Great books make better doctors


After spending much of the first 40 years of my life poring over textbooks and medical journals, I decided to start reading literary fiction. At the time, I had no ulterior motive — only a vague sense that I had been missing something important, a metaphoric vitamin without which my development would not be complete. I certainly did not expect that the great novels would make me a better doctor. That was what my textbooks and journals were for.

My wife, a former English major who has kept a stack of books by her bedside ever since I have known her, encouraged my fledgling interest like a gardener watering flowers. She culled from her collection, an assortment of titles she thought I might enjoy. Some of these were classics, familiar even to me, at least in their general outline. “Beloved,” “The Grapes of Wrath,” “Lolita,” and “The Great Gatsby” come to mind. Others were less well known, but she believed just as compelling.

My new hobby did not come easily. Unlike research papers or CME articles, the novels I read did not give me the immediate satisfaction of feeling I had filled my brain up with a bunch of useful facts. Often the first chapters left me bored or unmoved, as the authors erected the stage on which their stories would unfold. A long slog through the first third of Crime and Punishment was particularly grueling, but I was not about to give up. After all, I was — like most of us docs — nothing if not persistent.

Usually that persistence paid off, as I eventually fell under the spell of the books’ intricate, nuanced narratives. I still did not necessarily like the characters I read about, but I did become more curious about them. I wanted to understand them, to get a sense of what made them tick.

These people (and I use that term because the best did feel alive to me) were often very different from me — and yet in ways, I might not want to acknowledge, unnervingly similar, too.

Unlike the characters in many bestsellers, who functioned mostly to move their plots along, Jay Gatsby and Rabbit Angstrom, Richard Wright’s Bigger Thomas, and Madame Bovary resisted my knee-jerk attempts to put them into boxes. Not simply good or bad, kind or cruel, brave or cowardly, they were too complex to judge summarily. Instead, I was forced to step into their shoes and go for a nice long hike.

Little did I realize that by doing so, I would be cultivating what neuroscientists call “theory of mind.”

According to Wikipedia, theory of mind (ToM) is the capacity to “attribute mental states…to oneself, and to others, and to understand that others have beliefs, desires, intentions, and perspectives that are different from one’s own.” In everyday social interactions, ToM is constantly at work, allowing us to analyze and make inferences about other people’s behavior. The better our ToM — that is, the more finely attuned and accurate — the more effective we are likely to be at negotiating our relationships with others.

A growing body of research suggests that reading literary fiction enhances this ability. It builds up what Etgar Keret calls our “empathy muscle.” In one study, experimental subjects read excerpts from “Saffron Dreams,” a novel by Pakistani-American author Shaila Abdullah, which portrays the psychological experience of a pregnant Muslim woman who is harassed because of her culture and ethnicity. Meanwhile, a control group read an abridged synopsis of the plot, which lacked the emotional intensity of the original. Later, the two groups were shown racially ambiguous faces and asked if they were white, Arabic, or mixed. They were also instructed to guess the amount of DNA shared between whites and Arabs. In a vivid illustration of how good storytelling can break down barriers and foster inclusiveness, the subjects who read the original excerpt demonstrated more fluid racial boundaries. They were more likely to describe the faces as ethnically mixed and guessed a higher degree of DNA overlap than the second group.

In a profession as emotionally taxing as ours, there can be a tendency to see our patients as “other.” While we might not want to admit it, the belief that they have brought their illnesses upon themselves – through weakness of character of one sort or another — is unfortunately quite common. Think of AIDS, addiction, even heart disease. It is an understandable defense against the frightening truth that awful things can happen to anyone, for no apparent reason. But it exacts a very high price, on both sides of the stethoscope.

The stronger our empathy muscle, the greater our ability not only to see but to feel our shared humanity. Empathy serves as a powerful antidote to the tribal instincts that tear at the fabric of our multicultural society. In our examining rooms, it provides a counterbalance to the detached objectivity encouraged by our medical training. William Osler understood this when he wrote, “The good physician treats the disease; the great physician treats the patient who has the disease.”

Reading great fiction will probably make you a better doctor, but just as importantly, it may make you a happier, healthier one. Functional imaging studies have shown that it puts the brain into a pleasurable, trance-like state, not unlike meditation. What better way to fight against burnout! So pick up your Kindle or head down to your local library. For those who are social or need deadlines to move them along, consider joining a book club, or starting one yourself. Literature is a powerful nutrient, for your mind and for your heart.

David Rosenfeld is a psychiatrist.

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