Medicine owns the planet: the pedagogies of illness, a memoir

One of these stories is true

Story one

I’ve just finished reading an astonishing book, non-fiction, about women and their doctors. In fact, that was the subtitle, ‘women and their doctors’. Astonishing because even though its publication date was 1985, its content seems ancient. Was 1985 really so long ago? Perhaps. By 1985 I had completed my undergraduate studies and was off to London, but this book would have me believe I was living in the dark ages. What makes women ill? What makes women take medicine and go to their doctor more than men do? What do doctors think of these women? One psychiatrist said the most extraordinary thing of a woman patient. He described her as ‘defrosting’, and said that just as fridges drip during this process, so too did this lady seem to be dripping. But then ‘all my ladies drip, so I’m quite used to that’. Do we drip our way through life, us women? Did my psychiatrists think this of me? Have I stopped leaking? Is Medicine, too, haemorrhaging, or is it in the process of revolutionising itself, as this book insists at its conclusion. The most unpromising of questions serve as a vehicle for insights, you know, and women and interviews and data and their sociological conclusions can be untrustworthy animals.

Story two

Once upon a time, long ago in the olden days of the 1970s, at their usual Wednesday-morning Senior School Assembly, the careers advisor was having his turn to lecture the lazy, stupid, final year students. ‘One of them’, he spat, ‘came to me the other day and said she wanted to be a Psychiatrist! I ask you — how does Music, Art, English, and all the History subjects under the sun, help this young lady get into medical school? Well let me tell you children. They don’t. And all of you sitting out there on your lazy bottoms thinking your dreams will come true just because Mummy told you they would, might as well go and wax your surfboards. Wake up! Grow up! Enrol in the right subjects before it is too late’.

Some years and a few degrees later, this young girl, now grown up and teaching her own students, was sitting in a Professorial office at the Indigenous Studies Centre on campus, with a few senior colleagues, waiting for the Head of the Centre to arrive, so they could talk some whitefellas business about inviting her to a medical humanities conference. As keynote speaker. Her work in narrative and healing in Aboriginal Australia was world acclaimed. In she walked. The woman we had been warned about. Grief, she began, grief. What does anyone know about grief? Since the day they cut my womb out I haven’t stopped crying. Doctors! What do I want to talk to doctors for? There were tears in her eyes. The men in the room looked as if they were trying to think about football. Or anything. No one spoke, until the girl-woman, who looked too young to have had children let alone lost the chance, sniffed back her gubba tears. I’ve written some poems about my hysterectomy. They’re pretty lame, but…did you write about it? Actually, they are really bad poems, now I think about it. They’re crap. The professor laughed a river. They all went outside, then, on to the veranda for some coffee, and some talk, and some business. In a few months time, the professor would talk to all those doctors, about having her womanhood stolen, about healing narratives, about how the best place to talk this gently through, is sitting in the shallows of the Indian Ocean, in a circle of women, sharing and crying and comforting, as the sun sets.

Story three

It was a mistake. People make mistakes, we all know that. But he was a doctor, and the mistake he made was with a little girl. He failed to diagnose something properly, with the unfortunate consequence of robbing this little girl of her future fertility. The little girl was alive and well and happy and ignorant. The mother, a writing student at the local college, wrote a short story about her doctor being well-qualified as a vet, and he in return, after reading this prize-winning story in the local newspaper, sulked his way into creative fame, by writing his own story ‘back’. He had a lot more publishing clout, and authority, and credentials. And mates. He wrote about what it was like to be a doctor in a small, regional town a long way from Sydney. Where everyone knows you, and dinner parties were worse than surgery sometimes, so full of ailments were the conversations. Where you can’t go to the beach without being expected to save someone’s life. Where you can’t be weak and needy as a colleague at your practice because every doctor is as overburdened as you are and all of them forget all day long to go to the toilet, let alone eat. They are that busy, that needed. He published the story of his life, and was invited on lots of radio programmes, and television shows, and started getting invited to conferences to talk about this dilemma, and as he became famous, wrote more and doctored less, he and his family moved away. Now it’s even harder to get an appointment to be misdiagnosed, and you never see a doctor at the hospital. The little girl likes to play netball. The mother took up painting instead.

Actually, while none of these stories are true, neither is any one of them entirely fictional. For at the heart of each lies an explanation of me, and my professional life. This next story does the same. And it is as true as true can be. It is a story of how a former patient and her GP and their mutual interests in doctors’ wellbeing lead them to wondering what creative writing could possibly, if anything, do for them.

The autobiographical pulse is a loud one, and lurks even in fiction. We know that. The psychological motive behind my desire to be involved in this area of medical humanities — that place where medicine and the arts meet for morning tea, cake, and autopsies — has its own elusiveness, but also its own certainties. It begins with sitting beside a dying child, and watching them as they are healed, and hoping that these healers never go away or astray. It is the impolite curiosity of a sister to know all that her brother has witnessed and suffered. It is the travesty of believing that you — your story — has something to offer people, because you have suffered, medically, and are, consequently, maybe, enlightened. By your own experience of chronic postnatal depression, and by the near-death of your child.

And it is homage to the art of medicine and its complicated heart.

And so it began

The email was a big surprise. I had been back at work for ages, or so it felt; the book of poems was in production; I was concentrating on other things. Thinking about buying a new surfboard. Or moving back to London. Same old same old. It was from my former GP (I didn’t go to the doctor any more). It read something like this:

Hi Susan
 
I have read your poems and just wanted to say thank you for sharing them with me. I was surprised by how deeply they moved me. In fact, I was so moved that I wrote some poems myself, I couldn’t help it. I haven’t written a poem since primary school! It was your poem ‘And You’ that made me do it. I’m sending it along with this email, a little embarrassed to show it to you, but there it is. A thank you.

Have a good day at work

Yours…

But it was the ‘PS’ that intrigued me as much — I had yet to read the poem. It contained an invitation for collaboration: maybe we could work together and write an article about the doctor-patient relationship? Ours seemed to have ended in poetry — though they were not easy, the poems. Eventually, they took on a bigger life. Here is what happened. Officially.

This sylvan game: creative writing and GP wellbeing

Sebastian Faulks’s novel, Human Traces, explores the profession of psychiatry in its infancy. One of the ill and wealthy patients in Faulks’s narrative has retreated to an Austrian sanitarium. There he explains to his doctor that his sadness stems from the fact that ‘at the age of fifty-five I have essentially ceased to be of interest to myself’. The doctor smiles, and says ‘I suppose you still have your painting … presumably that provides some consolation.’ ‘I did not turn to art for consolation’, the patient responds with ferocity, ‘I turned to it in the hope that I could use it to push back experience. I hoped that I could use it to reset reality.’[i]

During 2006, a research partnership between a GP training organisation — a business which teaches and examines doctors who wish to specialise as general practitioners — and myself was established. We set up a pilot project to explore GP wellbeing and creative writing. Part of the project involved offering creative writing workshops for GPs and medical educators. Our research was sympathetic to the notion expressed by Faulks: the ‘resetting of reality’ was a guiding rationale, alongside the belief that the desire to ‘be of interest’ to oneself is an essential component of wellbeing. The intention was not to offer ‘consolation’ or insist on writing as a therapeutic tool, but to focus on creative explorations of what it meant to be a GP, and to estimate the value of creativity and reflexivity to wellbeing.

This partnership, and its concern for writing and wellbeing for GPs, had a somewhat unusual genesis. Some years ago, recovering from a severe depression, which included a period of being unable to read or write, part of my recovery involved the completion of a collection of poems.[ii] Once well, the GP who had treated me through my illness asked to read the poems written at the height of my depression (subsequent, of course, to termination of our doctor-patient relationship). One was rather uncomplimentary: it reflected upon the suggestion that ECT was a genuine therapeutic option. When erstwhile GP read this poem, he was ‘inspired’ to write one ‘back’ to ‘me’, the first he had written since primary school. Thus began our creative and research relationship.

The GP, also a senior medical educator at an award-winning provider of GP training, was intrigued about the effects of his creativity — this process of getting something off your chest by writing it down, this ‘resetting of reality’. At his suggestion, we decided to co-write a play about the doctor-patient relationship, exploring in particular the doctor’s feelings.[iii. This cooperative venture soon expanded. Funds were secured for a pilot project, and the ‘Beyond the medical record: Creative writing for doctors’ workshops were formulated. Conducted during 2006, along with other arts and medicine initiatives,[iv] they went on to win an Australian General Practice Education and Training award for innovation.

From Anton Chekhov to Australia’s own Peter Goldsworthy and Nic Earls, to cite but a few, it is clear that doctors write about anything and everything. Our workshops, however, with their focus on reflective writing, which, by its very nature, concentrates on self-exploration, had a more defined outline. Although an exercise might have begun, for example, with the challenge to write a poem pretending that you are a disease, the final draft of that poem could easily be about guilt, or love, or any emotion that might surface during the reflective process.

The workshops had distinct themes. The first, ‘Once upon a time: Medicine, literature and writing’, explored the role of stories in the doctor-patient relationship; the role of language in clinical practice; and stories of doctors’ experiences, as well as the effect their work has upon their lives. The second themed workshop, ‘And they all lived happily ever after: Writing for personal and professional development’, enabled participants to explore the use of creative writing as a prophylactic for professional burn-out; the potential that reflective writing possesses for revealing the impact of work on a doctor’s wellbeing; and the use of creative writing as tool for improving communication skills within the doctor-patient relationship. The stated objectives of this program were to: assist in a greater understanding of what it means to be a doctor; to enhance participants’ creative writing skills; and to improve participants’ professional and personal wellbeing.

So what did the participants think? In general, formal evaluations reveal that the respondents were highly satisfied. Of particular note was the amount of praise for the workshop facilitation which combined not only a writer and a doctor, but did so in the form of two individuals who had been frank and revealing about their own selves, whilst prefacing the workshops, during the warm-up discussions, with a history of their collaboration (which involved revealing their own frailties).

Several themes, or effects, were revealed by the feedback. Participants noted, for example, that certain (unbidden) needs surfaced through their writing, including ‘the urge to tell one’s story’ (‘There are incredible stories we want to record and are not able to do justice to’), and, ‘writing our pain’ to enhance wellbeing: ‘We know there are a lot of miserable doctors. Burnt out’, commented one participant. ‘We talk a lot about ways you can manage, like doing less work. That is not a solution. We need to find ways to enjoy the work. Courses like this might help you get out of it what you said you wanted from it (the profession) in the beginning.’[v]

Furthermore, writing about significantly harrowing or vexing events and situations in which they found themselves was oft mentioned. Comments ranged from ‘Today I wrote about something I was angry about. It can help doctors to cope’, to ‘I will suffocate unless I do something creative in my life’. But allied with this notion that creative writing might function as a release, was the expressed belief of some participants that the act of writing would help to find new meaning in daily practice, with its manifold complexities. Significantly, one participant reflected, some six weeks later, that:

‘The workshop seems to have given me a fresh look on my profession. I feel a bit less isolated with concerns that I sometimes have. It is a great opportunity to share ideas and feelings among colleagues. This usually does not happen between fellow doctors as we are too busy in our jobs. We also do not want to bother each other on the assumption that the colleague might not be responsive to that issue or that we might stir up some personal issues, he/she might have’.[vi]

It was generally agreed that the workshops provided a ‘wonderful chance to share experiences with your colleagues’ in an open, frank and non-judgmental forum. Most agreed that the focus on ‘doctoring’ was a key ingredient of the workshops’ success: ‘being a doctor is inhibiting — you can’t talk about it. The general public has a different experience than we do. This gave me a chance to do a workshop where we share common experiences among doctors’. [vii]

What next, reader?

While evaluation can never fully capture the participants’ experiences, it does appear that these pilot workshops were popular. The professional evaluation also provides data significant enough to suggest that a larger, longitudinal project would be of great value, if indeed the outcome were happier doctors. In Australia the combined disciplines of the Arts and Health have specific challenges to meet; particularly the recruitment and retention of GPs to rural, isolated or marginal communities. If GPs in these types of ’communities can be kept healthy and happy, the ailing outback town, for example, has a better opportunity to survive and thrive, healthily. In theory.

But would it work in practice? Despite the splices of evidence offered above, can creative and reflective writing ‘reset reality’, or at least tamper with it? According to the social anthropologist Claude Lévi-Strauss, the tales that a society invents and mythologizes are similar to mathematical structures, in that they seek to solve contradictions. He argues that stories and ‘mythical thought always progresses from the awareness of oppositions toward their resolution’. That is, myths consist of elements that oppose or contradict each other, and as the narrative of the story progresses, bothersome contradictions are mediated.[viii] If it is true that storytelling and mythmaking — vital components of creative thinking — can solve problems, then the GPs who attended these writing workshops, were, for that time at the very least, ‘of interest’ to themselves. Less ‘contradicted’. Happier. Is this what we mean when we discuss Arts and Health initiatives? If so, what real dignity and gravitas can be found in such initiatives?

The arts and sciences and their Royal ambitions

In her novel The Autograph Man, dedicated to taking the psychological temperature of London as it struggles on with life in the twenty-first century, Zadie Smith reminds us that ‘On the magnificent mosaic that wraps itself around the Albert Hall the following is engraved’:

THIS HALL WAS ERECTED FOR THE ADVANCEMENT OF THE ARTS AND SCIENCES, AND WORKS OF INDUSTRY OF ALL NATIONS, IN FULFILMENT OF THE INTENTIONS OF ALBERT, PRINCE CONSORT[ix]

Queen Victoria’s beloved Albert was dead by the time she opened the hall in 1871, but Smith asks us to imagine the Queen as sometimes touring the hall alone, ‘thinking of her dead husband and the fulfilment of his intentions’. Smith also suggests that, if one felt like it, one could possibly ‘date the current pliancy of the phrase “Arts and Sciences” to the inauguration of Victoria’s Albert Hall’, arguing that ‘Arts and Sciences did at one point mean Painting and Stuff and Petri Dishes and Stuff. It was a quite specific, stiff phrase and there wasn’t a lot of room in it. The Albert Hall (one could argue, if one had a mind to) helped change that.’ Smith’s characters are a sad father with a terminal illness and his son, off to see a wrestling match in the Albert Hall, both of them ‘smart enough to note the incongruity between these massive engraved words — ARTS AND SCIENCES — and what they are about to see’. But Smith assures us that father and son, ‘jittery with anticipation’ as they walk in under the arch, are ‘about to take part in the latest episode of a very long wake’.

A serious question

I am embarrassed to ask this question, of a disciplinary marriage that I enthusiastically advocate, but I do wonder sometimes about the integrity of the relationship between the disciplines. For all kinds of reasons. Not unlike Smith’s fictional wrestling event in the Royal Albert Hall, reducing what was once Prince Albert’s noble ambition into a rubble of crass spectatorship, the medical humanities have become, I hesitate to suggest, a plaything of too many overzealous interlopers, damaging the credibility of the emerging discipline. I think that the Arts are definitely the poor cousin in the partnership, and I have sadly observed much condescension on the part of medical people towards the writers/artists they may be working with. On the other hand, I have observed exactly the opposite. I think immediately, for example, of the work of Operating Theatre at Newcastle University (UK). No authenticity or respect lacking in that relationship. I want to honour all good intentions, all work that is genuinely involved in moving knowledge forward. But, sometimes, people don’t keep their promises.

Once, I was on a two-day retreat in England, mostly full with medicos from all over Europe. They were a fascinating, warm, gifted, dedicated, hard-working bunch of people. Only about ten percent of the participants were artists and writers working in health-care scenarios. The retreat’s express purpose was to explore how the Humanities illuminate medical practice. Workshops ranged form art therapy to dramatic play to literary appreciation and criticism and film studies. For most participants, it was a case of them being there to expose themselves to the medical humanities experience, and either take away from it the benefits of being able to reflect on practice, of simply for the gain of intellectual or other pleasures. Of course, it was an accredited retreat in that the medicos could earn their compulsory professional development points. I was there for all of the above, but also to observe practice: how is this business of the medical humanities being peddled, and what quality controls are in place, in pedagogy, for example?

Some conduct verged on scandalous. I was roundly shocked at the literature workshops. We were having a lengthy discussion (the workshop went all morning) about a series of texts where a doctor was the protagonist, and exploring the doctor as literary subject through time. The pre-reading schedule had been large, heavy, and predictable, and the facilitation was more in the style of a nineteenth-century lecture than a seminar or workshop. It was being lead by someone with no qualification or expertise in literature other than they knew how to read, and were smart. She was a doctor. I was supremely silent. Not many people were allowed to finish what they were saying. Many of the doctors in the workshop, particularly the Europeans, who often had different educational experiences to those trained in the UK, had much to say about the texts in their historical and sociological contexts. All were genuinely involved in the quest to locate meaning, and to apply this to their own contexts. Eventually, squarely, the facilitator told us what the text really meant. Discussion was closed down.

Some of the participants were left feeling sorely confused, and one doctor who knew my core business (as an academic literary specialist) asked me my opinion. It was a controversial moment. I said, timidly, that literary theory had moved a little beyond the insistence on singularity of meaning. In my opinion. Oh. Really? Then what do you think the writer meant in this instance? I gave her a three minute potted summary of what a variety of literary interpretations and readings of the text might offer, from the psychoanalytical to the postcolonial. Everyone started talking at once. It was fun. Then the mistress pulled out her whip. Yes. Of Course. But that’s not really what the author meant and so none of that is useful at all. Is it? Such tuition would constitute negligence in any contemporary English department. It seems that doctors can ‘do’ our jobs — after all, how skilled do you have to be to read a book? — but this presumption, quite sensibly, is a one-way street.

Margaret Atwood, whose own grandfather was the kind of doctor who drove sleighs through blizzards to deliver babies on kitchen tables, has famously related an anecdotal exchange between herself and a surgeon at a cocktail party. I’ve always wanted to write a book, he said, I think I might try one this summer, to which she responded something along the lines of that over the summer holidays she herself was planning a bit of brain surgery. She put it more pointedly in her book on writing, Negotiating With the Dead: ‘everyone can dig a hole in a graveyard, but not everyone is a grave-digger’. The problem is that most people don’t really understand what it is to be a gravedigger: the crafts and the skills of the occupation. Few respect the fact that they probably don’t possess the necessary special relationship to soil, the architecture of digging deep and straight, or the reverence for funerary customs and the world of the dead, for example. Even if they do own their own shovels.

Thankfully, it is not always that undignified, this waltz between two very different disciplines. And I’ve met my fair share of doctors who are dually qualified. And, hello, world acclaimed authors at that. So you can see how ungracious my bitch might sound. Perhaps the artist’s expertise is easier to imitate (replicate?) than that of the physician. At least you don’t kill anybody by running a bad writing workshop.

On doctors and writing: why?

The doctors who came to our research workshops had plenty to say about why they needed to write. I was overwhelmed by responses. The volume and particular calibre of the responses made me reflect on writing, and need, as did the doctors.

The urge to tell one’s stories, it is urgent in nature.

‘It was so unusual in a medical program. Permission. There are incredible stories we want to record and are not able to do justice to. When it comes to the profession we are very proficient at getting patient stories, but not our own. How do you go about it? I have no training in that. To record seminal work experiences and the insights gained, to pursue medicine as an “art”, not just a science, to use writing a vehicle to alleviate stress and longer-term prevention of burnout; to improve written language skills (some participants did not have English as their first language). To develop creative writing as a hobby and creative outlet, to publish as opportunities arise. To write.’

‘Writing our pain’: the need for professional wellbeing, and help-seeking behaviour

‘We know there are a lot of miserable doctors. Burnt out. We talk a lot about ways you can manage, like doing less work. That is not a solution. We need to find ways to enjoy the work. Courses like this might help you get out of it what you said you wanted from it (the profession) in the beginning. The thing I will get out of this is: I had a patient the other day, a doctor-shopper who really annoyed me. I could have written it down and reflected on it in a creative way to get over that.’

Finding new meaning in practice: this, too, as a human need

‘Writing about my life is an important release, it has helped me to find new meaning in the complex encounters of daily practice; the concept of using writing as a tool to explore and discuss insights into the human condition (both patient and doctor) is very attractive; telling stories helps alter understanding, attitudes and behaviour; the workshop seems to have given me a fresh look on my profession. I feel a bit less isolated with concerns that I sometimes have. It is a great opportunity to share ideas and feelings among colleagues. This usually does not happen between fellow doctors, as we are too busy in our jobs. We also do not want to bother each other on the assumption that the colleague might not be responsive to that issue or that we might stir up some personal issues, he/she might have.’

A collegial experience: we are all in this, alone, together

‘A wonderful chance to share experiences with your colleagues’ in an open, frank and non-judgmental forum. No. Just doctors, that’s what makes the workshop work. The focus on ‘doctoring’ was a key ingredient and an important strength of this workshop. One of the things that take time to do is being truthful. It’s good to be with doctors because most of us will take a while to be able to tell the world what we really think. We come to it slowly before going outside this (doctors) group. Being a doctor is inhibiting — you can’t talk about it. The general public has a different experience than we do. This gave me a chance to do a workshop where we share common experiences among doctors.’

Doctors write for all kind of reasons. The above are ones they have shared with me. But there are more interesting questions, beyond research experimentation: what does one do with all these excited, talented doctors? Enrol them along with every other aspirant in a Creative Writing MA? As Zadie Smith’s protagonist, an autograph trader, thinks one day to himself, irritated by the cultural naivety of fellow auction attendees, ‘if you got all the part-time mature students in the world and laid them head to toe around the line of the equator strapped down in some way so they couldn’t move, that would be a good thing. Ditto anyone in evening classes’.[x] Such sentiments are sacrilege, of course, for any academic to entertain, but it is nevertheless worthy of serious examination, this question to both individuals and society of the purpose of further education: in the 21st centruy does it and should it mean the same thing?

While it’s not fair to answer such a big question with a small answer, and a mean joke at that, I would rather respond with the suggestion that certain societies, in particular regional Australian ones, cannot afford to lose their doctors. Professional attrition is a real problem. If an ‘MA in Creative Writing and Reflective Practice’, for doctors would keep those surgeries open, then I for one don’t mind marking their theses. Even if I have to do it on the weekend. At the beach. Ah, the perils of being an Arts professional.

The Arts and Health in Australia do have some particular challenges, and I believe that the wellbeing of doctors is one of them. And that Creative Writing as a discipline can contribute something. Politicians talk about ‘knowledge economies’ and the need to vitalise those economies with creative approaches. Measurement, of course, is always involved. What proportion of health benefits can be attributed to reflective writing practice for doctors in regional Australia, or elsewhere? Not much really, because it hasn’t been statistically audited. Yet. I hope someone does. This call for revitalisation, though, surely echoes Prince Albert’s entreaty down the centuries. It is a distant echo of that historic call for the advancement of the Arts and Sciences, still seeking fulfilment. The medical humanities in Australia, as elsewhere, seeking as they do to enhance our knowledge economies, do well to remember this royal ambition.

Happiness and other ambitions

I do not believe that any one of the many doctors who attended my creative writing workshops were particularly concerned with political accountabilities or the sensibilities of royal and historic ambitions. They wanted to be happier, as part of ‘wellness’, I think, and they were interested in writing.

Definitely, that pursuit of happiness and the enhancement of wellbeing were the primary concerns of the GP Training organization I was working with, which is why they put their money on the research table. Even though I am deeply interested in writing and therapy, and believe that reflective writing, in the proper context, enhances wellbeing, I am nevertheless wary of the way these expressed needs might be (and have been) commodified. As David Grieves has pointed out, when writing about the obsessive pursuit of health and happiness, ‘Richard Bentall once proposed that happiness be classified as a mental disorder, but only as a device to parody psychiatric orthodoxy, and so did not intend it to be taken literally’. But in so doing ‘He may have stumbled unwittingly, however, on a modern truth — that the obsessive pursuit of happiness is a sort of madness to which our society is particularly prone’. The reason being, that health and happiness ‘bypasses the unalterable reality of most people’s lives, so the quest for such a perfect ideal of health is an equivalent form of madness’. [xi] Which returns me to my expressed concern of medical humanities being rumbled by the wrestling matches of unclothed emperors.

One of the problems of creative writing as therapy, and reflective writing viewed through the same prism, is that it risks being reduced to this regrettable utilitarian imperative, that is, the drive for the greatest health and happiness for all, and the corresponding decrease in demand on health care resources, to which all good citizens should rightly aspire. Such an imperative, with its reek of addiction and correspondent promise of disappointment, sounds more like a Beckett play than an arts and health initiative. Maybe such a performance would indeed suit the twenty-first century Albert Hall.

The end of the world as we know it

In pondering the fledgling — floundering? — medical humanities discipline, I have reached some tentative conclusions. Beyond the predictable sense of grievance that any ‘partner’ (read Humanities scholar) feels when they don’t perceive themselves to be enjoying a relationship of equals, and that one (read Medicine/medical practitioner) dominates often unscrupulously, taking more than it gives, what is there to explore?

Two things. The first is, why might this be so? If notions of superiority exist, are they justified?  Your average Arts student at university these days is not necessarily the brightest of the bright (shoot me). This of course varies from institution to institution — I have taught, for example, in departments where the students would have been able to study whatever they wanted to, with their world-class results, but English, for them, was first choice. But universities (and schools that feed them to us) are very different places this century: often English students can’t even write an essay; often they are surprised if you ask them to read a whole book. Medical students have posed no such problems for me. Doctors as mature students, ditto. You set reading, they do it. You say something once, they get it. You ask them to follow a complicated line of logic involving theoretical considerations, they are there with you. You ask them to reflect on practice, they make the connections. Uniformly.

My point is, Medicine demands a different kind of smarts. I would not want to preclude the normal range of human idiocy — ask any GP examiner for a story or two involving the lack of street-smarts, or the social naivety, that some of their doctor-students display and you will be laughing for hours. (Tip: suggesting that you can help your patient should they decide to stop ‘shooting up’ marijuana might not be terribly useful information.) However, I put forward here one possible justification for the ‘superior’ feelings of medical students: we live in a hierarchical society with meritocratic overtones, scientifically measured; in these terms, getting into Medicine usually requires an individual to be the ‘best of the best’.

There are other factors that might explain the ‘one-way traffic’, a contra-flow of power that defines, I believe, the medical humanities. Doctors save lives. Writers write books. You make a mistake as a doctor and the consequences are enormous. I make a mistake as an academic, sure I can lose my job, but I won’t be going to anyone’s funeral while I’m at it. I make a mistake as a writer and it’s egg-on-face time, not much else. There’s all this and then, of course, there’s the financial dimensions of these different worlds to consider. When you have to fill in the budget section of grant applications, and cost staffing, it is almost embarrassing to put in your hourly rates as an Arts academic compared with medical professionals: it looks so, well, uneven. And sometimes, around the conference table or in the teaching seminar room or on a writing retreat, this divergence pans out in real life like this: two different kinds of people are sharing that space, and for one of them, the medical professional, the cost of being there is measurably far greater. This creates its own pressures. Should I apologize beforehand?

The second, and far better, thing worth exploring is to ask how we can revisit the philosophical yearnings which fund the medical humanities project, and ask some different questions. ‘What can the Arts bring to Medicine?’ is an old question, and the wrong one for today. Rather, what can Medicine bring to the Arts? Reconfiguring the core rationale of the relationship might be fruitful. I don’t have concrete answers, only ideas. One of them is: why shouldn’t Arts subject have a medical dimension? I don’t mean simply the ‘Literature and Medicine’ model, but a more clinical framework. Why, when English departments the world over relish recruiting creative writing students and bolstering enrolment figures, and graduating them skilled enough to earn the yearly average wage (in Australia, as cited by a professional body) of $11, 000 from their craft, why don’t universities have different responsibilities here? What about more courses accrediting students to a standard enabling them to seek work in the writing and health care industry, for example? A course as part of an English major, like ‘Bibliotherapy in the Community’, let’s say, where creative writing students have to think about their work as writers in an applied way, might be a good beginning. Some work is being done in this area, but it is usually in the Health Sciences and involves ‘upskilling’ those who work in the Health sector to offer writing as a therapeutic add-on. More is needed.

Look up the word for ‘traffic jam’ in any language you like: it uniformly expresses frustration, and regret. My wish for the medical humanities is that different conversations can begin to change some of the old-fashioned routes that we rely on. At present, colonial relationships prescribe the parameters of the Arts and Medicine marriage, and all its permissions. There is room to be far more intrepid than I’ve described here, I’m just voting to abandon those ties that bind.

Therapeutic writing and its wellbeing factor is big business, for many. It is too important a business, I argue, for Medicine to own, solely. As confessional poets and memoirists know, confessional and therapeutic writing traffics in intimate, and sometimes unflattering, information about your personal life. Is it truly therapeutic, writing about illness? I’d make no such claims. For a start, those words, once they’re printed, they’re printed.  Sometimes, writing is an absolutely traumatizing experience. Of the best kind. And for me, I have always made it safely home — this is my traffic history. But we writers need our medicine. It has been a privilege being involved in saying ‘thank you’ to medicine, and its good captains, in this small way, by working together. I’d like to do it some more — but they run the workshops I devised without me now. Does Medicine honestly believe in writers, and our currency?

What if I told you all these stories were true? And that you’d have to sit in the Indian Ocean for the rest of your life to forget them? Some cure.