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Poetry, medicine, and the International Hippocrates Prize

2010; Elsevier BV; Volume: 375; Issue: 9719 Linguagem: Inglês

10.1016/s0140-6736(10)60427-8

1474-547X

Donald R.J. Singer, Michael Hulse,

Empathy and Medical Education

In November, 2009, we launched the annual Hippocrates Prize for Poetry and Medicine, with the inaugural 2010 awards to be presented at an international symposium in early April. Why this focus on what may seem at first sight an unlikely pairing? If we think of medical matters as they are reflected in literature, it is likely that our minds turn first to the doctors who appear in prose fiction, such as Tertius Lydgate, who struggles so valiantly to become established in George Eliot's Middlemarch, or Charles Bovary, who disastrously tries a new surgical approach in Gustave Flaubert's Madame Bovary. Or we may think of the comic mileage in medical matters discovered by Molière in The Hypochondriac or A Doctor in Spite of Himself, in which he shows us a man whose reputation for working miracles goes before him, so that he finds it easy to slip into a medical role in which he can deliver delightfully absurd pronouncements such as: "She mustn't die without a doctor's prescription". From the physician who observes the distressed Lady Macbeth sleepwalking, to the doctors who turn to homicide in the pages of Agatha Christie, and television hospital settings from Emergency Ward 10 to ER and House MD, medicine and the medical profession have steadily emerged in the modern era as objects of profound fascination to writers, readers, and audiences. Nonetheless, an initial scepticism is often evident when medicine and poetry are mentioned in the same breath. In part this arises from lingering preconceptions concerning the proper subject matter of poetry. Love, the contemplation of beauty, and expressions of grief and loss are imagined to be the major provinces of the poet, from Ovid, the Romantic poets, and Nobel laureate Seamus Heaney in the western tradition, to delicate haiku in Japan. We also tend to think of poetry as dealing with grand philosophical and historical themes, such as in Homer's The Odyssey and Dante Alighieri's Inferno. However if we believe that "the proper study of mankind is Man", as stated by Alexander Pope in the 18th century, then we should also agree with the ancient principle that the writer's province is anything within human experience. Indeed, to the Roman Lucretius, engaged in the first century BC in philosophical and scientific inquiry into natural phenomena, it did not seem unnatural to write about these themes in verse in his De rerum natura. Poetic themes may also have a medical resonance beyond the imaginings of the poet. Ovid's Metamorphoses, for example, provide metaphors and names for a wide range of psychiatric disorders, from narcissism to the Oedipus complex. Among the Romantic poets, the writings of John Keats most obviously illustrate the effect on poetry of both medicine as a profession and the personal experience of illness—in Keats' case tuberculosis which led to his death at the age of 25 years. There are echoes of William Harvey's Exercitatio anatomica de motu cordis et sanguinis in animalibus in Keats': "…thou would wish thine own heart dry of bloodSo in my veins red life might stream again" His "Ode to a Nightingale" refers to the place "Where palsy shakes a few, sad, last grey hairs" and he reflects on his own intimations of mortality in his cameo "When I have fears that I may cease to be". In the 20th century, eminent physician poets come to mind. The German Gottfried Benn was the doctor in attendance for Edith Cavell when she was executed as a spy by the Germans on Oct 12, 1915, near Brussels. Benn later specialised in dermatological and venereal diseases. 2 years before the outbreak of World War I, he had published his first volume of poems, Morgue, in which his point of view was often not only detached but ostentatiously shocking: "Come now, go ahead, lift the blanket.See, this lump of fat and rancid juiceswas once magnificent to some man or otherand was bliss to him and meant home." In the USA, William Carlos Williams, a general practitioner in New Jersey, frequently drew on his professional experiences, both in his prose writings (The Doctor Stories) and in verse. In his poems of death, sickness, and frailty, Williams strikes us as a medical man more likely to show compassion and understanding of the patient's perspective: "Oh, oh, oh! she criedas the ambulance men liftedher to the stretcher—Is this what you call making me comfortable?By now her mind was clear—Oh you think you're smartyou young people, she said, but I'll tell youyou don't know anything." Keats' allusions to melancholy and mortality, Benn's cancer ward, and Williams' dying grandmother all illustrate some of the vast terrain open to poems influenced by medical knowledge and experience. This includes experience of disease, accident, and death from various points of view; it includes medical science and its history; it includes everything from the Renaissance theory of the humours to the contemporary routine of the ambulance driver. Recent years have seen extraordinary growth in the use of poetry for therapeutic purpose. What led to this use of poetry to help in treatment of clinical disorders? Here too it is necessary to begin by recognising that poetry may serve many ends and come in many forms. We are more accustomed to the use of music and painting in therapy. Ideas that passive experience of poetry may reset abnormal mood—comedy for the depressed, tragedy for the manic—go back at least two millennia to the Greek doctor Soranus. As early as the 18th century, the US physician and psychiatrist Benjamin Rush pioneered active engagement in writing poetry for his patients. There is now increasing interest in exploring the idea that by unlocking the doors of depression or denial of serious illness, reading and writing poetry may bring understanding and coming to terms with illness, through encouraging expression of mood, feelings, concerns, expectations, and insights. 20th-century interest in poetry as therapy has inspired a substantial body of poetry written about serious medical disorders, including psychiatric problems, HIV/AIDS, and terminal illness, especially cancers. Since these subjects tend to be the very opposite of beautiful or uplifting, poets, while foregrounding the distressing features of illness, often contrast upsetting clinical experiences with inappropriately elegant or jolly poetic styles. In these lines from his long sequence on cancer, entitled C (1984), Peter Reading disarmingly includes ironic comment within the poem: "My fistulae ooze blood and stink,I vomit puce spawn in the sink,diarrhoea is exuded.Do not be deluded:mortality's worse than you think. You find the Limerick inapposite? Try the pretty Choriamb?Bed-sores without; swarm-cells within.Rancified puke speckles my sheets.Faeces spurt out quite uncontrolledinto my bed, foetid and warm.Vomit of blood tasting of brass,streaked with green veins, splatters my face." Self-evidently this is not poetry for the faint-hearted; neither for those who demand their daffodils in verse. To ask what the function of such verse might be entails inquiring into the essential nature of poetry. Those who want poetry to consider the facts of our physical existence as unflinchingly as the surgeon will want to defend Reading's approach. Those who want poetry to impart consolation or courage may turn from Peter Reading in disappointment or anger; yet may be uplifted by "light deny'd" in John Milton's "Sonnet XIX On his blindness". Milton encourages readers under the "yoak" to value modest achievements, greatly understating his own highly productive 22 years of blindness, supported by gifted amanuenses, including Andrew Marvell. For the Hippocrates Prize, we wished to draw together national and international perspectives on three major historical and contemporary themes uniting the disciplines of poetry and medicine: medicine as inspiration for the writings of poets; effects of poetic creativity on the experience of illness by patients, their families, friends, and carers; and poetry as therapy. The Prize has an international open category eligible for unpublished poems in English by any poet; and separate awards for UK health students and NHS-related staff, including clinical teachers, researchers, and biomedical scientists and their supporting staff. Has our vision been justified? At this stage it is already clear that initial interest has been remarkable, with over 1600 entries from 28 countries and six continents. The inaugural 2010 awards will be judged by physician and poet Dannie Abse, broadcaster and Man-Booker Prize trustee James Naughtie, and National Health Service Medical Director Sir Bruce Keogh, with awards presented during a Symposium on Poetry and Medicine on April 10, 2010. Within both the Hippocrates Prize and the associated Symposium, contributors are encouraged to explore medicine as a theme in its broadest sense. Themes could include the nature of the body; the history, evolution, current and future state of medical science; the nature and experience of tests; and the experience of patients, their families and friends, and of doctors, nurses, and other staff in hospitals and in the community. In this spirit, the first Symposium will include discussion of the influence of doctor poets, from Williams to our Australian keynote speaker Peter Goldsworthy, alongside discussion of poetry as an aid to understanding illness, as well as early anatomy as inspiration, poisoning in Shakespeare, and poetry as passion for creative health professionals. The response to the Prize and Symposium confirms our sense that the meeting of poetry and medicine is attracting growing national and international interest. Among the reasons for that interest is the widening understanding of the therapeutic value of words. We are creatures of language, and finding words for critical experiences helps us to cope and find the way forward. Today, in the practice of the medical community, poetry is increasingly joining music and the visual and plastic arts as an aid to recuperation and convalescence. At the same time, professional poets have increasingly written candidly of painful illness and death. Poetry and medicine—with all the beauty and all the harsh reality that either discipline can bring into our lives—are too big to belong to the "experts", and must be shared by us all. The 2010 International Hippocrates Prize for Poetry and Medicine and the associated International Symposium on Poetry and Medicine are supported by the Fellowship of Postgraduate Medicine and the Warwick Institute of Advanced Study.