Medicine engages life’s existential mysteries: the miraculous moment of birth, the jarring exit at death, the struggle to find meaning in suffering.That is, what some might call life's Big Questions -- what is life? what is the meaning of life? why do the good suffer? what is death? -- are the stuff of daily life at the hospital (and are the reason why hospitals are a natural setting for chaplains -- people trained in engaging the big questions!). But, as Groopman points out, the daily grind of hospital work can quickly desensitize people to the grand nature of what is happening around them. And one way to re-sensitize folks is to engage other sources of the big questions. Few in history have more dramatically and directly engaged these questions than the great authors of 19th century Russia, like Tolstoy, Chekov and Dostoevsky, who wrote in an environment where an entire nation was engaging those questions as it stood on the brink of its cataclysmic and incredibly rapid transition from feudalism to Communism.
Not surprisingly, then, one of Tolstoy's works -- his novella, "The Death of Ivan Ilyich" -- stands at the center of Groopman's course. Some clinical pastoral education programs have also used this work as a means to spur discussion among aspiring clergy and chaplains. In an article in the winter 2006 issue of The Journal of Pastoral Care & Counseling, Paul Steinke gives an extensive bibliography, including The Death of Ivan Ilyich, of works he has used in teaching his students. Many others have been doing this kind of work. I wrote here, recently, about a similar course at U Penn. [And here is a syllabus, including a bibliography, for a similar course at U. Colorado.]
But what I really like about Groopman's piece is that he links modern works like Tolstoy's to a very-much-not-modern book that still remains the greatest of all time for engaging the big questions:
Whether read as revealed truth or as a literary work, the Bible is a sourcebook of human psychology and an enduring inspiration for authors trying to capture the drama and dilemmas of medicine.As Groopman points out, one way to find the Bible's encounter of the big questions is to read modern literature, carefully -- so many references to the Bible are in there if you look for them. Certainly, Tolstoy refers to it, often.
Another thing I liked about Groopman's piece is the sharp critique he makes at the end of some of the most popular "spiritual" New Age success books out, today. Groopman points out that they are full of some very damaging -- and antiquated -- notions about why bad things happen to people; in effect, they blame people for their own misfortune:
Later in the semester we shift to New Age writing, examining the message of books like the surgeon Bernie Siegel’s “Love, Medicine and Miracles” and, new this spring, Rhonda Byrne’s “The Secret,” the runaway best seller that asserts you can solve all your problems, including “eradicating disease,” by correctly aligning your thoughts and aspirations. . . . Both Siegel and “The Secret,” for example, suggest that even cancer arises from anger, resentment and other “negative” emotions. Miraculous cures occur when sick people fix their disease-causing psychology.
Magical thinking is a common malady as we strain to find moral or metaphysical explanations for why, say, some cells mutate and grow abnormally. But there is not a shred of scientific evidence to support the enduring view that patients bring such events on themselves through incorrect thinking. While the Bible contains the seeds of this idea, later religious thinkers like Maimonides, who was deeply influenced by Greek and Roman physicians, drew sharp distinctions between magic and empirical medicine. The New Age writers confuse them anew.