Then he moved to Florida. His parents came to visit and he got asthma. Eureka! It wasn’t the errant dust. It was his parents. The second shock of epiphany was that the exposure of the critical connection between parent and bronchospasm was force enough to keep the asthma from ever reactivating again. He was well aware of the “talking cure” of Breuer, Freud, and the world of psychotherapy. He reasoned that the private realm of writing was perhaps a better place to stumble upon these therapeutic linkages. As professor of psychology, he did experiments. College students wrote for twenty minutes, three times in one week. Some wrote a grocery shopping list. Some wrote about a traumatic event. Some wrote about the emotional response to a traumatic event. Some wrote both the details of the event and the emotional response to it. Only the last group demonstrated a diseaseprevention effect, an immune system enhancement that lasted six months after. The linguistic connection between a traumatic event and the emotional response to that event was the key to health maintenance and disease prevention. Later experiments demonstrated that “expressive writing” improves air flow during asthma attacks, reduces the pain of rheumatiod arthritis, and improves immune markers in AIDS, among other positive effects upon our physical wellbeing—concrete examples of events in the psychological realm having a direct effect upon the physical. Well, that process so distinct to “expressive writing” is what poets have been doing all along, isn’t it? Mining truth and defining its connection to our emotional lives? In a way, Pennebaker demonstrated an important contributor to making the art of poetry into art: its capacity to engage and strengthen the human spirit. Well, that’s how this business of heart and poetry connects to healing. Finding truth turns out to be a healthy experience. How about that? OK, but now I have one more question: 4) What does this mean for us in the practice of medicine? For one thing, get our patients writing. For another, ourselves.
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Medical school has the distinct ability to annihilate altruism. We’ve all seen it. We enter the hallowed halls full of piss and vinegar, out to save the world and hell-bent to do it, and then by the third year we are arrogant, cold, and distant, or perhaps just distracted and fearful. Not always, surely. But there is more than a grain of truth lurking there. It’s because we’re deluged with science—not the fault of science, I hasten to add; without it we’d all be frauds. It’s the fault of curriculum committees who do not recognize that brain balance is critical to an existence marked by contentment. My guess is that in the same way the London cabbies induce, by the constant bombardment of cartography, PET scan-documented hypertrophy in grey matter regions responsible for geographic knowledge, third-year medical students suffer hypertrophied regions of linear thought and atrophied regions of altruism. Don’t attempt didactic lectures on humanistic subjects to try and correct this problem. They’ll never work. Leave it to the experts. Just a little poetry in the right tea cup might do. Some stories
authentic to the circumstance of medicine. Expressive writing here and there, perhaps. We cannot hope to become humanistic physicians by thinking about the subject, or by analyzing external manifestations. The brain informs, but it is the heart that sets behaviors. To influence behavior we must speak the language of the heart, that which is to be found in poetry and in stories that engage the imagination and model the human personality, with all its quirks and richness of spirit. Such would be true as well of those of us in practice. Regular contact with our interiors, our pasts, our experiences of the day reflected in the tranquility of a quiet moment under the guidance of the truthwriting hand might serve to make us more compassionate in thought and in deed. It is easy enough to lead the unexamined life. Anyone can do that. But the consequence of that deprivation is a tragically missed opportunity for pleasure . . . but also, and importantly, for a lasting state of balance in our lives. David Watts, MD, is a poet and a regular commentator on NPR’s All Things Considered.
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tzweig@tracyzweig.com w w w. t r a c y z w e i g . c o m March 2011 San Francisco Medicine 27