Literature and Medicine

^Seeing Patients Mary G. Winkler The contemporary American portraitist Alice Neel remembers the town in which she grew up as "a benighted little town." She recalls that "all the events for art were there, but there was no art."1 In medicine, as in Neel's hometown, there are "events for art." But the visual arts are linked to medicine in a unique way that has its roots in the development of modern science. From the time of Andreas Vesalius and the great Renaissance anatomists , artistic interpretations of rational observation have been central to the acquisition of medical knowledge. At the heart of the practice of illustrating scientific texts are the beliefs that we learn from what we see and that the image of an authoritative observation is a powerful pedagogical tool.2 Vesalius explained the prominence of the careful and beautiful illustrations of De Fabrica Humani Corporis (1543) thus: "The books contain pictures of all the parts [of the human body] inserted into the context of the narrative, so that the dissected body is placed, so to speak, before the eyes of those studying the works of nature."3 Equally powerful is the conviction that, when aided by technology, the eye may uncover the truth about physical phenomena. Michel Foucault 's discussion of "the medical gaze" in the history of the power struggle between medical professionalism and the subjective experience of the patient has been very influential in recent scholarly discourse. In The Birth of the Clinic, Foucault argues that "modern medicine has fixed its own date of birth as . . . the last years of the eighteenth century . . . with a return ... to the modest but effecting level of the perceived."4 He attributes the "rejuvenation of medical perception" to the technology that allowed nineteenth-century physicians to see things no one had ever seen before. What was fundamentally invisible is suddenly offered to the brightness of the gaze, in a movement of appearance so simple, so immediate that it seems to be the natural consequence of a more highly developed experience. It is as if for the first time for thousands of years, doctors, free at last of theories and chimeras, agreed to apLiterature and Medicine 11, no. 2 (Fall 1992) 216-222 © 1992 by The Johns Hopkins University Press Mary G. Winkler 217 proach the object of their experience with the purity of an unprejudiced gaze.5 And, again, "The eye becomes the depositary and source of clarity; it has the power to bring a truth to light that it receives only to the extent that it has brought it to light."6 Thus, for Foucault, the medical gaze is characterized by a peculiar, cool distance: "The observing gaze refrains from intervening: it is silent and gestureless. Observation leaves things as they are; there is nothing hidden to it. . . ."7 At the end of her exposition of the centrality of "the seen and unseen" to Enlightenment science, Barbara Maria Stafford concludes that the seeds of the breakdown in the doctor-patient relationship were sown early in the history of modern medicine. She perceives the problem to be "the constructs of dissecting and abstracting," which "introduced us to a tenacious dualistic philosophy. . . ."8 The ideal posited in the medical gaze is an objective way of seeing, but it is doubtful that such objectivity is possible, especially when the gaze falls on another human being. There is no innocent eye. To the task of seeing, each observer brings experiences, hates, loves, prejudices, preconceptions, and knowledge. There is no perception without interpretation , and interpretation of the observed world is one of art's functions . By interpreting reality, the artist transforms our perceptions of what we see, just as the trained medical eye interprets what it reads from the body. Neither the artist's nor the scientist's eyes merely record, as do technological devices. Alan Blum, whose sketches appear here, is a physician who sees "events for art" in his patients—individual personalities who act in a human drama of courage, despair, humor, pettiness, suffering, and death. Certainly, he derives his ability to heal his patients from the long medical tradition I have discussed. But he uses his sketches to learn something...