“Systematizing compassion risks introducing a parade of disingenuous gestures that will be read as artificial and patronizing.”
(David Watts, “Cure for the Common Cold,” NEJM 9/272012, 1185)
Good cooks know the limits of the recipe. Good cooking is about patient practice of observation with all the senses engaged: as the sauce is stirred the good cook notices texture, color, the layers of fragrance—rosemary mingling with oregano—even how the simmer sounds, and, at the appointed moment, taste. Good cooks trust their trained intuitions—a phrase that may seem oxymoronic, but, in fact, points to the well established fact that intuition can be trained, and in the culinary arts, as in any other art, must be trained.
The analogies to medicine may seem a stretch. But after years of hanging around medical professionals, medical students, and aspiring premeds, I believe nothing is more important in training competent, compassionate clinicians than helping them develop intuition, imagination, and empathy—all prerequisites to real compassion. What one beloved colleague has wryly called the “social sciencing” of higher education troubles me—meaning no particular insult to those who labor in the social sciences. They have their place. But when the methods of social science—data gathering, measurement, graphs, charts, and—well—systems–dominate academic discourse those of us who inhabit alternative discursive universes—in the humanities, for instance—are increasingly encouraged to forsake our “soft” language and methods for what seems to be more reliable.
This morning a student in our “Narratives in Medicine” seminar brought in a bar graph with a bell curve on it illustrating the “vicious cycle of avoidance.” One axis is labeled “anxiety.” The other is labeled “time. The right end of the bell curve is labeled “mastery of anxiety.” It looks definitive there in black and white, neatly symmetrical. But those of us who experience anxiety in fits and starts, or who have learned to laugh at ourselves in the midst of it, or who know it can coexist with deeper levels of calm and trust, and that “mastery” doesn’t really even serve as a meaningful objective, have to wonder at the way such diagrams too readily invalidate experiences that are better accommodated by other, messier narrative structures. Wendell Berry’s description of a dying man’s relatives who, unlike the efficient folk in the hospital bureaucracy, offer a kind of care that belongs to “the larger looser, darker order of merely human love” comes to mind as a vision that challenges what medical and educational institutions institutionalize.
Watts claims that “the product we should seek is not proficiency in literature, but brain balance.” Yes to the latter, but I’m not sure the latter can be fully achieved without the former. Proficiency in literature, after all, offers the skills necessary to defend oneself against the domination of bell curves and bar graphs and numerical analyses of data. There may be, as one critic opined, only 36 plots, but the ways to tell a story are nearly endless, and endlessly generative. To recognize a patient’s narrative strategies, to wonder why she might have begun her story with an allusion to her mother’s fear of abandonment, to consider the logic of her metaphors and the parabolic quality of her stories from the workplace, to notice how she situates herself relative to the incidents she reports, or how the inflection of her sentences disempowers her and invites her listener to doubt…these noticings can be sharpened and enhanced by literary awareness. Anyone who has noticed that Romeo and Juliet’s first conversation is a double sonnet is not likely to skim through any other dialogue without looking at its architecture. Anyone who has laughed over Holden Caulfield’s recurrent opener, “If you want to know the truth…” is less likely to overlook the little flags and tags that offer clues to a good listener.
Can compassion be trained? To a point, absolutely. To what point? I can’t, or won’t put a number on it: 85%, 50%? It doesn’t matter. Compassion can be encouraged, modeled, reinforced, spotted in stories, witnessed on Grand Rounds, recognized in the moments when one’s own heart opens. We develop it in community, in koinonia—the ancient Greek term that means both community and participation. We step into a magnetic field created by others’ compassion and find ourselves reoriented. It is difficult to get a bell curve from poems, yet doctors deepen their practice every day by means of what is found there.