Session 9: Making Sense of Medicine

Betty Bednarski - Writing to ‘Make Sense' of Medicine: the Case of Physician-Writer, Jacques Ferron
Professor of French, Coordinator of Canadian Studies, Dalhousie University, Halifax, Nova Scotia, Canada

Any consideration of the ways in which medical professionals "make sense" of their experience of health, illness and disease must necessarily take into account the phenomenon of the physician-writer. The purpose of this paper is to shed light on that phenomenon by studying the case of Quebec's Jacques Ferron (1921-1985), a much celebrated literary figure and a family physician for almost forty years. Ferron is the author of a prodigious body of work, which contains powerful fictions of illness and healing and much outspoken commentary on medicine. We will explore the relationship of literature and medicine in Ferron's case in three distinct but interconnected ways.

The first approach will be biographical. We will focus on the man himself, on the co-existence of writing and medical practice in his life, asking: How did Ferron reconcile the two activities? Did he reconcile them? How did they fit together? What was the nature of the partnership between the physician and the literary man? We will refer here to Ferron's own autobiographical statements and to a published biography.

In the second part of the paper we will focus on Ferron's ideas on medicine. What did he say, explicitly, about his profession, its effectiveness, its claims? About doctors themselves? About patients? Or about particular illnesses and their treatment? What were the medical debates he engaged in? We will concentrate here on published interviews, on Ferron's polemical writings -letters to the editor, essays -, as well as on passages from novels and short stories, where there are bold authorial intrusions and Ferron comes as close as one can in fiction to speaking out in his own name.

In the third and final part we will examine the fictional writings themselves. And we will ask: What are the situations, the experiences, that have found their way from medicine into Ferron's books? What are the modes of incorporation of medical material into these literary texts? What has been done with (and for?) medicine? What is the nature of the literary transformation that has taken place? We will touch on notions of "metaphor", "voice" and "story", and in particular on the question of narrative points of view. The paper will be broadly introductory in its aims and scope, but rigorous in its
categorizations of the means literature uses to put medicine "in its place."

Bob Leckridge - The Art of Medicine and the Science of Medicine
Glasgow Homeopathic Hospital, Glasgow, G12 0XQ

Human beings understand nature in both reductionist and holistic ways. The former is expressed through attention, focus and the ability to quickly notice differences and change. The latter is expressed through the capacity to integrate diverse sources of information and the uniquely human ability to utilise symbols, not least of which is language. These two approaches underpin the struggle between materialist and vitalist models of sickness historically. This struggle is currently evident in the alternative concepts of disease and illness. Each of these concepts produces different understandings of health and consequently of the goals of medicine. Illness concepts are essentially holistic and are gaining support over the dominant reductionist disease model. This shift in perspective is both being driven by, and is contributing to, a shift in power away from experts and towards individual patients. These changes contribute towards an explanation for the rise in the popularity of traditional and complementary medicines. Truth can be discovered through scientific, reductionist means or through artistic, holistic ones. The integration and balancing of these approaches is encapsulated in a new balance between the science and the art of medicine. This paper tracks the development of these understandings and highlights the impact this is having on delivery of health care.

Susan Massad - What do Health Care Professionals Need? They Need to Philosophize
Attending Physician, Long Island College Hospital, Clinical Asst. Prof of Med, SUNY Brooklyn, Health Science Center
NY NY 10014

As a teacher and practitioner of Internal Medicine for forty years, I have observed that conversations with patients have changed considerably in recent years. Today they are more methodological and philosophical, than informational, and are more likely to be about choice, method, value, truth, and meaning than about what I know. These changes seem to be coming from the broader culture, rather than from my maturity as a physician or from significant change in the profession. As society becomes more post modernized, it is less enamored of the grand truths/explanations of medicine. Most medical practitioners have experienced the effects of some or all of the following in our clinical work: the democratization of medical knowledge; the explosion of technology that has given rise to both choice and uncertainty; the publicly displayed shifting sands of medical research (such as the recent mammogram controversy); and the flourishing practice of alternative medicine providing choices to patient outside of the western medicine paradigm.

The question raised by these, and other societal-cultural changes, is whether, as medical practitioners/ teachers, we might play a more active role in changing our practice to be more coherent with what is going on in society. Could we approach our medical conversations as philosophical dialogues: could we talk with our patients about such things as method, value, truth, and meaning and help them to see that their practice of health and illness is strongly impacted on by such methodological/philosophical issues?

The presentation will include a performance of an office conversation to illustrate a philosophical medical conversation, followed by a review of the contributions of various postmodern movements-narrative therapy, social therapy, social constructionism, social poetics - to a practice of philosophical medicine.