Raleigh, North Carolina
|John Brewer Eberly, Jr. “Study on seeing, 2007.” Personal collection.|
Charles Stegeman, professor of fine arts at Haverford College, once took up the task of teaching medical students how to draw. He did so because he observed that students who learned to draw well went on to perform better in anatomy.1 They could see better, not just in terms of spatial representation, but in seeing and attending to the wholeness of things.
Today’s medical education does not form trainees to see with this sense of wholeness. Instead, they are often trained to disarticulate what is whole: suffering persons become suffering bodies. Suffering bodies become anatomical systems. Anatomical systems become organs, tissues, and cells. As internist and philosopher Jeffrey Bishop puts it, the clinical gaze anticipates not a person, but a corpse.2
Physician Eric Cassell writes something similar in The Nature of Suffering and the Goals of Medicine, that this anatomizing gaze, while necessary in some ways, is inadequate for understanding suffering: “For [understanding] pain, difficulty in breathing, or other afflictions of the body, superbly yes: for [understanding] suffering, no.” 3 For Cassell, equipping medicine to understand suffering requires much, including what he names as the task of aesthetics — learning to see.4
This link between what we see and what we do, between aesthetics and ethics, has enjoyed renewed attention in recent decades.5 As the theologian and ethicist Stanley Hauerwas writes, “Morally speaking, the first issue is never what we are to do, but what we should see. … You can only act in the world you can see and you can only see what you have learned to say.”6 Hauerwas is channeling the enigmatic Iris Murdoch, who sought to develop not an ethic of choice, but an ethic of vision,7 what fellow ethicist Nancy Snow calls the practices of “successive picturing” that draw us ever closer to moral transformation.8
While modern medical ethics has been modeled on science, and therefore emphasizes categories like autonomy, Murdoch thought our ethics should be modeled on art — on seeing and learning how to see. Classically, the cultivation of aesthetic judgment was necessary not merely for learning how to draw or attract interest at a cocktail party. Aesthetics was necessary for the proper formation of reason itself, specifically the development of phronesis or practical wisdom9 — what bioethicists Edmund Pellegrino and David Thomasma called “the indispensable virtue of the medical life.”10 It would seem that aesthetics is indispensable for the indispensable.
Philosopher Elaine Scarry is perhaps the champion of this conclusion, publishing her account of bodily suffering The Body in Pain, over a decade before publishing On Beauty and Being Just. Her analysis of injury laid a sort of soil for her future work on beauty and justice.11 As she stated last year, “When you see something beautiful, it is a call to you to begin to repair the injuries of the world.”12
Indeed, beauty and injury have always shared a strange, tense harmony, especially in visual art. As Aristotle noted, it is a mysterious reality that an artist can portray an ugly thing in a beautiful way.13 What Bishop names “the call of the suffering other” resounds in the ear of the artist and the medical worker alike.14 In the artist’s case, the opportunity to portray suffering in a moving way offers a sort of healing or redemption from it.15 If aesthetics matters to transform how medicine sees, then visual art is a helpful resource, as it can “tell the truth” about wounds and bodily injury in a way that anatomy and pathology cannot. “A picture is worth a thousand words” may be particularly true in injury, where the arts can “speak” on behalf of the sufferer when words fail them.
But for the link between aesthetics and ethics to matter for changing the way medicine understands suffering, it cannot merely tell the truth about suffering, but move the viewer toward moral transformation made manifest in embodied practices. We can only act in the world we can see, but to only see would miss something crucial about the link between aesthetics and action.
For example, it is striking that of TIME Magazine’s top 100 “most influential images of all time” — many of which are quickly recognizable — roughly half depict suffering in some way.16 A quarter explicitly capture bodily injury, including David Jackson’s 1955 photograph of Emmett Till.
Emmett Till was an African-American boy who was accused of whistling at a white woman in Money, Mississippi in the Jim Crow-era South. Emmett was kidnapped from his home, mutilated, shot in the head, and dumped in a local river. The two white men responsible for Emmett’s death were acquitted by an all-white, all male jury and living free, despite admitting to the murder afterward. Jackson’s photograph is widely credited as sparking the Civil Rights Movement.
This photograph is worth highlighting for many reasons — one of which is that it was posed, designating it as a work of art of a richer order than other shots, which might rely more on serendipity than intentionality. The photographer, David Jackson, was himself a black man, and I think understood what needed to happen.
All architectural and perspectival lines converge on the focal point: the face of the mother, Mamie Till, who gazes at her son. Our eyes follow hers to Emmett in the foreground, before spilling back, bewildered and undone, into the eyes of the Father, who looks at us as if asking, “Do you see? What then will you do?”
Ms. Till said, “Let the people see what I’ve seen,” and made the decision to widely publicize Emmett’s funeral as open casket. That funeral, along with the publication of this photograph — both lessons dependent on sight — forced the world to wake up to the brutality of American racism.17 A photograph — a work of art — demanded moral transformation in those with eyes to see.
And yet, we need eyes that see. Our vision is entrained in modern medicine. We quickly grow myopic — blinders on in order to focus and maintain momentum. The fourth century theologian Augustine and nineteenth century theologian Hans Urs von Balthasar, both lovers of beauty, each affirm the need for our eyes to be healed and cleansed,18 and it is therefore worth asking what it is that disciplines our vision toward moral transformation and outward action rather than mere contemplation.19 For I doubt that even the most elegant of reflections on aesthetics (let alone having today’s medical trainees learn to draw) will be enough to transform the anatomizing gaze of medicine or form an embodied ethic of vision. Many medical schools already have some sort of “art in medicine” intervention.20 If anything, these aesthetics interventions may risk furthering the divorce between aesthetic experience and everyday goodness, implying that beauty takes place “out there,” but has no place in the real world of medicine or ethics. Art interventions that aim to cultivate attention may only further galvanize the medical trainee’s tendency to specialize their sight, in which students that get better at “dissecting the canvas” only proceed to become more efficient at dissecting the suffering person.
To offer a concluding example: I grew up with my father — a family physician — giving me the covers of JAMA, The Journal of the American Medical Association. These covers famously featured a work of art and an accompanying piece of commentary, usually written by Marie Therese Southgate, MD. A stack of some of my favorites — lovingly torn out of the journal itself — sits on my desk.
At times, JAMA’s covers and commentary were truly moving. The July 1, 1998 cover, which presented the current research on HIV/AIDS at the time, was blank, including only the title “A Cover Without Art.” Southgate wrote, beautifully, “It is the blank canvas that reminds us of how much there is yet to do.”21
For my dad, JAMA’s covers were a way of pausing in front of a canvas before perusing a table of contents. The covers were a reminder that the tasks of patient care before him were, before anything else, acts of “long and loving attention.”22
You can imagine my disappointment when, in 2013 (both the year Southgate died23 and the year I started medical school), JAMA removed their iconic artwork and redesigned their cover in favor of a new layout: a detailed Table of Contents. While previous readers may have appreciated the art, JAMA noted that an increasing number of readers wanted more efficient access to content.24 Readers wanted to “generate insights more quickly” and “access information more quickly.”25
I do not blame them. We have work to do after all, not art to reflect on, but the message was clear to me, only weeks into medical school, when I was beginning to feel my own myopia for the first time: the days of “long and loving attention” are over. The medical learner only has time for short and efficient attention. If it is truly “the blank canvas that reminds us how much there is yet to do,” it is the Table of Contents that reminds us how little space there is to be reminded.
And yet, beauty is not so easily quieted. Beauty remains a launchpad for medical education and moral formation.26 As any musician will understand, there are some arguments that cannot be made, only “played.” There are some lessons that cannot be taught through words, only experienced through sight. An ethic of vision starts with asking ourselves, our colleagues, and our students, when we encounter suffering and injury, not only what we should do, but what it is that we see. As Thoreau wrote, “The question is not what you look at, but what you see.”27
The author recommends viewing David Jackson’s photograph, “Emmett Till, 1955,” Online at TIME 100 Photos project & Johnson Publishing Company, LLC. http://100photos.time.com/photos/emmett-till-david-jackson.
- Cassell E. The Nature of Suffering and the Goals of Medicine. Oxford: Oxford University Press; 1991:205.
- Bishop J. The Anticipatory Corpse: Medicine, Power, and the Care of the Dying. Notre Dame, IN: University of Notre Dame Press; 2011.
- Cassell E. Nature of Suffering. vii.
- Ibid., 206.
- Eberly B. The Good, the True, and the Beautiful and the Oscars. Mere Orthodoxy. 2018. Available at https://mereorthodoxy.com/good-true-beautiful-oscars/. Accessed April 12, 2019. Consider also the book of Job in the Old Testament of the Christian Scriptures. The story of Job is one of the paradigmatic examples of suffering in the Abrahamic traditions, particularly as it relates to the absurdity of suffering—suffering without a clear answer or purpose. Job, a righteous man, loses all he has and suffers greatly. Early in the book, Job’s friends arrive to console him. These “counselors” are perhaps best known for their cold theodicies—at one point being called, literally, “worthless physicians.” Initially, however, they demonstrate faithful, embodied practices of responding to suffering that are framed by seeing: “…When they saw him from a distance, they did not recognize him, and they raised their voices and wept aloud; they tore their robes and threw dust in the air upon their heads. They sat with him on the ground seven days and seven nights, and no one spoke a word to him, for they saw that his suffering was very great.”—-Job’s friend lament (raising their voices, weeping aloud; tearing robes, throwing dust), practice presence (sitting shivah, literally “sitting seven”) and silence (no one speaking a word). And these actions of lament, presence, and silence are bookended by sight (“…they saw him from a distance […] they saw that his suffering was very great”). See Job 2:12–13. New Revised Standard Version. See also Abd-El-Barr M., Davis E., and Lieber L. “They Sat Down on the Ground With Him…” Responding to Job’s Suffering. 2019 Conference on Medicine & Religion. March 29, 2019 in Durham, North Carolina.
See also Theologian Friedrich Schleiermacher, who wrote that what we do and what we say begins with what we see, what he called “the prior aesthetic impulse.” Schleiermacher F. Dialektik. Berlin: G. Reimer. 1839 :12,41. Cited in Dryness W. The Oxford Handbook of Systematic Theology. Webster J., Tanner K., and Torrance I., eds. New York, NY: Oxford University Press; 2010:561–579,573.
- Hauerwas S. How I Think I Learned to Think Theologically. The Work of Theology. Grand Rapids, MI: William. B. Eerdmans; 2015:11–31.
- Antonaccio M. The virtues of metaphysics: A review of Murdoch’s philosophical writings. Cited in Broackes J., ed. Iris Murdoch, philosopher: A collection of essays. Oxford: Oxford University Press; 2014:155–179,161. All cited in Snow N. Learning to Look: Lessons from Iris Murdoch. Teaching Ethics. 2013;13(2):1–22,2–3.
- Snow N. Learning to Look: Lessons from Iris Murdoch. Teaching Ethics. 2013;13(2):1–22,2–3.
- Gorringe T. J. The Common Good and the Global Emergency: God and the Built Environment. Cambridge: Cambridge University Press; 2011: 46. See also Plato. Republic. 402. Cited in Lewis C. S. Men Without Chests. The Abolition of Man. San Francisco, CA: HarperOne; 2015:16–17
- Pellegrino E. and Thomasma D. The Virtues in Medical Practice. Oxford: Oxford University Press; 1993.
- Scarry E. On Beauty and Being Just. Princeton, NJ: Princeton University Press; 2001:62,81.
- Scarry E. Lecture by Honorary Doctor Elaine Scarry: The Beauty of the World and the Nuclear Peril. 2018. Uploaded by “Uppsala universitet.” 2018. Available at https://www.youtube.com/watch?v=8BhOkP5bsDM. Accessed March 20, 2019.
- Grosseteste R. De Divisione. Cited in Eco U. On Ugliness. McEwen A., trans. Milan: Rizzoli International Publications; 2007:48.
- Bishop. Anticipatory Corpse. 27.
- Scruton R. Beauty: A Very Short Introduction. Oxford: Oxford University Press; 2011:139. The paradigmatic case is probably the crucifixion of Jesus Christ, a rite of passage for many artists—regardless of religious conviction—learning how to portray beauty, injury, and suffering while also attempting to capture something true about the human condition.
- The 100 Most Influential Images of All Time: 100 Photographs. TIME. 2016. Available at http://100photos.time.com. Accessed March 14, 2019.
- Jackson D. Emmett Till. 1955. In The 100 Most Influential Images of All Time: 100 Photographs. TIME. 2016. Available at http://100photos.time.com/photos/emmett-till-david-jackson. Accessed March 14, 2019.
- Augustine. Sermon 2.16.2. Cited in Jeffrey D. In the Beauty of Holiness: Art and the Bible in Western Culture. Grand Rapids, MI: Wm B Eerdmans; 2017:56.
- Christie D. The Blue Sapphire of the Mind: Notes for a Contemplative Ecology. New York, NY: Oxford University Press; 2013:141–178. Early Christian communities had practices called the theoria physike (the “seeing of God’s Creation”) and prosoche (“the art of attention”). Their attending to physical beauty required attending to physical brokenness, but their seeing was disciplined by the practices of monastic life: prayer, charity, and communion with neighbors and with God. For example, in the Christian tradition, beauty and justice are both located, paradoxically, in a set of injuries—the wounds of Christ—created throughout the crucifixion accounts present in the Bible, and mysteriously remaining present after the resurrection, as captured in the famous Isenheim Altarpiece by Matthias Grünewald, originally housed in the Monastery of St. Anthony, which specialized in care for those suffering from plague and debilitating injuries of the flesh. Both the suffering and those caring for them would have looked up and seen both profound injury and profound beauty. They would have had their ethic of vision disciplined by wounds.
- Lesser C. Looking at Art Could Help Med Students Become Better Doctors. Artsy. 2018. Available at https://www.artsy.net/article/artsy-editorial-art-help-med-students-better-doctors. Accessed March 13, 2018.
- Southgate M. T. A Cover Without Art. JAMA 1998;280(1):5. See also Southgate M. T. The Cover. JAMA 1996;276(2):84.
- Young R. K. and Southgate M.T. JAMA Physician-Editor Who Connected Art, Medicine, and Life, Dies at 85. [email protected]. 2013. Availabe at https://newsatjama.jama.com/2013/11/26/m-therese-southgate-jama-physician-editor-who-connected-art-medicine-and-life-dies-at-85-2/. accessed September 26, 2018.
- In memoriam, M. Therese Southgate. Oxford University Press Blog. 2013. Available at https://blog.oup.com/2013/11/in-memoriam-m-therese-southgate/. Accessed September 26, 2018.
- Hensley S. Medical Journal Goes to the Dogs. NPR. 2013. Available at https://www.npr.org/sections/health-shots/2013/12/04/248815474/medical-journal-goes-to-the-dogs. Accessed September 26, 2018.
- Press Release: VSA redesigns the Journal of the American Medical Association. VSA Partners. 2013. Available at https://www.vsapartners.com/news/vsa-redesigns-the-journal-of-the-american-medical-association/. Accessed September 26, 2018.
- Scarry E. On Beauty and Being Just. Princeton, NJ: Princeton University Press; 2001:31. See also Robinson M. Grace and Beauty. Ploughshares 2018;44(1):157–167.
- Thoreau H. I to Myself: An Annotated Selection from the Journal of Henry David Thoreau. Cramer S., ed. New Haven: Yale University Press; 2007:86. Cited in Christie D. The Blue Sapphire of the Mind: Notes for a Contemplative Ecology. New York, NY: Oxford University Press; 2013:171.
JOHN BREWER EBERLY, JR., MD, MA, is the interim program coordinator of the Theology, Medicine, and Culture Fellowship at Duke Divinity School, and a rising PGY-1 resident with AnMed Family Medicine Residency in Anderson, South Carolina. His interests include medical student formation, phronesis, the philosophy of beauty, theological approaches to bioethics, women’s health, mental health, operative obstetrics, and the medical humanities. He plans to practice family medicine and hopes to teach medical ethics, theology, and aesthetics. He lives in Raleigh, North Carolina, with his wife, Dendy, and sons, Jack and Weller.