Novels and medicine

Dr Joe Baker

All you need to  know about General Practice can be learnt from reading Austen.”

So said Anne, my GP training supervisor. Needless to say when it came to the final exam I fared poorly with the medical emergencies, although I did better with those patients who had  complex interpersonal relationship problems.

Anne’s advice was consistent with the general consensus that medical students and doctors should be encouraged to read literary fiction; it allows them to experience worlds not otherwise readily accessible to them. There is some scientific backing for this consensus. For example, a 2013 study published in Science showed that readers exposed to literary fiction had increased levels of empathy and social behavior, and were better able to infer other’s beliefs and intentions. The study only looked at short term effects and concluded more research was needed (which of course would mean more funding).

So it might be a good idea to expose all medical students to literary fiction.

Or perhaps we want them  to play more video games. For example a 2010 paper showed that pro-social video games have the ability  to increase empathy in gamers (Greitemeyer, T. & Osswald, S. (2010). Effects of Prosocial Video Games on Prosocial Behavior. Journal of Personality and Social Psychology, Vol 98, No 2: 211-221).

Or perhaps we want our future doctors to spend some time living in a hole in the ground. Charles Foster (a trained veterinarian), in his book Being a Beast,  set out to live as a badger, an otter, a fox, a stag, and a swift. He dived into cold rivers as an otter would. He munched on worms and slept in a badger sett. As he told Kim Hill, these experiences might not only help  us understand animals better they might also help us understand other humans better. Foster’s hypothesis seems sound. I knew a flat full of medical  students who spent their undergraduate years living like animals; they eventually turned out as fine surgeons.

It seems clear: we need more Pynchon reading, pro-social video game playing, worm-munching medical students; the benefits for patients will be immeasurable.

But how should doctors use novels when caring for patients?

Discovering what a patient is reading can be very helpful in medicine. If a young man tells you he is slowly making his way through some Sartre you know you are in for a rocky ride and are likely to miss your afternoon tea break. When he returns several weeks later telling you he has almost completed the latest Alexander McCall Smith you know he has made great progress.

What about bibliotherapy, or the practice of  advising patients to read certain works? The term bibliotherapy is thought to have first been used in a 1916 Atlantic Literary article by Samuel MCChord Crothers. Crothers contrives a  visit to his friend Dr Bagster who prescribes novels to patients in his literary clinic. Bagster classifies novels as stimulants, sedatives, irritants, or soporifics and  tailors therapies to patients’ needs. Although the article, published in the midst of the First World War, makes very salient points about the role of literature in therapy, it does read mainly as a tongue in cheek piece of humour: “Pure satire is not irritating. It belongs not to medicine, but to surgery. When the operation is done skillfully, there is little shock. The patient is often unaware that anything has happened.” At the end of the article, Bagster is called away to attend a patient who had taken an overdose of war literature (remember this was 1916).

The concept of bibliotherapy has since expanded.  Alain de Botton’s School of Life runs a bibliotherapy service. A sufferer completes a questionnaire then receives a  prescription of suitable fiction, poetry, and philosophy to help one’s troubles. The analogy between filing in mental health questionnaire then being told what psychiatric drug to take seems too obvious.

More recently ReLit has been launched as a charitable organisaton dedicated help those with of stress, anxiety, and other conditions through, mindful reading. ReLit argues that attentive immersion in great literature can relieve, restore, and reinvigorate the human mind.

We all know literature can be transforming and we all know of people whose lives have been radically changed for the better after reading fiction. But  should doctors tell individual patients to read certain literary works?

I personally think the answer has to be a big No! Recommending a novel exposes the doctor to a number of risks. A 300-page literary work involves so many concepts that a patient is likely at some stage to misconstrue the doctor’s intentions. And what about the potential for harm? In general if a drug, and the argument surely is that literature can be thought of as a drug, has the potential for great good, it also has the potential for great harm. Generally we do not allow doctors to prescribe therapeutic interventions until they have been rigorously tested (although with novels I think the preclinical animal testing stage could be skipped to hurry things along).

My final thoughts about the subject come from some local research. In a straw poll of my  GP friends none said they would ever suggest a patient read a particular work of fiction. “That would be a bit weird” was the general consensus.

A second straw poll, asking non-health worker friends how they would feel if their doctor prescribed a novel, reached a slightly different conclusion  with, “ That would be REALLY weird,” being the overwhelming opinion.

More research (and certainly more research money) is desperately needed.

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Dr Joe Baker: Joe Baker is a GP in Dunedin, New Zealand.