The Rise of Autobiographical Medical Poetry and the Medical Humanities

ibidem Press, Stuttgart

Contents

Preface New Zealand as the Literary Locus of this Study

Introduction The Modern Marriage of Medicine and Poetry

The Medical Humanities

Medical Poetry

Critical Perspectives

The Autobiographical Lyric in the Context of Confessionalism

Narrative Perspective

Social Commentary and Subversion via the Manipulation of Discourses

Chapter 1 The USA and the UK

Introduction: The Early Adopters

A Knowing Art

Dannie Abse

Rafael Campo

Children and Parents

Sharon Olds

Philip Gross

Chapter 2 New Zealand’s Doctor-poets: Glenn Colquhoun, Angela Andrews, and Rae Varcoe

Introduction

Glenn Colquhoun

Angela Andrews

Rae Varcoe

Conclusion

Chapter 3 New Zealand’s Patient-poets: C.K. Stead, Jenny Bornholdt, and Sarah Broom

Introduction

C.K. Stead

Jenny Bornholdt

Sarah Broom

Conclusion

Chapter 4 New Zealand’s Parent-poets: Ingrid Horrocks, Anne Kennedy, and Jessica Le Bas

Introduction

Ingrid Horrocks

Anne Kennedy

Jessica Le Bas

Conclusion

Epilogue

Acknowledgements

Bibliography

Studies in World Literature SWL

Copyright

Preface

New Zealand as the Literary Locus of this Study

This book concentrates largely on poetry published in my home country, New Zealand. I first noticed the abundance of poetry collections based on personal stories of illness and medical treatment at the time I began piecing together my own medically based collection, Family History, in 2010 (Emeney 2017). When I looked further into the context of this proliferation of medical poetry, I noted both the academic and popular interest in the medical humanities, and the larger trend in medical literature of which my country appeared to be a part. Indeed, New Zealand makes a fitting microcosm for the investigation of how ideas contained in so many of these poetry collections reflect global thinking about healthcare, and the doctor-patient relationship.

Since the new millennium, a large number of poetry collections which are both autobiographical and medically themed have been published in New Zealand, a small island nation of some 4.5 million people. Several of these books have sold very successfully, and won national prizes for literary merit, made an impact on the community and gained popularity with the reading public. In addition, the country’s two medical schools at Otago and Auckland universities include the medical humanities in their curricula, and each possesses an associated website or journal—corpus.nz belongs to Otago University’s Division of Humanities, and Atlas Literary Journal is edited by Helen Ker, an alumna of Auckland University’s Faculty of Medicine and Health Sciences. It is fair to say that both medical poetry and the medical humanities are reasonably well established in New Zealand.

As part of a global model, New Zealand is a useful literary locus when exploring the ways in which ideas underpinning the medical humanities appear in the poetry written during the period of its introduction and propagation. Put simply, the sociological and philosophical principles that originally launched the medical humanities can be summarised thus: “An education that includes the arts can help doctors to be more reflective, compassionate practitioners and diagnosticians, and may also draw attention to the deficits and inequalities in the doctor-patient relationship that preclude the best medical outcomes”. The need for those empathetic doctors who can listen to or co-author patients’ stories, and who can balance the biomedical and the personal, negotiating hierarchies and barriers of language, is communicated in these poetry collections published from 2000 onwards. New Zealand, having looked to adopt the medical humanities in the late 1990s, reflects a pattern, both in its tertiary medical training and in its literature, which began in the countries that introduced bioethics and the medical humanities some two decades earlier.

The recent surge of autobiographical medical poetry in New Zealand attracted criticism from some quarters for craftless solipsism on the part of the poets. At the extreme end of critique, reviewer Hugh Roberts, who teaches at the University of California Irvine, USA, wrote for the New Zealand Listener that poetry about personal medical experience was “a new genre that could be described as exercises in Higher Blogging: free-verse ruminations on Stuff That Has Happened To Me Lately” (2010b, par. 1). However, it can more seriously be viewed as an example of literature that voices concerns about medical treatment in New Zealand—concerns that are universally relevant in terms of their perception of the doctor-patient relationship and the often dehumanising nature of medical treatment.

These are collections that reflect life in New Zealand—Māori words and customs feature in at least three of the collections, problems of racist assumptions loom large in one, allusions to artists and authors most familiar to a New Zealand readership abound in at least two more—but as World Literature scholar David Damrosch (2009) says, “the writers who prove to be of real importance are those who negotiate most creatively the tensions as well as the possibility of their cultural situation” (107). In Walking to Africa (2009), Jessica Le Bas presents us with the situation of being a monolingual Pākehā who understands more of the visiting Māori elder’s prayer in Te Reo Māori than the medical terminology used to describe her daughter’s treatment plan. In Anne Kennedy’s Sing-song (2003), the mother of a child covered in eczema likens her family’s inability to receive a treatment that works from the doctor or the pharmacist to the contentious Treaty of Waitangi signed by the Māori and the Pākehā settlers of New Zealand. Yet, there is nothing local that cannot be understood (in terms of transliteration, at least) by a global readership. The rest is empathy.

These collections deserve attention not only in the medical humanities classroom of a local medical school; they demand a readership that is global, because what they have to say is a commentary on human nature under duress. Their central tensions hearken back to Foucault (1997) and notions of the “privilege of expertise” (44); their presentation of doctor-patient talk echoes Bakhtin’s (1981) ideas about the “professional stratification of language” (289). The ways in which the poets choose to mediate the areas of conflict in their works are common for postcolonial writers, “code-switching”, or enacting a “social contest […] for which the language variance is synecdochic” (Ashcroft, Griffiths and Tiffin 1989, 73). The poets to be discussed appropriate medical language and amalgamate it with personal, vernacular language and “poetic” language, thereby weakening its power or lessening its frightening otherness. As scholar and poet Bill Manhire (2011) puts it, New Zealanders have a history of “mix[ing] the hieratic with the demotic” (401) to subversive, sometimes comedic, effect.

At the emotional core of these poems, though, lies something more than subversion, and more than wresting power from one site in order to bestow it upon another. It is finding a place of common ground and a place of understanding. Again, in keeping with the aims of the medical humanities, this poetry seeks to address inequities and share a view of experience in order that gaps between people close. Current Poet Laureate, Selina Tusitala Marsh, one of the New Zealand poets who has published a collection with a personal, medical theme (Dark Sparring 2013), sums this up beautifully in her poem “Unity”, which was written and performed for Her Majesty Queen Elizabeth at the Commonwealth Observance Service, at Westminster Abbey, on the 14th of March 2016. The poem begins with an apt Hawaiian proverb: “Maluna a’e o nā lāhui apau ke ola ke kanaka /Above all nations is humanity” (Marsh 2016).

Johanna Emeney

Auckland, New Zealand

September, 2017

Introduction

The Modern Marriage of Medicine and Poetry

Over the past 30 years, international symposia, prizes, publications and university programmes have come to accord the marriage of medicine and poetry our modern measures of approval: monetary value, media focus and academic recognition. Medical poetry has developed into a thriving literary sub-genre, with many contemporary poets publishing whole collections based on personal medical experience. The core concepts expressed by a good number of the individual poems and collections are shared by sociological research into illness and the doctor-patient relationship. These poetic texts are frequently taught in tertiary medical humanities courses, to complement pathography, autobiography and fiction.

Among the earliest countries to adopt the concept of the medical humanities, the United States and the United Kingdom, are at the forefront of symposia and conferences that combine lectures on medicine and poetry, highlighting their reciprocal relationship. The sheer number and magnitude of such events in the past two decades is evidence of the popularity and rigour of the field. For example, in 2004, Duke University’s inaugural poetry and medicine conference, Vital Lines: Vital Signs, welcomed 70 speakers from both medical and literary specialisms. Their May 2010 conference Life Lines: Poetry for Our Patients, Our Communities, Our Selves, featured talks and workshops combining the talents of leading American poets, creative writing teachers, oncologists and family doctors. In October of the same year, a symposium was held at the University of California, Berkeley, hosted by the Program for the Medical Humanities, to examine the use of narrative and metaphor in medicine. Some 8,000 kilometres away, in England, every May since 2010, the International Symposium on Poetry and Medicine has taken place at the University of Warwick, with themes such as the history of interactions between medicine and poetry, and the impact of health and disease on the writings of professional poets.

An international award with a £15,000 prize fund for poetry on medical subjects, The Hippocrates Poetry Prize, is also associated with the University of Warwick. This annual prize, first awarded in 2010, by nature of its monetary value and media coverage eclipses other prizes for medical poetry such as those sponsored by the Annals of Internal Medicine (since 1997) and Yale UCL (since 2011). Since its inception, The Hippocrates Prize has received thousands of entries from over 60 countries. The presence of such a prestigious and far-reaching award signals the growth of medical poetry as a significant global sub-genre, and one for which poets seek publication and recognition.

Well-known medical journals such as the Journal of the American Medical Association,1 the Medical Journal of Australia2 and The British Journal of Psychiatry,3 which were for many years publications solely dedicated to scholarly reviews and research-based articles, now publish poetry by physicians on a regular basis. Moreover, “new literary journals have sprung up at medical schools” (Thernstrom 2004, 44) and elsewhere: for example, the journal Medical Humanities, co-owned by the Institute of Medical Ethics (IME) and BMJ. There is also the extensive “Literature, Arts and Medicine Database” (established in 1994), maintained by the New York University School of Medicine, which is a rich online source of annotated poetry, prose, art and film for use in teaching in the medical humanities, and Oxford University’s TORCH website (established in 2013), offering early career scholars opportunities to embark on research projects or to attend workshops and conferences on humanities and mental health; humanities and science etc.

The Medical Humanities

The growth of resources in the area of the medical humanities4 runs parallel to the increase in medical humanities and narrative medicine programmes at universities and other institutions—first in the United States, then in the United Kingdom, Canada and, more recently, in Australia and New Zealand. According to some scholars, the humanities were incorporated into medical training as a countermeasure to “the emergence of seemingly miraculous but morally troubling medical and technological advances” of the 1970s (Jones, Wear and Friedman 2014, 1). To others, the narrowness of the “new criticism” dominating the literature curriculum drove many educators to seek out the socio-political, cross-curricular opportunities offered by the study of literature and medicine. Kathryn Montgomery Hunter (1991), Professor of Medicine, Medical Ethics and Humanities at Northwestern University Medical School, explains this view in greater detail:

Much as medical ethics was occupied with the patient-physician relationship, literary criticism was occupied with the intricacies of the reader-writer dyad, a terminal formalism that excluded social issues. Literary scholars interested in the social contexts of literature, in history or culture, in the author’s relation to the text, or in the work’s political force or societal reception were intellectually underemployed, even if they held academic positions. In the late 1970s and early 1980s, the field of literature and medicine put a spin on customary teaching by opening up interesting questions about literature and culture, literature and the lives of human beings. (5)

At present, thriving medical humanities programmes are taught in tertiary institutions all over the world and have been referred to as “part of the mainstream in medical education” in North America and in the United Kingdom since 2005 (Gordon 6). In 2003, the journal Academic Medicine reported that there were over 40 medical humanities programmes internationally (Gordon 2005, 6), including those in countries such as Hong Kong, India, Nepal, Israel, Qatar, The Netherlands, Switzerland and Australia. In 2015, Great Britain had more than 12 universities with the medical humanities on their curricula, and “most undergraduate medical programmes offer[ed] either mandatory or optional courses in one or more humanities subjects at some point in the degree” (Jack 2015, n.p.).

With regard to New Zealand, the country’s two medical schools now make humanities subjects compulsory. Since 1996, Otago University’s students have had to choose one option from 18 humanities “Selectives” which run for six weeks from April to mid-May in their third year. An expert humanities tutor in each “selective” takes the students for six two-hour sessions over this period.

As of 2017, students in their first year may also choose one extra humanities paper from 20 options, and use the marks from this extra paper towards their final aggregate mark to decide their placement for the next year. This new initiative rewards the students’ extra effort to explore topics outside the purely biomedical and to foster their critical thinking skills. Options include: “An Engagement with Poetry or Fiction”, “Healing and Death in the Ancient World”, “Introductions to Buddhist Thought”, “The Graphic Narrative”, “Myth in French Film”, “The Politics of Health”, and “Modern Irish Drama”.

In addition to Otago University’s medical school and its resources for the medical humanities, the Corpus website was founded in May 2016, by University of Otago historian Barbara Brookes and poet Sue Wootton, as a forum for the creative and reflective discussion of disability, illness, health and medical practice.

A comprehensive medical humanities course also exists in Auckland. The Auckland University Medical School (now The Faculty of Medical and Health Sciences) [FMHS] introduced the humanities into their curriculum in 2000, an interfaculty committee having been set up to implement this in 1995 (Grant 2013, 1072). In the comparative literature topic of the FMHS’s course, third-year students are encouraged to read and write medically relevant poetry and prose in order to perceive the place of narrative and metaphor in their future profession. The FMHS’s course blends concepts from Rita Charon’s “pioneering Program in Narrative Medicine at Columbia University” (Thernstrom 2004, 44), with its focus on co-constructed doctor-patient narratives, and the commensurately important study of image or metaphor in writing by doctors and patients.5

It is no coincidence that the medical story-telling courses taught at Columbia, Harvard and Pennsylvania State universities, and the feasibility of increasing the number of such courses taught in his home country, were the subject of New Zealand doctor-poet Glenn Colquhoun’s 2010 Fulbright scholarship research (Yeats 2009, 6).

Having explored the relationship between writing and medical practice extensively in his 2002 collection Playing God, Colquhoun then chose to study beside recognised leaders in medical humanities teaching, such as the poet and physician Rafael Campo, whose creative reading and writing programme for medical students at Harvard seeks to redress “the occasional disconnect between medical facts and human truths” (Brown and Woodruff 2014, n.p.).

Medical Poetry

It is not difficult to summon to mind the names of several famous physician-poets throughout western history: Oliver Goldsmith, John Keats, Oliver Wendell Holmes, William Carlos Williams, Dannie Abse. It is not quite so simple, but eminently possible, to come up with a long list of poems about illness and medical experience, both from a patient’s perspective, and from the perspective of an observer of suffering or a carer. Again, to give a selective list:6 “The Wound-Dresser” by Walt Whitman, (1881–82), “Mental Cases” by Wilfred Owen (1917), “Tulips” by Sylvia Plath (1961), “Anorexic” by Eavan Boland (1980), “What the Doctor Said” by Raymond Carver (1989), “Mastectomy” by Alicia Ostriker (1998), “The Halving” by Robin Robertson (2013). The poems in this short selection are about a variety of medical subjects, and might be found in single collections or anthologised in a work such as A Body of Work: An Anthology of Poetry and Medicine, edited by Brown and Wagner (2016). The first two poems in the list are set against the backdrop of war (Whitman’s wound-dresser tends injured soldiers, and Owen’s “mental cases” are those whom we would now term sufferers of Post-Traumatic Shock Disorder). Plath’s “Tulips” is a first-person account of a hospital stay, during which the numbness and anonymity associated with the clinical environment highlights the speaker’s growing distance from her family, as well as her fragile mental state. Another poet taking on the patient’s role, Boland articulates the inner prompts of an anorexic, forced to destroy herself by starvation, while both Carver and Ostriker describe momentous encounters with doctors: Carver’s a diagnosis with lung cancer and Ostriker’s the removal of a breast. Robin Robertson’s (2016) “The Halving” takes the reader viscerally through the median sternotomy performed upon the speaker, followed by the operation’s aftermath.

In the 1960s and 1970s, there were several poets writing series of poems with links to medicine and health—notably, a number of the Confessional poets—Robert Lowell, Anne Sexton, John Berryman, Sylvia Plath—all of whom considered the previously taboo subjects of mental illness in their poetry, and at length. A fine example from the 1970s is Robert Pinsky, and his “Essay on Psychiatrists” (in his 1975 collection Sadness and Happiness), which consists of 21 titled sections, 464 lines of poetry, contemplating the nature of the psychiatrist-patient relationship. Yet, some of the poetry to come in the following decades was to prove equally autobiographical and even more intensely interrogative in its approach to the doctor-patient relationship and the relation of the biomedical to the personal.

This book will consider the following “stage” in medical poetry: the seeming shift to the whole collection or extended series on an autobiographical medical theme with a socially-focused polemic at its core. Once more, to selectively exemplify such works—and, once more, to limit the discussion to works within the western, anglophone tradition—it is notable that in the time period during which ideas about medical humanities and narrative medicine were beginning to positively saturate the United States and the United Kingdom, writers like Rafael Campo, Sharon Olds, Mark Doty, Dannie Abse, Carole Satyamurti and Philip Gross (to name but a few) were producing collections that contained a large number of poems with personal, medical bases. Furthermore, much as the Confessionals challenged the thematic taboos of mental health, alcoholism etc. in their time, the works that I will examine from the United States and the United Kingdom often are about diseases and physical states or practices that doctors, patients and parts of society in later eras found, and perhaps still find, confronting—from homosexual sex and the early management of HIV/AIDS patients to the ways in which the aged and dying are treated by healthcare professionals.

I shall provide a brief discussion of medical poetry in the United Kingdom and in the United States, with analysis of the work of four poets whose oeuvre lies within the span of this study and substantively reflects a consciousness of the issues central to the medical humanities and narrative medicine. The autobiographical medical poetry of Dannie Abse (1923–2014) and Rafael Campo (1964–), the two doctor-poets, and Sharon Olds (1942–) and Philip Gross (1952–), will be discussed in two separate chapters in order that the writing of the doctor-poets’ poetry and the “lay” poets’ poetry can be discussed independently, in terms of their connection with medicine, their narrative position, presentation of biomedical and personal languages, and critical reception. These chapters are intended to form a backdrop for the close discussion of medical poetry in New Zealand, whose adoption of the medical humanities, and whose flourishing of medical poetry appears to have occurred within the context of a global trend. The remainder of the book, then, will concentrate on examination of the proliferation of medical poetry in New Zealand that appeared to begin with medical doctor Glenn Colquhon’s 2002 collection Playing God.

Written during his medical training at Auckland University (now the Faculty of Health and Medical Sciences), Colquhoun’s Playing God is New Zealand’s best-selling and most nationally-renowned book of medical poetry (Yeats 2009, 6). It was the first poetry collection to win a Readers’ Choice Montana Award (as well as winning the 2003 Montana Award for Poetry). In October 2006, it climbed the Booksellers New Zealand list and became the only poetry collection in New Zealand to have gained Platinum status.7 By September 2009, it had sold over 10,000 copies world-wide, gaining Double-Platinum status (Yeats 2009, 6).

In addition to Colquhoun’s Playing God, several New Zealand poetry collections on a medical theme, both from doctors’ and patients’ perspectives, have won awards and plaudits in the 2000s, proving demonstrably popular with readers and ranking highly on best-seller lists. Haematologist Rae Varcoe’s medically-based Tributary was published in 2007, the same year as C.K. Stead’s The Black River (Auckland University Press). Stead won first place (and ₤5,000) in the inaugural Hippocrates competition with his poem, “Ischaemia”, and Varcoe won first and second place in the Annals of Internal Medicine’s Poetry Prize in 2004.