For many years, medicine has been regarded primarily as a technical-scientific practice based on the need to repair an object that disease or the wear of time has damaged, rendering it no longer efficient. This reflects a process by which the human body has increasingly been equated with a machine, expected to become ever more incorruptible. The enormous expansion of scientific knowledge, both in diagnostics and therapeutics, which we have witnessed over recent decades, has on the one hand significantly increased life expectancy, but on the other has reinforced this almost omnipotent belief. Without renouncing technological progress, which remains precious and indispensable, there has been an increasingly urgent need to recover the humanistic dimension of medical practice—that is, to recognize that working with human beings necessarily involves not only a physical aspect, but also a psychological and emotional dimension that can no longer be ignored or separated, according to the well-known “Descartes’ Error.”
To heal this dichotomy, attention has turned toward the Medical Humanities, particularly music, art, and literature, as tools to accompany and alleviate the suffering of ill individuals, supporting not only their physical but also their psychological wellbeing. Numerous studies have shown this support to be highly effective even from a biological perspective, since these two dimensions are deeply interconnected. Similarly, for too long, the emotional burden to which healthcare professionals are inevitably exposed in clinical practice has been underestimated, in a profession that constantly confronts suffering, fear, and often death.
In an era in which the paternalistic concept of the physician has, hopefully, been abandoned, the therapeutic relationship is increasingly understood as the meeting of two forms of expertise: that of the physician or nurse, expert in the theory of disease (disease), and that of the patient, expert in the lived experience of illness (illness), which has taken residence in the body. Within this relationship, narrative becomes the principal tool through which information is acquired, although such information is too often considered exclusively technical or scientific in nature. This meeting of competencies can no longer remain confined to the technical sphere; it must be acknowledged that this relationship involves two human beings, each made of emotions, thoughts, doubts, and uncertainties.
It is therefore time to consider the human factor of healthcare professionals.
Throughout my long clinical experience, I have always felt profoundly the responsibility of taking charge of the precious good that each person was placing in my hands: their health. This assumption of responsibility has generated many emotions in me, foremost among them the fear of making mistakes, of failing to establish the correct diagnosis, of not mastering the full therapeutic arsenal that science now offers, or of failing to choose the most effective treatment. Personally, I believe that the often-lamented lack of empathy among physicians is frequently a form of shield and protection against emotions such as these—not to mention the emotional involvement that inevitably arises when facing human suffering, in which one cannot help but see oneself reflected.
Unfortunately, I must observe that schools of Medicine and Surgery, far from embracing this emotional dimension, have for decades encouraged healthcare professionals to adopt a rational and detached attitude, considering such an approach more scientific and more appropriate to the physician’s role. In doing so, they have sacrificed the human dimension on the altar of a presumed professionalism, under the illusion that emotions could be suppressed—when, in fact, emotions are by nature irrepressible. This presumption, together with often unsustainable working shifts, has contributed significantly to the widespread burnout affecting the medical profession: that internal burning and exhaustion which causes enormous harm to the caregiver and, consequently, to the patient.
Over the years, I believe I was protected from burnout by my deep passion for literature, in which I found refuge whenever the human and psychological impact of another person’s suffering, the need to tolerate uncertainty regarding therapeutic outcomes, or the fear of making mistakes and not being adequate threatened to overwhelm me. For this reason, I strongly advocate for the introduction of courses in Medical Humanities and Narrative Medicine within Faculties of Medicine, Surgery, and Nursing.
Why can literature, as well as music or visual art, help a person who has chosen to wear a white coat, who has chosen a profession devoted to helping others, and who has envisioned a future in close contact with suffering in the hope of alleviating it? Why can a walk through a museum or listening to a concert help someone who often encounters this wave of human suffering completely unprepared, despite knowing by heart the molecular structure of the insulin receptor?
The arts do not possess merely an intrinsic beauty linked to form; they are extraordinary because they offer forms of knowledge about the world that allow us to explore even the nocturnal side of life and enable us to look within ourselves, identifying emotions and feelings that belong fundamentally to the human condition.
Literature offers us a remarkable training ground where we may exercise resilience to pain, familiarity with grief, and the search for hope even in extreme situations—skills that will become invaluable when, at a patient’s bedside, we must confront pain, mourning, and despair; when, before a suffering person, we experience the profound solitude of being astonished and powerless before the mystery of death.
Then we may remember reading The Death of Ivan Ilyich, the voice of a cynical man whom suffering renders profoundly human—a voice that helps us understand both the person before us and our own inevitable emotions, having already encountered them in the protected space of literature.
The same can be said of listening to Verdi’s Requiem, in which the sudden and overwhelming entrance of the drum evokes humanity’s astonishment before the mystery of the universe—an astonishment and fear that healthcare professionals may also experience in the face of illness. This disturbance is something I have personally felt many times, and music can first help identify it and then soothe it through its cathartic effect.
When confronted with the greatest of sorrows—a mother losing her child—we may recall Michelangelo’s Pietà. The emotion experienced before that extraordinary work of art may bring us closer to that woman and perhaps allow us to find words of comfort in the face of an unspeakable tragedy, one that inevitably touches the deepest parts of our own soul.
At the same time, having already encountered such emotions through art allows us to keep them under control and to exercise a rational empathy that supports the patient while protecting us from being devastated by another person’s pain. It also enhances empathy more broadly through the emotional education that the arts provide.
The frequent encounter with works of art—whether literary, visual, or musical—is profoundly salvific because it allows us to encounter life, suffering, and death; to experience indirectly the darker side of existence; and to symbolically exorcise it through beauty.
Healthcare professionals therefore have an absolute need to know themselves intimately, just as they know cell biology. They must understand their own limits, fragilities, and suffering, so as to contain them without ever excluding or underestimating them, granting themselves the right to feel, as every human being does.
At the same time, they must also learn to recognize human emotions even when they do not experience them directly, in order to adopt the empathic posture that the profession they have chosen necessarily demands.
This knowledge—uniquely enhanced through the study of the arts, despite appearing so distant from the daily routine of hospital wards—not only supports the wellbeing of the caregiver, which in the therapeutic relationship is just as important as the wellbeing of the patient, but also helps shape healthcare professionals into individuals who are complete not only professionally, but also humanly.
By Raffaella Pajalich