Over the last century, medical science has undergone extraordinary progress in the diagnostic and therapeutic spheres that has led to an increasing emphasis on technology and an increasingly clear separation between scientific culture and the humanistic component of medicine.
With the prevalence of the so-called Evidence Based Medicine, which relies on objective, measurable, quantifiable and generalisable facts, the psychological, emotional, personal side of the disease has been increasingly neglected, the singularity and uniqueness of both the patient and the healthcare professional, protagonists of the therapeutic relationship, has been obscured (Zannini, 2008). In the second half of the twentieth century, therefore, the need was to recover the humanistic portion of the medical art through the Medical Humanities with the aim of bringing attention back to the human experience of illness and cure. The encounter of medicine with social and behavioural sciences such as sociology, psychology and cultural anthropology was enriched by the contribution of expressive arts such as literature, music and figurative arts.
In my experience as a doctor, the daily confrontation with many colleagues has unfortunately highlighted the lack of awareness of health professionals about the usefulness of the arts in our chosen aid work, which cannot be limited to the knowledge of blood glucose or azotaemia values, but requires us to place health and illness in the personal, family, and social context of the patient and therefore to understand their specificity in a pathway that is not alternative but complementary to the generalisation implemented by contemporary medicine. This holistic vision urges the health professional to review his preparation in order to be able to refine the so-called ‘clinical eye’ considered as the ability to use all the senses in the diagnostic pathway (Ferrara, 2020). It is therefore appropriate to broaden the spectrum of health workers’ knowledge and skills, to go beyond mere technical competence, to train capacities for empathic understanding of the other, and at the same time to take into account the emotions often silenced or denied by the health worker himself, which are unavoidable in anyone who faces suffering and deals with the night side of life.
How can such skills be developed? The figurative arts, music, literature prepare for the encounter with the pain of the other by providing emotional and psychological tools necessary for the reception of the patient, tools that make the health care worker not only a ‘good’ professional, encountered by luck or chance, but a good professional able to understand the painful experience of the patient, avoiding being overwhelmed by it. The arts make it possible to develop skills of observation and interpretation, of attributing meaning to the experience of illness by connecting the emotions contained in artistic works with those of the persons assisted and with one’s own, using personal experiences to better understand those of the patient in the complexity of his or her experience (Zannini, 2008).
Literature is a gymnasium for experiencing stories and feelings that our profession will present to us, not only pain and suffering but also love, birth and child rearing: anyone who has experience of a clinic or ward understands how literature shares with medicine the great themes of life and can therefore prepare us to deal with them, to experience emotions in advance through the filter of a book, letting them decant in a protected environment.
At the same time, the exercise of careful reading of a passage, as it happens in the Narrative Medicine workshops under the guidance of facilitators trained through a specific course, trains the semantic understanding of the meaning of the text and thus exercises the understanding of the “oral text” that the patient offers us in the collection of the anamnesis. This reading exercise, in addition to implementing attentive and active listening by fostering empathy, allows us to arrive at a more accurate and precise diagnosis, reverberating on the technical data of the treatment pathway. As Rita Charon writes “to make a good doctor you need a good reader” to emphasise how this attitude is fundamental for the good exercise of our profession and not only in a utopian vision of the literate doctor that has been handed down historically. In a similar way, the figurative arts are used in the laboratories of Narrative Medicine to train the spirit of observation and attention to detail: observation is a basic element in the process of scientific research and it is fundamental in the preparation of the nursing staff that through this ability becomes better able to assess the condition of a patient (Ferrara, 2020).
Let us therefore imagine that we are observing a painting in its various traits, shades and colours, just as we observe the face, gait, mimicry, and gaze of a patient from the moment he or she enters our clinic; let us consider the wealth of information that we can draw from the conscious attention placed on the non-verbal expression and on the body itself of the person seeking help. Moreover, the beauty, intensity, expressiveness of an artistic work arouses emotions in us, training our ability to welcome and tolerate these feelings by processing them in a neutral place in relation to the bed of the suffering person, allowing us to know ourselves more deeply. I believe that carefully and emotionally observing Michelangelo’s Pieta or reading Tolstoy’s The Death of Ivan Ilic or listening to Verdi’s Requiem can prepare us for mourning and the consequent turmoil that it induces in us as health workers, through the vision of the suffering face of a Mother holding a Son, through the journey in the mind of a man nearing the end of life or the shattering power of notes that describe man’s dismay before the mystery of transcendence, with the capacity of artistic expressions to describe and sublimate human pain. The arts prepare us for the inevitable emotions inherent in the work we have undertaken, supporting us in the self-care necessary to care for others, thus making us more resilient, effective and efficient as well as offering us moments of dazzling beauty. Last but not least, the arts with their content of humanity can help us to exercise empathy, that ability to take on the perspective of the other looking from the patient’s point of view, to perceive and think the emotions that the other experiences and also our own emotions, empathy is in fact a behaviour generated by a cognitive condition that includes thinking skills, emotional attitudes and the ability to distinguish in the relationship one’s own self from the other with positive effects on both sides of the relationship (Ardis, 2022).
Empathy can therefore be implemented through attending art with its content of knowledge and description of the human soul, in addition to being a vocation of the student who has chosen a helping profession, and which unfortunately recent studies show is even partly lost in the course of study in the faculty of medicine. For all the above reasons, I hope that the medical humanities and the arts in a specific way will be included in the training of healthcare personnel, to the benefit of the relationship with the patient and the wellbeing of the caregiver.
Raffaella Pajalich, Medical Surgeon – Specialist in Endocrinology and Cognitive Psychotherapy
Board member of the Italian Society of Narrative Medicine
References:
Ardis S., Marcucci M., (2022) Dictionary of Narrative Medicine, Morcelliana
Charon R., (2019) Medicina Narrativa, Honouring Patients’ Stories, Raffaello Cortina
Ferrara V., (2020) Art as a tool for training in the medical and health area, Aracne
Zannini L., (2008) Medical Humanities and Narrative Medicine, Raffaello Cortina