Hektoen International

A Journal of Medical Humanities

The truth of the imagination

John Graham-Pole
Antigonish, Nova Scotia, Canada

Image of a scene from "As You Like It"
Scene from As You Like It
Photography by UMTAD

“All the world’s a stage, And all the men and women merely players: They have their exits and their entrances.”


Life as performance art

The bard got it right: we are all actors, whether stars or bit players. Our metaphors bespeak it: we make our entry onto life’s stage; we play out our parts in the tragi-comedy of life; our final scene heralds our exit; and the curtain falls upon us.

For forty years, I played out the role of doctor. Most of that time, I had no concept of it as a performance, an art; I certainly wasn’t born with the skills ready honed. Having no mentor to disabuse me, I bought into the 1960s fiction that medicine was, first and last, science. The year before I entered one of London University’s nine medical schools on a classics scholarship, C.P. Snow (1959) had already delivered his Rede Lecture, The Two Cultures, bemoaning the schism in western intellectual life between the sciences and the humanities; he described it, in elegant understatement, “a major hindrance to solving the world’s problems.”1 For me, however, the theatres, galleries, and museums that occupied every highway and byway of London’s West End quickly became a vanishingly rare digression from the true path of my education, with no apparent relevance to my immersion in the science of medicine.

Once I graduated, I started at once to don countless hats in my daily performances. And gradually to grasp the deep fun inherent in adopting a new persona for every patient encounter. I would shift from plain speech to conciliation, from detachment to intimacy. I learned, almost unaware, the art of changing my posture and appearance, my pitch and tone of voice, dozens of times in my working day. It took me half my career to see the truth:  these skills I was clumsily learning in my daily intercourse and discourse with patients—the choice and timing of the perceptive word, the imaginative gesture, the empathic touch—had huge power for healing. In identifying my patients’ problems, the cause of their illnesses, and—given time—their identities mostly quite hidden during my histories and physicals, I began to identify myself. I began to uncover my own truth.

It was the children with cancer who woke me up to it. They did not hide their identities the way adults did. They did not dissemble, try to hide their feelings, act nice to me. They slipped effortlessly from tears to smiles, from tantrums to laughter. And so told me their truth—in words spoken and unspoken. They taught me, astoundingly but most crucially, that performing comedy is much harder, but of much greater value, than performing tragedy. “Tragedy is easy—it’s comedy that’s hard,” said award-winning comedy writer Laurence Marks.2 Was I really allowed to see lightness in their burdensome and cruel diseases? If I felt guilt at finding joy in the midst of tragedy, my young patients had no trouble with it. It was as if they protested, “Show us the data that solemnity ever cured—or even comforted—anyone.”

The children led me to see my own performance as their doctor not just as an art, but as a life lesson. In this, I was not so much discovering something new; I was recovering, “re-membering,”3 the true identity I had been hiding, as we all do, from early childhood on. That image of re-membering conjures up a deep wound—that of losing a limb. The French call the wound blessure: blessing, for from the wound begins the healing. Without our wounds, what would there be from which to heal?

Art as instinct

I had been unconsciously learning these performance skills I would bring to my life’s work from the moment my mother first lifted me up and smiled at what she had created. Then and there, she and I began echoing and matching each other’s sounds, expressions, movements, touches—checking out each other’s identity. This instinctual adventure—this deep play of mutual child-mother bonding, observed and described at length in Daniel Stern’s elegant research4—at once began to awaken within me the innate sensory and cognitive skills with which I would henceforth experience and process the world—and reciprocate to it.

My growing awareness of the art of medicine as being as important as any scientific expertise led me to explore the place of all creative arts in human healing.5 I began to write poems, both as requiems to my patients and as a way to understand and express my own feelings. I quickly rediscovered John Keats, became inspired by the heroism of one who could renounce his apothecary’s license, and its assured income for life, to follow his heart and become a fulltime poet. Hard to conceive; but his chosen path must have come to him clear as an epiphany: “I am certain of nothing but of the holiness of the heart’s affections, and the truth of the imagination,” he wrote to his friend Benjamin Bailey6 “What the imagination seizes as Beauty must be truth.” Sure enough, in the few years granted to him, he went on to create a transcendent gift to our world’s healing.

It began to dawn on me: self-expression—putting our creative intelligence to work—is a means for everyone of us to become aware of the intuitive truth of our lives, to uncover our true identity. And that fully realizing this identity can be a God-given journey of healing. I was hardly the first to come upon this truth; it is part of the heritage of many Aboriginal cultures. Mi’Kmaq elders Murdina and Albert Marshall7 have long aspired to the ideal of “two-eyed seeing,” celebrating “seeing from one eye with the strengths of Indigenous ways of knowing, and from the other eye with the strengths of Western ways of knowing, and finally to use both of these eyes together.”

Alice Muirhead and Sarah de Leeuw8 have advocated for artistic expression and revitalization as a powerful strategy to combat the world’s health disparities. “Feasting and gifting rituals…singing, dancing, drumming, weaving, basket-making, and carving were simultaneously…creative expression, religious practice, ritual…having the opportunity to practice and express the things that define you as unique, creates an incentive to imagine and care for the person you will be in the future.” We are all a part of this global tribe, which extols creative self-expression as a Human Universal, committed to uncovering its true identity.9 Only in this way can we aspire together to reclaim our full health of body, mind, and spirit.

The origin of self-expression

Nigel Spivey draws our attention to images, perhaps 77,000 years old, uncovered in the Blombos Cave of Southern Africa.10 He states, “The art of humans consists in our singular capacity to use our imaginations.” This echoes the seminal work of the American anthropologist, Franz Boas: “The play of the imagination is universal, and in conjunction with situations and experiences common to all societies, gives rise to many cultural similarities.”11 The sociocultural anthropologist, Donald Brown9 developed this theme by creating a kind of extended metaphor he termed the Universal People (UP), and attributing to the UP a huge glossary of innate commonalities. Of particular relevance to my thesis is the UP’s omnipresent instinct to make art in all its myriad forms, seeing it not solely as sublime aesthetic fulfillment but, crucially, as promoting the total health of both individual and community. This has its origin in the UP’s recognition of a link between illness and death; both the actuality and appearance of good health as being attractive to others; and the consequent universal drive to find ways to heal its sick.

These universal concepts underscore the extensive research of developmental anthropologist, Ellen Dissanayake, who argues that our aesthetic and art-making instincts are a biologically evolved and vital element in our nature that is both natural and necessary.12 She sees art as gifting us our capacity to intertwine our human traits, to create order from chaos, to evolve our symbolic rituals, to fashion our tools, to express our feelings and emotions, and to socialize with each other. This leads to the inescapable conclusion that art is inextricably linked to our survival as a species. Or, in the words of Fyodor Dostoevsky, “Beauty will save the world.”13


  1. Snow, Charles P. 1959. The Two Cultures. London: Cambridge University Press.
  2. Marks, Laurence, 2011. Tragedy is Easy – It’s Comedy That’s Hard. London: The Telegraph, January 22, 2011.
  3. Gifford, Don.  2011. Zones of Re-membering. New York: Rodopi.
  4. Stern, Daniel N. 1985. The Interpersonal World of the Infant: A View from Psychoanalysis and  Developmental Psychology. New York: Basic Books.
  5. Graham-Pole, John, 2000. Oakland, CA: New Harbinger.
  6. Keats, John. 1817. Letter to Benjamin Bailey. November 22, 1817.
  7. Marshall, Murdina and Albert Marshall, cited by Malcolm King. 2012. Two-Eyed Seeing. Ottawa: Canadian Institutes of Health Research Aboriginal Health Research News.
  8. Muirhead, Alice and Sarah de Leeuw. 2012. Art and Wellness: The Importance of Art for Aboriginal Peoples’ Health and Healing. Prince George: National Collaboration Center for   Aboriginal Health.
  9. Brown, Donald E. 1991. Human Universals. Boston: McGraw-Hill.
  10. Spivey, Nigel. 2005. How Art Made The World. New York: Basic Books.
  11. Boas, Franz. 1938. General Anthropology. Boston: Heath.
  12. Dissanayake, Ellen. 1988. What Is Art For? Seattle: University of Washington.
  13. Dostoevsky, Fyodor, translated by Brailovsky, Anna. 2003. The Idiot. New York: The Modern Library.

JOHN GRAHAM-POLE, MD, MRCP-UK, ABHM, a 1966 graduate of St. Bartholomew’s Medical College, London University, is Professor Emeritus, Pediatric Hematology, Oncology & Palliative Care at the University of Florida. He co-founded the university’s Center for Arts & Health Research & Education and received the 2012 Outstanding Leadership Award from the Global Alliance for Arts in Health. He has written and edited six books, as well as many articles, chapters, poems, and short stories. He has just submitted his first young-adult novel, and is completing a memoir. He and his wife are currently researching the role of the arts in palliative care.

Highlighted in Frontispiece Volume 6, Issue 4 – Fall 2014

Fall 2014



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