Introduction: “Literature and Medicine: Origins and Destinies” by Rita Choran
“Literature and Medicine: Origins and Destinies” by Rita Charon first appeared in Academic Medicine, Vol. 75, No. 1, in January 2000, marking a significant contribution to the interdisciplinary study of literature and medicine. Charon explores the historical interconnections between these fields, arguing that both literature and medicine share intrinsic concerns with human origins, destinies, and the articulation of suffering. She highlights how literary methods, particularly close reading and narrative analysis, have increasingly been incorporated into medical education to enhance physicians’ interpretative and empathetic abilities. The article underscores the growing recognition of literature’s role in medical practice, noting how storytelling and narrative competence help doctors better understand patient experiences beyond clinical data. Charon’s work is pivotal in literary theory as it bridges medical humanities with literary studies, demonstrating that language and storytelling are not merely adjuncts but fundamental components of medical diagnosis and care. Through a historical analysis, she traces medicine’s evolution from a narrative-based discipline to a reductionist science and back to a renewed appreciation for narrative medicine, positioning literature as a crucial tool for restoring the humanistic dimensions of healthcare.
Summary of “Literature and Medicine: Origins and Destinies” by Rita Choran
Shared Goals and Methods
- Understanding Human Experience: Both literature and medicine aim to comprehend individual human experiences, particularly concerning origins and destinies. Literature provides insights into life’s beginnings and endings, while medicine addresses patients’ questions about their health’s origins and outcomes. Charon states, “Both literature and medicine, at their most fundamental levels, are concerned with individual persons’ origins and destinies.”
- Narrative Techniques: The practice of medicine involves interpreting patients’ stories, similar to how literary scholars analyze texts. Physicians gather medical histories and interpret various narratives—symptoms, test results, and personal accounts—to diagnose and treat patients. Charon notes, “The means the doctor uses to interpret accurately what the patient tells are not unlike the means the reader uses to understand the words of the writer.”
Historical Interconnection
- Reciprocal Influence: Historically, literature has drawn upon medical themes, and medicine has utilized narrative forms. Authors like Shakespeare and Tolstoy explored medical conditions to delve into human nature, while physicians like Freud recognized the narrative aspects of their case studies. Charon observes, “Literature lives in the shadow of the themes and concerns of medicine, and medicine respects the diagnostic and therapeutic power of words.”
Shift Toward Reductionism
- Technological Focus: Advancements in medical technology led to a more reductionist approach, emphasizing diagnostics and treatments over patient narratives. This shift resulted in a decline in physicians’ attentiveness to patients’ stories. Charon reflects, “Medical practice moved gradually from being a narrative and personal activity… to a technical, impersonal activity.”
Revitalizing Narrative Competence
- Integrating Literature into Medical Education: The resurgence of interest in narrative medicine seeks to balance technological proficiency with narrative competence. By incorporating literary studies into medical curricula, physicians can better understand and empathize with patients’ experiences. Charon asserts, “The time has come to recuperate the practice of a narratively competent medicine.”
- Benefits of Narrative Medicine: Embracing narrative practices in medicine enhances diagnostic accuracy, patient satisfaction, and physician empathy. It allows for a more holistic understanding of patients’ conditions beyond mere symptoms. Charon concludes, “A medicine that is technologically competent and narratively competent is able to do for patients what was heretofore impossible to do.”
Theoretical Terms/Concepts in “Literature and Medicine: Origins and Destinies” by Rita Choran
| Theoretical Term/Concept | Description |
| Literature and Medicine | A subdiscipline of literary studies examining the relationship between literary acts/texts and medical acts/texts. It explores how literature can enhance medical practice by providing narrative skills and humanistic insights. |
| Narrative Competence | The ability to interpret and understand patients’ stories, recognizing the human meanings of illness. It involves close reading and interpretation of clinical narratives. |
| Close Reading | A literary method used to analyze texts deeply, focusing on structure, diction, imagery, and plot. In medicine, it helps doctors interpret clinical stories and medical language. |
| Textual Interpretation in Medicine | The process of interpreting medical texts (e.g., patient histories, charts, interviews) to uncover deeper meanings beyond the literal words. |
| Origins and Destinies | Both literature and medicine are concerned with questions of human origins (where we come from) and destinies (where we are going), addressing existential and medical concerns. |
| Reciprocity Between Literature and Medicine | Literature often draws on medical themes (birth, suffering, death), while medicine borrows literary forms (case histories, narratives) to describe and understand illness. |
| Historical Antecedents | The enduring connection between literature and medicine, traced back to figures like Hippocrates, Thomas Sydenham, and Sigmund Freud, who used narrative to describe and treat illness. |
| Reductionism in Medicine | The shift in medicine toward a specialized, organ-based understanding of disease, moving away from narrative and personal interaction with patients. |
| Narrative Medicine | A modern approach that emphasizes the importance of storytelling in medicine, helping doctors understand patients’ experiences and fostering empathy. |
| Technological Competence vs. Narrative Competence | The balance between technical medical skills and the ability to interpret and respond to patients’ stories, both of which are essential for effective care. |
| Empathy and Sympathy | The emotional connection between doctors and patients, historically linked to literary notions of sentiment and the therapeutic power of words. |
| Case Histories | Detailed narratives of patients’ illnesses, used historically and contemporarily to understand disease and treatment. Freud’s case studies are notable examples. |
| Language and Medicine | Medicine is fundamentally a language-based practice, relying on textual and narrative forms to convey and interpret medical knowledge. |
| Humanism in Medicine | The integration of humanistic values, such as compassion and respect, into medical practice, often facilitated by literary studies. |
| Literature as a Diagnostic Tool | Literary texts and methods help medical students and doctors understand pain, suffering, and the human condition, enhancing diagnostic and interpretive skills. |
Contribution of “Literature and Medicine: Origins and Destinies” by Rita Choran to Literary Theory/Theories
1. Narrative Theory and Medicine
- Narrative Competence in Medicine: Charon emphasizes the importance of narrative competence in medical practice, arguing that doctors must develop skills in interpreting and constructing patient stories. This aligns with narrative theory, which focuses on how stories shape human understanding and experience.
- “The time has come to recuperate the practice of a narratively competent medicine, that is, a medical practice that acknowledges the textual and singular dimensions of illness by paying attention to patients’ (and doctors’) stories and their meanings.” (p. 26)
- Interpreting Clinical Stories: Charon highlights the parallels between literary close reading and the interpretation of clinical narratives, suggesting that both require attention to language, structure, and context.
- “Literary methods of close reading have been helpful in training doctors and doctors-to-be in the fundamental skills of interpreting clinical stories.” (p. 23)
2. Hermeneutics and Interpretation
- Textual Interpretation in Medicine: Charon draws on hermeneutic theory to argue that medical texts (e.g., patient histories, charts) are interpretative acts that reveal more than their literal meanings.
- “The texts of medicine—for example, the medical interview, the case presentation, the hospital chart, and the consultant’s report—can also be found to reveal more than the sum of the meanings of the individual words.” (p. 24)
- Ambiguity and Uncertainty: The article underscores the importance of tolerating ambiguity in both literary and medical interpretation, a key tenet of hermeneutic theory.
- “He or she also must tolerate the ambiguity and uncertainty of what is told, understand one narrative in the light of others told by the same teller, and be moved by what he or she reads and hears.” (p. 24)
3. Interdisciplinary Theory (Literature and Medicine)
- Inherent Connection Between Literature and Medicine: Charon argues that the relationship between literature and medicine is enduring and inherent, as both fields address fundamental human concerns such as suffering, origins, and destinies.
- “The beliefs, methods, and goals of these two disciplines, when looked at in a particular light, are strikingly and generatively similar.” (p. 23)
- Reciprocity of Themes: The article highlights how literature borrows medical themes (e.g., birth, suffering, death) and medicine borrows literary forms (e.g., case histories, narratives).
- “If literature borrows medicine’s plots, then medicine borrows literature’s forms.” (p. 25)
4. Reader-Response Theory
- Reader as Diagnostic Instrument: Charon suggests that the reader of a literary text functions similarly to a doctor interpreting a patient’s story, emphasizing the active role of the reader in constructing meaning.
- “The serious reader of a literary work becomes a diagnostic instrument for the text, offering himself or herself as a medium for transforming the text into meaning.” (p. 24)
- Empathy and Engagement: The article aligns with reader-response theory by emphasizing the emotional and empathetic engagement required in both literary reading and medical practice.
- “Not from science but from literature might a physician learn how better to perform these actions.” (p. 24)
5. Historical and Cultural Theory
- Historical Antecedents of Literature and Medicine: Charon traces the historical relationship between literature and medicine, demonstrating how cultural and intellectual shifts have influenced their interplay.
- “Examining the deep sources of the companionship and resonance between these two rather quite dissimilar fields and searching for their relationship’s historical antecedents demonstrate that the connection between literature and medicine is enduring because it is inherent.” (p. 23)
- Impact of Specialization and Reductionism: The article critiques the move toward reductionism in medicine, arguing that it has diminished the role of narrative and language in medical practice.
- “As a consequence, in part, of the 18th century’s development of pathologic anatomy and the 19th century’s discovery of the germ theory, disease began to be seen as separable from the patient’s body.” (p. 25)
6. Ethical and Humanistic Theory
- Humanistic Medicine: Charon advocates for a medicine that is both technologically and narratively competent, emphasizing the ethical imperative of understanding patients as individuals with unique stories.
- “A medicine that is technologically competent and narratively competent is able to do for patients what was heretofore impossible to do.” (p. 26)
- Compassion and Respect: The article highlights the ethical dimensions of narrative competence, arguing that it fosters compassion and respect in medical practice.
- “Medicine’s disregard of the most basic human requirements for compassion and respect in the face of pain and fear can deter patients from accepting whatever scientific help for their disease is forthcoming.” (p. 26)
7. Structuralist and Post-Structuralist Theory
- Language and Meaning: Charon’s analysis of medical texts as instances of specialized language aligns with structuralist and post-structuralist theories, which emphasize the role of language in constructing meaning.
- “Like literary texts, medicine’s texts are instances of specialized language governed by convention and shadowed by but unbounded by intention.” (p. 24)
- Beyond the Sum of Words: The article echoes post-structuralist ideas by suggesting that meaning in both literature and medicine transcends the literal words used.
- “Literary studies arise from a fundamental belief that a literary text and literary language, written or oral, mean more than the sum of the meanings of the individual words.” (p. 24)
8. Theories of Embodiment and Suffering
- Embodied Experience: Charon emphasizes the importance of understanding illness as an embodied experience, a perspective that aligns with theories of embodiment in literary and cultural studies.
- “Both literature and medicine, at their most fundamental levels, are concerned with individual persons’ origins and destinies.” (p. 24)
- Suffering and Meaning: The article explores how literature and medicine grapple with the meaning of suffering, a central concern in both fields.
- “Much of literature provides tentative answers to the reader’s and writer’s often unspoken questions about their own sources.” (p. 24)
Examples of Critiques Through “Literature and Medicine: Origins and Destinies” by Rita Choran
| Literary Work & Author | Critique/Observation | Connection to Medicine |
| The Golden Bowl – Henry James | James’s preface emphasizes that “to ‘put’ things” is to do them with careful, transformative attention—suggesting that writing turns events into meaningful acts. | Just as James crafts layered narratives, clinical documentation must transform patient details into a coherent story that guides compassionate, effective care. |
| The Divine Comedy – Dante Alighieri | Dante’s epic journey navigates themes of suffering, transformation, and redemption, using narrative to express the inexpressible aspects of human existence. | Like Dante’s progression from despair to enlightenment, patient experiences of illness involve uncertainty and change, reminding clinicians to consider the holistic human story. |
| Hamlet – William Shakespeare | Shakespeare’s exploration of inner conflict and ambiguous language reveals multiple layers of meaning behind every word and action. | Physicians, similarly, must interpret ambiguous patient narratives and complex symptoms, honing the sensitivity needed to discern deeper meanings beyond the surface details. |
| The English Patient – Michael Ondaatje | Ondaatje’s work interweaves personal history with trauma and healing, using poetic language to capture the delicate balance between fragility and resilience. | This narrative approach mirrors how understanding a patient’s story—rich with emotional and physical complexity—requires narrative competence alongside technological expertise. |
Criticism Against “Literature and Medicine: Origins and Destinies” by Rita Choran
- ·Overgeneralization of the Relationship: Some critics argue that Charon overstates the inherent similarities between literary and medical practices, simplifying complex professional domains into neat parallels.
- Lack of Empirical Support: The essay largely relies on historical narrative and anecdotal evidence, leaving critics questioning whether its claims about narrative competence are backed by robust, measurable outcomes in clinical practice.
- Idealization of Narrative Competence: Critics contend that Charon’s romantic view of narrative medicine may overlook the pragmatic challenges of integrating literary approaches into the fast-paced, data-driven modern medical environment.
- Insufficient Acknowledgment of Reductionist Successes: Some suggest that while critiquing reductionist trends, the article downplays the significant technological and scientific advancements that have dramatically improved patient care.
- Ambiguity in Defining Core Concepts: The concept of “narrative competence” is not clearly delineated, leading to ambiguity about how it should be taught, measured, or integrated effectively into medical curricula.
- Practical Implementation Challenges Overlooked: While advocating for a more narrative approach, the essay offers limited guidance on overcoming real-world obstacles—such as time constraints and institutional inertia—that hinder its adoption in clinical settings.
- Simplified Historical Analysis: Critics argue that Charon’s historical overview, though engaging, may oversimplify the evolution of medicine’s relationship with narrative, glossing over the nuanced interplay between tradition and innovation.
Representative Quotations from “Literature and Medicine: Origins and Destinies” by Rita Choran with Explanation
| Representative Quotation | Explanation |
| “The future of poetry is immense,” wrote poet and literary critic Matthew Arnold in 1889, “because in poetry, where it is worthy of its high destinies, our race, as time goes on, will find an ever surer and surer stay.” | This opening quotation sets the stage by asserting the enduring, stabilizing power of poetry. Charon uses it to suggest that, similarly, narrative holds a lasting value for medicine. |
| “Literature and medicine is a flourishing subdiscipline of literary studies that examines the many relations between literary acts and texts and medical acts and texts.” | This statement defines the field, framing the intersection of literature and medicine as a vital area of study that bridges the methods and meanings of both disciplines. |
| “Instead, the beliefs, methods, and goals of these two disciplines, when looked at in a particular light, are strikingly and generatively similar.” | Charon argues that literature and medicine share foundational approaches to understanding human experience, suggesting that both fields are engaged in interpreting complex, multifaceted realities. |
| “To ‘put’ things, as Henry James suggests in his preface to The Golden Bowl, ‘is very exactly and responsibly and interminably to do them.'” | By invoking Henry James, Charon emphasizes the meticulous, responsible nature of both literary creation and medical documentation, underscoring the need for careful, sustained attention in each practice. |
| “The readerly skills that allow doctors to recognize that which patients tell them and the writerly skills that gain them access to that which, in the absence of writing, would remain unknown were increasingly overlooked by medicine in favor of the relentless biological positivism of the age of specialization and mechanization.” | This passage criticizes the modern medical focus on technology and reductionism, lamenting the loss of narrative sensitivity and the nuanced interpretive skills that are crucial for understanding patient experiences. |
| “The time has come to recuperate the practice of a narratively competent medicine, that is, a medical practice that acknowledges the textual and singular dimensions of illness by paying attention to patients’ (and doctors’) stories and their meanings.” | Here, Charon issues a call to action for reintegrating narrative competence into medicine, advocating for an approach that values the unique, personal stories embedded in clinical encounters. |
| “A medicine that is technologically competent and narratively competent is able to do for patients what was heretofore impossible to do.” | This quote highlights the synergistic potential of combining technical expertise with narrative insight, arguing that such an integrated approach can achieve healthcare outcomes that neither could accomplish alone. |
| “Literature is not merely a civilizing veneer for the cultured physician, and medicine is not merely the source of convenient plot twists for the novelist.” | Charon rejects simplistic views that either field is ornamental or secondary; instead, she asserts that both literature and medicine carry deep, intrinsic value in shaping understanding and care. |
| “If literature borrows medicine’s plots, then medicine borrows literature’s forms.” | This succinct observation illustrates the reciprocal influence between the two disciplines, suggesting that each draws on the narrative structures and techniques of the other to enhance meaning. |
| “Together with medicine, literature looks forward to a future when illness calls forth, in witnesses and in helpers, recognition instead of anonymity, communion instead of isolation, and shared meanings instead of insignificance.” | In this visionary statement, Charon encapsulates her hope for a future where healthcare is enriched by narrative, leading to a more empathetic and connected practice that fully honors the human experience of illness. |
Suggested Readings: “Literature and Medicine: Origins and Destinies” by Rita Choran
- Charon, Rita. “Literature and medicine: origins and destinies.” Academic medicine 75.1 (2000): 23-27.
- Funlayo E. Wood, editor. “Sacred Healing and Wholeness in Africa and the Americas.” Journal of Africana Religions, vol. 1, no. 3, 2013, pp. 376–429. JSTOR, https://doi.org/10.5325/jafrireli.1.3.0376. Accessed 12 Feb. 2025.
- Downie, R. S. “Literature and Medicine.” Journal of Medical Ethics, vol. 17, no. 2, 1991, pp. 93–98. JSTOR, http://www.jstor.org/stable/27717024. Accessed 12 Feb. 2025.
- Spiegel, Maura, and Rita Charon. “Editing and Interdisciplinarity: Literature, Medicine, and Narrative Medicine.” Profession, 2009, pp. 132–37. JSTOR, http://www.jstor.org/stable/25595923. Accessed 12 Feb. 2025.
- Rousseau, G. S. “Literature and Medicine: The State of the Field.” Isis, vol. 72, no. 3, 1981, pp. 406–24. JSTOR, http://www.jstor.org/stable/230258. Accessed 12 Feb. 2025.