MEDICAL HUMANITIES CURRICULA
Be a master of the job before you. Be
a student of the job above you.
And be a teacher of the job below you.
Callejo, Fort Worth attorney and
community leader. Her mentor, "an
old Spaniard," taught her this, adding
that it would lead to an interesting
and fruitful life.
+ + +
Stripling writes and lectures full-time
and does curriculum consulting. She
offers the following essay,
delivered at the Conference of College
Teachers of English in
2006, for your use in teaching
literature and medicine.
American Literature: A Journal of Theory
and Practice. Vol. 3.1 [http://www.cpcc.edu/taltp]
Teaching Literature and Medicine:
Kesey’s One Flew Over the Cuckoo’s
There’s a special kind of writing that
relates medical history and scientific
issues in a captivating way. It’s
called literature and medicine,
an interdisciplinary field of study
established thirty years ago. Of course
medical issues have appeared in
literature since the time of Homer. And
two well-known novels, Mary Shelley’s
Frankenstein (1818) and Aldous
Huxley’s Brave New World (1932),
are frequently taught works. The
authors’ engaging stories placed
characters in situations beyond the
realm of what was known. They also show
how literature explores issues that
science has not yet anticipated.
More recent examples in this
genre, which used to be called
medicine in literature, are
Charlotte Gilman Perkin’s
story, “The Yellow Wallpaper,” which is
her riveting account of descending into
madness; and David Feldshuh’s
late-twentieth-century play Miss
Evers’ Boys, which describes the
unconscionable forty-year Tuskegee
Syphilis Study conducted by the U.S.
Public Health Service. With weighty
medical issues and scientific topics in
the daily headlines, teachers feel the
classroom is the right place to explore
important social matters. They include
discussions on the global spread of
infectious diseases such as a probable
bird flu pandemic, the ethical issues
surrounding stem-cell research and
cloning, and the continuing
controversies over diagnosing and
medicalizing mental illnesses (we are a
In fact, Harvard University
recognized its duty to educate students
to be responsible and informed citizens
by instituting its new interdisciplinary
core curriculum. It believes that
English students can learn science and
science students can understand English
literature. Harvard’s program is good
pedagogy because the brain loves
diversity. Whether English students or
science students, studying scientific
issues situated in literature helps them
understand the human character and
condition. Their teachers recognize that
this dual literature-and-medicine
facility helps their students deal with
twenty-first century cutting-edge
issues. Harvard’s “skills across the
curriculum” approach to teaching is
sweeping American colleges.
One very accessible work
taught in the literature and medicine
genre is Kesey’s popular One Flew
Over the Cuckoo’s Nest (1962). It’s
helpful for students studying the novel
to first get a fundamental understanding
of America’s long and arduous history in
learning to identify and to treat mental
disorders. Before we had psychoanalysis
and institutions, the mentally ill (who
were not distinguished from the retarded
and nonconformists) roamed the streets,
were confined by relatives, or were
thrown into prisons with criminals.
When demonic causation (“The devil made
me do it”) could no longer explain
aberrant behavior, moral movements to
control the environment were tried. In
the late nineteenth century so called
“rest cures” became popular with the
rich to cure their nervous disorders,
and in the early twentieth century,
during the Eugenics Movement,
individuals were forcibly sterilized for
feeblemindedness and many types of
unacceptable behaviors such as
alcoholism, promiscuity, criminal acts,
epilepsy, and even running away from
home. It was all done, of course, “for
the greater good.”
Then in the 1930s a
neuropsychiatrist from Washington, D.C.,
Dr. Walter Freeman, pioneered his
drastic ice-pick psychosurgery, also
known as lobotomy. Anxious and fearful
patients underwent his surgery to change
their antisocial behavior. The surgery
involved partially destroying one of the
brain’s frontal lobes, causing great
disfiguration. Often it relieved them of
their psychological suffering so they
could go back to the environment in
which the disorder developed, Freeman
said, “without the long, painful process
of developing insight in the patients”
(Robinson et al 15). Of course Freud
had something to say about this. What
the treatment did was change the
patient’s undesirable personalities to
others described as slothful, irritable,
and angry. Nonetheless, in A History
of Psychiatry Edward Shorter points
out, “The idea of operating on the brain
to cure madness does not seem
intrinsically unreasonable. Physicians
have always intuited that a physical
intervention in the brain, perhaps
cutting some tract causing compulsive
behavior or removing a center producing
some malignant protein, might put an end
to a pattern of psychosis” (225).
Finally, in 1946 the National Institute
of Mental Health was created,
recognizing the need to diagnose and to
help the mentally ill. This brought
about mental institutions in which
patients were studied and treated.
Cuckoo’s Nest is set into a mental
institution where a power struggle
exists between the staff and patients
afflicted by many types of mental
illnesses. The period is the rebellious,
psychedelic sixties, a prosperous time
following World War II. Drugs were
rampant, and the counterculture
challenged authority. It is a classic
description of mental illnesses and
encapsulates Kesey’s own experimentation
with alternative forms of perception.
After taking graduate writing classes at
Stanford University, Kesey took a night
shift job as a Veteran’s Administration
psychiatric ward orderly. He observed
the patients. Many of them weren’t
crazy, he believed, but rather they were
just nonconformists in a sterile
environment. While drug induced, Kesey
hallucinated about an Indian sweeping
the floors. He became “Chief Broom,” his
schizophrenic narrator who had developed
a bicultural schism, fitting neither
into the white nor the American Indian
world. The novel was an immediate
success. But it is a myth that Kesey
wrote all of it in a drug-induced state.
When Cuckoo’s Nest and
the 1975 movie starring Jack Nicholson
as its misfit antihero “Mack” McMurphy
and Louise Fletcher as the authoritarian
Nurse Ratched, first came out, shocked
readers and viewers were repulsed by the
graphic depictions of mental patients in
an institution and the many kinds of
barbaric treatments administered to
them. The idea of lobotomy and
electroshock therapy (EST) took many
people out of their comfort zones. But
the scientific inspiration for EST is a
marvel of science. In 1938 two Italian
scientists observed schizophrenics to be
symptom-free following seizures, and EST
as an efficient way to manage
uncontrollable patients was born.
Today, a severely depressed
patient receiving EST, administered in a
series of treatments, has an IV-relaxant
administered and a mouth guard inserted
before an anesthetic renders him
unconscious. The airway is protected,
and electrodes are connected to
conducting jelly on the temples.
Electric current comparable to a 60-watt
bulb shoots through the brain causing a
20-second grand-mal seizure. The patient
wakes about 30-minutes later, confused
and disoriented, with a headache and
short-term memory loss. In essence, EST
helps disturbed patients regain the
control necessary to enter into a
therapeutic relationship. Short-term
impaired memory follows; complications
from possible fractures and dislocations
caused by muscle contractions are a
thing of the past.
For generations Cuckoo’s
Nest inflamed the public
consciousness by depicting EST as a
means to punish misbehaving patients,
easily associating it with
electrocution. The movie’s graphic
portrayal of treatments administered to
unforgettable characters changed the
course of medical history: electroshock
treatment was replaced by talk therapy
and drugs like Prozac. But it also went
underground. Over the years attempts to
pass state laws banning EST have
failed. As horrific as it sounds, some
neuropsychiatrists still find EST to be
an effective treatment for severely
depressed and suicidal patients,
especially after psychotherapy and
slow-acting, cyclical drug regimens
But the subjects in Cuckoo’s
Nest are not all graphic, grotesque
violence, like watching a CSI autopsy
television show. English students of all
ages will enjoy reading how humor heals
and will come to understand that
sexuality is also a part of
institutional behavior. There are many
types of mentally ill people depicted in
Cuckoo’s Nest: schizophrenics,
depressives, and passive-aggressives.
Sometimes the line between sanity and
insanity is blurred, as is the case with
this black satire’s protagonist, Mack
McMurphy. But what Mack, who has
actually conned his way into the mental
institution to escape prison work
detail, proves is not that laughter has
the power to heal but, rather, that it
can lift a spirit desperately in need of
healing. Mack takes the inmates on a
therapeutic fishing trip that reads like
fun road literature, and their laughter
at fishing mishaps rings out over the
lake. It is contagious and therapeutic.
More importantly, it gave them a hopeful
spirit as it activated endorphins and
enhanced respiration, becoming an
antidote to apprehension and panic.
Sexuality is also a part of life—even in
an institution. Mack arranges for Billy
Bibbit, thirty-one but mentally an
adolescent controlled by his mother, to
lose his virginity to a smuggled-in
prostitute during a drunken evening on
the ward. Mack’s attempt to restore a
manly independence in the men may
release some from psychosomatic illness;
however, for Billy, things are not that
simple. Nurse Ratched, in her zeal to
keep things under control, shames him
into extreme guilt. Fearful of his
mother, he commits suicide. Cuckoo
Nest is filled with rich literary
references to Melville’s Moby Dick (good
versus evil overtones) and suggests
Billy Budd’s stuttering, innocent
protagonist. Christ-like images can also
be tracked throughout the novel.
Of the many questions posed in
Cuckoo’s Nest, first and foremost
is, who among us is completely sane?
And how important are experiencing
laughter and maintaining self-respect
for the institutionalized? Ethical
queries include, would electroshock
therapy and lobotomy administered as
therapy or punishment be ethical now;
and is extreme nonconformity (sometimes
manifest as an immigrant’s cultural
schism) a mental illness? One of the
most intriguing parts of the novel is
tracing Mack’s influence on the Chief’s
passage out of the fog of schizophrenia.
is as relevant today as it was in the
sixties when it horrified readers. It
is arguably the most influential novel
of its time and continues to influence
twenty-first century medical issues and
ethics. As the
students read the classic novel, they
become immersed in its rich
characterization and setting and explore
its ideas, helping them to think
critically about important issues. Its
themes, such as showing how mental
illness derives from culture as well as
from disease, are important to all of us
because we are all patients. Its
significance stems from showing how
literature has the power to change our
society because modern concerns can be
anticipated and addressed to varying
degrees in literary works. And its
lesson is, we have much to learn from
the past, which literature encapsulates,
and we can never know what the future
The merging of literature and
medicine, which William James described
in a letter to his brother Henry as two
distinct languages and cultures, now
gives teachers a fearless way to show
their students how they can understand
pertinent medical and bioethical
issues. Use more literature and
medicine stories in your
interdisciplinary classroom. There are
many to choose from.
Cousins, Norman. Anatomy of an
Illness: As Perceived by the Patient.
New York: Bantam, 1981.
Gilman, Charlotte Perkins. “Why I Wrote
the Yellow Wallpaper.” World Wide
School Library. Originally in 1913
James, William. The Letters of
William James. Ed. Henry
James [his son]. Boston: Little, 1926.
Kesey, Ken. One Flew Over the
Cuckoo’s Nest. (40th
Anniversary Edition). New
York: Viking, 2002.
One Flew Over the Cuckoo’s Nest
(1975 movie). D. Milos Forman. Jack
Nicholson, Louise Fletcher, Danny DeVito,
Christopher Lloyd. Misfit inspires
reform. Based on Kesey novel.
Robinson, Mary Frances, Ph.D. and Walter
Freeman, M.D., Ph.D. “Glimpses of
Psychosurgery and the Self: New
York: Grune, 1954: 15-32.
Shorter, Edward. A History of
Psychiatry. New York: Wiley, 1997.
Stripling, Mahala Yates. “Illness and
Culture.” Bioethics and
Medical Issues in Literature.
Westport, Ct.: Greenwood Press, 2005:
“What’s Wrong with Harvard?” (Chronicle
of Higher Education May 7, 2004) http://chronicle.com/weekly/v50/i35/35a01401.htm
* * *
LITERATURE AND MEDICINEWorld Literature II
(Curriculum designed for Tarrant County
The relationships between medicine and literature are many and varied, dating back to the Ancient Greeks. In this course you will read works that access the different viewpoints of the medical practitioner, patient, and family. With today’s climate of advanced technology and managed-care time limitations, it is more important than ever to focus on both the duty and ability to relate to a patient. All across the country increasing numbers of humanities courses address these concerns. TCC’s new course highlights medical issues in short stories, poetry, case studies, plays, movies, biography, autobiography, journals, and letters. From these literary models, students will learn communication skills, professional ethics, and how to develop a caring attitude in delivering patient care; that is, they will learn a healing art.
|The History of Medicine
|| Alternative Medicine
|The Mind and Healing
|| Social and Cultural Issues
|AIDS and Tuberculosis Epidemics
|| Mental and Chronic Illness
|Moral and Ethical Concerns
|| Death, Spirituality, and Dying
The Bible (Ecclesiasticus), Chaucer’s The Doctor’s Tale, John Donne’s Death Be Not Proud, Defoe’s The Journal of the Plague Year, Hawthorne’s Dr. Rappacini’s Daughter (ss & movie), Mary Shelley’s Frankenstein (movie), Dickinson’s I Heard a Fly Buzz When I Died, Flannery O’Connor’s Good Country Doctor, Raymond Carver’s What the Doctor Said, Alice Walker’s Medicine, Charlotte Perkins Gilman’s The Yellow Wallpaper, S. Weir Mitchell, Sir Arthur Conan Doyle’s The Curse of Eve, James Dickey’s Diabetes, Robert Frost’s Out, Out__, Maya Angelou’s The Last Decision, John Keats’ and William James’ Letters, Richard Selzer’s Follow Your Heart (play), Robin Williams’ Patch Adams (movie), Anton Chekhov’s Misery and A Doctor’s Visit, Sir Thomas Browne’s A Letter to a Friend, William Carlos Williams’ The Use of Force, Franz Kafka’s A Country Doctor, W. Somerset Maugham’s The Summing Up (excerpt), Dylan Thomas’ Do Not Go Gentle intoThat Good Night, and Philip Larkin’s Faith Healing.
TEXTS: On Doctoring, ed. R. Reynolds; Richard Selzer’s The Doctor Stories.
PLAYBACK THEATRE: class creates a whole tableau of "how I feel"
can explore their special interests.
Medical Humanities Curriculum
I have a confession to make. Half of what we have taught you is in error, and, furthermore, we cannot tell you which half it is.
Sir William Osler, addressing a graduating medical class
Medical Humanists explore the interdisciplinary attributes of medicine and literature, for instance, to uncover the art of healing. By crossing borders that separate forms of human expression, they realize the ways humans make and find meaning in life. All helping professionals (e.g., doctors, lawyers, educators) gain from these explorations.
II. The sample World Lit II curriculum that makes this a Medical Humanities course:
A. The doctor-patient relationship:
- listening and touching communication (Use of Force and Brute);
- physical pain v. soul pain (emotional detachment or rampant empathy)
B. The Hippocratic Oath (to be useful; first, do no harm); ethics (abortion; mercy killing)
C. Head v. heart (hubris v. humility): Shelley’s Frankenstein and Hawthorne’s
Rappacini’s Daughter vs. Selzer’s the bath lady (Down From Troy 223-6)
Logic (facts/dogma) v. intuition (third-eye awareness/analogy)
D. Twice-told tales (different points of view) + the complication of two distinct languages/epistemologies (ways of knowing: humanism v. unilateral scientific), explaining an inability to communicate at times (and get courses established).
||Literature-and-medicine brothers Henry and William James illustrate these ideals:
The Medical Ideal--to say a thing in one sentence as straight and as explicit as it can be made and then to drop it forever;
The Literary Ideal--to avoid naming it straight; but, rather, to build out the poor little initial perception--enveloping it in gigantic suggestive atmosphere (innuendo and associative reference)--until it grows like a germ into something vastly bigger and more substantial. (The Letters of Wm. James).
E. The Impostor Syndrome: We can’t ever know enough! Relates to all professions.
F. Medical Mistakes/Failure of Will: Learning perspective and to compartmentalize.
G. On death, dying, and disposal: metaphorical metaphysics; and Anatomy of the Spirit (to symbolically discern spirituality in the bifurcated world of Emersonian tradition).
H. Romance: hormones; perfume; what is the nature of love; empathy belly; The Flea
III. Relaxation, fun, and games: humor magnifies; the grotesque illuminates.
Dr. Andrew Weil’s breathing exercises.
The humorous side of medicine.
The Socratic Dialogue Game.
*The above curriculum was developed specifically for students in or entering a medical profession.
*See Student Papers for individual assignments and examples.
Semester Assignments: four 2pp papers on specific readings (exactteaches focus); one 4-5pp paper (more room to think things through); one 6-8pp research paper or interview; and two oral presentations. Aristotle’s rhetorical approach (logos, ethos, and pathos) in analyses is encouraged. The class discusses outside readings, with three questions prepared in advance. Students bring in weekly journal/newspaper articles on contemporary medicine (double points for humor). Mid-term and Final Exam.
Textbooks: Richard Selzer’s The Doctor Stories and anthology, On Doctoring, ed. Richard Reynolds, M.D. and John Stone, M.D..
|| The age-old Socratic Method of training doctors teaches students to think for themselves, to solve their own problems, and eventually to be their own teachers (doctor means teacher). During the training answers are freely given, with the Socratic process leading students toward their own answer. That is, a doctor’s mettle may be proved in not so much what he knows as by what he understands. [Socratic ironywrong path)
[Method used in class explorations]
The Socratic Method: A Lesson Plan (Live Wire Media)
- Define the lesson you want the students to learn--decide beforehand what idea you want them to come away with.
- Think up a hypothetical situation to use as a point of departure.
- Devise a line of questions designed to pull the students toward your conclusion.
- Make the students take a position by asking, What would you do if . . .
- Plan for a dialogue to move in several different directions.
- Complicate the situation by throwing in a money wrench:What if this happened, what would you do then?
- At each step, up the ante:Now what would you do?
- Expect to be surprised. Be prepared to think on your feet.
- If all attempts to extract the right conclusion fails, play your trump cards: What if the hero of a movie did that? How would you feel about the character? (Pose an objective, hypothetical situation.) Remember, you’re the hero of your own movie. (Compare the position with the student’s self in asking, Would that be the right thing to do. (A consensus should develop. People usually have a good idea of what’s right!
- Tips for facilitating the Socratic Method:
- Give something of yourself--share something personal. Don’t just take.
- Let the students know you don’t have all the answers. You have fears and insecurities, too.
- Be nonjudgmental.
- Be honest with the students
- Take the students seriously and show respect for their thoughts and opinions.