Jane Austen is very much like other Austen novels; one Harlequin romance is pretty much like another; a comedy by Shakespeare has the same structure as other comedies; one neo-conservative attack on “political correctness” resembles another; a feminist critique of pornography is likely to say what we expect it to say.

Those things which conform to our expectations are things which resemble what we have read before, things where we have learned what to expect. English teachers call this similarity “genre.” Writings in the same genre will follow the same pattern; experienced readers of the genre will learn the pattern and know by and large what is coming. This is, of course, too simplistic. While the new Harlequin romance will mainly conform to the genre, it probably will have a few surprising details.

Rare is the text that does not, to some extent, belong to a genre; even texts which seem shockingly original often participate unwittingly in familiar patterns. Equally rare is the text which completely follows the rules of a genre: even the most conventional will usually display some individual expressivity, some originality in its details. A text generally engages the expectations of genre and also varies from or even breaks those expectations, combining the surprising and the familiar.

When the reader concentrates on the familiar, she is reassured that what she already knows is sufficient in relation to this new book. Focusing on the surprising, on the other hand, would mean giving up the comfort of the familiar, of the already-known for the sake of learning, of encountering something new, something she didn’t already know.

In fact, this all has to do with learning. Learning is very difficult; it takes a lot of effort. It is of course much easier if once we learn something we can apply what we have learned again and again. It is much more difficult if every time we confront something new, we have to learn something new.

Reading what one expects to find means finding what one already knows. Learning, on the other hand, means coming to know something one did not know before. Projecting is the opposite of learning. As long as we project onto a text, we cannot learn from it, we can only find what we already know. Close reading is thus a technique to make us learn, to make us see what we don’t already know, rather than transforming the new into the old.

Close reading can thus be a crucial part of our education, the very sort of thing we most need from college. Close reading can equip us to learn, to be open to learning, to keep on learning all our life. Given the pace of change, there is no way you can ...