“Reading, Writing and Doctoring: Literature and Medicine” by Rita Charon: Summary and Critique

Contribution of “Reading, Writing and Doctoring: Literature and Medicine” by Rita Charon to Literary Theory/Theories

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1. Narrative Theory and Narrative Medicine

Charon expands on narrative theory, particularly in the way stories construct meaning, by introducing narrative medicine—a field that emphasizes the importance of storytelling in patient care. She argues that illness narratives are fundamental to medical practice, as patients tell chaotic and fragmented stories that physicians must interpret with literary sensitivity (Charon, 2000, p. 286). Drawing from Paul Ricoeur’s and Peter Brooks’ theories of narrative coherence, she suggests that physicians, like literary scholars, follow a plot structure when diagnosing a patient’s condition.

• This aligns with Ricoeur’s Time and Narrative (1984), where he suggests that human experience gains meaning through storytelling.
• Charon builds on Brooks’ (1984) “reading for the plot”, emphasizing that physicians must see a patient’s history as a narrative rather than isolated symptoms.
  Thus, she bridges literary narrative theory with clinical practice, arguing that both literature and medicine construct, analyze, and interpret human stories to create meaning (p. 286).

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2. Reader-Response Theory: The Role of Interpretation in Medicine

Charon applies reader-response theory—which suggests that meaning is co-constructed by the reader—to the doctor-patient relationship. She posits that a physician, like a literary reader, must engage actively with a patient’s story, interpreting both explicit and implicit details (p. 288).

• This theory, pioneered by Wolfgang Iser and Stanley Fish, argues that meaning is not fixed in a text but emerges through interaction with the reader.
• Charon applies this idea to medicine, suggesting that the physician becomes the “reader” of a patient’s text (story), co-creating meaning through interpretation (p. 289).
  She highlights how medical records, case histories, and even diagnostic reports function as narrative texts, requiring interpretation just like literary works.

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3. Hermeneutics and the Interpretation of Medical Texts

The hermeneutic approach—the theory of interpretation, especially of texts—plays a central role in Charon’s argument. She suggests that medical records, case reports, and patient histories must be read as complex, multi-layered texts, much like literature (p. 290).

• This connects with Hans-Georg Gadamer’s hermeneutics, which emphasizes that understanding requires dialogue and historical context.
• Charon suggests that medical hermeneutics involves “reading between the lines” to capture a patient’s experience beyond clinical symptoms (p. 291).
  This perspective challenges the traditional biomedical model, advocating instead for a humanistic, interpretive approach to medicine.

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4. Postmodernism and the Decentered Medical Narrative

Charon also draws on postmodern literary theory, particularly in questioning the objectivity of medical texts.

• Postmodern theorists like Michel Foucault critique the medical field for its authoritative, impersonal approach to human bodies (The Birth of the Clinic, 1963).
• Charon challenges this authoritative medical gaze by emphasizing the subjective, fragmented, and interpretive nature of patient narratives (p. 291).
  She suggests that medical knowledge, like literature, is not absolute but constructed through multiple perspectives, including those of the patient, doctor, and medical institution.

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5. Empathy and Ethical Criticism in Literature

Charon’s work aligns with ethical literary criticism, which suggests that literature fosters moral development.

• Drawing on Martha Nussbaum’s argument in Poetic Justice (1995) that literature enhances moral reasoning, Charon argues that reading literary texts cultivates a doctor’s empathy and ethical sensitivity (p. 288).
• She provides examples from The Death of Ivan Ilych by Leo Tolstoy, The Dead by James Joyce, and The Odour of Chrysanthemums by D.H. Lawrence to illustrate how literature deepens a physician’s understanding of human suffering (p. 289).
  By advocating for literature as a tool for medical ethics and emotional intelligence, Charon expands the ethical function of literature beyond academia to clinical practice.

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6. The Intersection of Literature and Medical Humanities

Charon’s work contributes to the broader field of medical humanities, which integrates literary studies, ethics, and history into medical education. She highlights the historical tradition of physician-writers like Anton Chekhov, William Carlos Williams, and Richard Selzer, arguing that literature and medicine have always been deeply intertwined (p. 285).

• This supports interdisciplinary literary theory, particularly in how literature influences real-world professional practices.
• She also references Sigmund Freud’s case histories, which he described as reading “like short stories” (p. 286), reinforcing how medical texts and literary narratives overlap.

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Conclusion: Expanding the Scope of Literary Theory

Rita Charon’s Reading, Writing, and Doctoring: Literature and Medicine expands literary theory beyond its traditional boundaries by applying narrative analysis, hermeneutics, postmodernism, and ethical criticism to medicine.
Her work contributes to:
✔ Narrative Theory, by emphasizing how doctors construct meaning from patient histories.
✔ Reader-Response Theory, by highlighting the physician’s role in co-creating a patient’s medical story.
✔ Hermeneutics, by framing medical records as texts that require deep interpretation.
✔ Postmodern Critique, by challenging the authority of objective medical knowledge.
✔ Ethical Literary Criticism, by advocating literature’s role in fostering physician empathy.
✔ Interdisciplinary Theory, by merging literary studies with medical humanities.

Through these contributions, Charon establishes narrative medicine as both a literary and clinical practice, reshaping our understanding of how literature influences human care.

1. Overemphasis on Narrative at the Expense of Medical Objectivity

• Critics argue that Charon’s focus on narrative competence may undermine the importance of medical objectivity and empirical evidence.
• While storytelling is valuable in understanding patient experiences, it may not always lead to accurate diagnoses or effective treatments.
• Medical professionals must prioritize scientific data over subjective interpretations of illness narratives, which may sometimes be misleading.

2. Limited Practical Application in Fast-Paced Medical Settings

• Modern healthcare, especially in hospitals and emergency departments, operates under time constraints that make it difficult for doctors to deeply engage with patient narratives.
• The demands of medical practice require quick decision-making based on clinical evidence rather than extended literary analysis.
• Some physicians may view narrative medicine as an impractical luxury rather than a necessary skill in high-pressure medical environments.

3. Potential for Narrative Bias and Subjectivity

• Patient narratives are inherently subjective and influenced by emotions, memory, and personal biases.
• Charon’s model assumes that narratives lead to deeper understanding, but doctors may misinterpret or overemphasize certain aspects of a patient’s story, leading to diagnostic errors.
• Critics argue that narrative medicine risks reinforcing confirmation bias—where doctors seek evidence that aligns with a preconceived narrative rather than objectively assessing symptoms.

4. Lack of Empirical Evidence Supporting Narrative Medicine’s Effectiveness

• While Charon promotes the use of literature to improve physician empathy and communication skills, there is limited empirical research proving that narrative medicine significantly improves patient outcomes.
• Some critics demand more quantitative studies and controlled trials to measure the impact of narrative-based training on clinical efficiency, diagnostic accuracy, and patient care.

5. Risk of Emotional Burnout for Physicians

• Encouraging doctors to deeply engage with patient suffering may lead to emotional exhaustion and compassion fatigue.
• While empathy is crucial, physicians must also maintain emotional boundaries to prevent becoming overwhelmed by the weight of patient narratives.
• Some argue that an overemphasis on storytelling may place an additional emotional burden on healthcare providers who are already dealing with high stress.

6. Exclusion of Non-Verbal and Cultural Aspects of Illness

• Charon’s approach focuses heavily on written and spoken narratives but does not fully address non-verbal expressions of illness, such as body language, silence, or cultural differences in storytelling.
• In many cultures, illness is expressed through actions, rituals, or communal practices rather than linear storytelling.
• The Western literary framework that Charon promotes may not be applicable across diverse cultural and linguistic contexts.

7. Romanticization of Literature’s Role in Medicine

• Some critics argue that Charon idealizes literature’s role in medicine, assuming that reading fiction will naturally lead to better doctors.
• Not all doctors or medical students engage with literature in the same way, and its impact on professional development may vary widely among individuals.
• There is a risk of treating literature as a cure-all solution for medical empathy and ethics, when in reality, ethical practice requires more than just reading literary texts.