Fort Worth, Texas, United States
Richard Selzer was among the first physicians to understand the power of writing and reading fiction within medicine.
He helped to open up this whole territory to those of us who came after. His legacy is, on the one hand, the text—what he’s written—and, on the other hand,
what I consider to be the radical transformation of medicine and medical education in the past twenty-five years
along the line of medicine recognizing that which it can only get from the Humanities and particularly from literature.
— Rita Charon, Director of the Program in Narrative Medicine at the Columbia University College of Physicians and Surgeons1
Yale surgeon-writer Richard Selzer (b. 1928) hit his stride as a writer just as a new idea was taking shape: illness narratives could play a useful role in medical education. The Pennsylvania State University College of Medicine pioneered the idea, with Joanne Trautmann heading up the first medical school department of humanities in 1972. She introduced into her curriculum the works of Anton Chekhov, William Carlos Williams, and other authors of fiction, poetry, and drama. Her purpose was to explore the medical and bioethical issues in a life lived, as represented in literature.
These varied narratives, besides being entertaining, portrayed people with medical issues embedded in lives fraught with the uncertainties of being human. Yet the idea of incorporating literature into medical education was slow to catch on. Interdisciplinary teachings were foreign, even suspect, in a system that prized reductionistic scientific study and dazzling new technologies. This reevaluation of how to use literature was in part a critique of the advance of technological medicine. Barely a century before, compassion was nearly all a doctor could offer, and this new movement suggested that alongside the vast benefits scientific medicine had achieved, some profound costs had been exacted. It had become possible for a doctor to enter a room, look at a bank of machinery and lab test results, and five minutes later—not having touched the patient or listen to him—diagnose and order treatment. Could aesthetics, ethics, and a contemplation of the ambiguities of human existence hold a candle to that?
In addition to Joanne Trautmann, Ed Pellegrino thought they might. A physician and philosopher with Christian values, he was both Chancellor of the University of Tennessee and Professor of Medicine and Medical Humanities from 1978-1982. His long view of how the humanities fit with medicine came from ancient ideals, and he knew the time was right to explore how the liberal arts might be reintroduced into medical education to prepare students for a more humane practice. The more self-reflective doctor who was shown compassion for his psychological needs would better meet the needs of his patients. The system of medical education, with its rigid curricula and “trial-by-ordeal proclivities,” needed reform, Pellegrino argued.2
He instituted these beliefs in his role as the Chairman of the Board of Directors of the Institute on Human Values in Medicine (1972-81), creating an NEH-funded program called “Dialogue between the Disciplines.” Pellegrino got humanists and physicians interested in the humanities together, and then he stirred the mix to address the crisis of values in medicine. Five small groups, or task forces, would address philosophy, history, literature, theology, and anthropology. Out of this study of what it means to be human, the hope was that reform would take place to reinterpret medicine’s Cartesian view of the body as a machine.
The literature and medicine group of ten was convened at the Sugar Loaf Conference Center, a retreat in Pennsylvania outside of Chestnut Hill, for a series of five, two-day sessions that began in the spring of 1975. Joanne Trautmann, its chair, found getting even ten people together was a strain, and she observed, “Most people in medicine couldn’t think in separate categories very easily, or not for long. They could only think in one way. Others who could might be considered as being disabled. People whose wires were crossed. For the most part, I found them and invited them to the dialogues. Richard Selzer was one of these.”
A literary ancestor of Chekhov and Williams, Selzer held great interest for Trautmann. She had read his first book Rituals of Surgery (1974), admiring his courage in telling the secrets of the medical priesthood. “You know,” she thought, “what a shameful thing to do. He was showing the public that there were feelings involved and a kind of voyeurism about the body that surgeons felt, and it was not a bad thing. It was an elevation of humanity. But it was not always seen that way. He was thought of as a pariah.”3
Of those coalescing to theorize literature and medicine as a discipline, Selzer was the only doctor present who wrote stories about his patients. “To be at the first literature and medicine symposium in the world,” he says, “was electrifying. We suspected that under Jo’s pioneering leadership, we were standing on the brink of a vast, unexplored territory. When it occurred to me that I might be the only surgeon in America writing about my patients, I trembled with expectation.”4 So much was open-ended, however, that an exiting participant challenged the group after one meeting, saying that and is a neutral word. You can link anything [like literature and medicine] and anything else, and pretend for a while that you have a subject, but do you really have one?”5
Selzer, Trautmann, and seven others remained to hash things out, among them the poet Denise Levertov, the brain researcher Nancy Andreasen, and the pathologist Bill Ober. Nervous at the outset, Trautmann broke the ice quickly to elicit a response from Nancy Andreasen, who connected with the others by saying her medical colleagues thought her literary interests an affectation while the literary people in her life found her too hardheaded. Bill Ober admitted that as a pathologist he counted on the empirical sensation, but he sought out the literature of William Carlos Williams to defray boredom in a practice that was “not much different from trying out a new recipe [that] becomes routine.”6
Leading the next meeting, Selzer read a new piece, “The Surgeon as Priest.”7 At a time when he was still being looked upon with disdain by the world of surgery, the group’s applause fortified him, and he felt vindicated. Then, unexpectedly, Bill Ober put Selzer on the defensive. He questioned his diagnosis in the real case history at the center of the piece about the short order cook Joe Riker who had a large hole in his scalp. Resisting Selzer’s scalpel, Joe showed him weeks later his shiny new scalp healed by holy water. To Ober, rather than a miracle, it was “keratoacanthoma which heals itself in six months and looks exactly like a squamous carcinoma clinically.”8 Feeling hot under the collar, Selzer said regardless of the diagnosis, the story was complete unto itself.
It did not stop there. After Selzer read his creative essays in Esquire on abortion and smoking, Denise Levertov declared that he was “evil.” By taking a nonjudgmental stance on these public health issues, he was using his “art for negative purposes,” she said.9 These long and intense days of readings and discussions were followed by dinners flowing with wine and walks on the grounds of the conference center. Selzer formed friendships, including with Denise Levertov and Bill Ober, regardless of their heated exchanges.
In spite of all the stimulating dialogue, after five sessions a field of endeavor had not even been defined. But the mindset of the “doctor with two heads” became a new exemplar, the whole-brained physician. Three key players had set things into motion. Ed Pellegrino challenged the status quo. Joanne Trautmann created a curriculum and organized the dialoguers. And Richard Selzer wrote stories about patients that were honest, elegant, and accessible.
This large-scale emotional and intellectual investment Selzer was making in a new direction did not come without turmoil. His surgery partners felt angry when he left town “to do something so frivolous,” and his wife Janet, who was raising their three children, did not see the reason for his absences and involvement in a new circle including many women. When he boarded the train for Philadelphia, he felt quite wayward. Now he says, “Out of these unlikely loins sprang the newborn Literature & Medicine of which I was the placenta”; it nourished the fledgling movement.
The author of sixteen books and hundreds of journal articles, a playwright, and teacher of both medicine and literature, Richard Selzer was a creative writer who was going to write no matter what. But, besides achieving individually, he rode high on the zeitgeist of the times to become part of the driving force that led to a new field of study. His work is taught in three-fourths of medical schools, encouraging others to write. “He was at the forefront of a real transformation, with medical education moving away from the idea that anything not basic science is peripheral and silly,” says Rita Charon, adding: “Richard Selzer has begotten the field of literature and medicine.”10
- Telephone interview with author 10-12-00.
- Pellegrino, Edmund. “Educating the Humanist Physician.” JAMA (18 March 1974): 1288–1294.
Telephone interview with author 01-02-04.
- Telephone interview with author 9-12-01.
- Selzer quotations are from interviews with author.
Trautmann, Joanne. Healing Arts in Dialogue: Medicine and Literature. Carbondale and Edwardsville: Southern Illinois UP, 1981: xvi. (HAD)
- HAD 3.
- HAD 39-49 & Mortal Lessons (Simon & Schuster, 1976),24-36.
- HAD 50.
- Qtd. in Josyph, Peter. What One Man Said to Another. East Lansing: Michigan State UP, 1994: 261.
- Telephone interview with author 10-12-00.
Note: This article is excerpted from Chapter 7, “Mortal Lessons, 1968-75,” of Dr. Stripling’s forthcoming biography, Mister Stitches: the Life and Arts of Richard Selzer, M.D.
, PhD, is a Yaddo Fellow and the author of Bioethics and Medical Issues in Literature (2nd updated edition, U Cal MH Press 2013). She has lectured on her work at Yale Medical School and presented three readers’ theater performances of Selzer’s work, including “Follow Your Heart” at the 2014 Narrative Medicine Conference at the Medical University of South Carolina in Charleston. She is an ACBL bridge aficionado and master swimmer who lives in Fort Worth, Texas. Please visit Dr. Stripling’s web site here: www.medicalhumanities.net.